Eurosurveillance - Volume 15, Issue 37, 16 September 2010

Australian and New Zealand health authorities identified seasonal trivalent inactivated influenza vaccines manufactured by CSL Biotherapies as the probable cause of increased febrile convulsions in children under five within 24 hours of vaccination and recommended against their use in this age group. We quantified the benefit-risk profile of the CSL vaccines using the number needed to vaccinate and suggest they might have caused two to three hospital admissions due to febrile convulsions for every hospital admission due to influenza prevented.

TA cluster of hepatitis A cases in the Orthodox Jewish community in London, United Kingdom in July 2010 has triggered extensive contact tracing and vaccination. Two primary cases imported from a common source in Israel and three secondary cases have resulted in immunisation of over 900 contacts to date. Rapid response by local public health, primary care services and a dedicated community health team, and active hepatitis A vaccination rather than immunoglobulin treatment were used to avert a larger outbreak.

Between December 2008 and September 2009, 11 cases of invasive meningococcal disease (IMD) group B were reported in a 20 km diameter area in the Département Landes, France. Two of them presented with purpura fulminans and one of them died. The strain responsible for this community outbreak was of the clonal complex ST-269.The incidence rate for IMD group B was 3 per 100,000 inhabitants in Landes from week 40 in 2008 to week 40 in 2009; it was the highest in France during that period. The number of cases observed was significantly higher than expected, especially in young adults (standardised incidence ratio: 23.5, p<0.001). A nightclub located in the 20 km diameter area was a possible place of transmission and a prophylaxis recommended for the staff members helped in decreasing the transmission. However, several cases notified later suggested that the bacteria circulated during several months through healthy carriers in the community. This situation prompted increased surveillance of IMD in Landes and medical practitioners were asked to remain vigilant because of the possible emergence of new cases within the following months. .

In July 2008 an onychomadesis outbreak in a nursery setting was reported in Saragossa (Spain). Some of the cases had previously suffered from hand, foot and mouth disease (HFMD). In order to study the outbreak and to determine the relation between the two diseases, two epidemiological studies were conducted: a descriptive study focused on cases and a retrospective cohort study. Samples from stool, pharynx and nails were obtained from cases for microbiological analysis. During the study period, 27 children fulfilled the case definition. The average age was 1.8 years. A case shed on average four nails (minimum one maximum twelve). Twenty-four of the 27 cases had previously presented with HFMD which started an average of 40 days before the onset of onychomadesis (relative risk: 14). Unidentified non-polio enterovirus (n=10), coxsackie B1 (n=4) and coxsackie B2 virus (n=3) were isolated in 28 specimens obtained from 14 cases. The analysis showed a strong association between HMFD and onychomadesis. Microbiological results have not been conclusive; consequently more studies are necessary to determine the causal agent of infectious onychomadesis.