First cases of coronavirus disease 2019 (COVID-19) in the WHO European Region, 24 January to 21 February 2020.

In the WHO European Region, COVID-19 surveillance was implemented 27 January 2020. We detail the first European cases. As at 21 February, nine European countries reported 47 cases. Among 38 cases studied, 21 were linked to two clusters in Germany and France, 14 were infected in China. Median case age was 42 years; 25 were male. Late detection of the clusters' index cases delayed isolation of further local cases. As at 5 March, there were 4,250 cases.

Host-related risk factors and clinical features of community-acquired legionnaires disease due to the Paris and Lorraine endemic strains, 1998-2007, France.

BACKGROUND: In France, Legionnaires disease is mainly caused by Legionella pneumophila. Here, we investigated possible host factors associated with susceptibility to community-acquired Legionnaires disease caused by the endemic Paris and Lorraine strains. METHODS: We conducted a double-nested exploratory case-control study with use of data from the French national surveillance network of incident Legionnaires disease cases notified from 1998 through 2007. Patients with community-acquired Legionnaires disease and an L. pneumophila serogroup 1 isolate were eligible. Case patients were patients infected by the Paris or Lorraine strain, and control patients were those infected by sporadic strains. Epidemiological and clinical factors associated with infection with the Paris and Lorraine strains were assessed by calculating adjusted odds ratios (aOR) in multivariate logistic regression models. RESULTS: We studied 1090 patients infected by sporadic strains (n = 920), the Paris strain (n = 80), or the Lorraine strain (n = 90). Infection with the Paris strain was significantly associated with female sex (aOR, 1.98; 95% confidence interval [CI], 1.19-3.28), steroid therapy (aOR, 3.16; 95% CI, 1.76-5.68), and a history of cancer or hematologic malignancies (aOR, 2.08; 95% CI, 1.15-3.76). In addition, the mortality rate was higher among patients infected with the Paris strain than in the control group (38% vs. 25.5%). The Lorraine strain was associated with smoking (aOR, 1.82; 95% CI, 1.14-2.91) and reduced mortality (9.9%). . CONCLUSION: Several host characteristics were associated with the risk of infection by endemic strains of L. pneumophila serogroup 1. These findings may help to guide preventive measures. Factors predisposing patients to infection by specific strains need to be explored further.

A community-wide outbreak of legionnaires disease linked to industrial cooling towers--how far can contaminated aerosols spread?

A community-wide outbreak of legionnaires disease occurred in Pas-de-Calais, France, in November 2003-January 2004. Eighteen (21%) of 86 laboratory-confirmed cases were fatal. A case-control study identified smoking, silicosis, and spending >100 min outdoors daily as risk factors for acquiring the disease. Legionella pneumophila strain Lens was isolated from cooling towers, wastewater, and air samples from plant A. This unique strain matched all 23 clinical isolates, as assessed by pulsed-field gel electrophoresis subtyping. Modeling of atmospheric dispersion of aerosols emitted from plant A cooling towers showed good coverage of the communes where patients lived and showed that the dispersion extended over a distance of at least 6 km from plant A. No other aerosol-producing installation was identified as a plausible source, and no common source of indoor exposure was found. These findings implicate plant A as the most likely outbreak source and suggest that the distance of airborne transmission of L. pneumophila may be greater than previously reported.

Past excessive alcohol consumption: a major determinant of severe liver disease among newly referred hepatitis C virus infected patients in hepatology reference centers, France, 2001.

PURPOSE: Our study aimed to identify factors associated with the occurrence of severe liver disease in hepatitis C virus (HCV) positive patients at first referral to hepatology reference centers in France in 2001. METHODS: Patients reported through the national hospital-based hepatitis C surveillance system in 2001 were included. The definition of severe liver disease was based on clinical, biological, and morphological evaluation; cirrhosis (+/- complication) and primary liver cancer were classified as severe liver disease. Patient characteristics were compared for those with and without severe liver disease. RESULTS: Of the 3404 newly referred patients in the 26 participating centers, 391 (11.5%) had severe liver disease. Male gender (adjusted odds ratios [aOR]=1.4; 95% confidence interval [CI], 1.0-1.9), age over 39 years at referral (aOR=3.8; 95% CI, 2.7-5.3), past excessive alcohol consumption (aOR=2.6; 95% CI, 1.9-3.5), and HIV seropositivity (aOR=1.9; 95% CI, 1.1-3.3) were each independently associated with an increased risk of severe liver disease. In the subgroup of patients with known age at time of HCV exposure, age over 39 years at time of exposure (aOR=1.6; 95% CI, 1.1-2.4), duration of HCV infection over 15 years (aOR=2.6; 95% CI, 1.8-3.7), known HBs antigen positivity (aOR=2.4; 95% CI, 1.1-5.2), and past excessive alcohol consumption (aOR=2.7; 95% CI, 1.8-3.9) were each associated with increased risk of severe liver disease. CONCLUSIONS: Our findings underscore the important role of past excessive alcohol consumption on the development of severe liver disease for HCV patients.