Eurosurveillance - Volume 12, Issue 1, 01 January 2007

“Prisons are among the most unhealthy places in our societies. In them, people are not only deprived of their freedom but they are also exposed to threats such as violence, addiction and infectious diseases, while at the same time their own capacity to manage these risks is severely constrained” [1].

A study was undertaken in Northern Ireland (NI) prisons to (i) determine prevalence of bloodborne viruses among inmates, (ii) estimate the extent of self-reported risk behaviours. All three prisons in NI were included in the study. Outcome measures included (i) antibodies to hepatitis C (HCV), hepatitis B (HBV) core antigen, HIV, (ii) self-reported risk behaviour. Five prisoners (0.75 %) tested positive for HBV, seven (1.1%) for HCV and none for HIV. Eleven per cent reported ever having injected drugs. Of these, 20% had started injecting while in prison, and 12% shared injecting equipment in prison. Two per cent had completed HBV immunisation. Injecting drugs was associated with HCV (adjusted prevalence ratio=5.2; 95% CI 0.9-16) and HBV infection (adjusted prevalence ratio=4.1; 95% CI 0.7-23). The low prevalence of bloodborne viruses within NI prisons is not consistent with findings of studies in other countries, possibly reflecting the unique sociopolitical situation in NI. In spite of knowledge of the risks of transmission of bloodborne viruses in prison, high-risk practices are occurring. Preventing risk behaviours and transmission of infection in prisons now poses a challenge for health services in the United Kingdom.

This manuscript aims to determine the prevalence of antibody to and risk factors for hepatitis A virus (HAV) in individuals attending three intellectual disability services through a cross-sectional survey held in Dublin, Ireland. Participants were 636 individuals aged four to 78 years attending three intellectual disability services. The main outcome measure was the measurement of anti-HAV (IgG antibody) in oral fluid swabs using an antibody capture enzyme immunoassay (EIA) technique. Risk factor information was obtained by questionnaire from the individual’s medical record. Participants were 362 males and 274 females. The median age was 36 years. The median age of the individuals differed significantly from one institution to another (P<0.001). The prevalence of antibody to HAV was 43% overall but the individual levels for the three institutions were 65%, 30% and 68% respectively, the difference being statistically significant (P<0.05). Although a number of factors were statistically significantly associated with prevalence of antibody on univariate analysis, only age was associated with the prevalence of antibody on multivariate analysis. Among clients living at home, both age and use of respite care were associated with having antibodies to HAV. In conclusion, the prevalence of antibody increased with age and 14% had evidence of infection in the first ten years of life. We recommend that consideration should be given to immunising new entrants to the service with the combined hepatitis A and B vaccine.

We investigated the treatments given and the outcome in a national cohort of culture-verified pulmonary tuberculosis cases in Finland. Our aim was to find out how adequate TB treatment was, and the outcome of treatment. Medical records of all culture-verified pulmonary tuberculosis cases in 1995 - 1996 were abstracted to assess treatment and outcome, using the European recommendations for outcome monitoring.

The overuse and misuse of antibiotics pose a serious danger to public health by contributing to the development of bacteria resistant to treatment. In 2001, the European Commission launched a strategy to combat the threat of antimicrobial resistance to human, animal and plant health, which includes data collection, surveillance, research, awareness-raising exercises and the phasing out of antibiotics for non-medical use in animals. The Council Recommendation on the prudent use of antibiotics in human medicine adopted in 2002 was a component in this strategy, outlining clear-cut measures in human medicine that EU Member States could take to reduce antimicrobial resistance. This report summarises the main actions taken at Member State and Community level and highlights the areas of the Recommendation needing further attention. The report outlines a variety of measures already taken by Member States in line with the Recommendation, including improved surveillance of antibiotic use and resistance, and closer cooperation between different professionals on this issue. Member States have taken good steps forward in putting measures in place against antimicrobial resistance. However, some key areas need to be better addressed, in particular infection control, reducing self-medication with antibiotics and educating health professionals and the general public on the proper use of antimicrobial treatments. The report remarks that self-medication with antibiotics is still a problem in many Member States: a ‘prescription-only’ approach should be strictly enforced and educational activities are needed.

We present 10 years of results from a paediatrician hospital network surveillance in France, set up in 1996 to monitor the trend of pertussis (whooping cough) in children and the impact of the vaccination strategies. Microbiologists from 43 hospitals that participate in the network on a voluntary basis notify pertussis diagnosis, and paediatricians complete a questionnaire for the infants under 6 months that fulfil the microbiological, clinical or epidemiological case definition. The network covers about 30% of pertussis cases seen in French hospitals. Around 300 cases of pertussis are notified in France annually. Two peaks occurred in 1997 and 2000. The estimated national incidence rate for the 0-2 months old children is 276/100 000 on average. Since March 1996, the network has described 1688 cases under-6 month. The male-female ratio was 1.0 and 63 % were less than 3 months of age. Most patients (96%) were hospitalised with 17% admitted in intensive care. The case fatality ratio was 2% with 32 deaths. Vaccination status was confirmed through medical records for 83% of children and 78% were not vaccinated. The source of contamination was identified for 53 % of cases and was in majority the parents. The Renacoq data confirmed the risk for young children, the role of parents as source of infection and the need of a pertussis vaccination in time. Vaccination is now recommended to adults who hope to become parents, and this should help to reduce this burden.

An outbreak of chikungunya fever has been occurring in the islands of the South West Indian Ocean since early 2005. We describe the clinical and biological manifestations observed in 80 patients presenting with confirmed imported chikungunya fever in our infectious disease department between March 2005 and August 2006. Forty eight patients were women (60%) and the median age was 50 years (range: 15-75). Median delay between onset of symptoms and consultation was 35 days (range: 2 days-9 months). All patients suffered from fever and joint pains. The median duration of fever was three days (range: 1-7). Joint pains were mainly peripheral, involving wrist, ankles and phalanges in more than 70% of the patients. An erythematous exanthema occurred in 60 patients (75%). Bleeding from the nose or gums was reported in nine patients (11%). Blood test anomalies, including lymphopenia, thrombopenia and moderate increased liver transaminase levels, were observed particularly during the first week of symptoms. After the first week of symptoms, the main complaints were persistent arthalgia, peripheral oedema, lethargy and sadness. At the time of this report, the treatment remains exclusively symptomatic and no vaccine is available which emphasizes the leading part played by anti vectorial measures..

In 2005, 755 cases of travel-associated legionnaires’ disease with onset in 2005 were reported to the EWGLINET surveillance scheme by 20 countries. A total of 85.8% of cases were diagnosed by the urinary antigen test, and 37 cultures were obtained. Twenty nine deaths were reported, giving a case fatality rate of 3.8% (down from 5.6% in 2004). Ninety three new clusters were identified, 36.6% of which would not have been detected without the EWGLINET scheme. One hundred and twenty two accommodation sites were investigated and the names of nine sites were published on the EWGLI website. Thirty two sites were associated with additional cases after a report was received to say that investigations and control measures had been satisfactorily carried out. This level of re-offending is greater than in previous years and care should be taken to ensure the guidelines are being properly applied, especially in Turkey.