Eurosurveillance - Volume 19, Issue 30, 31 July 2014

We describe four cases in Sweden of verified treatment failures of pharyngeal gonorrhoea with ceftriaxone (500 mg; n=3) or cefotaxime (500 mg; n=1) monotherapy. All the ceftriaxone treatment failures were caused by the internationally spreading multidrug-resistant gonococcal NG-MAST genogroup 1407 clone. Increased awareness of treatment failures is crucial particularly when antimicrobial monotherapy is used. Frequent test of cure and appropriate verification/falsification of suspected treatment failures, as well as implementation of recommended dual antimicrobial therapy are imperative.

Crimean-Congo haemorrhagic fever (CCHF) was diagnosed in a United Kingdom traveller who returned from Bulgaria in June 2014. The patient developed a moderately severe disease including fever, headaches and petechial rash. CCHF was diagnosed following identification of CCHF virus (CCHFV) RNA in a serum sample taken five days after symptom onset. Sequence analysis of the CCHFV genome showed that the virus clusters within the Europe 1 clade, which includes viruses from eastern Europe.

We investigated a Q fever outbreak with human patients showing high fever, respiratory tract symptoms, headache and retrosternal pain in southern Hungary in the spring and summer of 2013. Seventy human cases were confirmed by analysing their serum and blood samples with micro-immunofluorescence test and real-time PCR. The source of infection was a merino sheep flock of 450 ewes, in which 44.6% (25/56) seropositivity was detected by enzyme-linked immunosorbent assay. Coxiella burnetii DNA was detected by real-time PCR in the milk of four of 20 individuals and in two thirds (41/65) of the manure samples. The multispacer sequence typing examination of C. burnetii DNA revealed sequence type 18 in one human sample and two manure samples from the sheep flock. The multilocus variable-number tandem repeat analysis pattern of the sheep and human strains were also almost identical, 4/5-9-3-3-0-5 (Ms23-Ms24-Ms27-Ms28-Ms33-Ms34). It is hypothesised that dried manure and maternal fluid contaminated with C. burnetii was dispersed by the wind from the sheep farm towards the local inhabitants. The manure was eliminated in June and the farm was disinfected in July. The outbreak ended at the end of July 2013.

Identification of acute hepatitis A virus (HAV) infection in a foodhandler in a London hotel led to a large incident response. We identified three potentially exposed groups: hotel staff who had regularly consumed food prepared by the case and shared toilet facilities with the case, patients who shared the same hospital ward as the case and hotel guests who consumed food prepared by the case. We arranged post-exposure HAV vaccination for all 83 potentially exposed hotel staff and all 17 patients. We emailed 887 guests advising them to seek medical care if symptomatic, but did not advise vaccination as it was too late to be effective for most guests. Through the International Health Regulations national focal points and the European Union Early warning and response system (EWRS), we communicated the details of the incident to public health agencies and potential risk of HAV transmission to international guests. Potentially exposed hotel staff and guests were asked to complete an online or telephone-administered questionnaire 50 days following possible exposure, to identify any secondary cases. Survey response was low, with 155 responses from guests and 33 from hotel staff. We identified no secondary cases of HAV infection through follow-up.