Eurosurveillance - Volume 16, Issue 50, 15 December 2011

Emergence of influenza viruses from the animal reservoir is a permanent challenge. The rapid description and immediate sharing of information on these viruses is invaluable for influenza surveillance networks and for pandemic preparedness. With the help of data generated from the World Health Organization Collaborating Centre for Reference and Research on Influenza at the United States Centers for Disease Control and Prevention*, we provide here information on the swine-origin triple reassortant influenza A(H3N2) viruses detected in human cases in the north-east of the United States. .

The 2011 influenza season (May to October) in the southern hemisphere was dominated by the A(H1N1) viruses that emerged during the 2009 influenza A(H1N1) pandemic and influenza B viruses, although the proportion of these two varied between and within countries. Some influenza A(H3N2) viruses were also seen. We discuss here the preliminary implications for Europe of the 2011 influenza season in five temperate southern hemisphere countries.

In October 2011, a child who had arrived in Sweden from Somalia presented with atypical tonsillitis, was treated with penicillin and the symptoms resolved. A throat swab was positive for toxigenic Corynebacterium diphtheriae. The child's family were then vaccinated with diphtheria, tetanus and pertussis vaccine and screened for C. diphtheriae. No secondary cases were found. A high level of adherence to childhood vaccination programmes is an effective way to protect populations against diphtheria. .

We report the first documented case of OXA-48-producing Klebsiella pneumoniae in Slovenia isolated from rectal surveillance cultures from a patient transferred from Libya. The patient was colonised with both ESBL-producing Escherichia coli and ESBL- and OXA-48-producing K. pneumoniae. Three further patients were colonised with ESBL-producing E. coli. This underscores the importance of an early warning system on European level and screening upon admission of patients transferred across borders and between healthcare systems.

In March 2010 the Rapid Alert System for Food and Feed (RASFF) was used to inform about Salmonella Montevideo in a herbal food supplement, formulated in capsules, distributed under a Dutch label in Germany. Simultaneous to the first RASFF notice, in the last two weeks of March 2010 an unusual number of 15 infections with S. Montevideo was notified within the electronic reporting system for infectious diseases at the Robert Koch Institute. Adult women (median age: 43, range: 1-90 years) were mainly affected. An outbreak was suspected and the food supplement hypothesised to be its vehicle. Cases were notified from six federal states throughout Germany, which required efficient coordination of information and activities. A case-control study (n=55) among adult women showed an association between consumption of the specific food supplement and the disease (odds ratio (OR): 27.5, 95% confidence interval (CI): 3.1-infinity, p-value=0.002). Restricting the case-control study to the period when the outbreak peaked (between 29 March and 11 April 2010) resulted in an OR of 43.5 (95% CI: 4.8-infinity, p-value=0.001). Trace-back of the supplement's main ingredient, hemp seed flour, and subsequent microbiological testing by pulsed-field gel electrophoresis supported its likely role in transmission. This outbreak investigation illustrates that information from RASFF may aid in hypothesis generation in outbreak investigations, though likely late in the outbreak. .