Eurosurveillance - Volume 14, Issue 8, 26 February 2009

The Netherlands experienced a nationwide outbreak of Shiga toxin-producing Escherichia coli (STEC) O157 with onset of symptoms from the end of December 2008 until the end of January 2009. A total of 20 laboratory-confirmed cases were linked to the outbreak strain, serotype O157: H-, stx1, stx2, eae and e-hly positive. The investigation into the source of this outbreak is still ongoing, but evidence so far suggests that infection occurred as a result of consuming contaminated raw meat (steak tartare).

An outbreak of pharyngoconjunctival fever affecting 59 children was detected in a municipality of northern Spain in July 2008. The outbreak was related to insufficient doses of water disinfectant in the municipal swimming pool. Adenovirus was detected in the pharyngeal swabs of five of six affected children and the four strains that were sequenced were all Adenovirus type 4.

A cluster of six confirmed cases with identical measles virus genotype was reported in Denmark between December 2008 and January 2009. Transmission occurred among unvaccinated children aged 15-23 months admitted to the same hospital as a 36-month-old unvaccinated girl diagnosed with measles following travel. The findings highlight the importance of vaccination before travelling and adherence to the routine vaccination schedule.

In June 2008 an outbreak of gastroenteritis was registered in Sunny Beach resort situated on the Black Sea coast in Bulgaria, affecting 14 employees of a hotel, five of whom tested positive for Salmonella Enteritidis. During June-July 2008 four sporadic S. Enteritidis cases were also reported and two of them were foreign tourists. In the same period S. Enteritidis cases connected with travel to Bulgaria were reported to the European Centre for Disease Prevention and Control (ECDC) from Finland, United Kingdom, Sweden, Germany and Norway. We describe a study performed to find out relatedness between Bulgarian and Finnish S. Enteritidis isolates using phage typing (PT) and pulse-field gel electrophoresis (PFGE). Fifteen S. Enteritidis isolates from Bulgaria and 195 from Finland (including 28 from travellers to Bulgaria) were phage typed. Within Bulgarian isolates four different PTs were found and PT6c with eight strains was predominant. Nineteen out of 28 strains isolated from the Finns visiting Bulgaria belonged also to PT6c. PFGE typing (with one enzyme) of all S. Enteritidis PT6c strains (8 Bulgarian and 19 Finnish isolates) showed indistinguishable PFGE profile. The typing results thus demonstrated a link between Bulgarian and Finnish S. Enteritidis isolates. We conclude that S. Enteritidis PT6c was the cause of a salmonellosis outbreak in Sunny Beach and was exported to Finland, and likely to the United Kingdom, Norway, Sweden and Germany.

Cryptosporidium is a protozoal parasite which is of public health interest primarily due to its frequent association with drinking water. Since cryptosporidiosis became a notifiable human disease in 2004 in Ireland, evidence has been growing as to the national burden of illness caused by this pathogen. Nationally, crude incidence rates of between 8.7 and 13.4 per 100,000 were reported annually in the period 2004-2006. Rural areas reported more cases, with regional incidence rates as high as 31.4/100,000 per year. Over this time period, there has consistently been a peak in the number of notifications in springtime, contrasting with the reported seasonal distribution of cases elsewhere in Europe. Outbreak surveillance data suggest that drinking water is an important transmission route for general outbreaks, with person-to-person spread more common in family outbreaks. Cryptosporidium is an important gastrointestinal pathogen in Ireland, with much still to be learned about its epidemiology here.