bluuebunny/crossref_metadata_2025 huggingface dataset:
Public health concerns in bat rabies across Europe
Authors: Stantic-Pavlinic Mirjana
Published: October 2017

Rabies due to two independent and different genotypes of lyssaviruses - European bat lyssaviruses (EBLV) type 1 and type 2 - is present in many European countries. Infection is usually seen in bats, the primary reservoirs of the viruses but a few spillover infections have been seen in three other species: stone martens, sheep and humans. Spillover infections (with the exception of the two human cases) were EBLV-1 only. No EBLV-2 spillover cases have been reported in terrestrial animals.
The disease is fatal in humans and has been described in Europe following a bat bite. We have studied in the available literature EBLV rabies cases across Europe in bats and humans, and have also carried out an analysis of recommendations for rabies prevention and treatments in humans. Rabies pre-exposure vaccination and post-exposure treatment is recommended for occupationally exposed persons. Some European countries have already adopted recommendations through specific protocols. Treatment of international travellers after bat bites is also recommended. The promoting of research programmes on bat rabies in Europe is underway. Bats are listed as protected species across Europe.
A human case of travel-related rabies in Austria, September 2004
Authors: Strauss R , Gränz A , Wassermann-Neuhold M , Krause R , Bago Z , Revilla-Fernández S , Simón-Soria F , Echevarria J E , Popow-Kraupp T , Allerberger F , Schönbauer M , Hrabcik H
Published: October 2017

A young male Austrian tourist, aged 23 years and unvaccinated against rabies, was bitten by a dog in Morocco in July 2004. One month later he was hospitalised in Ceuta with symptoms compatible with rabies. He died on 23 September in an Austrian hospital after a diagnosis of rabies was confirmed by FAT, IHC and RT-PCR (including sequencing) of the neck skin and the RT-PCR (including sequencing) of the pharyngeal swab. This Austrian case of laboratory confirmed rabies highlights the urgent need for reinforcement of the international recommendations for travel vaccinations.
Fox rabies in Germany – an update
Authors: Müller T , Selhorst T , Pötzsch C
Published: October 2017

In comparison with conventional methods of wildlife rabies control, oral rabies vaccination of foxes (ORV) is without doubt the most (cost-) effective method in wildlife rabies control. As a result of ORV, several European countries have become rabies-free. Although rabies had been eliminated from much of Germany, there still exists a residual rabies focus in the border triangle of Hesse, Baden-Württemberg and Rhineland Palatinate. Corrective actions have been initiated to eliminate this last remaining rabies hotspot in Germany.
Community-acquired methicillin-resistant Staphylococcus aureus in Switzerland : first surveillance report
Authors: Aramburu C , Harbarth S , Liassine N , Girard M , Gervaix A , Scherenzel J , Renzi G , Sudre P
Published: October 2017

Methicillin resistant Staphylococcus Aureus (MRSA) infection is an emerging community pathogen. Community-acquired MRSA (CA-MRSA) has been associated with virulent strains producing Panton-Valentine leukocidin (PVL) and a variety of other exotoxins. In Geneva, PVL-producing CA-MRSA was first reported in 2002 and a surveillance system based on voluntary reporting was set up.
Meat inspection for Trichinella in pork, horsemeat and game within the EU: available technology and its present implementation
Authors: Webster P , Maddox-Hyttel C , Nöckler K , Malakauskas A , van der Giessen J , Pozio E , Boireau P , Kapel C M O
Published: October 2017

A new EU directive relating to meat inspection for Trichinella, expected to come into force in 2006, imposes important modifications to current legislation. Nevertheless, several issues need more attention. Optimisation of methods, especially concerning sensitivity and digestibility of the meat to be inspected, along with further simplification of the legislation with regard to the number of techniques accepted, is recommended to guarantee that all member states of the EU will be given tools to perform inspection of consumer meat at the same high level. Additionally, there is a need for guidelines and protocols regarding optimal proficiency testing procedures.
First general outbreak of Verocytotoxin-producing Escherichia coli O157 in Denmark
Authors: Jensen C , Ethelberg S , Gervelmeyer A , Nielsen E M , Olsen K EP , Mølbak K ,   the outbreak investigation team
Published: October 2017

This report describes the first general outbreak of verocytotoxin-producing E. coli (VTEC) in Denmark. Twenty five patients, 18 children and seven adults, with culture-confirmed VTEC O157:H- infection and indistinguishable pulsed-field gel electrophoresis DNA profiles, were identified during a six month period from September 2003 to March 2004. The outbreak strain possessed the virulence genes: eae, vtx1 and vtx2c. All patients but one presented with diarrhoea; none developed haemolytic uraemic syndrome. The outbreak was restricted to Copenhagen and surrounding areas. A case-control study including 11 cases and 55 matched controls revealed an association between VTEC O157:H- infection and shopping in a specific supermarket chain in Copenhagen and surrounding area, matched odds ratio (OR): 8.7 (95% confidence interval (CI): 1.1-71). After exclusion of three assumed secondary cases, only consumption of a particular kind of organic milk from a small dairy was associated with disease OR: 8.7 (95% CI 1.6-48). Environmental and microbiological investigations at the suspected dairy did not confirm the presence of the outbreak strain, but the outbreak stopped once the dairy was closed and thoroughly cleaned.
Surveillance of antimicrobial resistance of invasive pathogens: the Estonian experience
Authors: Loivukene K , Kermes K , Sepp E , Adamson V , Mitt P , Kallandi Ü , Otter K , Naaber P ,   on behalf of the European Antimicrobial Resistance Surveillance System, Estonian Study Group
Published: October 2017

The aim of the present study was to evaluate the needs for surveillance of invasive Gram-negative pathogens in Estonia. The antimicrobial susceptibility data of invasive isolates of Acinetobacter baumannii, Pseudomonas aeruginosa, Klebsiella spp, Escherichia coli, Staphylococcus aureus, Streptococcus pneumoniae and enterococci were collected in accordance with EARSS (European Antimicrobial Resistance Surveillance System) protocols. Despite the higher rate of Gram positive pathogens, their resistance to antimicrobials was low in contrast to the elevated resistance established for Gram negative pathogens. The higher resistance to antimicrobials was particularly associated with A. baumannii and P. aeruginosa. Also, the proportion of extended spectrum betalactamase (ESBL)-producing strains was 23% among Klebsiella spp. and 3.6% among E. coli. The inclusion of invasive Gram negative pathogens in antimicrobial resistance surveillance provides useful information concerning local pathogen susceptibility, as well as for the empirical treatment of suspected infections.
Prospects for the BCG vaccination programme in France
Authors: Lévy-Bruhl D
Published: October 2017

Until recently, the French BCG vaccination programme consisted of a mandatory BCG vaccination before children started at daycare centres, and of re-vaccination of tuberculin-negative children. A re-assessment of this programme has been undertaken in recent years. It has led to the discontinuation of all revaccinations and post-vaccination tuberculin tests except those post-vaccination tuberculin tests performed as part of a diagnosis of tuberculosis infection or disease or of the follow-up of health or social workers for whom BCG vaccination remains mandatory. Based on an estimate of the epidemiological impact of either selective vaccination of high risk children or discontinuation of BCG vaccination, and taking into account the risk-benefit balance that can be made of the two options, the Conseil Supérieur d’Hygiène Publique de France (CSHPF, national high council of public hygiene) has recommended a change to selective vaccination. However, the committee has proposed the strengthening of other control measures aimed at decreasing the risk of infection for children, as a pre-requisite to the implementation of this strategy. This position is made more complex by the withdrawal of the multipuncture technique in early 2006, previously used in France in more than 90% of BCG primary vaccinations.
BCG in Finland: changing from a universal to a selected programme
Authors: Salo E PI
Published: October 2017

In Finland, all newborns are currently offered BCG vaccination, and the national coverage is over 98%. The annual incidence of tuberculosis is low, at 6.6/100 000 in 2004 and has been steadily declining in recent years. Finland differs from the other Nordic countries in that the majority of cases are detected in people aged 65 and over in the indigenous population, and only a smaller proportion (12%) detected in immigrants. The high incidence of TB and MDR TB in neighbouring countries has raised concern, but no increase in TB detected in Finnish-born citizens has been seen. A decision has been made to change from mass BCG vaccination to targeting risk groups.
SurvNet@RKI – a multistate electronic reporting system for communicable diseases
Authors: Faensen D , Claus H , Benzler J , Ammon A , Pfoch T , Breuer T , Krause G
Published: October 2017

In 2001 Germany implemented a new electronic reporting system for surveillance of notifiable infectious diseases (SurvNet@RKI). The system is currently being used in all 431 local health departments (LHD), the 16 state health departments (SHD) and the Robert Koch-Institut (RKI), the national agency for infectious disease epidemiology. The SurvNet@RKI software is written in MS Access 97 and Visual Basic and it supports MS Access as well as MS SQL Server database management systems as a back-end. The database is designed as a distributed, dynamic database for 73 reporting categories with more than 600 fields and about 7000 predefined entry values. An integrated version management system documents deletion, undeletion, completion and correction of cases at any time and entry level and allows reproduction of previously conducted queries. Integrated algorithms and help functions support data quality and the application of case definitions. RKI makes the system available to all LHDs and SHDs free of charge. RKI receives an average of 300 000 case reports and 6240 outbreak reports per year through this system. A public web-based query interface, SurvStat@RKI, assures extensive and timely publication of the data. During the 5 years that SurvNet@RKI has been running in all LHDs and SHDs in Germany it has coped well with a complex federal structure which makes this system particularly attractive to multinational surveillance networks. The system is currently being migrated to Microsoft C#/.NET and transport formats in XML. Based on our experiences, we provide recommendations for the design and implementation of national or international electronic surveillance systems.
Two outbreaks of measles in Germany 2005
Authors: Siedler A , Tischer A , Mankertz A , Santibanez S
Published: October 2017

Measles re-emerged in some counties in Germany in 2005, despite increasing vaccination coverage rates in children at school entry in recent years, which had led to decreasing incidence (with the lowest incidence ever recorded, 0.2 cases per 100 000 inhabitants in 2004).
Regional outbreaks have been detected by the mandatory reporting system in the states of Hesse and Bavaria. Although both outbreaks led to similar incidences in the affected areas (14 and 12 cases respectively per 100 000 inhabitants) they differed in age distribution, transmission patterns and measles virus genotype.
In Hesse, 223 cases were submitted, from which 160 belonged to 41 clusters mainly defined by family or household contacts. Attack rate was highest in children aged between 1-4 years (102 cases per 100 000). Results of measles virus diagnosis showed genotype D4 and identical nucleotide sequences for all analysed cases from Hesse.
In Bavaria, 279 cases were submitted, most of which had occurred in schools and preschool facilities. Age-specific attack rate was highest in children aged between 5-9 years (129 per 100 000). Laboratory diagnosed viruses were identified as genotype D6 and were identical at the nucleotide level.
In both outbreaks the vast majority of cases (95% in Hesse and 98% in Bavaria) were in unvaccinated children, but vaccination coverage differed in the affected areas and was slightly lower in Bavaria than in Hesse. Local accumulation of unvaccinated children and their concentration in schools and kindergarten preceded the outbreak in Bavaria.
Despite high average vaccination coverage levels, local variations may lead to regionally limited outbreaks.
Travel-associated legionnaires’ disease in Europe: 2004
Authors: Ricketts K D , McNaught B , Joseph C A
Published: October 2017

Six hundred and fifty five cases of travel-associated legionnaires’ disease with onset in 2004 have been reported to the EWGLINET surveillance scheme by 25 countries. A total of 84.9% of cases were diagnosed by the urinary antigen test, and 37 cultures were obtained. Thirty seven deaths were reported, giving a case fatality rate of 5.6%.
Eighty six new clusters were detected, 45% of which would not have been detected without the EWGLINET scheme. Ninety four accommodation sites were investigated and the names of four sites were published on the EWGLI website. Fifteen sites were associated with additional cases after a report was received to say that investigations and control measures had been satisfactorily carried out.
Further improvements could be made in the data collected on deaths due to travel-associated legionnaires’ disease, and on the number of samples taken for culture throughout Europe.
Current trends in HIV/ AIDS epidemiology in Poland, 1999 – 2004
Authors: Rosinska M
Published: October 2017

The first HIV/ AIDS cases in Poland were diagnosed in the mid-1980, and the outbreak in injecting drug users was first observed in 1989. For many years the HIV epidemic in Poland was driven by injecting drug use. In this study we examine the trends in the HIV/ AIDS epidemic based on the surveillance data for 1999-2004. During this period, 3561 new HIV infections (annual rate of 15.4 per 1 000 000 inhabitants) were reported and 803 incident AIDS cases (incidence 3.5 per 1 000 000) were diagnosed. Both the annual number of newly detected HIV infections and the AIDS incidence showed a slight increasing trend. In particular, the vertically transmitted AIDS incidence increased from 0.46 in 1999 - 2000 to 0.91 per 1 000 000 children under 15 years in 2003 - 2004. Approximately 36% of AIDS patients aged 15 years or above had not been previously diagnosed with HIV. The annual number of the late presenters increased markedly between 1999 and 2004 and was higher amongst individuals infected through sexual transmission (51.0%) than those infected by injecting drug use (20.1%) . Injecting drug users made up 78.6% of new HIV infections with known transmission route, but for 47.9% of all cases the route of transmission was not reported.
In order to generate more accurate data, HIV surveillance must be enhanced. Nevertheless, there is clear evidence for implementation of a comprehensive programme of prevention of vertical transmission and encouraging more extensive HIV testing especially in the groups at risk for sexual transmission. An effort is needed to enhance HIV surveillance and prevention in the framework of programmes for STI.
Comparison of the European Union Disease Surveillance Networks’ websites
Authors: Lenglet A , Hernández Pezzi G
Published: October 2017

Currently the surveillance of infectious disease in the European Union (EU) is supported by the Basic Surveillance Network (BSN) and other disease specific surveillance networks (DSNs). Each network has its own website. The objective of the current study was to describe the information presented with public access on each website from the perspective of its usefulness for the surveillance of an EU member state. The BSN and the DSNs cited in Decision 2003/542/CE were included. Each website was reviewed and assessed on the inclusion of characteristics from three broad categories: 1) general information, 2) procedures for data collection and 3) data presentation. Ten surveillance network websites were reviewed during the week of 5 December 2005. At least 80% of the 10 networks included a list of participating countries, the contact addresses for the coordinator of the network and the participating country gatekeepers and the network’s objectives. Only one network specified the source and coverage of the data of each country on its website, and seven presented the disease case definition. Raw data were shown on eight websites and only two networks included presentation of elaborated data for the whole of the EU. Four networks included no reports on their websites. The periodicity of presentation for both raw data and elaborated data varied greatly between networks.
The publicly available information on the 10 network websites studied was not homogeneous. We recommend that all networks present a basic set of characteristics on their websites, including case definitions, procedures used for data collection and periodic reports covering elaborated data for the entire EU.
Listeria in Europe: The need for a European surveillance network is growing
Authors: Hedberg C
Published: October 2017

Four years ago, Henriette de Valk and colleagues determined both the need for and feasibility of a European network on Listeria infections in humans. The network was envisioned as a way to strengthen surveillance in individual countries by harmonising microbiological methods and providing epidemiologic tools for investigations. The results of their survey were clear: respondents felt that such a network would aid in the detection and investigation of outbreaks, and that it could be based on existing national surveillance systems. There has been considerable institutional support for developing a European Listeria network, and in response to planning efforts, Listeria surveillance has improved in several countries. However, the network has yet to be realised.
Diagnosis of non-viral sexually transmitted infections in Lithuania and international recommendations
Authors: Vagoras A , Butylkina R , Juseviciute V , Hallén A , Unemo M , Domeika M
Published: October 2017

The aim of this study is to evaluate the range, quality and availability of diagnostic services for non-viral sexually transmitted infections (STIs), i.e. C. trachomatis, N. gonorrhoeae, T. vaginalis and T. pallidum, in Lithuania from September 2002 to December 2003.
Surveillance data describing the organisation and performance characteristics of non-viral STI diagnostic services in Lithuania were collected using a questionnaire and subsequent site-visits. International evidence-based recommendations for non-viral STI diagnosis were used to evaluate the quality of the STI diagnostics.
There were 171 facilities providing non-viral STI diagnostic services for the 3.5 million inhabitants of Lithuania. However, only 6% (n=9) of the respondents (n=153) could provide a confirmatory diagnosis, in accordance with international recommendations, for the full minimum range of relevant non-viral STIs in Lithuania, i.e. C. trachomatis, N. gonorrhoeae, T. pallidum, and T. vaginalis. In addition, accessibility to STI diagnostic services differed significantly among the different counties in Lithuania. Several of the respondents analysed low numbers of samples each year, and overall the sampling size was extremely low, especially for C. trachomatis diagnostics.
In Lithuania, optimisation of non-viral STI diagnostics as well as of epidemiological surveillance and management of STIs is crucial. It may be worth considering a decrease in the number of laboratories, with those remaining having the possibility of performing STI diagnostic services that are optimised, in concordance with international recommendations, standardised, and quality assured using systematic internal and external quality controls and systems. In addition, establishment of national inter-laboratory networks and reference centres for non-viral STIs is recommended.
Antibiotic resistance in the southeastern Mediterranean – preliminary results from the ARMed project
Authors: Borg M A , Scicluna E , De Kraker M , Van de Sande-Bruinsma N , Tiemersma E , Gür D , Ben Redjeb S , Rasslan O , Elnassar Z , Benbachir M , Pieridou Bagatzouni D , Rahal K , Daoud Z , Grundmann H , Monen J
Published: October 2017

Sporadic reports from centres in the south and east of the Mediterranean have suggested that the prevalence of antibiotic resistance in this region appears to be considerable, yet pan-regional studies using comparable methodology have been lacking in the past.
Susceptibility test results from invasive isolates of Staphylococcus aureus, Streptococcus pneumoniae, Escherichia coli, Enterococcus faecium and faecalis routinely recovered from clinical samples of blood and cerebrospinal fluid within participating laboratories situated in Algeria, Cyprus, Egypt, Jordan, Lebanon, Malta, Morocco, Tunisia and Turkey were collected as part of the ARMed project.
Preliminary data from the first two years of the project showed the prevalence of penicillin non-susceptibility in S. pneumoniae to range from 0% (Malta) to 36% (Algeria) [median: 29%] whilst methicillin resistance in Staphylococcus aureus varied from 10% in Lebanon to 65% in Jordan [median: 43%]. Significant country specific resistance in E. coli was also seen, with 72% of isolates from Egyptian hospitals reported to be resistant to third generation cephalosporins and 40% non-susceptible to fluoroquinolones in Turkey. Vancomycin non-susceptibility was only reported in 0.9% of E. faecalis isolates from Turkey and in 3.8% of E. faecium isolates from Cyprus.
The preliminary results from the ARMed project appear to support previous sporadic reports suggesting high antibiotic resistance in the Mediterranean region. They suggest that this is particularly the case in the eastern Mediterranean region where resistance in S. aureus and E. coli seems to be higher than that reported in the other countries of the Mediterranean.
Lymphogranuloma venereum emerging in men who have sex with men in Germany
Authors: Bremer V , Meyer T , Marcus U , Hamouda O
Published: October 2017

A resurgence of lymphogranuloma venereum (LGV) has been observed in several European countries. LGV is not a mandatorily notifiable disease in Germany. Reports of LGV cases have actively been collected by the Robert Koch-Institut since 2004 to describe the outbreak and estimate the extent of the LGV problem in Germany.
Updates on the LGV outbreak were published in the German national epidemiological bulletin. Physicians were asked to send their samples to a laboratory for genotyping. A possible case was defined as a person with symptoms of proctitis and/or inguinal lymph node swelling and a positive chlamydia serology. A probable case had in addition a positive chlamydia rectal or urinary PCR test. A case was confirmed if the genotype L1-L3 was identified based on sequence analysis of omp1 gene sequences.
Since 2003, LGV has been reported in 78 male patients in Germany. Of these, 61 patients were confirmed as genotype L2. Fifty eight out of 78 patients (74%) are known to be men who have sex with men (MSM). Fifty five patients (71%) had rectal symptoms and 49 (63%) knew they were HIV positive. Sixty two (79%) of the patients were residents of Berlin or Hamburg.
LGV has emerged in MSM in Germany at the same time as in other European countries. It is thought that LGV may become endemic in the MSM community in German metropolitan areas, because the number of reported patients with LGV continues to increase. The increase in the number of LGV cases and the high HIV prevalence in LGV patients are of great public health concern. Clinicians and MSM may not be sufficiently aware of the disease, and existing efforts to promote awareness and prevention of sexually transmitted infections and HIV need to be strengthened.
Laboratory diagnosis of Lyme borreliosis at the Portuguese National Institute of Health (1990-2004)
Authors: Lopes de Carvalho I , Núncio M S
Published: October 2017

Lyme borreliosis is considered to be an emerging infection in some regions of the world, including Portugal. The first Portuguese human case of Lyme borreliosis was identified in 1989. Since 1999, this disease is considered a notifiable disease (DDO) in Portugal, but only a few cases are reported each year, which does not allow consistent analysis of risk factors and the impact on public health. In this study the authors analyse the data available at the Centre for Vectors and Infectious Diseases Research (CEVDI) laboratory, at the Instituto Nacional de Saúde Dr. Ricardo Jorge (National Institute of Health, INSA) during the past 15 years (1990-2004) and evaluate them against the registry of national reported cases (1999-2004). Serological tests were the basis for laboratory diagnosis. Data on year of diagnosis, sex, age, geographical origin and clinical signs are available for 628 well documented Portuguese positive cases. The number of cases per year varied between 2 and 78, with the highest number of cases reported in 1997. Of the positive cases, 53.5% were female and the age group most affected was 35-44 years old. Neuroborreliosis was the most common clinical manifestation (37.3%). Human cases were detected in 17 of the 20 regions of Portugal, and the highest number of laboratory confirmed cases were from the Lisbon district. The comparison of the number of notified cases and the number of positive cases confirmed by our laboratory show that Lyme borreliosis is clearly an underreported disease. Due to the scattered distribution of the positive cases and the low prevalence of the tick species Ixodes ricinus, the most effective prevention measure for Lyme borreliosis in Portugal is education of the risk groups on how to prevent tick bites.
Outbreak of Salmonella enterica serotype Manhattan infection associated with meat products, France, 2005
Authors: Noël H , Dominguez M , Weill F X , Brisabois A , Duchazeaubeneix C , Kerouanton A , Delmas G , Pihier N , Couturier E
Published: October 2017

Between August 2005 and March 2006 in France, 69 cases of Salmonella enterica serotype Manhattan (Salmonella Manhattan) were reported, 51 (74%) of them from southeastern France.
At the time of the alert (November 2005), 13 cases and 33 controls were interviewed. Cases were more likely than controls to have eaten pork sausages (OR=5.9, confidence interval CI [1.3; 26.9]) and beef (OR=9.3, CI [1.3; 68.6]). At the same time, 19 strains of Salmonella Manhattan isolated from meat products in southeastern France, reported to the French food safety agency (Afssa, Agence française de sécurité sanitaire des aliments) in September and November 2005, had an indistinguishable PFGE profile to the 7 human isolates of Salmonella Manhattan from the outbreak in southeastern France. Trace-back investigations revealed that pork samples came from one wholesaler whose pork products had tested positive for S. Manhattan during routine food testing in August 2005. This wholesaler supplied retail outlets in southeastern France. Additionally, a slaughterhouse supplying the wholesaler was inspected and widespread contamination with Salmonella spp. and S. Manhattan was found. Cooperation between the national agencies in charge of human health (Institut de veille sanitaire, InVS) and food safety (Afssa) allowed us to determine the most probable source of contamination and to take appropriate control measures.
Are there ‘new’ and ‘old’ ways to track infectious diseases hazards and outbreaks?
Authors: Desenclos J  C
Published: October 2017

In May 2005 the World Health Assembly approved an innovative and ambitious revision of the International Health Regulations, known as IHR(2005), in order to detect and control, in a timely manner, all public health events that may have a serious international impact. It represents a dramatic move from administrative notification by Member States (MS) to the World Health Organization (WHO) of cases of a limited list of diseases to a systematic analysis of health events of international concern, infectious or not [1]. The analysis of the public health events will take into account severity, unexpectedness, potential for international spread, and interference with international movement of people and goods. National focal points are to be identified in each MS to interact with WHO. The philosophy behind the new IHR is to promote early dialogue between MS and WHO, leading to early mutual risk assessment of events which may not necessarily have to be notified, depending on the results of the assessment and measures taken. WHO can also use informal sources to detect earlier events of international concern and then, together with the national focal point, conduct verification, risk assessment and implement appropriate measures.
Epidemic intelligence: a new framework for strengthening disease surveillance in Europe
Authors: Paquet C , Coulombier D , Kaiser R , Ciotti M
Published: October 2017

In a rapidly changing environment, national institutions in charge of health security can no longer rely only on traditional disease reporting mechanisms that are not designed to recognise emergence of new hazards. Epidemic intelligence provides a conceptual framework within which countries may adapt their public health surveillance system to meet new challenges.

Epidemic intelligence (EI) encompasses all activities related to early identification of potential health hazards, their verification, assessment and investigation in order to recommend public health control measures. EI integrates both an indicator-based and an event-based component. ‘Indicator-based component’ refers to structured data collected through routine surveillance systems. ‘Event-based component’ refers to unstructured data gathered from sources of intelligence of any nature.

All EU member states have long-established disease surveillance systems that provide proper indicator-based surveillance. For most countries, the challenge lies now in developing and structuring the event-based component of EI within national institution in charge of public health surveillance.

In May 2006, the European Union member states committed to comply with provisions of the revised International Health Regulations (IHR(2005)) considered relevant to the risk posed by avian and potential human pandemic influenza. This provides for the European Centre for Disease Prevention and Control (ECDC) with an opportunity to guide member states in developing and/or strengthening their national EI , in addition to the ECDC’s task of developing an EI system for the EU.
Syndromic surveillance based on emergency department activity and crude mortality: two examples
Authors: Josseran L , Nicolau Javier , Caillère N , Astagneau P , Brücker G
Published: October 2017

Recent public health crises have shown the need for readily available information allowing proper management by decision-makers. One way of obtaining early information is to involve data providers who already record routine data for their own use.
We describe here the results of a pilot network carried out by the InVS (Institut national de veille sanitaire) which gathered data available in real time from hospital emergency departments and register offices.

Emergency departments data were registered from patients’ computerised medical files. Mortality data were received from the national institute of statistics (Insee). Data were transmitted automatically on a daily basis. Influenza data from outbreaks in 2004/05 and 2005/06 were compared with data from the sentinel network for the same periods. Environmental health data were compared with meteorological temperatures recorded in Paris between June and August 2006. A mortality analysis was conducted on a weekly basis.
Correlation between influenza data from emergency departments and data from Sentiweb (sentinel network) was significant (p<0.001) for both outbreaks. In 2005 and 2006, the outbreaks were described similarly by both sources with identification of the start of the outbreaks by both systems during the same weeks. As for data related to heat, a significant correlation was observed between some diagnoses and temperature increases. For both types of phenomena, mortality increased significantly with one to two weeks lag.
To our knowledge, this is the first time that a study using real time morbidity and mortality data is conducted. These initial results show how these data complement each other and how their simultaneous analysis in real time makes it possible to quickly measure the impact of a phenomenon.
Enhanced Surveillance of Infectious Diseases : the 2006 FIFA World Cup experience, Germany
Authors: Schenkel K , Williams C , Eckmanns T , Poggensee G , Benzler J , Josephsen J , Krause G
Published: October 2017

The 2006 FIFA World Cup was held in 12 German cities between 9 June and 9 July 2006. We identified a need to accelerate and sensitise the pre-existing surveillance system for infectious diseases in order to timely detect adverse health events during the World Cup. Enhanced surveillance, based on Germany’s pre-existing system of mandatory notifications was conducted between 7 June and 11July 2006 in the 12 World Cup cities by: accelerating frequency of electronic data transmission of case-definition based notifiable diseases from weekly to daily transmission, additional reporting of non-case definition-based infectious disease events, lay and expert press screening and intensifying communication between all stakeholders of the surveillance system. Median delay of notification data transmission from the community to the federal level was reduced from three days to one day. The enhanced reporting system detected a norovirus outbreak in the International Broadcast Centre in Munich with 61 epidemiologically linked cases within the first week after onset, as well as four single cases related to the World Cup, two of them with relevance for the International Health Regulations. After the World Cup, all surveillance stakeholders agreed that communication between local, state and federal levels had improved considerably. Unlike the majority of health planners of previous mass gatherings in the last decade we did not introduce syndromic surveillance. Nevertheless, enhancement of infectious disease surveillance successfully detected adverse health events in a timely manner during the FIFA World Cup. Additionally, it provided a valuable communication and networking exercise for potentially critical health-related events. We recommend continuing daily notification data transmission for routine infectious disease surveillance in Germany.
Recognition of threats caused by infectious diseases in the Netherlands: the early warning committee
Authors: Rahamat-Langendoen J C , van Vliet J A , Suijkerbuijk A WM
Published: October 2017

The early warning committee was established in order to recognise threats to public health caused by infectious diseases in the Netherlands in a timely and complete fashion. This article describes the outcome of a retrospective and descriptive evaluation into the completeness of the recognitions made by the early warning committee.
Information about outbreaks of infectious disease in the Netherlands in 2002 and 2003, as reported in the Nederlands Tijdschrift voor Geneeskunde (Dutch Journal of Medicine), and about infectious disease events in other countries, was compared with reports of the regular weekly meetings of the Dutch early warning committee. If an outbreak or a foreign event was not mentioned in the meetings of the early warning committee, the cause for this was established. For events in other countries, it was established on the basis of whether or not the event could have been a threat to public health in the Netherlands.
All outbreaks of infectious disease in the Netherlands, published or mentioned in the Nederlands Tijdschrift voor Geneeskunde were discussed by the early warning committee. Three of the events occurring in other countries in 2002 had not been discussed by the committee although, based on the criteria for a potential threat to the Netherlands, they should have been: the outbreak of avian influenza A/H5N1 in domestic fowl in Hong Kong, the increase among hospitalised patients of carriers of extended-spectrum â-lactamase producing micro-organisms in Scotland, and outbreaks of measles in several countries. In 2003, all events in other countries that could have posed a threat to the Netherlands were discussed by the early warning committee.
In 2002 and 2003, the early warning committee recognised nearly all threats due to infectious diseases and outbreaks of infectious diseases which were of national importance and published in various sources of literature.
Emergence and dissemination of the methicillin resistant Staphylococcus aureus USA300 clone in Denmark (2000-2005)
Authors: Larsen A R , Stegger M , Goering R V , Sørum M , Skov R
Published: October 2017

The problem of methicillin resistant Staphylococcus aureus (MRSA) is increasing worldwide, and the spread of MRSA in the community challenges infection control since it is no longer restricted to hospital settings but involves private homes, places of work and kindergartens [1]. Furthermore, community acquired (CA)-MRSA may circumvent existing hospital infection control, since patients are rarely screened at admission. In the United States, the predominant CA-MRSA is defined by the Center for Disease Control (CDC) as the USA300 (ST8) clone. USA300 primarily causes skin and soft tissue infections (SSTI) in the community [2], but healthcare acquired infections with USA300 are rapidly emerging in the United States [3,4]. Comparison of the Danish collection of MRSA from 1997-2005 with the USA300 reference strain showed that USA300 has been introduced into Denmark on several occasions. Between 2000 and 2005, we identified 44 isolates which in addition to identical pulsed-field gel electrophoresis (PFGE) pattern shared other molecular characteristics with USA300: spa type t008 or closely related variants, Panton-Valentine leukocidin (PVL) positive and Staphylococcal Cassette Chromosome mec (SCCmec) type IVa. The isolates primarily caused SSTI, but cases of invasive infections were also encountered.
The number of USA300 has increased several-folds in Denmark from 2003 to 2005 (2, 11 and 28 new cases, respectively) and with the experience from the US in mind, this is of great concern, especially as it is observed in a country with a long reputation for controlling MRSA.
Large outbreak of E. coli O157 in 2005, Ireland
Authors: Mannix M , Whyte D , McNamara E , O’Connell N , FitzGerald R , Mahony M , Prendiville T , Norris T , Curtin A , Carroll A , Whelan E , Buckley J , McCarthy J , Murphy M , Greally T
Published: October 2017

In October/November 2005, the largest outbreak of verotoxin-producing Escherichia coli (VTEC) ever recorded in Ireland occurred. Eighteen E. coli O157 culture-positive cases, phage type 32, verotoxin 2 positive, were identified in a small rural area of mid-west Ireland. Half of these patients were asymptomatic. Two children were admitted to hospital with haemolytic uraemic syndrome, one of whom required peritoneal dialysis, and both recovered. All 18 culture-positive patients had indistinguishable or closely related pulsed field gel electrophoresis (PFGE) patterns. Nine of the VTEC O157 culture-positive individuals were in preschool children attending two local crèches. Several culture-positive individuals apparently had exposure to a vulnerable private group water scheme (GWS) in an agricultural area. No microbiological evidence of VTEC was found in food or water. One veterinary sample (an animal rectal swab) was positive for E. coli O157 and the PFGE strain was indistinguishable from the outbreak strain. A case control study showed analytical epidemiological evidence of risk related to potential exposure to the GWS but not related to reported consumption of that water. Selection of cases and controls proved challenging. Transmission occurred primarily in childcare and family settings, with significant person-to-person spread. Control measures included voluntary closure of the crèches, exclusion of culture-positive individuals in risk groups until microbiological clearance was achieved and the issuing of a ‘boil water’ advisory for drinking water pending upgrading of disinfection facilities.
Surveillance of varicella and herpes zoster in Slovenia, 1996 – 2005
Authors: Socan M , Blaško M
Published: October 2017

In Slovenia, varicella and herpes zoster infections are case-based mandatorily notifiable diseases. We present surveillance data for a period of ten years (1996 - 2005). Incidences of varicella ranged from 456 to 777 per 100 000 population in all age groups. As many as 75% of varicella cases reported were in pre-school children, with children aged three and four years being most affected. The incidence of varicella increased between October and January and was lowest in August and September; the seasonal pattern matches patterns in the school calendar. Herpes zoster was declared a reportable disease in 1995. In 2005, 1627 cases were notified (81.3/100 000). Female cases outnumbered male. The highest incidence of herpes zoster was noted in elderly individuals over 70 years of age. Complications, such as zoster meningitis and meningoencephalitis, were rarely reported (3.05/1 000 000).
Characterisation of swabbing for virological analysis in the Spanish Influenza Sentinel Surveillance System during four influenza seasons in the period 2002-2006
Authors: Larrauri A , De Mateo S ,   Spanish Influenza Sentinel Surveillance System
Published: October 2017

This study sought to characterise the swabbing pattern in the Spanish Influenza Sentinel Surveillance System (SISSS) and ascertain to what extent the system meets the guidelines currently being drafted by The European Influenza Surveillance Scheme (EISS). Data on seasons 2002/2003 to 2005/2006 were drawn from SISSS. The study analysed collection and dispatch of swab specimens for virological analysis by reference to variables relating to patient sex, age group, vaccination status, specimen collection period, period of influenza activity, time of swabbing and epidemiological season. SISSS adapts to EISS recommendations with respect to the specimen collection period and period of influenza activity, but there is a tendency to collect fewer specimens than recommended as the age of patients increases, and in the case of elderly patients (65 years and older), frequency of collection is clearly insufficient. Furthermore, sentinel physicians collect a higher percentage of specimens in cases where patients have received the influenza vaccine.
Cryptosporidiosis surveillance and water-borne outbreaks in Europe
Authors: Semenza J C , Nichols G
Published: October 2017

Cryptosporidium causes diarrhoeal disease that can be particularly severe in immuno-compromised individuals. Cryptosporidiosis is a notifiable disease at European Union level, and surveillance data are collected through the European Basic Surveillance Network. The disease distribution in Europe for 2005 showed 7,960 cryptosporidiosis cases reported from 16 countries. The crude incidence rate was 1.9 cases per 100,000, although there were considerable differences in the rates of cryptosporidiosis between countries. Infection was more commonly reported in young children. A pronounced seasonal peak was observed in the autumn of 2005, with 59% of the cases reported between August and November, although Ireland and Spain experienced a peak in spring and summer, respectively. Cryptosporidiosis outbreak investigations and analytic studies have associated the disease with drinking water supplies, animal contact, travel, and swimming pools. Contamination of the source water for drinking water supplies, as well as inadequate water treatment can be responsible for cryptosporidiosis outbreaks. Routine cryptosporidiosis surveillance from North West England over 17 years showed that the cases occurred predominantly in spring and autumn. British drinking water regulations and improvements in drinking water treatment have coincided with a decline in cryptosporidiosis incidence. Improvements in cryptosporidiosis surveillance such as detection, recording and reporting will help to recognise outbreaks and monitor interventions.
Update of Clostridium difficile-associated disease due to PCR ribotype 027 in Europe
Authors: Kuijper E  J , Coignard B , Brazier J  S , Suetens C , Drudy D , Wiuff C , Pituch H , Reichert P , Schneider F , Widmer A F , Olsen K EP , Allerberger F , Notermans D  W , Barbut F , Delmée M , Wilcox M , Pearson A , Patel B , Brown D  J , Frei R , Akerlund T , Poxton I R , Tüll Peet
Published: October 2017

Recent outbreaks of Clostridium difficile-associated diarrhoea (CDAD) with increased severity, high relapse rate and significant mortality have been related to the emergence of a new, hypervirulent C. difficile strain in North America, Japan and Europe. Definitions have been proposed by the European Centre of Disease Prevention and Control (ECDC) to identify severe cases of CDAD and to differentiate community-acquired cases from nosocomial CDAD (http://www.ecdc.europa.eu/documents/pdf/Cl_dif_v2.pdf). CDAD is mainly known as a healthcare-associated disease, but it is also increasingly recognised as a community-associated disease. The emerging strain is referred to as North American pulsed-field type 1 (NAP1) and PCR ribotype 027. Since 2005, individual countries have developed surveillance studies to monitor the spread of this strain. C. difficile type 027 has caused outbreaks in England and Wales, Ireland, the Netherlands, Belgium, Luxembourg, and France, and has also been detected in Austria, Scotland, Switzerland, Poland and Denmark. Preliminary data indicated that type 027 was already present in historical isolates collected in Sweden between 1997 and 2001.
Toscana virus meningitis in Portugal, 2002-2005
Authors: Santos L , Simões J , Costa R , Martins S , Lecour H
Published: October 2017

Toscana virus infection is endemic in Italy, but has also been documented in other Mediterranean countries. Our aim was to investigate the occurrence of Toscana virus (TOSV) meningitis in children and young adults in a metropolitan area in the north of Portugal. Cerebrospinal fluid samples from 308 patients with the diagnosis of meningitis and with negative bacterial culture were tested for enteroviruses and herpesviruseses by reverse transcription PCR. Those samples that proved negative for enterovirus and herpesvirus were tested for Toscana virus with a commercial reverse transcription nested PCR assay. In total, we investigated 106 samples, collected between May and September during the four-year period between 2002 and 2005 from patients younger than 30 years old. Toscana virus was the cause of meningitis in six (5.6%) of the cases, three children and three young adults. All had a benign course and self-limited disease. Since a first case report of TOSV infection 1985 and another in 1996, both in foreign tourists, these six cases of Toscana virus meningitis are, to our knowledge, the first diagnosed in Portuguese inhabitants, and they underline the need for more studies on the prevalence of this virus in Portugal.
A curriculum for training healthcare workers in the management of highly infectious diseases
Authors: Baka A , Fusco F M , Puro V , Vetter N , Skinhoj P , Ott K , Siikamäki Heli , Brodt H R , Gottschalk R , Follin P , Bannister B , De Carli G , Nisii C , Heptonstall J , Ippolito G ,   European Network of Infectious Diseases
Published: October 2017

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