Eurosurveillance - Volume 13, Issue 2, 10 January 2008

On 19 November 2007, a 34-year-old woman was admitted to the Academic Medical Center of the University of Amsterdam in the Netherlands with dysarthria, hypesthesia of both cheeks and unsteady gait, all of which started the day before. She had also experienced dizziness, nausea and general malaise since 16 November.

Meningococcal infections occur worldwide as endemic disease; there have also been outbreaks in Europe and in the Americas in the last 30 years but they have not reached the high incidence levels of epidemics in other parts of the world [1].

Institutes charged with the surveillance of norovirus (NoV) outbreaks in Ireland, Germany, the Netherlands and Sweden reported high NoV activity to the European Food-borne Viruses in Europe network (FBVE) in late 2007. In these countries, the number of reported NoV outbreaks exceeds that of October and November of the previous record seasons, 2004 and 2006. A similar situation has been reported in the United Kingdom (UK) [1]. In recent years, most norovirus outbreaks have been caused by GII.4 strains. These viruses evolve rapidly by genetic mutation coupled with selective pressure. The rapid evolution of GII.4 noroviruses resulting in the successive emergence of new variants has been observed since 2002. In the norovirus outbreak season of 2006-7, two variants emerged that co-circulated. Early observations for the 2007-8 season suggest that one of these variants now dominates. The currently circulating strains have mutations that set them apart from the older strains, leading to one amino acid change in the capsid sequence. Although we do not consider the strains that currently circulate as new variants, based on the global character of norovirus and previous experience with high numbers of reported outbreaks we are expecting high norovirus activity in other countries. .

Vaccinations are regarded as the most cost-effective health care intervention available [1,2]. Vaccines prevent disease by stimulating a protective immune response in the individual and creating a 'herd immunity' in the society [3]. .

Since 2003, the emergence and distribution of a hypervirulent strain of Clostridium difficile PCR ribotype 027 has been described in North America, Japan and several European countries [1-6]. In December 2007, C. difficile PCR ribotype 027 was found in two cases of C. difficile-associated disease treated in a hospital in Oslo, Norway.

In the early 1990s, Romania had a high incidence of hepatitis B, with over 30 cases per 100,000 population annually. The disease represented a serious public health problem, especially for children. As a result, public health measures were introduced during the 1990s such as the enforcement of the use of single-use needles and a routine vaccination programme for children and health workers. This paper describes the change in incidence of HBV infection in Romania from the late 1980s until 2005, and demonstrates the impact of those measures. They have lead to a dramatic decrease in hepatitis B incidence across the country: overall, the incidence has decreased from 43 per 100,000 in 1989 to 8.5 per 100,000 in 2004. The decrease has been most prominent in children under 15, dropping from 81 to 11 per 100,000 population and year during that period.