bluuebunny/crossref_metadata_2025 huggingface dataset:
Effectiveness of tuberculosis contact tracing among migrants and the foreign-born population
Authors: Mulder C , Klinkenberg E , Manissero D
Published: March 2021

A literature review was performed to assess the effectiveness of tuberculosis (TB) contact tracing among migrants and the foreign-born population with emphasis on the European Union. Effectiveness of contact tracing was assessed using the following indicators: coverage, proportion of contacts with TB (TB yield), proportion of contacts with latent tuberculosis infection (LTBI yield) and number of investigated contacts per index case (contacts/index case ratio). The key findings from the literature review were: Among foreign-born contacts, a higher median LTBI yield was found compared with contacts born in the country, when exposed to the same foreign-born index cases. No clear differences were observed between TB and LTBI yield among contacts of foreign-born index cases compared with contacts of index cases from the general population (including the foreign-born) due to the large variation seen between the studies. The included non-European studies screened more contacts per foreign-born index case, used lower cut-off values to define a positive tuberculosis skin test and found higher LTBI yields among contacts. Although the high heterogeneity across the studies made the comparison challenging, several conclusions are made regarding contact tracing among migrants.
Marked decrease in reporting incidence of salmonellosis driven by lower rates of Salmonella Enteritidis infections in Germany in 2008 – a continuing trend
Authors: Frank C , Käsbohrer A , Stark K , Werber D
Published: March 2021

In Germany, since the enactment of the Protection Against Infection Act (IfSG) in 2001, notification of cases of salmonellosis is based on a stable case definition [1], facilitating comparability of data. The annual incidence of notified cases of salmonellosis has declined from over 90 per 100,000 population in 2001 to 60-70 per 100,000 in 2004 through 2007. After very little change from 2005 through 2007, a marked decrease of the number of notified cases (22.6% compared to 2007) was observed in 2008. This drop, as well as the overall decline since 2001 was almost entirely due to the dwindling number of notifications of infections with Salmonella enterica subsp. enterica of serotype Enteritidis (SE) (Figure 1).
Compliance with boil water advice following a water contamination incident in the Netherlands in 2007
Authors: Karagiannis I , Schimmer B , de Roda Husman A  M
Published: March 2021

In May 2007, Escherichia coli was detected in tap water supplied by a company in North Holland. The company issued advice through mass media to boil tap water before consumption; this advice was lifted six days later. A cross-sectional study was implemented to investigate compliance among residents in this area. Based on postcode, a total of 300 households, chosen randomly from a database of a private company performing internet-based surveys for different marketing purposes, were sent a self-administered questionnaire for this study. The questionnaire contained questions on demographic information, source of information regarding the advice, response to it and personal opinions on the company's reaction and the advice. Ninety-nine (66%) households of the affected area and 90 (60%) households from non-affected areas served by the same company replied to the survey. All respondents knew about the advice. 81.8% of the respondents in the affected area and 5.6% of the non-affected areas reported complying with the advisory. Most respondents from the affected area still used unboiled water to brush teeth, wash salads and wash fruit. There was no difference in compliance between men and women. Using the mass media was proved to be efficient to inform the public and could be used in the future in similar settings. However, more detailed wording of boiling advices should be considered in the future.
Internet surveillance systems for early alerting of health threats
Authors: Linge J P , Steinberger R , Weber T P , Yangarber R , van der Goot E , Al Khudhairy D H , Stilianakis N I
Published: March 2021

In order to gather a comprehensive picture of potential epidemic threats, public health authorities increasingly rely on systems that perform epidemic intelligence (EI). EI makes use of information that originates from official sources such as national public health surveillance systems as well as from informal sources such as electronic media and web-based information tools.
Nation-wide prospective surveillance of Clostridium difficile infections in hospitals in Belgium, July 2007-June 2008
Authors: Lambert M L , Mertens K , Ramboer I , Delmée M , Suetens C
Published: March 2021

We report here baseline data from the first year of compulsory surveillance of Clostridium difficile infections (CDI) in hospitals in Belgium. Between 1 July 2007 and 30 June 2008, 2,704 CDI were reported: 12% were recurrent and 66% were hospital-associated (half of which occurred 15 days or more after admission). CDI was considered the cause of death (direct or indirect) for 10% of the episodes. The median incidence of CDI was 1.5 per 1,000 admissions and 1.9 per 10,000 hospital-days for all cases, and 0.9 per 1,000 admissions, and 1.1 per 10,000 hospital-days for hospital-associated cases. Further investigation of risk stratification by average length of stay in the reporting hospitals is warranted as a way to improve the comparability of indicators across hospitals and surveillance systems. In spite of methodological issues, the surveillance of CDI in Belgian hospitals has been able to produce robust baseline data that should allow monitoring of trends at hospital and national level, and provide a basis for international comparisons. Remaining challenges are to define and monitor targets for the control of CDI, and to improve the individual feed-back of data at hospital level.
Impact of immigration on HIV and tuberculosis epidemiology in the Euro-Mediterranean area
Authors: El Aouad R , Diez M , Cherkaoui I
Published: March 2021

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Characterisation of Neisseria meningitidis C strains causing two clusters in the north of Italy in 2007 and 2008
Authors: Fazio C , Neri A , Sofia T , Carannante A , Caporali M G , Salmaso S , Mastrantonio P , Stefanelli P
Published: March 2021

Two clusters of invasive meningococcal disease in the north of Italy both due to serogroup C/ST-11 clonal complex are here described. The objective of the investigation was to analyse the phenotype and the genotype of meningococci involved in the two clusters which were of national relevance due to the fatal outcome of the majority of cases (six of the total of 10 cases). All the strains were C:2a:P1.5 ST-11/ET-37 clonal complex. Two pulsed field gel electrophoresis (PFGE) and variable number tandem repeats (VNTR) profiles were identified, one for each cluster. VNTRs were different from those detected in Italy for C/ST-11 strains isolated from sporadic cases in the same period. This laboratory surveillance report highlights the importance and the crucial role of molecular characterisation to confirm the relatedness among meningococci responsible for clusters of cases.
Outbreak of Clostridium difficile 027 infection in Vienna, Austria 2008-2009
Authors: Indra A , Huhulescu S , Fiedler A , Kernbichler S , Blaschitz M , Allerberger F
Published: March 2021

From November 2008 to 15 April 2009, 36 isolates of CD027 were identified in Austria, all originating from four hospitals in Vienna. All isolates were positive for toxin A, toxin B and the binary toxin, and showed a characteristic 18 bp deletion in the tcdC gene.
Investigation of the spread of brucellosis among human and animal populations in southeastern Bulgaria, 2007
Authors: Tzaneva V , Ivanova S , Georgieva M , Tasheva E
Published: March 2021

Three human cases of brucellosis were reported in summer 2007 in the region of Haskovo in southeastern Bulgaria. Subsequently, the regional veterinary and public health authorities carried out investigations to determine the spread of infection in domestic animals and in the human population. As a result, over 90,000 animals were tested, and 410 were found infected with brucellosis. The screening of 561 people believed to have been at risk of infection yielded 47 positive results. The majority of these persons had direct contact with domestic animals or had consumed unpasteurised dairy products. The investigations revealed evidence of disease among animals in the region and a considerable risk to humans, thus emphasising the need for effective prevention and control programmes.
National Hand Hygiene Campaigns in Europe, 2000-2009
Authors: Magiorakos A P , Suetens C , Boyd L , Costa C , Cunney R , Drouvot V , Farrugia C , Fernandez-Maillo M M , Iversen B G , Leens E , Michael S , Moro M L , Reinhardt C , Serban R , Vatcheva-Dobrevska R , Wilson K , Heisbourg E , Maltezou H C , Strauss R , Böröcz K , Dolinšek M , Dumpis U , Erne S , Gudlaugsson O , Heczko P , Hedlova D , Holt J , Jõe L , Lyytikäinen O , Riesenfeld-Örn I , Stefkovikova M , Valinteliene R , Voss A , Monnet D L
Published: March 2021

Hand hygiene represents the single most effective way to prevent healthcare-associated infections. The World Health Organization, as part of its First Global Patient Safety Challenge, recommends implementation of multi-faceted strategies to increase compliance with hand hygiene. A questionnaire was sent by the European Centre for Disease Prevention and Control to 30 European countries, regarding the availability and organisation of their national hand hygiene campaigns. All countries responded. Thirteen countries had organised at least one national campaign during the period 2000-2009 and three countries were in the process of organising a national campaign. Although the remaining countries did not have a national campaign, several reported regional and local hand hygiene activities or educational resources on national websites.
Chikungunya infection confirmed in a Belgian traveller returning from Phuket (Thailand)
Authors: Bottieau E , Van Esbroeck M , Cnops L , Clerinx J , Van Gompel A
Published: March 2021

Chikungunya infection has been increasingly reported in international travellers following its epidemic re-emergence in the Indian Ocean islands in 2006 and its spread to southern Asia thereafter. We describe the first case of chikungunya in a Belgian traveller returning from Phuket, Thailand and discuss the potential implications of chikungunya cases imported to European countries for patient management and public health.
The emerging influenza pandemic: estimating the case fatality ratio
Authors: Wilson N , Baker M G
Published: March 2021

To determine appropriate influenza pandemic containment and mitigation measures, health authorities need to know the approximate case fatality ratio (CFR) for this new infection. We present four different methods for very provisionally estimating the plausible range of the CFR for symptomatic infection by this pandemic strain in developed countries. All of the methods produce substantially lower values (range 0.06% to 0.0004%) than a previously published estimate for Mexico (0.4%). As these results have many limitations, improved surveillance and serological surveys are needed in both developed and developing countries to produce more accurate estimates.
StatFlu - a static modelling tool for pandemic influenza hospital load for decision makers
Authors: Camitz M
Published: March 2021

The emergence of a new influenza virus strain setting off a global epidemic can put considerable strain on the current hospital capacity. The task of estimating hospital load during an influenza pandemic event remains difficult, despite a number of tools that are publicly available for decision makers today. The estimate depends on a multitude of parameters, each with associated uncertainties. We provide a new tool, StatFlu, combining advances in static modelling using historic influenza data with a pedagogical interface designed to highlight propagation of parameter settings and uncertaintiesin the output. StatFlu provides graphs of the load on hospital wards as well as primary care units as a function of time, aiding the user in decision making. Here we present the model and software. We also demonstrate it with an example and compare the results with a similar tool.
Verocytotoxin-producing Escherichia coli O157 outbreak in Wrexham, North Wales, July 2009
Authors: Hart J , Smith G
Published: March 2021

An outbreak of Escherichia coli O157 involving four people in North Wales is currently being investigated. Laboratory typing shows all the isolates belong to phage type 2. All four cases reported eating different products from a fast food outlet in the area. The possibility of other common exposures is being explored.
The Swedish new variant of Chlamydia trachomatis (nvCT) remains undetected by many European laboratories as revealed in the recent PCR/NAT ring trial organised by INSTAND e.V., Germany
Authors: Reischl U , Straube E , Unemo M
Published: March 2021

The May 2009 round of INSTAND's ring trial ""Chlamydia trachomatis detection PCR/NAT"" included a sample with high amount of the Swedish new variant of C. trachomatis (nvCT). A spectrum of at least 12 different commercial diagnostic nucleic acid amplification tests (NAATs) and many different in house NAATs were applied by the 128 participating laboratories which reported 152 results. Approximately 80% of the results correctly reported the presence of C. trachomatis in the nvCT specimen. The nvCT sample was mainly missed, as expected, by participants using the Roche COBAS Amplicor CT/NG (15.5% of reported results) but also by several participants using in house NAATs. The trend towards using nvCT-detecting NAATs is obvious and in addition to the new dual-target NAATs from Roche and Abbott, and BD ProbeTec ET, also a number of new CE mark-certified commercial tests from smaller diagnostic companies as well as many different in house NAATs were used. Laboratories using commercial or in house NAATs that do not detect the nvCT are encouraged to carefully monitor their C. trachomatis incidence, participate in appropriate external quality assurance and controls schemes, and consider altering their testing system. The reliable detection of low amounts of the wildtype C. trachomatis strain in other samples of the ring trial set indicates a good diagnostic performance of all applied commercial NAATs while also detecting the nvCT strain.
Finland introduces rotavirus vaccine into the national vaccination programme in September 2009
Authors: Nohynek H , Salo H , Renko M , Leino T
Published: March 2021

Supported by an economic evaluation, rotavirus vaccine is introduced into the national immunisation schedule in Finland. The vaccination programme has been estimated to be reasonably cost-effective. Given at the age of two, three and five months, the vaccine is expected to prevent annually in Finland among children under the age of five years approximately 2,000 rotavirus diarrhoea episodes needing hospitalisation, and over 10,000 outpatient visits. The impact of the programme will be evaluated in 2011 by repeating the economic analysis and carefully monitoring adverse events.
Tuberculosis in a child – search for the infected adult nearby; case report, Portugal, 2007
Authors: Duarte R , Tavares E , Miranda A , Carvalho A
Published: March 2021

Tuberculosis (TB) transmission in a non-household setting is difficult to detect, because contact with the source case is often not obvious. Here, we report on a case of a four-year-old child who got infected through sporadic non-household exposure at a coffee shop. The source case was a woman who had suffered from weight loss, productive cough and fatigue for two months before being diagnosed with TB. Screening the child’s contacts revealed two active TB cases within its family. Overall 148 contacts were screened for both cases and 18 cases of latent TB infection detected. The connection between the child and the source case, who were not aware of their contact, was confirmed by molecular fingerprinting. Our case report illustrates the difficulty in detecting non-household transmission between individuals that do not have significant contact, and draws attention to the need to look for the infected adult whenever a child falls ill with TB. This report is a reminder of the importance to consider possibly neglected ways of TB transmission and highlights once again the need of early diagnosis of TB.
Legionnaires’ disease cluster linked to a metal product aqueous pre-treatment process, Staffordshire, England, May 2008
Authors: Coetzee N , Liu W K , Astbury N , Williams P , Robinson S , Afza M , Duggal H V
Published: March 2021

In May 2008, a report of two workers from the same construction equipment manufacturing plant who were admitted to hospital with Legionnaires’ disease confirmed by urine antigen prompted an outbreak investigation. Both cases were middle aged men, smokers, and with no travel, leisure or other common community exposure to Legionella sources. There were no wet cooling towers at the plant or in the surrounding area. No increase in respiratory disease or worker absenteeism occurred at the plant during the preceding month. Wider case ascertainment including alerts to hospitals and medical practitioners yielded no further cases. The environmental investigation (and sampling of water systems for Legionella) identified a Legionella pneumophila serogroup1 (Mab 2b) count of >3.0x104cfu/l in water samples from an aqueous metal pre-treatment tunnel, which generates profuse water aerosol. Drainage, cleaning and biocide treatment using thiazalone eliminated Legionella from the system.
First isolations of KPC-2-carrying ST258 Klebsiella pneumoniae strains in Finland, June and August 2009
Authors: Österblad M , Kirveskari J , Koskela S , Tissari P , Vuorenoja K , Hakanen A J , Vaara M , Jalava J
Published: March 2021

The first two Klebsiella pneumoniae carbapenemase-producing (KPC) type 2 strains carrying ST258 were detected in Finland in June and early August 2009. They were found colonising two patients transferred from the Mediterranean; one patient referred from a hospital in Greece where isolates were first found in 2007 and another from Italy where the first isolates have been described only very recently.
A foodborne outbreak of norovirus gastroenteritis associated with a Christmas dinner in Porto, Portugal, December 2008
Authors: Mesquita J R , Nascimento M S
Published: March 2021

An outbreak of acute norovirus gastroenteritis was detected and epidemiologically linked to a Christmas dinner reunion of 22 recent graduate students in a restaurant in Porto, Portugal, in December 2008. A retrospective cohort study was carried out using online standardised questionnaires. Sixteen primary and three secondary cases were identified and the risk ratios with 95% confidence intervals for each food item were calculated. The response rate to the online questionnaires was 96%. The outbreak met all four Kaplan’s criteria and the attack rate was 73%. Norovirus GII.4 2006b was detected in stools and emesis samples of two primary cases. The ingestion of soup and lettuce salad was considered a risk factor for this norovirus outbreak, as determined by statistical analysis. Our investigation demonstrated two routes of transmission of norovirus starting with foodborne exposure followed by secondary person-to-person spread. To our knowledge this is the first study identifying norovirus as the causative agent of a foodborne outbreak in Portugal.
Use of an inactivated vaccine in mitigating pandemic influenza A(H1N1) spread: a modelling study to assess the impact of vaccination timing and prioritisation strategies
Authors: Sypsa V , Pavlopoulou I , Hatzakis A
Published: March 2021

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Pandemic H1N1 influenza: predicting the course of a pandemic and assessing the efficacy of the planned vaccination programme in the United States
Authors: Towers S , Feng Z
Published: March 2021

We use data on confirmed cases of pandemic influenza A(H1N1), disseminated by the United States Centers for Disease Control and Prevention(US CDC), to fit the parameters of a seasonally forced Susceptible, Infective, Recovered (SIR) model. We use the resulting model to predict the course of the H1N1 influenza pandemic in autumn 2009, and we assess the efficacy of the planned CDC H1N1 vaccination campaign. The model predicts that there will be a significant wave in autumn, with 63% of the population being infected, and that this wave will peak so early that the planned CDC vaccination campaign will likely not have a large effect on the total number of people ultimately infected by the pandemic H1N1 influenza virus.
An outbreak of hospital-acquired Staphylococcus aureus skin infection among newborns, Nan Province, Thailand, January 2008
Authors: Pawun V , Jiraphongsa C , Puttamasute S , Putta R , Wongnai A , Jaima T , Tithsayatikom P , Wattanasri S
Published: March 2021

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Applied epidemiology training in Europe: quite a success - but more to be done
Authors: Krause G , Stefanoff P , Moren A
Published: March 2021

This article describes the development of training in applied epidemiology in Europe and outlines the current situation in Europe with a view of how the system can be improved to meet future challenges.
Contribution of EPIET to public health workforce in the EU, 1995-2008
Authors: Bosman A , Schimmer B , Coulombier D
Published: March 2021

We analyse activities and outputs of fellows of the European Programme for Intervention Epidemiology Training (EPIET) between 1995 and 2008 and describe the employment history of graduates after the training to demonstrate the contribution of this programme and of national EPIET-associated programmes to the public health workforce in the European Union and Norway. Up to 2008, some 161 fellows entered the training: 121 in EPIET and 40 in EPIET-associated programmes. Of these 149 were awarded a diploma. Fellows engaged in projects in all areas of surveillance, in outbreaks and field investigations and produced 340 publications in peer-reviewed journals. Seventy fellows were sent to 98 individual assignments on 65 international missions. The vast majority of graduates (90%) take up a position and remain employed in applied public health, either on regional, national or international level. Several (27) are working outside the EU, all in public health, including 13 working in Switzerland for international organisations. Only three of the 12 EU Member States that joined the EU since 2004, employ EPIET graduates. A major challenge for training the public health workforce is the retention of professionals in countries with limited job opportunities or wages significantly below the EU average.
Genome sequence analysis of the first human West Nile virus isolated in Italy in 2009
Authors: Barzon L , Franchin E , Squarzon L , Lavezzo E , Toppo S , Martello T , Bressan S , Pagni S , Cattai M , Piazza A , Pacenti M , Cusinato R , Palù G
Published: March 2021

In 2009, six new human cases of West Nile neuroinvasive disease (WNND) were identified in Veneto region, following the six cases already reported in 2008. A human West Nile virus (WNV) isolate was obtained for the first time from an asymptomatic blood donor. Whole genome sequence of the human WNV isolate showed close phylogenetic relatedness to the Italy-1998-WNV strain and to other WNV strains recently isolated in Europe, with the new acquisition of the NS3-Thr249Pro mutation, a trait associated with avian virulence, increased virus transmission, and the occurrence of outbreaks in humans.
Interpreting “Google Flu Trends” data for pandemic H1N1 influenza: The New Zealand experience
Authors: Wilson N , Mason K , Tobias M , Peacey M , Huang Q S , Baker M
Published: March 2021

For the period of the spread of pandemic H1N1 influenza in New Zealand during 2009, we compared results from Google Flu Trends with data from existing surveillance systems. The patterns from Google Flu Trends were closely aligned with (peaking a week before and a week after) two independent national surveillance systems for influenza-like illness (ILI) cases. It was much less congruent with (delayed by three weeks) data from ILI-related calls to a national free-phone Healthline and with media coverage of pandemic influenza. Some patterns were unique to Google Flu Trends and may not have reflected the actual ILI burden in the community. Overall, Google Flu Trends appears to provide a useful free surveillance system but it should probably be seen as supplementary rather than as an alternative.
Single-nucleotide polymorphism in the SCCmec-orfX junction distinguishes between livestock-associated MRSA CC398 and human epidemic MRSA strains
Authors: Reischl U , Frick J , Hoermansdorfer S , Melzl H , Bollwein M , Linde H J , Becker K , Köck R , Tuschak C , Busch U , Sing A
Published: March 2021

A number of real-time PCR assays for direct detection of methicillin-resistant Staphylococcus aureus (MRSA) in clinical specimens are targeting staphylococcal cassette chromosome mec (SCCmec) right extremity sequences and the S. aureus chromosomal orfX gene sequences located to the right of the SCCmec integration site. When testing 184 MRSA strains of human and animal origin from geographically distinct locations, we identified several characteristic single-nucleotide polymorphisms (SNPs) within the SCCmec-orfX junction of livestock-associated (LA) MRSA CC398 which serve as suitable strain markers for screening purposes. Within an assay time of 60 minutes and an additional 10 minutes for the melting curve analysis, all MRSA CC398 isolates were correctly identified by their characteristic Tm value in the commercial LightCycler MRSA Advanced test. Studies to confirm the diagnostic accuracy of the SNP-based strain identification assay with a larger collection of clinical and LA-MRSA strains are ongoing.
Large measles epidemic in Switzerland from 2006 to 2009: consequences for the elimination of measles in Europe
Authors: Richard J L , Masserey Spicher V
Published: March 2021

Switzerland adheres to the objective of eliminating measles within the European region of the World Health Organization (WHO) by 2010. After several years with a relatively low annual incidence rate (0.3 to 1 case per 100,000 inhabitants), there has been a large epidemic of measles from November 2006 to August 2009. By mid September 2009, 4,415 cases were notified by physicians and laboratories, corresponding to an incidence rate of 15 per 100,000 in 2007 and 29 per 100,000 in 2008; by far the highest rates in Europe. This exceptionally long nationwide epidemic comprised three successive waves, with peaks in August 2007 (171 cases), March 2008 (569 cases) and March 2009 (417 cases). It mainly affected children aged from five to 14 years (48% of cases). Most cases were not vaccinated (93%) or were incompletely vaccinated (5%). In total 656 patients (15%) suffered complications or were hospitalised. Insufficient, spatially heterogeneous immunisation coverage (87% for at least one dose at the age of two years at the national level) has allowed a sequence of numerous outbreaks to occur, despite the gradual strengthening of measures to control the disease. Several exportations to Europe (81 in 2007 and 2008) and to the rest of the world (10 for the whole of the epidemic) have in some instances caused large outbreaks. The epidemic was a threat to the goal of eliminating measles in Switzerland and in Europe. The Federal Office of Public Health (FOPH) and its partners are currently working on a national strategy to eliminate measles.
WHO criteria for measles elimination: a critique with reference to criteria for polio elimination
Authors: Kelly H , Riddell M , Heywood A , Lambert S
Published: March 2021

Smallpox was formally declared as eradicated in 1979. Smallpox is the only infectious disease of humans that has ever been eradicated. Poliomyelitis has been eliminated from three of the six World Health Organization (WHO) regions although not all countries within those regions always meet the elimination criteria. Elimination criteria for measles are being discussed. We use poliomyelitis and measles as examples to illustrate our assertion that the current approach to documenting measles elimination relies too heavily on criteria for surveillance quality, disadvantaging countries with long established and relatively inflexible surveillance systems. We propose an alternative approach to documenting measles elimination, with the two key criteria being molecular evidence to confirm the lack of a circulating endemic genotype for at least one year and maintenance of 95% coverage of one dose of measles-containing vaccine, with an opportunity for a second dose. Elimination status should be reviewed annually. We suggest four principles that should guide development of final criteria to document measles elimination: countries that have eliminated measles should be able to meet the elimination criteria; quality surveillance criteria are necessary but not sufficient to define elimination; quality surveillance criteria should be guided by elimination criteria, not the other way around; and elimination criteria should not differ between the WHO regions without good reason.
Update: Follow-up study showing post-pandemic decline in hand sanitiser use, New Zealand, December 2009
Authors: Manning S , Barry T , Wilson N , Baker M G
Published: March 2021

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Preliminary report: outbreak of Legionnaires’ disease in the cities of Ulm and Neu-Ulm in Germany, December 2009 - January 2010
Authors: von Baum H , Härter G , Essig A , Lück C , Gonser T , Embacher A , Brockmann S
Published: March 2021

Currently an investigation is ongoing to explore and control an outbreak of Legionnaires’ disease, affecting 65 people as of 22 January 2010, in the cities of Ulm and Neu-Ulm, south-west Germany. A hitherto unidentified wet cooling system in these twin cities is considered as the most likely source of infection.
Avian influenza A(H5N1) in humans: lessons from Egypt
Authors: Fasina F O , Ifende V I , Ajibade A A
Published: March 2021

Highly pathogenic avian influenza A(H5N1) has ravaged the Egyptian poultry population. Ninety human cases, including 27 fatalities have been recorded by 30 December, 2009. However, epidemiological information on the infection in humans in Egypt is scarce. We analysed the first three years of highly pathogenic avian influenza A(H5N1) in Egypt between 20 March 2006 and 31 August 2009) and found that more cases occurred in females than males, especially in 2006 and 2007. Women in the age group 20-39 years had the greatest tendency to be infected. It took an average of one day and 18 hours to seek medical assistance in patients who recovered and of six days in fatal cases. Children sought treatment much earlier than adults. On average, a patient died 11 days after the onset of symptoms. Exposure to infected poultry remained the most important risk factor.
Campylobacteriosis and other bacterial gastrointestinal diseases in Sofia, Bulgaria for the period 1987 – 2008
Authors: Ivanova K , Мarinа M , Petrov P , Kantardjiev T
Published: March 2021

Campylobacter is the most commonly reported enteric bacterial pathogen in humans. We still do not have any systematic data concerning campylobacteriosis in Bulgaria. For that reason, we present data of the thermophilic Campylobacter jejuni and Campylobacter coli in the aetiology of diarrhoeal diseases in Sofia, for the period from 1987 to 2008. The study included patients from 0 to over 65 years-old. A total of 51,607 faecal specimens were screened for Campylobacter. C. jejuni and C. coli were detected in 3.58% (1,847) of the strains, with the highest percentage in 1988 (7.5%) and the lowest in 2006 (0.3%). Campylobacteriosis occurred most frequently in the wet months of March, April, May and June, with 105, 102, 124 and 141 cases, respectively, and was rare in January with 25 cases. The most affected groups were children between 0 and 4 years of age (52%) and between five and 14 years of age (30%). Campylobacter infection occurred in 22% of all bacterial gastrointestinal diseases in the city of Sofia during the study period. Salmonella was the most frequently identified pathogen with 32%, followed by Shigella (30%), Campylobacter (22%) and diarrhoeagenic Escherichia coli (16%). The study shows that Campylobacter plays an important role as a bacterial cause of enterocolitis in Sofia, Bulgaria.
Estimating the impact of the 2009 influenza A(H1N1) pandemic on mortality in the elderly in Navarre, Spain
Authors: Castilla J , Etxeberria J , Ardanaz E , Floristán Y , López Escudero R , Guevara M
Published: March 2021

We analysed mortality among people aged 65 years or older in Navarre, Spain in 2009 and compared it with the mean for the same period of time in the previous three years. In the pandemic weeks 24 to 52 2009 we observed 4.9% more deaths than expected (p=0.0268). Excess mortality occurred during the circulation of seasonal influenza (8.0%, p=0.0367) and the first wave of pandemic influenza (9.9%, p=0.0079). In the second wave of pandemic influenza there was a non-significant excess of deaths (5.2%, p=0.1166). Surveillance of laboratory-confirmed severe influenza cases detected only one death in this age group.
Household transmissibility and other characteristics of seasonal oseltamivir-resistant influenza A(H1N1) viruses, Germany, 2007-8
Authors: Buchholz U , Brockmann S , Duwe S , Schweiger B , an der Heiden M , Reinhardt B , Buda S
Published: March 2021

During the influenza season 2007-8, the proportion of seasonal influenza A(H1N1) viruses resistant to the neuraminidase inhibitor oseltamivir increased worldwide. We conducted an investigation to compare patients infected with oseltamivir-resistant (ose-R) and oseltamivir- susceptible (ose-S) influenza A(H1N1) viruses regarding risk factors for resistance and the capability to transmit in the household setting. Within a cohort of 396 laboratory confirmed influenza patients from sentinel physicians we conducted a nested case-control study among patients infected with A(H1N1). Thirty patients in the cohort were infected with influenza B, none with influenza A(H3N2) and 366 with A(H1N1). Of the 366 A(H1N1) viruses 52 (14%) were ose-R. Demographic characteristics, oseltamivir exposure, travel history and outcome were not significantly different between ose-S and ose-R patients. Among 133 households in the nested case-control study, secondary household attack rates in households with ose-R cases and households with ose-S cases were similar (23 versus 26%; p-value=0.54). Ose-R household status and occurrence of secondary cases were associated with an odds ratio of 0.85 (95% confidence interval 0.38-1.88). We conclude that seasonal ose-R influenza A(H1N1) viruses have transmitted well in the household setting.
Low acceptance of vaccination against the 2009 pandemic influenza A(H1N1) among healthcare workers in Greece
Authors: Rachiotis G , Mouchtouri V A , Kremastinou J , Gourgoulianis K , Hadjichristodoulou C
Published: March 2021

A questionnaire survey on the attitude of healthcare workers towards pandemic influenza vaccination showed low acceptance (17%) of the pandemic vaccine. Factors associated with vaccine uptake were acceptance of seasonal influenza vaccination, medical profession and age. The main reason for refusal of vaccination was fear of side effects, which was stronger in those who received information on the safety of the vaccine mainly from mass media.
Crimean-Congo hemorrhagic fever in Europe: current situation calls for preparedness
Authors: Maltezou H C , Andonova L , Andraghetti R , Bouloy M , Ergonul O , Jongejan F , Kalvatchev N , Nichol S , Niedrig M , Platonov A , Thomson G , Leitmeyer K , Zeller H
Published: March 2021

During the last decade Crimean-Congo hemorrhagic fever (CCHF) emerged and/or re-emerged in several Balkan countries, Turkey, southwestern regions of the Russian Federation, and the Ukraine, with considerable high fatality rates. Reasons for re-emergence of CCHF include climate and anthropogenic factors such as changes in land use, agricultural practices or hunting activities, movement of livestock that may influence host-tick-virus dynamics. In order to be able to design prevention and control measures targeted at the disease, mapping of endemic areas and risk assessment for CCHF in Europe should be completed. Furthermore, areas at risk for further CCHF expansion should be identified and human, vector and animal surveillance be strengthened.
West Nile virus in Europe: understanding the present to gauge the future
Authors: Reiter P
Published: March 2021

The appearance of West Nile virus in New York in 1999 and the unprecedented panzootic that followed, have stimulated a major research effort in the western hemisphere and a new interest in the presence of this virus in the Old World. This review considers current understanding of the natural history of this pathogen, with particular regard to transmission in Europe.
Risk of developing tuberculosis from a school contact: retrospective cohort study, United Kingdom, 2009
Authors: Caley M , Fowler T , Welch S , Wood A
Published: March 2021

To quantify the risk of developing tuberculosis (TB) following school contact with a student with smear positive respiratory TB in a population with a high background rate of tuberculosis, a retrospective cohort study was conducted. This study included all students and staff (n=1,065) at an inner city secondary school in Birmingham, United Kingdom (UK).

Being in the same school year as the index case resulted in a significantly higher risk of being diagnosed with active TB (odds ratio (OR) 6.11) and either active or latent TB (OR 10.52) compared to the risk for pupils in other school years. Neither lower level classroom exposure in tutoring groups nor being a staff member resulted in significantly increased risk of infection. The number of cases detected in the school was significantly higher than compared with the TB notification rate for the respective age groups in the population in the area.

This study is consistent with the small body of evidence that already exists suggesting that greater levels of classroom contact with a student with smear positive active TB significantly increases the risk of contracting active and latent TB. It also suggests that staff may be at a lower risk of active TB than students. It does not appear that being in an area with high TB incidence substantially alters the epidemiology of the outbreak or risk of transmission between students in comparison to other populations.
Multidrug- and extensively drug-resistant tuberculosis: a persistent problem in the European Union and European Economic Area
Authors: Ködmön C , Hollo V , Huitric E , Amato-Gauci A , Manissero D
Published: March 2021

Since 2008, the European Centre for Disease Prevention and Control has been collecting data from the European Union (EU) and European Economic Area (EEA) on resistance to first- and second-line drugs against tuberculosis (TB). In 2008, the proportion of multidrug-resistant tuberculosis (MDR TB) was 6.0% of the total case load for 25 countries reporting data. Extensively drug-resistant (XDR TB) reporting has increased since 2007 and was observed in 7.3% of the MDR TB cases in 13 reporting countries. MDR TB remains a threat and XDR TB is now established within the EU/EEA borders.
The new automated daily mortality surveillance system in Portugal
Authors: Nogueira P J , Machado A , Rodrigues E , Nunes B , Sousa L , Jacinto M , Ferreira A , Falcão J  M , Ferrinho P
Published: March 2021

The experience reported in an earlier Eurosurveillance issue on a fast method to evaluate the impact of the 2003 heatwave on mortality in Portugal, generated a daily mortality surveillance system (VDM) that has been operating ever since jointly with the Portuguese Heat Health Watch Warning System. This work describes the VDM system and how it evolved to become an automated system operating year-round, and shows briefly its potential using mortality data from January 2006 to June 2009 collected by the system itself. The new system has important advantages such as: rapid information acquisition, completeness (the entire population is included), lightness (very little information is exchanged, date of death, age, sex, place of death registration). It allows rapid detection of impacts (within five days) and allows a quick preliminary quantification of impacts that usually took several years to be done. These characteristics make this system a powerful tool for public health action. The VDM system also represents an example of inter-institutional cooperation, bringing together organisations from two different ministries, Health and Justice, aiming at improving knowledge about the mortality in the population.
The emergence of oseltamivir-resistant pandemic influenza A(H1N1) 2009 virus amongst hospitalised immunocompromised patients in Scotland, November-December, 2009
Authors: Harvala H , Gunson R , Simmonds P , Hardie A , Bennett S , Scott F , Roddie H , McKnight J , Walsh T , Rowney D , Clark A , Bremner J , Aitken C , Templeton K
Published: March 2021

To investigate the frequency of oseltamivir resistance in circulating strains of the 2009 influenza A(H1N1) pandemic virus in Scotland, 1,802 samples from 1,608 infected hospitalised patients were screened by the H275Y discriminatory RT-PCR. Among these, we identified 10 patients who developed the H275Y mutation. All of them were immunocompromised and were under treatment or had been treated previously with oseltamivir.
Evaluation of a risk assessment questionnaire to assist hepatitis C screening in the general population
Authors: Zuure F , Davidovich U , Kok G , Depla A C , Hoebe C , van den Hoek A , Jansen P L , van Leeuwen-Gilbert P , Weegink C J , Coutinho R  A , Prins M
Published: March 2021

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Update: Multinational listeriosis outbreak due to ‘Quargel’, a sour milk curd cheese, caused by two different L. monocytogenes serotype 1/2a strains, 2009-2010
Authors: Fretz R , Pichler J , Sagel U , Much P , Ruppitsch W , Pietzka A T , Stöger A , Huhulescu S , Heuberger S , Appl G , Werber D , Stark K , Prager R , Flieger A , Karpíšková R , Pfaff G , Allerberger F
Published: March 2021

Binary file ES_Abstracts_Final_ECDC.txt matches
Changes to the varicella and pertussis immunisation schedule in Germany 2009: Background, rationale and implementation
Authors: Wiese-Posselt M , Hellenbrand W
Published: March 2021

In July 2009, the German Standing Committee on Vaccination (STIKO) modified its recommendations for varicella and pertussis vaccination, based on newly available data on disease epidemiology, vaccine effectiveness (VE) and safety, and an evaluation of the feasibility of the recommended immunisation strategy. The recommendation for varicella vaccine now includes a routine two-dose schedule with the administration of the first dose at the age of 11 to 14 months and the second dose at the age of 15 to 23 months, with a minimum interval of four weeks between these doses. Furthermore, STIKO recommended adding a one-time pertussis booster to the adult vaccination schedule to expand the cocoon strategy in place since 2004. The recommendation of a booster vaccination with an acellular pertussis vaccine every 10 years for persons employed in the care of pre-school children and for healthcare personnel in paediatric, gynaecologic and obstetric health facilities was extended to persons employed in schools and in other institutions caring for older children, and to all healthcare personnel. These recommendations were based on available epidemiological data showing an increase in incidence from 7-10 cases per 100,000 inhabitants in 2002-2004 to over 30 by 2007. Moreover, the high burden of pertussis in infants at 94 hospitalised cases per 100,000 infants in 2007 suggested that the previous cocoon strategy was insufficient.
Spotlight on measles 2010: A cluster of measles in a hospital setting in Slovenia, March 2010
Authors: Grgic-Vitek M , Frelih T , Ucakar V , Prosenc K , Tomažič J , Petrovec M , Kraigher A
Published: March 2021

After ten years of being measles free, Slovenia experienced a cluster with secondary transmission in a hospital setting in March 2010. The index case, a resident of Ireland, was hospitalised on the day after his arrival to Slovenia and diagnosed with measles two days later. After his discharge, two cases of measles were notified, a hospital staff member and a visitor to the clinic, suggesting transmission in a hospital setting.
Multiresistant Salmonella enterica serovar 4,[5],12:i:- in Europe: a new pandemic strain?
Authors: Hopkins K L , Kirchner M , Guerra B , Granier S A , Lucarelli C , Porrero M C , Jakubczak A , Threlfall E  J , Mevius D. J
Published: March 2021

A marked increase in the prevalence of S. enterica serovar 4,[5],12:i:- with resistance to ampicillin, streptomycin, sulphonamides and tetracyclines (R-type ASSuT) has been noted in food-borne infections and in pigs/pig meat in several European countries in the last ten years. One hundred and sixteen strains of S. enterica serovar 4,[5],12:i:- from humans, pigs and pig meat isolated in England and Wales, France, Germany, Italy, Poland, Spain and the Netherlands were further subtyped by phage typing, pulsed-field gel electrophoresis and multilocus variable number tandem repeat analysis to investigate the genetic relationship among strains. PCR was performed to identify the fljB flagellar gene and the genes encoding resistance to ampicillin, streptomycin, sulphonamides and tetracyclines. Class 1 and 2 integrase genes were also sought. Results indicate that genetically related serovar 4,[5],12:i:- strains of definitive phage types DT193 and DT120 with ampicillin, streptomycin, sulphonamide and tetracycline resistance encoded by blaTEM, strA-strB, sul2 and tet(B) have emerged in several European countries, with pigs the likely reservoir of infection. Control measures are urgently needed to reduce spread of infection to humans via the food chain and thereby prevent the possible pandemic spread of serovar 4,[5],12:i:- of R-type ASSuT as occurred with S. Typhimurium DT104 during the 1990s.
Case report: Fulminant pneumococcal sepsis in an unvaccinated asplenic patient in Italy
Authors: Chironna M , Sallustio A , De Robertis A , Quarto M , Germinario C
Published: March 2021

We report a fatal case of overwhelming pneumococcal infection in an asplenic young adult not vaccinated against Streptococcus pneumoniae (S. pneumoniae). Post-mortem microbiological investigations revealed the presence of S. pneumoniae in blood samples and lungs. Serotyping by molecular methods identified the presence of a 6C serotype not comprised in the current 23-valent pneumococcal vaccine, highlighting that a risk of fatal infections may persist even in vaccinated splenectomised individuals.
Nationwide outbreak of Salmonella enterica serotype 4,12:i:- infections in France, linked to dried pork sausage, March-May 2010
Authors: Bone A , Noel H , Le Hello S , Pihier N , Danan C , Raguenaud M E , Salah S , Bellali H , Vaillant V , Weill F  X , Jourdan-da Silva N
Published: March 2021

In May 2010, a nationwide excess of infections with the specific monophasic variant Salmonella enterica serotype 4,12:i:- was investigated in France. Subtyping with multilocus variable number of tandem repeats analysis revealed a distinct epidemic strain within this excess. Epidemiological investigations identified a dried pork sausage sold by a particular chain of supermarkets as the likely vehicle of transmission. The suspected batches have been withdrawn and recalled.