Eurosurveillance - Volume 13, Issue 33, 14 August 2008

The development of efficient human papillomavirus (HPV) vaccines has required long lasting and tremendous research and development efforts by both academia and industry. However, their availability now turns out to be a major challenge for the public health services of many member states within the European Union (EU) and beyond.

An outbreak of gastroenteritis affecting residents in the United Kingdom, Ireland and Finland is currently being investigated. As of Wednesday 13 August, a total of 119 cases have been identified. An investigation that includes interviews of persons with Salmonella Agona infections, comparison of pulsed field gel electrophoresis (PFGE) profiles of S. Agona isolates from cases and also food samples from an Irish food production company and retail outlet chain supplied by the company, suggests that food products from that company may be related to some of these cases. A number of food products including beef steak strips, chicken in various forms, bacon in various forms, and pork have been withdrawn (see: http://www.fsai.ie/ for details). The investigation is ongoing.

A 46-year-old woman with disseminated intravascular coagulation (DIC) died in a hospital in Alexandroupoli, in north-eastern Greece, in the end of June 2008. The woman was admitted to the hospital four days earlier, with fever, malaise, myalgia, chills and abdominal pain. One day before death, her condition deteriorated rapidly and she developed heavy hemorrhage from the genital tract, DIC and multi-organ failure. The patient reported a tick bite four days before admission, and that she had tried to remove the tick herself. No travel abroad was reported. She was engaged in agricultural activities in a rural area near the town of Komotini, in Rhodope prefecture, south of the Greek-Bulgarian border.

Crimean-Congo haemorrhagic fever (CCHF) is a disease caused by a virus belonging to Bunyaviridae family. CCHF virus isolation and/or disease have been reported from more than 30 countries in Africa, Asia, south-eastern Europe, and the Middle East [1]. The main transmission routes of the virus are tick-bite and contact with tissues, body fluids and blood of infected animals [1-4]. Nosocomial transmission is another important route of infection [1]. The incubation period is generally described as 1-3 days after tick-bite and 5-6 days after exposure to infected animal or human blood or body fluid, but it can be longer. Fever, chills, headache, fatigue and myalgia are the most common symptoms in the pre-haemorrhagic period. The disease progresses to haemorrhagic form in severe cases [1]. The fatality rate of disease is reported between 7.5-50% in hospitalised patients [4-7]. This wide range may due to phylogenetic variation of the virus, transmission route and different treatment facilities [4-7].

The European Union Member States are simultaneously considering introducing HPV vaccination into their national immunisation schedules. The Vaccine European New Integrated Collaboration Effort (VENICE) project aims to develop a collaborative European vaccination network. A survey was undertaken to describe the decision status and the decision-making process regarding the potential introduction of human papillomavirus (HPV) vaccination into their national immunisation schedules. A web-based questionnaire was developed and completed online in 2007 by 28 countries participating in VENICE. As of 31 October 2007, five countries had decided to introduce HPV vaccination into the national immunisation schedule, while another seven had started the decision-making process with a recommendation favouring introduction. Varying target populations were selected by the five countries which had introduced the vaccination. Half of the surveyed countries had undertaken at least one ad hoc study to support the decision-making process. According to an update of the decision-status from January 2008, the number of countries which had made a decision or recommendation changed to 10 and 5 respectively. This survey demonstrates the rapidly evolving nature of HPV vaccine introduction in Europe and the existence of expertise and experience among EU Member States. The VENICE network is capable of following this process and supporting countries in making vaccine introduction decisions. A VENICE collaborative web-space is being developed as a European resource for the decision-making process for vaccine introduction.