Eurosurveillance - Volume 13, Issue 15, 10 April 2008

2007 saw the highest number of measles cases reported in England and Wales since current surveillance began in 1995, with 971 confirmed cases reported, compared with 740 reported in 2006 [1]. London was the region with the highest number of cases, and a large outbreak of measles in north-east London contributed to this high number of cases [2]. There were several outbreaks of measles elsewhere in Europe in 2007, and case have been reported this year in Switzerland [3], France [4] and Denmark [5].

Salmonella can be spread through contaminated food, person-to-person transmission, waterborne transmission and numerous environmental and animal exposures. Reptiles (e.g. turtles, lizards, snakes, tortoises, terrapins) serve as reservoirs of Salmonella and can shed Salmonella organisms in faecal material. Over 2,460 serotypes of Salmonella have been identified and many serotypes have been associated with reptiles.

In 2005, the first case of variant Creutzfeldt-Jakob disease (vCJD) was reported in Spain, in a woman born in 1978 with clinical onset of symptoms in 2004 [1]. She subsequently died in 2005.

The Gonococcal Resistance to Antimicrobials Surveillance Programme (GRASP) in England and Wales has monitored azithromycin resistance since 2001. In 2007, high-level azithromycin resistance (MICs >256 mg/L) was identified for the first time in six isolates, all of which were the same sequence type (ST 649).

A Chinese report of a case from Jiangsu province of an almost certain son-to-father transmission of avian influenza type A/H5N1 infection was published this week, along with an accompanying comment [1,2]. The source of the 24-year-old son's infection was not established, but the authors suggest this might have occurred during a visit to a market where there was live poultry [1]. Such a way of acquiring infection (rather than direct or close contact with sick domestic poultry) has been suggested in a number of the few human cases recently detected in China [3]. However, in the case described in The Lancet, contact with poultry was not certain and, despite some retrospective investigations in the market, no H5N1 viruses were detected in birds. The son eventually died and his 52-year-old father almost certainly acquired the infection while caring for him in the hospital, as was the case in another probable human-to-human transmission in Thailand in 2004 [1,4]. In the recent Chinese cluster, the cases, their contacts and the circumstances of transmission were well investigated epidemiologically and virologically, with over ninety contacts traced. Control measures were vigorous, with contacts being treated with chemoprophylaxis, as recommended by the World Health Organization (WHO) [1,5]. The rigour of the investigation contrasts with many earlier outbreaks and is praised in the accompanying comment [2,6]. Only two of the contacts developed illness that was compatible with bird flu by symptoms and timing, but both were negative for markers of A/H5N1 infection (i.e. their illness had to be due to another cause) [1]. .

The objective of this investigation was to describe systems for the epidemiological surveillance of congenital toxoplasmosis implemented in European countries. In September 2004, a questionnaire, adapted from the evaluation criteria published by the United States Centers for Disease Control and Prevention, was sent to a panel of national correspondents in 35 countries in the European geographical area with knowledge of the epidemiological surveillance systems implemented in their countries. Where necessary, we updated the information until July 2007. Responses were received from 28 countries. Some 16 countries reported routine surveillance for toxoplasmosis. In 12 countries (Bulgaria, Cyprus, Czech Republic, England and Wales, Estonia, Ireland, Latvia, Lithuania, Malta, Poland, Scotland and Slovakia), surveillance was designed to detect only symptomatic toxoplasmosis, whether congenital or not. Four countries reported surveillance of congenital toxoplasmosis, on a regional basis in Italy and on a national basis in Denmark, France and Germany. In conclusion, epidemiological surveillance of congenital toxoplasmosis needs to be improved in order to determine the true burden of disease and to assess the effectiveness of and the need for existing prevention programmes.

HIV and sexually transmitted infections (STI) reported among men having sex with men (MSM) have risen in western Europe in recent years. This is thought to be a result of unsafe sexual practices, but data in this field are lacking. Many European Union (EU) Member States conduct surveys or hand out questionnaires about sexual behaviour and attitudes, either to patients visiting STI clinics, or in at-risk communities, such as MSM. However, the methods of such behavioural surveillance vary greatly between countries, making it difficult to compare data and obtain an overall view of the current sexual behaviour and attitudes in the EU.