bluuebunny/crossref_metadata_2025 huggingface dataset:
Outbreak of verocytotoxin-producing E. coli O145 and O26 infections associated with the consumption of ice cream produced at a farm, Belgium, 2007
Authors: De Schrijver K , Buvens G , Possé B , Van den Branden D , Oosterlynck O , De Zutter L , Eilers K , Piérard D , Dierick K , Van Damme-Lombaerts R , Lauwers C , Jacobs R
Published: October 2017

In October 2007, an outbreak of verocytotoxin-producing Escherichia coli (VTEC) O145 and E. coli O26 occurred among consumers of ice cream produced and sold in September 2007 at a farm in the province of Antwerp (Belgium). The ice cream was consumed at two birthday parties and also eaten at the farm. Five children, aged between two and 11 years, developed haemolytic uraemic syndrome (HUS), and seven other co-exposed persons contracted severe diarrhoea. In three of the five HUS cases VTEC O145 infections were laboratory confirmed, one in association with VTEC O26. Identical isolates of E. coli O145 and O26 were detected with PCR and PFGE in faecal samples of patients and in ice cream leftovers from one of the birthday parties, in faecal samples taken from calves, and in samples of soiled straw from the farm at which the ice cream was produced. Ice cream was made from pasteurised milk and most likely contaminated by one of food handlers.
Is there room for improving case management for contacts of meningococcal disease in the European Union?
Authors: Lopalco P L
Published: October 2017

Invasive meningococcal disease (IMD) is a severe illness primarily affecting children and young adults. It has a high case fatality rate (10%-14%) and 11%-19% of patients who recover experience permanent hearing loss, mental retardation, loss of limbs or other serious sequelae.
Job vacancies at the ECDC
Authors:   Eurosurveillance editorial team
Published: October 2017

The European Centre for Disease Prevention and Control invites applications for several positions.
Conference on Global Health: Current Issues, Future Trends and Foreign Policy
Authors:   Eurosurveillance editorial team
Published: October 2017

The Royal College of Physicians is organising a conference on 'Global Health: Current Issues, Future Trends and Foreign Policy' on 29 April 2008 at the Royal College of Physicians, London.
Author's correction for: Euro Surveill 2008;13(8)
Authors:   Eurosurveillance editorial team
Published: October 2017

A Siedler was included in the authors list of the article "Measles in south-west Germany imported from Switzerland - a preliminary outbreak description".
The role of public health officers in preparedness planning and management of health crises
Authors: Strauss R , Muchl R , Kunze M , Hrabcik H
Published: October 2017

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Measles outbreaks in London, United Kingdom - a preliminary report
Authors: Heathcock R , Watts C
Published: October 2017

2007 saw the highest number of measles cases reported in England and Wales since current surveillance began in 1995, with 971 confirmed cases reported, compared with 740 reported in 2006 [1]. London was the region with the highest number of cases, and a large outbreak of measles in north-east London contributed to this high number of cases [2]. There were several outbreaks of measles elsewhere in Europe in 2007, and case have been reported this year in Switzerland [3], France [4] and Denmark [5].
Emergence of high-level azithromycin resistance in Neisseria gonorrhoeae in England and Wales
Authors: Chisholm S A , Ison C
Published: October 2017

The Gonococcal Resistance to Antimicrobials Surveillance Programme (GRASP) in England and Wales has monitored azithromycin resistance since 2001. In 2007, high-level azithromycin resistance (MICs >256 mg/L) was identified for the first time in six isolates, all of which were the same sequence type (ST 649).
Workshop on European behavioural indications for men who have sex with men
Authors: Editorial team Collective
Published: October 2017

HIV and sexually transmitted infections (STI) reported among men having sex with men (MSM) have risen in western Europe in recent years. This is thought to be a result of unsafe sexual practices, but data in this field are lacking. Many European Union (EU) Member States conduct surveys or hand out questionnaires about sexual behaviour and attitudes, either to patients visiting STI clinics, or in at-risk communities, such as MSM. However, the methods of such behavioural surveillance vary greatly between countries, making it difficult to compare data and obtain an overall view of the current sexual behaviour and attitudes in the EU.
Hepatitis B virus transmission from a nurse to a patient, France, 2005
Authors: Poujol I , Floret N , Servant-Delmas A , Marquant A , Laperche S , Antona D , Lot F , Coignard B
Published: October 2017

Infection by the Hepatitis B virus (HBV), which is often asymptomatic at the acute phase, can progress to chronic liver disease, particularly when infection occurs early in life. Hepatitis B is mainly transmitted sexually or through blood or body fluids. Episodes of healthcare-associated transmission of HBV have been previously described [1-3]. Transmission of HBV results either from patient to patient through invasive healthcare procedures with improper disinfection of devices used between patient care or from a patient to a healthcare worker (HCW). Transmission can also take place from a chronically infected HCW to a patient. In those episodes, breaches in healthcare practices and standard precaution play a major role. Prevention of HBV transmission in healthcare settings also relies on the immunisation of HCW, which has been mandatory in France since 1991. HCW are considered immune if they have documented proof that they were vaccinated before 13 years of age, or if a positive anti-HBs antibody test is provided [4].
A preliminary report on Crimean-Congo haemorrhagic fever in Turkey, March - June 2008
Authors: Yilmaz G R , Buzgan T , Torunoglu M A , Safran A , Irmak H , Com S , Uyar Y , Carhan A , Ozkaya E , Ertek M
Published: October 2017

Crimean-Congo haemorrhagic fever (CCHF) is a disease caused by a virus belonging to Bunyaviridae family. CCHF virus isolation and/or disease have been reported from more than 30 countries in Africa, Asia, south-eastern Europe, and the Middle East [1]. The main transmission routes of the virus are tick-bite and contact with tissues, body fluids and blood of infected animals [1-4]. Nosocomial transmission is another important route of infection [1]. The incubation period is generally described as 1-3 days after tick-bite and 5-6 days after exposure to infected animal or human blood or body fluid, but it can be longer. Fever, chills, headache, fatigue and myalgia are the most common symptoms in the pre-haemorrhagic period. The disease progresses to haemorrhagic form in severe cases [1]. The fatality rate of disease is reported between 7.5-50% in hospitalised patients [4-7]. This wide range may due to phylogenetic variation of the virus, transmission route and different treatment facilities [4-7].
Survey of rotavirus surveillance, laboratory capacity and disease burden in the eastern part of the WHO European Region
Authors: Williams C  J , Gray J J , Pebody R  G , Lobanov A
Published: October 2017

Following the licensure of two rotavirus vaccines in Europe, we aimed to assess factors, such as surveillance, disease burden and laboratory capacity, which will be relevant for making decisions about rotavirus vaccine introduction in the different countries. We conducted an email-based survey of the national public health bodies in the World Health Organization (WHO) European Region in 2006 and report here the results from the 23 countries in the eastern part of the region. The survey included questions on rotavirus surveillance, laboratory capacity, burden (in children under the age of five years) and intention to introduce rotavirus vaccination. Countries were grouped into the four per-capita income categories defined by the World Bank. Fourteen of the 23 countries responded to the survey. All except one country reported that less than a quarter of their laboratories had rotavirus diagnostic capacity. Four countries had some form of specific rotavirus surveillance, but half were of very limited coverage. Ten countries did not report data on the incidence of rotavirus hospital admissions, although nine were able to report some data on rotavirus burden. Six of the responding countries said they were likely to introduce universal rotavirus vaccination. Rotavirus surveillance and laboratory capacity in the eastern part of the WHO European Region is limited but most countries had some estimate of rotavirus burden, often from special studies. The reported mortality rates were lower than those from a WHO mortality data source. Many countries in the eastern part of WHO European Region face a number of challenges before vaccine implementation, including strengthening surveillance, improving laboratory capacity and addressing financial barriers.
Outbreak of Salmonella serovar Stanley infections in Switzerland linked to locally produced soft cheese, September 2006 – February 2007
Authors: Pastore R , Schmid H , Altpeter E , Baumgartner A , Hächler H , Imhof R , Sudre P , Boubaker K
Published: October 2017

Salmonella serovar Stanley is rare in Europe. In Switzerland, the number of reported isolates has increased from 2 in 2000 to 25 in 2005. A nationwide outbreak of gastrointestinal illness due to S. Stanley occurred from September 2006 through February 2007. Eighty-two cases were documented. Males were 56%; mean age of the cases was 45.7 years (range 0-92). Forty-seven cases (57%) occurred in three western cantons: Vaud, Bern, and Geneva. Twenty-three cases (28%) were hospitalised. In the case-control study conducted to find the source of the outbreak, cases were more likely than controls to have eaten local soft cheese (OR 11.4, p=0.008). One clone of S. Stanley strain was isolated from soft cheese and from 77 cases (94%) who reported no history of having travelled abroad. The outbreak ended after the withdrawal of the cheese from the market. This is the first S. Stanley outbreak in Switzerland and the first in Europe unrelated to imported products, suggesting an increased local circulation of this previously rare serotype.
High rates of community-acquired, Panton-Valentine leukocidin (PVL)- positive methicillin-resistant S. aureus (MRSA) infections in adult outpatients in Greece
Authors: Vourli S , Vagiakou H , Ganteris G , Orfanidou M , Polemis M , Vatopoulos A , Malamou-Ladas H
Published: October 2017

Staphylococcus aureus was isolated in 88 (30. 8%) of 286 adult patients suffering from various skin and soft-tissue infections examined in the outpatient department of a 650 bed tertiary-care hospital of Athens, Greece between January 2006 and December 2007. Twenty-seven (30.7%) of the S. aureus infections were caused by methicillin-resistant S. aureus (MRSA). All MRSA isolates were also resistant to tetracycline, fucidic acid and kanamycin, but were sensitive to gentamicin and tobramycin, as well as to to cotrimoxazole, chloramphenicol, quinolones, clindamycin and erythromycin. All isolates belonged to staphylococcal cassette chromosome mec elements (SCCmec) type IV, and were found to carry the lukF-PV and lukS genes coding for Panton-Valentine leukocidin (PVL). Pulsed-field gel electrophoresis (PFGE) and spa-typing revealed high genetic similarity among all MRSA isolates and with the PFGE pattern of the well-described ST80 clone that seems to be spreading through Europe. The high prevalence of MRSA among S. aureus infections in the community signify that empiric therapy in Greece, when clinically indicated, should exclude β-lactam antibiotics. Moreover, the establishment of an active screening for PVL-positive community-acquired (CA)-MRSA carriage and the adoption of a search and destroy strategy for CA-MRSA in all patients admitted with purulent skin and soft-tissue is of high priority in Greece as well as in all European countries which face high rates of CA-MRSA infection.
Use of oseltamivir in 12 European countries between 2002 and 2007 – lack of association with the appearance of oseltamivir-resistant influenza A(H1N1) viruses
Authors: Kramarz P , Monnet D , Nicoll A , Yilmaz C , Ciancio B
Published: October 2017

Variable levels of oseltamivir resistance among seasonal influenza A(H1N1) isolates have been reported in Europe during the 2007-8 northern Hemisphere influenza season. It has been questioned whether oseltamivir use could have driven the emergence and predominance of resistant viruses. This study aimed at describing the levels of use of oseltamivir in 12 European Union (EU) Member States and European Economic Area (EEA)/European Free Trade Area (EFTA) countries. The data were converted into prescription rates and compared with the national proportions of resistant influenza A(H1N1) viruses through regression analysis. Overall use of oseltamivir in European countries between 2002 and 2007 was low compared to e.g. the use in Japan. High variability between the countries and over time was observed. In eight of the 12 countries, there was a peak of prescriptions in 2005, coinciding with concerns about a perceived threat from an influenza pandemic which might have lead to personal stockpiling. Ecological comparison between national levels of use of oseltamivir in 2007 and the proportions of A(H1N1) viruses that were resistant to oseltamivir showed no statistical association. In conclusion, our results do not support the hypothesis that the emergence and persistence of these viruses in 2007-8 was related to the levels of use of oseltamivir in Europe. Further investigation is needed to elucidate the reasons for different level of use between the countries.
Estimating the Global Burden of Foodborne Diseases - a collaborative effort
Authors: Kuchenmüller T , Hird S , Stein C , Kramarz P , Nanda A , Havelaar A H
Published: October 2017

Illness and death from diseases caused by unsafe food are a constant threat to public health security as well as socio-economic development throughout the world. The full extent of the burden and cost of foodborne diseases associated with pathogenic bacterial, viral and parasitic microorganisms, and food contaminated by chemicals is still unknown but is thought to be substantial. The World Health Organization (WHO) Initiative to estimate the global burden of foodborne diseases aims to fill the current data gap and respond to the increasing global interest in health information. Collaborative efforts are required to achieve the ambitious task of assessing the foodborne disease burden from all causes worldwide. Recognising the need to join forces, the WHO Initiative has assembled an alliance of stakeholders which share and support the Initiative's vision, intended objectives and outcomes. One important collaborator is the European Centre for Disease Prevention and Control (ECDC) which has embarked on a burden of disease study covering at least 18 foodborne diseases in nearly 30 countries.
Avian influenza A(H5N1) – current situation
Authors: Melidou A
Published: October 2017

The A(H5N1) influenza virus has re-emerged in 2003 in Asia, Africa, the Pacific Region as well as Europe and since then has become endemic in some countries. The virus is usually highly pathogenic and is associated with high morbidity and overall mortality rates that reach 61%.
Initial epidemiological findings in the European Union following the declaration of pandemic alert level 5 due to influenza A (H1N1)
Authors: ECDC Technical Emergency Team
Published: October 2017

The recent detection of a novel influenza A(H1N1) virus has led to the first WHO declaration of a Public Health Event of International Concern under the International Health Regulations (IHR 2005). Here we review the early epidemiological findings of confirmed cases in Mexico, the United States, Canada and EU/EFTA countries. Strengthened surveillance and continued, transparent communication across public health agencies globally will be necessary in coming months.
Why are Mexican data important?
Authors: Coulombier D , Giesecke J
Published: October 2017

This issue of Eurosurveillance contains an article by a French team on the transmission of the new influenza A(H1N1) in Mexico, which uses published figures from the outbreak to estimate important parameters for transmission, among them the reproduction rate, R [1]. Such studies may have important implications for public health action in Europe.
Rapid spread of drug-resistant influenza A viruses in the Basque Country, northern Spain, 2000-1 to 2008-9
Authors: Vicente D , Cilla G , Montes M , Mendiola J , Pérez-Trallero E
Published: October 2017

A worldwide increase of adamantane-resistant influenza A(H3N2) and oseltamivir-resistant influenza A(H1N1) viruses has been observed in recent years. The aim of this study was to analyse the prevalence of antiviral drug-resistant influenza A in a region of northern Spain. Resistance to adamantanes was detected in 45.3% (68/150) of influenza AH3 viruses analysed for the period from 2000-1 to 2008-9. Adamantane-resistance was absent in our region during the 2000-1 to 2002-3 influenza seasons. However, after the first adamantane-resistant virus (characterised as A/Fujian/411/2002) was detected in the 2003-4 season, a rapid increase in the proportion of resistant strains was observed (4.9% [2/41], 80% [8/10] and 100% [53/53] in the 2004-5, 2006-7 and 2008-9 seasons, respectively). Four of the first five adamantane-resistant AH3 viruses detected were isolated from adult patients, but the subsequent spread was observed mainly among children. No resistance to adamantanes was detected among the 65 influenza AH1 viruses analysed throughout the study period. Among the 172 influenza A (76 AH1 and 96 AH3) viruses analysed, five strains (AH1 with mutation H274Y) showed oseltamivir resistance, and all were detected in the last season. Amantadine use was very scarce in our region, and oseltamivir was not used at all; therefore the increase of resistance was attributed to imported drug-resistant influenza viruses.
Norwegians approve of the health authorities’ strategy to communicate worst case pandemic scenarios
Authors: Wøien G , Tonsberg K I
Published: October 2017

According to the Norwegian pandemic preparedness plans, health authorities shall assess their communication activities before and during an outbreak of infectious diseases. A survey was conducted on 29 April 2009 on acceptance of communications by the national public health authorities concerning the emerging threat from the new influenza A(H1N1) virus. The survey was similar to other surveys in 2005-6 about the avian flu. The results were not very different – the overall majority of the people interviewed were not worried and the health authorities were regarded as trustworthy.
A methodological approach to investigating a nationwide clinical specimen contamination problem in England
Authors: Pezzoli L , Campbell C , Lamagni T  L , Johnson E , Saei A , Duckworth G
Published: October 2017

Outbreaks of pseudo-infection due to contamination of specimens have been described, often as localised incidents. From August 2006, several English hospital laboratories began to refer an unusually high number of isolates of the fungus Paecilomyces variotii from clinical specimens to the national mycology reference laboratory for microbiological testing. We describe the methods used during the outbreak investigation in order to provide infection control specialists with an overview of how such national incidents may be investigated. We surveyed the hospitals reporting the contamination problem and conducted microbiological and environmental sampling. We applied analytical epidemiology to supply chain data, comparing the supply lines of key equipment to affected and unaffected hospitals in England. The survey was useful to describe procedures and equipment in use in the hospitals reporting the problem. The microbiological aspects of the investigation helped us understand how the fungal spores were distributed in the hospital environment. In the supply chain investigation we used data that was previously only used for logistical purposes. Overall the investigation were methodologically challenging, with no existing protocol to guide the investigators. To our knowledge, this is a novel approach to the investigation of such a widespread contamination problem, affecting geographically disparate hospitals at the same time.
Preliminary analysis of influenza A(H1N1)v individual and aggregated case reports from EU and EFTA countries
Authors: ECDC working group on influenza A(H1N1)v
Published: October 2017

Since the first importation of influenza A(H1N1)v virus to Europe in late April of this year, surveillance data have been collected in the Member States of the European Union and European Free Trade Association. This is the first preliminary analysis of aggregated and individual data available as of 8 June 2009 at European level.
Enhanced influenza surveillance on Réunion Island (southern hemisphere) in the context of the emergence of influenza A(H1N1)v
Authors: D’Ortenzio E , Do C , Renault P , Weber F , Filleul L
Published: October 2017

With the winter season on the southern hemisphere that starts in Réunion Island in June seasonal influenza activity usually increases shortly afterwards. The new influenza A(H1N1)v virus is rapidly spreading worldwide and may reach the island during the coming winter season. We have therefore enhanced influenza surveillance to detect the introduction of influenza A(H1N1)v, monitor its spread and impact on public health and characterise potential viral changes, particularly if seasonal influenza A(H1N1), resistant to oseltamivir, co-circulates with A(H1N1)v.
How the media reported the first days of the pandemic (H1N1) 2009: results of EU-wide media analysis
Authors: Duncan B
Published: October 2017

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Oseltamivir adherence and side effects among children in three London schools affected by influenza A(H1N1)v, May 2009 – an internet-based cross-sectional survey
Authors: Kitching A , Roche A , Balasegaram S , Heathcock R , Maguire H
Published: October 2017

This report describes the results of a cross-sectional anonymised online survey on adherence to, and side effects from oseltamivir when offered for prophylaxis, among pupils from one primary and two secondary schools with confirmed cases of influenza A(H1N1)v in London in April-May 2009. Of 103 respondents (response rate 40%), 95 were estimated to have been offered oseltamivir for prophylaxis, of whom 85 (89%) actually took any. Less than half (48%) of primary schoolchildren completed a full course, compared to three-quarters (76%) of secondary schoolchildren. More than half (53%) of all schoolchildren taking prophylactic oseltamivir reported one or more side effects. Gastrointestinal symptoms were reported by 40% of children and 18% reported a mild neuropsychiatric side effect. The results confirmed anecdotal evidence of poor adherence, provided timely information with which to assist decision-making, and formed part of the body of growing evidence that contributed to policy changes to restrict widespread use of prophylaxis for school contacts of confirmed cases of influenza A(H1N1)v.
Epidemiology of fatal cases associated with pandemic H1N1 influenza 2009
Authors: Vaillant L , La Ruche G , Tarantola A , Barboza P , for the epidemic intelligence team at InVS
Published: October 2017

This article describes the characteristics of 574 deaths associated with pandemic H1N1 influenza up to 16 July 2009. Data (except from Canada and Australia) suggest that the elderly may to some extent be protected from infection. There was underlying disease in at least half of the fatal cases. Two risk factors seem of particular importance: pregnancy and metabolic condition (including obesity which has not been considered as risk factor in previous pandemics or seasonal influenza).
Biogeographical origin and varicella risk in the adult immigration population in Catalonia, Spain (2004-2006)
Authors: Valerio L , Escribà J M , Fernández-Vázquez J , Roca C , Milozzi J , Solsona L , Molina I
Published: October 2017

Immigrants to the European Union may have a higher susceptibility to varicella-zoster virus primo-infection than the indigenous population. There is no evidence as yet that this is caused by genetic or social factors. Therefore, susceptibility could be due to a lesser transmission of the virus in their ecosystems of origin. A multicentre observational study was performed from July 2004 to June 2006 in four primary healthcare centres in Catalonia, Spain, monitoring varicella incidences and comparing standardised incidence rates and standardised rate ratios among different populations classified according to their biogeographical origin (holarctic, Asian paleotropical, African paleotropical or neotropical). Overall, 516 varicella cases were recorded. The standardised incidence rates per 1,000 inhabitants per year were: holarctic: 2.17 (95% confidence interval (CI): 1.95-2.39); autochthonous 2.26 (95% CI: 2.03-2.49); immigrants 3.59 (95% CI: 2.92-4.26); neotropical 4.50 (95% CI: 3.28-5.71); non-holarctic 5.38 (95% CI: 4.27-6.14); Asian paleotropical 7.03 (95% CI: 4.77-9.28); and African paleotropical 7.05 (95% CI: 1.12-23.58). The difference to the autochthonous population was greatest in immigrants of neotropical origin (standardised rate ratio = 2.07 (95% CI: 1.61-2.64) or 4.5 excess cases per 1,000 inhabitants per year) and Asian paleotropical origin (standardised rate ratio = 3.24 (95% CI: 2.47-4.11) or 9.6 excess cases per 1,000 inhabitants per year). Biogeographical origin may therefore account for the vulnerability of certain immigrant populations to varicella, in particular those from Asian paleotropical (Indostan and Southest Asia) and neotropical (South America and the Caribbean) ecosystems. Vaccination of immigrants at high risk (fertile women, healthcare workers) could be recommendable.
Early estimates of 2009 pandemic influenza A(H1N1) virus activity in general practice in France: incidence of influenza-like illness and age distribution of reported cases
Authors: Turbelin C , Pelat C , Boëlle P Y , Lévy-Bruhl D , Carrat F , Blanchon T , Hanslik T
Published: October 2017

In the end of August 2009, an unusually elevated level of influenza-like illness (ILI) activity was reported to the French Sentinel Network. We quantified the observed excess in ILI cases in France during summer 2009 and characterised age patterns in reported cases. An excess of cases has been observed since 5 July, with a time increasing trend. The cumulated estimated excess number of ILI cases was 269,935 [179,585; 316,512], corresponding to 0.5% French population over the period. Compared to the same period in the past years, relative cumulated incidence was greater among young subjects and lower among subjects over 65 years-old. Compared to past epidemics, the relative cumulated incidence was greater in children less than five years-old. This excess of cases may reflect the current spread of the A(H1N1) virus in France, subject to the following limitations: estimates were based on clinical cases consulting a GP; large media coverage may have led to a non specific increase in consultation rates.
Ongoing rubella outbreak in Bosnia and Herzegovina, March-July 2009 - preliminary report
Authors: Novo A , Huebschen J M , Muller C P , Tesanovic M , Bojanic J
Published: October 2017

Between 24 March and 31 July 2009, 342 clinically diagnosed cases of rubella were notified in five municipalities in Republika Srpska, Bosnia and Herzegovina. Fourteen cases were laboratory-confirmed by positive IgG against rubella virus. Four virus isolates were obtained and identified as genotype 2B strains, with one isolate differing by a single mutation in the region of the E1 gene. This ongoing outbreak revealed gaps in the immunisation programme during the war in BiH (1992-1995) and highlights the need to revise legislation to permit immunisation of children above 14 years of age with measles, mumps, rubella (MMR) vaccine and to introduce supplemental immunisation activities.
Early transmission characteristics of influenza A(H1N1)v in Australia: Victorian state, 16 May – 3 June 2009
Authors: McBryde E S , Bergeri I , van Gemert C , Rotty J , Headley E J , Simpson K , Lester R A , Hellard M , Fielding J E
Published: October 2017

Australia was one of the first countries of the southern hemisphere to experience influenza A(H1N1)v with community transmission apparent in Victoria, Australia, by 22 May 2009. With few identified imported cases, the epidemic spread through schools and communities leading to 897 confirmed cases by 3 June 2009. The estimated reproduction ratio up to 31 May 2009 was 2.4 (95% credible interval (CI): 2.1-2.6). Methods designed to account for undetected transmission reduce this estimate to 1.6 (95% CI: 1.5-1.8). Time varying reproduction ratio estimates show a steady decline in observed transmission over the first 14 days of the epidemic. This could be accounted for by ascertainment bias or a true impact of interventions including antiviral prophylaxis, treatment and school closure. Most cases (78%) in the first 19 days in Victoria were under the age of 20 years-old. Estimates suggest that the average youth primary case infected at least two other youths in the early growth phase, which was sufficient to drive the epidemic.
A simple mathematical approach to deciding the dosage of vaccine against pandemic H1N1 influenza
Authors: Nishiura H , Iwata K
Published: October 2017

Results from early clinical trials have shown that a single dose of pandemic H1N1 influenza vaccine may generate sufficient antibody response, but the relevance of this fact to public health decision making has yet to be clarified. The present study compares the risk of clinical attack (i.e. clinical attack rate) between one- and two-dose vaccination schemes. If the efficacies do not greatly vary between one- and two -dose schemes, one-dose vaccination may well be supported. Nevertheless, two-dose vaccination is shown to result in less morbidity if the vaccine efficacies are greatly diminished by reducing the dose. As long as the detailed efficacy estimates rest on theoretical assumptions, single-dose vaccination may only be sufficiently justified in a specific setting where the number of vaccines is extremely limited.
Clostridium difficile ribotypes 001, 017, and 027 are associated with lethal C. difficile infection in Hesse, Germany
Authors: Arvand M , Hauri A M , Zaiss N H , Witte W , Bettge-Weller G
Published: October 2017

From January 2008 to April 2009, 72 cases of severe Clostridium difficile infection were reported from 18 different districts in the state of Hesse, Germany. A total of 41 C. difficile isolates from 41 patients were subjected to PCR ribotyping. PCR ribotype (RT) 027 was the most prevalent strain accounting for 24 of 41 (59%) of typed isolates, followed by RT 001 (eight isolates, 20%), RT 017 and 042 (two isolates each), and RT 003, 066, 078, 081, and RKI-034 (one isolate each). Eighteen patients had died within 30 days after admission. C. difficile was reported as underlying cause of or contributing to death in 14 patients, indicating a case fatality rate of 19%. The patients with lethal outcome attributable to C. difficile were 59-89 years-old (median 78 years). Ribotyping results were available for seven isolates associated with lethal outcome, which were identified as RT 027 in three and as RT 001 and 017 in two cases each. Our data suggest that C. difficile RT 027 is prevalent in some hospitals in Hesse and that, in addition to the possibly more virulent RT 027, other toxigenic C. difficile strains like RT 001 and 017 are associated with lethal C. difficile infections in this region.
Pandemic influenza A(H1N1)v: Human to pig transmission in Norway?
Authors: Hofshagen M , Gjerset B , Er C , Tarpai A , Brun E , Dannevig B , Bruheim T , Fostad I G , Iversen B , Hungnes O , Lium B
Published: October 2017

In Norway there is an ongoing outbreak in pigs of infections with pandemic influenza A(H1N1)v virus. The first herd was confirmed positive on 10 October 2009. As of 26 October, a total of 23 herds have been diagnosed as positive. The majority of the herds seem to have been infected by humans. Sequence analysis of pig viruses from the index farm shows that they are identical or virtually identical to human viruses from the same geographical region.
Symptomatic primary HIV infection in a 49-year-old man who has sex with men: beware of the window phase
Authors: van Oosten H E , Damen M , de Vries H JC
Published: October 2017

A 49-year-old man with a history of receptive unprotected anal intercourse with multiple anonymous men presented with a symptomatic primary HIV infection. Upon his initial visit the rapid HIV antibody screening test was negative but a p24 antigen test suggested a highly infectious phase in the HIV infection. An immunoblot assay confirmed the HIV diagnosis only 14 days later. Recent infections are characterised by a highly infectious phase and, if gone unnoticed, can have a large contribution to the ongoing transmission of HIV. Healthcare providers should be aware of primary HIV infection and the pitfalls in its diagnosis.
Outbreak of 2009 pandemic influenza A(H1N1), Los Lagos, Chile, April-June 2009
Authors: Chilean Task Force for study of Pandemic Influenza A (H1N1) Collective , Pedroni E , García M , Espínola V , Guerrero A , González C , Olea A , Calvo M , Martorell B , Winkler M , Carrasco M V , Vergara J A , Ulloa J , Carrazana A M , Mujica O , Villarroel J E , Labraña M , Vargas M , González P , Cáceres L , Zamorano C G , Momberg R , Muñoz G , Rocco J , Bosque V , Gallardo A , Elgueta J , Vega J
Published: October 2017

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Genesis of a KPC-producing Klebsiella pneumoniae after in vivo transfer from an imported Greek strain
Authors: Barbier F , Ruppé E , Giakkoupi P , Wildenberg L , Lucet J C , Vatopoulos A , Wolff M , Andremont A
Published: October 2017

We document here the in vivo transfer of blaKPC-2 between intensive care unit-acquired and a commensal strain of K. pneumoniae in a French patient after his repatriation from Greece. This first report of in vivo transfer of a blaKPC-2 between two K. pneumoniae strains raises further concerns about the spread of carbapenem resistance among Enterobacteriaceae.
Epidemiological analysis of mosquito-borne Pogosta disease in Finland, 2009
Authors: Sane J , Guedes S , Kurkela S , Lyytikäinen O , Vapalahti O
Published: October 2017

Pogosta disease is a viral disease caused by a mosquito-borne alphavirus, Sindbis virus (SINV), and large human outbreaks of SINV infection have emerged in Finland every seven years. After a major outbreak in 2002 an epidemic was expected to take place in 2009. Data from the National Infectious Disease Registry showed a small outbreak in humans in 2009 with a total of 105 reported cases but the seven-year cycle did not recur as anticipated.
Chikungunya infection in a French traveller returning from the Maldives, October, 2009
Authors: Receveur M , Ezzedine K , Pistone T , Malvy D
Published: October 2017

In the last years, cases of chikungunya fever have been reported in international travellers returning from the Indian Ocean region. The cases have been linked to the re-emergence of chikungunya fever on Indian Ocean islands in 2006. We describe the first case of chikungunya fever in a French traveller returning from Malé, an island of the Maldives islands, confirming the permanence of virus circulation by the end of 2009.
Observed association between the HA1 mutation D222G in the 2009 pandemic influenza A(H1N1) virus and severe clinical outcome, Norway 2009-2010
Authors: Kilander A , Rykkvin R , Dudman S G , Hungnes O
Published: October 2017

Infection with the recently emerged pandemic influenza A(H1N1) virus causes mild disease in the vast majority of cases, but sporadically also very severe disease. A specific mutation in the viral haemagglutinin (D222G) was found with considerable frequency in fatal and severe cases in Norway, but was virtually absent among clinically mild cases. This difference was statistically significant and our data are consistent with a possible causal relationship between this mutation and the clinical outcome.
Spotlight on measles 2010: Measles outbreak in Ireland 2009-2010
Authors: Gee S , Cotter S , O’Flanagan D , on behalf of the national incident management team Collective
Published: October 2017

Measles cases are increasing in Ireland, with 320 cases notified since August 2009. Nearly two-thirds of these cases (n=206) were unvaccinated. In the early stages of the outbreak a substantial number of cases were linked to the Traveller community with some cases also reported among the Roma community, other citizens from eastern Europe and children whose parents objected to vaccination. By February 2010, there had been considerable spread to the general population.
Spotlight on measles 2010: An epidemiological overview of measles outbreaks in Poland in relation to the measles elimination goal
Authors: Rogalska J , Santibanez S , Mankertz A , Makowka A , Szenborn L , Stefanoff P
Published: October 2017

The objective of this study was to describe transmission chains of measles observed in Poland during 2008-2009. A decade ago, the incidence of measles in Poland declined and approached one case per million inhabitants one of the World Health Organization's criteria for measles elimination. Following a period of very few reported measles cases (2003 to 2005), an increase in incidence was observed in 2006. Since then, the incidence has constantly exceeded one case per million inhabitants. Of 214 measles cases reported in 2008 and 2009 in Poland, 164 (77%) were linked to 19 distinct outbreaks, with 79% of cases belonging to the Roma ethnic group. Outbreaks in the non-Roma Polish population had different dynamics compared to those in the Roma population. On average, measles outbreaks in Roma communities involved 10 individuals, seven of whom were unvaccinated, while outbreaks in the non-Roma Polish population involved five individuals, half of whom were incompletely vaccinated. The majority of outbreaks in Roma communities were related to importation of virus from the United Kingdom. In six outbreaks, the epidemiologic investigation was confirmed by identification of genotype D4 closely related to measles viruses detected in the United Kingdom and Germany. Our data indicate that Poland is approaching measles elimination, but measles virus circulation is still sustained in a vulnerable population. More efforts are needed to integrate the Roma ethnic group into the Polish healthcare system and innovative measures to reach vulnerable groups should be explored.
Outbreak of poliomyelitis in Tajikistan in 2010: risk for importation and impact on polio surveillance in Europe?
Authors: World Health Organization Country Office Tajikistan collective , WHO Regional Office for Europe Collective , European Centre for Disease Prevention and Control
Published: October 2017

On 23 April 2010, the World Health Organisation announced the confirmation of wild poliovirus serotype 1 (WPV1) in seven samples from children with Acute Flaccid Paralysis in Tajikistan, in the context of a multi-district cluster starting in December 2009. As of 28 April, 32 of 171 reported cases were laboratory-confirmed and most closely related to virus from Uttar Pradesh, India. This outbreak demonstrates the high risk that still exists for importation of wild poliovirus into polio-free regions.
Clostridium perfringens in London, July 2009: two weddings and an outbreak
Authors: Eriksen J , Zenner D , Anderson S R , Grant K , Kumar D
Published: October 2017

Food poisoning outbreaks caused by Clostridium perfringens enterotoxin occur occasionally in Europe but have become less common in recent years. This paper presents the microbiological and epidemiological results of a large C. perfringens outbreak occurring simultaneously at two weddings that used the same caterer. The outbreak involved several London locations and required coordination across multiple agencies. A case-control study (n=134) was carried out to analyse possible associations between the food consumed and becoming ill. Food, environmental and stool samples were tested for common causative agents, including enterotoxigenic C. perfringens. The clinical presentation and the epidemiological findings were compatible with C. perfringens food poisoning and C. perfringens enterotoxin was detected in stool samples from two cases. The case-control study found statistically significant associations between becoming ill and eating either a specific chicken or lamb dish prepared by the same food handler of the implicated catering company. A rapid outbreak investigation with preliminary real-time results and the successful collaboration between the agencies and the caterer led to timely identification and rectification of the failures in the food handling practices.
Human activities predominate in determining changing incidence of tick-borne encephalitis in Europe
Authors: Randolph S E , on behalf of the EDEN-TBD sub-project team Collective
Published: October 2017

Explanations for the dynamics of tick-borne disease systems usually focus on changes in the transmission potential in natural enzootic cycles. These are undoubtedly important, but recent analyses reveal that they may not be quantitatively the most significant side of the interaction between infected ticks and humans. Variation in human activities that may impact inadvertently but positively on both the enzootic cycles and the degree of human exposure to those cycles, provide more robust explanations for recent upsurges in tick-borne encephalitis in Europe. This can account for long-term increases in incidence that coincided with post-soviet political independence, for small-scales spatial variation in incidence within a country, and for short-scale fluctuations such as annual spikes in incidence. The patterns of relevant human activities, typically those related to the use of forest resources, are evidently driven and/or constrained by the cultural and socio-economic circumstances of each population, resulting in contrasting national epidemiological outcomes.
Human listeriosis in England, 2001–2007: association with neighbourhood deprivation
Authors: Gillespie I  A , Mook P , Little C L , Grant K A , McLauchlin J
Published: October 2017

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The influenza A(H5N1) epidemic at six and a half years: 500 notified human cases and more to come
Authors: Tarantola A , Barboza P , Gauthier V , Ioos S , El Omeiri N , Gastellu-Etchegorry M , for the Epidemic Intelligence team at InVS Collective
Published: October 2017

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Alarming spread of vancomycin resistant enterococci in Sweden since 2007
Authors: Söderblom T , Aspevall O , Erntell M , Hedin G , Heimer D , Hökeberg I , Kidd-Ljunggren K , Melhus Å , Olsson-Liljequist B , Sjögren I , Smedjegård J , Struwe J , Sylvan S , Tegmark-Wisell K , Thore M
Published: October 2017

The total number of persons infected or colonised with vancomycin-resistant enterococci mandatorily reported to the Swedish Institute for Infectious Disease Control increased dramatically during 2007 and 2008. During a period of twenty months from 1 July 2007 to 28 February 2009, a total of 760 cases were reported compared with 194 cases reported during the entire period from 2000 to 2006. This rise was mainly attributed to a wide dissemination of vancomycin resistant enterococci which started in a number of hospitals in Stockholm in the autumn of 2007 and was followed by dissemination in various healthcare facilities (hospitals and homes for the elderly) in a further two Swedish counties in 2008. The majority of the cases (97%) were acquired in Sweden and among these, healthcare-acquired E. faecium vanB dominated (n=634). The majority of these isolates had identical or closely related pulsed-field gel electrophoresis patterns indicating clonal dissemination in the affected counties. The median minimum inhibitory concentration of vancomycin was 32 mg/L (ranging from 4 to >128 mg/L) and of teichoplanin 0.12 mg/L (ranging from 0.06 to 0.25 mg/L). Particular emphasis was placed on countermeasures such as screening, contact tracing, cleaning procedures, education in accurate use of infection control practices as well as increasing awareness of hygiene among patients and visitors. With these measures the dissemination rate decreased substantially, but new infections with the E. faecium vanB strain were still detected.
Laboratory-based surveillance for Cryptosporidium in France, 2006–2009
Authors: The ANOFEL Cryptosporidium National Network Collective
Published: October 2017

In 2002, the French Food Safety Agency drew attention to the lack of information on the prevalence of human cryptosporidiosis in the country. Two years later, the ANOFEL Cryptosporidium National Network (ACNN) was set up to provide public health authorities with data on the incidence and epidemiology of human cryptosporidiosis in France. Constituted on a voluntary basis, ACNN includes 38 hospital parasitology laboratories (mainly in university hospitals). Each laboratory is engaged to notify new cases of confirmed human cryptosporidiosis, store specimens (e.g. stools, duodenal aspirates or biopsies) and related clinical and epidemiological data, using datasheet forms. From January 2006 to December 2009, 407 cryptosporidiosis cases were notified in France and 364 specimens were collected. Of the notified cases, 74 were children under four years of age, accounting for 18.2%. HIV-infected and immunocompetent patients represented 38.6% (n=157) and 28% (n=114) of cases, respectively. A marked seasonal pattern was observed each year, with increased number of cases in mid to late summer and the beginning of autumn. Genotyping of 345 isolates from 310 patients identified C. parvum in 168 (54.2%) cases, C. hominis in 113 (36.4%) and other species in 29 (9.4%), including C. felis (n=15), C. meleagridis (n=4), C. canis (n=4), Cryptosporidium chipmunk genotype (n=1), Cryptosporidium rabbit genotype (n=1) and new Cryptosporidium genotypes (n=4). These data represent the first multisite report of laboratory-confirmed cases of cryptosporidiosis in France.
Outbreak of invasive meningococcal disease in Goleniów County, north-west Poland, March 2009
Authors: Skoczyńska A , Wasko I , Kuch A , Gołębiewska A , Foryś M , Hryniewicz W
Published: October 2017

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Retrospective screening of solid organ donors in Italy, 2009, reveals unpredicted circulation of West Nile virus
Authors: Capobianchi M R , Sambri V , Castilletti C , Pierro A M , Rossini G , Gaibani P , Cavrini F , Selleri M , Meschi S , Lapa D , Di Caro A , Grossi P , De Cillia C , Venettoni S , Landini M P , Ippolito G , Nanni Costa A , on behalf of the Italian Transplant Network Collective
Published: October 2017

Since the occurrence of West Nile virus (WNV) infection in humans in 2008 in Italy, concerns have been raised about the potential risks associated with solid organ transplantation (SOT). A nationwide retrospective survey showed that 1.2% of SOT donors in 2009 were WNV-seropositive and demonstrated that human WNV infection is distributed throughout several Italian regions. Transmission of WNV or other arboviruses through SOT is a possibility and risk assessment should be carried out before SOT to avoid infection through transplantation.
Dengue virus infection in a traveller returning from Croatia to Germany
Authors: Schmidt-Chanasit J , Haditsch M , Schöneberg I , Günther S , Stark K , Frank C
Published: October 2017

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Spotlight on measles 2010: Ongoing measles outbreak in Northern Ireland following an imported case, September-October 2010
Authors: Smithson R , Irvine N , Hutton C , Doherty L , Watt A
Published: October 2017

We report an ongoing outbreak of measles with five laboratory-confirmed and four epidemiologically linked cases in Northern Ireland as at 26 October 2010. The index case was an unvaccinated non-Northern Ireland resident with subsequent genotyping suggesting that infection originated in the usual country of residence of this case. Confirmed cases include one patient with a history of two measles-mumps-rubella vaccine doses.