bluuebunny/crossref_metadata_2025 huggingface dataset:
Epidemiology of tetanus in Italy in years 1971-2000
Authors: Pedalino B , Cotter B , Ciofi Degli Atti M L , Mandolini D , Parroccini S , Salmaso S
Published: October 2017

The incidence of reported tetanus in Italy decreased from 0.5/100 000 in the 1970s to 0.2/100 000 in the 1990’s. During this period of time, the case-fatality ratio decreased from 68% to 39%. Italy has the highest reported number of tetanus cases in European countries. Elderly women are the most affected: the proportion of women aged over 64 years among cases has increased from 60% in the 1970s to 76% in the 1990s. Vaccination campaigns need to be conducted to target this group, and the surveillance of tetanus has to be improved to identify additional groups of population at risk.
Outbreak of trichinellosis in Cáceres, Spain, December 2001–February 2002
Authors: Cortés-Blanco M , García-Cabañas A , Guerra-Peguero F , Ramos-Aceitero J- M , Herrera-Guibert D , Martinez Navarro J. F.
Published: October 2017

An outbreak of trichinellosis by T. britovi occured in Cáceres, Spain, between 18 December 2001 and 11 February 2002, following the consumption of insufficiently cooked meat from a domestic pig. Among the 56 people exposed, 26 cases of trichinellosis were diagnosed, of which 17 serologically confirmed. The mean incubation period was 23.5 days (3–45). Among the foodstuffs suspected, salami-type sausages were associated with an attack rate of 93.3% (14/15), and a dose-response relationship was observed. Trichinella britovi is essentially a sylvatic species, but this study suggests a change in the epidemiology of trichinellosis.
Quality control assessment of influenza and RSV testing in Europe: 2000-01 season
Authors: Valette M , Aymard M
Published: October 2017

The Quality Control Assessment (QCA) was initiated to evaluate the quality of the influenza and respiratory syncytial virus (RSV) testing in the national reference centres belonging to the European Influenza Surveillance Scheme (EISS) network. Samples were coded and sent in two panels of 12 samples within a two week interval to 16 laboratories during the 2000-01 winter season. The antibodies titration by HI test was reported by 60% of the laboratories (n=16), and the results were correct for 56% of them. One false detection of influenza B antibodies was reported by one laboratory, and for the others the sensitivity varied widely. The sensitivity of the tests for the detection of influenza virus varied for A(H3N2) from 10 to 100 000 TCID50/ml. The influenza A subtyping was performed by 87% of the laboratories, and 31% gave correct results. The characterisation of the variants was undertaken by six laboratories and half of them fully achieved it. Fifty six percent of the laboratories used RT-PCR for the diagnosis; the results were specific and the sensitivity equivalent to the cell culture.
Surveillance of influenza in the North-West Region of England 2001-02
Authors: Regan C M , Sopwith W , Ashton M , Syed Q , Painter M , Mutton K , Paver K
Published: October 2017

A local sentinel network of general practitioners has been established in the north west of England for the surveillance of influenza. In the 2001–02 winter, consultation rates for influenza-like-illness (ILI) were low but the surveillance network was able to demonstrate sub-regional variations in the timing of peak influenza activity, and the infection of different age groups. This suggests the network can contribute to better planning to winter pressures on the North West health service.
An outbreak of Norwalk-like viral gastroenteritis in holidaymakers travelling to Andorra, January–February 2002
Authors: Pedalino B , Feely E , McKeown P , Foley B , Smyth B , Moren A
Published: October 2017

A retrospective cohort study was conducted to investigate an outbreak of Norwalk-like viral gastroenteritidis that occurred in Irish holidaymakers visiting Andorra, in January–February 2002. Preliminary results showed the risk exposure was higher for tourists who stayed in Soldeu and consumed ice cubes in their drinks (OR = 2.5, 95% CI [1.3–4.6)], after logistic regression and adjusting for sex and water consumption).
Investigation of human infections with Salmonella enterica serovar Java in Scotland and possible association with imported poultry
Authors: Brown D  J , Mather H , Browning L  M , Coia J  E
Published: October 2017

PFGE analysis of S. Java strains (29 from humans, 30 from poultry meat) showed two major clusters. All isolates from poultry imported from the Netherlands belonged to Cluster A, which also comprised 10 human isolates. Thirty-one of the 37 isolates in this cluster had an identical JavX1 pattern, similar to the X8 profile of a particular S. Java clone predominant in poultry production in several European countries. Cluster B comprised 19 human isolates and two poultry isolates of unknown origin. These results combined with epidemiological data and information on the origins of poultry meat strongly suggested that imported poultry meat is an important source of Java infections in humans in Scotland.
Investigation of an outbreak of E. coli O157 infections associated with a trip to France of schoolchildren from Somerset, England
Authors: Duffell E , Espié E , Nichols T , Adak G K , de Valk H , Stuart J M
Published: October 2017

A retrospective cohort study was conducted after 2 confirmed and 8 probable cases of VTEC 0157 occurred in a schoolgroup from Somerset following a trip to France. The strain of the 2 confirmed cases was vero-cytotoxin type 2, phage type 34. Despite its low statistical power due to small numbers, this study suggested the most likely vehicle of infection was cucumber salad (crude RR=4.3, 95%CI [0.6-29], adjusted OR=107, 95%CI indeterminate, p=0.08). The cucumbers were purchased from Belgium but it was not possible to trace them back to source. The international nature of this outbreak emphasises the importance of close collaboration between organisations in the management of outbreaks, of ensuring international standards in food safety, and of agreeing a common standard in VTEC typing across Europe.
Harmonisation of national influenza surveillance morbidity data from EISS: a simple index
Authors: Uphoff H , Cohen J  M , Fleming D M , Noone A
Published: October 2017

The European Influenza Surveillance Scheme is a collaboration with 18 member countries (2001/02) which monitors the activity and impact of influenza by collecting morbidity and virological data in primary care facilities throughout the winter season each year. Despite being in principle similar in the surveillance concept, the indicators used and observations made are very different. Different healthcare systems and organisational needs (eg a certificate of illness for the employer) influence the consultation behaviour. Furthermore, and partly as a result of differences in the healthcare systems, the definitions used for the numerator and denominator when calculating morbidity rates are different. Thus comparative interpretation of participating countries' morbidity data is extremely difficult.
Reporting 'harmonisation' by using equivalent numerators and denominators is one option but is difficult to achieve in the short term. Moreover, several additional issues would need to be considered, for example, the need for continuity of surveillance and whether such steps would indeed result in direct comparability etc.
A simple index was tested, through which the impact of influenza morbidity in any one year is compared with what is considered a 'usual' epidemic in that country. The index in principle describes numerically the extent to which the influenza-attributable excess morbidity in the current epidemic in each country is within, exceeds, or is less than a range typical for an influenza epidemic.
In this pilot study, the usefulness of such an index is explored with the example of eight countries for the seasons 1999/2000 and 2000/01. A fine tuning of the methods has not yet been performed.
Brucellosis outbreak due to unpasteurized raw goat cheese in Andalucia (Spain), January - March 2002
Authors: Mendez Martinez C. , Paez Jimenez A , Cortés-Blanco M , Salmoral Chamizo E. , Mohedano Mohedano E. , Plata C. , Varo Baena A. , Martinez Navarro J. F.
Published: October 2017

Eleven brucellosis cases were identified in three municipalities of Cordoba (Andalucia, Spain). A case-control study was conducted, selecting three cases per control. Persons having eaten unpasteurized raw goat cheese produced in a farmhouse located in the epidemic territory, were at higher risk for presenting brucellosis ( OR=21.6, IC95%=1.6-639.8). Brucella melitensis serovar 3 was identified in clinical specimens and in goat tissue and milk samples from the herd's farmhouse. Preventive measures were implemented and the outbreak was stopped after the withdrawal of all suspicious cheeses from the market, additional sanitation of the farmhouse and health promotion activities.
Infectious diseases in Rome during the Millennium Year
Authors: Giorgi Rossi P , Sangalli M. , Faustini A. , Forastiere F , Perucci C. A.
Published: October 2017

During 2000, the millennium year, 26 million people visited Rome. An improved surveillance system for infectious diseases, especially for foodborne disease outbreaks (FBDO), meningitis, and legionnaires' disease was introduced in 1997. This rapid alert network links public health services with the principal sources of diagnosis and laboratory based surveillance. For travel related legionnaires' disease, international surveillance was implemented. Specific control measures for FBDOs were adopted. No increase in the overall incidence of these diseases was observed, and no atypical pathogens in FBDOs or meningitis were isolated in 2000 relating to 1998-99. Cases of legionnaires' disease and FBDOs involving foreign tourists increased (10/4 and 7/2 observed/expected respectively). Three out of six FBDOs involving pilgrims occurred in religious guesthouses. While an increase in cases of legionnaires' disease and FBDOs among foreign tourists was observed by the surveillance system, the millennium year did not influence the epidemiology of infectious diseases in the residential population of Lazio.
Seventh International Meeting of the European Laboratory Working Group on Diphtheria - Vienna, June 2002
Authors: Kelly C , Efstratiou A ,   on behalf of DIPNET: European Diphtheria Surveillance Network and the European Laboratory Working Group on Diphtheria, Respiratory and Systemic Infection Laboratory, Specialist and Reference Microbiology Division, Health Protection Agency, United Kingdom
Published: October 2017

The Seventh International Meeting of the European Laboratory Working Group on Diphtheria (ELWGD) was held in Vienna, Austria in June 2002 and brought together the microbiologists and epidemiologists responsible for diphtheria in many countries throughout the world. The ELWGD was formed in 1993 in response to the epidemics of diphtheria in Russia and the Newly Independent States (NIS) of the former Soviet Union (1,2). These epidemics, and others elsewhere, highlighted the importance of strengthening and maintaining both epidemiological surveillance and reliable laboratory screening. Since December 2001, these areas have been progressed and strengthened by European Commission (EC) funding to undertake a feasibility study for diphtheria surveillance amongst European Union (EU) member states and accession countries, and to establish a definitive and official European diphtheria surveillance network called DIPNET (EC DG SANCO Agreement No. S12.324473 (2001 CVG4-012)). This was the first international meeting of the ELWGD to be organised and funded under the auspice of the DIPNET (European Diphtheria Surveillance Network).
A regional outbreak of S. Enteritidis phage type 5, traced back to the flocks of an egg producer, Austria
Authors: Berghold C , Kornschober C. , Weber S.
Published: October 2017

In the spring and summer of 2002, the Nationale Referenzzentrale für Salmonellen (National Reference Centre for Salmonella - NRCS) in Austria noticed a cluster of human Salmonella enterica subsp. enterica ser. Enteritidis phage type 5 (S. Enteritidis PT5) infections in two neighbouring districts of Austria. Another small outbreak of S. Enteritidis PT5 infections that occurred in the same region in 1999 had been traced back to the flocks of a local egg producer (approximately 6 000 hens). Attention was therefore again directed at this farm. The results of voluntary bacteriological examinations from the farm and further epidemiological investigations identified the same egg producer as the source of the second outbreak. The 70 human isolates of S. Enteritidis PT5 ascertained in 2002 represented a minority of all infections. It is realistic to estimate that several hundred infections occurred in the course of the 2002 outbreak. The farmer had not vaccinated new flocks against Salmonella since August 2001. It is likely that the change in vaccination policy resulted in the reappearance of the S. Enteritidis PT5 infections. By the end of September 2002 the farmer had stopped selling untreated table eggs. In October 2002 only one isolate of S. Enteritidis PT5 was ascertained in the region.
Surveillance of human Campylobacter infections in France - Part 1 - Which data? A study of microbiological laboratories, 2000
Authors: Gallay A , Simon F , Mégraud F.
Published: October 2017

The frequency of Campylobacter infections in humans, their potential severity, and the existence of preventive measures justify the implementation of a surveillance system for these infections. Before the implementation of the surveillance system, a survey of the Campylobacter diagnostic practices in the laboratories was performed. In the laboratories that responded, most investigated for Campylobacter at least once in 1999. Identification of the Campylobacter species was carried out by 86% of hospital laboratories and 37% of private laboratories. Antibiotic sensitivity tests were carried out by 75% and 32% of them respectively.
Many laboratories test for Campylobacter in stool samples using comparable methods showing the feasibility of a surveillance system.
Heterogeneous influenza activity across Europe during the winter of 2002-2003
Authors: Paget W J , Meerhoff T J , Rebelo de Andrade H ,   on behalf of EISS
Published: October 2017

Influenza activity varied across Europe during the 2002-2003 season both in terms of the intensity of clinical activity and the circulating virus types/subtypes. Influenza B was generally predominant in the 'western' parts of Europe (Portugal, Spain, the United Kingdom and Ireland) and influenza A (H3N2) in the 'central' and 'eastern´ areas (Germany, Italy, Denmark, Switzerland, Poland, Slovenia, the Slovak Republic, the Netherlands). A number of countries experienced mixed seasons, first experiencing activity associated with influenza B and then with influenza A (Belgium, France and Spain). Generally, countries where influenza B was predominant had low (compared to historical data) levels of intensity (a mild season) and longer periods of influenza activity compared to countries where influenza A (H3N2) was predominant. A number of countries, all where influenza A (H3N2) was predominant, reported high levels of intensity compared to historical data: the Czech Republic, Denmark, Germany and Poland. In the six countries where age-specific incidence rates were available, the highest rates were observed among those aged 0-14 years. The influenza virus strains circulating in Europe had a good match with the virus strains in the influenza vaccine. A small number of isolates (A/Fujian/411/2002 (H3N2)-like) were reported at the end of the season that had a reduced reactivity to anti-sera of the vaccine strain. The composition of the 2003-2004 influenza vaccine is the same as during the 2002-2003 season.
European Guidelines for Control and Prevention of Travel Associated Legionnaires' Disease: the Italian experience
Authors: Rota M C , Caporali M G , Massari M
Published: October 2017

In Italy, 35 clusters of travel associated Legionnaires' disease were identified from July 2002, when the European Guidelines for Control and Prevention of Travel Associated Legionnaires' Disease have been adopted by the EWGLINET network, to October 2003. Eight per cent (28.6%) would not have been identified without the network.
The clusters detected were small, ranging from 2 cases to a maximum of 6. All clusters involved 5 camping sites and 30 hotels/residences, and an overall of 87 patients. The diagnosis was confirmed in 92.0% of the cases and mainly performed by urinary antigen detection (84.7%). A clinical isolate was available only in one case.
Following environmental investigations, samples were collected for all the 35 clusters from the water system, and Legionella pneumophila was found in 23 occasions (65.7%). In 15 resorts out of 35, investigations were already in progress at the time of EWGLI cluster notification, since in Italy full environmental investigation is performed even after notification of a single case. Control measures were implemented in all accommodation sites at risk and one hotel only was closed.
In all the 35 clusters, reports were completed and sent on time, highlighting that it is possible to comply with the procedures requested by the European Guidelines.
Norovirus foodborne outbreaks associated with the consumption of oysters from the Etang de Thau, France, December 2002
Authors: Doyle A , Barataud D , Gallay A , Thiolet J M , Le Guyaguer S , Kohli E , Vaillant V
Published: October 2017

In January 2003, the Institut de Veille Sanitaire received notification of clusters of gastroenteritis (GE) thought to be associated with consumption of oysters harvested from Etang de Thau in the south of France. At the same time Italy reported an outbreak (200+ cases) associated with oysters from the Etang de Thau. An investigation was carried out to determine the source and vehicle of the outbreaks.
Descriptive analysis of reported clusters in France, microbiological analysis of stool and oyster samples, genotyping of noroviruses and an environmental investigation of the Etang de Thau were carried out. A retrospective cohort study was also undertaken among those attending a number of family meals in Paris.
Thirteen family clusters in four districts of France (69 cases) could be attributed to the consumption of Thau oysters based on descriptive evidence. Oysters distributed at an office in Paris and consumed at fourteen family meals between 19 and 24 December led to a further outbreak. In this outbreak the attack rate was 21/36 (58%) for Thau oyster consumers and 0/22 for non-consumers (p=0.00002). Noroviruses (genogroups I and II) were found in stool samples from four clusters and oysters from three clusters (including Paris). Environmental investigations revealed heavy rainfall, an overflow of a water purification station and faecal contamination of the Etang de Thau in December.
Oysters from the Etang de Thau were responsible for a number of clusters of norovirus GE in winter 2002 in France and also in Italy. High Escherichia Coli levels in Thau water and shellfish led to an official request, mid-December, for oyster purification before distribution. This was not possible, due to lack of purification facilities. This investigation has contributed to a change in the way that shellfish harvesting areas are classified in France.
Epidemiology of rubella and congenital rubella syndrome in Greece, 1994-2003
Authors: Panagiotopoulos T , Georgakopoulou T
Published: October 2017

In 1993, there was a large epidemic of rubella and congenital rubella syndrome (CRS) in Greece. The epidemiology of rubella and CRS after 1993 is described in this paper using information from surveillance data and published studies and reports. The incidence of rubella fell sharply after 1993, but a smaller outbreak occurred in 1999, mainly in young adults, and four CRS cases (4.0 per 100 000 live births) were recorded. A very high proportion of the child population in Greece are currently vaccinated for rubella, while teenagers are inadequately covered (60-80% in different studies). A substantial proportion of women of childbearing age are susceptible to rubella (10-20% in urban areas). This could lead to local or more extended outbreaks. This situation shows that a comprehensive preventive policy should be implemented.
Current situation of human diphyllobothriasis in Europe
Authors: Dupouy-Camet J , Peduzzi R
Published: October 2017

Diphyllobothriasis, a parasitosis caused by the flatworm Diphyllobothrium latum, is contracted by consuming raw or undercooked freshwater fish. The aim of this study was to evaluate the situation of this parasitosis during the past 20 years in Europe through the analysis of databases and search engines (Medline, Cabi Helminthological abstracts,Yahoo, Google), and through a questionnaire sent to a network of European parasitologists and to microbiological laboratories located on the shores of the large Alpine lakes. This study has shown that several dozen cases have been reported each year in Finland and Sweden, that there have been numerous cases in the French or Italian speaking areas of subalpine lakes, and that sporadic cases only have been observed in Austria, Spain, Greece, Romania, Poland and Norway. Over 30 cases have been identified on the Swiss shores of Lake Maggiore since 1990, and 70 cases on the Swiss and French shores of Lake Léman between 1993 and 2002. Eight to 12% of perch fillets from Lake Leman and 7.8 % of perch from Lake Maggiore were infested with larvae. Contamination sources include marinated fish fillets in northern Europe, 'carpaccio di persico' in northern Italy, and perch and charr consumed raw or undercooked around Lake Léman. Factors allowing the continuation of the parasitic cycle include the continued dumping of wastewater into lakes, yachtsmen who also fish, and a possible animal reservoir.
Interruption of measles transmission in Gipuzkoa (Basque Country), Spain
Authors: Cilla G , Basterretxea M , Artieda J , Vicente D , Pérez-Trallero E
Published: October 2017

Measles vaccine was introduced in Gipuzkoa (Basque country, Spain) in 1978 and was replaced by the measles, mumps, and rubella (MMR) vaccine for children aged 12-15 months in 1981. A second dose of the MMR vaccine was introduced in 1992. Both doses of the MMR vaccine were well accepted by the population and high coverage was achieved (95% and 91% for the first and second doses respectively for the period 1993-2002). Measles virus circulation was interrupted in the second half of the 1990s: no cases of indigenous measles were notified between 1998 and 2003, and only imported cases have been confirmed during this period. These data indicate that the measles vaccination programme implemented has been effective. Nevertheless, to avoid measles outbreaks following viral introduction, high MMR vaccine coverage levels for the two doses have to be maintained (>95%).
Towards a standard HIV post exposure prophylaxis for healthcare workers in Europe
Authors: Puro V , Cicalini S , De Carli G , Soldani F , Ippolito G ,   on behalf of the European Occupational Post-Exposure Prophylaxis Study Group
Published: October 2017

Antiretroviral prophylaxis (PEP) after occupational exposure to HIV in healthcare workers (HCWs) is used across Europe, but not in a consistent manner. A panel of experts, funded by the European Commission, formulated a set of recommendations.
When it has been decided that the characteristics of the exposure indicate the initiation of PEP, PEP should be started as soon as possible; initiation is discouraged after 72 hours. PEP should be initiated routinely with any triple combination of antiretrovirals approved for the treatment of HIV-infected patients; a two class regimen is to be preferred. The source patient's treatment history should be sought. Counselling, psychological support, HIV testing and clinical evaluation should be performed at baseline, at 6-8 weeks, and at least 6 months post exposure. Additional clinical and laboratory monitoring at one and two weeks should be considered, as adherence with and tolerance of the regimen can highlight adverse reactions and potential toxicity. Routine HIV resistance tests in the source patient, and direct virus assays in the exposed HCW are not recommended.
A large increase of Salmonella infections in 2003 in the Netherlands: hot summer or side effect of the avian influenza outbreak?
Authors: van Pelt W , Mevius D. J , Stoelhorst H G , Kovats S , van de Giessen A. W , Wannet W J B , Duynhoven Y T H P
Published: October 2017

In June 2003, the Dutch national Salmonella centre reported a significant excess isolation rate of Salmonella Enteritidis when compared with earlier years in most regional public health laboratories. By the end of 2003, this amounted to an extra 540 laboratory confirmed cases for the whole of the Netherlands, which implies an estimated 7500 extra cases of gastroenteritis caused by S. Enteritidis in the general population, an increase of 50% on previous years. The hot summer could not explain the findings. Strong evidence has been found to suggest that the increase in importation of salmonella contaminated eggs, as a side effect of a concurrent avian influenza outbreak, was the most probable reason for this excess.
Occurrence of Salmonella Enteritidis phage type 29 in Austria : an opportunity to assess the relevance of chicken meat as source of human salmonella infections
Authors: Berghold C , Kornschober C. , Lederer I , Allerberger F
Published: October 2017

Assuming that the various phage types of Salmonella Enteritidis (S. Enteritidis) are largely equally virulent, the importance of certain foods as sources of infection for human salmonellosis can be deduced from differences in the distribution of phage types in human and non-human samples. In 2002, S. Enteritidis phage type 29 (PT29) was first isolated from non-human test samples in Austria. S. Enteritidis PT29 accounted for 44 (27.7%) of 159 S. Enteritidis strains, derived from veterinary samples of chicken (e.g. meat, giblets) or chicken habitations (e.g. swabs from the coop and excrement). At the food retail level (chicken meat, chicken liver), five (13.1%) of 38 S. Enteritidis isolates were PT29. The proportion of S. Enteritidis PT29 in human samples was much lower. Only 0.4% (30 human primary isolates) of all S. Enteritidis isolates in the year 2002, and 0.33% (23 human primary isolates) of all human S. Enteritidis strains in 2003 were PT29. In our opinion, the discrepancy between the high prevalence of S. Enteritidis PT29 in broilers and chicken meat and the low number of PT29 cases in humans indicates that chicken meat of Austrian origin is currently only a minor source of human S. Enteritidis infections.
International trends in salmonella serotypes 1998-2003 - a surveillance report from the Enter-net international surveillance network
Authors: Fisher I. S.T.
Published: October 2017

One of the objectives of any surveillance activity is to monitor trends in infections. The international surveillance network for human enteric infections, Enter-net, has been collecting and reporting data on laboratory-confirmed human salmonella infections since 1993. The number of cases identified rose in the mid-1990s, with the peak being in 1997. This paper describes the subsequent decline in salmonella serotypes being reported by the national reference laboratories participating in the Enter-net surveillance network between 1998-2003. The total number of human cases of salmonellosis reported by the Enter-net participating countries has fallen from 220 698 to 142 891 during this period. Even at these reported levels salmonellosis remains a major cause of morbidity in humans.
Syphilis surveillance and epidemiology in the United Kingdom
Authors: Righarts A A , Simms I , Wallace L , Solomou M , Fenton K. A.
Published: October 2017

The aim of this article is to describe trends in infectious syphilis in the UK, and specifically the epidemiology of the London syphilis outbreak, the largest in the UK to date. Analysis of routine surveillance data from genitourinary medicine (GUM) clinics was performed as well as data collection through enhanced surveillance systems. There have been substantial increases in diagnoses of infectious syphilis between 1998 and 2003, with a 25-fold increase seen in men who have sex with men (MSM) (from 43 to 1028 diagnoses); 6-fold (138 to 860) in heterosexual men and 3-fold (112 to 338) in women. The national rise in syphilis was driven by a series of local outbreaks, the first of which occurred in 1997. To date, 1910 cases have been reported in the London outbreak, first detected in April 2001. High rates of HIV co-infection were seen among MSM, with MSM likely to be of white ethnicity and born in the UK. In contrast, heterosexuals were more likely to be of black ethnicity and born outside the UK. Most syphilis infections were acquired in London. MSM bear the brunt of the national resurgence in infectious syphilis. Substantial rises in male heterosexual cases has resulted in a divergence between male heterosexual and female cases, which now requires further investigation.
Bichat guidelines for the clinical management of anthrax and bioterrorism-related anthrax
Authors: Bossi P , Tegnell A , Baka A , van Loock F , Hendriks J , Werner A , Maidhof H , Gouvras G
Published: October 2017

The spore-forming Bacillus anthracis must be considered as one of the most serious potential biological weapons. The recent cases of anthrax caused by a deliberate release reported in 2001 in the United States point to the necessity of early recognition of this disease. Infection in humans most often involves the skin, and more rarely the lungs and the gastrointestinal tract. Inhalational anthrax is of particular interest for possible deliberate release: it is a life-threatening disease and early diagnosis and treatment can significantly decrease the mortality rate. Treatment consists of massive doses of antibiotics and supportive care. Isolation is not necessary. Antibiotics such as ciprofloxacin are recommended for post-exposure prophylaxis during 60 days.
Bichat guidelines for the clinical management of smallpox and bioterrorism-related smallpox
Authors: Bossi P , Tegnell A , Baka A , van Loock F , Werner A , Hendriks J , Maidhof H , Gouvras G
Published: October 2017

Smallpox is a viral infection caused by the variola virus. It was declared eradicated worldwide by the Word Health Organization in 1980 following a smallpox eradication campaign. Smallpox is seen as one of the viruses most likely to be used as a biological weapon. The variola virus exists legitimately in only two laboratories in the world. Any new case of smallpox would have to be the result of human accidental or deliberate release. The aerosol infectivity, high mortality, and stability of the variola virus make it a potential and dangerous threat in biological warfare. Early detection and diagnosis are important to limit the spread of the disease. Patients with smallpox must be isolated and managed, if possible, in a negative-pressure room until death or until all scabs have been shed. There is no established antiviral treatment for smallpox. The most effective prevention is vaccination before exposure.
Bichat guidelines for the clinical management of glanders and melioidosis and bioterrorism-related glanders and melioidosis
Authors: Bossi P , Tegnell A , Baka A , van Loock F , Hendriks J , Werner A , Maidhof H , Gouvras G
Published: October 2017

Glanders and melioidosis are two infectious diseases that are caused by Burkholderia mallei and Burkholderia pseudomallei respectively. Infection may be acquired through direct skin contact with contaminated soil or water. Ingestion of such contaminated water or dust is another way of contamination. Glanders and melioidosis have both been studied for weaponisation in several countries in the past. They produce similar clinical syndromes. The symptoms depend upon the route of infection but one form of the disease may progress to another, or the disease might run a chronic relapsing course. Four clinical forms are generally described: localised infection, pulmonary infection, septicaemia and chronic suppurative infections of the skin. All treatment recommendations should be adapted according to the susceptibility reports from any isolates obtained. Post-exposure prophylaxis with trimethoprim-sulfamethoxazole is recommended in case of a biological attack. There is no vaccine available for humans.
Measles outbreak in the Provence - Alpes - Côte d’Azur region, France, January - July 2003
Authors: Six C , Franke F , Mantey K , Zandotti C , Freymuth F , Wild F , Parent du Châtelet I , Malfait P
Published: October 2017

At the end of May 2003, the Marseilles Hospital Centre’s virology laboratory informed the French public heath institute of 5 cases of confirmed measles among young adults living in Marseilles. An investigation was conducted, consulting different community and hospital health services, to determine the virus circulation in the Provence-Alpes-Côte d’Azur (PACA) region by the southern interregional epidemiological cell. The investigation identified 259 cases: 183 clinical, 74 serologically confirmed and 2 epidemiologically linked cases. The first cases were identified during the first six months of 2003, with a peak in April. This outbreak of measles in the PACA region was favoured by poor vaccination coverage, which created groups of susceptible population. The real number of cases was probably higher than the number identified. This investigation has outlined the limitations of the measles surveillance system in France: the sentinel network had not detected any case for this period. France needs to reach the WHO objective of measles elimination by 2010 and the surveillance tools used must be those already used in the most countries that are furthest advanced in the elimination process. To reach this goal, the Direction Générale de la Santé has nominated a working group to be in charge of proposing a national plan to interrupt indigenous measles transmission in France.
Impact of nucleic acid amplification technology (NAT) in Italy in the three years following implementation (2001-2003)
Authors: Velati C , Fomiatti L , Baruffi L , Romanò L , Zanetti A ,   for the Gruppo Italiano per lo Studio delle Malattie Trasmissibili con la Trasfusione
Published: October 2017

The use of NAT technology to screen blood donations in Italy became mandatory on 28 June 2002, but had been available experimentally since 2001. During the transition period, an EIA test to detect hepatitis C core antigen (HCVcoreAg) had also been permitted. Considering the large number of blood transfusion centres in Italy, an initial reorganisation of the biological validation of blood units was necessary, with a partial centralisation of NAT testing. The Gruppo Italiano per lo Studio delle Malattie Trasmissibili con la Trasfusione (Italian Group for the Study of Transfusion-Transmissible Diseases) conducted a national survey evaluating NAT testing, based on an annual collection of data through a questionnaire sent to all centres. In the first three years of the investigation, 219 blood transfusion centres returned the questionnaires.
In the period between January 2001 and December 2003, 3 894 894 blood donations were investigated for HCV RNA and 2 186 468 for HIV RNA. Of these, 12 were found to be HCV RNA positive and four HIV RNA positive, with an observed NAT versus antibody-based assay yield of 3.1/106 donations for HCV and 1.8/106 donations for HIV, respectively. Five of the 12 HCV RNA positive and anti-HCV negative donors had abnormal ALT values and their donations would have been discarded even in absence of NAT testing. Thus the final NAT yield for HCV is 1.79/106. The residual risk for HCV or HIV transmission by blood transfusion after NAT implementation is currently estimated to be extremely low in Italy.
Incidence of viral markers and evaluation of the estimated risk in the Swiss blood donor population from 1996 to 2003
Authors: Niederhauser C , Schneider P , Fopp M , Ruefer A , Lévy G
Published: October 2017

Among the well known transfusion-associated risks, the transmission of pathogenic viruses is regarded as one of the most serious. Over the past two decades, a series of overlapping safety procedures have been successively implemented to minimise this risk. It is now generally considered that the risk of transmitting viral infections via blood products is very low in developed countries.
The present study analyses the incidence of the key infectious diseases HIV, hepatitis B virus (HBV) and hepatitis C virus (HCV) between 1996 and 2003 from 99% of voluntary repeat blood donors visiting the blood transfusion service of the Swiss Red Cross. Furthermore the estimated risk of these viral markers was calculated. From 1996 to 2003 the incidence rate for HCV decreased continuously, whereas no significant decrease in the incidence rate of HIV and HBV was observed. From 2001 to 2003, the last calculated period, the residual risk was estimated to be 1 in 1 900 000 for HIV, 1 in 2 200 0000 for HCV and 1 in 115 000 for HBV, respectively. This agrees with international studies, which have been shown that the estimated residual risk for HBV between 1996 and 2003 is higher than that of HCV and HIV.
Trends in risk of transfusion-transmitted viral infections (HIV, HCV, HBV) in France between 1992 and 2003 and impact of nucleic acid testing (NAT)
Authors: Pillonel J , Laperche S ,   l’Etablissement Français du sang
Published: October 2017

Monitoring trends in residual risk of transfusion-transmitted viral infections is important to assess improvements in blood safety and to adapt the risk reduction policies. These trends were analysed in France over 4 periods of 3 years (1992-1994, 1995-1997, 1998-2000 and 2001-2003). The 2001-2003 estimates were compared to the results of HIV-1 and HCV NAT implemented on all blood donations in July 2001.
Due to improvements in donor recruitment and selection, continuing progress in screening assays, and preventive measures taken in the community to control infections, a significant decrease was observed in residual risks for HIV, HCV and HBV between 1992 and 2003. The residual risk is currently extremely low: for the 2001-2003 period, this risk was estimated at 1 in 3.15 million donations for HIV, at 1 in 10 million for HCV and at 1 in 640 000 for HBV. Of the 6.14 million donations screened with NAT between July 2001 and December 2003 in France, 2 HIV-positive and 3 HCV-positive donations were discarded thanks to NAT, representing a yield of 1 in 3.07 million for HIV and 1 in 2.05 million for HCV. These results show the limited benefit of NAT and suggest that its cost-effectiveness is poor.
Hospital preparedness and management of patients affected by viral haemorrhagic fever or smallpox at the Lazzaro Spallanzani Institute, Italy
Authors: Ippolito G , Nicastri E , Capobianchi M R , Di Caro A , Petrosillo N , Puro V
Published: October 2017

The US cases of anthrax in 2001 and the recent severe acute respiratory syndrome outbreak have heightened the need for preparedness and response to naturally emerging and re-emerging infections or deliberately released biological agents.
This report describes the response model of the Istituto Nazionale per le Malattie Infettive Lazzaro Spallanzani (INMI), Rome, Italy for managing patients suspected of or affected by smallpox or viral haemorrhagic fever (VHF) either in the context of an intentional release or natural occurrence.
The INMI is Italy’s leading hospital in its preparedness and response plan to bioterrorism-related infectious agents. All single and double rooms of INMI are equipped with negative air pressure, sealed doors, high efficiency particulate air (HEPA) filters and a fully-equipped anteroom; moreover, a dedicated high isolation unit with a laboratory next door for the initial diagnostic assays is available for admission of sporadic patients requiring high isolation. For patient transportation, two fully equipped ambulances and two stretcher isolators with a negative pressure section are available. Biomolecular and traditional diagnostic assays are currently performed in the biosafety level 3/4 (BSL 3/4) laboratories.
Continuing education and training of hospital staff, consistent application of infection control practices, and availability of adequate personnel protective equipment are additional resources implemented for the care of highly infectious patients and to maintain the readiness of an appropriately trained workforce to handle large scale outbreaks.
Suspected SARS patients hospitalised in French isolation units during the early SARS epidemic: The French experience
Authors: Issartel B , Lesens O , Chidiac C , Mouton Y , Christmann D , Peyramond D ,   members of the French SARS study group
Published: October 2017

During the SARS epidemic, many patients were screened according to WHO criteria but never went on to develop SARS. In May 2003, early in the epidemic, we conducted a retrospective study to describe suspected SARS patients hospitalised in France and compared them with documented cases of patients with SARS to evaluate the screening strategy. A total of 117 patients were studied. Only 3.4% had been in close contact with a SARS patient but 73.5% came from an affected area. 67.5% had fever and respiratory symptoms on their admission to hospital. 49.6% had fever and non specific symptoms. Clinical symptoms that were significantly more common among patients with SARS were fever, myalgia, dyspnoea, and nausea or vomiting. Presumed viral fever and respiratory tract infection were the most common diagnosis. Symptoms cannot be distinguished from an early stage of SARS confirming the usefulness of the WHO case definitions in isolation decision to avoid further transmission.
Survey of the contamination of foodstuffs of animal origin by Shiga toxin producing Escherichia coli serotype O157:H7 in Belgium from 1999 to 2003
Authors: Chahed A , Ghafir Y , China B , Dierick K , De Zutter L , Piérard D , Daube G
Published: October 2017

A survey of the prevalence of Shiga toxin-producing Escherichia coli (STEC) of O157 serotype in foodstuffs of animal origin (beef, veal, pork, chicken, fish) from 1999 to 2003 in Belgium was performed. STEC strains were only isolated from beef with a prevalence of 0.73%. This percentage is low in comparison with the prevalence in other countries. Among the 76 isolated STEC O157 strains, 75% belonged to the serotype O157:H7 and 25% to the serotype O157 non H7. Moreover, the most frequent pathotype was eae stx2 ehxA (74%).
Sexual practices and transmission of HAV and HCV
Authors: Bouvet E
Published: October 2017

In the current issue of Eurosurveillance, two articles report outbreaks of hepatitis A (Copenhagen) and hepatitis C (Paris) in the male gay community, and it seems likely that specific sexual practices of this community may have been the mode of transmission.
For decades, it has been accepted that the hepatitis A virus (HAV) is transmitted through direct contact from person to person either through the oro-faecal route or by contaminated food that is unprepared or contaminated during preparation, whereas the hepatitis C virus (HCV) is transmitted through a parenteral mode (through blood and its components). As far as hepatitis A is concerned, several outbreaks have already been reported in gay men, leading to recommendations for vaccination against hepatitis A by the health authorities in several countries.
The incidence of S. aureus bacteraemia in acute hospitals of the Mid-Western Area, Ireland, 2002-2004
Authors: Whyte D , Monahan R , Boyle L , Slevin B , FitzGerald R , Barron D , De Freitas J , Kelleher K
Published: October 2017

Concerns about healthcare-associated infections and the global crisis in antimicrobial resistance has combined to accentuate the fears around so-called "superbugs". In Ireland there is no single agreed indicator regarded as a true measure of the level of methicillin resistant Staphylococcus aureus (MRSA) in hospitals. The objective of this study was to compare two crude measures of MRSA - the percentage of bacteraemia caused by MRSA and the incidence rate (per 1000 bed days used) of MRSA bacteraemia in six acute hospitals. We examined all blood cultures positive for S. aureus (methicillin sensitive and resistant) from 2002 to 2004 in the Health Service Executive (HSE) Mid-Western Area of Ireland. Hospital In-Patient Enquiry (HIPE) data was used to determine monthly in-patient bed days used. Of 245 patient episodes of bacteraemia, 119 were MRSA. The trends in the percentage of isolates that were MRSA and the incidence rate calculated were compared. The incidence rate appears to be a more reliable and robust indicator of MRSA in hospitals than the percentage. Despite many difficulties in interpreting indicators of MRSA they should not preclude the regular publication of data at least at regional level in Ireland.
A strategy to increase and assess vaccine coverage in the north of Portugal
Authors: Gonçalves G , Frutuoso M A , Ferreira M C , Freitas M G
Published: October 2017

In the Northern Health Region of Portugal, vaccine coverage is measured by checking and studying individual vaccination records in health centres. Each year from 2001-2004, birth cohorts completing 2, 6 and 14 years of age were selected for assessment. Data collection occurred on January the following year and meetings with district immunisation coordinators took place every March. For all vaccines and birth cohorts considered, vaccine coverage values observed in the north of Portugal were excellent. In this paper, we make comparisons with published international data on vaccine coverage and discuss validity issues; we believe that no serious biases have affected the validity of our vaccine coverage data but comparisons with international data must be addressed with caution; the methods we used have been useful in increasing vaccination coverage.
Outbreaks caused by parvovirus B19 in three Portuguese schools
Authors: Gonçalves G , Correia A M , Palminha P , Rebelo de Andrade H , Alves A
Published: October 2017

This paper reports the study of outbreaks of an acute exanthematous disease among children of three schools in the municipality of Braga (Portugal). Laboratory tests were performed for five cases, showing that the disease was not due to infection by measles or rubella virus, and infection with parvovirus B19 was confirmed. There were 41 cases in children: 12 in the kindergarten, 17 in the secondary school and 12 in the primary school. There was only one case in a staff member, who worked in the kindergarten. Eight cases were identified among household contacts; two of them were brothers, one from the kindergarten and another from the secondary school, where the outbreak occurred after the kindergarten outbreak. The estimated values of the basic reproduction number R0 were very low and it is very likely that asymptomatic infectious cases have occurred. The local health authority produced written documents and met with staff members and parents. Primary healthcare facilities and the obstetric department of the local hospital were also informed. As we are approaching the elimination of measles in Portugal and the rest of Europe, with very high vaccine coverage, it is very likely that a high proportion of infectious non-vesicular exanthemas will be due to B19 infections. This is to be taken into account in the design and conduct of surveillance activities, in the context of measles and rubella elimination programmes.