Eurosurveillance - Volume 13, Issue 6, 07 February 2008

Public health surveillance remains the cornerstone of the detection of health threats requiring public health action. Two articles in this issue of Eurosurveillance refer to the challenges of epidemic intelligence activities in European Union Member States.

Gastrointestinal infections caused by Campylobacter spp. can manifest as self-limited gastroenteritis or more severe diarrhoea. They can also cause secondary complications, such as reactive arthritis and Guillian-Barré syndrome. Recent publications have indicated that Campylobacter is a leading cause of food-borne diseases in many countries in Europe, clearly surpassing former frontrunners, such as non-typhoidal Salmonella [1,2]. Furthermore, recent studies from Europe have reported a worrying rise in resistance to fluoroquinolones among Campylobacter strains [2,3]. However, few data on Campylobacter are available from Portugal. A report from 2003 singled out Portugal as the only country among 18 European states that had no existing surveillance system for Campylobacter infections in 2000 [4]. A PubMed search in February 2008, using the terms Campylobacter and Portugal, retrieved just seven publications. Only one of these reported results collected on the national level, but it was published in 1992 [5]. Official notification reports in Portugal do not include many food-borne diseases; among the bacterial infections, only cholera, salmonellosis, shigellosis and botulism are reported [6]. Furthermore, stool cultures for Campylobacter are not routinely performed in all Portuguese laboratories. .

Following the publications in Eurosurveillance on 31 January [1,2], the European Centre for Disease Prevention and Control (ECDC), the European Influenza Surveillance Scheme (EISS), the World Health Organization (WHO) and their partners have agreed to update the data on the occurrence of resistance of influenza A/H1N1 viruses to oseltamivir appearing on the ECDC and EISS websites on a weekly basis (every Thursday afternoon). Data on the ECDC website are for European Union (EU) and European Free Trade Association (EFTA) countries. The WHO has also published a global table, which it will also refresh weekly. All these data are available through an HTML page on the ECDC web-site [3]. The European data made available through EISS and the EU DG Research-funded European Surveillance Network for Vigilance Against Viral Resistance (VIRGIL) are based on the data that have been uploaded to the EISS antiviral resistance data-base by a fixed time on a Wednesday for publication on a Thursday.

This article describes a retrospective and descriptive study into the added value of ProMED-mail - the global electronic reporting system for outbreaks of emerging infectious diseases and toxins maintained by the International Society for Infectious Diseases - as an early warning system for the Netherlands Early Warning Committee (NEWC). Information about infectious disease events in foreign countries originating from ProMED-mail was retrieved from the reports of the NEWC between May 2006 and June 2007. Each event was analysed in depth in order to determine if it could have been a possible threat to public health in the Netherlands. It was determined whether these events were mentioned in other sources of information used by the NEWC besides ProMED-mail. In addition, we assessed the possible consequences of missing an event when not reading ProMED-mail or of being informed of the event with a time delay. Semi-structured interviews with stakeholders were conducted to explore other functions of ProMED-mail besides early warning. Five out of 25 events reported in ProMED-mail were assessed as a potential threat to the Netherlands, mainly because of the known vulnerability of the Netherlands for vaccine preventable diseases: an outbreak of measles in the United Kingdom and Japan, a case of poliomyelitis in Kenya, and two events concerning Highly Pathogenic Avian Influenza (HPAI) H5N1. The outbreak of measles in Japan and one case of HPAI H5N1 infection in a bird in Germany were only reported by ProMED-mail; the other potential threats were mentioned in other sources with a time delay. ProMED-mail has a limited but real added value over other sources in the early warning of threats. A more specific approach of using ProMED-mail by defining vulnerabilities of a country would be useful and efficient. ProMED-mail is appreciated for providing background and preliminary outbreak information. .

The European Centre for Disease Prevention and Control (ECDC) has a mandate to identify, assess and communicate current and emerging threats to human health from communicable diseases in the European Union (EU) [1]. The identification of threats is undertaken through the use of 'epidemic intelligence', the systematic collection and collation of information from a variety of sources, usually in real-time, which is then verified and analysed and, if necessary, activates response. .

The United Nations Joint Programme on HIV/AIDS (UNAIDS) and the World Health Organization (WHO) issued a joint statement on 1 February regarding the use of condoms as a measure of protection against the AIDS virus [1]. The statement followed an article by Switzerlands Federal AIDS Commission, which reviewed a large body of literature to conclude that certain HIV-positive people may be able to have sexual intercourse with their seronegative partners without risk of transmitting the virus.

A short course on Infectious Disease Modelling and its Applications will be run by the London School of Hygiene and Tropical Medicine from 14 to 25 July.