bluuebunny/crossref_metadata_2025 huggingface dataset:
The Salm-gene project - a European collaboration for DNA fingerprinting for food-related salmonellosis
Authors: Peters T M , Maguire C , Threlfall E J , Fisher I. S.T. , Gill N , Gatto A J
Published: October 2017

An external quality assessment of PFGE method to discriminate between salmonella serotypes and lysotypes was carried out by the Salm-Gene project in Europe. A set of 16 strains of S. Enteritidis was sent to 9 national salmonella reference laboratories. By using a harmonised protocol, the PFGE profiles produced were comparable between each centre. In most cases, there was at least 90% similarity between isolates tested in the different European laboratories and there was usually >95% similarity. This suggests that PFGE analyses are reproducible and therefore can be used as a valuable investigation tool combined with epidemiological data.
Salmonella enteric infections in Gipuzkoa, Spain, 1983-2000
Authors: Marimon J. M , Pérez-Trallero E , Gomariz M. , Rodríguez-Andres C. , López-Lopategui C.
Published: October 2017

The incidence of Salmonella enteric infections in Gipuzkoa, Spain, was estimated by studying a stable population between 1983 and 2000. Only stool culture confirmed cases were included. The annual mean rate of infection in children under 2 years old was 1121 per 100 000 (CI 95%; 1060-1181). This age group had the highest relative risk (RR), 16.2-fold higher than the RR of those aged over 14 years. Salmonella Enteritidis was the most prevalent serovar (80.4% of all patients), followed by Salmonella Typhimurium (11.7%).
Malaria in Austria 1990-2000
Authors: Strauss R , Pfeifer C
Published: October 2017

In Austria, between 1990 and 2000, 924 travel related malaria cases were reported (mean = 84/year). No significant decreasing or increasing trends were observed. P. falciparum (n=517; 55.9%) accounted for the highest number of cases followed by P. vivax or ovale (n=321; 34.7%) and P. malariae (n=29; 2.2%). Most infections were contracted in highly endemic malaria regions (n=686; 74.2%) and most cases were reported from the largest counties: Vienna (n=336, 36.4%), Styria (n=156, 16.8%), and Lower Austria (n=151, 16.3%). Overall, 12 deaths occurred, most were caused by P. falciparum (n=9, 75%; case fatality rate: 1.9%). Data on chemoprophylaxis was available for 752 cases (81.4%) but only half of them (n=367, 48.8%) gave detailed information on the drug used. Data on compliance were obtained for only 45.4% of the cases, with only about 60% of patients completing the full course of prophylaxis.
The challenge of hepatitis C surveillance in Europe
Authors: Desenclos J C
Published: October 2017

Hepatitis C has become an important public health issue because of its high prevalence, severe liver complica-tions,
ongoing transmission among intravenous drug users (IDUs), the risk of iatrogenic transmission and the availability
of prevention measures and treatment.
Surveillance of HCV infection in the Netherlands
Authors: Chaves S , Widdowson M A , Bosman A
Published: October 2017

Two surveillance systems exist in the Netherlands to monitor hepatitis C (HCV) infections. Aggregated weekly laboratory data have been available since 1990. In 1999, HCV infection became a notifiable disease.
Data showed the number of reported cases has remained stable. Male cases predominated (66%), mainly between age 15 to 54. Injecting drug use was the main route of transmission (64%). Despite its added value, the notifiable system should include more clinical data to better scrutinize future changes in transmission patterns.
Hepatitis C in Austria 1993–2000: reporting bias distort HCV epidemiology in Austria
Authors: Strauss R , Fülöp G , Pfeifer C
Published: October 2017

From 1993 to 2000 in Austria, the notification system registered 2232 cases of hepatitis C whereas 10 607 hospital cases were reported in the hospital discharge register (HDR). These differences can be explained by under–reporting due to lax reporting behaviour and stigma associated with this disease. The distribution of HCV infection varied geographically. The notification data showed the highest incidence rates in Tyrol, while HDR data showed highest hospitalisation rates in Vienna and Lower Austria. This study highlights the urgent need for a clear case definition at the national level and an electronic reporting system.
Immunisation: the views of parents and health professionals in Ireland
Authors: Cotter S , Ryan F , Hegarty H , McCabe T. J , Keane E
Published: October 2017

A knowledge, attitude and practice study on vaccinations was undertaken among Irish parents and healthcare professionnels between May and August 2001. Parents expressed fear of vaccine side effects, mistrust of health services, and felt poorly informed on the vac-cination issues. According to group discussions, health professionnals felt they lack time and user-friendly materials to properly inform the parents.
Clonal circulation of Salmonella enterica serotype Heidelberg in Italy?
Authors: Mammina C , Talini M , Pontello M , Di Noto A M , Nastasi A
Published: October 2017

Phenotypic and genetic characteristics of 21 strains of Salmonella serotype Heidelberg isolated in the years 1999 - 2003 from different sources in Italy were studied. Susceptibility patterns, plasmid analysis, and PFGE were used as epidemiological markers.
Although non-homogeneous drug resistance patterns and plasmid profiles had been detected, PFGE patterns suggest the hypothesis of a nationwide clonal spread of this serotype associated with poultry.
The use of near patient tests in influenza surveillance: Swiss experience and EISS recommendations
Authors: Thomas Y , Kaiser L , Wunderli W ,   on behalf of EISS Task Group on Near Patient Test
Published: October 2017

Surveillance requires time for analysis and for the communication to physicians. In order to reduce this delay, a new surveillance system based on the use of a near patient test (NPT) has been evaluated. The high specificity of NPT together with the rapidity in obtaining the results, make these tests attractive for surveillance of influenza epidemic in community practice. Such surveillance has been used in several countries including Switzerland. Four different seasons - between 1999 and 2003 - of this type of surveillance experienced in Switzerland have been analysed. The heterogeneity in terms of intensity and type of strains detected during these four epidemics seasons allowed an efficient evaluation. The average gain of time with NPT compared to cell culture was nine days. Furthermore, training of participants appeared to be essential to assure the quality of the surveillance system. A statement on the use of NPTs for influenza surveillance has finally been endorsed by EISS members. Included are recommendations that the network should use the NPTs data, which provides additional information to the classical surveillance systems, as an "early warning" system of a change in influenza activity.
Emergence of a new community acquired MRSA strain in Germany
Authors: Witte W , Cuny C , Strommenger B , Braulke C , Heuck D
Published: October 2017

Analysis of community-acquired methicillin-resistant Staphylococcus aureus (c-MRSA) from Germany producing the Panton-Valentine leukocidin revealed a unique SmaI-macrorestriction pattern, different from epidemic nosocomial strains. This molecular pattern corresponds to those shown in c-MRSA strains from other countries in the European Union. All isolates exhibited resistance to fusidic acid, which is coded by the far-1 gene. From data on geographical dissemination and time of occurrence, this strain appears to have emerged in Germany in the second half of 2002, and so an already wider dissemination is likely. The emergence of MRSA with resistance to fusidic acid is a first sign of the emergence of a PVL-positive MRSA clone.
Travel associated legionnaires' disease in Europe: 2002
Authors: Ricketts K D , Joseph C ,   on behalf of the European Working Group for Legionella Infections
Published: October 2017

Twenty countries reported 676 cases of travel associated legionnaires' disease to the EWGLINET surveillance scheme, and 94 clusters were detected.
80.5% of all cases were diagnosed by the urinary antigen test.
On average there were 20.5 days between onset and report of cases, compared with 51.5 days in 1993.
Between the introduction of the EWGLI investigation guidelines (on 1st July 2002) and the end of 2002, 37 six-week investigation reports were accepted as satisfactory and on time by the coordinating centre. 274 sites were investigated in total in 2002.
The travel patterns of the main reporters in EWGLINET influenced the months of peak activity, and helped to determine which countries bore the greatest investigation burden.
Clusters of travel associated legionnaires' disease in France, September 2001- August 2003
Authors: Decludt B , Campese C ,   M Lacoste,   D Che,   S Jarraud,   J Etienne
Published: October 2017

Clusters of travel associated legionnaires' disease warrant urgent attention, and are detected by the French national surveillance system and the European network EWGLINET.
Between September 2001 and August 2003, 37 clusters were identified in French tourist accommodation: 27 hotels and 10 campsites. The number of clinical cases per cluster was as follows: 30 clusters of 2 cases (81%), 6 clusters of 3 cases (16%) and one cluster of 4 cases (3%), a total of 82 cases. The local health authorities performed environmental investigations for 36 of the 37 clusters. Among the 36 clusters investigated, water samples were collected for 35. At 16 (46%) sites, Legionella pneumophila was found at a level of more than 103 cfu/litre. In all of the accommodation where risk assessment was found to be inadequate- control measures were implemented immediately. Six hotels were closed immediately following cluster alerts.
Comparison of clinical and environmental isolates by pulsed field gel electrophoresis (PFGE) was possible in 3 clusters and identical genomic profiles of the isolates were found in all. During this two year period of surveillance, we found that on many sites there has been a risk of exposure to Legionella. This reinforces the importance of the European surveillance network and the timely notifications of all the cases to EWGLINET.
Preventing congenital rubella infection in the European Region of WHO: 2010 target
Authors: Spika J. S. , Hanon F X , Wassilak S , Pebody R G , Emiroglu N
Published: October 2017

The World Health Organisation (WHO) Regional Office for Europe has recently published a strategic plan and surveillance guidelines for measles and congenital rubella infection. The strategy prioritises measles control activities but encourages the introduction of rubella vaccine when measles vaccine coverage has reached >90 %; although, many western European countries with suboptimal measles vaccine coverage are already using the combined measles, mumps and rubella (MMR) vaccine. Women in these countries may have an especially high risk of having an infant with congenital rubella syndrome. WHO is seeking to improve the surveillance for rubella and congenital rubella syndrome as a means to obtain better information on the burden of these diseases and engage policy decision makers in the need to support the WHO European Region's strategies for rubella.
Serological surveillance of rubella in Europe: European Sero-Epidemiology Network (ESEN2)
Authors: Nardone A , Miller E ,   on behalf of the ESEN2 group
Published: October 2017

Serological surveillance is an important resource to evaluate vaccine programmes, especially for diseases such as rubella, where a sub-optimal programme can lead to an increase in morbidity. A coordinated vaccine policy in Europe is needed and the aim of the European Sero-Epidemiology Network (ESEN2) is to standardise serological surveillance in 22 countries for eight diseases, including rubella.
A large rubella outbreak, Romania - 2003
Authors: Rafila A , Marin M , Pistol A , Nicolaiciuc D , Lupulescu E , Uzicanin A , Reef S
Published: October 2017

Romania experienced a large rubella outbreak in 2002-03, with more than 115 000 reported cases nationwide, and an incidence of 531 reported cases per 100 000 population. The incidence was highest in children of school age. The cohorts of adolescent girls vaccinated in 1998 and 2002 (when a rubella-containing vaccine was available) had significantly lower incidence rates (p<0.001) compared with those in boys in the same age groups who were not vaccinated. In 2003, of the 150 suspected congenital rubella syndrome (CRS) cases reported, seven (4.6%) were confirmed by positive rubella IgM antibodies. In the absence of available rubella containing vaccine for outbreak control, an outbreak response plan to improve the detection of cases and to limit rubella virus transmission was developed. The following activities were conducted: surveillance of pregnant women with suspected rubella or history of exposure to rubella virus was implemented, with follow up of pregnancy outcomes; surveillance for CRS was strengthened; existing infection control guidelines to prevent disease transmission within healthcare facilities were reinforced; and a communication plan was developed. In May 2004, Romania is introducing measles, mumps and rubella (MMR) vaccine for routine vaccination of children aged 12 to 15 months, while continuing vaccination of girls in the 8th grade of school (13-14 years of age) with rubella-only vaccine.
Epidemiology of rubella in Finland
Authors: Davidkin I , Peltola H , Leinikki P
Published: October 2017

Before rubella vaccination programmes began, rubella infection was prevalent in Finnish children. The disease occurred as epidemics at intervals of a few years. Rubella infection was most often contracted between the ages of 2 and 12 years. Vaccinations specifically aimed at eradicating rubella were begun with monocomponent vaccine in the mid-1970s, and the measles, mumps and rubella (MMR) vaccination programme with two injections got underway in 1982. A clear reduction in rubella cases was evident a few years after the launch of the MMR programme. Owing to a sufficiently high vaccination coverage (>95% since 1987), circulation of the indigenous rubella virus in the Finnish population ceased in the late 1990s. Some rubella cases have been imported to Finland since elimination, but they have not caused any secondary cases. This shows unambiguously that protection against rubella continues to be effective, although our cohort studies imply that the vaccine induced antibody levels do decrease with time. The MMR programme has also eliminated congenital rubella syndrome (CRS) from the country. The last CRS case was recorded in 1986. As a result of the high coverage two dose MMR vaccination programme, rubella was successfully eliminated from Finland. How long the acquired protection will last remains to be seen.
Rubella control in Italy
Authors: Ciofi Degli Atti M L , Filia A , Revello M G , Buffolano W , Salmaso S
Published: October 2017

In Italy, rubella vaccination has been recommended since 1972 for pre-adolescent girls, and since the early 1990s for all children in the second year of life. Nevertheless, coverage in children from 12 to 24 months of age is suboptimal (i.e., 56% in 1998, 78% in 2003), with wide variations among regions.
As a result, rubella is still circulating in Italy, and in 1996 the percentage of women susceptible to rubella between 15 and 39 years of age was >5%.
Congenital rubella syndrome (CRS) was a notifiable disease between 1987 and 1991, with a range of 8-76 cases reported annually. Since 1992, national incidence data are no longer available, but local reports show that CRS cases are still occurring.
Nationwide, coordinated and uniform actions are needed to control CRS effectively. For this reason, the National Plan for the Elimination of Measles and of Congenital Rubella has recently been launched. This plan includes strategies aimed at increasing MMR vaccination coverage in children and specific control measures for congenital rubella control, i.e., improving the vaccination of susceptible women of childbearing age, and reintroducing national surveillance of CRS.
New features of rubella in Spain: the evidence of an outbreak
Authors: Lemos C , Ramirez R , Ordobas M , Guibert D H , Sanz J C , Garcia L , Martinez Navarro J. F.
Published: October 2017

In most of western Europe the rubella vaccine coverage is high. However, prior to the introduction of the vaccine in Latin America, rubella susceptibility in women of childbearing age was 10-25%. Forty one (93%) countries in Latin America have adopted the rubella vaccine since 2002. The adult immigrant population in Spain constitutes a group of susceptibles.
In February 2003, the Madrid Community Measles Elimination Plan detected an increase in rubella notifications in women who had been born in Latin America. A descriptive study was undertaken to characterise the outbreak. A confirmed case was a person with fever or rash and a positive IgM serology, and living in Madrid, between 1 December 2002 and 31 March 2003. The secondary attack rate (SAR) per household was calculated.
A total of 19 cases of rubella were identified, 15 were confirmed and 4 were probable cases. Fourteen (73.7%) cases were women at childbearing age. The mean age was 25.1 years. One pregnancy was diagnosed with a voluntary termination. Eleven (57.9%) cases were from Ecuador. The mean time of residence in Spain was 41 months. None of the cases or the 54 (78.3%) household contacts had been vaccinated against rubella. The SAR was 9.1%.
This study showed the spread of rubella in the susceptible Latin American Community that is resident in Madrid. The interventions proposed were a vaccination programme towards immigrants, a health education campaign to prevent congenital rubella, and a health professional training programme case management.
Sentinel surveillance of HIV infection in HIV test clinics, Spain 1992-2002
Authors: Barrasa A , Castilla J , del Romero J , Pueyo I , de Armas C , Varela J A , Ureña J M , Bru F J , Ordoñana J R , Sáez de Vicuña L M ,   and the EPI-VIH Group
Published: October 2017

HIV infection in Spain was monitored in persons undergoing voluntary HIV testing in ten sentinel clinics between 1992 and 2002. Only patients on their first visit were considered for inclusion, and their numbers rose from 4426 in 1992 to 6649 in 2002. Most of them recognised their risk exposure as heterosexual. The proportion of injecting drug users decreased from 19% to 2% of the study population, and the proportion of female sex workers increased from 6% to 26%. The number of patients diagnosed with HIV infection declined from 604 in 1992 to 153 in 2002, and HIV prevalence fell from 13.6% to 2.3% in the same period. In all risk exposure categories, a decrease in HIV prevalence was observed, more pronounced during the first few years and stabilised in the later years. In 2002, the highest HIV prevalence was found in injecting drug users (IDUs) (14.2%), homo/bisexual men (7.5%) and individuals who had an HIV infected heterosexual partner (10.2%).
The need to harmonise management of HIV exposure in Europe
Authors: Tubiana R
Published: October 2017

Harmonised European recommendations for the management of HIV exposure have been needed for some time. Important and impressive work has been achieved by two groups of experts from a total of 14 countries, and their conclusions and recommendations are reported in the two papers from Jesús Almeda et al and Vincenzo Puro et al [1,2].
Two characteristic settings are specified, although the difference between each is debatable if the issue is to avoid or prevent an established infection after exposure to HIV (or, indeed, HCV or HBV). As the authors point out, post-exposure prophylaxis (PEP) is the standard of care for healthcare workers (HCW) in almost all countries including the United States, but not for the management of sexual, injecting drug use or other non-occupational exposures to HIV.
Proposed recommendations for the management of HIV post-exposure prophylaxis after sexual, injecting drug or other exposures in Europe
Authors: Almeda J , Casabona Barbarà J , Simon B , Gérard M , Rey D , Puro V , Thomas T ,   on behalf of the Euro-NONOPEP Project group
Published: October 2017

Post-exposure prophylaxis (PEP) is the standard of care for a healthcare worker (HCW) accidentally exposed to an HIV infected source person (occupational exposure), but this is not the case for non-occupational exposures. Very few national guidelines exist for the management of non-occupational exposures to HIV in Europe, contrarily to the occupational ones. The administration of non-occupational post-exposure prophylaxis (NONOPEP) for HIV may be justified by: a biological plausibility, the effectiveness of PEP in animal studies and occupational exposures in humans, efficacy in the prevention of mother to child HIV transmission, and cost effectiveness studies. These evidences, the similar risk of HIV transmission for certain non-occupational exposures to occupational ones, and the conflicting information about attitudes and practices among physicians on NONOPEP led to the proposal of these European recommendations.
Participant members of the European project on HIV NONOPEP, funded by the European Commission, and acknowledged as experts in bloodborne pathogen transmission and prevention, met from December 2000 to December 2002 at three formal meetings and a two day workshop for a literature review on risk exposure assessment and the development of the European recommendations for the management of HIV NONOPEP.
NONOPEP is recommended in unprotected receptive anal sex and needle or syringe exchange when the source person is known as HIV positive or from a population group with high HIV prevalence. Any combination of drugs available for HIV infected patients can be used as PEP and the simplest and least toxic regimens are to be preferred. PEP should be given within 72 hours from the time of exposure, starting as early as possible and lasting four weeks. All patients should receive medical evaluation including HIV antibody tests, drug toxicity monitoring and counseling periodically for at least 6 months after the exposure.
NONOPEP seems to be a both feasible and frequent clinical practice in Europe. Recommendations for its management have been achieved by consensus, but some remain controversial, and they should be updated periodically. NONOPEP should never be considered as a primary prevention strategy and the final decision for prescription must be made on the basis of the patient-physician relationship. Finally, a surveillance system for these cases will be useful to monitor NONOPEP practices in Europe.
Preliminary results from the new HIV surveillance system in France
Authors: Lot F , Semaille C , Cazein F , Barin F , Pinget R , Pillonel J , Desenclos J C
Published: October 2017

In addition to AIDS surveillance, data on HIV infection are necessary to better follow the dynamics of the epidemic. We report the first results of France's mandatory anonymous HIV notification system, which is linked to a virological surveillance of recent HIV infections and of circulating HIV types, groups and subtypes. HIV notifications are initiated by microbiologists who create an anonymous code of patient's identity. Clinicians complete the notification form with epidemiological and clinical data. Notifications are sent to the local health authorities and passed to the Institut de Veille Sanitaire (InVS).
Report on the first PVL-positive community acquired MRSA strain in Latvia
Authors: Miklaševics E , Hæggman S , Balode A , Sanchez B , Martinsons A , Olsson-Liljequist B , Dumpis U
Published: October 2017

Infections by community-acquired methicillin resistant Staphylococcus aureus (CA-MRSA) have been reported worldwide. Here we present characterisation of the first CA-MRSA isolated in Latvia. A PVL-positive ST30-MRSA-IV strain was isolated from a nasal swab and the central venous catheter of a patient with fever and multiple organ failure. The PFGE pattern of this strain was identical to pattern SE00-3 of MRSA isolated in Sweden from 29 patients during 2000-2003. This strain is related to the South Pacific area, and its appearance in Sweden and Latvia demonstrates its global spread.
Syphilis surveillance in France, 2000-2003
Authors: Couturier E , Michel A , Janier M , Dupin N , Semaille C ,   the syphilis surveillance network
Published: October 2017

This article describes syphilis trends, characteristics of patients from 2000 to 2003 in France and trends of the benzylpenicillin benzathine 2.4 million UI sales from 2001 to 2003. The ongoing surveillance system for syphilis case reporting since 2001 has been set up in volunteer settings, mostly public settings where STI treatment is offered. Clinical case reporting is complemented by sexual behavioural data based on a self-administered questionnaire. From 2000 to 2003, 1089 syphilis cases were reported in France, increasing from 37 cases in 2000 to 428 in 2003. Overall, 96% of syphilis cases were in men with a mean age of 36.5 years and 70% of whom were born in France. The proportion of syphilis cases with HIV co-infection decreased over time from 60% in 2000 to 33% in 2003. The most affected area by the syphilis epidemic is the Ile-de-France region, mainly the city of Paris. The greatest proportion of syphilis cases diagnosed in men who have sex with men (MSM) were in the Ile-de-France region, where they made up 87% of cases, compared with 75% in other regions. Among the patients who completed the self-administered questionnaire on sexual behaviour, 83% reported having casual sex partners in the 3 months prior to their syphilis diagnosis. Trends in the sales of benzylpenicillin benzathine 2.4 million UI in private pharmacies are similar to those observed in the surveillance system, and increased between 2001 and 2003. In conclusion, syphilis transmission is still ongoing in France in 2003 and the role of unprotected oral sex in the transmission of syphilis should be emphasised.
Bichat guidelines for the clinical management of plague and bioterrorism-related plague
Authors: Bossi P , Tegnell A , Baka A , van Loock F , Werner A , Hendriks J , Maidhof H , Gouvras G
Published: October 2017

Yersinia pestis appears to be a good candidate agent for a bioterrorist attack. The use of an aerosolised form of this agent could cause an explosive outbreak of primary plague pneumonia. The bacteria could be used also to infect the rodent population and then spread to humans. Most of the therapeutic guidelines suggest using gentamicin or streptomycin as first line therapy with ciprofloxacin as optional treatment. Persons who come in contact with patients with pneumonic plague should receive antibiotic prophylaxis with doxycycline or ciprofloxacin for 7 days. Prevention of human-to-human transmission via patients with plague pneumonia can be achieved by implementing standard isolation procedures until at least 4 days of antibiotic treatment have been administered. For the other clinical types of the disease, patients should be isolated for the first 48 hours after the initiation of treatment.
Bichat guidelines for the clinical management of botulism and bioterrorism-related botulism
Authors: Bossi P , Tegnell A , Baka A , Werner A , van Loock F , Hendriks J , Maidhof H , Gouvras G
Published: October 2017

Botulism is a rare but serious paralytic illness caused by botulinum toxin, which is produced by the Clostridium botulinum. This toxin is the most poisonous substance known. It 100 000 times more toxic than sarin gas. Eating or breathing this toxin causes illness in humans. Four distinct clinical forms are described: foodborne, wound, infant and intestinal botulism. The fifth form, inhalational botulism, is caused by aerosolised botulinum toxin that could be used as a biological weapon. A deliberate release may also involve contamination of food or water supplies with toxin or C. botulinum bacteria. By inhalation, the dose that would kill 50% of exposed persons (LD50) is 0.003 microgrammes/kg of body weight.
Patients with respiratory failure must be admitted to an intensive care unit and require long-term mechanical ventilation. Trivalent equine antitoxins (A,B,E) must be given to patients as soon as possible after clinical diagnosis. Heptavalent human antitoxins (A-G) are available in certain countries.
Bichat guidelines for the clinical management of brucellosis and bioterrorism-related brucellosis
Authors: Bossi P , Tegnell A , Baka A , van Loock F , Hendriks J , Werner A , Maidhof H , Gouvras G
Published: October 2017

Interest in Brucella species as a biological weapon stems from the fact that airborne transmission of the agent is possible. It is highly contagious and enters through mucous membranes such as the conjunctiva, oropharynx, respiratory tract and skin abrasions. It has been estimated that 10-100 organisms only are sufficient to constitute an infectious aerosol dose for humans. Signs and symptoms are similar in patients whatever the route of transmission and are mostly non-specific. Symptoms of patients infected by aerosol are indistinguishable from those of patients infected by other routes. Regimens containing doxycycline plus streptomycin or doxycycline plus rifampin are effective for most forms of brucellosis. Isolation of patients is not necessary. Trimethoprim-sulfamethoxazole and fluoroquinolones also have good results against Brucella, but are associated with high relapse rates when used as monotherapy. The combination of ofloxacin plus rifampicin is associated with good results. Even if there is little evidence to support its utility for post-exposure prophylaxis, doxycycline plus rifampicin is recommended for 3 to 6 weeks.
Estimates of the frequency of HBV, HCV, and HIV infectious donations entering the blood supply in the United Kingdom, 1996 to 2003
Authors: Soldan K , Davison K , Dow B
Published: October 2017

Several new tests have been recently introduced by the United Kingdom Blood Services to improve safety. The frequency (or risk) of hepatitis B virus (HBV), hepatitis C virus (HCV) and HIV infectious donations entering the UK blood supply during 1996-2003 has been estimated. These years span the introduction of nucleic acid testing (NAT) for HCV, HIV combination antigen and antibody test and NAT for HIV.
The frequency of an infectious donation entering the blood supply due to i) the window period, ii) assay failures and iii) human and technical errors in testing and processing, was estimated. The window period risk was estimated using the incidence of infection in donors and the length of the window period for tests in use, with an adjustment for atypical inter-donation intervals in seroconverting donors.
The estimated frequency of infectious donations entering the blood supply during 1996-2003 was 1.66, 0.80 and 0.14 per million for HBV, HCV and HIV respectively. HCV NAT resulted in an over 95% fall in the risk of HCV. Current usage of HIV combined antibody-antigen tests and of HIV NAT reduced the estimated risk of HIV by 10%.
Since 1996, the risk of transfusion-transmitted HBV, HCV and HIV infection in the UK has been lowered by several improvements to donation testing, although the absolute reduction in risk has been small. Vigilance for errors and the affects of donor selection may be as or more important than further reductions to window periods of tests for improving blood safety with respect to HBV, HCV and HIV.
Residual risk of transfusion-transmitted viral infections in Spain, 1997-2002, and impact of nucleic acid testing
Authors: Alvarez do Barrio M , González Díez R , Hernández Sánchez J M , Oyonarte Gómez S
Published: October 2017

Estimates of the risk of bloodborne viral infections are essential for monitoring the safety of the blood supply and the impact of new screening tests. Incidence rates of seroconversion and the residual risk for HBV, HIV and HCV were calculated among Spanish repeat donors between 1997 and 1999 at 22 blood donation centres, and at 7 centres between 2000 and 2002. The residual risk per million donations was estimated to be 18.67 for HBV, 2.49 for HIV and 10.96 for HCV (between 1997 and 1999). For the 2000-2002 period, the residual risk per million donations was estimated to be 9.78 for HBV, 2.48 for HIV and 3.94 for HCV. Between 1999 and 2003, about 3.4 million donations were tested by NAT, mainly in pools of 44 donations, in 12 of the 22 Spanish blood donation centres participating in the study. Eight anti-HCV negative and HCV-RNA positive donations were found, which represent an approximate yield of 1/420 000, versus a projected yield of 1/240 000 obtained from 1995-1997 data. The residual risks of transfusion-transmitted viral infections in Spain were low, and with the implementation of NAT these risks are even lower.
Human immunodeficiency virus, hepatitis C and hepatitis B infections among blood donors in Germany 2000-2002: risk of virus transmission and the impact of nucleic acid amplification testing
Authors: Offergeld Ruth , Faensen D , Ritter S , Hamouda O
Published: October 2017

Blood and plasma donations in Germany are collected by several institutions, namely the German Red Cross, community and hospital-based blood services, private blood centres, commercial plasma donation sites and transfusion services of the army. All blood donation centres are required to report quarterly data on infection markers to the Robert Koch Institute, thus providing current and accurate epidemiological data. The prevalence and incidence of relevant viral infections are low in the blood donor population in Germany, with a decreasing trend for hepatitis C infections in new and repeat donors since 1997. The implementation of mandatory nucleic acid amplification technique (NAT) testing for hepatitis C virus (HCV) in 1999 has markedly improved transfusion safety. HIV-NAT became mandatory in 2004 but was done voluntarily by the majority of the blood donation services before then. The potential benefit of hepatitis B virus (HBV) minipool NAT is not as clear because chronic HBV carriers with very low virus levels might donate unidentified. The residual risk of an infectious window period donation inadvertently entering the blood supply can be estimated using a mathematic model which multiplies the incidence rate by the number of days during which an infection may be present but not detectable, i.e. the length of the window period. The risk of an undetected infection without NAT testing was estimated to be 1 in 2 770 000 for HIV, 1 in 670 000 for HCV and 1 in 230 000 for HBV in 2001/2002. This contrasts with 1 in 5 540 000 for HIV, 1 in 4 400 000 for HCV and 1 in 620 000 for HBV with minipool NAT testing. This demonstrates that NAT testing can further reduce the already very small risk of infectious donations entering the blood supply.
Harmonisation of the acute respiratory infection reporting system in the Czech Republic with the European community networks
Authors: Kyncl J , Paget W  J , Havlickova M , Kriz B
Published: October 2017

Respiratory virus activity is detected in Europe each winter, yet the precise timing and size of this activity is highly unpredictable. The impact of influenza infection and/or acute respiratory infection in European countries is continuously monitored through a variety of surveillance systems. All of these sources of information are used to assess the nature and extent of activity of influenza and other respiratory viruses, and to offer guidance on the prevention and control of morbidity and mortality due to influenza at a local, national and international level.
The early warning system for a forthcoming influenza epidemic is mainly based on the use of a set of thresholds. In the Czech Republic, the acute respiratory infection (ARI) reporting system, with automated data processing, uses a statistical model for the early detection of unusual increased rates of the monitored indicators. The collected data consists of the number of ARI, the number of complications due to ARI and the population registered with the reporting general practitioners and paediatricians, all collected separately in five age groups. To improve the reporting system in the Czech Republic, clinical data on the weekly incidence of influenza-like illness (ILI) within the same population and the same age groups was started in January 2004. These data fit the European Commission’s recently adopted ILI case definition and allows a better comparison of data with other countries in Europe, in particular those participating in EISS (European Influenza Surveillance Scheme).
Bioterrorism, Glanders and melioidosis
Authors: Cheng A C , Dance D AB , Currie B J
Published: October 2017

We note with interest the recently published guidelines for management of melioidosis and glanders. We are clinicians with extensive experience with melioidosis in Australia and Thailand and would like to express our concern at a number of inaccuracies in these guidelines.
A medical locum service as a site for sentinel influenza surveillance
Authors: Turner J , Kelly H
Published: October 2017

Surveillance of influenza in the countries of the European Union includes a sentinel network of general practitioners reporting cases of influenza-like illness (ILI), the collection of specimens for virological testing, and laboratory reporting of influenza diagnoses. In Victoria, Australia we have a similar sentinel surveillance system, with ILI defined by fever, cough and fatigue, and influenza seasons described by thresholds. The coordination of sentinel general practices can, however, be time consuming and expensive. For the last two influenza seasons we have used a deputising medical locum service as a sentinel site for influenza surveillance. We are not aware of such a service being used as a sentinel site elsewhere in the world. In both retrospective and prospective comparisons, we have shown that ILI surveillance patterns from sentinel general practices are very similar to those from the locum service. Because of its timeliness, flexibility, patient mix and geographic spread, locum service surveillance is able to supplement sentinel ILI surveillance and may also have a role in the recognition of emerging disease patterns. This is likely to be true not only in Australia but also in countries of the European Union.
An outbreak of Campylobacter jejuni enteritis in a school of Madrid, Spain
Authors: Jiménez M , Soler P , Venanzi J D , Canté P , Varela C , Martinez Navarro J. F.
Published: October 2017

An outbreak of gastroenteritis caused by Campylobacter infection was identified in May 2003 in a school in Madrid, Spain. Eighty one cases were identified in a total of 253 people studied. A retrospective cohort study showed that a custard made with ultra high temperature (UHT) milk was associated with illness (RR: 3.15; 95% CI: 1.25-7.93). The custard was probably contaminated with Campylobacter jejuni from a raw chicken prepared a day previously in the same kitchen. Our recommendations were to periodically remind the school’s authorities how to act if an outbreak should be suspected, to include the monitoring of a food handler’s working day in each environmental investigation in order to detect any risk behaviour; to implement microbiological analysis from the surfaces and utensils of the collective kitchens and improve the sanitary education of food handlers.
Acute hepatitis C infection in HIV positive men who have sex with men in Paris, France, 2001-2004
Authors: Gambotti L , Acute hepatitis C collaborating group Collective
Published: October 2017

In mid-2004, three Parisian hospital wards informed the Institut de veille sanitaire of recent acute hepatitis C in HIV-infected (HIV+) men who had sex with men (MSM). These cases for whom none of the usual bloodborne routes for hepatitis C (HCV) transmission was found, reported having had unprotected sex. In October 2004, we conducted a retrospective investigation in Parisian hospital wards to explore HCV modes of transmission in recent acute hepatitis C in HIV+ MSM. Patient demographics, clinical and biological status of HIV infection, reasons for HCV testing, sexual behaviour and risk factors for HCV transmission within the 6 months before hepatitis onset were collected from medical records. An anonymous self-administered questionnaire on sexual behaviour within the six months before hepatitis onset was also offered to all cases. We identified 29 cases of acute hepatitis C in HIV+ MSM with onset from April 2001 to October 2004. HIV infection was asymptomatic for 76%. Median age at hepatitis C onset was 40 (28-54) years. In all records, were noted unprotected anal sex, fisting in 21% and a concomitant sexually transmitted infection (STI) in 41%. Median time between HIV diagnosis and HCV infection was 6.5 years (0-22). From the 11 self-administered questionnaires completed, 10 reported an STI, 8 “hard” sexual practices, 6 bleeding during sex and 5 fisting. HCV transmission probably occurred through bleeding during unprotected traumatic anal sex among HIV+ MSM and may be facilitated by STI mucosal lesions. This report stresses the continuous need to strongly advocate safer sex to MSM.
Pulmonary tuberculosis in two remand prisons (SIZOs) in St Petersburg, Russia
Authors: Lobacheva T , Sazhin V , Vdovichenko E , Giesecke J
Published: October 2017

The tuberculosis (TB) situation in the Russian penitentiary system has received much attention. We performed a descriptive epidemiological study of TB in two St Petersburg remand prisons (SIZOs). The medical databases of the TB divisions in these prisons were searched for all diagnosed cases of TB from 1 January 2000 to 31 December 2002. The main diagnostic method was chest x ray.
The total number of reported TB cases in these two remand prisons during this three-year period was 876. Out of these, 432 were diagnosed at entry to prison, and 444 developed the disease during incarceration, with the proportion diagnosed during incarceration increasing over time. The majority of cases were aged under 30 years.
TB incidence in Russian remand prisons is still very high and needs to be monitored closely.
Vulnerable populations: lessons learnt from the summer 2003 heat waves in Europe
Authors: Brücker G
Published: October 2017

What lessons can be learnt from the exceptionally long and severe heatwave experienced in Europe in 2003?
First, that these heatwaves can be responsible for a dramatic excess mortality: certainly more than 50 000 excess deaths for Europe in August 2003. The consequences of the heatwave were probably underestimated in many countries, at least those based on the first estimates. This excess mortality affects vulnerable groups, particularly those who are old or ill. Identification of risk factors is a priority if the necessary prevention actions are to be implemented.
The impact of the summer 2003 heat waves on mortality in four Italian cities
Authors: Michelozzi P , de Donato F , Bisanti L , Russo A , Cadum E , DeMaria M , D'Ovidio M , Costa G , Perucci C. A.
Published: October 2017

This study evaluates the impact of the 2003 heat wave on cause-specific mortality and the role of demographic characteristics and socioeconomic conditions that may have increased the risk of mortality in four Italian cities: Bologna, Milan, Rome and Turin.
Daily mortality counts, for the resident population by age, sex and cause of death were considered. Daily excess mortality was calculated as the difference between the number of deaths observed and the smoothed average. The impact of heat on health is measured in terms of maximum apparent temperature.
The greatest excess in mortality was observed in the north west of Italy (Turin, +23% and Milan, +23%). The old (75-84 years) and the very old (85+ years) were the age groups most affected, and when stratifying by sex, the increase in mortality seemed to be greater among females. The greatest excess in mortality was registered in those with low socioeconomic status in Rome (+17.8%) and in those with lower education levels in Turin (+43%).
The analysis of cause-specific mortality not only confirms results from previous studies of an increase in heat-related mortality by respiratory and cardiovascular diseases, but also shows a significant excess in mortality for diseases of the central nervous system and for metabolic/endocrine disorders.
Results from 2003 highlight the necessity of targeting future prevention programmes at the susceptible sub-groups identified. The introduction of warning systems alongside efficient preventive plans and the monitoring of mortality during heat waves may represent a valid tool for the reduction of heat-related deaths.
Letter to the Editor: Outbreaks caused by parvovirus B19
Authors: Cohen B  J
Published: October 2017

In response to the recent report of school outbreaks of parvovirus B19 infection in Portugal [1], Heath Kelly and Jennie Leydon of the Western Pacific Regional Measles Laboratory, have echoed the call for parvovirus B19 tests to be included in measles and rubella surveillance
New diagnoses of HTLV infection in England and Wales: 2002-2004
Authors: Dougan S , Smith Alan , Tosswill J C , Davison K , Zuckerman M , Taylor G P
Published: October 2017

Human T cell lymphotropic viruses (HTLV) are retroviruses transmitted through breastfeeding, sexual contact, blood transfusion and injecting drug use. HTLV is endemic in the Caribbean, and parts of Africa, Japan and South America, with isolated foci in other areas. Infection is life long. Fewer than 5% of those infected progress to one of the HTLV-related diseases, but these are debilitating and often fatal.
In England and Wales, laboratory and clinical reports of new HTLV diagnoses are routinely collected, including infections identified by the blood service since the introduction of anti-HTLV testing in August 2002.
Between 2002 and 2004, 273 individuals were diagnosed with HTLV: 102 (37%) were male and 169 female (sex was not reported for two). Median ages at diagnosis were 54 and 50 years respectively. Clinical reports were received for 78% (212/273) individuals. Where reported, 58% (116/199) of individuals were of black Caribbean ethnicity and 29% (57/199) white; 87% (128/147) were probably infected heterosexually or through mother-to-child transmission; 45% (66/146) were probably infected in the Caribbean and 40% (59/146) in the United Kingdom.
An appreciable number of HTLV infections continue to be diagnosed within England and Wales, with increases in 2002-2003 because of anti-HTLV testing of blood donations. While most infections diagnosed are directly associated with the Caribbean, transmission of HTLV infection is occurring within England and Wales. Specialist care services for HTLV-infected individuals and their families have improved in recent years, but prevention remains limited.
Late detection of a shigellosis outbreak in a school in Madrid
Authors: Jonsson J , del Álvarez-Castillo M C , Sanz J C , Ramiro R , Ballester E , Fernánez M , Echeíta A , Martinez Navarro J. F.
Published: October 2017

Even though shigellosis in Spain is rare, an indigenous outbreak is occasionally detected. We describe an outbreak in a school in Madrid caused by person-to-person transmission of Shigella sonnei.
After the detection of Shigella sonnei in a stool sample from a 3 year old girl, an investigation at her school was initiated. Questionnaires were distributed to the parents of 520 pupils attending the school. A case was defined as a school case if it was the first case in a child’s household, and as a household case if other members of the household had fallen ill first.
We identified 88 cases (60 pupils and 28 of their family members). The attack rate (AR) was 12% in the school and 32% in the families. There was a significant association between higher AR and lower age. The outbreak lasted for two months. The length and the shape of the epidemic curve of the 60 cases in pupils suggests person-to-person transmission. Shigella sonnei isolated from 5 different cases were typed by pulsed field gel electrophoresis (PFGE) and was found to be an identical strain. The prolonged duration of the outbreak was probably due to delayed detection, and stopped as soon as control measures were introduced.