Eurosurveillance - Volume 14, Issue 29, 23 July 2009

Up to early July 2009, surveillance of H1N1 cases in France was based on the identification of all possible cases in order to implement, around each of them, control measures aimed at delaying the spread of the virus. The global dissemination of the virus and the starting community transmission in France led us to shift to a population-based surveillance relying mainly on the identification and investigation of clusters of influenza-like illness, on the identification and individual follow-up of confirmed hospitalised cases as well as on the monitoring, through various sentinel systems, of the use of ambulatory and hospital care for influenza-like symptoms.

Following the emergence of a novel influenza virus (influenza A(H1N1)v) with pandemic potential in late April 2009, public health measures were put in place in an effort to contain disease spread in Greece. These included enhanced surveillance of infections due to influenza A(H1N1)v virus, in order to continuously ascertain the situation and guide further public health action. On 15 July, Greece moved to mitigation phase. This report summarises surveillance findings in Greece during the delaying (or “containment”) phase, from 30 April to 14 July 2009.

This report describes the clinical characteristics of influenza A(H1N1)v virus infection in Osaka. By the end of May, 171 cases had been reported in Osaka. Most patients were from one school. No patient had a serious underlying medical condition.Clinical symptoms were mild and resembled those of seasonal influenza. The sensitivity of the rapid antigen test was 77%. Antivirals were given to the majority of the cases. Early antiviral treatment may have shortened the duration of fever.

The following case report describes a cluster of Escherichia coli O157 cases in the United Kingdom related to undercooked beef at a barbecue, resulting in an intensive care admission in France with haemolytic uraemic syndrome and highlighting the need to cook beef properly.

We report an outbreak of viral gastroenteritis linked to municipal drinking water in a town in northern Italy in June 2009. Over one month we identified 299 probable cases of whom 30 were confirmed for at least one of the following viruses: norovirus, rotavirus, enterovirus or astrovirus. Water samples and filters from the water system also tested positive for norovirus and enterovirus. Control measures included treating the water system with chlorine dioxide and filters with peracetic acid, while providing temporary alternative sources of drinking water to the population.

Europe has experienced more than two months of the first transmissions and outbreak of the 2009 pandemic of A(H1N1)v. This article summarises some of the experience to date and looks towards the expected autumn increases of influenza activity that will affect every country. To date the distribution of transmission has been highly heterogenous between and within countries, with one country the United Kingdom (UK) experiencing the most cases and the highest transmission rates. Most infections are mild but there are steadily increasing numbers of people needing hospital care and more deaths are being reported. An initial difference in practice between Europe and North America was over case-finding and treatment with some authorities in Europe using active case-finding, contact tracing and treatment/prophylaxis with antivirals to try and delay transmission. This article details the history of this practice in the past two months and explains how and why countries are moving to mitigation, especially treating with antivirals those at higher risk of experiencing severe disease.