Eurosurveillance - Volume 13, Issue 35, 28 August 2008

On 5 August 2008, the National Reference Laboratory of Salmonella (NRLS) noted an increase in the number of isolates of Salmonella enterica serotype Kedougou. As of 22 August, 29 isolates have been reported during 2008, which is ten times more than the average number of isolates identified by the NRLS during 2002-2007. All isolates have a typical, indistinguishable Pulse Field pattern (SALKEDXB-1, Spanish code) and are fully sensitive to the standard suite of antimicrobials.

To date, 110 cases of measles have been identified by local health authorities in the Bourgogne and Nord-Pas-de-Calais regions of France, with onset of symptoms between 3 May and 19 July. The first three cases were reported on 25 June by a general practitioner to the French national institute of health (Institut de Veille Sanitaire, InVS) regional office in Bourgogne, in the centre of France. The three unvaccinated cases were students at a private religious school for girls located in Bourgogne and had onset of rash between mid-May and 23 June. On the same day, another general practitioner in Nord-Pas-de-Calais reported a case of measles in an unvaccinated 14 year-old boy attending a private religious boarding school for boys. The boy had developed a rash on 19 June and happened to live in the same place in Bourgogne where the above-mentioned girls' school was located. The two schools have elementary to secondary students. Both are private religious boarding schools. Most of the students come from the surrounding areas, some resident pupils are from other French regions, and some from abroad. All students returned home on 26 June for summer holidays.

Vaccination with the 7-valent pneumococcal conjugate vaccine (PCV) has been recommended in France since 2003 for children under the age of two years who are at risk due to medical or living conditions. From 2006, the recommendation has been extended to all children under two years. The impact of PCV introduction on the incidence of pneumococcal meningitis and bacteraemia and on the serotype distribution in French children and other age-groups was assessed using laboratory surveillance data. The coverage with three doses of PCV was 44% in children aged 6-12 months in 2006. From 2001/2002 to 2006, the incidence of pneumococcal meningitis decreased from 8.0 to 6.0 cases per 100,000, and the incidence of pneumococcal bacteraemia decreased from 21.8 to 17.5 cases per 100,000 in children under the age of two years. For the vaccine strains, the incidence of pneumococcal meningitis and bacteraemia decreased from 20,4 to 6.0 cases per 100,000, while the incidence of pneumococcal meningitis and bacteraemia due to non-vaccine strains increased from 9.4 to 17.5 cases per 100,000 in this time period. The incidence in older children and adults did not decrease. Further expansion of PCV coverage is expected to increase the impact of the vaccination in both children and adults. However, the fact that cases caused by vaccine serotypes have been partially substituted by cases of non-vaccine serotypes is likely to reduce the overall benefit of PCV in France, should this early observation be confirmed in the future.

Methicillin-resistant Staphylococcus aureus (MRSA) is associated with increased mortality and morbidity and a leading cause of hospital-acquired infections. Community-acquired (CA)-MRSA are a growing concern worldwide. In the last 10 years, an increase in the MRSA rate from 2% to approximately 23% has been observed in Germany, while a rate under 5% has been recorded for many years in the Netherlands and Scandinavia. In the Netherlands in particular, MRSA rates have become very low in stationary care due to a consistent 'search and destroy' policy. The main focus in Germany lies on hospital-acquired MRSA, whereas the Netherlands focus on the control of the importation of MRSA cases from abroad and on CA-MRSA. As MRSA in hospitals and in the community can be a problem in cross-border health care, the European Union-funded EUREGIO MRSA-net project was established in the bordering regions Twente/Achterhoek, the Netherlands and Münsterland, Germany. The main aim of the project is the creation of a network of the major health care providers in the EUREGIO and the surveillance and prevention of MRSA infections. A spa-typing network was established in order to understand the regional and cross-border dissemination of epidemic and potentially highly virulent MRSA genotypes. As the reduction of differences in health care quality is an important prerequisite for cross-border health care, a transborder quality group comprising hospitals, general practitioners, public health authorities, laboratories, and insurerance companies has been established since 2005 equalising the quality criteria for the control of MRSA on both sides of the border. .