Download Infectious Diseases in Finland 2010

REPORT
REPORT
Terhi Hulkko
Outi Lyytikäinen
Sari Jaakola
Markku Kuusi
Jani Puumala
Petri Ruutu
(eds.)
Terhi Hulkko, Outi Lyytikäinen, Sari Jaakola,
Markku Kuusi, Jani Puumala, Petri Ruutu (eds.)
Infectious Diseases in Finland 2010
ISSN 1798-0070
National Institute for Health and
Welfare
P.O. Box 30 (Mannerheimintie 166)
FI-00271 Helsinki, Finland
Telephone: +358 20 610 6000
www.thl.fi
39 | 2011
39 | 2011
Infectious Diseases in Finland
2010
© Publisher
National Institute for Health and Welfare (THL)
Department of Infectious Disease Surveillance and Control
P.O. Box 30 (Mannerheimintie 166)
00271 Helsinki, Finland
Phone: +358 20 610 6000
http://www.thl.fi
Editors: Terhi Hulkko, Outi Lyytikäinen, Sari Jaakola, Markku Kuusi, Jani Puumala and Petri Ruutu.
In addition to commentary, the report includes figures and tables that are not employed in our regular reporting.
Distributions by gender, age and region are available on our website.
The figures for some of the diseases in the National Infectious Diseases Register (NIDR) will still be updated
after the figures have been published in print.
Up-to-date figures are available at http://tartuntatautirekisteri.fi/tilastot
Layout: Kati Tiirikainen, Luovinet Osk (http://www.verkkokettu.net)
Infectious Diseases in Finland 2010.
National Institute for Health and Welfare, Report 39/2011
ISSN 1798-0070 (printed)
ISSN 1798-0089 (PDF)
Juvenes Print
Tampere 2011
Infectious Diseases in Finland 2010
contents
RESPIRATORY INFECTIONS • 7
Influenza A ............................................................................................................................................... 7
Influenza B ............................................................................................................................................... 7
RSV .......................................................................................................................................................... 8
Legionella ................................................................................................................................................. 8
Whooping cough ...................................................................................................................................... 9
Adenovirus.............................................................................................................................................. 10
Parainfluenza .......................................................................................................................................... 10
Mycoplasma ............................................................................................................................................ 11
Chlamydial pneumonia........................................................................................................................... 11
GASTROINTESTINAL INFECTIONS • 12
Salmonella .............................................................................................................................................. 12
Campylobacter........................................................................................................................................ 14
Yersinia ................................................................................................................................................... 15
Shigella ................................................................................................................................................... 15
Enterohaemorrhagic Escherichia coli (EHEC) .......................................................................................... 15
Norovirus................................................................................................................................................ 16
Rotavirus ................................................................................................................................................ 16
Enterovirus ............................................................................................................................................. 17
Listeria .................................................................................................................................................... 17
Clostridium difficile.................................................................................................................................. 18
Food- and water-borne outbreaks............................................................................................................ 18
HEPATITIDES • 20
Hepatitis A ............................................................................................................................................. 20
Hepatitis B.............................................................................................................................................. 20
Hepatitis C ............................................................................................................................................. 20
SEXUALLY TRANSMITTED DISEASES • 23
Chlamydia .............................................................................................................................................. 23
Gonorrhoea ............................................................................................................................................ 23
Syphilis ................................................................................................................................................... 24
HIV and AIDS ....................................................................................................................................... 24
ANTIMICROBIAL RESISTANCE • 26
MRSA .................................................................................................................................................... 26
VRE........................................................................................................................................................ 26
ESBL ...................................................................................................................................................... 27
Invasive pneumococcal disease ................................................................................................................ 29
MYCOBACTERIAL INFECTIONS • 30
Tuberculosis ............................................................................................................................................ 30
OTHER INFECTIONS • 33
Haemophilus .......................................................................................................................................... 33
Meningococcus ....................................................................................................................................... 33
MMR diseases (measles, mumps, rubella) ............................................................................................... 33
Puumala virus ......................................................................................................................................... 34
Report 39/2011
National Institute for Health and Welfare
3
Infectious Diseases in Finland 2010
Tick-borne encephalitis (TBE) ................................................................................................................ 34
Tularemia ................................................................................................................................................ 34
Pogosta disease ........................................................................................................................................ 35
Borrelia (Lyme disease) ........................................................................................................................... 36
Malaria and other travel-related infections .............................................................................................. 36
Blood and CSF findings in children ........................................................................................................ 38
Blood and CSF findings in adults ........................................................................................................... 43
AUTHORS • 59
4
Report 39/2011
National Institute for Health and Welfare
Infectious Diseases in Finland 2010
Introduction
No significant changes occurred in national or international cooperation in the surveillance and control of infectious diseases in 2010. Evaluation of the
impact of the 2009 pandemic, development of the
required surveillance systems and updating of pandemic contingency plans were key areas of action at
all levels in Finland. The WHO appointed an independent external working group to evaluate actions
based on the International Health Regulations since
they entered into force in 2007 in general and WHO
actions based on them in connection with the 2009
influenza pandemic in particular. The working group
will submit its report at the WHO general assembly
in 2011, and this will be a cornerstone for the development of surveillance and control of infectious
diseases internationally in biothreat scenarios in the
near future.
At the national level, the 2009 pandemic highlighted
the importance of setting up a geographically and
demographically comprehensive procedure for the
surveillance of respiratory infections in the primary
health care system. A pilot study conducted in 2010
with daily collecting of reasons for primary health care
visits produced promising results. Vital for achieving
high-quality surveillance are comprehensive registration and correct encoding of reasons for visits as a
part of the routine clinic work. Virological monitoring must be closely linked to surveillance of reasons
for clinic visits. An online alert system for suspected
food- and water-borne epidemics was introduced for
the use of health, food and environmental authorities
at the beginning of 2010.
Extending the vaccination programme to include rotavirus vaccinations (2009) and pneumococcal vaccinations (2010) for small children on the one hand
and the adverse side effects of the pandemic vaccinations on the other further emphasised the importance of surveillance for the diseases to be prevented
through the vaccination programme, of the coverage
of the vaccination programme and of the analysis of
its effectiveness.
EPIDEMIOLOGICAL OVERVIEW 2010
While the epidemic peak of the 2009 pandemic
came well before new year 2010, there was no significant surge in influenza in 2010 until the end of
the year. At that time, the number of diagnoses of the
H1N1 virus, which caused the 2009 pandemic and
integrated into the seasonal influenza cycle, becoming the dominant virus of the year, and of influenza
B virus began to increase. Extending influenza vaccinations in the autumn to include also health care
personnel proved to be a challenging effort, not least
because of the emerging adverse side effects of the
Pandemrix vaccine, even if in the previous pandemic
season of 2009–2010 vaccination coverage of health
care personnel was in many areas quite high, according to unpublished data. The RSV epidemic in 2010
was unexpectedly late and of record intensity. The
number of cases of whooping cough remained low, as
has been the case since the whooping cough vaccinations were changed in 2005, and the epidemic cycle
of a few years that used to be prevalent no longer exists. The number of mycoplasma findings increased in
autumn 2010, heralding a robust epidemic for winter
2010–2011.
The epidemiological profile of gastrointestinal infections caused by salmonella and campylobacter
remained unchanged. The number of Yersinia and
EHEC diagnoses decreased on the previous year.
Norovirus infections remained very common, but
the number of rotavirus infections declined sharply,
probably because of the introduction of rotavirus vaccinations into the national vaccination programme
for small children in 2009. The number of enterovirus infections, causing multiple types of syndromes,
was clearly higher than in previous years. The incidence of Clostridium difficile infections has decreased
substantially in recent years, indicating that enhanced
preventive measures at health care institutions are
taking effect.
Exceptionally, there were a number of outbreaks of
food poisoning in 2010 in which uncooked red beet
was the suspected source. A toxin was indicated as the
cause because of the rapid onset and short duration of
symptoms. The number of listeria infections was considerably higher than in previous years, which was a
cause for concern. Enhanced monitoring of fish production and publicity aimed at groups at risk from
listeria were undertaken.
There were fewer cases of hepatitis A than ever before, and also fewer cases of hepatitis B than at the
beginning of the decade. This reflects a higher activity
in vaccinations and the impact of syringe and needle
exchange programmes on users of intravenous drugs.
There are indications that the average age of patients
contracting hepatitis C is rising.
Report 39/2011
National Institute for Health and Welfare
5
Infectious Diseases in Finland 2010
In venereal diseases, the number of cases of chlamydia
remained stable at a high level, continuing to emphasise the need for enhancing the prevention of venereal diseases. Treatment of gonorrhoea is complicated
by the fact that more than half of the strains found
are resistant to quinolones, forcing the use of thirdgeneration cephalosporins. Tourism to Russia is a key
source of cases of syphilis, and its incidence is highest
in the hospital districts of southeastern and southern Finland. The number of new HIV infections remained high, as in previous years. What is worrying
is that an increasing percentage of newly diagnosed
patients are willing to disclose how they contracted
the infection.
Pneumococcus strains in blood and cerebrospinal fluid cultures are very often resistant to erythromycin,
and the percentage of strains with reduced susceptibility to penicillin continues to rise, being almost one in
four in 2010. The prevalence of strains of Escherichia
coli and Klebsiella pneumoniae with reduced susceptibility to third-generation cephalosporins, which usually are ESBL strains, continues to increase in both
blood cultures and other types of samples. Findings
of gram-negative bacterial strains highly resistant to
carbapenems are also increasing. The number of cases
of MRSA has remained stable in recent years.
The number of cases of tuberculosis has varied widely
in recent years, being clearly lower in 2010 than in
the previous year. The percentage of cases of tuberculosis accounted for by immigrants is increasing, placing new challenges on the physicians treating them
and on those responsible for disease prevention. Instructions on screening and preventing infectious diseases among refugees and asylum seekers were issued
in 2010, and a new national recommendation on the
investigation of contacts in cases of infectious tuberculosis was issued recently; there are about 100 cases
of the latter in Finland annually.
Although indigenous occurrences of MMR diseases
in Finland were eliminated 15 years ago, travel-related
cases of measles and mumps and potential secondary
transmission in Finland underline the importance of
high vaccination coverage in preventing epidemics.
The area where tick-borne encephalitis is endemic in
Finland is gradually expanding. The number of borrelia infections matched that of the previous peak
year, 2009.
A new feature in this annual report is a summary of
the incidence of the principal travel-related infections.
Of the more than 20 patients who fell ill with falciparum malaria no one had used malaria prophylaxis.
The number of cases of dengue fever is constantly
6
Report 39/2011
National Institute for Health and Welfare
increasing, which demonstrates the importance of
protecting against mosquitoes when travelling to the
tropics or other warm climates.
The number of severe bacterial and fungal infections
detected by blood culture in adults exceeded 11,000
per year for the first time ever. The overall number
of bacterial and fungal infections found in children
by blood and cerebrospinal fluid culture remained
stable. The proportion of pneumococcus was significant, and it will be interesting to monitor in the next
few years how the pneumococcal vaccination introduced for small children in autumn 2010 as part of
the national vaccination programme will affect this.
Helsinki, 19 April 2011
Petri Ruutu
Head of Department
Infectious Diseases in Finland 2010
Respiratory infections
•
The incidence of influenza did not peak until the end of the year in 2010.
•
The RSV epidemic was bigger than ever but occurred later than expected.
•
The number of cases of Mycoplasma pneumoniae increased in autumn 2010,
heralding an epidemic in the winter of 2010–2011.
INFLUENZA A
The year 2010 was a mild one for influenza A, especially considering that influenza A epidemics usually
occur immediately after the New Year, in January and
February. In spring 2009, a new type of pandemic influenza virus, A(H1N1) 2009, appeared and quickly
spread worldwide. The virus was first found in Finland in May 2009, but the epidemic proper did not
start until early October 2009. The epidemic caused
by the pandemic influenza A (H1N1) 2009 virus
peaked in late 2009 (October and November 2009),
and only isolated cases were reported to the National
Infectious Diseases Register (NIDR) between December 2009 and March 2010.
In all, 418 findings of influenza A virus were reported
to the NIDR in 2010 (12,564 in 2009), of which
228 (7,652) were laboratory-confirmed findings of
pandemic influenza A (H1N1) 2009. Between January and March, 17 findings of pandemic influenza
A (H1N1) 2009 were reported, following which the
first laboratory-confirmed finding in the autumn was
not reported until late November. Between early November (week 44) and the end of 2010, 383 findings of influenza A were reported, of which 211 were
laboratory-confirmed findings of pandemic influenza
A (H1N1) 2009. A significant percentage of the cases
diagnosed were in the age groups 15 to 19 and 20
to 24. The percentage of men among these cases was
disproportionate, probably because these age groups
include young men undergoing national service. Influenza virus epidemics tend to hit garrisons first, and
this happened in 2010 too. In the age group 19 to 24,
the coverage of vaccination against pandemic influenza A (H1N1) virus (Pandemrix) was no more than
30% to 36%. The low vaccination coverage among
young men of national service age and close proxim-
ity favouring the spreading of infections in garrisons
ensured the quick and efficient spreading of the epidemic.
The pandemic influenza A (H1N1) viruses that
caused epidemics were similar in their antigen profile
to the vaccine virus A/California/07/2009, although
their genetic diversity was increasing. The strains that
were circulating in Finland towards the end of the
year represented three genetically distinct groups, one
of them a group found in the southern hemisphere as
early as in summer 2010. Despite the genetic mutations undergone by the viruses, being infected by or
vaccinated against the pandemic influenza A (H1N1)
2009 virus can be considered to have provided good
antigen protection.
In addition to findings of the pandemic influenza A
(H1N1) 2009 virus, 190 cases of influenza A infection of unknown subtype were reported to the NIDR
in 2010. Of these, 172 were reported in November and December. Some of these cases are known
to have been caused by viruses of the influenza A
(H3N2) subtype, which are similar in their antigen
profile to the influenza A/Perth/6/2009 (H3N2) vaccine virus present in the seasonal vaccination administered in autumn 2010. However, at the European
level A (H3N2) virus infections were rare during the
2010–2011 season.
INFLUENZA B
In 2010, the number of influenza B cases reported
to the NIDR totalled 140 (2009: 769), nearly all of
them (121) in December. There are two lineages of
influenza B, Victoria and Yamagata. The prevalence
of these two lineages has varied over the years. In
Report 39/2011
National Institute for Health and Welfare
7
Infectious Diseases in Finland 2010
H1N1V
7500
2000
H3N2
1800
H3N2
1600
1400
1200
1000
H3N2
H3N2
800
H1N1
600
H3N2
H1N1
H3N2
H1N1V
H3N2
400
H3N2
H1N1
200
0
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
Figure 1. Cases of influenza A by epidemic virus type per month, 2000–2010 (no. of cases).
8
2009 and 2010, epidemics worldwide were principally caused by viruses in the Victoria lineage, although
there were also some findings of the Yamagata lineage
in China in 2010. The seasonal influenza vaccination
in autumn 2009 and 2010 included a virus from the
Victoria lineage as its influenza B component, B/
Brisbane/60/2008. The first case of influenza B infection in the 2010–2011 season was reported in the
last week of October, and the number of cases began
to increase and exceeded the epidemic threshold after
mid-December. Viruses from both lineages have been
found in Finland. The Yamagata lineage was prevalent at the beginning of the epidemic, but findings
of the Victoria lineage increased steadily thereafter.
Cases of influenza B infection reported in 2010 were
equally distributed among age groups, from children
to the elderly.
minor epidemic in the spring, with a more violent attack in the following winter (Figure 3). The incidence
of RSV varied by hospital district (5–104/100,000),
most likely caused by differences in the use of laboratory diagnostics. As always, nine out of ten RSV
cases involved children aged 0 to 4. Even though
infections occur in all age groups, babies and small
children constitute the majority of cases leading to
hospitalisation and laboratory diagnostics. Reliable
quick tests for RSV diagnostics have been developed
for use at health centres, outpatient clinics and hospitals. In hospital conditions, RSV is easily transmitted
between patients. Quick tests make it easier to identify RSV infections and therefore to prevent further
transmission. Specialised virus laboratories increasingly use genetic replication methods for diagnosing
RSV.
RSV
LEGIONELLA
In 2010, 2,597 cases of RSV confirmed with laboratory tests were reported to the NIDR (2009: 1,611).
The record number of cases was due to the fact that
the onset of the epidemic expected before the New
Year was delayed until January, and the epidemic
did not peak until March. In Finland, RSV follows
a regular two-year pattern; in uneven years, there is a
In 2010, 31 cases of Legionella were reported to the
register on the basis of laboratory findings. The diagnosis was based on detection of antigen in the urine
in 9 cases and in sputum in one case, on bronchoalveolar lavage fluid culture or PCR in 4 cases, and
on serological methods in the rest. In further investigations, the clinical picture was found to be consist-
Report 39/2011
National Institute for Health and Welfare
Infectious Diseases in Finland 2010
700
Yamagata
600
500
Victoria,
Yamagata
400
Victoria
300
Victoria,
Yamagata
200
Victoria,
Yamagata
Yamagata
100
Yamagata
Yamagata
Yamagata
Yamagata
0
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2009
2010
Figure 2. Cases of influenza B by epidemic virus type per month, 2000–2010 (no. of cases).
1400
1200
1000
800
600
400
200
0
2000
2001
2002
2003
2004
2005
2006
2007
2008
Figure 3. Cases of RSV per month, 2000–2010 (no. of cases).
ent with legionellosis in 14 cases; in other words, the
patient had radiologically diagnosed pneumonia. All
9 patients whose Legionella was confirmed by a urinary antigen test had pneumonia. Of the legionellosis
cases, 8 were men and 6 were women. They were aged
between 35 and 80; only two were under 50. One
person died of legionellosis in 2010. About 60% (8
out of 14) of the legionellosis patients had spent time
abroad before falling ill. The accommodation data of
these patients were reported to ELDSNET (European
Legionnaires’ Diseases Surveillance Network), which
collects data on travel-associated legionellosis.
WHOOPING COUGH
In 2010, the number of whooping cough cases reported to the NIDR totalled 343 (6.4/100,000).
This was somewhat higher than the all-time low recorded in 2009 (267). Of these patients, 14 were under 12 months old, 9 of them under three months
old (vaccinations against whooping cough begin at
the age of three months in the national vaccination
programme). The diagnosis of all patients under 12
months old was based on a PCR test, while the majority of cases were diagnosed from antibody testing.
Report 39/2011
National Institute for Health and Welfare
9
Infectious Diseases in Finland 2010
250
200
150
100
50
0
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
Figure 4. Cases of whooping cough per month, 2000–2010 (no. of cases).
Patients under 20 years old accounted for 57% of all
cases. This percentage was lower in previous years, being 49% in 2008 and 39% in 2009. Once again, incidence of whooping cough varied greatly by hospital
district (1–14/100,000), being highest in the Central
Finland hospital district and lowest in the Kainuu
hospital district.
ADENOVIRUS
In 2010, 900 confirmed cases of adenovirus infection were recorded (2009: 622). Most of these were
recorded in March and between August and November (more than 100 cases per month), but there were
plenty of adenovirus infections in the summer too,
particularly among small children. More than 50
types of adenovirus are known. Some cause respiratory infections, some intestinal infections. Adenoviruses
are common pathogens in infants and small children;
they occur more rarely in adults. Significant adenovirus epidemics occur in the Defence Forces, often following an influenza epidemic. This is what happened
in March 2010, a typical time of year for a peak in
adenovirus infections in garrisons. Unlike in spring
2010, there were only a few cases of adenovirus infection following the pandemic of 2009. Respiratory
tract adenovirus infections are diagnosed using an antigen test, genetic replication test or extracted mucus
culture or similar method (sputum or bronchoscopy
sample), or serologically. The largest number of cases
was in the age group 0 to 4, with significant numbers
also in age groups 5 to 9, 15 to 19 and 20 to 24,
the latter including young men of conscription age.
10
Report 39/2011
National Institute for Health and Welfare
Adenovirus infections among conscripts tend to appear as epidemics whenever new arrivals enter service,
particularly in February and March. There were fewer
cases in the higher age groups, and their distribution
throughout the year was even.
PARAINFLUENZA
Parainfluenza viruses are grouped under one heading
in the NIDR, even though laboratories usually differentiate between parainfluenza viruses 1, 2 and 3. In
2010, 393 parainfluenza infections were confirmed
(2998: 378), most of them in the age group 0 to 4.
The months with the highest numbers of cases (more
than 50 per month) were February, March and December. Parainfluenza infections are found in all age
groups. A child’s first parainfluenza infections may
lead to a severe condition, even requiring hospitalisation. In an older child or an adult, a parainfluenza
infection is typically much milder in its symptoms. It
often presents as an ordinary upper respiratory tract
infection and requires no laboratory diagnostics. In
special groups, however, such as immune deficiency
patients, parainfluenza viruses can cause quite serious symptoms. In 2010, as earlier, high numbers of
parainfluenza infections were found in infants, small
children and, to some extent, young schoolchildren.
Parainfluenza virus type 3 causes minor epidemics in
the summer and autumn nearly every year. By contrast, parainfluenza viruses types 1 and 2 do not cause
epidemics every year. Parainfluenza viruses, especially
type 1, typically cause laryngitis in small children.
Infectious Diseases in Finland 2010
MYCOPLASMA
CHLAMYDIAL PNEUMONIA
There were 1,927 cases of Mycoplasma pneumoniae recorded in 2010. The number of cases of Mycoplasma
pneumoniae increased in autumn 2010, heralding an
epidemic in the winter of 2010−2011. The most recent such epidemics in Finland occurred in winters
2004–2005 and 2005–2006. In Denmark, epidemics of Mycoplasma pneumoniae have been observed
regularly at intervals of four to six years ever since the
1950s, and there too the number of cases increased
beginning in summer 2010. The largest number of
cases relative to population (more than 60/100,000)
were found in the Varsinais-Suomi and Vaasa hospital districts, whereas the largest number of cases in
absolute terms was found in the hospital district of
Helsinki and Uusimaa. As expected, most of the findings were in patients aged 5 to 19.
In 2010, 214 laboratory-confirmed cases of Chlamydia
pneumoniae were recorded, 60% of them between October and December. This heralded an increase in the
incidence of cases in winter 2010–2011. The number
of annual cases is the highest recorded since 2004.
The largest number of cases relative to population
was found in the Vaasa hospital district (19/100,000),
whereas the largest number of cases in absolute terms
was found in the hospital district of Helsinki and
Uusimaa and the Varsinais-Suomi hospital district.
The findings were for the most part from patients aged
5 to 14 and thus most probably involved a primary infection diagnosed on the basis of an IgM positive test
result. A large number of cases was also found among
patients aged 40 to 50; most of these were probably
reinfections, where IgM is only found in some cases.
As such, diagnosis requires accurately timed paired
samples and testing for elevated IgG levels.
350
300
250
200
150
100
50
0
2000
2001
2002
2003
2004
2005
Mycoplasma pneumoniae
2006
2007
2008
2009
2010
Chlamydia pneumoniae
Figure 5. Cases of Mycoplasma pneumoniae and Chlamydia pneumoniae per month, 2000–2010 (no. of cases).
Report 39/2011
National Institute for Health and Welfare
11
Infectious Diseases in Finland 2010
Gastrointestinal infections
•
The number of rotavirus cases recorded in 2010 was less than half of what the
annual number used to be before vaccinations were begun in September 2009.
•
The enterovirus epidemic season began exceptionally early, in July.
•
A record number of Listeria monocytogenes infections was recorded.
•
The number of cases of Clostridium difficile continued to decline.
SALMONELLA
In 2010, there were 2,438 reported cases of salmonella (2009: 2,329), 55% of them in women patients. Annual incidence in the entire country was
45/100,000 population. The incidence was highest
in the South Karelia hospital district (55/100,000)
and lowest in the Länsi-Pohja and Päijät-Häme hospital districts (21/100,000 and 25/100,000, respectively). The incidence was highest in the age group
20 to 24 (70/100,000) and lowest in the age group
over 75 (8/100,000). The most common salmonella
serotypes were Enteritidis (854 cases), Typhimurium
(246 cases), group B (112 cases) and Stanley (106
cases).
There were 9 diagnosed cases of the Typhi serotype,
which causes typhoid; 2 cases of S. Paratyphi A,
which causes paratyphoid; and 5 cases of S. Paratyphi
B. In all the cases where travel information was available (14 cases), the patients had contracted the infection abroad. India, Thailand and Nepal were the
most common sources for S. Typhi and S. Paratyphi
infections.
Out of all cases of salmonella, 336 (16%) were of
domestic origin, roughly the same percentage as in
earlier years. The incidence of domestic infections
was 6/100,000. Domestic salmonella infections were
caused by 55 different serotypes. The leading four
serotypes were Typhimurium (39%), Enteritidis
(13%), Thompson (4%) and Infantis (3%). The majority (54%) of the domestic cases of Typhimurium
were of the endemic FT 1 phage type. The second
most common phage type (14%) was FT U277. The
FT 1 strains are divided into nine genotypes, most
of which, as in previous years, were of the genotype
STYMXB.0098, which is susceptible to antimicrobi-
12
Report 39/2011
National Institute for Health and Welfare
als. Strains in this genotype were further typed using
the MLVA method based on differences between repeated sequences in DNA; the majority (64%) presented with the MLVA profile 3-16-NA-NA-0311.
There were only 44 cases caused by the domestic Enteritidis serotype. These were divided into 14 phage
types, most of them (more than half ) of the types FT
4B, FT 2, FT 4 and FT 8, and into 17 genotypes, the
most common being SENT 15.
Information on whether a salmonella infection was
acquired in Finland or abroad remained lacking for
56 (2.3%) cases in 2010. The total number of foreign
salmonella infections was 2,030, and the incidence
was 38/100,000 population. The salmonella infections acquired abroad represented 122 serotypes. The
S. Enteritidis serotype caused 778 (38%) of the cases
with foreign origin. The next most common serotypes
acquired abroad were Typhimurium (142 cases),
group B (103), Stanley (98) and Virchow (77). The
leading countries of acquisition were Thailand (30%),
Egypt (12%), Turkey (11%) and Spain (5%).
There were 665 strains phage-typed from the foreign
Enteritidis strains and 99 from the Typhimurium
strains. The most common phage types of S. Enteritidis were FT 21 (18%, mostly from Turkey), FT 1
(16%, from 23 different countries) and FT 4 (10%,
from Turkey, Estonia, Latvia and Egypt), while those
of S. Typhimurium were FT NST (17%, from 13 different countries), FT 120 (14%, mostly from Thailand) and FT 193 (13%, from Thailand and Kenya).
Infectious Diseases in Finland 2010
Table 1. The most common serotypes of salmonella cases, 2000–2010 (excluding S. Typhi and S. Paratyphi)
(no. of cases].
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
Infection acquired abroad (Source: NIDR)
Salmonella Enteritidis
1052
1243
904
887
758
834
879
735
1066
657
778
Salmonella Typhimurium
205
143
115
155
183
194
141
246
198
166
142
Salmonella group B
45
32
33
23
37
38
55
93
166
119
103
Salmonella Virchow
50
79
55
67
74
88
80
135
115
90
77
Salmonella Hadar
125
96
69
58
22
33
45
22
24
17
27
Salmonella Newport
20
57
47
40
53
47
66
57
76
54
54
Salmonella Infantis
23
34
20
16
33
39
31
54
31
42
42
Salmonella Braenderup
49
45
50
26
16
16
32
53
37
39
38
Salmonella Stanley
44
63
65
67
105
113
116
175
136
111
98
Salmonella Corvallis
7
21
10
40
39
60
56
59
70
68
42
Other
602
563
476
483
520
483
526
644
687
576
629
Total
2222
2376
1844
1862
1840
1945
2027
2273
2606
1939
2030
Domestically acquired infections (Source: Bacteriology Unit, THL)
Salmonella Typhimurium
124
152
222
137
132
241
170
150
80
134
132
Salmonella Enteritidis
52
63
42
61
81
75
69
61
49
48
44
1
26
1
1
1
Salmonella Hvittingfoss
Salmonella Hadar
17
11
4
3
3
4
3
1
Salmonella group B
5
2
3
2
7
1
4
11
2
2
2
3
Salmonella Infantis
7
19
4
4
4
11
6
3
Salmonella Newport
11
5
3
16
8
3
9
Salmonella Saintpaul
12
1
3
4
2
3
Salmonella Agona
27
41
16
12
32
11
Salmonella Poona
8
1
4
9
2
5
Salmonella Virchow
15
8
3
2
5
11
Salmonella Thompson
1
Salmonella Ohio
27
3
4
2
5
7
8
3
2
12
7
2
9
23
70
9
8
2
5
2
2
40
15
2
2
14
12
8
6
6
4
2
1
1
2
2
8
5
12
Salmonella Abony
5
3
15
Salmonella Stanley
5
9
1
Salmonella Give
1
1
Salmonella Bovismorbificans
3
2
Salmonella Reading
1
Salmonella Mikawasima
3
15
2
1
1
6
Salmonella Braenderup
1
4
1
7
2
2
12
7
7
2
7
5
5
12
8
6
7
1
4
39
3
2
1
2
4
2
2
1
1
2
1
1
1
31
25
2
5
23
1
2
2
1
7
Other
28
39
45
45
43
49
49
52
55
36
78
Total
325
390
406
310
336
443
397
372
374
309
336
145
102
107
86
111
151
92
150
81
56
Country of acquisition not specified
Total
224
Report 39/2011
National Institute for Health and Welfare
13
Infectious Diseases in Finland 2010
1000
900
800
700
600
500
400
300
200
100
0
2000
2001
2002
2003
2004
Salmonella
2005
2006
2007
2008
2009
2010
2008
2009
2010
Campylobacter
Figure 6. Salmonella and campylobacter cases by month, 2000–2010 (no. of cases).
700
600
500
400
300
200
100
0
2000
2001
2002
2003
2004
Culture
2005
2006
2007
Antibody
Figure 7. Yersinia enterocolitica culture and antibody findings, 2000–2010 (no. of cases).
CAMPYLOBACTER
In 2010, the NIDR received 3,944 notifications of
campylobacter infections, 104 cases fewer than in
2009. Campylobacter jejuni remained the single most
common type of campylobacter (2,052 cases); there
were 195 reported cases of C. coli, and no fewer
than 1,696 cases where the campylobacter species
was not specified. The hippurat test used to distinguish between species has been abandoned in some
laboratories, because it cannot correctly identify all
strains. The incidence in the entire population was
14
Report 39/2011
National Institute for Health and Welfare
74/100,000. Men accounted for 53% of the cases,
and the highest number of cases was in the age group
25 to 49. Incidence was highest in the hospital district of Helsinki and Uusimaa (116/100,000). The
seasonal variation was typical for campylobacter: incidence was highest in July-August (Figure 6).
Of the cases in 2010, 528 (13%) were domestic in
origin, although almost one in three cases lacked data
on the country of acquisition. Leading sources for
foreign infections were Thailand (528 cases), Turkey
(236), Spain (222) and India (152).
Infectious Diseases in Finland 2010
YERSINIA
SHIGELLA
Yersinia enterocolitica
In 2010, the incidence of shigellosis was 3.0/100,000.
There were 160 reported cases, 72 in men and 88 in
women. Only a very small percentage of the cases was
found in patients aged under 20 (14 cases) or over 65
(7). More than half (85) of the cases were reported in
the hospital district of Helsinki and Uusimaa. Five
hospital districts had no diagnosed cases. Of the total,
140 infections (88%) were acquired abroad and 12 in
Finland. In 8 cases, the country of acquisition was not
specified. The most common countries of origin were
Egypt (58 cases) and India (38). The prevailing shigella species were Shigella sonnei (97 cases), followed
by S. flexneri (44) and S. boydii (12). There were seven
reported cases of S. dysenteriae (no shigatoxin-producing serotypes were among the pathogens). Eighty
per cent of the strains were multi-resistant (R to at
least 4 out of 12 antimicrobials tested), and 29%
were completely resistant or had reduced susceptibility to ciprofloxacin (MIC 0.125–12 mg/l). Moreover,
five strains were completely resistant to cephotaxim
(some are estimated to produce ESBL enzyme).
In 2010, the NIDR received 458 notifications of
Yersinia enterocolitica, 14% fewer than in 2009
(534). In 2010, the incidence in the entire country
was 8.6/100,000 population. Based on the cases recorded in the NIDR, the incidence was highest in
the age group 45 to 49 (13.5/100,000) and lowest
in age groups under 15 (less than 4/100,000). There
is great regional variation in the number of Yersinia
enterocolitica cases, with the highest incidence reported in the Kainuu hospital district (21/100,000
population); Åland and the Itä-Savo hospital district
reported no cases.
Typing data were reported for less than half of Y. enterocolitica cases in 2010, which makes it difficult to
draw conclusions about the percentages of the various
bio/serotypes. However, a separate study found that
Y. enterocolitica bacteria isolated from elderly patients
tend to be non-pathogenic strains, while pathogenic
strains are over-represented in small children.
Yersinia pseudotuberculosis
The number of Yersinia pseudotuberculosis cases (57
cases) continued to decrease, having been 80 in 2009.
In 2010, the incidence in the entire country was
1.0/100,000 population. The number of cases is too
low to reliably indicate any regional variation. Ten
hospital districts diagnosed no cases at all in 2010.
Outbreaks cause variation in the annual incidence of
cases of Y. pseudotuberculosis.
ENTEROHAEMORRHAGIC
ESCHERICHIA COLI (EHEC)
In 2010, 20 microbiologically confirmed cases of
enterohaemorrhagic Escherichia coli (EHEC) were
reported to the NIDR (0.37/100,000). This is fewer
than in 2009 (31). Foreign acquisition accounted
for six of the cases. Ten of the patients were women
and ten were men; 11 were under the age of 15, and
300
250
200
150
100
50
0
2000
2001
2002
2003
2004
Culture
2005
2006
2007
2008
2009
2010
Antibody
Figure 8. Yersinia pseudotuberculosis culture and antibody findings, 2000–2010 (no. of cases).
Report 39/2011
National Institute for Health and Welfare
15
Infectious Diseases in Finland 2010
four of these were in the 0 to 4 age group. HUS syndrome was diagnosed as a complication in four of the
patients. The O157-serogroup strains were divided
into two common phage types (FT 4 and FT 8) and
caused a total of 9 cases. There were 11 non-O157serogroup cases, divided into seven O groups, some
of them extremely rare (O2, O104, O121, O146,
OX182). Most of the strains had the genes to produce both Stx1 and Stx 2 shigatoxin. Four small clusters of infections were identified among people who
lived in the same household or had otherwise been in
close contact with the index patients.
NOROVIRUS
breaks that occurred in 2010 were institutional outbreaks. This also explains the high incidence among
the elderly.
Unlike in previous years, the norovirus outbreaks in
2010 were caused almost exclusively by the new norovirus variant GII.4 2010, which arrived in Finland
in December 2009. This variant is a recombination of
two earlier GII.4 variants that emerged in 2006 and
2008. With the appearance of the new variant, the
previously dominant norovirus variant in Finland,
GII.4 2006b, became rare; it only caused a handful
of individual outbreaks 2010. There were also individual outbreaks caused by other genotypes (GI.4,
GI.b, GI.7, GII.b, GII.7) in 2010.
Norovirus has become one of the most common causes of food- or water-borne outbreaks in the 2000s.
The number of food poisoning outbreaks decreased
considerably in comparison with the frozen raspberry
scenario of 2009. Noroviruses of genotype I are commonly associated with food-borne outbreaks, and the
year 2010 was no exception, as GI.4 was identified as
the main cause of food poisoning.
In 2010, there were 2,740 reported cases of norovirus; 1,561 of the patients (57%) were women. The
incidence rate, 51/100,000, was higher than in the
previous year. Over 80% of the cases were reported
between January and April. More than half (57%) of
the patients were over 75 years of age, but infections
were diagnosed in all age groups. The incidence was
highest in the province of Lapland (108/100,000) and
lowest on Åland (25/100,000). There was less variation in the other provinces than in previous years, the
incidence being 45–59/100,000.
ROTAVIRUS
The year 2010 was the fourth year running when new
variants of the norovirus GII.4 genotype, emerging
every one or two years, caused a widespread epidemic
in Finland, as indeed they did elsewhere in the world.
As in previous years (2007–2009), most of the out-
In 2010, 426 cases of rotavirus infection were reported, less than half of the usual level in previous years.
However, as in previous years, boys made up the majority of patients (56%). The epidemic of early 2010
was clearly less potent than previous ones.
3000
2500
2000
1500
1000
500
0
2005
2006
2007
Figure 9. Cases of norovirus infection, 2005–2010 (no. of cases).
16
Report 39/2011
National Institute for Health and Welfare
2008
2009
2010
Infectious Diseases in Finland 2010
The first rotavirus vaccine was launched in Finland
in the summer of 2006. The vaccine was initially underused, but by 2008 one child in three was receiving
a rotavirus vaccination, paid for by the parents. The
rotavirus vaccine was finally added to the national
vaccination programme in September 2009. At the
end of the follow-up period, the first children to have
received the vaccination in the programme were 18
months old. Because the incidence of the infection is
in any case low during the first months of life, probably because of antibodies received from the mother,
the incidence at this time only reflects the programmebased vaccinations of one cohort of newlyborns.
The incidence was again clearly highest in children
under five years of age (120/100,000). However, this
has fallen to one fourth of what it was 10 years ago.
With increasing vaccination of infants, the percentage of cases in older age groups will increase. In 2010,
just over 16% of all cases were in patients aged 5 or
over, whereas this figure was never higher than about
10% in previous years.
Cases were reported in all hospital districts, the incidence being highest in the Lapland, Vaasa and Northern Bothnia hospital districts. The incidence in Lapland was ten times higher than in the south, and the
incidence in the age group under 5 years has not really
decreased at all since the addition of the vaccine to the
vaccination programme. It is possible that in Lapland
the virus circulates more virulently, vaccination coverage is lower, or sampling is more efficient.
The rotavirus serotypes that most commonly cause
illness in humans are G1P[8], G2P[4], G3P[8],
G4P[8] and G9P[8]. The illnesses caused by the various serotypes are very similar. Rotavirus diagnoses are
mainly based on quick tests that do not indicate the
type of virus. In the future, however, it will become
increasingly important to identify the type of rotavirus so that it can be established which serotypes cause
infections regardless of the vaccination.
ENTEROVIRUS
In 2010, 560 cases of enterovirus infection were reported, considerably more than in 2009 (364) or
2008 (354). Men accounted for 313 (56%) of the
cases.
About one third (183, 33%) of the patients were under the age of 10, and the majority of cases involved
patients under the age of 20. The epidemic season
began exceptionally early, in July, and enterovirus infections were particularly prevalent in late summer
and in the autumn. Several extensive aseptic meningitis epidemics caused by the Echo 30 virus were ob-
served in Kanta-Häme, North Karelia and Southern
Savo in 2010. Also, there were clusters of hand, foot
and mouth disease in North Karelia, featuring not
only the typical body rash with sores but also severe
headache (meningitis). These clusters turned out to
have been caused by coxsackie viruses CVA-6 and
CVA-10.
Enteroviruses cause infections of the central nervous system (aseptic meningitis, encephalitis, myelitis, neuritis, etc.), myocarditis and typical enteroviral
conditions (hand, foot and mouth disease, epidemic
myalgia, etc.) Upper respiratory tract infections have
also been found to be ‘typical’ enteroviral conditions.
The reports in the NIDR contain no information on
symptoms. Human enteroviruses are divided into
four categories, A to D (abbreviated HEV-A to HEVD). Rhinoviruses, which cause the common cold, are
nowadays included in the enterovirus family.
Enterovirus diagnostics is increasingly based on the
RT-PCR method, which does not distinguish between
virus serotypes. Therefore, a stool culture remains the
recommended and most useful way of diagnosing an
enterovirus infection. Stool cultures also enable the
monitoring of the possible circulation of polio viruses
in the population; this monitoring is important and
necessary even in Finland.
LISTERIA
Listeria monocytogenes infections were clearly more
numerous in 2010 than in previous years (71 cases).
The median age in these cases was 73 years, and 38
of the patients (54%) were men. There were five reported pregnancy-related infections. The listeria cases
were spread out across the country. In 17 (24%) of
the cases, the patient died within one month of the
diagnosis. The annual number of cases varied between
18 and 46 from 2000 to 2008; in 2009, 33 cases were
reported.
Listeria was isolated from blood culture in 64 (90%)
cases; in seven cases, listeria was diagnosed from cerebrospinal fluid; in four of these, listeria was found
also from blood culture. Serotypes 1/2a, 4b, 1/2c
and 1/2b caused 50 (70%), 16 (23%), 2 (3%) and
1 (1%) of the cases, respectively. More than 30 different PFGE genotypes of listeria were identified.
Listeria monocytogenes causes severe infections in infants, pregnant women, patients with immune deficiency and the elderly. The incidence of listeriosis has
increased worldwide in recent years, especially among
elderly people who have other factors sensitising
them to the condition. The infection is food-borne;
Report 39/2011
National Institute for Health and Welfare
17
Infectious Diseases in Finland 2010
risk foods include products made of unpasteurised
milk and other animal- or plant-based foodstuffs
and ready-to-eat foods that are in cold storage for
a long time. Listeria bacteria may also occur in the
food production environment, contaminating food
products after the heat treatment in the production
process. Finland’s risk foods include vacuum-packed
salt-cured and cold-smoked fish products.
A study conducted in 2010 found that the majority of
listeriosis patients had a medication or underlying illness that compromised their immune system. Nearly
two thirds of the patients had consumed salt-cured or
cold-smoked fish. Most of the cases were individual
ones. The most common genotype of listeria by far in
the cases was type 96 (13 cases). Half of the type 96 listeria case patients who were interviewed had consumed
salt-cured or cold-smoked fish before falling ill. At the
same time, the same listeria genotype was discovered
at a Finnish fish processing facility, where an extensive renovation was then carried out. This genotype
has become more widespread in Finland since 2006,
being regularly isolated for instance from Finnish fish
products. This is, however, a relatively common genotype worldwide and can be found in a variety of foods,
not just fish. In December 2010 and January 2011,
four cases of listeriosis of genotype 62 were reported in
Finland. All the patients were women aged over 80. All
of them had access at their respective nursing homes at
Christmas to salt-cured salmon prepared by a specific
fish processing facility. A bacterial strain of genotype
62 identical to that found in the patients was isolated
from the salt-cured salmon served at one of the nursing homes involved. This listeria genotype was found
at the same time in products of other fish food producers as well. To rectify the situation, local authorities sent inspectors to perform extra inspections and
sample-taking at fish processing facilities.
The National Institute for Health and Welfare cooperated with the Finnish Food Safety Authority Evira
in publicising repeatedly during 2010 that listeria
causes severe illnesses in at-risk groups. Authorities
supervising institutional kitchens were provided with
information on foods that may carry a risk of listeria
infection.
CLOSTRIDIUM DIFFICILE
Clostridium difficile has been a finding reportable to
the NIDR from the beginning of 2008. More than
6,000 cases were reported in 2010 (2009: more
than 7,000; 2008: more than 8,000), out of which
4,804 involved a toxin-producing strain (2009:
5,700; 2008: 6,301). Almost 60% of patients diag-
18
Report 39/2011
National Institute for Health and Welfare
nosed with C. difficile were women, and half were 75
years of age or older. Over 150 (3%) cases of toxinpositive strains were reported in under-15-year-olds
(2008–2009: 2% to 3%), and almost one third of
these had been isolated in infants under 12 months
old. There was significant regional variation in the incidence (45–165/100,000), with the hospital districts
of Satakunta, Lapland and Kymenlaakso showing the
highest incidence.
In severe cases or when a local outbreak is suspected, clinical laboratories have been asked to send
C. difficile strains for further examination by the THL
reference laboratory. There continued to be great local variation in the number of strains sent: although
all hospital districts reported toxin-positive C. difficile
cases, only 11 of them sent strains for genotyping.
The total number of strains sent was only about 5%
of the number of infectious disease reports (228 out
of 4,442). Of the strains examined, 16% were of
PCR ribotype 027, which so far has been found in
at least nine hospital districts: Helsinki and Uusimaa,
Varsinais-Suomi, Satakunta, Central Ostrobothnia,
North Ostrobothnia, Pirkanmaa, Kanta-Häme, Kymenlaakso and South Karelia. In addition to PCR
ribotype 027, other ribotypes were detected that may
be possible hyper-producers of toxin. Severe cases
were caused not only by PCR ribotype 027 but also
by ribotypes 001, 005, 018 and 056. So far, more
than 90 different PCR ribotypes have been detected
in Finland, of which about 30 have been identified as
genotypes previously reported internationally.
FOOD- AND WATER-BORNE
OUTBREAKS
From the beginning of 2010, municipal epidemic
investigation working groups entered notifications of
suspected food- and water-borne epidemics directly
into the register IT system jointly maintained by the
National Institute for Health and Welfare and the
Finnish Food Safety Authority Evira, known as the
RYMY information system. In the course of the year,
53 such notifications were entered. These included
several cases of illnesses associated with the consuming of uncooked red beet. Several other intestinal infection clusters were investigated as well.
Epidemics caused by uncooked red beet
In 2010, seven reported food poisoning outbreaks
were suspected to have been caused by uncooked red
beet. These outbreaks involved more than 100 people, all of whom had fallen ill after consuming uncooked red beet in shredded form at a workplace or
Infectious Diseases in Finland 2010
school canteen. The most common symptoms were
abdominal pain and nausea; headaches, fatigue and
vomiting were also reported. The onset of symptoms
was rapid (less than an hour after eating), and their
duration was brief (a few hours). The clinical profile
was consistent with intoxication. No findings that
could explain the symptoms were discovered in the
patient samples. Microbiological examination of the
red beets also showed no traditional food poisoning
microbes or toxins. Because of these outbreaks, the
Finnish Food Safety Authority Evira recommends
that red beet should be cooked before consumption.
Higher than usual number of severe listeria
infections
A higher number of listeriosis cases than usual was
reported to the NIDR in 2010. This is discussed in
more detail in the Listeria section on page 17. In
2010, 13 cases of serotype 1/2a, genotype 96 listeria were found in Finland. Interviews revealed that
half of the patients had consumed salt-cured or coldsmoked fish before falling ill. At the same time, the
same listeria genotype was discovered at a Finnish fish
processing facility, where an extensive renovation was
then carried out. This is, however, a relatively common genotype worldwide and can be found in a variety of foods, not just fish.
In December 2010 and January 2011, four cases of
listeriosis of serotype 1/2a, genotype 62 were reported in Finland. All the patients were women aged over
80. All of them had access at their respective nursing
homes at Christmas to salt-cured salmon prepared by
a specific fish processing facility. A bacterial strain of
genotype 62 identical to that found in the patients
was isolated from the salt-cured salmon served at one
of the nursing homes involved. This listeria genotype
was found at the same time in products of other fish
food producers as well. The municipal supervisory
authorities enhanced monitoring of fish processing
facilities to clarify the situation.
Yersinia enterocolitica O:9 caused
gastroenteritis at Leppävirta
In May 2010, 42 people contracted gastroenteritis at
Leppävirta. Yersinia enterocolitica bio/serotype 2/O:9
was isolated from stool samples in seven of these
cases. The bacteria strains were found to be identical
using the MLVA method based on tandemly repeated
DNA sequences. The Finnish Food Safety Authority
Evira, through a PCR-based assay, found Yersinia
bacteria in all samples of salads and shredded carrot
recovered from the institutional kitchen associated
with all of the cases in April and May. However, the
presence of yersinia could not be confirmed by culture, so it could not be conclusively established that
the salad and shredded carrot had been the cause of
the outbreak.
Salmonella Urbana cases in Finland, the
Czech Republic and Latvia
In January and February, a strain of Salmonella Urbana of a specific genotype caused 14 reported infections: seven around Finland, six in the Czech Republic and one in Latvia. Most of the patients were aged
under 16, the age median being 5 years. The majority were boys. Three out of four of those who fell ill
had to be hospitalised. An epidemic investigation was
launched because of the severity of the symptoms and
the rarity of the Salmonella Urbana serotype. The investigation was conducted by questionnaire in cooperation with the Czech and Latvian authorities, but
no link between the cases could be established. No
further cases were reported in any European country
after early February.
Other salmonella clusters
Salmonella Typhimurium, phage type 1 (FT 1) and
genotype STYM1 caused clusters of infections in August: 6 in Huittinen and 5 in Pori. This serotype, and
specifically FT 1, is a Finnish domestic variant that is
endemic in wild and domestic animals. This type of
salmonella causes minor epidemics in Finland every
year, principally in late summer. Some of the cases
referred to here constituted a family epidemic.
Another cluster of Salmonella Typhimurium FT 1 was
found in February 2010, when genotype STYM28
caused 5 cases in Uusikaarlepyy. This is a genotype
rare in Finland.
In the summer (mainly in May), Salmonella Thompson caused 8 infections in western Finland. The
strains were of genotype STMP 11, which had not
been found earlier in Finland. Interviews indicated
that the source of the infection was sprouts.
Infections caused by Salmonella group E (3.10:-:1.5),
genotype E2 were found in 9 patients in eastern Finland in July and August. This serotype is rare in Finland and has not caused epidemics previously.
A Salmonella Mikawasima genotype SMIK3 infection was found in 6 patients in central Finland in November and December. The link between them was a
specific health centre ward. Mikawasima is a serotype
rare in Finland, but the same SMIK3 genotype also
caused a cluster of infections among the personnel of
a cruise ship in November 2008.
Report 39/2011
National Institute for Health and Welfare
19
Infectious Diseases in Finland 2010
Hepatitides
•
There were fewer cases of hepatitis A than ever before.
•
Hepatitis B infections contracted from intravenous drug use have decreased
conspicuously.
HEPATITIS A
In 2010, the NIDR received 14 notifications of hepatitis A (incidence: 0.3/100,000), fewer than in any
previous year. The patients were equally divided, 7
men and 7 women. The median age in these cases
was 33 years (variation 13–80). More than half of
the cases (9) were diagnosed in the hospital district of
Helsinki and Uusimaa, while 17 hospital districts had
no diagnosed cases. Two infections were acquired in
Finland and 10 abroad; in two cases, the country of
acquisition was not specified. Hepatitis A cases have
remained at a low level since 2002–2003, probably
because of high vaccination coverage among travellers and at-risk groups.
There are problems in differentiating between acute
and chronic hepatitis B infections. In some cases,
the diagnosis code and the laboratory test results in
the reports are contradictory. The number of cases
reported as acute is thus probably not entirely accurate, although the big picture and long-term trends
are reliable.
HEPATITIS C
In 2010, 46 acute hepatitis B infections were reported (35 men and 11 women). The mode of transmission was given only for one in four cases. Of the cases
where this was given, the mode of transmission was
sexual contact in 15 cases and intravenous drug use in
one case (Figure 10). About half of the cases involved
a patient of foreign origin (born outside Finland or
with non-Finnish citizenship). Infections acquired
by a number of Finns abroad were also reported, although on the whole the hepatitis A and B combination vaccine used by travellers largely protects Finns
travelling abroad.
In 2010, 1,138 new hepatitis C (HCV) infections
were reported to the NIDR, 66% of the patients being men and 34% women. This was 88 more than
in 2009. The annual number of new HCV cases had
been decreasing over the past decade before this slight
upturn (Table 2). Similar findings have been made
in prevalence studies conducted among intravenous
drug users. The incidence of HCV among intravenous drug users is so high (c. 55%) that bringing it
down is a slow process that will take a decade at least
even in the best case where risks are brought under
immediate control. However, because it is difficult
to distinguish acute HCV infections from those contracted years ago, trends in case numbers must be
viewed with caution.
The number of cases of acute hepatitis B increased by
9 in 2010 on 2009. However, this is still much lower
than in the peak years of the 1990s, even if the falling trend has been levelling off in the past five years
(Figure 10). The number of cases involving infection
In the majority of hepatitis HCV cases (596) in 2010,
the mode of transmission reported was intravenous
drug use (Table 2). The number of unclear cases decreased slightly on previous years, though it was still
high (406 in 2010). In general, these cases are con-
HEPATITIS B
20
through intravenous drug use have decreased the most
rapidly, due to drug users and their family members
being vaccinated and an effective needle and syringe
exchange programme being put into place.
Report 39/2011
National Institute for Health and Welfare
Infectious Diseases in Finland 2010
sidered to be related to intravenous drug use because
HCV is not transmitted easily through sexual contact
and no community transmission has been detected.
Regionally, the incidence of hepatitis C has remained
fairly stable in recent years, being the highest in the
provinces of Southern Finland and Oulu (Figure 12).
Health counselling for intravenous drug users should
be further enhanced in high-incidence areas to reduce
the number of infections.
The number of annual cases in the age groups 15 to
19 and 20 to 24 have remained stable or decreased
(Figure 11). This may be a sign that health counselling for intravenous drug users and the related preventive work has decreased the risk of infection most
effectively in younger age groups and that hepatitis C
is now more typically contracted at a later age, after
prolonged intravenous drug use. Indeed, the number
of annual cases in age groups over 25 is increasing
(Figure 11).
120
100
80
60
40
20
0
1998
1999
2000
2001
2002
2003
2004
2005
Injecting drugs
2006
2007
2008
2009
2010
Sex
Figure 10. Acute hepatitis B cases involving intravenous drug use and sexually transmitted infections,
1998–2010 (no. of cases).
Table 2. All cases of hepatitis C according to physicians’ reports, organised by means of transmission, 2000–2010.
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
Injecting drugs
937
826
717
637
615
629
578
468
574
516
596
Sex
40
42
45
46
60
62
72
68
74
70
73
Perinatal
6
3
3
1
11
5
5
3
11
9
10
Blood products
25
20
19
22
18
24
7
21
20
2
9
Other
31
31
28
35
31
34
37
28
34
31
38
Unknown
700
565
560
524
506
490
469
577
429
422
406
Total
1739
1487
1372
1265
1241
1244
1168
1165
1142
1050
1132
Report 39/2011
National Institute for Health and Welfare
21
Infectious Diseases in Finland 2010
700
600
500
400
300
200
100
0
2000
2001
0−14
2002
2003
15−19
2004
2005
20−24
Figure 11. Hepatitis C by age group, 2000–2010 (no. of cases).
Hepatitis C, cases/100,000 population
<10/100,000
10–15/100,000
16–20/100,000
21–25/100,000
>25/100,000
figure 12. Incidence of Hepatitis c in finland 2010.
22
Report 39/2011
National Institute for Health and Welfare
2006
25−29
2007
30−34
2008
2009
35−
2010
Infectious Diseases in Finland 2010
Sexually transmitted diseases
•
The annual number of gonorrhoea cases continued to increase, as did the
fluoroquinolone resistance of the strains found.
•
The number of HIV infections contracted through heterosexual contact and in
sexual contact between men both increased.
•
Most of the infections contracted by men through heterosexual contact were
acquired abroad.
CHLAMYDIA (CHLAMYDIA
TRACHOMATIS)
GONORRHOEA (NEISSERIA
GONORRHOEAE)
In 2010, the number of chlamydia cases reported to
the NIDR totalled 12,825 (241/100,000), slightly
less than in 2009 (13,317). About 59% of the patients were women. The highest incidence of chlamydia cases was found in the hospital districts of Lapland (331/100,000), Pirkanmaa (280/100,000), and
Helsinki and Uusimaa (280/100,000). The majority
of the cases involved women aged 15 to 24 (73%)
and men aged 20 to 29 (66%). As previously, among
under-20-year-olds, women constituted a significantly larger group of patients (2,449) than men (719).
The annual number of cases of gonorrhoea continued
to increase. The NIDR received 257 notifications of
gonorrhoea (4.8/100,000). Men accounted for 75%
of the cases. The majority of cases (79%) were diagnosed among patients aged 15 to 39. More cases were
found in the age groups under 25 than in previous
years. The highest incidence was in the hospital district of Helsinki and Uusimaa (11.4/100,000), where
the incidence has been steadily increasing since 2007
(7.6/100,000). The country of acquisition was specified in 82% of the cases; 42% of the infections had
been acquired abroad. The most common country of
4000
3500
3000
2500
2000
1500
1000
500
0
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
Men, 15−19 years
Men, 20−24 years
Men, 25−29 years
Women, 15−19 years
Women, 20−24 years
Women, 25−29 years
2010
Figure 13. Chlamydia cases in the young adult age groups, 2000–2010 (no. of cases).
Report 39/2011
National Institute for Health and Welfare
23
Infectious Diseases in Finland 2010
Table 3. Gonorrhoea infections acquired domestically and abroad, 2000–2010 (no. of cases).
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
Finland
129
113
100
89
133
133
112
79
90
115
123
Russia
48
34
28
9
7
23
12
6
17
8
8
Estonia
7
3
5
2
6
1
-
2
-
-
3
Thailand
18
17
31
27
38
30
42
44
34
36
45
Other
32
26
18
21
21
20
25
22
24
40
33
Unknown
50
54
53
41
47
33
45
42
35
40
45
Total
284
247
235
189
252
240
236
195
200
239
257
Table 4. Syphilis infections acquired domestically and abroad, 2000–2010 (no. of cases).
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
Finland
54
32
25
30
22
25
21
56
57
69
36
Russia
80
49
22
18
16
22
18
17
26
18
26
Estonia
3
2
1
6
1
6
3
4
9
3
9
1
2
2
Somalia
Thailand
1
1
Other
17
11
12
3
3
4
8
10
5
1
2
1
1
2
6
5
4
14
12
18
17
25
35
30
45
Unknown
49
63
67
62
58
68
67
79
75
67
84
Total
204
159
129
133
111
143
130
187
216
202
209
origin was Thailand (45 cases) (Table 3). Fluoroquinolone resistance in gonorrhoea continues to increase.
In 2009, 72% of gonococcal strains were found to be
resistant to ciprofloxacin (Finres 2009).
SYPHILIS (TREPONEMA
PALLIDUM)
In 2010, the number of syphilis cases reported to the
NIDR totalled 209 (3.9/100,000), which is nearly equal
to the figure for 2009 (202). Sixty-four per cent of the
cases were diagnosed in men. Patients aged 25 to 54 accounted for 68% of the cases. The incidence was greatest
in the hospital districts of South Karelia (11/100,000),
Kymenlaakso (6.7/100,000) and Helsinki and Uusimaa
(6.5/100,000). The country of acquisition was specified
in 60% of the cases, and of these 71% were acquired
abroad, most often in Russia (26).
HIV AND AIDS
In 2010, 188 new HIV infections were reported to
the NIDR, 70% of the patients being men and 30%
women. This was 10 more than in 2009, matching
the peak year 2006. By the end of the year, 2,778 new
24
Report 39/2011
National Institute for Health and Welfare
HIV infections had been reported in Finland. There
is a rising trend: infections reported in the 2000s
constitute 60% of all HIV infections ever found in
Finland. This increasing trend is due to an increasing
number of HIV infections contracted in heterosexual
contact and in sexual contact between men.
The number of infections from heterosexual transmission in 2010 was 93 (2009: 96), 57 of them in Finns
and 36 in foreigners. The number of HIV infections
in this group has increased substantially in the 2000s
compared to what it was before that, among both foreigners and Finns. Most of the foreigners diagnosed
came from areas with a high prevalence of HIV and
had contracted HIV before coming to Finland. Most
of the infections contracted by Finnish men through
heterosexual contact were also acquired abroad.
The number of infections from sexual contacts between men in 2010 was 45, 32 of them in Finns and
13 in foreigners. This was about the same as in the
two previous years. Infections from sexual contacts
between men began to increase again at the beginning of the 2000s. This trend seems to have peaked
over the past three years, however, even though the
annual number of new cases is still high. A prevalence study among homosexual and bisexual men
Infectious Diseases in Finland 2010
conducted in 2010 found a prevalence of 1.4% for
HIV, significantly higher than in the population on
average. The majority of HIV infections from sexual
contacts between men were found in Finnish citizens
and had been acquired in Finland.
There were 6 cases of HIV associated with intravenous drug use in 2010, one Finn and 5 foreigners. It
is important to note that only one Finn contracted
HIV through intravenous drug use during the year.
However, 6 further cases of HIV were found among
drug users, the means of transmission being reported
as sexual contact with an intravenous drug user. Effective preventive measures have kept infections from
intravenous drug use at a low level following the HIV
epidemic at the turn of the millennium.
HIV infections in children are rare in Finland. One
case of mother-to-child infection was reported in
2010; this child had been born abroad. A total of 13
mother-to-child HIV infections have been found in
Finland in the 2000s, all but one of them of foreign
origin. Mother-to-child transmission can be effectively prevented with medication during pregnancy.
One HIV infection possibly transmitted by a blood
transfusion was reported in 2010. The transfusion had
been performed abroad. Only one other transfusiontransmitted HIV infection has been reported in the
2000s. There have been no reported cases of infection
through blood products in Finland since HIV testing
of donated blood began in 1985.
The percentage of cases where the means of transmission is not known has grown steadily, from 13%
on average in the 1990s to 22% in 2010. Of the
cases where means of transmission was not reported
in 2010, 40% also lacked a physician’s notification.
In the remaining cases, the patient did not know or
did not want to say how the infection had been contracted.
A record number of HIV infections were found in
foreigners in Finland in 2010: 80 cases, representing
43% of the annual total. Most of the foreigners diagnosed came from areas with a high prevalence of
HIV and had contracted HIV through a heterosexual
contact before coming to Finland. In the 2000s, HIV
infections contracted by foreigners through sexual
contacts between men and intravenous drug use
have clearly increased, although in absolute terms the
numbers are still rather low.
In 2010, 33 cases of AIDS were diagnosed, and
AIDS was the cause of death in 8 cases. The number
of AIDS cases and deaths has remained similar since
the introduction of effective combination drugs in
the mid-1990s. By the end of 2010, 296 persons
have died from AIDS. A significant percentage of the
AIDS cases occurring in the 2000s were due to a late
HIV diagnosis. In 2010, infection was detected late
in about half of the cases (CD4 < 350). Late diagnosis weakens the treatment prognosis and increases the
possibility of further infections.
Changes in primary resistance were found in about
5% of the HIV virus strains in 2010. The comparable
figure for Europe as a whole has been around 10% in
recent years.
120
100
80
60
40
20
0
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
Heterosexual transmission
Injecting drug use
Mother-to-child transmission
Men having sex with men
Blood products
Not notified
2010
Figure 14. HIV cases by transmission group, 2000–2010 (no. of cases).
Report 39/2011
National Institute for Health and Welfare
25
Infectious Diseases in Finland 2010
Antimicrobial resistance
•
The MRSA situation remained stable.
•
The number of VRE findings increased on the previous year.
•
There were considerably more ESBL findings than in 2009.
•
More carbapenemase-producing gram-negative bacilli were found than in
previous years.
•
The percentage of pneumococcal strains with reduced susceptibility to penicillin
increased, and the major proportion of pneumococcal strains remain resistant to
macrolides.
MRSA
In 2010, 1,267 cases of methicillin-resistant Staphylococcus aureus (MRSA) were reported to the NIDR,
about the same number as in the year before. Nearly
one in four, 23% (2009: 25%), was diagnosed from
samples taken from the nose or the nostrils. There
were 26 MRSA cases found through blood culture
(2009: 30) and two found through CSF culture. Of
these invasive MRSA findings, 13 (46%) were in
the Pirkanmaa hospital district (2.7/100,000) and 6
(21%) in the Helsinki and Uusimaa hospital district
(0.4/100,000). The other hospital districts reported
zero to three cases each, totalling 9. Most (18 out of
28) of the invasive cases occurred in patients older
than 65, and none in children. As earlier, the hospital districts of Pirkanmaa and of Helsinki and Uusimaa reported the highest total figures. The incidence
per 100,000 population was highest in the hospital
districts of Pirkanmaa, Western Bothnia, Northern
Karelia, Northern Savo and Kymenlaakso. A slightly
smaller percentage of the findings than previously was
in patients aged over 75, 42%. The number of MRSA
cases in children remained stable (84–82).
An MRSA strain isolated from the blood was typed in
1,300 individuals. There were 165 different spa types
in the MRSA strains (2009: 155). The most common
spa types were the same as in the previous year: t067
28% (2009: 26%), t172 14% (16%), t008 9% (7%),
t002 4% (5%) and t032 3% (6%). Nine hospital districts found t067, Pirkanmaa having the most findings, and 16 hospital districts found t172. Strains of
t008 and t002 were also typed using pulsed field gel
26
Report 39/2011
National Institute for Health and Welfare
electrophoresis (PFGE). Both were sub-divided into
several PFGE types. Nearly half (48%) of the t008
strains were of PFGE type FIN-25, an internationally
known strain of MRSA originating in outpatient care
(USA300), and more than one in three (36%) were
of PFGE type FIN-7. Local clusters (MRSA strain
isolated in more than 10 patients) also occurred in
the Kymenlaakso (t223), Northern Karelia (t721)
and Helsinki and Uusimaa (t2377 and t020) hospital
districts. The most common spa type among patients
over 75 was t067 (39%; 2009: 35%). Unlike in the
previous year, the most common spa types among
children were t223 (18%), t008 (12%, mostly of
PFGE type FIN-25) and t172 (9%; 2009: 32%). An
MRSA strain isolated from the blood was typed in 15
individuals: 6 were of spa type t067, the rest (9 out of
15) representing 8 different spa types.
VRE
In 2010, the number of vancomycin-resistant enterococcus (VRE) findings reported to the NIDR increased on the previous year. Most of the findings
were in the Southwest Finland hospital district (68
out of 92), in patients aged over 75 (51 out of 92)
and in women (56 out of 92). In the other hospital
districts, the number of findings varied from one to 7.
Three of the findings were from blood. VRE findings
were typed in 88 individuals. All findings except for
one were of the E. faecium species, and most of these
were of the vanB type (82 out of 87). PFGE revealed
that a new epidemic strain, VRE VIII, was spreading
in the Southwest Finland hospital district, and this
Infectious Diseases in Finland 2010
700
600
500
400
300
200
100
0
Central Finland
Southern
Bothnia
Vaasa
Central
Bothnia
Northern
Bothnia
Kainuu
Western
Bothnia
Lapland
Åland
Helsinki and
Uusimaa
700
600
500
400
300
200
100
0
Southwest
Finland
Satakunta
Kanta-Häme
Pirkanmaa
Päijänne
Tavastia
Kymenlaakso
Southern
Karelia
Southern
Savo
Eastern
Savo
Northern
Karelia
Northern
Savo
Figures 15a and 15b. MRSA cases by hospital district, 2000–2010 (no. of cases).
was eventually the most common type of strain in
2010 (63 out of 88 cases). VRE IX was the cause of 4
cases in 2010, of which 3 were in the Southwest Finland hospital district. Both epidemic strains were also
identified using multilocus sequence typing (MLST);
their sequence types – ST17 (VRE VIII) and ST192
(VRE IX) – belong to the E. faecium CC-17 clone,
which is internationally known as spreading in hospitals. The remaining 21 out of 88 cases involved isolated unique findings.
ESBL
Since the beginning of 2008, third-generation
Escherichia coli and Klebsiella pneumoniae exhibiting
reduced susceptibility or resistance to cephalosporin
(I for intermediate and R for resistant, respectively)
have been reported to the NIDR. The majority of
these bacteria are enzyme-producing ESBL strains
that split extended-spectrum cephalosporins and
penicillin.
In 2010, the majority of ESBL findings (2,258) were
E. coli (2009: 2,158), with a small number (184) of
Klebsiella pneumoniae (2009: 154). ESBL in E. coli
was diagnosed in all age groups – almost 75% in
women and over half in patients aged 65 years or
more. The majority of diagnoses (71%, 1,794 out of
2,528) were made from urine. The largest number of
cases was found in the hospital district of Helsinki
and Uusimaa (912, 60/100,000), but the incidence
was highest in the Southern Bothnia and Kymenlaakso hospital districts (71 and 63/100,000, respectively). There were considerably more ESBL findings
in blood than in 2009 (112 vs. 77) (ESBL percentage
Report 39/2011
National Institute for Health and Welfare
27
Infectious Diseases in Finland 2010
Table 5. MRSA-findings and their percentage of S. aureus blood culture findings, 1995–2010 (no. of cases
and %).
1995
All MRSA findings
S. aureus blood culture
findings
MRSA blood culture findings and the
methicillin resistance of S. aureus (%)
89
627
2 (0,3)
1996
110
667
0 (0,0)
1997
121
747
4 (0,5)
1998
190
719
5 (0,7)
1999
212
813
8 (1,0)
2000
266
850
4 (0,5)
2001
340
887
4 (0,5)
2002
600
989
9 (0,9)
2003
859
981
7 (0,7)
2004
1478
1059
30 (2,8)
2005
1381
1013
27 (2,7)
2006
1330
1239
37 (3,0)
2007
1297
1179
32 (2,7)
2008
1772
1261
40 (3,2)
2009
1267
1288
30 (2,3)
2010
1267
1370
26 (1,9)
Total
12579
15689
265 (1,7)
Table 6. Antimicrobial resistance of Streptococcus pneumoniae findings in blood and CSF, 1998-2010 (no. of
cases and %).
Cases reported to the
NIDR
Studied strains
Erythromycin
(R) (%)
Penicillin (I+R)
(%)
Multidrug
resistance (%)
1998
561
84
3,6
0
0
1999
568
471
5,9
7,2
0
2000
601
439
8,0
3,7
1,4
2001
658
360
18,8
7,5
5,0
2002
599
594
16,3
8,0
3,7
2003
721
739
21,9
12,7
5,7
2004
748
748
20,5
9,6
3,7
2005
735
731
20,5
9,6
4,4
2006
741
760
27,9
16,4
5,4
2007
788
794
23,2
14,4
3,5
2008
924
930
24,5
17,7
3,4
2009
854
848
28,4
19,9
4,7
2010
827
819
28,6
23,4
1,7
I – reduced susceptibility: R – resistant; Multidrug resistance – strains simultaneously resistant to penicillin (I+R), erythromycin (R) and tetracycline (R)
28
Report 39/2011
National Institute for Health and Welfare
Infectious Diseases in Finland 2010
of E. coli blood culture findings was 3.5%, or 112 out
of 3,211, as opposed to 2.6% in 2009). The majority of the findings were made in the hospital district
of Helsinki and Uusimaa. However, the incidence in
blood findings was highest in the Pirkanmaa, KantaHäme and Kymenlaakso hospital districts.
Over half of the ESBL cases reported that involved
K. pneumoniae were also diagnosed in patients aged
65 years or over, but the percentage of women was
smaller than with E. coli, being 58%. The majority
of diagnoses (54%, 99 out of 184) were made from
urine. The highest number of cases were found in the
Northern Bothnia hospital district (60) and the hospital district of Helsinki and Uusimaa (37), but the
incidence was highest in the Northern Bothnia and
Kainuu hospital districts. There were 16 blood findings (2009: 6) (Percentage of ESBL in K. pneumoniae
blood cultures was 3.2%, or 16 out of 504, as opposed to 1.3% in 2009).
In 2010, genes encoding extended-spectrum betalactamases were specified in 135 bacterial strains. The
strains had been collected for epidemic control, research, and confirmation of third-generation cephalosporin-resistance. The figure includes 107 E. coli
and 28 K. pneumoniae strains. Out of the E. coli and
K. pneumoniae strains isolated in 2010, 83% and
75%, respectively, had an extended-spectrum betalactamase of the CTX-M group. Changes in the
ESBL genetic profile of E. coli were slight compared
to 2009, but with K. pneumoniae the percentage of
CTX-M genes had increased substantially from the
44% recorded in 2009.
In 2010, carbapenemase-coding genes in 131 species of the Enterobacteriaceae genus were investigated.
These strains had been sent for carbapenemase gene
studies because of their reduced susceptibility to carbapenems. Of the strains examined, 9 (7%) had a
carbapenemase gene: KPB, OXA-48, GES, NDM
or VIM. All these genes were found in strains of
K. pneumoniae. The VIM gene was the most common, being found in 5 separate strains isolated from 3
patients. For all K. pneumoniae strains with a carbapenemase gene, except for the GES gene, the patient
had had contact with a hospital abroad (in Greece,
India or Spain).
strains were found to have metallo-beta-lactamase
genes VIM and IMP. Patients from whom a strain of
P. aeruginosa with the VIM carbapenemase gene was
isolated had had contact with a hospital abroad, in
Russia or Turkey. No similar link to hospitals abroad
could be established for strains with the IMP gene.
This means that strains with IMP metallo-beta-lactamase may already be present in Finnish hospitals.
The majority of K. pneumoniae and P. aeruginosa
strains with carbapenemase are, however, from
abroad. The situation parallels that found in 2009
with the isolation of the first strains to contain a KPC
gene.
INVASIVE PNEUMOCOCCAL
DISEASE (STREPTOCOCCUS
PNEUMONIAE)
In 2010, 827 cases (15/100,000) of invasive pneumococcal disease were reported (2009: 855, 16/100,000).
As in previous years, the incidence was higher among
men than among women (17 vs. 14/100,000). Regional variation was significant (8–26/100,000),
which may be due to differences in how actively samples were taken. In 2010, the antimicrobial susceptibility of 819 pneumococcal strains isolated from invasive infections was analysed. Compared with 2009,
2010 saw the percentage of strains with reduced susceptibility to penicillin (MIC ≥ 0.125 mg/L) increase
to 23%. The percentage of penicillin-resistant strains
(MIC ≥ 2 mg/L) was 3.7%. The proportion of macrolide-resistant strains remained almost the same as
in the previous year; 29% of invasive pneumococcal
strains were resistant to erythromycin. Multiresistant
(PEN IR – ERY R – TET R) accounted for 1.7%
of the strains, which is slightly lower than in 2009.
In 2010, one levofloxacin-resistant (MIC ≥ 8 mg/L)
and two ceftriaxone-resistant (MIC ≥ 2 mg/L) strains
were detected. In general, the changes in the susceptibility of invasive pneumococcus strains were minor
when compared with 2009 findings. However, the
percentage of strains with reduced susceptibility to
penicillin continues to grow.
In addition to the species in the genus Enterobacteriaceae, 60 strains of Acinetobacter baumannii and
Pseudomonas aeruginosa were examined for carbapenemase genes because of their reduced susceptibility to
carbapenems. The PCR test found a positive result
in 25 (42%) of the cases. A. baumannii had genes
of the OXA group which are typical for it (OXA-51,
OXA-58, OXA-24 and OXA-23). P. aeruginosa
Report 39/2011
National Institute for Health and Welfare
29
Infectious Diseases in Finland 2010
Mycobacterial infections
•
The percentage of immigrants among tuberculosis patients increased.
TUBERCULOSIS
(MYCOBACTERIUM
TUBERCULOSIS)
Tuberculosis surveillance
Between 1995 and 2006, the registered tuberculosis
cases included all cases confirmed by culture, as reported by the laboratories. In addition, cases reported
by a physician were included, but only if the diagnosis was based on histology or a case of pulmonary
tuberculosis was confirmed by positive sputum staining for tuberculosis bacilli. From 2007 onwards, following the case definition of tuberculosis cases in EU
infectious disease surveillance, the statistics include
all cases where a physician suspected tuberculosis on
the basis of clinical evidence and decided to give full
tuberculosis treatment even if the infection was not
confirmed by microbiological tests or histology. The
new criteria for compiling statistics do not affect the
number of cases confirmed by laboratory tests or histology.
Incidence of tuberculosis in 2010
There were 325 tuberculosis cases in 2010
(6.0/100,000), 21% fewer than in 2009 (411,
7.7/100,000); 242 (74%) of the cases in 2010 were
pulmonary tuberculosis, and of these 88 (36%) had a
positive sputum smear. In 2010, there were 258 cases
of tuberculosis confirmed by culture, 15% fewer than
in 2009 (303). As judged by physicians’ notifications,
22 patients (7%) had a previous history of tuberculosis diagnosed after 1950, when anti-tuberculosis
medication became available.
The increase in the overall number of tuberculosis cases in Finland in 2007 and 2008 compared to
2006 is explained by the introduction in 2007 of the
broader EU case definition of tuberculosis. There was
no increase in the number of cases of pulmonary tuberculosis confirmed by culture or positive sputum
30
Report 39/2011
National Institute for Health and Welfare
smear in the aforementioned years. In 2009, there
was a clear increase in the number of comparable,
culture-confirmed cases, with a temporal correlation
with a clear increase in the number of cases of foreign
origin.
The age distribution of tuberculosis cases was as
follows: under 15, 6 cases (2%); 15 to 29, 64 cases
(20%); 30 to 44, 41 cases (13%); 45 to 59, 51 cases
(16%); 60 to 74, 59 cases (18%); and 75 or more,
104 cases (32%). No increasing trend has been found
in children aged under 5 after the change in the vaccination programme in 2006.
In 2010, the patient was foreign in 104 cases (32%),
i.e. born abroad (in the absence of country of birth,
citizenship other than Finnish). The age distribution
of these was as follows: under 15, 4 cases (4%); 15 to
44, 81 cases (78%); 45 to 59, 13 cases (13%); and 60
or more, 6 cases (6%). Among these there were 72
cases (69%) of pulmonary tuberculosis and 32 cases
(31%) of other forms of tuberculosis. Information on
the patient’s country of birth or citizenship was missing in 5 cases (2%).
The susceptibility of Mycobacterium tuberculosis
strains in Finland remains good. Of all cultured
strains, 93% had full susceptibility; 6 MDR strains
were isolated (2%). However, while the latter were
more resistant than before, none of them fulfilled
XDR criteria.
In 4 (1%) of the tuberculosis cases reported in 2010,
the patient also had an HIV infection. Three of these
were new HIV infections reported in 2010, and one
had been reported earlier.
Tuberculosis typing findings in 2010
All new strains of M. tuberculosis were genotyped in
2010 according to internationally harmonised typing
methods (spoligotyping and MIRU-VNTR typing).
Genotyping was used to trace the source of infection
Infectious Diseases in Finland 2010
Table 7. Incidence of tuberculosis and percentage of culture-confirmed cases in Finland, 1995–2010 (no. of
cases and %).
Pulmonary tuberculosis
Other
tuberculosis
All cases
Cases
Cases
/100,000
Cases with
positive
sputum
smear
Cases with
positive sputum smear
/100,000
Cases
Cases
/100,000
Cases
Cases
/100,000
Cultureconfirmed
cases
Proportion
of cultureconfirmed
cases (%)
1995
436
8,6
241
4,7
217
4,3
653
12,8
475
72,7
1996
442
8,6
232
4,5
193
3,8
635
12,4
513
80,8
1997
360
7,9
185
3,6
197
3,8
557
10,9
442
79,4
1998
397
7,7
203
3,9
213
4,1
610
11,9
494
81
1999
405
7,8
185
3,6
188
3,6
593
11,5
510
86
2000
376
7,3
227
4,4
171
3,3
547
10,6
460
84,1
2001
312
6
150
2,9
181
3,5
493
9,5
411
83,4
2002
299
5,8
136
2,6
175
3,4
474
9,1
392
82,7
2003
290
5,6
144
2,8
122
2,3
412
7,9
348
84,5
2004
233
4,5
128
2,5
103
2
336
6,4
291
86,6
2005
269
5,1
136
2,6
100
1,9
369
7
321
87
2006
212
4,0
101
1,9
83
1,6
295
5,6
270
91,5
2007
235
4,5
93
1,8
111
2,1
346
6,6
250
72,3
2008
222
4,2
109
2,1
124
2,3
346
6,5
247
71,4
2009
295
5,5
96
1,8
116
2,2
411
7,7
303
73,7
2010
242
4,5
88
1,6
83
1,5
325
6,0
258
79
Table 8. Cases of tuberculosis in foreigners, 1995–2010 (no. of cases and %).
Pulmonary tuberculosis
1995
Other tuberculosis
All cases
Cases in
foreigners
Proportion
of foreigners
(%)
Cases in
foreigners
Proportion
of foreigners
(%)
Cases in
foreigners
Proportion
of foreigners
(%)
25
5,7
13
6
38
5,8
1996
17
3,8
24
12,4
41
6,5
1997
23
6,4
23
11,7
46
8,3
1998
26
6,5
31
14,6
57
9,3
1999
25
6,2
21
11,2
46
7,8
2000
29
7,7
16
9,4
45
8,2
2001
34
10,9
28
15,5
62
12,6
2002
23
7,7
24
13,7
47
9,9
2003
36
12,4
13
10,7
49
11,9
2004
22
9,4
20
19,4
42
12,5
2005
28
10,4
24
24
52
14,1
2006
30
14,2
22
26,5
52
17,6
2007
45
19,1
28
25,2
73
21,1
2008
31
14
22
17,7
53
15,3
2009
81
27,4
43
37,1
124
30,1
2010
72
30
32
39
104
32
Report 39/2011
National Institute for Health and Welfare
31
Infectious Diseases in Finland 2010
in 35 different situations, including 89 cases of tuberculosis.
Surveillance of the outcomes of
tuberculosis treatment 2007–2009
Links between strains of tuberculosis were explored
in a total of 32 cases in seeking the source of infection.
Table 9 shows the distribution of treatment outcomes
between 2007 and 2009. The group under surveillance consists of cases of pulmonary tuberculosis confirmed by culture, genetic replication or mycobacterial smear. An outcome evaluation is performed 12
months after the date of registration. This means that
some of the outcome evaluation forms for 2009 have
not yet been returned, which is why the surveillance
is not yet as comprehensive as in previous years.
In a cluster of 12 cases among homeless persons in the
Tampere area, the strains of TB bacteria were found
to be of the same type (SIT53). The possible connection of the Tampere TB cluster to the other cases
caused by the SIT53 strain in Finland was investigated, and a further eight cases with genotypically
similar strains were found in Kotka region. In this
investigation, another cluster of cases among homeless persons with an identical strain (SIT40) was discovered in Tammisaari.
Preliminary figures for 2009 show that the outcome
was good in 65% of cases, a percentage slightly lower
than in 2007 and 2008. It falls clearly short of the international target set by the WHO at 85%, but is on
a par with the average for most EU Member States.
Unlike in previous years, the group of good outcomes
in 2009 included fewer cases fulfilling the criteria for
microbiological full recovery than cases where treatment had been completed.
In a cluster of cases among young immigrants from
Africa, a previously unknown type (F404) was found
to have caused altogether 14 cases.
Three clusters in a hospital environment were investigated, involving a total of 4 cases of TB. The three
strains isolated from medical care personnel in these
cases were identical (SIT914).
The mortality rate (before starting treatment or during treatment) was 17% in 2009, on a par with other
EU Member States and similar to the situation in the
two previous surveillance years.
Laboratory contamination was suspected in three
cases. In two cases, an obvious cross-contamination
between samples was found using typing.
Table 9. Results of surveillance of pulmonary tuberculosis treatment outcomes, 2007–2009 (no. of cases and %).
Cases under surveillance
2007
2008
2009
203
191
246
144 (71%)
143 (75%)
159 (65%)
85
91
75
TREATMENT OUTCOME
Favourable
Cured
59
52
84
Non-favourable
Treatment completed
44 (22%)
37 (19%)
44 (18%)
Deceased
41 (20%)
33 (17%)
41 (17%)
Treatment failure
1
1
0
Interrupted treatment
2
3
3
Missing
32
15 (7%)
14 (7%)
43 (17%)
Transfer
3
2
13
Treatment continues at 12 months
7
9
6
Form not returned or treatment
outcome was not indicated
5
3
24
Report 39/2011
National Institute for Health and Welfare
Infectious Diseases in Finland 2010
Other infections
•
Repeated imported measles infections and further infections from these highlight
the importance of good vaccination coverage.
•
The number of TBE cases contracted in mainland Finland is gradually increasing,
but the risk of contracting TBE is the highest by far on Åland.
•
None of the patients who fell ill with falciparum malaria had used the appropriate
prophylaxis.
•
The number of cases of dengue fever is constantly increasing, which demonstrates
the important of protecting against mosquitoes when travelling to the tropics or
other warm climates.
•
The number of severe bacterial and fungal infections detected by blood culture
exceeded 11,000 per year for the first time ever.
HAEMOPHILUS (HAEMOPHILUS
INFLUENZAE)
In 2010, there were 40 reported infections caused
by the Haemophilus influenzae bacterium, diagnosed
in blood or CSF. The majority of these (73%) were
caused by unencapsulated strains. Serotype b was the
pathogen in 4 adult patients and one child aged 3.
The adults were in an age group for which the Hib
vaccination was not yet included in the vaccination
programme in their childhood. Children born in
1985 or later have received the Hib vaccine at the
child care clinic. Since the beginning of 2005, under
the revised vaccination programme, the Hib vaccination is administered as a component of a combination vaccine at 3, 5, and 12 months. The efficiency
of the vaccination is monitored, and vaccination data
are investigated for all children diagnosed with Hib.
MENINGOCOCCUS (NEISSERIA
MENINGITIDIS)
The number of meningococcus infections detected
in blood or CSF totalled 35 (0.65/100,000), which
is about the same as in the previous two years. The
serogroup distribution of the culture-confirmed cases
(n=33) differed from previous years in that the absolute number and percentage of group Y cases had
quadrupled: 14 of the cases (42%) were caused by
group B meningococcus and 13 cases (39%) by
group Y. There were 4 group C strains (12%). The
age distribution of the cases was much the same as
in previous years: 8 patients aged 0 to 4, 7 patients
aged 15 to 20, and 16 patients aged 21 or over. No
temporal or local clusters were detected.
MMR DISEASES (MEASLES,
MUMPS, RUBELLA)
Five cases of measles were confirmed in Finland in
2010, two of them imported and three secondary
cases. Measles was brought into the country by two
young adults who had not been vaccinated against it,
and they further infected three unvaccinated adults.
The original patients had contracted measles in Senegal and Sicily. The genotypes of the measles viruses
involved were B3 (Senegal) and D4 (Sicily), which
are known to occur in or near the relevant areas.
Four cases of mumps were confirmed, three in adults
and one in a child. All patients were unvaccinated.
One of the adults acquired the mumps in Thailand;
the source of acquisition could not be established for
the others.
No cases of rubella were reported in 2010.
Report 39/2011
National Institute for Health and Welfare
33
Infectious Diseases in Finland 2010
Table 10. Meningococcal infections by serogroup, 2000-2010 (no. of cases).
Group A
Group B
Group C
Group Y
Group W135
Unknown
Total
2000
30
11
2
3
2
48
2001
34
9
4
1
3
51
2002
36
6
4
1
2
49
2003
28
5
6
2
41
2004
29
5
4
4
44
2005
33
1
3
3
40
2006
38
5
1
1
45
2007
29
8
5
1
43
2008
19
8
2
2009
24
3
5
2010
14
4
13
PUUMALA VIRUS
The number of Puumala virus cases reported in 2010
was 1,434, some 500 cases fewer than in 2009 and
less than half of the 3,200 cases in the peak year of
2008. In each of the previous peak years, 2002 and
2005, there were about 2,500 cases. The number of
cases varies, depending on the virus reservoir, i.e. the
size of the bank vole population. The variation usually follows a three-year cycle such that two abundant
years are followed by a quieter year. The patients’ age
and gender distribution was the same as before. Of
the patients, 60% were men, and most patients were
of working age. There were 74 (5%) under 20 years of
age. This time, the incidence was highest in the Kainuu hospital district (96/100,000 population) and in
the Etelä-Savo hospital district (93/100,000 population) (Figure 16).
TICK-BORNE ENCEPHALITIS (TBE)
After the turn of the millennium, between 16 and 42
cases of TBE have been reported in Finland annually.
In 2010, 44 TBE antibody findings were reported to
the NIDR, and 38 patients had symptoms consistent
with the disease.
The TBE season in 2010 was from June to October,
peaking in August and September. The patients were
aged 5 to 85; one patient died of the disease. The
patients included 10 people from Åland, 27 from
elsewhere in Finland and one Swedish national who
contracted the disease on Åland.
In order to identify the place of acquisition, the National Institute for Health and Welfare interviewed
34
Report 39/2011
National Institute for Health and Welfare
2
29
1
1
33
3
35
patients who had been diagnosed with TBE in 2010
and/or studied their patient records. The results show
that in 13 of the cases (34%) the patient contracted
the infection on Åland, followed by the Imatra/Lappeenranta area (4), the Maalahti/Närpiö area (3), the
Kokkola area (3), the Turku archipelago (3), the Kotka archipelago (2), Länsi-Uusimaa (1), Simo (1) and
the Kuopio area (1). Three Finnish nationals were infected in the Baltic states. In two cases, the location
of acquisition remained unclear (either in the Baltic
states or in Finland, possibly on the south coast of the
Gulf of Finland).
Because of the systematic investigation of the place of
acquisition, the Maalahti/Närpiö area (in 2007 and
2010), Varkaus (2008), Simo (2008, 2009 and 2010)
and the Kotka archipelago (2010) have been identified as possible endemic TBE regions.
If a patient falls ill with meningitis or encephalitis
between May and October even though he or she
has not noticed a tick bite, TBE should be suspected.
Because new endemic TBE regions may continue to
emerge, it is a good idea to consider the possibility
of TBE infection even beyond currently known risk
areas.
TULAREMIA (FRANCISELLA
TULARENSIS)
The annual incidence of tularemia varies between 0.5
and 18/100,000 population. There are also notable
variations in geographical incidence; epidemics tend
to be local. In 2010, 91 laboratory-confirmed cases
of tularemia were reported (1.7/100,000). The North-
Infectious Diseases in Finland 2010
Puumala virus
Cases/100,000 population
0–25/100,000
26–50/100,000
51–75/100,000
76–100/100,000
Figure 16. Cases of Puumala virus by hospital district, 2010 (no. of cases per 100,000 population).
ern Bothnia hospital district had the highest number
of cases (26). As in previous years, the incidence
relative to population was highest in the Southern
Bothnia, Northern Bothnia and Central Finland hospital districts, being 7.6/100,000, 6.6/100,000 and
5.1/100,000, respectively. The age and gender distribution of the patients also did not differ markedly
from that of previous years. Most of the patients were
in the age group 40 to 54; 54 of the patients (59%)
were men. As is typical, the majority of the cases were
diagnosed in August and September.
POGOSTA DISEASE (SINDBIS
VIRUS)
Wild rodents are considered to be the animal reservoir for tularemia bacteria; the most common means
of transmission to humans is by mosquito bite. Francisella tularensis may also be contracted from the bite
of other kinds of invertebrate, or it can be transmitted
in aerosol form, through contaminated water or food,
or through direct contact with an infected animal.
Sindbis virus is assumed to be transmitted mainly by
insect bites. Rainfall about a month before the appearance of infections has been found to be a significant factor in incidence. Epidemics may be linked to
local ecological factors and the cyclical variation of
available animal reservoirs (forest game birds) or vectors. Cases of Pogosta disease tend to cluster in the
In 2010, 57 cases were reported. The incidence was
highest in the Central Finland, Southern Bothnia
and Northern Karelia hospital districts (2.6/100,000,
2.5/100,000 and 1.8/100,000, respectively). The patients were 28 to 82 years old (median: 53 years), and
32 of them (56%) were women. The majority of the
cases, 49 (86%), were diagnosed between July and
September.
Report 39/2011
National Institute for Health and Welfare
35
Infectious Diseases in Finland 2010
period from late July to September. The disease has
an incubation period of less than a week and raises
a fever, possibly with a rash and chronic symptoms
(arthritic symptoms, for instance) that may persist for
years. Pogosta disease has followed a regular sevenyear cycle since 1974 except for 2009. The epidemic
peaked in 1981, 1995 and 2002; in 2009, however,
only 106 cases were found (2/100,000).
BORRELIA (LYME DISEASE)
In 2010, the number of borrelia cases reported was
1,442, which is about the same as in the recordbreaking year 2009. The incidence in the whole
country was 27/100,000 on average, but there was
significant regional variation (Figure 17). Once again,
the incidence was highest in the province of Åland
(1,320/100,000), accounting for one in four of all
diagnosed borrelia infections in Finland, 366 cases.
As in previous years, the frequency of borrelia was
highest in the autumn, from August to November.
The majority of the patients (75%) were aged over
45; 54% of the patients were women.
MALARIA AND OTHER TRAVELRELATED INFECTIONS
Malaria
Malaria was diagnosed in 33 patients in Finland in
2010. There were 22 cases of Plasmodium falciparum,
8 cases of P. vivax, 2 cases of P. ovale and one case
of P. malariae. One patient had a relapse of vivax
malaria. The majority of infections (26 cases, 79%)
Borreliosis
Cases/100,000 population
0–5/100,000
6–10/100,000
11–15/100,000
16–20/100,000
> 20/100,000
Figure 17. Borreliosis cases by hospital district, 2010 (no. of cases/100,000).
36
Report 39/2011
National Institute for Health and Welfare
Infectious Diseases in Finland 2010
were acquired in Africa: 23 were acquired in western
Africa and 3 in eastern or southern Africa. Of the
rest, 4 came from the Indian subcontinent, 2 from
Southeast Asia and one from the Caribbean. Five of
the patients were native Finns who had taken a trip
of less than six months to a malaria region, and four
were Finns residing in a malaria region. Ten of the
patients were immigrants who came from a malaria
region and had returned to visit their home region;
six were refugees who fell ill immediately after arriving in Finland. Eight were visitors to Finland. The
number of malaria cases and the risk groups remained
approximately the same as in previous years. None of
the patients who fell ill with falciparum malaria had
used the appropriate prophylaxis.
Dengue fever
Dengue fever cases have been on the increase in recent years. In 2010, laboratories reported 50 findings,
when in 2009 the figure was 35.
Rabies
Doctors are required to report cases where risk assessment has led to the start of rabies vaccination treatment after exposure. In 2010, 46 suspected cases of
rabies were reported to the NIDR. There were 21 patients who had been exposed during a trip abroad, 9
of them in Thailand. Some had been exposed in Russia, India and Turkey, and there were some additional
isolated cases. In most cases, exposure consisted of
dog bites.
Other infections
A significant percentage of the following infections
are travel-related; the data on country of acquisition
and routes of transmission are discussed separately
for each of the following in their respective sections:
Legionella p. 8, salmonella p. 12, campylobacter
p. 14, shigella p. 15, EHEC p. 15, hepatitis A p. 20,
hepatitis B p. 20, gonorrhoea p. 23, syphilis p. 24,
HIV and AIDS p. 24, carbapenem-resistent gramnegative bacilli p. 29, MMR-diseases p. 33.
Table 11. Malaria cases in Finland in 2010 by country
of acquisition.
Continent
Country
Asia
India
4
Cambodia
2
Africa
America
Total
Cases
Total
6
Angola
1
Gambia
2
Ghana
6
Guinea
1
Cameroon
3
Liberia
1
Morocco
1
Nigeria
4
Ivory Coast
1
Sierra Leone
3
Sudan
1
Swaziland
1
Uganda
1
Total
26
Haiti
1
Total
1
33
Report 39/2011
National Institute for Health and Welfare
37
Infectious Diseases in Finland 2010
BLOOD AND CSF FINDINGS IN
CHILDREN
Blood culture findings in children
The number of blood culture positive cases in children under 15 reported in 2010 was 659, roughly
the same as in recent years (average between 2000
and 2009 was 617, variation 530 to 689). Just over
half of the findings (321 out of 659) were in babies
under 12 months old. Among infants, Staphylococcus epidermidis and other coagulase-negative staphylococci caused over 30% of blood culture positive
infections. Though these bacteria belong to normal
skin flora, they typically cause late-onset sepsis in
newborn babies in intensive care. The second most
common cause (17% of the findings) was Streptococcus agalactiae (Group B streptococcus, GBS). It
is typically contracted from the mother’s birth canal
during labour and causes an infection (early-onset
sepsis) in the newborn baby during its first days of
life. Other common causes of infection were Escherichia coli (14% of the findings), Staphylococcus
aureus (7%), Enterococcus faecalis (6%) and Streptococcus pneumoniae (6%), as expected. S. pneumoniae
(28%) and coagulase-negative staphylococcus (17%)
were the most common findings in children aged 1
to 14 accounting for half of the reported cases in this
age group. These were followed by S. aureus (13%)
and the Streptococcus viridans group (11%).
38
Report 39/2011
National Institute for Health and Welfare
CSF findings in children
The number of bacterial and fungal findings related
to children’s central nervous system infections remained at the same level as in the preceding years,
as did the distribution of pathogens. The number of
cases reported in 2010 was 30 (annual average from
2000 to 2009 was 36, variation 15 to 64). A majority
of the findings (19 out of 30) were in babies under
12 months old. The most common findings in the
age group of under 12 months were S. agalactiae,
pneumococci and S. epidemidis (Table 14); in the
age group 1 to 14, the most common findings were
meningococci, pneumococci and S. aureus.
GBS in newborns
Between 1995 and 2010, an average of 35 cases per
year of early-onset GBS in newborns (diagnosed from
blood and/or CSF under the age of 7 days) were reported; the variation was 28 to 57 cases per year, and
the incidence was 0.5 to 1.0 per 1,000 live births.
There were 34 cases in 2010 (0.6 cases per 1,000 live
births). The average figure for late-onset GBS between
1995 and 2010 was 16 cases per year; the variation
was 6 to 24 cases per year, and the incidence was 0.1
to 0.4 per 1,000 live births. There were 22 cases in
2010 (0.4 cases per 1,000 live births).
Infectious Diseases in Finland 2010
Table 12. Blood culture findings in infants (under 12 months), 2000–2010 (no. of cases).
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
Staphylococcus, other
coagulase-negative
27
23
36
20
36
31
42
39
33
43
32
Staphylococcus epidermidis
49
76
76
61
110
98
100
92
87
64
71
Streptococcus agalactiae
38
41
46
37
45
73
55
51
49
51
54
Escherichia coli
43
39
40
39
37
41
44
42
38
38
45
Streptococcus pneumoniae
26
19
17
25
28
26
28
21
26
25
19
S. aureus
17
17
24
21
32
32
37
25
23
22
24
Enterococcus faecalis
4
6
11
11
9
15
22
8
5
10
20
Streptococcus viridans group
6
10
8
13
15
12
10
9
8
9
17
Klebsiella species
9
8
7
8
9
9
8
6
8
9
3
Neisseria meningitidis
8
3
2
2
5
3
2
3
3
5
4
Streptococcus pyogenes
1
2
1
1
3
3
2
4
2
Enterobacter species
6
6
6
6
5
8
6
3
3
Streptococcus, other
beta-haemolytic
1
1
1
2
3
2
Haemophilus influenzae
2
3
2
1
2
1
2
2
1
Enterococcus faecium
4
1
2
2
3
2
3
1
2
2
Streptococcus bovis group
1
1
1
1
1
Enterococcus, other or
unidentified
3
13
1
2
1
Serratia species
3
5
2
4
Acinetobacter species
1
4
3
1
Listeria monocytogenes
1
1
Other bacteria
18
14
19
15
17
Bacteria, total
265
269
306
270
Candida albicans
3
3
10
2
Other candida species
9
8
8
2
2
2
3
4
1
2
3
2
1
1
3
2
1
1
2
10
14
19
17
12
13
364
359
387
333
313
309
319
3
4
4
2
3
1
2
1
1
1
2
1
1
Other fungi
Fungi, total
1
1
12
11
18
4
3
5
4
4
4
Report 39/2011
National Institute for Health and Welfare
39
Infectious Diseases in Finland 2010
Table 13. Blood culture findings in children (aged 1 to 14), 2000–2010 (no. of cases).
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
Streptococcus pneumoniae
72
76
92
94
88
101
99
115
87
92
94
Staphylococcus,
other coagulase-negative
15
18
14
16
9
13
8
18
13
17
21
S. aureus
42
35
58
47
58
41
37
42
40
36
43
Staphylococcus epidermidis
48
26
40
30
25
41
40
33
22
31
37
Streptococcus viridans group
18
23
13
13
18
24
24
23
21
25
36
Escherichia coli
20
5
13
13
15
10
16
12
14
12
15
Streptococcus pyogenes
9
9
10
12
4
9
13
11
11
6
Enterococcus faecium
2
2
4
1
2
2
3
4
2
7
7
Other gram-positive cocci
6
6
4
2
8
7
9
6
4
6
11
2
4
2
2
4
2
6
6
4
6
5
8
2
1
4
1
2
2
4
1
1
6
3
3
1
2
4
3
2
2
1
2
3
3
3
6
3
2
1
3
7
Enterococcus faecalis
Acinetobacter species
5
Enterobacter species
2
Haemophilus influenzae
2
2
1
5
Pseudomonas aeruginosa
6
7
4
6
Pseudomonas, other than
aeruginosa
1
3
1
1
Klebsiella species
2
2
6
4
5
10
3
6
Streptococcus, other
beta-haemolytic
1
1
3
2
2
4
1
Neisseria meningitidis
9
9
6
2
7
5
3
1
2
1
Serratia species
1
1
1
3
5
2
4
2
2
4
6
1
Other bacteria
36
18
27
27
25
38
26
39
32
17
34
Bacteria, total
296
249
309
290
270
317
293
331
271
278
336
Candida albicans
4
1
2
1
1
1
Other candida species
1
1
Other fungi
Fungi, total
40
8
3
5
Report 39/2011
National Institute for Health and Welfare
1
1
2
3
3
1
1
2
2
3
2
1
5
4
2
1
3
0
2
Infectious Diseases in Finland 2010
Table 14. Cerebrospinal fluid culture findings in infants (under 12 months), 2000–2010 (no. of cases).
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
4
2
5
1
10
7
7
6
3
6
8
Staphylococcus,
other coagulase-negative
5
1
2
1
4
1
Streptococcus pneumoniae
3
6
8
3
4
3
2
3
3
2
1
1
2
2
1
3
3
3
3
3
2
1
2
2
1
2
4
1
2
1
2
1
Streptococcus agalactiae
S. aureus
1
Staphylococcus epidermidis
Neisseria meningitidis
4
3
Streptococcus viridans group
1
1
Escherichia coli
3
1
1
2
2
2
1
1
Streptococcus pyogenes
1
2
1
Haemophilus influenzae
1
Klebsiella species
1
1
Enterococcus faecalis
1
1
1
1
1
1
2
Enterococcus faecium
1
1
Pseudomonas, other than
aeruginosa
1
1
3
1
3
22
22
37
Other Haemophilus species
Other bacteria
Bacteria, total
9
9
16
2
2
19
19
15
Candida albicans
1
2
22
19
1
Other candida species
Other fungi
Fungi, total
0
0
0
0
0
0
0
0
0
1
0
Report 39/2011
National Institute for Health and Welfare
41
Infectious Diseases in Finland 2010
Table 15. Cerebrospinal fluid culture findings in children (aged 1 to 14), 2000–2010 (no. of cases).
2000
2002
2003
2004
2005
2006
2007
2008
2009
2010
Streptococcus pneumoniae
2
10
2
1
5
5
2
4
2
Staphylococcus,
other coagulase-negative
3
2
2
2
1
2
2
7
1
4
2
7
4
4
5
1
1
S. aureus
2001
1
Staphylococcus epidermidis
Neisseria meningitidis
5
4
Streptococcus pyogenes
7
2
3
3
2
1
5
2
1
5
3
2
3
1
Streptococcus viridans group
Enterococcus faecalis
1
1
1
Enterococcus faecium
1
2
1
1
1
Enterococcus, other or
unidentified
Escherichia coli
1
1
Klebsiella species
1
Other bacteria
1
2
8
4
2
7
3
Bacteria, total
10
6
30
25
19
18
18
0
0
1
Candida albicans
8
5
2
13
21
17
11
0
0
0
0
1
Other candida species
Other fungi
Fungi, total
42
0
Report 39/2011
National Institute for Health and Welfare
0
0
0
1
Infectious Diseases in Finland 2010
BLOOD AND CSF FINDINGS IN
ADULTS
Blood culture findings in adults
The total number of blood culture findings in adults
has grown steadily and was nearly 11,000 in 2010
(2009: 10,226). Gram-positive bacteria were more
common in the working-age population (aged 15
to 64) and gram-negative bacteria among those
aged 65 or more. Anaerobic bacteria constituted less
than 4% and fungi about 1% of all blood culture
positive findings among adults. In the working-age
population, the most common bacterial finding was
Escherichia coli, constituting about 20% of all cases
(Table 16). The next most common findings were
Staphylococcus aureus (14%), coagulase-negative staphylococci (10%), Streptococcus pneumoniae (10%)
and Klebsiella species (5%). E. coli was also the most
common blood culture finding among patients aged
65 years or more, accounting for a third of all findings (Table 17). The next most common findings
were Staphylococcus aureus (11%), coagulase-negative staphylococci (7%), Klebsiella species (7%) and
Streptococcus pneumoniae (4%).
CSF findings in adults
There were 116 reported cases of microbial findings
in CSF in adults in 2010; the annual average for the
period 2000–2009 was 147, variation 32 to 193. Just
under one third of the cases (36 out of 116) involved
patients over 65 years old. Coagulase-negative staphylococcus was reported in about a quarter of the cases
in working-age patients (Table19). The most common actual pathogens were pneumococcus (19%),
S. aureus (15%) and meningococcus (8%). In patients
aged 65 years or older, coagulase-negative staphylococcus accounted for 17% of the findings (Table 20).
The most commonly reported actual pathogens were
pneumococcus (17%), Listeria monocytogenes (17%)
and S. aureus (14%).
Group A streptococcus
The prevailing emm types of Group A streptococcus (Streptococcus pyogenes) have given way in part to
new, less known types, but the emm 1 type (previously T1M1) that caused severe illnesses in the past
has also increased in prevalence. The most common
emm types of the preceding years (emm1 and emm28)
still prevail; the percentage of the emm84 type clearly decreased in 2008. A new type, emm119.1, has
emerged. It was the fourth most common type, at
8% (Table 18, p. 49).
Report 39/2011
National Institute for Health and Welfare
43
Infectious Diseases in Finland 2010
Table 16. Blood culture findings in patients aged 15 to 64, 2000–2010 (no. of cases).
44
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
Escherichia coli
533
613
580
645
707
780
798
837
871
885
926
S. aureus
393
437
458
447
486
457
564
544
526
539
578
Staphylococcus,
other coagulase-negative
128
108
143
114
126
113
120
141
152
137
138
Streptococcus pneumoniae
312
343
333
406
388
377
347
353
479
441
413
Staphylococcus epidermidis
274
298
301
286
294
286
281
265
279
313
261
Klebsiella species
115
114
134
121
159
184
145
159
198
187
207
Streptococcus viridans group
119
118
105
126
141
141
130
118
140
144
150
Streptococcus pyogenes
84
60
93
78
93
76
105
133
157
117
113
Streptococcus, other beta-haemolytic
59
66
78
79
102
96
127
117
113
113
131
Enterococcus faecalis
67
95
99
84
80
100
83
105
83
107
86
Streptococcus agalactiae
63
76
78
68
64
99
76
83
96
95
110
Enterococcus faecium
39
61
53
51
45
66
69
81
91
89
89
Enterobacter species
75
92
53
60
62
49
77
70
69
82
98
Pseudomonas aeruginosa
79
72
73
85
58
88
62
72
74
78
91
Bacteroides fragilis group
69
64
61
59
67
83
85
82
109
68
110
Streptococcus milleri group
48
46
48
48
48
54
62
64
72
57
68
Other gram-positive bacilli
18
14
20
30
33
32
28
18
31
40
39
Citrobacter species
19
18
14
10
21
15
28
19
23
29
31
Salmonella, other than Typhi
21
37
12
22
36
30
51
59
48
27
43
Fusobacterium species
17
26
15
21
32
31
19
31
31
27
36
Serratia species
8
10
12
14
10
16
18
19
24
27
20
Peptostreptococcus and Peptococcus
15
20
22
23
15
21
18
11
12
27
15
Other gram-negative bacilli
3
2
16
13
10
21
23
18
22
24
24
Clostridium, other than perfringens
17
9
7
9
7
19
14
11
13
22
11
Bacillus
23
20
18
22
15
18
22
24
25
21
32
Haemophilus influenzae
14
14
9
14
12
13
9
26
18
19
19
Proteus mirabilis
18
20
15
11
15
12
18
14
14
18
26
Acinetobacter species
18
9
13
10
16
16
10
21
13
18
14
Other gram-positive cocci
21
19
24
19
22
26
24
25
26
17
11
Report 39/2011
National Institute for Health and Welfare
Infectious Diseases in Finland 2010
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
Clostridium perfringens
6
8
6
9
6
16
11
12
10
16
16
Enterococcus, other or unidentified
6
9
14
11
10
12
6
4
8
14
13
Prevotella species
6
11
4
11
11
15
11
8
13
13
15
Neisseria meningitidis
13
19
20
18
18
16
20
21
9
13
14
Corynebacterium species
28
19
23
9
12
12
9
8
8
13
11
Stenotrophomonas maltophilia
11
15
14
6
12
12
7
5
15
12
12
Capnocytophaga canimorsus
3
6
6
6
6
8
8
8
8
11
11
Campylobacter species
10
14
7
10
13
5
3
8
7
11
10
Bacteroides, other than fragilis group
2
6
5
6
2
4
3
5
11
2
Listeria monocytogenes
9
7
9
12
7
10
10
9
8
9
15
Propionibacterium species
20
19
8
11
6
9
7
5
3
9
6
Streptococcus, unidentified
6
4
14
5
9
6
8
8
14
8
5
Morganella morganii
7
4
3
4
4
3
8
7
14
8
6
Clostridium, unidentified
7
7
5
5
5
10
11
7
11
7
11
Pseudomonas, other than aeruginosa
3
2
3
4
5
4
4
9
7
7
Other gram-negative cocci
1
1
2
2
4
4
4
5
7
6
Veillonella species
4
4
2
3
1
6
3
5
3
7
5
Hafnia alvei
4
1
1
5
4
3
1
3
6
2
Streptococcus bovis group
4
3
2
2
3
8
5
7
1
6
7
Proteus vulgaris
1
3
3
4
3
7
3
2
3
2
Other enterobacteriaceae species
1
3
4
1
1
2
5
1
3
3
Salmonella Typhi
1
1
3
4
3
3
4
1
3
9
17
12
12
5
8
6
3
2
2
2
2
2
1
2
2
2
1
5
3
1
5
1
1
Staphylococcus, unidentified
11
15
Mycobacterium avium
2
3
Other gram-negative anaerobes
3
Yersinia enterocolitica
1
1
4
1
2
1
Other Haemophilus species
1
8
4
1
Mycobacterium, other than avium
1
1
1
4
Yersinia pseudotuberculosis
1
2
2
1
5
1
6
3
3
3
1
3
4
1
2
1
Report 39/2011
National Institute for Health and Welfare
45
Infectious Diseases in Finland 2010
2000
2001
2
1
16
10
Bacteria, total
2855
3090
3063
3138
3333
3504
3577
3686
Candida albicans
41
44
29
43
45
42
54
Other candida species
15
27
23
36
24
22
2
1
2
54
80
71
Other non-specified bacteria
2002
2003
2004
2005
2006
2007
2008
2009
2010
3980
3971
4090
55
55
55
57
24
27
43
30
38
1
2
2
4
5
2
65
80
84
102
90
97
1
Mycobacterium, unidentified
Other gram-negative bacteria
Other fungi
Fungi, total
46
56
Report 39/2011
National Institute for Health and Welfare
71
Infectious Diseases in Finland 2010
Table 17. Blood culture findings in patients aged 65 or over, 2000-2010 (no. of cases).
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
Escherichia coli
1033
1179
1213
1314
1466
1625
1706
1760
1890
2056
2223
S. aureus
398
398
449
466
483
483
601
568
672
691
725
Klebsiella species
201
241
230
253
341
339
326
338
420
462
466
Staphylococcus,
other coagulase-negative
121
108
139
113
114
118
129
139
165
155
142
Streptococcus pneumoniae
189
216
200
241
239
229
270
294
326
294
298
Staphylococcus epidermidis
228
253
224
231
254
284
265
275
299
270
324
Enterococcus faecalis
144
142
149
146
192
183
202
220
217
222
228
Streptococcus, other beta-haemolytic
88
105
100
123
135
140
174
171
176
220
251
Pseudomonas aeruginosa
119
132
148
148
139
151
154
188
191
184
217
Enterococcus faecium
61
61
48
76
97
74
108
132
126
175
180
Bacteroides fragilis group
96
104
96
118
120
135
119
135
146
164
178
Streptococcus viridans group
74
93
83
103
103
106
110
115
140
135
132
Enterobacter species
79
97
87
97
92
115
95
105
131
128
156
Streptococcus agalactiae
53
61
49
62
76
84
81
77
94
104
126
Proteus mirabilis
61
51
57
62
80
57
68
93
99
102
106
Streptococcus milleri group
42
30
28
43
45
50
67
54
53
62
59
Streptococcus pyogenes
21
28
46
28
30
34
48
58
51
62
52
Citrobacter species
26
39
40
44
43
42
42
35
65
59
76
Clostridium perfringens
23
31
26
27
32
29
36
39
34
49
40
Other gram-positive cocci
11
9
13
15
13
13
22
22
34
38
22
Serratia species
15
30
15
28
18
33
27
33
50
37
59
Other gram-positive bacilli
22
14
17
28
34
36
33
27
39
36
45
Peptostreptococcus and Peptococcus
15
9
14
20
13
17
22
25
14
29
36
Streptococcus bovis group
9
10
7
9
20
12
17
17
15
25
12
Clostridium, other than perfringens
17
17
13
7
12
22
19
15
22
24
25
Enterococcus, other or unidentified
7
22
19
21
17
17
19
16
24
22
26
Haemophilus influenzae
17
27
15
13
13
28
21
24
21
22
19
5
10
15
24
18
17
21
21
20
11
19
18
20
26
26
26
20
44
Other gram-negative bacilli
Listeria monocytogenes
7
15
Report 39/2011
National Institute for Health and Welfare
47
Infectious Diseases in Finland 2010
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
Morganella morganii
12
9
13
10
14
21
14
26
11
18
28
Acinetobacter species
13
18
17
8
13
10
18
11
12
16
16
Prevotella species
5
8
11
4
11
10
10
8
11
15
13
Clostridium, unidentified
7
9
8
11
14
7
11
18
6
15
18
Bacteroides, other than fragilis group
7
5
3
5
8
4
3
5
8
13
8
Corynebacterium species
21
16
15
7
11
14
11
13
12
12
17
Bacillus
13
17
11
10
10
10
17
9
11
12
7
Pseudomonas, other than aeruginosa
9
3
6
6
3
7
10
11
11
11
11
1
1
2
5
1
3
8
9
5
Other gram-negative cocci
Propionibacterium species
19
12
15
4
8
13
9
4
5
9
10
Fusobacterium species
6
6
16
7
13
10
9
15
10
8
17
Other enterobacteriaceae species
1
1
3
4
4
3
1
4
8
8
Hafnia alvei
3
7
1
1
4
4
3
6
8
7
7
Salmonella, other than Typhi
5
4
7
5
6
15
11
8
19
6
8
Streptococcus, unidentified
8
7
12
9
12
10
15
7
12
6
16
Neisseria meningitidis
5
4
4
4
3
2
5
2
6
6
6
Campylobacter species
2
3
3
1
5
3
5
3
5
6
3
Stenotrophomonas maltophilia
4
8
3
6
10
6
10
8
3
6
7
Veillonella species
3
1
1
7
2
6
9
5
4
Staphylococcus, unidentified
23
27
16
21
21
6
4
5
6
5
6
Proteus vulgaris
4
8
7
8
7
9
9
9
4
4
8
2
1
1
2
2
1
1
1
1
1
1
1
4
2
3
2
2
Other gram-negative anaerobes
3
1
3
1
1
2
4
1
2
Other Haemophilus species
2
1
3
2
2
1
1
1
1
1
3
1
1
1
1
1
1
2
3
5
1
Yersinia pseudotuberculosis
Capnocytophaga canimorsus
3
Yersinia enterocolitica
3
1
Mycobacterium, other than avium
2
2
Mycobacterium avium
Salmonella Typhi
48
Report 39/2011
National Institute for Health and Welfare
1
1
1
1
3
1
1
4
Infectious Diseases in Finland 2010
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
Other non-specified bacteria
2
Other gram-negative bacteria
14
8
Bacteria, total
3371
3709
3723
4007
4443
4686
5019
5204
5752
6073
6520
Candida albicans
41
48
39
63
51
39
54
56
66
49
93
Other candida species
27
22
31
47
27
25
22
27
25
43
35
92
128
Other fungi
1
1
Fungi, total
68
3
71
70
3
113
78
2
67
76
83
93
Table 18. Group A Streptococcus blood findings by emm-type, 2006−2010 (no. of cases and %).
Cases
notified to
NIDR
Strains
examined
emm1
emm28
emm84
emm89
Other
NT
2006
163
25 (15 %)
33 (20 %)
24 (15 %)
11 (7 %)
59 (36 %)
11 (7 %)
2007
205
58 (28 %)
26 (13 %)
32 (16 %)
12 (6 %)
72 (35 %)
5 (2 %)
2008
225
52 (23 %)
47 (21 %)
9 (4 %)
10 (4 %)
102 (45 %)
5 (2 %)
2009
191
25 (13 %)
56 (29 %)
4 (2 %)
29 (15 %)
74 (39 %)
3 (2 %)
2010
167
22 (13 %)
37 (22 %)
4 (2 %)
26 (16 %)
77 (46 %)
1 (<1 %)
Report 39/2011
National Institute for Health and Welfare
49
Infectious Diseases in Finland 2010
Table 19. Cerebrospinal fluid culture findings in patients aged 15 to 64, 2000–2010 (no. of cases).
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
15
7
16
14
12
7
14
10
8
19
26
21
15
17
14
26
19
15
27
21
24
34
32
17
27
18
11
6
10
17
10
9
16
13
13
12
19
15
11
15
20
16
4
9
6
Pseudomonas aeruginosa
5
4
2
4
6
3
4
5
3
Pseudomonas, other than aeruginosa
6
6
11
5
5
5
4
4
7
7
4
3
3
4
1
3
5
2
2
9
3
1
Staphylococcus,
other coagulase-negative
Streptococcus pneumoniae
1
4
Staphylococcus epidermidis
S. aureus
11
Neisseria meningitidis
9
Escherichia coli
8
2
3
Enterobacter species
Enterococcus faecalis
1
2
3
5
3
4
5
4
3
4
Other non-specified bacteria
1
1
1
4
7
5
3
3
2
Acinetobacter species
2
1
1
3
3
5
2
3
2
1
1
3
2
1
4
2
1
Streptococcus pyogenes
1
1
2
2
1
Streptococcus viridans group
6
2
1
2
1
Klebsiella species
3
2
Listeria monocytogenes
3
2
1
1
Other gram-positive cocci
1
Streptococcus, other beta-haemolytic
2
1
2
1
Haemophilus influenzae
1
3
Pseudomonas, other
1
Other gram-negative cocci
1
Enterococcus faecium
1
Corynebacterium species
1
Staphylococcus, unidentified
3
Peptostreptococcus and Peptococcus
4
7
2
1
2
2
2
1
1
2
1
1
1
2
1
2
3
1
1
1
1
1
1
1
1
2
1
1
2
1
1
1
1
1
1
1
1
1
1
2
1
Capnocytophaga canimorsus
50
1
Bacillus
5
Streptococcus agalactiae
1
Mycobacterium, other than avium
1
2
Report 39/2011
National Institute for Health and Welfare
2
3
2
1
6
4
3
1
5
2
1
2
2
Infectious Diseases in Finland 2010
2000
2001
Salmonella, other than Typhi
1
Enterococcus, other or unidentified
1
2002
2003
2004
2005
2006
2007
1
2008
2009
2010
2
1
1
1
Streptococcus milleri group
1
1
Serratia species
2
1
1
3
Citrobacter species
1
1
2
1
Stenotrophomonas maltophilia
1
1
1
Other Haemophilus species
1
Other gram-negative bacilli
2
1
1
Streptococcus, unidentified
Other gram-positive bacilli
1
Morganella morganii
1
1
Campylobacter species
1
Fusobacterium species
Prevotella species
Bacteria, total
1
31
23
136
111
127
139
Candida albicans
1
1
2
1
Other candida species
1
4
1
146
139
114
79
1
3
Other fungi
Fungi, total
124
4
1
1
1
0
0
2
1
6
2
3
6
1
0
1
Report 39/2011
National Institute for Health and Welfare
51
Infectious Diseases in Finland 2010
Table 20. Cerebrospinal fluid culture findings in patients aged 65 or over, 2000–2010 (no. of cases).
2000
2002
2003
2004
2005
2006
2007
2008
2009
2010
Streptococcus pneumoniae
4
5
4
9
10
4
7
10
6
Staphylococcus,
other coagulase-negative
5
4
5
5
3
2
3
3
4
7
5
6
10
9
12
10
6
2
2
7
7
5
3
2
3
6
5
1
1
3
1
3
2
2
2
6
2
2
1
1
1
1
1
1
1
1
1
1
1
Staphylococcus epidermidis
S. aureus
2001
1
2
Streptococcus viridans group
1
Listeria monocytogenes
1
2
Pseudomonas, other than aeruginosa
1
4
1
4
2
4
1
Haemophilus influenzae
2
1
Mycobacterium, other than avium
2
1
1
4
1
3
Escherichia coli
1
1
1
2
2
1
2
2
1
Proteus mirabilis
Klebsiella species
Enterococcus faecalis
1
1
1
Other non-specified bacteria
Streptococcus agalactiae
2
1
3
1
4
2
2
2
3
1
1
2
2
1
4
1
1
1
Streptococcus, other beta-haemolytic
2
1
1
Streptococcus milleri group
1
Streptococcus bovis group
1
Enterococcus faecium
1
1
Bacteroides fragilis group
1
Pseudomonas aeruginosa
1
Staphylococcus, unidentified
1
Bacillus
Neisseria meningitidis
52
1
1
2
1
1
3
1
1
1
Enterobacter species
2
Acinetobacter species
2
Streptococcus pyogenes
2
Streptococcus, unidentified
1
Enterococcus, other or unidentified
1
Report 39/2011
National Institute for Health and Welfare
1
1
2
1
1
1
1
1
1
2
1
1
1
1
Infectious Diseases in Finland 2010
2000
2001
2002
Peptostreptococcus and Peptococcus
2003
2004
2005
2006
2007
2008
2009
2010
1
Mycobacterium avium
1
Corynebacterium species
1
Other gram-positive bacilli
1
Serratia species
1
1
Proteus vulgaris
1
Morganella morganii
Yersinia enterocolitica
Other enterobacteriaceae species
1
Pseudomonas, other
1
Stenotrophomonas maltophilia
1
Other Haemophilus species
Capnocytophaga canimorsus
Bacteria, total
10
9
42
45
37
Candida albicans
47
42
32
1
Other candida species
2
1
37
45
36
1
2
2
Other fungi
Fungi, total
0
0
2
0
1
1
2
0
1
2
0
Report 39/2011
National Institute for Health and Welfare
53
Infectious Diseases in Finland 2010
Table 21. Blood culture findings in all age groups, 2000–2010 (no. of cases).
54
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
Escherichia coli
1629
1836
1846
2011
2225
2456
2564
2651
2813
2991
3209
S. aureus
850
887
989
981
1059
1013
1239
1179
1261
1288
1370
Staphylococcus,
other coagulase-negative
291
257
332
263
285
275
299
337
363
352
333
Streptococcus pneumoniae
599
654
642
766
743
733
744
783
918
852
824
Staphylococcus epidermidis
599
653
641
608
683
709
686
665
687
678
693
Klebsiella species
327
365
377
386
514
542
482
509
631
660
680
Enterococcus faecalis
215
245
263
243
283
302
309
339
311
343
340
Streptococcus, other beta-haemolytic
149
172
179
206
241
238
306
289
289
338
386
Streptococcus viridans group
217
244
209
255
277
283
274
265
309
313
335
Enterococcus faecium
106
125
107
130
147
144
183
217
220
273
278
Pseudomonas aeruginosa
204
213
226
240
204
245
219
262
268
265
317
Streptococcus agalactiae
155
178
173
169
186
256
212
213
240
250
290
Bacteroides fragilis group
169
170
158
177
189
221
204
218
256
233
289
Enterobacter species
162
195
147
169
162
170
186
185
210
216
259
Streptococcus pyogenes
115
99
150
119
130
110
162
207
221
194
173
Streptococcus milleri group
93
77
78
91
93
107
132
118
127
121
129
Proteus mirabilis
79
71
72
73
97
69
87
109
113
120
132
Citrobacter species
50
60
56
55
64
59
71
56
90
90
109
Other gram-positive bacilli
42
31
42
64
70
75
62
47
70
80
90
Clostridium perfringens
29
39
33
37
38
46
48
53
44
66
57
Serratia species
26
40
33
44
32
50
49
56
78
65
82
Other gram-positive cocci
41
35
44
38
45
48
57
56
67
62
44
Peptostreptococcus and Peptococcus
33
31
36
43
28
38
40
36
26
56
52
Other gram-negative bacilli
3
2
26
28
27
47
42
38
47
47
47
Clostridium, other than perfringens
35
27
20
16
20
42
34
26
35
47
37
Haemophilus influenzae
35
46
25
34
26
45
32
53
44
46
42
Acinetobacter species
37
32
42
23
31
31
32
36
28
39
34
Bacillus
46
41
34
39
29
37
46
37
46
38
43
Enterococcus, other or unidentified
13
31
33
34
30
29
27
23
35
38
40
Report 39/2011
National Institute for Health and Welfare
Infectious Diseases in Finland 2010
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
Fusobacterium species
27
33
34
28
46
43
31
51
46
36
54
Salmonella, other than Typhi
27
42
21
28
43
46
64
72
69
34
57
Streptococcus bovis group
14
13
10
12
24
21
23
24
16
33
19
Listeria monocytogenes
17
24
20
32
25
30
38
36
34
30
61
Prevotella species
11
19
15
15
23
25
21
16
25
28
28
Corynebacterium species
53
37
39
18
24
29
24
24
21
27
29
Morganella morganii
20
13
16
14
18
24
22
33
25
26
34
Neisseria meningitidis
35
35
34
30
28
28
32
29
22
24
30
Bacteroides, other than fragilis group
10
11
8
5
14
6
7
8
13
24
10
Stenotrophomonas maltophilia
17
25
18
14
25
19
18
18
22
22
23
Clostridium, unidentified
14
16
14
16
19
17
22
26
18
22
31
Pseudomonas, other than aeruginosa
13
8
10
11
8
12
10
16
20
21
18
Propionibacterium species
40
31
24
16
14
22
16
10
8
18
16
Other gram-negative cocci
1
1
5
2
8
12
10
12
18
17
18
Campylobacter species
14
18
10
11
18
8
8
11
12
17
13
Streptococcus, unidentified
14
12
27
14
21
16
24
16
26
15
22
Capnocytophaga canimorsus
6
7
7
7
7
9
12
10
11
13
13
Hafnia alvei
7
8
2
6
8
7
3
7
11
13
9
Veillonella species
7
4
2
4
2
13
7
11
12
12
10
Other enterobacteriaceae species
2
4
3
8
1
6
5
6
5
11
11
Staphylococcus, unidentified
36
43
40
38
40
15
12
16
10
7
8
Proteus vulgaris
6
11
7
11
11
12
16
12
6
7
10
1
2
5
5
6
3
6
1
3
9
4
3
3
3
2
1
1
1
3
3
7
2
5
3
2
8
7
2
7
3
2
2
2
2
2
2
2
1
3
Salmonella Typhi
Yersinia pseudotuberculosis
1
Other gram-negative anaerobes
Mycobacterium avium
2
3
1
1
Yersinia enterocolitica
3
2
1
3
1
2
1
1
Other Haemophilus species
1
8
6
3
8
9
6
4
5
Mycobacterium, other than avium
3
3
1
6
3
1
8
5
2
4
Report 39/2011
National Institute for Health and Welfare
55
Infectious Diseases in Finland 2010
2000
2001
2002
4
1
1
33
21
Bacteria, total
6787
7317
7401
7705
8410
8866
9276
9554
Candida albicans
89
96
80
109
99
86
113
Other candida species
52
57
62
85
52
48
1
3
6
2
154
145
200
153
Other non-specified bacteria
2003
2004
2005
2006
2007
2008
2009
2010
10316
10631
11265
113
126
105
154
48
58
70
73
73
4
4
4
6
5
2
138
165
175
202
183
229
1
Mycobacterium, unidentified
Other gram-negative bacteria
Other fungi
Fungi, total
56
141
Report 39/2011
National Institute for Health and Welfare
Infectious Diseases in Finland 2010
Table 22. Cerebrospinal fluid culture findings in all age groups, 2000–2010 (no. of cases).
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
28
14
25
22
15
9
21
15
12
4
28
47
35
28
33
27
38
35
26
1
44
30
37
49
44
32
43
28
16
9
22
28
16
12
21
21
24
20
Staphylococcus,
other coagulase-negative
Streptococcus pneumoniae
1
Staphylococcus epidermidis
S. aureus
15
Neisseria meningitidis
18
16
27
22
20
22
29
23
9
13
12
Streptococcus agalactiae
8
5
6
2
12
7
8
11
5
7
11
Streptococcus viridans group
7
4
3
4
10
3
1
7
3
Other non-specified bacteria
4
1
1
9
10
7
9
6
7
1
10
7
13
6
7
5
6
6
8
4
5
3
4
8
8
4
5
6
4
Pseudomonas aeruginosa
5
4
3
4
7
3
6
5
3
Enterobacter species
3
6
5
2
3
9
4
2
Pseudomonas, other than aeruginosa
Escherichia coli
4
Klebsiella species
3
2
3
3
3
3
2
1
5
4
1
Enterococcus faecalis
5
4
4
7
7
6
8
9
4
4
5
2
2
6
3
4
5
3
3
4
7
3
2
1
2
1
4
1
2
3
1
2
2
2
4
3
Acinetobacter species
6
2
2
4
5
6
2
3
Streptococcus pyogenes
4
1
2
3
Other gram-positive cocci
5
1
3
Enterococcus faecium
2
1
3
1
3
6
1
3
Corynebacterium species
2
1
2
Pseudomonas, other
1
1
2
1
Listeria monocytogenes
Streptococcus, other beta-haemolytic
Haemophilus influenzae
Mycobacterium, other than avium
2
1
1
1
1
2
3
1
1
1
1
2
1
2
1
1
1
1
1
1
Streptococcus milleri group
1
1
Proteus mirabilis
1
1
1
1
Other gram-negative cocci
Other gram-negative bacilli
1
1
1
Staphylococcus, unidentified
4
5
4
2
2
2
3
1
1
1
1
Report 39/2011
National Institute for Health and Welfare
57
Infectious Diseases in Finland 2010
2000
2001
2002
2003
2004
2005
2006
2007
2008
Streptococcus bovis group
Peptostreptococcus and Peptococcus
3
1
2009
2010
1
1
1
Capnocytophaga canimorsus
1
Bacteroides fragilis group
1
Bacillus
8
Salmonella, other than Typhi
1
Enterococcus, other or unidentified
1
7
4
1
1
Stenotrophomonas maltophilia
1
1
2
3
1
3
1
1
2
2
1
2
1
1
2
1
Other Haemophilus species
1
Bacteroides, other than fragilis group
1
Streptococcus, unidentified
4
2
2
Serratia species
Citrobacter species
3
1
1
1
Mycobacterium avium
1
Other gram-positive bacilli
1
1
1
Proteus vulgaris
1
Morganella morganii
1
Yersinia enterocolitica
Other enterobacteriaceae species
1
Campylobacter species
1
Fusobacterium species
Prevotella species
Bacteria, total
1
60
47
230
203
220
220
Candida albicans
1
1
3
2
Other candida species
3
5
1
225
5
Other fungi
Fungi, total
58
188
212
198
146
1
1
1
4
1
2
1
2
3
1
1
0
Report 39/2011
National Institute for Health and Welfare
0
4
1
8
3
5
6
Infectious Diseases in Finland 2010
Authors
Respiratory infections
Influenza A and B
Niina Ikonen, Thedi Ziegler, Outi Lyytikäinen
(National institute for health and welfare, THL)
RSV
Thedi Ziegler, Outi Lyytikäinen (THL)
Legionella
Teija T Korhonen, Outi Lyytikäinen, Sari Jaakola (THL)
Whooping cough
Teija T Korhonen, Qiushui He (THL)
Adenovirus
Thedi Ziegler, Outi Lyytikäinen (THL)
Parainfluenza
Thedi Ziegler, Outi Lyytikäinen (THL)
Mycoplasma
Mirja Puolakkainen (University of Helsinki)
Chlamydial pneumonia
Mirja Puolakkainen (University of Helsinki)
Hepatitides
Hepatitis A
Markku Kuusi, Irja Davidkin (THL)
Hepatitis B
Henrikki Brummer-Korvenkontio, Kirsi Liitsola (THL)
Hepatitis C
Henrikki Brummer-Korvenkontio, Kirsi Liitsola (THL)
Gastrointestinal infections
Salmonella
Ruska Rimhanen-Finne, Anja Siitonen, Taru Lienemann, Aino Kyyhkynen (THL)
Campylobacter
Markku Kuusi, Ulla-Maija Nakari (THL)
Yersinia
Elisa Huovinen, Leila Sihvonen (THL)
Shigella
Markku Kuusi, Anja Siitonen (THL)
EHEC
Katri Jalava, Aino Kyyhkynen, Anja Siitonen (THL)
Norovirus
Merja Roivainen, Markku Kuusi (THL), Leena
Maunula (University of Helsinki)
Rotavirus
Tuija Leino, Merja Roivainen (THL)
Enterovirus
Katri Jalava, Merja Roivainen, Outi Lyytikäinen (THL)
Listeria
Ruska Rimhanen-Finne, Ulla-Maija Nakari (THL)
Clostridium difficile
Outi Lyytikäinen (THL) , Anni Virolainen-Julkunen (Ministry of social affairs and health, STM) ,
Silja Mentula (THL)
Food- and water-borne outbreaks
Ruska Rimhanen-Finne, Markku Kuusi, Taru Lienemann, Aino Kyyhkynen, Anja Siitonen (THL)
Antimicrobial resistance
MRSA
Outi Lyytikäinen , Saara Salmenlinna, Jaana Vuopio (THL)
VRE
Outi Lyytikäinen, Minna Kardén-Lilja , Jaana
Vuopio (THL)
ESBL
Outi Lyytikäinen, Jari Jalava (THL)
Invasive pneumococcal disease
Outi Lyytikäinen, Jari Jalava, Antti Hakanen (THL)
Sexually transmitted diseases
Chlamydia
Eija Hiltunen-Back (HUS)
Gonorrhoea
Eija Hiltunen-Back (HUS), Antti Hakanen (THL)
Syphilis
Eija Hiltunen-Back (HUS)
HIV and AIDS
Henrikki Brummer-Korvenkontio, Kirsi Liitsola (THL)
Mycobacterial infections
Tuberculosis
Petri Ruutu, Merja Marjamäki (THL), Tuula Vasankari (Turku University Hospital and THL)
Other infections
Haemophilus
Anni Virolainen-Julkunen (STM ), Maija Toropainen (THL)
Meningococcus
Anni Virolainen-Julkunen (STM), Maija Toropainen, Outi Lyytikäinen (THL)
MMR diseases (measles, mumps, rubella)
Irja Davidkin (THL)
Puumala virus
Teija T Korhonen (THL)
Report 39/2011
National Institute for Health and Welfare
59
Infectious Diseases in Finland 2010
Tick-borne encephalitis (TBE)
Teija T Korhonen (THL), Olli Vapalahti (HUS)
Tularemia
Heidi Rossow (THL)
Pogosta disease
Katri Jalava (THL)
Borrelia
Teija T Korhonen (THL)
Malaria and other travel-related infections
Heli Siikamäki (HUS), Eeva Pekkanen (THL)
Blood and CSF findings in children
Outi Lyytikäinen (THL)
Blood and CSF findings in adults
Outi Lyytikäinen, Tuula Siljander, Jaana Vuopio (THL)
60
Report 39/2011
National Institute for Health and Welfare
Infectious Diseases in Finland 2010
Report 39/2011
National Institute for Health and Welfare
61
Infectious Diseases in Finland 2010
62
Report 39/2011
National Institute for Health and Welfare
Infectious Diseases in Finland 2010
Report 39/2011
National Institute for Health and Welfare
63
Infectious Diseases in Finland 2010
64
Report 39/2011
National Institute for Health and Welfare