Eurosurveillance - Volume 10, Issue 4, 01 April 2005

The 2003-2004 influenza season in Europe was dominated by the spread of the new drift variant A/Fujian/411/2002 (H3N2)-like virus which was not perfectly matched with the A(H3N2) component of the influenza vaccine. Sporadic cases of this virus were detected in Europe at the end of the 2002-2003 season and influenza activity associated with this virus began relatively early during the 2003-2004 season. Generally, influenza activity first occurred in the west of Europe (Ireland, the United Kingdom and the Iberian Peninsula) in October/November and gradually moved east across Europe, affecting Latvia, Lithuania and Poland during the months of January and February 2004. In general, the intensity of clinical activity was higher than during the 2002-2003 season (in 13 out of 20 networks) and, in countries reporting age specific data, the highest consultation incidences were observed among children aged 0-14. However, despite the emergence of the A(H3N2) drift variant, clinical incidences were not especially high compared with historical data. The composition of the 2004-2005 influenza vaccine has been modified compared with the 2003-2004 season and includes an A/Fujian/411/2002 (H3N2)-like virus strain and a new B virus strain (a B/Shanghai/361/2002-like virus).

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.

Lyme borreliosis is a potentially serious infection common in Germany, but little data about its incidence, distribution, and clinical manifestations are available. Lyme borreliosis is not a notifiable disease in Germany, but six of Germany’s 16 states – Berlin, Brandenburg, Mecklenburg-Vorpommern, Sachsen, Sachsen-Anhalt and Thüringen, have enhanced notification systems, which do include Lyme borreliosis. The efforts made in these states to monitor confirmed cases through notification are therefore an important contribution to understanding the epidemiology of Lyme borreliosis in Germany. This report summarises the analysis of Lyme borreliosis cases submitted to the Robert Koch-Institut during 2002-2003. The average incidence of Lyme borreliosis of the six East German states was 17.8 cases per 100 000 population in 2002 and increased by 31% to 23.3 cases in 2003, respectively. Patient ages were bimodally distributed, with incidence peaks among children aged 5- 9 and elderly patients, aged 60- 64 in 2002, and 65- 69 in 2003. For both years, 55% of patients were female. Around 86% of notified cases occurred from May to October. Erythema migrans affected 2697 patients (89.3%) in 2002 and 3442 (86.7%) in 2003. For a vector-borne disease, like Lyme borreliosis, the risk of infection depends on the degree and duration of contact between humans and ticks harbouring Borrelia burgdorferi. As infectious ticks probably occur throughout Germany, it is likely that the situation in the remaining 10 German states is similar to that of the states in this study.

A European football tournament (EURO 2004) took place in Portugal, from the 12 June to the 4 July 2004. Portugal’s Northern Regional Health Authority serves a population of 3.2 million people. This region hosted 12 matches, more than any other region. We describe the communicable disease surveillance activities in the region, during EURO 2004. Ten foodborne outbreaks, seven cases of meningococcal disease and one case of legionnaires’ disease, were detected. Visitors were not affected, furthermore, cases among residents seemed not to be influenced by the presence of thousands of visitors. A similar pattern has been observed at other mass gatherings where special surveillance activities were implemented. This does not reduce the importance of public health surveillance during such mass gatherings. Furthermore, evaluation of this special activities should be an opportunity to put, issues of communicable disease surveillance resources, priorities, organisation and training back on the agenda.

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.