Eurosurveillance - Volume 18, Issue 24, 13 June 2013

In May 2013, Middle East Respiratory Syndrome Coronavirus (MERS-CoV) infection was diagnosed in an adult male in France with severe respiratory illness, who had travelled to the United Arab Emirates before symptom onset.

Detection of human cases of Middle East Respiratory Syndrome Coronavirus (MERS-CoV) infection internationally is a global public health concern. Rigorous risk assessment is particularly challenging in a context where surveillance may be subject to under-ascertainment and a selection bias towards more severe cases. We would like to assess whether the virus is capable of causing widespread human epidemics, and whether self-sustaining transmission is already under way. Here we review possible transmission scenarios for MERS-CoV and their implications for risk assessment and control. We discuss how existing data, future investigations and analyses may help in reducing uncertainty and refining the public health risk assessment and present analytical approaches that allow robust assessment of epidemiological characteristics, even from partial and biased surveillance data. Finally, we urge that adequate data be collected on future cases to permit rigorous assessment of the transmission characteristics and severity of MERS-CoV, and the public health threat it may pose. Going beyond minimal case reporting, open international collaboration, under the guidance of the World Health Organization and the International Health Regulations, will impact on how this potential epidemic unfolds and prospects for control.

Between 2007 and 2010, the Netherlands experienced one of the largest outbreaks of Q fever. Since asymptomatic Coxiella burnetii infection has been associated with maternal and obstetric complications, evidence about the effectiveness of routine screening during pregnancy in outbreak areas is needed. We performed a clustered randomised controlled trial during the Dutch outbreak, in which 55 midwife centres were randomised to recruit pregnant women for an intervention or control strategy. In both groups a serum sample was taken between 20 and 32 weeks of gestation. In the intervention group (n=536), the samples were analysed immediately by indirect immunofluorescence assay for the presence of IgM and IgG (phase I/II) and treatment was given during pregnancy in case of an acute or chronic infection. In the control group (n=693), sera were frozen for analysis after delivery. In both groups 15% were seropositive. In the intervention group 2.2% of the women were seropositive and had an obstetric complication, compared with 1.4% in the control group (Odds ratio: 1.54 (95% confidence interval 0.60-3.96)). During a large Q fever outbreak, routine C. burnetii screening starting at 20 weeks of gestation was not associated with a relevant reduction in obstetric complications and should therefore not be recommended.

 We evaluated the epidemiology of and trends in primary nosocomial candidemia within a network of 682 German intensive care units (ICUs) during 2006 to 2011. Nosocomial laboratory-confirmed bloodstream infection (NLCBI) was diagnosed using standard definitions from the United States Centers for Disease Control and Prevention. Incidences were calculated by NLCBI per 1,000 patients and incidence densities per 1,000 patient-days and per 1,000 central-line days. In the 682 ICUs, there were 2,220,803 patients, 7,943,615 patient-days and 5,363,026 central-line days. A total of 381 of the 6,666 NLCBIs were associated with Candida albicans, 142 with non-albicans Candida. Non-albicans Candida made up 26% of all the Candida isolates. The mean incidence density of Candida central line-associated NLCBIs was 0.09 per 1,000 central-line days and remained unchanged between 2006 and 2011. Crude ICU mortality was 21.9% for C. albicans and 29.7% for non-albicans Candida. Candida was the fourth leading cause of primary NLCBIs, accounting for 6.5% of all bloodstream infections acquired in ICUs. Based on an incidence density of 0.07 per 1,000 patient-days, extrapolation of our data resulted in 465 primary nosocomial Candida NLCBIs in German ICUs per year. Our data show that there was no increase in primary Candida NLCBIs during 2006 to 2011.