Improving preparedness to respond to cross-border hepatitis A outbreaks in the European Union/European Economic Area: towards comparable sequencing of hepatitis A virus.

IntroductionSequence-based typing of hepatitis A virus (HAV) is important for outbreak detection, investigation and surveillance. In 2013, sequencing was central to resolving a large European Union (EU)-wide outbreak related to frozen berries. However, as the sequenced HAV genome regions were only partly comparable between countries, results were not always conclusive.AimThe objective was to gather information on HAV surveillance and sequencing in EU/European Economic Area (EEA) countries to find ways to harmonise their procedures, for improvement of cross-border outbreak responses.MethodsIn 2014, the European Centre for Disease Prevention and Control (ECDC) conducted a survey on HAV surveillance practices in EU/EEA countries. The survey enquired whether a referral system for confirming primary diagnostics of hepatitis A existed as well as a central collection/storage of hepatitis A cases' samples for typing. Questions on HAV sequencing procedures were also asked. Based on the results, an expert consultation proposed harmonised procedures for cross-border outbreak response, in particular regarding sequencing. In 2016, a follow-up survey assessed uptake of suggested methods.ResultsOf 31 EU/EEA countries, 23 (2014) and 27 (2016) participated. Numbers of countries with central collection and storage of HAV positive samples and of those performing sequencing increased from 12 to 15 and 12 to 14 respectively in 2016, with all countries typing an overlapping fragment of 218 nt. However, variation existed in the sequenced genomic regions and their lengths.ConclusionsWhile HAV sequences in EU/EEA countries are comparable for surveillance, collaboration in sharing and comparing these can be further strengthened.

The assessment of the spinal curvatures in the sagittal plane of children using an ultrasound-based motion analysing system.

In children's posture examinations the question often arises whether an X-ray examination is necessary or appropriate. On screening and in other cases when X-ray is contraindicated, alternative-non-invasive-examinations are available. To measure the shapes of the children's spines beside the Spinal Mouse also the Zebris ultrasound-based spine measuring instrument is accessible and nowadays commonly used. The main aim of the study is to determine the shape of the school-age children's spines in the sagittal plane with an alternative, non-invasive, radiation-free measuring method. From the results calculated from the values measured with the ultrasound-based motion analysing system-geared to age and height-the normal range of the values of kyphosis (TK), lordosis (LL) and inclination (TTI and LI) is determined. The subjects were children between the ages of 6 and 15 and between the heights of 120 and 180 cm (530 healthy, 394 with bad posture and 332 with flat feet). They were divided into groups according to their height with 5 cm long intervals. The age within the groups was irrelevant. So it is appropriate to give normal values according to height and not according to age. It was revealed that both in healthy children, in children with bad posture and in those with pes planus in the height groups, there was a significant difference between the values of males and females. On the basis of these results, normal values should be divided according to the gender. The measurement results also showed that in some of the height groups the pes planus and bad posture significantly affected the spinal curvatures.