Eurosurveillance - Volume 16, Issue 22, 02 June 2011

Since early May 2011, a large outbreak of haemolytic uraemic syndrome (HUS) and bloody diarrhoea related to infections with Shiga toxin-producing Escherichia coli (STEC) has been observed in Germany. The outbreak is focused in the north, but cases have been reported from all German states and other countries. Since our report last week, the number of HUS cases has increased to 470 and STEC serotype O104 has been confirmed in many cases.

People with chronic hepatitis B (CHB) are a major source of incident hepatitis B virus (HBV) infection. The Department of Health in Victoria, Australia, recommends household contacts of CHB cases to be screened and funds hepatitis B vaccination for those susceptible to infection. In July 2009, two cross-sectional surveys were conducted to assess the uptake of screening and vaccination: a postal survey of the treating doctors of a random sample of 65 CHB patients and a telephone survey of these patients. Twenty-six cases reported all adult household contacts had been screened, however only eight of these 26 patients reported that all susceptible adult contacts had been fully vaccinated. In contrast, child contacts of only three cases had been screened but 15 reported all child contacts to be fully vaccinated. Half of the surveyed doctors were unaware of state-funded hepatitis B vaccine for contacts and only 10 had conducted any contact tracing. This study highlights the need for health departments to play a greater role in the management of CHB patients in order to support doctors' delivery of preventive services to people at high risk of HBV infection. These findings are relevant for all countries receiving immigrants from areas where hepatitis B is endemic.

Emergence of carbapenemase-producing Enterobacteriaceae (CPE) is currently a major public health concern worldwide. This study showed that 53 episodes of CPE infection or colonisation have been notified by French healthcare facilities since 2004. A sharp increase in the number of notifications was observed in the last three years. Oxacillinase (OXA)-48 and Klebsiella pneumoniae carbapenemase (KPC) beta-lactamases were the most frequent enzymes reported in these episodes. The index cases in most episodes were patients with a history of hospitalisation abroad within the previous year. Around a third of the episodes (n=18) led to secondary transmission in hospitals but most of them were controlled due to reinforced measures. Reinforcement of screening and control measures at national level when there is cross-border transfer of patients, along with overall reinforcement of infection control and antimicrobial stewardship worldwide, is urgently needed to contain the spread of CPE.

A prospective infection surveillance study was carried out among residents of seven nursing homes in and around Berlin, Germany, from October 2008 to August 2009. A considerable number of infections were found to occur in clusters. Active surveillance was carried out using pre-established case definitions of infections in nursing homes (McGeer criteria). Case finding was based on routine nursing files. Infection rates were calculated per 1,000 resident days. Clusters were identified using a pre-established definition. In total 511 residents were observed during 74,626 resident days (rd), and 393 infections occurred in 243 participants, giving an overall incidence of infection of 5.3 per 1,000 rd. The most common infections were gastrointestinal infections (n=122; 1.6/1,000 rd), acute respiratory disease (n=86; 1.2/1,000 rd) and urinary tract infections (n=71; 1.0/1,000 rd). Seven clusters involving 74 infections in 57 residents were observed: three of acute respiratory disease, three of acute gastrointestinal disease and one of conjunctivitis. Attack rates varied between 11% and 61%. Clusters occurred frequently in the observed nursing homes and could be detected by infection surveillance based on routine documentation.