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PubMed2004

Epidemiology of meningococcal disease in Switzerland, 1999-2002.

In Switzerland, immunisation against serogroup C meningococcal disease is recommended for persons at increased risk but is not included in the national vaccination programme. The aim of this study was to present the nationwide surveillance data on invasive meningococcal disease collected from 1999 to 2002, emphasising the evolution in the absence of extended vaccination. The number of reported cases of meningococcal disease peaked at 178 cases in 2000 (incidence rate of 2.5/100,000 person-years), with 61% of all cases attributed to serogroup C meningococci (incidence rate, 1.5/100,000 person-years). Since 2001, a spontaneous decrease in the reported cases was observed, resulting in an overall incidence rate of 1.4/100,000 person-years in 2002 (serogroup C cases, 0.8/100,000 person-years). On the other hand, the case-fatality rate of serogroup C cases increased to 18% in 2002, leading to an increase in the overall case-fatality rate from 8% to 14% (P>0.05). The small sample size reduces the interpretability of this observation. However, when the introduction of a generalised vaccination against serogroup C meningococcal disease is discussed, the fluctuations in the number of vaccine-preventable deaths should receive greater attention.

Adolescent↗
PubMed2004

Ethical issues in HIV.

The number of people with HIV/AIDS continues to increase globally. Women, who represent the subgroup with the fastest rate of increase, are usually informed of their serostatus by the obstetrician/gynaecologist. As treatment of infected women raises a number of ethical issues, an understanding of the theoretical background for ethical decision making is requisite to ensure these problems are resolved within a morally appropriate framework. Vigorous debate has arisen from the tensions between the competing goals of HIV testing, third party disclosure, management of the critically ill HIV-infected woman, infertility management in the background of HIV/AIDS, and gender-based violence as cause or result of acquiring HIV infection. Women may be differently empowered economically, socially and culturally. What may be a satisfactory solution in the context of the USA and Europe may be far from ideal in that of the developing world.

Adult↗
PubMed2006

The impact of new guidelines in Europe for the control and prevention of travel-associated Legionnaires' disease.

On 1 July 2002, EWGLINET introduced European guidelines for the control and prevention of travel-associated legionnaires' disease. This paper presents the results gathered by the surveillance scheme during the first two and a half years of the operation of the guidelines (to the end of 2004). Two hundred and thirty-seven new clusters and 70 cluster updates were identified. Investigations at 146 sites returned positive samples for legionella, and the proportion of positive sites reached over 60% in 2004. Thirty-four cluster sites were reported to have been investigated satisfactorily, but have gone on to be associated with subsequent cases ('repeater sites'). Fifty-one sites were published on the European Working Group for Legionella Infections (EWGLI) website; the publication states that EWGLINET cannot be confident that the sites have adequate control measures in place. The operation of the guidelines is discussed, and the situation in Turkey highlighted as a particular success.

Disease Notification↗
PubMed2004

Food safety: emerging trends in foodborne illness surveillance and prevention.

Between 250 and 350 million Americans are estimated to suffer acute gastroenteritis annually, with 25% to 30% thought to be caused by foodborne illnesses. Most vulnerable to foodborne diseases are elderly people, pregnant women, immune-compromised people, and children. While bacterial causes such as Salmonella are widely recognized and monitored as foodborne infections, other important bacterial causes such as Clostridium perfringens , Bacillus cereus , and Staphylococcus aureus are less well known. While the majority of cases of foodborne diseases are of unknown cause, bacteria and viruses are the most likely causative agents. Caliciviridae (Norwalk-like) virus cases are more difficult to identify, but represent the most common cause of known and probably unknown cases. Fresh produce has to be added to the traditional list of foods requiring careful selection and handling to prevent foodborne disease. To assess the disease burden in the United States, morbidity and mortality surveillance activities are done by several networks and systems with collaboration among federal agencies and health departments. Not all important causes are being equally monitored. Critical behaviors by food processors, food retailers, foodservice personnel, and consumers can reduce the risk of foodborne illness episodes. Dietetics professionals can more readily monitor new developments and update knowledge and practice through online resources.

Consumer Product Safety↗
PubMed2004

Fever detection from free-text clinical records for biosurveillance.

Automatic detection of cases of febrile illness may have potential for early detection of outbreaks of infectious disease either by identification of anomalous numbers of febrile illness or in concert with other information in diagnosing specific syndromes, such as febrile respiratory syndrome. At most institutions, febrile information is contained only in free-text clinical records. We compared the sensitivity and specificity of three fever detection algorithms for detecting fever from free-text. Keyword CC and CoCo classified patients based on triage chief complaints; Keyword HP classified patients based on dictated emergency department reports. Keyword HP was the most sensitive (sensitivity 0.98, specificity 0.89), and Keyword CC was the most specific (sensitivity 0.61, specificity 1.0). Because chief complaints are available sooner than emergency department reports, we suggest a combined application that classifies patients based on their chief complaint followed by classification based on their emergency department report, once the report becomes available.

Algorithms↗
PubMed2005

Algorithms for rapid outbreak detection: a research synthesis.

The threat of bioterrorism has stimulated interest in enhancing public health surveillance to detect disease outbreaks more rapidly than is currently possible. To advance research on improving the timeliness of outbreak detection, the Defense Advanced Research Project Agency sponsored the Bio-event Advanced Leading Indicator Recognition Technology (BioALIRT) project beginning in 2001. The purpose of this paper is to provide a synthesis of research on outbreak detection algorithms conducted by academic and industrial partners in the BioALIRT project. We first suggest a practical classification for outbreak detection algorithms that considers the types of information encountered in surveillance analysis. We then present a synthesis of our research according to this classification. The research conducted for this project has examined how to use spatial and other covariate information from disparate sources to improve the timeliness of outbreak detection. Our results suggest that use of spatial and other covariate information can improve outbreak detection performance. We also identified, however, methodological challenges that limited our ability to determine the benefit of using outbreak detection algorithms that operate on large volumes of data. Future research must address challenges such as forecasting expected values in high-dimensional data and generating spatial and multivariate test data sets.

Algorithms↗
PubMed2005

Implementation of the community network of reference laboratories for human influenza in Europe.

BACKGROUND: The increased need for accurate influenza laboratory surveillance data in the European Union required formalisation of the existing network of collaborating national influenza reference laboratories participating in the European Influenza Surveillance Scheme (EISS). OBJECTIVE: To establish a Community Network of Reference Laboratories for Human Influenza in Europe (CNRL). METHODS: Virologists in EISS defined the objective and tasks of the CNRL. Performance of the laboratories in the tasks was monitored by questionnaire-based inventories and quality control assessments (QCA). Subsequently, actions were defined to improve the performance of the CNRL. RESULTS: The CNRL started in April 2003 and included as of May 2004 32 laboratories in 24 European countries. The objective is to provide high quality reference services for human influenza surveillance, early warning and pandemic preparedness in Europe. The defined basic tasks are direct detection, culture, typing, subtyping and strain characterisation of influenza virus, diagnostic influenza serology and storage of clinical specimens and virus isolates. The questionnaire-based inventories and QCAs revealed that the majority of CNRL laboratories perform well in most of the basic tasks, although improvements are needed in certain areas of virus testing. Therefore, task groups have been established to further improve the methods used in the network. The CNRL has proven its usefulness during the 2003-2004 season by the reporting of accurate data concerning the flu epidemic caused by A/Fujian/411/2002 (H3N2)-like viruses and by the rapid sharing of information, protocols and reagents during the A(H5N1) and A(H7N3) epizootics in Asia and Canada. CONCLUSION: EISS has established a functioning Community Network of Reference Laboratories for Human Influenza in Europe and laid the foundation for further enhancement and collaborations. Important next steps include improving the laboratories to carry out all basic tasks and collaboration with the European Centre for Disease Prevention and Control.

Community Networks↗
PubMed2005

Simulation of the options for a national control programme to eradicate scrapie from Great Britain.

Because of the risk to public health posed by the potential presence of bovine spongiform encephalopathy (BSE) in sheep, there are plans to eradicate transmissible spongiform encephalopathies (TSEs) from the British sheep population. We used a mathematical model for the spread of scrapie between sheep flocks to assess the efficacy of five control strategies at eradicating the infection from the national flock. These range from ram-genotyping schemes through whole-flock genotyping with selective culling to whole-flock slaughter. The impact of control was considered under three scenarios for the long-term dynamics of scrapie in GB: two in which scrapie is ultimately eliminated (with different median extinction times) and one in which scrapie remains endemic. Results suggested that it is feasible to eradicate scrapie from the British sheep flock, but that any national control programme will take decades to eliminate the disease and be costly. The most-effective strategy, measured in terms of the probability of eradication and time taken for eradication, was predicted to be whole-flock culling, which was effective under all three scenarios for the long-term dynamics of scrapie. Strategies involving whole-flock genotyping with selective culling were also effective, though they were predicted to take longer to eradicate scrapie than whole-flock culling. Ram-genotyping schemes were effective in some instances, but not for the scenario where scrapie remained endemic in the national flock. At low levels of reporting of clinical disease (< 20%) the probability of eradication within 100 years was predicted to be < 100% and, consequently, low levels of reporting could compromise the effectiveness of a control programme. Moreover, the predicted time taken to eradicate scrapie would increase markedly if the reporting compliance decreased.

Animals↗
PubMed2006

Reporting of suspect cases of foot-and-mouth-disease during the 2001 epidemic in the UK, and the herd sensitivity and herd specificity of clinical diagnosis.

We described the clinical diagnostic process utilized during the 2001 epidemic of foot-and-mouth-disease in the United Kingdom (UK), and considered it as a series of diagnostic tests. Premises were classified according to these diagnostic-test results and actual disease status, determined by the reference test, which in this case was one or more internationally accepted laboratory tests. The herd-level sensitivity (HSe) and herd-level specificity (HSp) of the clinical diagnostic process were calculated directly, relative to these internationally accepted reference tests. In this process, the first diagnostic test was 'routine monitoring', which resulted in the identification of suspect cases based solely on the clinical observations of farmers or veterinarians. 6762 suspect cases were identified, and the test had a HSe of 97.6% (95% C.I.: 96.7, 98.3) and a HSp of 95.2% (95% C.I.: 95.0, 95.3). Suspect cases were then subject to the second diagnostic test, termed 'declaration', which consisted of a review of a description of the clinical signs by government veterinarians. Premises that tested positive became 'clinical cases'. The HSe of this test was 97.1% (95% C.I.: 96.2, 97.9), and the HSp was 90.9% (95% C.I.: 90.1, 91.6). During the epidemic, these tests were combined and applied in series, with an overall HSe of 94.7% (95% C.I.: 93.5, 95.7) and an overall HSp of 99.6% (95% C.I.: 99.5, 99.6). We also examined the effect of a policy shift that prohibited delaying the diagnosis pending laboratory testing where the animals exhibited equivocal clinical signs.

Animals↗
PubMed2006

Programme of the Community Network of Reference Laboratories for Human Influenza to improve Influenza Surveillance in Europe.

All laboratories participating in the Community Network of Reference Laboratories for Human Influenza in Europe (CNRL) co-ordinated by the European Influenza Surveillance Scheme (EISS) should be able to perform a range of influenza diagnostics. This includes direct detection, culture, typing, subtyping and strain characterisation of influenza viruses, diagnostic serology and the creation of archives for clinical specimens and virus isolates. To improve the capacity and quality of the laboratories of the CNRL and to increase the consistency in performance among all 25 European Union countries plus Norway, Romania, and Switzerland, five task groups were set up in February 2005. These task groups developed work programmes in the areas of virus isolation, antibodies, molecular virology, quality control assessment and antiviral susceptibility testing. This report outlines the programmes and the results achieved in the first half-year of operation of the task groups. The action plans are challenging and it is expected that these efforts will lead to considerable improvements in the performance of the laboratories and in the standardisation of methods employed in Europe with regard to routine influenza surveillance and early warning for emerging viruses.

Community Networks↗
PubMed2006

Influenza surveillance: Why?

Surveillance is also one of the few bright spots in influenza preparedness in Europe. A sentinel network of 13,500 physicians provides an early warning in the event of an influenza outbreak. The network is part of the European Influenza Surveillance Scheme (EISS). Germany has one of the most advanced surveillance networks in Europe, and has made the reporting of laboratory-confirmed cases of influenza mandatory. Monitoring avian influenza is a good way to anticipate human influenza outbreaks. Coordinated surveillance of influenza in humans and animals is needed, and the human and veterinary surveillance systems should be linked to exchange information, diagnostic tools and antigens. Although not perfect, the current surveillance network managed by EISS functions effectively, and can play a key role in the early identification and ongoing monitoring of a pandemic influenza virus as well as the annual epidemics.

Animals↗