Eurosurveillance - Volume 12, Issue 5, 01 May 2007

This edition of Eurosurveillance contains reports of infectious disease surveillance systems from all corners of Europe. In some instances, routinely collected notifiable data coupled with microbiological data can provide sufficient information to allow appropriate public health intervention.

In England and Wales, clinical reports from primary care showed that influenza activity for the season 2005/06 only rose above the base line for four weeks during February 2006. However, outbreaks of influenza-like illness and/or gastrointestinal infection in schools began to be reported to the Health Protection Agency, Centre for Infections in early January 2006. To quantify the type, size and the spread of these outbreaks a reporting form was distributed to local Health Protection Units in England and to Wales for retrospective and prospective weekly completion. Between weeks 48/05 and 11/06, a total of 688 school outbreaks were reported, including 658 outbreaks of influenza-like illness with or without other symptoms. The remaining 30 outbreaks listed as gastrointestinal only were excluded from the present analysis. Influenza B was confirmed in 70 outbreaks where testing took place. 61% of the outbreaks were reported from primary schools for children aged 4-11 years. This large scale outbreak in school children with flu-like illness across England and Wales was not picked up by most of the routine surveillance schemes, therefore, we believe that a school absentee monitoring and reporting system may be needed to give an early warning of increased influenza activity, especially for the mild form of the disease caused by influenza B virus.

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

The objective of this study was to describe the general features of meningococcal meningitis epidemiology in 1970-2006 in Poland, in the context of changes made in surveillance system methods. Because of limited availability of case-based data, a more detailed analysis was performed only for the period 1994-2006 with special focus on case-fatality and diagnostic certainty. The reported annual number of meningococcal meningitis cases reached its peak of 416 (incidence 1.2 per 100,000) in 1981, after which it decreased to 76 cases in 2003 (incidence 0.2), and then increased to 151 cases in 2006 (incidence 0.4 per 100,000). The observed decrease was consistent with the decline in the number of live births and the drop in mortality from meningococcal disease observed using an independent reporting of death certificates. In 1994-2006, 1,677 cases of meningococcal meningitis were registered, with annual incidence varying between 0.2 and 0.5 per 100,000 inhabitants. Median age of patients was 4 years and 73% of cases were under 18 years of age. The majority of cases were caused by group B meningococci, but a trend towards increasing proportion of serogroup C has been identified. Meningococcal meningitis only was reported in 79% of cases, and meningitis with concomitant septicaemia in 21%. The overall case fatality was 3.7% - 4.5% in cases of meningitis only, and 7.1% in cases of meningitis with septicaemia. Based on the case definition introduced in 2005, 88.1% of the cases would be classified as confirmed and 4.8% as probable, whereas 7.1% would not fulfil the criteria of the case definition >Although diagnostic certainty of reported cases has improved in recent years, it is still problematic. Further efforts are needed to increase the proportion of serogrouped cases and assess the burden of meningococcal disease in Poland.

This study evaluates two sexually transmitted infections (STI) surveillance systems' ability to provide relevant, accurate, and timely information to inform prevention and control activities in England, using data from the South West, the largest of the country's nine regions. The systems were evaluated in terms of timeliness of reporting to subsequent levels; frequency of reporting and feedback; completeness of information in the reports; and representativeness of the reports to the resident population. To determine the usefulness of the system for those responsible for taking public health action, semi-structured interviews of a sample of users of surveillance information were conducted. Timeliness of the two main surveillance systems, laboratory reports and returns from genito-urinary medicine clinics were poor. Completeness of the laboratory system was good for date of birth and sex, but poor for geographical markers. Of the 27 respondents that participated in the survey, only eight were satisfied with the level of detail in the surveillance data they received. Most stakeholders felt that the STI data they received was not representative of the population they served and not useful in responding to emerging problems.Faced with increasing incidence of STIs, existing STI surveillance systems in England are unable to provide adequate epidemiological data for the fulfilment of basic uses of public health surveillance at the local level. Surveillance is inadequate in timeliness, geographical coverage, representativeness, does not allow for the identification of risk factors and conceals variations in sex, ethnicity, and sexual behaviour. Disaggregate data with some geographical and risk-factor information would greatly enhance the usefulness of the data. The goal should be of access to real-time data.

Pertussis is a disease of substantial public health importance that still lacks an efficient surveillance system. It has been a notifiable disease in Cyprus since 1930, and has had an incidence rate of 1 per 100,000 persons during the last 10 years. In 2001, the Greece-Cyprus Paediatric Surveillance Unit (GCPSU) was established with the aim of active surveillance for rare paediatric diseases, including weekly data reporting, zero reporting, and obligatory laboratory tests. From November 2002, pertussis has been included in the active surveillance scheme of GCPSU, resulting in a very early detection of an outbreak in June 2003 that led to immediate and successful action.

Cryptosporidium causes diarrhoeal disease that can be particularly severe in immuno-compromised individuals. Cryptosporidiosis is a notifiable disease at European Union level, and surveillance data are collected through the European Basic Surveillance Network. The disease distribution in Europe for 2005 showed 7,960 cryptosporidiosis cases reported from 16 countries. The crude incidence rate was 1.9 cases per 100,000, although there were considerable differences in the rates of cryptosporidiosis between countries. Infection was more commonly reported in young children. A pronounced seasonal peak was observed in the autumn of 2005, with 59% of the cases reported between August and November, although Ireland and Spain experienced a peak in spring and summer, respectively. Cryptosporidiosis outbreak investigations and analytic studies have associated the disease with drinking water supplies, animal contact, travel, and swimming pools. Contamination of the source water for drinking water supplies, as well as inadequate water treatment can be responsible for cryptosporidiosis outbreaks. Routine cryptosporidiosis surveillance from North West England over 17 years showed that the cases occurred predominantly in spring and autumn. British drinking water regulations and improvements in drinking water treatment have coincided with a decline in cryptosporidiosis incidence. Improvements in cryptosporidiosis surveillance such as detection, recording and reporting will help to recognise outbreaks and monitor interventions.

Strains of the Beijing genotype family of Mycobacterium tuberculosis have been associated with outbreaks and multidrug resistance. We performed a retrospective thirteen-year surveillance study (1993 - 2005) on the occurrence of this strain in Elche, Spain. Only one of the available isolates from 332 cases of tuberculosis tested positive for Beijing strain. The case, detected in 2001, was that of an immigrant patient from Senegal with pulmonary tuberculosis. The strain was not drug resistant and besides six close contact persons that were infected no secondary cases of this strain were detected. In the Elche area, the incidence of Beijing strains is very low and there is no evidence of transmission or higher virulence. .

This article aims to describe the Haemorrhagic Fever with Renal Syndrome (HFRS) situation in 2005 in five neighbouring countries (Belgium, France, Germany, the Netherlands and Luxembourg) and define the most affected areas. The 2005 HFRS outbreaks in these countries were the most significant in the region since 1990, with a total of 1,114 confirmed cases. The main feature of the epidemic was the extension of the known endemic area in several of the affected countries, with the involvement of urban areas for the first time. A significant increase in the number of cases was noted for the first time in the province of Liège in Belgium and in the Jura department in France. .