VOL.11 Issues 10-12 Oct-Dec 2006 EUROPEAN COMMUNICABLE DISEASE JOURNAL Early warning and response in Europe European regulation • Implementing the International Health Regulations (2005) in Europe Outbreak report • A pseudo-outbreak of human A/H5N1 infections in Greece Surveillance report • Improvement of a national public health surveillance system through quality circle FUNDED BY DG HEALTH AND CONSUMER PROTECTION OF THE COMMISSION OF THE EUROPEAN COMMUNITIES "Neither the European Commission nor any person acting on the behalf of the Commission is responsible for the use which might be made of the information in this journal. The opinions expressed by authors contributing to Eurosurveillance do not necessarily reflect the opinions of the European Commission, the European Centre for Disease Prevention and Control (ECDC), the Institut de veille sanitaire (InVS), the Health Protection Agency (HPA) or the institutions with which the authors are affiliated" Eurosurveillance VOL.11 Issues 10-12 Oct-Dec 2006 Peer-reviewed European information on communicable disease surveillance and control Articles published in Eurosurveillance are indexed by Medline/Index Medicus C ONTENTS E DITORIALS 202 • Measles elimination 2010 target: the need to meet the specific risk group 202 John S Spika • A/H5N1 in the European Union: current levels of risk to humans, and responding to human cases and outbreaks 203 Editorial offices Sarah De Martin, Angus Nicoll, Denis Coulombier France • From evaluation to continuous quality assurance Institut de Veille Sanitaire (InVS) 12, rue du Val d’Osne of surveillance systems 204 94415 Saint-Maurice, France Gérard Krause Tel + 33 (0) 1 41 79 68 33 Fax + 33 (0) 1 55 12 53 35 • Are there ‘new’ and ‘old’ ways to track infectious UK diseases hazards and outbreaks? 206 Health Protection Agency Jean-Claude Desenclos Centre for Infections 61 Colindale Avenue London NW9 5EQ, UK RIGINAL ARTICLES Tel + 44 (0) 20 8327 7417 O 208 Fax + 44 (0) 20 8200 7868 Topic: Early warning RESPONSIBLE EDITOR and response in Europe Gilles Brücker (InVS, France) • Implementing the International Health Regulations (2005) in Europe 208 MANAGING EDITORS G Rodier, M Hardiman, B Plotkin, B Ganter Hélène Therre (InVS, France) [email protected] • Epidemic intelligence: a new framework Elizabeth Hoile (HPA CfI, UK) for strengthening disease surveillance in Europe 212 [email protected] C Paquet, D Coulombier, R Kaiser, M Ciotti PROJECT LEADERS • The Early Warning and Response System for communicable Philippe Bossi (InVS, France) diseases in the EU: an overview from 1999 to 2005 215 Noel Gill (HPA CfI, UK)) P Guglielmetti, D Coulombier, G Thinus, F Van Loock, S Schreck ASSISTANT EDITORS • A national syndromic surveillance system for England Anneli Goldschmidt (InVS, France) and Wales using calls to a telephone helpline 220 [email protected] GE Smith, DL Cooper, P Loveridge, F Chinemana, Farida Mihoub (InVS, France) [email protected] E Gerard, N Verlander Candice Pettifer (ECDC, Sweden) • Syndromic surveillance based on emergency [email protected] department activity and crude mortality: two examples 225 L Josseran, J Nicolau, N Caillère, P Astagneau, G Brücker ASSOCIATE EDITORS Noel Gill (HPA CfI, UK) • Surveillance of ambulance dispatch data Stefania Salmaso (Istituto Superiore di Sanità, as a tool for early warning 229 Italy) KH Bork, BM Klein, K Mølbak, S Trautner, UB Pedersen, Henriette de Valk (InVS, France) E Heegaard Norman Noah (London School of Hygiene and Tropical Medicine, UK) • Enhanced Surveillance of Infectious Diseases : Richard Pebody (HPA CfI, UK) the 2006 FIFA World Cup experience, Germany 234 Kate Soldan (HPA CfI, UK) K Schenkel, C Williams, T Eckmanns, G Poggensee, Karl Ekdahl (ECDC, Sweden) J Benzler, J Josephsen, G Krause • Epidemiologic surveillance system implemented EDITORIAL ADVISORS in the Hautes-Alpes district, France, (see back cover) during the Winter Olympic Games, Torino 2006 239 F Franke, L Coulon, C Renaudat, B Euillot, N Kessalis, www.eurosurveillance.org P Malfait • Recognition of threats caused by infectious diseases © Eurosurveillance, 2006 in the Netherlands: the early warning committee 242 JC Rahamat-Langendoen, JA van Vliet, AWM Suijkerbuijk Eurosurveillance VOL.11 Issues 10-12 Oct-Dec 2006 S URVEILLANCE REPORTS 246 O UTBREAK DISPATCH 276 • Improvement of a national public health surveillance • Current outbreak of hepatitis A in Bulgaria, 2006 276 system through use of a quality circle 246 M Kojouharova, Editorial team G Krause, J Benzler, G Reiprich, R Görgen • Surveillance of influenza-like illness in England S HORT REPORTS 277 and Wales during 1966-2006 249 • Trichinella in pork: current knowledge on the suitability AJ Elliot, DM Fleming of freezing as a public health measure 277 • Respiratory viruses and influenza-like illness: E Pozio, CMO Kapel, AA Gajadhar, P Boireau, a survey in the area of Rome, winter 2004-2005 251 J Dupouy-Camet, HR Gamble G Rezza, C Valdarchi, S Puzelli, M Ciotti, F Farchi, • Impact of a genetic variant of Chlamydia trachomatis C Fabiani, L Calzoletti, I Donatelli, CF Perno on national detection rates in Sweden 278 • Using sentinel surveillance to monitor effectiveness of T Söderblom, A Blaxhult, H Fredlund, B Herrmann influenza vaccine is feasible: a pilot study in Denmark 254 A Mazick, AH Christiansen, S Samuelsson, K Mølbak O THER ONLINE- ONLY CONTENT 280 • Laboratory diagnosis of Lyme borreliosis at the Portuguese National Institute of Health (1990-2004) 257 N ATIONAL BULLETINS I Lopes de Carvalho, MS Núncio • Case-control study for risk factors for Q Fever in southwest England and Northern Ireland 260 HJ Orr, H Christensen, B Smyth, DAB Dance, D Carrington, Ian Paul, JM Stuart O UTBREAK REPORTS 263 • A pseudo-outbreak of human A/H5N1 infections in Greece and its public health implications 263 G Spala, T Panagiotopoulos, N Mavroidi, X Dedoukou, A Baka, P Tsonou, P Triantafyllou, A Mentis, V Kyriazopoulou, A Melidou, S Tsiodras • A measles outbreak in children under 15 months of age in La Rioja, Spain, 2005-2006 267 M Perucha, E Ramalle-Gómara, ME Lezaun, A Blanco, C Quiñones, M Blasco, MA González, C Cuesta, JE Echevarría, MM Mosquera, F de Ory • Outbreak of Salmonella enterica serotype Manhattan infection associated with meat products, France, 2005 270 H Noël, M Dominguez, FX Weill, A Brisabois, C Duchazeaubeneix, A Kerouanton, G Delmas, N Pihier, E Couturier • Investigation of a tuberculosis cluster at a job centre in Manchester, United Kingdom 273 A Kirkpatrick, C Bell, M Petrovic, M Woodhead, A Barrett, E Duffell, A Verma, F Reynolds The Eurosurveillance print edition is a compilation of weekly and monthly electronic releases published on the Eurosurveillance website. Only a representative selection of Eurosurveillance’s weekly release articles from each three month period are printed here, and the full listing of all Eurosurveillance articles can be found in the Archives section of the website. E DITORIAL M EASLES ELIMINATION 2010 TARGET: THE NEED TO MEET THE SPECIFIC RISK GROUP John S Spika WHO Regional Office for Europe, Copenhagen, Denmark Substantial progress has been made within the World Health may have received none or only one dose of measles vaccine, yet Organization European Region in recent years towards the measles they have not been exposed to measles because virus circulation has and rubella elimination targets for 2010. These 2010 targets were diminished with vaccine use. Ensuring that all healthcare workers set in 2005 by the WHO European Regional Office for Europe, are adequately protected is key to preventing healthcare-associated following the approval of the Resolution EUR/RC55/R7 [1,2]. In infections. Immunisation records of healthcare workers should be 2005, 28 (54%) of 52 WHO member states reviewed and careful consideration given to reported a measles incidence of < 1 per million The ability to epidemiologically ensuring that all have received two doses of population (one indicator for measuring measles measles vaccine, unless they were born well elimination status) and by 2006, 50 (96%) had and virologically link measles cases before measles vaccine was introduced. introduced rubella vaccine into their national with a source is critical for assessing The high proportion of measles cases programmes. In 2002, member states began observed in children aged 15 months or younger reporting measles cases by age and vaccination the interruption of endemic is noteworthy, given this is younger than the status to WHO on a monthly basis [3] and case- transmission within and between recommended age in La Rioja for the first dose based reporting was implemented in 2003. of measles vaccine. The most effective primary Since that time, the number of countries countries in the European Region. prevention strategies for measles among those reporting case-based data has increased from younger than the age of first dose are to ensure one in 2003 to 23 in 2006. In 2006, countries have been asked high levels of immunity among older siblings and caregivers. to report rubella cases monthly (either aggregate or case-based). Outbreaks such as the one in La Rioja require that public health The WHO European Region measles/rubella laboratory network has officials develop interventions customised to meet the specific risk also been strengthened through regular laboratory assessments and group based on a thorough epidemiological investigation. Once the proficiency testing and by having subregional meetings. decision has been taken to immunise infants at an age younger The past two years have been challenging, with several large than the routine first dose, it is also necessary to decide when the outbreaks in the European Region. The outbreaks in Romania and practice should be discontinued. Outbreaks such as this could the Ukraine [4] were the source of measles outbreaks in a number justify the decision for countries where the first dose of measles of EU countries, including Estonia, Germany, Lithuania, Portugal, vaccine is currently given at 12 months not to further postpone Poland and Spain.