Eurosurveillance - Volume 14, Issue 46, 19 November 2009

Analysis of all complete genome sequences of the pandemic influenza A(H1N1)v virus available as of 10 September 2009 revealed that two closely related but distinct clusters were circulating in most of the affected countries at the same time. The characteristic differences are located in genes encoding the two surface proteins - haemagglutinin and neuraminidase - and four internal proteins – the polymerase PB2 subunit, nucleoprotein, matrix protein M1 and the non-structural protein NS1. Phylogenetic inference was demonstrated by neighbour joining, maximum likelihood and Bayesian trees analyses of the involved genes and by tree construction of concatenated sequences.

Surveillance is a key component of the French plan for prevention of healthcare-associated infection (HAI) and has progressively evolved in the past decades. We describe the development and current organisation of surveillance of HAI in France and summarise key achievements and results. Surveillance of HAI is under the auspice of the national institute for public health surveillance through a central coordinating structure, the Réseau d’alerte, d’investigation et de surveillance des infections nosocomiales (RAISIN), which consists of five regional coordinating structures, two national advisory committees of the Ministry of Health and public health agencies. Surveillance includes the performance of national prevalence surveys every five years (latest in 2006), specific surveillance networks to follow trends and characterise HAI that are national priority, and mandatory reporting of HAI that meet specific criteria for alert purposes. RAISIN prioritises activities, defines technical specifications of surveillance systems, coordinates their implementation, and supports response to alerts, emergences or outbreaks of HAI. We demonstrate that the French surveillance program of HAI has become comprehensive and contributes to evaluating the impact of control and prevention of HAI. Data from RAISIN indicate a general decrease in the risk of HAI in acute care in France. They show a decrease in HAI during recent years, particularly of those related to methicillin-resistant Staphylococcus aureus (MRSA) for which a drop of 38% was documented between 2001 and 2006. RAISIN is also integrated into European surveillance of HAI coordinated by the European Centre for Disease Control.

During the 2007-08 influenza season, high levels of oseltamivir resistance were detected among influenza A(H1N1) viruses in a number of European countries. We used surveillance data to describe influenza A(H1N1) cases for whom antiviral resistance testing was performed. We pooled data from national studies to identify possible risk factors for infection with a resistant virus and to ascertain whether such infections led to influenza illness of different severity. Information on demographic and clinical variables was obtained from patients or their physicians. Odds ratios for infection with an oseltamivir resistant virus and relative risks for developing certain clinical outcomes were computed and adjusted through multivariable analysis. Overall, 727 (24.3%) of 2,992 tested influenza A(H1N1) viruses from 22 of 30 European countries were oseltamivir-resistant. Levels of resistance ranged from 1% in Italy to 67% in Norway. Five countries provided detailed case-based data on 373 oseltamivir resistant and 796 susceptible cases. By multivariable analysis, none of the analysed factors was significantly associated with an increased risk of infection with an oseltamivir-resistant virus. Similarly, infection with an oseltamivir-resistant virus was not significantly associated with a different risk of pneumonia, hospitalisation or any clinical complication. The large-scale emergence of oseltamivir-resistant viruses in Europe calls for a review of guidelines for influenza treatment.

This paper documents the progress of human papillomavirus (HPV) vaccine introduction in Belgium. Information on vaccine use is based on sales statistics and reimbursement claims. From November 2007 to November 2008, the National Institute for Health and Disability Insurance reimbursed the HPV vaccine for girls aged between 12-15 years. In December 2008, the age limit was extended to include girls up to the age of 18. In November 2008, the total number of HPV vaccines sold exceeded 530,000 doses. The number of vaccines reimbursed in Belgium, for the period November 2007-November 2008, corresponds to the amount required to fully vaccinate 44% of all girls aged between 12-15 years. However, the trend was decreasing over the last 10 months. By the current reimbursement policy, we can expect that maximum half of the target population can be reached. In Flanders (one of the three Communities in Belgium), the intention is to start, from September 2010, with a free school-based HPV immunisation for girls in the first year of secondary school (12 years of age), complemented with vaccination by a physician of choice. This strategy ensures a higher HPV vaccine coverage which is expected to be as high as the current coverage in the hepatitis B vaccination programme (approximately 80%) offered to boys and girls in the same age group and under the same circumstances.