Eurosurveillance - Volume 13, Issue 22, 29 May 2008

We describe an outbreak of trichinellosis in Verona, Italy, in early 2008 that was imported from Romania.

The European football championship (EURO 2008) is taking place in Austria and Switzerland between 7 and 29 June 2008. From a public health point of view, such a mass gathering requires attention with regard to infectious disease prevention because of (i) a potential increased risk for disease transmission (ii) increased media attention and (iii) its potential as a target for actions of a bioterrorist nature [2,6,8,9]. This article gives an overview of the preparations for Euro 2008 on the national level in Switzerland with regards to infectious diseases.

In November 2006, six symptomatic cases of hepatitis A in pupils of a secondary school in Upper Normandy, France, were reported to the district health service. This paper describes the outbreak investigation undertaken with the aim to identify the vehicle and source of infection, implement control measures and estimate the size of the outbreak. A primary case at the secondary school was defined as a pupil or a member of the staff with IgM anti-HAV detected in the serum and with onset of symptoms between 12 and 21 November 2006; a secondary case was defined as a contact to a primary case and who developed symptoms and had IgM anti-HAV two to seven weeks later. We performed a case control study of primary cases, controls being pupils visiting the same school (cases/controls 1:4) and inspected the canteen facilities. All 13 canteen employees were examined for anti-HAV IgM antibodies. A phylogenetic analysis of HAV of cases was performed. We identified 10 primary and 5 secondary cases. Among primary cases 90% reported eating liver pate at the canteen compared to 62% among controls (OR 5.5, 95% CI 0.62-256.9).One liver pate sample contained markers of faecal contamination. HAV genotypes were of one identical type. All 13 canteen employees were negative for IgM anti-HAV while four had anti-HAV total antibodies. We found deficiencies regarding food preparing procedures and insufficient hand washing facilities. The vehicle of the outbreak was believed to be the liver pate but the source of HAV could not be identified. Insufficient facilities in the canteen hindered staff from maintaining a high hygiene standard and were subsequently improved.

Our objective was to estimate the prevalence of HCV and HBV co-infection among HIV-infected adults in France and describe the epidemiological characteristics of co-infected patients and their clinical management. A one-day national cross-sectional survey was conducted in 2004. A random and proportional probability sample design was used, based on the number of AIDS cases reported since 1999 by hospital wards. Weighted estimations were computed. HIV-infected adults (out/in-patients) were included after consent. Data were collected on demographic criteria, HIV, HCV and HBV infections, as well as on antiviral therapies. Overall, 1849 HIV-infected patients were included. The prevalence of anti-HCV or HCV RNA positivity (HCV co-infection) was 24.3% [95% confidence interval (CI): 21.3-27.6] and varied from 3.1% in men who had sex with men to 92.8% in injecting drug users (IDUs). The prevalence of positive HCV RNA was 17.0% [95% CI:14.7-19.4]. The prevalence of HBs antigen (Ag) or HBV DNA positivity was 7.0% [95% CI: 5.9-8.1] and varied with the continent of birth from 2.1% in Northern Africa to 10.8% in sub-Saharan Africa. The prevalence of HIV-HCV-HBV co-infection was 1.6% [95% CI: 1.0-2.4], mostly IDUs (83.3%). A severe liver disease (cirrhosis or hepatocellular carcinoma) was diagnosed in 24.7% of the positive HCV RNA patients.This study confirmed the burden of HCV infection in French HIV-infected patients and described for the first time in France the epidemiological characteristics of HIV-HBV co-infection. Furthermore, it stresses the severity of liver disease related to HCV in HIV-infected population.

Infectious diseases circulating in the home and community are a continuing and significant burden on the health and prosperity of the European community. They could, however, be significantly reduced by better standards of hygiene. Across Europe, public health is currently structured such that the separate aspects of hygiene in different settings (food hygiene, personal hygiene, handwashing, pandemic flu preparedness, patient empowerment etc.) are dealt with by separate agencies. If efforts to promote hygiene at community level are to be successful in changing behaviour, we need a concerted family-centred approach to ensure that a basic understanding of infectious disease agents and their mechanisms of spread, together with an understanding of a risk-based approach to hygiene, are promoted as part of the school curriculum and as part of public health campaigns. Alongside this, we also need unambiguous communication with the public on issues such as the hygiene hypothesis and environmental issues.