Influmeter - an online tool for self-reporting of influenza-like illness in Denmark.

Background In October 2013, we implemented 'Influmeter', a web-based influenza-like illness (ILI) self-reporting system, to monitor ILI in the general population in a timely fashion, to provide data for estimations of the burden of influenza and to gain experience with online surveillance systems, in Denmark. After the season 2013/2014 we evaluated the system to decide on its future use. Methods Influmeter study participants provided personal details upon enrolment and reported symptoms weekly within predefined categories. We compared distribution of Influmeter participants with the Danish population, by sex, age, region, chronic diseases and educational level. We calculated the proportion of participants reporting symptoms of ILI weekly and the proportion of Influmeter ILI cases seeking medical assistance, using the Danish and the EU ILI case definitions. Further, we compared timing of increased ILI rates in Influmeter with existing Danish sentinel ILI surveillance using the Danish case definition. Results Compared with the Danish population, Influmeter had more females (p < 0.001) and persons with a higher education (p < 0.001), while the age group 0-24 was under-represented (p < 0.001). Influmeter ILI activity peaked 1 week before the exceeding of the sentinel epidemic threshold. Depending on ILI case definition 16-22% of ILI cases sought medical assistance. Conclusion Influmeter was useful in the timely monitoring of ILI activity in the population that did not seek medical assistance in relation to ILI. We recommend continuation of the system, targeted enrolment of the young and future analyses adjusted for uneven representation relative to the underlying population.

Real-time surveillance of laboratory confirmed influenza based on the Danish microbiology database (MiBa).

The Danish microbiology database (MiBa) is a national database that automatically accumulates patient test results from all Danish Departments of Clinical Microbiology. As an example for use of MiBa, we describe the real-time surveillance of laboratory confirmed influenza established in October 2012. It functions without any extra burdens of reporting by laboratories or clinicians. This is an important improvement of the existing surveillance for influenza like illness (ILI) which includes only limited virological testing. The MiBa based surveillance adds complete national virological data which are specific for influenza, in contrast to ILI, and serves as a tool for regional and national preparedness and planning.

Toward rubella elimination in Europe: an epidemiological assessment.

BACKGROUND: The elimination of rubella and prevention of congenital rubella syndrome (CRS) by 2015 are established goals for Europe. Our aim was to review the epidemiology of rubella in relation to this goal. MATERIAL AND METHODS: National surveillance institutions from 32 European countries provided information on rubella and CRS surveillance systems and data for 2000-08. We reported the number of notified rubella cases by year for countries with a national mandatory notification system for rubella covering total country population consistently throughout 2000-08 and analysed rubella surveillance data for 2008. RESULTS: Throughout 2000-08, 24 countries conducted passive routine surveillance based on mandatory reporting rubella covering total country population. Altogether these countries reported 526,751 rubella cases. The median incidence per million inhabitants declined from 7.2 in 2000 to 0.3 in 2008. By 2008, the number of countries with mandatory notification systems for rubella increased to 28. These countries reported 21,475 rubella cases of which 1.5% (n=317) were laboratory-confirmed. Most cases (n=21,075; 98%) were reported from Poland, Italy and Romania. Ten countries reported zero rubella cases and five others reported an incidence of <1 per million inhabitants. In 2008, 20 CRS cases were reported from five countries. CONCLUSION: The overall decline in rubella incidence and increase in the number of countries conducting rubella surveillance through a mandatory notification system are notable achievements toward the goal of rubella elimination in Europe. However, in a few countries with high rubella incidence the risk for CRS still exists. Achievement and maintenance of the required high vaccination coverage and high-quality surveillance of rubella and CRS including laboratory testing of all suspected cases are fundamental to eliminate rubella and prevent CRS in Europe.

Status of rubella and congenital rubella syndrome surveillance, 2005-2009, the World Health Organization European Region.

BACKGROUND: The World Health Organization European Region has a goal for rubella elimination and congenital rubella syndrome (CRS) prevention. Although all Member States recommend a rubella-containing vaccine in their national immunization programs, rubella and CRS continue to occur, and surveillance quality varies throughout the region. METHODS: To describe the status of regional rubella and CRS surveillance and assess progress toward elimination, we reviewed surveillance practices by surveying all 53 Member States and analyzed rubella and CRS surveillance data during 2005-2009. RESULTS: Overall, 41 (91%) of 45 responding Member States have nationwide rubella surveillance, and 39 (87%) have nationwide CRS surveillance. During 2005-2009, rubella cases reported in the region decreased by 94% from 206,359 cases to 11,623 cases. The greatest decrease (99%) was observed in newly independent states of the former Soviet Union. In the rest of the region, high rubella incidence was observed in Poland, Romania, Italy, and San Marino during 2005-2008 and in Poland, Bosnia and Herzegovina, and Austria in 2009. A total of 68 CRS cases were reported during 2005-2009. CONCLUSIONS: As the foundation to achieving and verifying rubella elimination, high-quality rubella and CRS surveillance needs to be implemented and sustained in all Member States.

Measles in Europe: an epidemiological assessment.

BACKGROUND: Measles persists in Europe despite the incorporation of the measles vaccine into routine childhood vaccination programmes more than 20 years ago. Our aim was therefore to review the epidemiology of measles in relation to the goal of elimination by 2010. METHODS: National surveillance institutions from 32 European countries submitted data for 2006-07. Data for age-group, diagnosis confirmation, vaccination, hospital treatment, the presence of acute encephalitis as a complication of disease, and death were obtained. 30 countries also supplied data about importation of disease. Clinical, laboratory-confirmed, and epidemiologically linked cases that met the requirements for national surveillance were analysed. Cases were separated by age: younger than 1 year, 1-4 years, 5-9 years, 10-14 years, 15-19 years, and older than 20 years. Countries with indigenous measles incidence per 100 000 inhabitants per year of 0, less than 0.1, 0.1-1, and more than 1 were grouped into categories of zero, low, moderate, and high incidence, respectively. FINDINGS: For the 2 years of the study, 12 132 cases of measles were recorded with most cases (n=10 329; 85%) from five countries: Romania, Germany, UK, Switzerland, and Italy. Most cases were unvaccinated or incompletely vaccinated children; however, almost a fifth were aged 20 years or older. For the same 2 years, seven measles-related deaths were recorded. High measles incidence in some European countries revealed suboptimum vaccination coverage. Of the 210 cases that were reported as being imported, 117 (56%) came from another country within Europe and 43 (20%) from Asia. INTERPRETATION: The suboptimum vaccination coverage raises serious doubts that the goal of elimination by 2010 can be attained. Achievement and maintenance of optimum vaccination coverage and improved surveillance are the cornerstones of the measles elimination plan for Europe.