bluuebunny/crossref_metadata_2025 huggingface dataset:
Tularaemia outbreak in Castilla y León, Spain, 2007: an update
Authors: Allue M , Ruiz Sopeña C , Gallardo M T , Mateos L , Vian E , Garcia M J , Ramos J , Berjon A C , Viña M C , Garcia M P , Yanez J , Gonzalez L C , Munoz T , Andres C , Tamames S , Ruiz C , Gómez Iglesias L A , Castrodeza J
Published: March 2021

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First report of a Salmonella enterica serovar Weltevreden outbreak on Réunion Island, France, August 2007
Authors: D'Ortenzio E , Weill F  X , Ragonneau S , Lebon J A , Renault P , Pierre V
Published: March 2021

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Workshop on the Serological Testing Algorithm for Recent HIV Seroconversion (STARHS) and HIV Incidence Estimates, Stockholm, 11-12 March 2008
Authors: Editorial team Collective
Published: March 2021

The recent development of serological assays for human immunodeficiency virus (HIV) that are able to distinguish recent from long-standing infection has generated an important tool for HIV surveillance. In the European Union (EU), a number of different serological assays are being used, and there is the danger that that HIV incidence estimates in different countries, or even within a country, may not be comparable.
West Nile fever in a patient in Romania, August 2008: case report
Authors: Popovici F , Sarbu A , Nicolae O , Pistol A , Cucuiu R , Stolica B , Furtunescu F , Manuc M , Popa M I
Published: March 2021

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Serologic and virologic surveillance of avian influenza in Nigeria, 2006-7
Authors: Joannis T M , Meseko C A , Oladokun A T , Ularamu H G , Egbuji A N , Solomon P , Nyam D C , Gado D A , Luka P , Ogedengbe M E , Yakubu M B , Tyem A D , Akinyede O , Shittu A I , Sulaiman L K , Owolodun O A , Olawuyi A K , Obishakin E T , Fasina F O
Published: March 2021

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Large outbreaks of Salmonella Typhimurium infection in Denmark in 2008
Authors: Ethelberg S , Wingstrand A , Jensen T , Sørensen G , Muller L , Lisby M , Nielsen E M , Mølbak K
Published: March 2021

An outbreak of Salmonella Typhimurium phage type U292 has been ongoing in Denmark since 1 April, with 1,054 cases registered until 23 October 2008. Extensive investigations including hypothesis-generating interviews, matched case-control studies, cohort studies in embedded outbreaks, shopping list analyses, analyses of food samples from patient's homes, trace-back analyses and extensive microbiological analysis of products have not provided clear indications of a specific source of infection but the main hypothesis is that the vehicle of the outbreak are different pork products. In addition to the large U292 outbreak, at least four other S. Typhimurium outbreaks (caused by phage types U288, DT120, DT3 and DT135) have been investigated in Denmark in 2008.
A case of ciguatera fish poisoning in a French traveler
Authors: Develoux M , Le Loup G , Pialoux G
Published: March 2021

Ciguatera is a toxic poisoning due to ingestion of fish and is rarely reported in France. Little is known about this imported tropical disease. We present a case observed in Paris in a traveller returning from the Dominican Republic.
West Nile virus infections in Hungary, August–September 2008
Authors: Krisztalovics K , Ferenczi E , Molnár Z , Csohán Á , Bán E , Zöldi V , Kaszás K
Published: March 2021

Between 2003 and 2007, a yearly average of six cases of West Nile virus neuroinvasive infection were diagnosed in Hungary. In 2008, 14 cases have been confirmed by the end of October. In contrast with previous years the infection has now appeared also in the north-western part of the country which is endemic for tick-borne encephalitis.
Measles outbreak in Gibraltar, August–October 2008 – a preliminary report
Authors: Kumar V
Published: March 2021

To date, 276 clinical diagnosed cases of measles have been notified in Gibraltar. The outbreak, which has been ongoing since August 2008 and affected almost 1% of the local population, unmasked errors in vaccination uptake assumptions and highlighted the need for improved data recording and research on disease transmission rates in small crowded populations.
Strama - a Swedish working model for containment of antibiotic resistance
Authors: Mölstad S , Cars O , Struwe J
Published: March 2021

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HIV infections and AIDS: continuous vigilance needed to contain the epidemic
Authors: Editorial team Collective
Published: March 2021

The 1 December, known as World AIDS Day since 1988, provides an occasion to raise awareness and take stock of the latest developments in the human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) epidemic.
Phylogenetic analysis of West Nile virus isolated in Italy in 2008
Authors: Savini G , Monaco F , Calistri P , Lelli R
Published: March 2021

In Italy the first occurrence of West Nile virus (WNV) infection was reported in Tuscany region during the late summer of 1998. In August 2008, the WNV infection re-emerged in Italy, in areas surrounding the Po river delta, and involving three regions Lombardy, Emilia Romagna and Veneto. WNV was isolated from blood and organs samples of one horse, one donkey, one pigeon (Columba livia) and three magpies (Pica pica). The phylogenetic analysis of the isolates, conducted on 255 bp in the region coding for the E protein, indicates that these isolates belong to the lineage I among the European strains. According to the analysis, both the 1998 and 2008 Italian strains as well as isolates from Romania, Russia, Senegal and Kenya fell in the same sub-cluster.
HIV and risk behaviour among men who have sex with men in Denmark – the 2006 Sex Life Survey
Authors: Cowan S  A , Haff J
Published: March 2021

Behavioural surveys among men who have sex with men (MSM) are important for HIV surveillance. The Danish 2006 Sex Life Survey was carried out as a self administered questionnaire, which was distributed at gay venues and bars and posted on the internet. The questionnaire was completed by 3,141 MSM. We describe the methods, the respondent group and the results of the 2006 Sex Life Survey, and discuss it implications. The main finding of this survey is that 33% of the respondents have practised unsafe sex, defined as unprotected anal intercourse with one or more partners of different or unknown HIV status. In the three previous Sex Life Surveys of 2000, 2001 and 2002, this figure was between 26% and 28%.
Parvovirus outbreak in a kindergarten in a municipality in the north of Portugal, April-June 2008
Authors: Gonçalves G , Dias M
Published: March 2021

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Tuberculosis outbreak associated with a mosque: challenges of large scale contact tracing
Authors: Duthie S , Black C , Douglas G , Jackson A D , Webster D
Published: March 2021

In this report, we describe the investigation and management of an outbreak of TB associated with a mosque in Scotland, and consider the implications of large-scale TB contact tracing. In 2005, an Algerian man living in the north-east of Scotland was found to be sputum smear-positive for TB. Initial investigation identified three (18.8%) close contacts with active disease. Due to the high rate of transmission, contact tracing was extended to casual contacts of the index case at a mosque. No sub-group at highest risk of exposure could be defined at the mosque. Screening of mosque attendees identified two cases (0.53%), with a further two identified by review of existing cases and enhanced surveillance. Two additional cases were linked to the outbreak by genetic profile. Response to the screening exercise was initially poor, but after modification of the communication strategy, 438 people were offered screening with 86% attending. The investigation and management of a TB outbreak is challenging and requires a complex message about risk to be communicated. In a mosque setting, there were additional complexities that, to the best of our knowledge, have not been reported previously. It was crucial, in designing the communication strategy, to identify key individuals within the community to assist with tailoring the message to address risk perception and to help to deliver the message. Despite this, approximately 50% of those considered to have the highest exposure (adult males regularly attending Friday lunchtime prayer meetings) did not come forward for screening. The screening of casual contacts in this setting was complex and time-consuming with a low detection rate.
Imported aseptic meningitis due to Toscana virus acquired on the island of Elba, Italy, August 2008
Authors: Sonderegger B , Hächler H , Dobler G , Frei M
Published: March 2021

We describe a case of aseptic meningitis due to Toscana Virus imported to Switzerland and discuss the epidemiological situation. To our knowledge this is the first description of this infection acquired on the Island of Elba.
An outbreak of non-typeable MRSA within a residential care facility
Authors: Fanoy E , van der Vaart W L , Helmhout L C , Weijdema K , van Santen-Verheuvel M G , Thijsen S F , de Neeling A  J , van Wamel W J , Maňásková S H , Kingma-Thijssen J L
Published: March 2021

In a household setting within a residential care facility for visually and intellectually disabled people, a resident (index case) was diagnosed with dermal abscesses caused by a methicillin-resistant Staphylococcus aureus (MRSA) which was non-typeable by standard pulsed-field gel electrophoresis. In the process of 'search and destroy', all residents and staff in contact with the index case (a total of 200 people) were screened for MRSA. Five people (three personnel and two residents) carried non-typeable MRSA and were treated with antibiotics to eradicate the infection. The 'search and destroy' efforts did not result in the identification of a source. Goats and rabbits which were kept on the premises tested negative for MRSA. The condition of the index case is improving. Further restrictive measures were implemented within the facility to prevent wider spread of the MRSA. This discovery and spread within a residential care facility of a non-typeable MRSA which is often associated with livestock, is remarkable.
A measles outbreak in Croatia, 2008
Authors: Kaic B , Gjenero-Margan I , Kurečić-Filipović S , Muscat M
Published: March 2021

We report an outbreak of measles in Croatia, involving 49 cases with onset of symptoms between end of April and June 2008. Cases occurred in Zagreb and Slavonski Brod but investigations indicated a common epidemiological link between these two geographically separate regions.
Cluster of hepatitis A cases among travellers returning from Egypt, Germany, September through November 2008
Authors: Bernard H , Frank C
Published: March 2021

From September to November 2008, 34 cases of hepatitis A imported from Egypt were reported to the German public health authorities. Investigations point to a continuing common source of infection, most likely linked to Nile river cruises. The patients affected had not been vaccinated, which emphasises the need for more effective travel advice before trips to hepatitis A endemic countries.
Zoonotic infections in Europe in 2007: a summary of the EFSA-ECDC annual report
Authors: Westrell T , Ciampa N , Boelaert F , Helwigh B , Korsgaard H , Chríel M , Ammon A , Mäkelä P
Published: March 2021

The European Food Safety Authority and the European Centre for Disease Prevention and Control have just published their Community Zoonoses Report for 2007, analysing the occurrence of infectious diseases transmittable from animals to humans. Campylobacter infections still topped the list of zoonotic diseases in the European Union and the number of Salmonella infections in humans decreased for the fourth year in a row. Cases of listeriosis remained at the same level as in 2006, but due to the severity of the disease, more studies on transmission routes are warranted. The report highlights the importance of continued co-operation between veterinarians and public health specialists, both at the EU level and within Member States.
Outbreak of norovirus infection in a nursing home for the elderly in Malta, November-December 2008
Authors: Grima A , Gatt A , Zahra G , Gambin A
Published: March 2021

In norovirus outbreak in a nursing home in Malta in November and December 2008, 44 people were affected. 35 of 91 residents and nine of 44 employees were symptomatic. The overall attack rate among residents was 38.5%. The outbreak lasted 17 days and the symptoms were mild.
Introduction of human papillomavirus (HPV) vaccination in Sweden
Authors: Tegnell A , Dillner J , Andrae B
Published: March 2021

The Swedish National Board of Health and Welfare (NBH) decided that a vaccine that protects against cervical cancer caused by human papillomavirus (HPV) should be included in the childhood vaccination directive as a nationwide-programme targeting 12-year-old girls from 2010 as a part of the school-health programme. Currently, vaccination of girls 13-18 years of age is covered by the public insurance. In this paper we describe the decision-making process behind the introduction of HPV vaccination in Sweden.
Human case of swine influenza A (H1N1), Aragon, Spain, November 2008
Authors: Adiego Sancho B , Omeñaca Terés M , Martínez Cuenca S , Rodrigo Val P , Sánchez Villanueva P , Casas I , Pozo F , Pérez Breña P
Published: March 2021

A human case of swine influenza A (H1N1) in a 50-year-old woman from a village near Teruel (Aragón, in the north-east of Spain), with a population of about 200 inhabitants, has been reported in November 2008.
Drug use and pregnancy – challenges for public health
Authors: Gyarmathy V A , Giraudon I , Hedrich D , Montanari L , Guarita B , Wiessing L
Published: March 2021

Problem drug use in pregnancy affects a sizeable population in Europe. A literature review was carried out of articles in PubMed, European Monitoring Centre for Drugs and Drug Addiction publications, and related documents in order to assess public health challenges and possible intervention strategies related to problem drug use and pregnancy in Europe. It revealed the following: Involving pregnant drug users in drug treatment is likely to decrease the chances of pre- and perinatal complications related to drug use and to increase access to prenatal care. Timely medical intervention can effectively prevent vertical transmission of human immunodeficiency virus, hepatitis B virus as well as certain other sexually transmitted diseases, and would allow newborns infected with hepatitis C virus during birth to receive immediate treatment. Pregnancy may be a unique opportunity to also help women with dual diagnosis (substance use combined with mental illness) and enrol them into special treatment and support programmes. Issues related to homelessness and intimate partner violence can also be addressed with appropriate interventions. Treatment and care for pregnant drug users should offer coordinated interventions in several areas: drug use, infectious diseases, mental health, personal and social welfare, and gynaecological/obstetric care.
An outbreak of Salmonella Typhimurium infections in Denmark, Norway and Sweden, 2008
Authors: Bruun T , Sørensen G , Forshell L P , Jensen T , Nygård K , Kapperud G , Lindstedt B A , Berglund T , Wingstrand A , Petersen R F , Muller L , Kjelsø C , Ivarsson S , Hjertqvist M , Löfdahl S , Ethelberg S
Published: March 2021

In November-December 2008, Norway and Denmark independently identified outbreaks of Salmonella Typhimurium infections characterised in the multiple-locus variable number of tandem repeats analysis (MLVA) by a distinct profile. Outbreak investigations were initiated independently in the two countries. In Denmark, a total of 37 cases were identified, and multiple findings of the outbreak strain in pork and pigs within the same supply chain led to the identification of pork in various forms as the source. In Norway, ten cases were identified, and the outbreak investigation quickly indicated meat bought in Sweden as the probable source and the Swedish authorities were alerted. Investigations in Sweden identified four human cases and two isolates from minced meat with the distinct profile. Subsequent trace-back of the meat showed that it most likely originated from Denmark. Through international alert from Norway on 19 December, it became clear that the Danish and Norwegian outbreak strains were identical and, later on, that the source of the outbreaks in all three countries could be traced back to Danish pork. MLVA was instrumental in linking the outbreaks in the different countries and tracing the source. This outbreak illustrates that good international communication channels, early alerting mechanisms, inter-sectoral collaboration between public health and food safety authorities and harmonised molecular typing tools are important for effective identification and management of cross-border outbreaks. Differences in legal requirements for food safety in neighbouring countries may be a challenge in terms of communication with consumers in areas where cross-border shopping is common.
Use of seven-valent pneumococcal conjugate vaccine (PCV7) in Europe, 2001-2007
Authors: De Carvalho Gomes H , Muscat M , Monnet D L , Giesecke J , Lopalco P L
Published: March 2021

The first pneumococcal vaccine targeting the youngest age groups, a seven-valent conjugate vaccine (PCV7), was licensed in Europe in 2001. Since then several European countries have introduced PCV7 in their childhood vaccination schedules. Still, information on vaccination schemes, vaccine uptake and impact of vaccine introduction is scarce in Europe. The following article summarises the characteristics of national pneumococcal vaccination programmes for children in 32 European countries and provides an estimate of vaccine use based on sales data for 22 countries between 2001 and 2007. There were wide variations in the recommended PCV7 vaccination schemes and in PCV7 use. High vaccine uptake was not always related to the presence of a national vaccination programme.
Trends in the epidemiology of dengue fever and their relevance for importation to Europe
Authors: Jelinek T
Published: March 2021

Dengue fever continues to spread globally, causing major epidemics and putting major strain on health systems in affected countries. For imported dengue in Europe, south east Asia is the most important region of origin, followed by Latin America, the Indian subcontinent, the Caribbean, and Africa. Information regarding mosquito protective measures is highly recommended for all travellers to affected areas.
Changes in the epidemiology of hepatitis B virus infection following the implementation of immunisation programmes in northeastern Greece
Authors: Zacharakis G , Kotsiou S , Papoutselis M , Vafiadis N , Tzara F , Pouliou E , Maltezos E , Koskinas J , Papoutselis K
Published: March 2021

The objective of this study was to investigate changes in the epidemiology of hepatitis B virus infection in the general population and selected groups of immigrants in the region of northeastern Greece over the last decade in relation to the introduction of hepatitis B vaccination programmes. Two population-based seroprevalence surveys were carried out during the years 1992-1994 and 1998-2006. In total, 25,105 individuals were tested for the presence of hepatitis B virus markers: HBsAg, anti-HBs and anti-HBc. Childhood/adolescence immunisation programmes began early in 1994 in selected groups of immigrants and were complemented by the national vaccination programme in 1998. Between 1992-1994 and 1998-2006, the HBsAg carrier rate declined from 5.4% [95% CI: 4.5-5.9] in adults (20-60 years old) and 1.9% [95% CI: 1.6-2.4] in children/adolescents (5-19 years old) of indigenous residents to 3.4% [95% CI: 2.9-3.8] and 0.6% [95% CI: 0.2-1.4] respectively (p<0.05). In spite of a decrease compared with 1992-1994, the percentage of HBsAg carriers was still relatively high in 1998-2006 among the Muslim religious minority group (8.2% [95% CI: 8.0-8.7] in adults and 2% [95% CI: 1.7-2.4] in children/adolescents) and in immigrants from the former Soviet Union (4.3% [95% CI: 3.6-4.7] in adults and 1.1% [95% CI: 0.8-2.4] in children/adolescents) (p<0.05 for both selected groups versus general population). The decline of the prevalence of HBsAg in the general population and selected groups of immigrants in northeastern Greece over the last decade supports the effectiveness of the ongoing immunisation programme although the information on the actual number of cases of acute HBV infection is not available.
Assessment of secondary attack rate and effectiveness of antiviral prophylaxis among household contacts in an influenza A(H1N1)v outbreak in Kobe, Japan, May–June 2009
Authors: Odaira F , Takahashi H , Toyokawa T , Tsuchihashi Y , Kodama T , Yahata Y , Sunagawa T , Taniguchi K , Okabe N
Published: March 2021

This report describes the assessment of the secondary attack rate (SAR) and the effectiveness of post-exposure antiviral prophylaxis among household contacts in the first domestic outbreak of a novel influenza A(H1N1)v between mid-May and early June 2009 in Kobe city, Japan. Of the 293 subjects, 14 (4.8%) household contacts met the case definition and most secondary cases were probably infected around the time of symptom onset date of the respective index case. The SAR among household contacts who did not receive prophylaxis was 7.6%, similar to the rate of seasonal influenza, and the attack rate in siblings was significantly higher than that in parents. We conclude that it is important to establish routine infection control measures for households in order to prevent the spread of the virus among household contacts and, possibly, to the community. We could not conclude whether antiviral prophylaxis was effective or not. However, among close contacts with underlying disease who received prophylaxis, nobody developed a severe form of the disease.
Progress in the surveillance of respiratory syncytial virus (RSV) in Europe: 2001-2008
Authors: Meerhoff T J , Mosnier A , Schellevis F , Paget W  J , the EISS RSV Task Group
Published: March 2021

Respiratory syncytial virus (RSV) surveillance is important to get insight into the burden of disease and epidemic pattern of RSV infection. This information is useful for healthcare resource allocation as well as the timing of preventive messages and palivizumab prophylaxis. For influenza surveillance the European Influenza Surveillance Scheme (EISS) was established in 1996, but no surveillance platform is available for RSV. To improve surveillance an RSV Task Group was established in 2003 and recommendations for RSV surveillance were developed. By 2008, progress was made for four out of six recommendations: the number of European countries testing specimens for RSV increased from six to fourteen; nose and/or throat swabs were generally used for detection of influenza and RSV; a total of 25 laboratories performed molecular testing for diagnosis and participated in a quality control assessment for RSV with an overall good performance; four of the ten countries that joined EISS in 2004 started reporting RSV detections in addition to influenza in the period 2004-8. Limited progress was achieved for standardising methods and the development of a sentinel surveillance system of representative hospitals. Improving RSV surveillance is possible by further harmonising the data collection and increased reporting of RSV.
West Nile virus transmission with human cases in Italy, August - September 2009
Authors: Rizzo C , Vescio F , Declich S , Finarelli A C , Macini P , Mattivi A , Rossini G , Piovesan C , Barzon L , Palù G , Gobbi F , Macchi L , Pavan A , Magurano F , Ciufolini M G , Nicoletti L , Salmaso S , Rezza G
Published: March 2021

In 2009, to date 16 human cases of West Nile neuroinvasive disease (WNND) have been reported in Italy, in three regions: Veneto, Emilia-Romagna and Lombardia. The number of cases is higher compared with last year when nine cases were identified (eight cases of WNND and one case of West Nile fever) and the geographical distribution indicates spread from east to west.
New perspectives after the transition of EPIET to ECDC – the future of the programme
Authors: Bremer V , Bosman A , Coulombier D
Published: March 2021

Strengthening capacity in intervention epidemiology is key to the overall goal of responding to the challenge to detect and counter threats posed by outbreaks of infectious diseases in the European Union (EU). Since its founding in 1995, the European Programme for Intervention Epidemiology Training (EPIET) has become a core resource in training in intervention epidemiology in the EU. EPIET was integrated into the European Centre for Disease Prevention and Control (ECDC) on 1 November 2007 and this has resulted in an increased sustainability of the programme, allowing for long-term planning. Also, a new training programme, the European public health microbiology training (EUPHEM), was set up in 2008 to increase the response capacity for microbiology. Collaboration with EU Member States and other training programmes has been further intensified. Merging EPIET and other training activities in the ECDC training section has created the opportunity to develop an integrated multilevel approach to training in applied field epidemiology. An integrated approach to training activities on EU level, and increasing the number of EPIET and EPIET-associated fellows are essential to respond to the training needs of EU Member States, particularly new Member States. An external evaluation of EPIET in 2009 will provide guidance for a future strategy for the programme. This article examines the achievements of the EPIET programme after its transition to ECDC and provides an outlook on its future.
Public perceptions in relation to intention to receive pandemic influenza vaccination in a random population sample: evidence from a cross-sectional telephone survey
Authors: Sypsa V , Livanios T , Psichogiou M , Malliori M , Tsiodras S , Nikolakopoulos I , Hatzakis A
Published: March 2021

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Viral hepatitis, HIV, human herpes virus and Treponema pallidum infection in haemodialysis patients from Kosovo, 2005
Authors: Quaglio G L , Pattaro C , Ramadani N , Bertinato L , Elezi Y , Dentico P , Volpe A , Ciotti M , Rezza G , Putoto G
Published: March 2021

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First human case of Usutu virus neuroinvasive infection, Italy, August-September 2009
Authors: Pecorari M , Longo G , Gennari W , Grottola A , Sabbatini A MT , Tagliazucchi S , Savini G , Monaco F , Simone M L , Lelli R , Rumpianesi F
Published: March 2021

We report the first worldwide case of Usutu virus (USUV) neuroinvasive infection in a patient with diffuse large B cell lymphoma who presented with fever and neurological symptoms and was diagnosed with meningoencephalitits. The cerebrospinal fluid was positive for USUV, and USUV was also demonstrated in serum and plasma samples by RT-PCR and sequencing. Partial sequences of the premembrane and NS5 regions of the viral genome were similar to the USUV Vienna and Budapest isolates.
School absence data for influenza surveillance: a pilot study in the United Kingdom
Authors: Schmidt W P , Pebody R , Mangtani P
Published: March 2021

School-age children are at a high risk of acute respiratory virus infections including the 2009 pandemic influenza A(H1N1). School absence records have been suggested as a tool for influenza surveillance. We analysed absence records from six primary schools (children aged from around five to 11 years) in London during the years 2005 to 2007 in order to provide baseline epidemiological characteristics of illness-related school absence, and to correlate school absence with seasonal influenza. The daily average prevalence of absence due to illness was 2.9%. The incidence was 1.3% per person-day. The mean duration of absence was 1.8 days (SD 1.8). Over 60% of absence episodes lasted for one day. Absence prevalence did not differ by sex. Prevalence was highest in the youngest children and then declined slightly, but was again high again in the oldest. Absence was slightly higher on Mondays and Fridays. In general, peaks of absenteeism coincided with peaks of influenza A and B (laboratory reports) but several high peaks were not associated with influenza. There was a better correlation between absence and laboratory reports and prevalence compared to incidence. School absence data may be useful for the detection of localised school outbreaks and as an additional surveillance tool but are limited by lack of data on weekends and during holidays.
Phage typing of Salmonella Typhimurium – is it still a useful tool for surveillance and outbreak investigation?
Authors: Baggesen D L , Sørensen G , Nielsen E M , Wegener H  C
Published: March 2021

Phage typing has for decades been useful as a phenotypical, definitive method for epidemiological characterisation of Salmonella Typhimurium. The system recommended by the World Health Organization (WHO) Collaborative Centre for phage typing of Salmonella has, however, become rather complex, and the present study illustrates the challenges of sufficient standardisation of the interpretation of lysis results to make sure that the same strain is assigned to the same phage type in different laboratories. Even though molecular typing methods will replace phenotypic characterisation methods in the future, it is our opinion that phage typing will remain for some time a useful tool to strengthen global Salmonella surveillance. Therefore, improved standardisation and quality assurance is essential to obtain a robust and harmonised method that allows comparison of results between laboratories.
High frequency of cross-reacting antibodies against 2009 pandemic influenza A(H1N1) virus among the elderly in Finland
Authors: Ikonen N , Strengell M , Kinnunen L , Österlund P , Pirhonen J , Broman M , Davidkin I , Ziegler T , Julkunen I
Published: March 2021

Since May 2009, the pandemic influenza A(H1N1) virus has been spreading throughout the world. Epidemiological data indicate that the elderly are underrepresented among the ill individuals. Approximately 1,000 serum specimens collected in Finland in 2004 and 2005 from individuals born between 1909 and 2005, were analysed by haemagglutination-inhibition test for the presence of antibodies against the 2009 pandemic influenza A(H1N1) and recently circulating seasonal influenza A viruses. Ninety-six per cent of individuals born between 1909 and 1919 had antibodies against the 2009 pandemic influenza virus, while in age groups born between 1920 and 1944, the prevalence varied from 77% to 14%. Most individuals born after 1944 lacked antibodies to the pandemic virus. In sequence comparisons the haemagglutinin (HA) gene of the 2009 pandemic influenza A(H1N1) virus was closely related to that of the Spanish influenza and 1976 swine influenza viruses. Based on the three-dimensional structure of the HA molecule, the antigenic epitopes of the pandemic virus HA are more closely related to those of the Spanish influenza HA than to those of recent seasonal influenza A(H1N1) viruses. Among the elderly, cross-reactive antibodies against the 2009 pandemic influenza virus, which likely originate from infections caused by the Spanish influenza virus and its immediate descendants, may provide protective immunity against the present pandemic virus.
Higher all-cause mortality in children during autumn 2009 compared with the three previous years: pooled results from eight European countries
Authors: Mazick A , Gergonne B , Wuillaume F , Danis K , Vantarakis A , Uphoff H , Spiteri G , van 't Klooster T , Junker C , Holmberg M , Mølbak K
Published: March 2021

The paper describes weekly fluctuations of all-cause mortality observed in eight European countries during the period between week 27 and 51, 2009, in comparison with three previous years. Our preliminary data show that the mortality reported during the 2009 influenza pandemic did not reach levels normally seen during seasonal influenza epidemics. However, there was a cumulative excess mortality of 77 cases (1 per 100,000 population) in 5-14-year-olds, and possibly also among 0-4-year-olds.
Recent expansion of dengue virus serotype 3 in West Africa
Authors: Franco L , Di Caro A , Carletti F , Vapalahti O , Renaudat C , Zeller H , Tenorio A
Published: March 2021

Due to non-existing or limited surveillance in Africa, little is known about the epidemiology of dengue illness in the continent. Serological and virological data obtained from returning European travellers is a key complement to this often flawed information. In the past years, dengue 3 virus has emerged in West Africa and has been detected in travellers returning to Europe. The first dengue epidemic in Cape Verde with more than 17,000 cases from September to December 2009 demonstrated that dengue virus is still expanding worldwide to new territories.
Surveillance of extensively drug-resistant tuberculosis in Europe, 2003-2007
Authors: Devaux I , Manissero D , Fernandez de la Hoz K , Kremer K , van Soolingen D , on behalf of the EuroTB network
Published: March 2021

This paper describes the results of second-line drug (SLD) susceptibility tests among multidrug-resistant tuberculosis (MDR TB) cases reported in 20 European countries aiming to identify extensively drug-resistant tuberculosis (XDR TB) cases. A project on molecular surveillance of MDR TB cases was conducted by EuroTB and the National Institute for Public Health and the Environment (RIVM) from 2005 to 2007. Information on drug susceptibility testing (DST) was provided to this project and case-based data on MDR TB cases were reported on a quarterly basis by 20 countries of the World Health Organization’s European Region, including 15 European Union Member States. Data included SLD susceptibility test results, enabling a retrospective description of XDR TB cases notified between 2003 and 2007 .In 18 countries DST was performed for two or more of the SLD included in the XDR TB definition. The proportion of MDR TB isolates tested for SLD varied widely between countries (range 20 to 100 percent). In the 18 countries, 149 (10%) XDR TB cases were reported among MDR TB cases with available DST results for SLD. Sixteen additional MDR TB cases were reported by the MDR TB surveillance system when compared with the number of routinely reported MDR TB cases to EuroTB in ten countries with representative data reported during three consecutive years (2003-2005). To counter the threat of XDR TB in Europe, a standardised approach to XDR TB surveillance and DST for SLD is needed, as well as increased laboratory capacity across European countries.
Spotlight on measles 2010: Preliminary report of an ongoing measles outbreak in a subpopulation with low vaccination coverage in Berlin, Germany, January-March 2010
Authors: Bätzing-Feigenbaum J , Pruckner U , Beyer A , Sinn G , Dinter A , Mankertz A , Siedler A , Schubert A , Suckau M
Published: March 2021

Since early January 2010, Berlin has been experiencing a measles outbreak with 62 cases as of 31 March. The index case acquired the infection in India. In recent years, measles incidence in Berlin has been lower than the German average and vaccination coverage in school children has increased since 2001. However, this outbreak involves schools and kindergartens with low vaccination coverage and parents with critical attitudes towards vaccination, which makes the implementation of public health interventions challenging.
Chikungunya fever in two German tourists returning from the Maldives, September, 2009
Authors: Pfeffer M , Hanus I , Löscher T , Homeier T , Dobler G
Published: March 2021

This report describes the first isolation and molecular characterisation of a chikungunya virus from two German tourists who became ill after a visit to the Maldives in September 2009. The virus contained the E1 A226V mutation, shown to be responsible for an adaptation to the Asian tiger mosquito Aedes albopictus. The E1 coding sequence was identical to chikungunya virus isolates from Sri Lanka and showed three nt-mismatches to the only available E1 nt sequence from the Maldives.
Cluster of botulism among Dutch tourists in Turkey, June 2008
Authors: Swaan C M , van Ouwerkerk I M , Roest H J
Published: March 2021

In June 2008, three Dutch tourists participating in a mini-cruise in Turkey needed urgent repatriation for antitoxin treatment because of symptoms of botulism. Because there was a shortage of antitoxin in the Netherlands, an emergency delivery was requested from the manufacturer in Germany. An outbreak investigation was initiated into all nine cruise members, eight of whom developed symptoms. C. botulinum type B was isolated in stool culture from four of them. No other patients were notified locally. Food histories revealed locally purchased unprocessed black olives, consumed on board of the ship, as most likely source, but no leftovers were available for investigation. C. botulinum type D was detected in locally purchased canned peas, and whilst type D is not known to be a cause of human intoxication, its presence in a canned food product indicates an inadequate preserving process. With increasing tourism to areas where food-borne botulism is reported regularly special requests for botulism antitoxin may become necessary. Preparing an inventory of available reserve stock in Europe would appear to be a necessary and valuable undertaking.
Dengue type 3 virus infections in European travellers returning from the Comoros and Zanzibar, February-April 2010
Authors: Gautret P , Simon F , Hervius Askling H , Bouchaud O , Leparc-Goffart I , Ninove L , Parola P , for EuroTravNet Collective
Published: March 2021

In late February-early April 2010, five cases of dengue fever were diagnosed in returning travellers in Europe in EurotravNet sites in Sweden and France in patients with travel history to the Comoros and/or Zanzibar, Tanzania. Four cases were non-complicated dengue fever and one case dengue hemorrhagic fever. Three patients were viraemic at the time of diagnosis and infected with Dengue type 3 virus.

An estimated 100 million cases of dengue fever and 250,000 cases of dengue haemorrhagic fever occur annually worldwide [1]. The past 20 years have seen a dramatic geographic expansion of epidemic dengue fever from Southeast Asia to the South Pacific Islands, the Caribbean, and the Americans. An increasing number of reports of dengue fever and associated illness among travellers to dengue virus–infected areas paralleled the changing epidemiology of dengue in local populations [1].
In 2010 (until 14 April), five cases of dengue fever including one case of dengue haemorrhagic fever, have been reported from EurotravNet sites in France and Sweden, in four travellers returning from the Comoros and one traveller returning from Zanzibar, Tanzania. EurotravNet, the Network for travel medicine and tropical diseases of the European Centre for Disease Control consists of 14 core sites in nine European countries and participants monitor travel related infectious diseases in Europe (www.eurotravnet.eu).
Investigations and control measures following a non-travel-associated case of toxigenic Cornyebacterium diphtheriae, London, United Kingdom, December 2009-January 2010
Authors: Perkins S , Cordery R , Nixon G , Abrahams A , Andrews J , White J , Efstratiou A , Anaraki S
Published: March 2021

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Pandemic Influenza A (H1N1) 2009 and mortality in the United Kingdom: risk factors for death, April 2009 to March 2010
Authors: Pebody R  G , McLean E , Zhao H , Cleary P , Bracebridge S , Foster K , Charlett A , Hardelid P , Waight P , Ellis J , Bermingham A , Zambon M , Evans B , Salmon R , McMenamin J , Smyth B , Catchpole M , Watson J  M
Published: March 2021

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Risk of Salmonella infection with exposure to reptiles in England, 2004-2007
Authors: Aiken A M , Lane C , Adak G  K
Published: March 2021

Non-typhoidal Salmonella infections are a common cause of gastroenteritis in England. Non-Enteritidis, non-Typhimurium Salmonella serotypes have gained in relative importance in recent years, but their modes of transmission are poorly understood. In a large case-case study in England between 2004 and 2007, the association between exposure to reptiles and Salmonella illness was investigated using multivariable logistic regression. Recent reptile exposure was associated with Salmonella illness with an odds ratio of 2.46 (95% confidence interval: 1.57-3.85, p<0.001), with much stronger effects among children under five years of age. The exposure was rare, and a population attributable fraction was estimated as 0.9%. Among the Salmonella serotypes found in people exposed to reptiles, several non-Enteritidis, non-Typhimurium serotypes were strongly associated with exposure. Reptile exposure is a rare but significant risk factor for Salmonella illness in England, with much higher risk in children.
Nationwide outbreak of Salmonella serotype Kedougou associated with infant formula, Spain, 2008
Authors: Rodríguez-Urrego J , Herrera-León S , Echeita-Sarriondia A , Soler P , Simon F , Mateo S , Investigation team Collective
Published: March 2021

On 5 August 2008, the National Centre of Microbiology in Madrid, Spain, notified an increase in Salmonella Kedougou isolations compared to 2007, with 21 cases including 19 children under one year of age. Active case finding and a matched case-control study were carried out to confirm this increase, identify source, transmission mode and risk factors in order to implement control measures. Cases were defined as any child under one year of age with S. Kedougou isolated since 1 January 2008, and were matched for age, sex, medical practitioner and diagnosis week with controls who were selected among patients of the cases' medical practitioners. An ad hoc questionnaire was completed for cases and controls and a univariate analysis was conducted to identify risk factors. We found 42 isolates from 11 of the 19 Spanish Regions. Completed questionnaires were available for 39 of 42 patients identified; 31 were children under one year of age and fulfilled the case definition. The median age of the 31 cases was 4.3 months and 13 were male. Main symptoms were diarrhoea (n=31) and fever (n=13). Ten cases required hospitalisation. All 31 cases had consumed infant formula milk of Brand A which was associated with illness in the univariate analysis (exact matched odds ratio: 74.92; 95% confidence interval: 12.89-∞). All patient isolates showed indistinguishable pulsed-field gel electrophoresis and antimicrobial susceptibility patterns. Five milk samples from three cases' households were negative for Salmonella. Our results suggest that Brand A was the transmission vehicle of S. Kedougou in the outbreak that occurred in Spain between January and August 2008. Food safety authorities recalled five batches of Brand A milk on 26 August 2008. No further cases have been detected as of 15 September 2009.
Mumps outbreak in the former Yugoslav Republic of Macedonia, January 2008 – June 2009: epidemiology and control measures
Authors: Kuzmanovska G , Polozhani A , Mikik V , Stavridis K , Aleksoski B , Cvetanovska Z , Binnendijk R , Bosevska G
Published: March 2021

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2009 pandemic influenza A(H1N1) virus in Scotland: geographically variable immunity in Spring 2010, following the winter outbreak
Authors: Adamson W E , Maddi S , Robertson C , McDonagh S , Molyneaux P J , Templeton K E , Carman W F
Published: March 2021

We determined the age- and location-specific seroprevalence of antibodies against 2009 pandemic influenza A(H1N1) virus in Scotland following the first two waves of infection. Serum samples collected following the winter outbreak were analysed by microneutralisation assay. The proportion of positive sera varied significantly between cities and, in the case of Inverness, between age groups (with younger adults more likely to be positive than older individuals). This study demonstrates that older people are no longer more likely to have antibodies against the virus than younger adults.
Cluster of Legionnaires´ disease associated with a public whirlpool spa, France, April – May 2010
Authors: Campese C , Roche D , Clément C , Fierobe F , Jarraud S , de Waelle P , Perrin H , Che D
Published: March 2021

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Small pharmacies are more likely to dispense antibiotics without a medical prescription than large pharmacies in Catalonia, Spain
Authors: Llor C , Monnet D L , Cots J M
Published: March 2021

The aim of this study was to explore the relationship between pharmacy size and the likelihood of obtaining antibiotics without medical prescription at a pharmacy. In 2008 in Catalonia, two actors presented three different cases in a randomised sample of pharmacies and asked pharmacists for an antibiotic. Pharmacies were considered as small when having limited space with only one counter and a maximum of two professionals selling medicines, as medium sized with three or four attending professionals, and as large with a large selling space and more than four attending professionals. Of the 197 pharmacies visited, 88 (44.7%) were considered as small while only 25 (12.7%) were large. Antibiotics were obtained without a medical prescription in 89 (45.2%) pharmacies, mainly in small pharmacies (63.6%), followed by medium-sized pharmacies (35.7%) and large pharmacies (12%) (p<0.001). Large pharmacies, that probably have a greater income, more closely followed the prevailing legislation of not selling antibiotics to patients without a medical prescription. This observation should now be confirmed in other countries where over-the-counter sales of antibiotics are prevalent and should be taken into account by programmes aiming at achieving a more prudent use of antibiotics.
First two autochthonous dengue virus infections in metropolitan France, September 2010
Authors: La Ruche G , Souarès Y , Armengaud A , Peloux-Petiot F , Delaunay P , Desprès P , Lenglet A , Jourdain F , Leparc-Goffart I , Charlet F , Ollier L , Mantey K , Mollet T , Fournier J P , Torrents R , Leitmeyer K , Hilairet P , Zeller H , Van Bortel W , Dejour-Salamanca D , Grandadam M , Gastellu-Etchegorry M
Published: March 2021

In September 2010, two cases of autochthonous dengue fever were diagnosed in metropolitan France for the first time. The cases occurring in Nice, south-east France, where Aedes albopictus is established, are evidence of dengue virus circulation in this area. This local transmission of dengue calls for further enhanced surveillance, active case finding and vector control measures to reduce the spread of the virus and the risk of an epidemic.
Increasing case numbers of adenovirus conjunctivitis in Germany, 2010
Authors: Adlhoch C , Schöneberg I , Fell G , Brandau D , Benzler J
Published: March 2021

In 2010 (as of 13 October 2010), the number of adenovirus conjunctivitis cases reported to the Robert Koch Institute in Berlin, Germany, has increased by more than 250% compared with same period in the previous two years. An investigation was initiated to identify spatial or temporal clusters, possible sources of infection and potential connections to cases abroad. The analysis did not show a disproportionately affected sex or age group, but many infections were preceded by exposure to ophthalmological facilities, communal facilities or public places.
Spotlight on measles 2010: Measles outbreak among travellers returning from a mass gathering, Germany, September to October 2010
Authors: Pfaff G , Lohr D , Santibanez S , Mankertz A , van Treeck U , Schönberger K , Hautmann W
Published: March 2021

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Spotlight on measles 2010: Measles outbreak in the Provence-Alpes-Côte d’Azur region, France, January to November 2010 - substantial underreporting of cases
Authors: Six C , Blanes de Canecaude J , Duponchel J L , Lafont E , Decoppet A , Travanut M , Pingeon J M , Coulon L , Peloux-Petiot F , Grenier-Tisserant P , Delarozière J C , Charlet F , Malfait P
Published: March 2021

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Cluster of Legionnaires’ disease in a newly built block of flats, Denmark, December 2008 – January 2009
Authors: Krøjgaard L H , Krogfelt K A , Albrechtsen H J , Uldum S  A
Published: March 2021

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