Eurosurveillance - Volume 15, Issue 4, 28 January 2010

Currently an investigation is ongoing to explore and control an outbreak of Legionnaires’ disease, affecting 65 people as of 22 January 2010, in the cities of Ulm and Neu-Ulm, south-west Germany. A hitherto unidentified wet cooling system in these twin cities is considered as the most likely source of infection.

Highly pathogenic avian influenza A(H5N1) has ravaged the Egyptian poultry population. Ninety human cases, including 27 fatalities have been recorded by 30 December, 2009. However, epidemiological information on the infection in humans in Egypt is scarce. We analysed the first three years of highly pathogenic avian influenza A(H5N1) in Egypt between 20 March 2006 and 31 August 2009) and found that more cases occurred in females than males, especially in 2006 and 2007. Women in the age group 20-39 years had the greatest tendency to be infected. It took an average of one day and 18 hours to seek medical assistance in patients who recovered and of six days in fatal cases. Children sought treatment much earlier than adults. On average, a patient died 11 days after the onset of symptoms. Exposure to infected poultry remained the most important risk factor.

Campylobacter is the most commonly reported enteric bacterial pathogen in humans. We still do not have any systematic data concerning campylobacteriosis in Bulgaria. For that reason, we present data of the thermophilic Campylobacter jejuni and Campylobacter coli in the aetiology of diarrhoeal diseases in Sofia, for the period from 1987 to 2008. The study included patients from 0 to over 65 years-old. A total of 51,607 faecal specimens were screened for Campylobacter. C. jejuni and C. coli were detected in 3.58% (1,847) of the strains, with the highest percentage in 1988 (7.5%) and the lowest in 2006 (0.3%). Campylobacteriosis occurred most frequently in the wet months of March, April, May and June, with 105, 102, 124 and 141 cases, respectively, and was rare in January with 25 cases. The most affected groups were children between 0 and 4 years of age (52%) and between five and 14 years of age (30%). Campylobacter infection occurred in 22% of all bacterial gastrointestinal diseases in the city of Sofia during the study period. Salmonella was the most frequently identified pathogen with 32%, followed by Shigella (30%), Campylobacter (22%) and diarrhoeagenic Escherichia coli (16%). The study shows that Campylobacter plays an important role as a bacterial cause of enterocolitis in Sofia, Bulgaria.

Phage typing has for decades been useful as a phenotypical, definitive method for epidemiological characterisation of Salmonella Typhimurium. The system recommended by the World Health Organization (WHO) Collaborative Centre for phage typing of Salmonella has, however, become rather complex, and the present study illustrates the challenges of sufficient standardisation of the interpretation of lysis results to make sure that the same strain is assigned to the same phage type in different laboratories. Even though molecular typing methods will replace phenotypic characterisation methods in the future, it is our opinion that phage typing will remain for some time a useful tool to strengthen global Salmonella surveillance. Therefore, improved standardisation and quality assurance is essential to obtain a robust and harmonised method that allows comparison of results between laboratories.