Eurosurveillance - Volume 13, Issue 3, 17 January 2008

The community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) clone known as ST8, t008 or USA300 is widespread in the United States (US) [1] and has been reported from Canada [2] and from several European countries [3-8]. It is characterised by a particular pulsed-field gel electrophoresis (PFGE) pattern, staphylococcal protein A (spa) type t008, multi locus sequence type 8 (ST8), Staphylococcal Cassette Chromosome mec (SCCmec) type IVa and encoding Panton-Valentine leukocidin (PVL). It can cause severe skin and soft tissue infections, endocarditis, sepsis, (necrotizing) pneumonia and neonatal death, and is spread by skin-to-skin contact. Transmission has been observed via contact sports [9,10] and in prison inmates [11], and it has now become a common cause of hospital-acquired infection in US hospitals [12,13]. In recent years, relatively large outbreaks of severe skin infection in men who have sex with men (MSM) caused by MRSA strains with the PVL gene were reported from the US [14-17]. In Europe, severe infections with PVL-positive S. aureus strains have been reported from France, Scotland, Sweden and the Netherlands [18]. Some, but not all, were in MSM. A study due to be published in the 19 February issue of Annals of Internal Medicine [19] has received prominent attention in the world's media this week, because it concludes that infection with multidrug-resistant USA300 (ST8) MRSA is common among MSM in San Francisco and Boston, and that infection may be sexually transmitted within the MSM community. Clinical manifestations include infections of the buttocks, genitals and the perineum. Male-male sex and previous MRSA infection are found to be independently associated with acquiring the multidrug-resistant strain. The same strain was also found in a homosexual man in Boston suggesting sexual transmission. HIV infection appeared not to be independently associated with the specific clone. .

In Italy, a national surveillance system for chikungunya fever coordinated by the National Public Health Institute has been in place since August 2006. In summer 2007, an outbreak of chikungunya fever affected the Italian provinces of Ravenna, Cesena-Forli and Rimini [1-3]. As of 16 December 2007, health authorities identified 214 laboratory-confirmed cases with date of onset from 15 July to 28 September 2007. Most cases (161) occurred in the two neighbouring villages of Castiglione di Cervia and Castiglione di Ravenna, but limited local transmission also took place in the cities of Ravenna, Cesena, Cervia, and Rimini. In September 2007, two confirmed cases (two women aged 68 and 70) were reported among residents of the city of Bologna (373,026 inhabitants). Both had a history of travel in the affected areas (municipality of Cervia). No unusual increase in the density of Aedes albopictus mosquitoes in the Bologna area was noted at that time (September).

Salmonellosis is a frequently occurring disease in Europe. Through their national surveillance systems, the European Union (EU) Member States collect a substantial amount of information on cases of salmonellosis, which may be used to gain new insights into the epidemiological characteristics of the many different Salmonella serotypes. One simple approach to this is by visualising the spatial distribution of the cases on maps.

Infective processes in the brain, spinal cord and meninges are considered to be the main causes of encephalitis, myelitis and meningitis. However, most cases remain unexplained. The incidence of different viral aetiologies (zoonotic and non-zoonotic) is especially poorly estimated, due to the lack of a standard case definition and of agreed diagnostic algorithms, including harmonised diagnostic methods and sample collection. It is important to clarify the incidence of viral encephalitis/meningitis and to optimise the diagnosis of infectious neurological illness, particularly to ensure early recognition of outbreaks or emerging infections such as West Nile encephalitis. The European Network for Diagnostics of 'Imported' Viral Diseases (ENIVD) has analysed the present surveillance situation for viral encephalitis/meningitis in Europe. Here we give an overview of the existing epidemiological sources of information in European Union (EU) Member States, mapping the laboratory capacity and identifying key requirements for a possible future surveillance study at European level. The data presented will help design a harmonised/standardised Europe-wide surveillance study investigating patients with encephalitis and/or meningitis in order to obtain more information on the role of infections in these rarely analysed syndromes, both from a clinical and an epidemiological perspective. .

The International Meeting on Microbial Epidemiological Markers (IMMEM-8, http://www.immem-8.org), will be held on 14-17 May 2008, in Zakopane, Poland.