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Eurosurveillance Weekly: Thursday 8 February 2001. Volume 5, Issue 6
Contents:
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Trichinella infections in Dutch wild animals: potential risk to humans
Patchy influenza activity across Europe
MRSA surveillance in Dutch hospitals in 1998 and 1999: an overview
Gastrointestinal infections in England and Wales, 2000
WHO surveys BCG programmes
Trichinella infections in Dutch wild animals: potential risk to humans
Game (meat from wild rather than domestic animals) is becoming increasingly popular in the Netherlands,
as it is regarded as more healthy, but parasitic infections are common in wild animals. Trichinellosis is a
foodborne parasitic zoonosis – often associated with eating horse meat and meat from domestic and wild
pigs - that can cause serious illness in humans (1-4).
In the Netherlands, industrialised pig farming and meat inspection in slaughterhouses have prevented
endemic trichinellosis for decades. In contrast, wildlife remains a reservoir of trichinella. The
seroprevalence of trichinella infections in wild pig increased from 1.8% in 1980 to 6.8% in 1999 and
among foxes the prevalence increased from 4.3% in 1985 to 13.6% in 1998 as tested by artificial digestion
of foreleg muscles sampled in the central region of the Netherlands (3).
These increases in the prevalence of trichinella infection in wildlife are without consequences for
industrialised pig farming, but they indicate an increasing risk in the Netherlands of the establishment of
new foci of domestic trichinellosis, particularly in organic pig farms. To avoid the potential increased risk of
the consumption of wild boar meat infected with trichinella, individual carcass control of all wild boar for
human consumption is needed.
References:
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Haeghebaert S, Servat M, Duchen C, Minet JC, Agrech AE, Thièse I, et al. Outbreak of trichinellosis in the MidiPyrénées region of France, January-March 1998. Eurosurveillance 1998; 3 (8/9): 83-5.
(http://www.ceses.org/eurosurveillance/v3n8/En25-221.htm).
Pozio E, Sacchini E, Boni P, Tamburrini A, Alberici F, Paterlini F. Human outbreak of trichinellosis associated with
the consumption of horsemeat in Italy. Eurosurveillance 1998; 3 (8/9): 85-6.
(http://www.ceses.org/eurosurveillance/v3n8/En25-222.htm)
Ancelle T. History of trichinellosis outbreaks linked to horse meat consumption, 1975-1998. Eurosurveillance 1998;
3 (8/9): 86-9. (http://www.ceses.org/eurosurveillance/v3n8/En25-223.htm)
Maillot E. Trichinellosis associated with the consumption of horse meat: European regulations and risk
management. Eurosurveillance 1998; 3 (8/9): 90. (http://www.ceses.org/eurosurveillance/v3n8/En25-224.htm)
Rehmet S, Sinnl G, Robstad O, Petersen L, Ammon A, Lesser D, et al. Two outbreaks of trichinellosis in the state of
Northrhine-Westfalia – Germany, 1998. Eurosurveillance 1998; 4 (7/8): 78-81.
(http://www.ceses.org/eurosurveillance/v4n8/En35-222.htm)
Giessen JWB van der. Trichinella-infecties en de risico's verbonden aan het eten van wild. Infectieziekten Bulletin
2001;12(1): 1-4. (http://www.isis.rivm.nl/inf_bul/home_bul.html)
Reported by Joke van der Giessen ([email protected]), Rijksinstituut voor de
Volksgezondheid en Milieu (RIVM), Bilthoven, Netherlands.
Patchy influenza activity across Europe
In the week from 22 to 28 January 2001 (week 04), 11 countries (12 networks) reported influenza activity
to the European Influenza Surveillance Scheme (EISS) (1). Nine networks reported clinical data, and 10
reported virological data. Isolates of both influenza A (H1N1) and, increasingly, influenza B were reported
from various European countries, in association with activity ranging from none to widespread. The overall
picture, however, remained one of low levels of influenza activity in comparison with previous seasons.
Activity in Germany (particularly in the north) and the Czech Republic reached a level described as
widespread mainly due to the influenza A (H1N1) virus. EuroGROG
(http://www.grog.org/EuroGROG1.htm) – a complementary influenza surveillance scheme which covers
24 countries in Europe and collects limited descriptive information on influenza activity from a large
number of European countries, but does not collect standardised clinical and virological data derived from
the same population – reported a similar level of influenza activity in the Slovak Republic in the same
week. In Switzerland, Ireland, the south of France, and England flu activity increased, although the level in
England remained low. Activity associated with influenza A (H1N1) was at regional levels in France,
remained at local levels in Belgium and Denmark, and was reported as sporadic in the Netherlands and
Spain. Both influenza A (H1N1) and B viruses circulated in Belgium, the Czech Republic, England,
France, Germany and Slovenia. An influenza A (H3N2) virus was detected in Spain.
<<INSERT MAP>>
Colours represent an epidemiological level. A =dominant virus A; H1 =dominant virus A(H1N1); H3
=dominant virus A(H3N2); B =dominant virus B.
References:
1.
European Influenza Surveillance Scheme. Patchy influenza activity across Europe: from none to widespread. EISS
Weekly Electronic Bulletin 2001; Week 4: issue 17. (http://www.eiss.org/cgifiles/bulletin.cgi?display=1&code=17&bulletin=17)
Reported by Jean-Claude Manuguerra ([email protected]) on behalf of EISS, Institut Pasteur, Paris,
France.
MRSA surveillance in Dutch hospitals in 1998 and 1999: an overview
A surveillance programme for methicillin resistant Staphylococcus aureus (MRSA) based in Dutch
hospitals was set up by the Rijksinstituut voor de Volksgezondheid en Milieu (RIVM, the National Institute
of Public Health and the Environment) in 1989, at the behest of the Dutch Health Inspectorate (1). Medical
microbiologists were asked to send all their MRSA isolates to RIVM for extended typing such as phage
typing and antibiotic resistance typing, which was carried out free of charge. Some 800 MRSA strains
were sent to RIVM in 1998 and 1999. The results of the surveillance programme are summarised below:
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MRSA continues to account for a small proportion, about 1%, of all S. aureus isolates; this is the result
of a restrictive antibiotic policy in the Netherlands and strict isolation of and eradication procedures for
patients and staff carrying MRSA.
The percentage of index patients who acquired MRSA abroad continues to decrease. This may mean
that most MRSA infections are caused by indigenous strains, or be a consequence of an increased
wariness of medical microbiologists in general of MRSA strains, irrespective of their source, or both.
Large hospital outbreaks were caused mainly by ‘epidemic’ strains (Dutch phage types Z-115 and Z151) that spread easily.
the importance of molecular techniques (especially pulsed field gel electrophoresis (PFGE)) for
epidemiological subtyping of MRSA is poised to increase.
Reference:
1.
Wannet WJB, Neeling AJ de, Geubbels ELPE. MRSA in Nederlandse ziekenhuizen: Surveillance-resultaten 19981999 en toekomstige ontwikkelingen. Infectieziekten Bulletin 2001; 12(1): 15-18.
(http://www.isis.rivm.nl/inf_bul/home_bul.html)
Reported by Wim Wannet ([email protected]), Rijksinstituut voor de Volksgezondheid en Milieu,
Bilthoven, Netherlands.
Gastrointestinal infections in England and Wales, 2000
The incidence of salmonellosis in England and Wales up to the end of 2000 continued to fall from the
peak in 1997, and the provisional total for the year (14 845) is the lowest annual total in the salmonella
dataset of the Public Health Laboratory Service (PHLS) since 1985 (figure 1).
Figure 1: Trends in selected gastrointestinal infections, England and Wales, 1977-2000
<<INSERT FIGURE 1>>
Note: Figures for 2000 are provisional.
The provisional total of Salmonella enteritidis phage type 4 was 4846 (about 33% of all cases of
salmonellosis in England and Wales), which is a much smaller proportion than in recent years (figure 2). It
is likely that this dramatic reduction in S. enteritidis PT4 has been achieved through the vaccination of
poultry flocks, an intervention that seems to have had major public health benefits. The provisional total for
cases of infection with S. typhimurium is 2652, with two large outbreaks during the summer contributing to
a slight increase in incidence over 1999 (1, 2).
Figure 2: Salmonella infections in humans, England and Wales, 1981-2000
<<INSERT FIGURE 2>>
Note: Figures for 2000 are provisional.
Campylobacter continues to be the most commonly identified bacterial cause of gastrointestinal infection,
and during 2000 almost 54 000 cases were reported to the PHLS Communicable Disease Surveillance
Centre (CDSC). During the first six months of sentinel surveillance of Campylobacter infection in England
and Wales (3), 2118 people reported a total of 16 443 days of illness, 236 people were admitted to
hospital for a total of 946 days, and 17 325 days were lost from work.
A provisional total of 5278 reports of cryptosporidiosis were received in 2000. Two large outbreaks, a
waterborne community outbreak in the north west of England (4) and an outbreak affecting British
holidaymakers returning from Majorca (5, 6), partly explained the slight increase in cases between 1999
and 2000. Rotavirus continues to be a major cause of diarrhoeal disease in infants. The incidence of
bacillary dysentery remained low.
A provisional total of 897 isolates of Vero cytotoxin producing Escherichia coli O157 (VTEC O157) was
confirmed by the PHLS Laboratory of Enteric Pathogens in 2000. The incidence of VTEC O157 in England
and Wales ranged from 890 to 1087 laboratory confirmed infections over the past four years (6). In each
of the years when there were more than 1000 cases (1997 and 1999) large outbreaks contributed to these
totals.
References:
O’Brien S, Horby P, Ward LR, Threlfall EJ. Upsurge in Salmonella typhimurium DT104 in England and Wales.
Eurosurveillance Weekly 2000; 4: 000907. (http://www.eurosurv.org/2000/000907.htm)
Fisher IST, Mather H, Briem H, Hardardottir H, Ward LR, Threlfall EJ, et al. Outbreaks of S. typhimurium DT204b
infection in England and Wales, Scotland, and elsewhere in Europe. Eurosurveillance Weekly 2000; 4: 000928.
(http://www.eurosurv.org/2000/000928.htm)
Sentinel surveillance of campylobacter in England and Wales. Commun Dis Rep CDR Weekly 2000; 10(19): 169, 172.
(http://www.phls.co.uk/publications/cdrw.htm)
Surveillance of waterborne disease and water quality: January to June 2000 and summary of 1999. Commun Dis Rep
CDR Weekly 2000; 10(36): 319-22. (http://www.phls.co.uk/publications/cdrw.htm)
de Mateo Ontañon S. Cryptosporidiosis in British tourists returning from Majorca, summer 2000. Eurosurveillance Weekly
2000; 4: 000810. (http://www.eurosurv.org/2000/000810.htm)
Smerdon W. Cryptosporidiosis outbreak associated with Majorcan hotel. Eurosurveillance Weekly 2000; 4: 000824.
(http://www.eurosurv.org/2000/000824.htm)
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Willshaw GA, Cheasty T, Smith HR, O’Brien SJ, Adak GK. Verocytotoxin-producing Escherichia coli (VTEC) O157 and
other VTEC from human infections in England and Wales: 1995-1998. J Med Microbiol 2001; 50: 135-42.
Reported by Sarah O’Brien ([email protected]), Public Health Laboratory Service Communicable
Disease Surveillance Centre, London, England.
WHO surveys BCG programmes
The World Health Organization (WHO) last week summarised its report on the use of BCG vaccine for the
prevention of tuberculosis (TB) in immunisation programmes (1) in the Weekly Epidemiological Record
(2). BCG vaccines are in common use throughout the world (given to about 100 000 million children each
year), but policies differ between countries and there is disagreement about the efficacy and impact of the
vaccines (2).
Policies vary between vaccination at birth (as recommended by WHO, and commonly practised in
developing countries), BCG once in childhood, repeated doses of BCG, and no routine use of the vaccine.
Forty-seven of the 49 countries in WHO’s European Region responded to WHO’s survey in 1995: 34 of
these give BCG at birth (30 with a repeat dose at an older age) and eight give the vaccine later in
childhood. In 29 European countries the vaccine is considered compulsory, and in seven it is voluntary.
The International Union against Tuberculosis and Lung Disease (IUATLD) has issued conditions that it
recommends should be met if a country intends to move from a universal programme to selective
vaccination of high risk groups. These are either an effective notification system and an annual rate of
smear positive TB <5/100 000, or an average notification rate of tuberculous meningitis among children
under 5 years of age of <1/10 million for the past five years and an average annual risk of tuberculous
infection of <0.1%, as evaluated through tuberculin sensitivity surveys.
WHO’s report reminds us that BCG is effective against other mycobacterial diseases, including leprosy. It
calls attention to the differences in contraindications to vaccination between different countries, describes
the administration of the vaccine, its efficacy in different kinds of patients, adverse reactions, and the
potential for further vaccine development.
References:
1.
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3.
WHO. Issues relating to the use of BCG in immunization programmes, a discussion document (WHO/V&B/99.23).
Geneva: WHO. (http://www.who.int/vacines-documents/DocsPDF99/www9943.pdf)
WHO. BCG in immunization programmes. Weekly Epidemiological Record 2001; 76(5): 33-8.
(http://www.who.int/wer/pdf/2001/wer7605.pdf)
Van Buynder P, Handysides S, Poulsen S, Nohynek H, Desenclos J-C, Rasch G. Inadvertent administration of BCG
during Heaf testing in schools: United Kingdom. Eurosurveillance Weekly 1998; 2: 981210
(http://www.eurosurv.org/1998/981210.html)
Reported by Stuart Handysides ([email protected]), Eurosurveillance editorial office.