Eurosurveillance - Volume 14, Issue 15, 16 April 2009

Salmonella enterica subsp. enterica serovar Typhimurium is a frequently occurring foodborne pathogen which causes many sporadic cases worldwide and is frequently the responsible agent in outbreaks of gastroenteritis. In elucidating outbreaks involving consumption of contaminated food, source tracing in a timely manner is imperative. Furthermore, it is important for risk managers to be able to accurately attribute sporadic cases to specific animal host species and to understand transmission routes of S. Typhimurium. Epidemiological meaningful subdivision of this serotype is therefore indispensable.

Between 1 September 2008 and 9 March 2009, 150 cases of hepatitis A were reported in Barcelona, representing a threefold increase compared with the same period in the previous two years. The majority of the cases occurred in adult men, including 87 who reported having sex with men. This indicated the possibility of an outbreak ongoing in the population of men who have sex with men (MSM) and emphasised the need to target this community with more effective vaccination programmes.

Multilocus variable number of tandem repeats analysis (MLVA) has recently become a widely used highly discriminatory molecular method for typing of the foodborne pathogen Salmonella Typhimurium. This method is based on amplification and fragment size analysis of five repeat loci. To be able to easily compare MLVA results between laboratories there is a need for a simple and definitive nomenclature for MLVA profiles. Based on MLVA results for all human S. Typhimurium isolates in Denmark from the last five years and sequence analysis of a selection of these isolates, we propose a MLVA nomenclature that indicates the actual number of repeat units in each locus. This nomenclature is independent of the equipment used for fragment analysis and, in principle, independent of the primers used. A set of reference strains is developed that can be used for easy normalisation of fragment sizes in each laboratory.

Increasing rates of Clostridium difficile infection (CDI) with an unusual, severe course have been reported in several countries; this rise has partly been ascribed to the emergence of a virulent strain, C. difficile PCR ribotype 027 (CD027). An intriguing question is whether this could be related to increasing consumption of broadspectrum antibiotics. From 1997 to 2007, the number of hospital discharges in Denmark with the diagnosis enterocolitis caused by C. difficile increased from eight to 23 per 100,000 hospital discharges. This increase was proportional to a concomitant rise in the consumption of fluoroquinolones and cephalosporins. The first outbreak of CD027 in Denmark occurred from October 2006 to August 2007 and included 13 patients, most of them elderly, admitted to three hospitals in the same region. Most of the patients had overlapping periods of admission. All patients had been treated with broadspectrum antibiotics, in particular cephalosporins and fluoroquinolones, prior to positive culture of CD027. Thirty days after confirmation of diagnosis, three of the 13 patients had died. Taken together, the data support the hypothesis that the increasing use of certain broadspectrum antibiotics may be related to a possible increase of C. difficile infection, and show that the specific contribution by CD027 in its emergence needs to be determined.

The Institut National d'Hygiène (Morocco) coordinates a consortium with the Instituto de Salud Carlos III (Spain) which is part of a project called ""Impact of migration on HIV and TB epidemiology in the Mediterranean area"", funded by the Sixth Framework Programme for Research of the European Commission. The project was launched in May 2007 and is intended as a specific support action to improve the capacity of the countries in the Euro-Mediterranean area for obtaining quality epidemiological information on human immunodeficiency virus (HIV) and tuberculosis (TB) among migrants, while taking into consideration ethical and legal issues related to health in migrant populations. To this end, the project proposed to hold two workshops [1] to bring together all the relevant stakeholders: delegates of international and national non-governmental organisations (NGOs) concerned with the process, experts and health professionals, researchers, representatives of the United Nations Agencies and other decision makers (Ministries of Health, Interior and Justice). .