Eurosurveillance - Volume 20, Issue 7, 19 February 2015

Two cases of human cutaneous anthrax were reported in September 2014 in south-western Bosnia and Herzegovina. The two men were involved in slaughtering a cow and handled its Bacillus anthracis-infected meat. Anthrax has been sporadically observed in livestock in Bosnia and Herzegovina, but no confirmed human cases had been reported in the country in the last two decades. Clinicians in the country should be aware that anthrax may occur in humans, arising from exposure to infected animals.

Data on long-term impact of universal national vaccination programmes against hepatitis A are lacking. We aimed at evaluating the impact on hepatitis A incidence of the Israeli toddlers-only universal routine two-dose vaccination programme against hepatitis A initiated in 1999. All hepatitis A episodes reported to the national surveillance system from 1993 to 2012 were analysed in relation to the vaccination programme and coverage. Mean vaccine coverage in Israel between 2003 and 2010 was 92% for the first dose, given at 18 months of age, and 88% for the second dose, given at 24 months. The annual hepatitis A incidence declined from a mean of 50.4 per 100,000 in the period between 1993 and 1998 to a mean of?<1.0, during the period from 2008 to 2012, representing a reduction of?>98%. The decline was evident in all ages and ethnicity groups, including unvaccinated populations. Of the 1,247 cases reported nationwide between 2002 and 2012, the vaccination status could be ascertained in 1,108 (89%). Among them, only 20 (2%) were reported be vaccinated with one dose and three (<1%) received two doses. The sustained results of this long-term impact study suggest that a toddlers-only universal routine two-dose vaccination programme is highly effective and practical. These findings underscore the importance of sustainability in both the surveillance systems and vaccination programmes and will aid to determine vaccination policies.

Since July 2009, there has been a community outbreak of leishmaniasis in south-west Madrid, Spain. The present study used the spatial distribution of cases to investigate the connection between the outbreak and a recently built peri-urban park. We included 157 cases of cutaneous (CL) and 90 cases of visceral (VL) leishmaniasis diagnosed at Fuenlabrada University Hospital between July 2009 and April 2013. CL and VL cases were geo-referenced and incidence rates by census tract were calculated. To identify high-risk areas, the spatial autocorrelation between individual cases was estimated. In a next step, areas where risk of disease was significantly increased were identified by cluster analysis. Higher incidence rates and the areas with highest intensity of CL and VL were located in the north-western part of the municipality. The most likely cluster of CL comprised three census tracks with relative risk (RR)?=?11.5 (95% confidence interval (CI): 9.2-13.6). Two additional significant VL clusters were detected, the most likely one with RR?=?9.2 (95% CI: 7.3-11.1). In addition, we found one significant VL cluster in the immigrant population (RR?=?12.8; 95% CI: 9.3-16.1). The spatial pattern of leishmaniasis transmission revealed a relation between the outbreak and the suspected risk area. .

This study was aimed at estimating the risk of all types of adverse events following immunisation (AEFI), neurological events and convulsions following the co-administration of 13-valent pneumococcal polysaccharide conjugate vaccine (PCV13) with hexavalent vaccine. Paediatric spontaneous reports and exposure to vaccinations in four Italian regions were available. The estimated incidence rate ratio (IRR) for AEFI following co-administration of hexavalent vaccine with either PCV13 or PCV7 was 1.08 (95% confidence interval (CI): 0.91-1.28); the IRR for, respectively, neurological events and convulsion following co-administration of PCV13 with hexavalent vaccine were 1.27 (95% CI: 0.85-1.89) and 1.43 (95% CI: 0.70-2.91). Co-administration of PCV13 with hexavalent vaccine had a protective effect against AEFI (IRR?=?0.59; 95% CI: 0.49-0.72). This protective effect was not observed for neurological events or convulsions following co-administration of PCV13 with hexavalent vaccine compared with single administration (IRR?=?1.44; 95% CI: 0.77-2.67 and IRR?=?1.46; 95% CI: 0.50-4.25, respectively). We observed a trend of increased risk of neurological events or convulsions following PCV13 used in routine practice. Analysis of spontaneously reported data is a quick method to estimate associations between vaccines and less common adverse events. Given methodological limitations these findings cannot be conclusive and require further investigations. .

The response to the emergence of the 2009 influenza A(H1N1) pandemic was the result of a decade of pandemic planning, largely centred on the threat of an avian influenza A(H5N1) pandemic. Based on a literature review, this study aims to define a set of new pandemic scenarios that could be used in case of a future influenza pandemic. A total of 338 documents were identified using a searching strategy based on seven combinations of keywords. Eighty-three of these documents provided useful information on the 13 virus-related and health-system-related parameters initially considered for describing scenarios. Among these, four parameters were finally selected (clinical attack rate, case fatality rate, hospital admission rate, and intensive care admission rate) and four different levels of severity for each of them were set. The definition of six most likely scenarios results from the combination of four different levels of severity of the four final parameters (256 possible scenarios). Although it has some limitations, this approach allows for more flexible scenarios and hence it is far from the classic scenarios structure used for pandemic plans until 2009.