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Eurosurveillance Weekly: Thursday 3 June 1999. Volume 3, Issue 23
Contents
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6.
From the editors: What Eurosurveillance Weekly is about
Outbreak of legionnaires' disease associated with a spa resort in Spain
New infectious disease law for the Netherlands
Malaria in Denmark: 1998
Meningococcal disease in students
June edition of Eurosurveillance is now available on the Internet
From the editors: What Eurosurveillance Weekly is about
This is a relatively short issue of Eurosurveillance Weekly, but it illustrates the purpose of the
bulletin. Four of the articles describe an outbreak currently being investigated in one
European country that could affect others, a new national law that should improve public
health practice and may suggest a way forward for policymakers in other countries, results of
surveillance of imported malaria in a European country, and a cohort study of a disease that
causes considerable morbidity and mortality worldwide. The sources of information are
national and regional public health officials, national bulletins, and a peer reviewed journal.
They represent several countries - Spain, the Netherlands, Denmark, the United States (and
the United Kingdom only in passing).
A research letter in the Lancet last week considered the numbers of biomedical publications
listed in Medline from 1990 to 1998 attributable to different European Union countries (based
on the country of the corresponding authors’ affiliations) and analysed by gross domestic
product and population size. For what it’s worth, the rank orders from their figures are
tabulated here - the figures show that many of the rates are not significantly different (table).
Table
Rank order
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
Publications/ECU 1
billion GDP/year
(1990-98)
Sweden
Finland
Netherlands
Denmark
Belgium
Ireland
United Kingdom
EC
Italy
France
Spain
Greece
Austria
Germany
Portugal
Luxembourg
Publications/100 000
population/year
(1990-98)
Sweden
Denmark
Finland
Netherlands
Spain
Belgium
Ireland
United Kingdom
France
EC
Austria
Italy
Germany
Greece
Luxembourg
Portugal
Reference:
1. Hefler L, Tempfer C, Kainz C. Geography of biomedical publications in the
European Union, 1990-98. Lancet 1999; 353: 1856. (http://www.thelancet.com)
Stuart Handysides, editor ([email protected]), PHLS Communicable Disease
Surveillance Centre, London, England
Outbreak of legionnaires' disease associated with a spa resort in Spain
An outbreak of legionnaires' disease has been identified in north east Spain among people
who stayed in the natural spa resort of Cestona in the province of Guipúzcoa between 1 and
22 May 1999. The first case was diagnosed on 20 May. By 31 May 1999, two confirmed cases
had been diagnosed by legionella urine antigen detection test, there were six suspected
cases, and 35 people were being investigated. Local health authorities have established that
432 people were staying in the resort during the period under investigation. Six visitors were
from other European Union countries, four from the United Kingdom (UK) and two from
Portugal - none of these is known to have become ill. All people who may have been exposed
have been identified and are being investigated for legionella infection.
The spa resort was closed on 22 May. The regional public health director of País Vasco
(Basque Country) has informed all doctors and the general public. The coordinating centre of
the European Working Group on Legionella Infections (EWGLI) was informed of the outbreak
in order to follow up the possible British and Portuguese cases and will be notified officially
when all the details of the cases have been obtained for reporting purposes. The regional
surveillance unit, in collaboration with the National Centre for Epidemiology, has begun an
epidemiological and environmental investigation to identify the source of the outbreak.
Legionella pneumophila serogroup (sg) 1 has been recovered from water samples taken in
the spa resort.
Reported by Rosa Cano ([email protected]) Centro Nacional de Epidemiología, Madrid, and
Txema Arteagoitia ([email protected]) Dirección de Salud Pública del País Vasco,
Vitoria, Spain
New infectious disease law for the Netherlands
A new Infectious Diseases Law introduced on 1 April 1999 in the Netherlands is better
designed to protect the privacy of individuals with notifiable diseases to a greater extent than
the old law (1). Fewer patient data will be reported to the chief medical officer and they will be
anonymised. A supplementary, voluntary, national registration system for cases of notifiable
diseases has been set up by the Rijksinstituut voor de Volksgezondheid en Milieu (RIVM) to
ensure the continuity of the surveillance of infectious diseases. A newly-designed form will be
sent to the RIVM at the same time as a case is notified to the chief medical officer. The
regional public health service will provide each case with a unique notification code so that
data from both systems can be linked.
Article 7 of the new law makes it compulsory for institutions caring for sick, disabled, old, and
young people to report to the chief medical officer exceptional numbers of cases of diarrhoea,
jaundice, skin disease, and other ‘severe infectious diseases’ (2). This legislation is intended to
aid the detection, investigation, and control of outbreaks of foodborne diseases, hepatitis A,
scabies, rubella, measles, and pneumonia in people in institutions.
References:
1. Bosman A, van Vliet JA. Infectieziektesurveillance na 1 april 1999: eein nieuwe lente, een
nieuw geliud. Infectieziekten Bulletin 1999; 10: 91-4. (http://www.isis.rivm.nl/inf_bul/)
2. Van Vliet JA. Artikel 7 van de nienwe infectieziektewet: de meldingsplicht voor instellingen.
Infectieziekten Bulletin 1999; 10: 91-4. (http://www.isis.rivm.nl/inf_bul/)
Reported by Arnold Bosman ([email protected]) and Hans van Vliet
([email protected]) Rijksinstituut voor de Volksgezondheid en Milieu, Bilthoven, the
Netherlands
Malaria in Denmark: 1998
The number of cases of malaria imported into Denmark in 1998 (181) was 15% less than in
1997 (213) (1), but between the totals for 1996 (191) and 1995 (172) (2). Fewer cases of
falciparum malaria were imported from Africa (90 compared with 119 in 1997) and fewer
cases of vivax malaria were imported from Asia (24 compared with 35 in 1997). At the same
time, infections with Plasmodium ovale among travellers from Africa increased, from 12 to
26. The report does not mention any deaths or describe the use of antimalarial prophylaxis by
cases (1).
References:
1. Petersen E, Glismann S. Malaria 1998 and suggested prophylaxis. Epi-News 1999;
(19/20): 1-2.
2. Poulsen S, Petersen E. Malaria 1997. Epi-News 1998; (15/16): 1-2.
Reported by Stuart Handysides ([email protected]), PHLS Communicable Disease
Surveillance Centre, London, England
Meningococcal disease in students
Outbreaks of meningococcal disease in secondary schools and universities in England and
Wales in recent years have led to calls for immunisation with the vaccine against serogroups
A and C before young people go to college (1,2). Data on group C disease collected between
September 1994 and March 1997 found higher rates in university students (2.5 cases per
100 000 population per year) than in 18 to 21 year olds in districts without universities
(1.3/100 000/year). Rates were higher, however, in teenagers aged 16 to 17 (>4/100
000/year). The risk of associated cases was much higher among household contacts than
university students (1). Current policy in the United Kingdom is not to immunise students.
A retrospective cohort study of residents of Maryland, United States from 1992 to 1997
published in JAMA last week offers data for further thought (3). The study made use of an
active system of laboratory based surveillance in place since 1991, and identified 228
patients with invasive meningococcal infection, 67 of whom were aged 16 to 30 years.
Fourteen of these attended colleges in Maryland, 11 on four year courses and three on
courses lasting two years. The average annual incidence of invasive meningococcal infection
was not significantly different between students on four year courses and the general
population of the same age (1.74 compared with 1.44/100 000, respectively). Among
students on four year courses, however, rates were significantly higher among campus
residents than among those who lived off-campus (p=0.05). Six of the 12 student cases
whose serogroup of infection was known had group C infections, as did two of the four fatal
cases (3). The authors note that case clustering did not occur in the first few months of the
academic year and that the incidence was not increased in first year students and suggest
that the situation of college students may therefore differ somewhat from that of military
recruits, whose housing may be more crowded, and who are immunised against
meningococcal infection routinely. They argue that it may be difficult to justify a national
immunisation policy that focuses on college students, given that they constituted only 6% of
cases in this cohort, that high levels of vaccine coverage can be difficult to achieve in young,
healthy adults, the lack of herd immunity offered by the current vaccine, and the absence of a
vaccine against group B meningococci (3). At the same time, however, they recognise the
gravity of meningococcal disease and the increasing proportion of cases due to vaccine
preventable strains (group C). They note the relative ineffectiveness of vaccination
campaigns in aborting institutional outbreaks and suggest that routine immunisation at
college entry could prevent outbreaks and sporadic cases, along with the ‘phenomenal
disruption’ caused by such events (3).
References:
1. CDSC. Meningococcal disease in university college students. Commun Dis Rep CDR
Wkly 1998; 8: 49, 52. (http://www.phls.co.uk/publications/cdr.htm)
2. CDSC. Managing meningococcal disease in higher education institutions. Commun Dis
Rep CDR Wkly 1998; 8: 219, 222. (http://www.phls.co.uk/publications/cdr.htm)
3. Harrison LH, Dwyer DM, Maples CT, Billmann L. Risk of meningococcal infection in
college students. JAMA 1999; 281: 1906-10.
(http://www.ama-assn.org/public/journals/jama/)
Reported by Stuart Handysides, ([email protected]), PHLS Communicable Disease
Surveillance Centre, London, England
June edition of Eurosurveillance is now available on the Internet
The June 1999 issue of the monthly Eurosurveillance bulletin, also funded by the European
Commission, is now available both on paper (in English and French) and on the Internet (in
English, French, Italian, Portuguese, and Spanish) at http://www.ceses.org/eurosurv/
Contents:
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The diversity of food poisoning and sources of contamination
Outbreak of calicivirus gastroenteritis associated with eating frozen raspberries
Surveillance of foodborne botulism in Poland: 1960-1998
Outbreak of salmonella gastroenteritis among attendees of a restaurant opening
ceremony in Greece in June 1998