[Neonatal enterovirus meningitis: transmission via parents during rooming-in and current epidemiology in Germany]. / Neonatale Enterovirus-Meningitis: Transmission durch die Eltern beim familiären Rooming-in und derzeitige Epidemiologie der Erkrankung in Deutschland.

INTRODUCTION: Non-polio-enterovirus infections are common in children and adults and usually lead to a mild, self-limiting disease. Perinatally acquired enterovirus infections, however, may lead to a severe disease including meningitis, encephalitis, hepatitis, coagulopathy or myocarditis. The mode of transmission may be not obvious. METHODS: 2 cases of neonatal enterovirus meningitis are presented. The disease was probably transmitted by the parents after birth during rooming-in within the hospital. The frequency of neonatal enterovirus infections in Germany was determined by analysing data of the enterovirus surveillance system of the national commission for polio eradication. RESULTS: In both cases, the parents suffered from a febrile infection. In case 1, transmission by the febrile mother was suspected. In case 2, transmission of Coxsackie B5-virus by the father was confirmed by viral culture. Both neonates exhibited fever, one patient had the typical clinical signs of meningitis. Levels of inflammatory indicators in blood (CRP, IL-6) were remarkably low. From 2006 to 2009, 322 neonates were included within the voluntary, passive enterovirus surveillance system. In 81 patients (25%) an enterovirus was detected via RT-PCR. The yearly frequency of infections was between 8 and 21. In 58 of 322 specimens (18%) serotyping was possible. CONCLUSION: Infections with enterovirus are both clinically and epidemiologically relevant during the neonatal period. Predominantly in the typical season, from June to October, enteroviral infections may be an important differential diagnosis to neonatal sepsis. The infection may be transmitted via infected parents during rooming-in within the hospital.

[Protracted nosocomial outbreak of Salmonella Enteritidis LT 8/7]. / Protrahiert verlaufender nosokomialer Ausbruch von Salmonella Enteritidis LT 8/7.

INTRODUCTION: In spring 2007a cluster of nosocomial salmonellosis cases, culture confirmed for SALMONELLA Enteritidis lysotype (LT) 8/7, occurred in a Wolfsburg hospital. An outbreak investigation was initiated to determine the epidemiology of the outbreak and to identify and control the possible sources. METHODS: A multidisciplinary outbreak team was formed including members from hospital hygiene and local, state and national health and veterinarian authorities. Active surveillance was set up in the hospital to find new cases. A retrospective case control study was conducted to identify possible risk factors for disease. Hospital workers and food samples were tested for the pathogen and positive isolates were typed. RESULTS: Between calendar weeks 4 and 24 of the year 2007, a total of 28 patients with a median age 66 years had nosocomial salmonellosis culture confirmed for SALMONELLA Enteritidis LT 8/7. In food samples from February, the same Salmonella lysotype was isolated in 4 different food samples. SALMONELLA Enteritidis LT 8/7 was also identified in stool samples from 5 kitchen personnel. The case control study indicated antacida therapy (odds ratio: 5.5, 95 % CI 1.2 - 26.0) as a risk factor for nosocomial salmonellosis among patients. No particular diet was associated with an increased risk of disease. DISCUSSION: This nosocomial salmonellosis outbreak was characterised by prolonged duration and a low infection rate among patients. The epidemiological investigation suggests that the origin of the outbreak was food that was probably associated with a contamination in the hospital kitchen. Furthermore, kitchen staff could, as carriers, have contributed to a low-level contamination of various foods for a long period. The intermittent occurrence of the cases is best explained by a low level of contaminated food which primarily led to clinical symptoms among especially vulnerable persons (older patients with antacida therapy). Considering the unusual progression of this outbreak, hospitals should initiate an intensive epidemiological and microbiological investigation, even if only few nosocomial salmonellosis cases occur.

Analysis of the surveillance situation for viral encephalitis and meningitis in Europe.

Infective processes in the brain, spinal cord and meninges are considered to be the main causes of encephalitis, myelitis and meningitis. However, most cases remain unexplained. The incidence of different viral aetiologies (zoonotic and non-zoonotic) is especially poorly estimated, due to the lack of a standard case definition and of agreed diagnostic algorithms, including harmonised diagnostic methods and sample collection. It is important to clarify the incidence of viral encephalitis/meningitis and to optimise the diagnosis of infectious neurological illness, particularly to ensure early recognition of outbreaks or emerging infectious such a West Nile encephalitis. The European Network for Diagnostics of 'Imported' Viral Diseases (ENIVD) has analysed the present surveillance situation for viral encephalitis/meningitis in Europe. Here we give an overview of the existing epidemiological sources of information in European Union (EU) Member States, mapping the laboratory capacity and identifying key requirements for a possible future surveillance study at European level. The data presented will help design a harmonised/standardised Europe-wide surveillance study investigating patients with encephalitis and/or meningitis in order to obtain more information on the role of infections in these rarely analysed syndromes, both from a clinical and an epidemiological perspective.

Legionnaires' disease outbreak associated with a cruise liner, August 2003: epidemiological and microbiological findings.

Eight cases of Legionnaires' disease were identified among the 215 German passengers after a cruise to the Nordic Sea in August 2003. An unmatched case-control study was conducted to identify risk factors and the source of infection. In total, eight passengers fulfilled the case definition, one of these died. Forty-two passengers served as controls. The attack rate was 4%. The mean age was 60 years for cases and 62 years for controls. Prolonged exposure to the spa pool seemed to be a risk factor of infection (OR 4.85, P=0.09). Legionella pneumophila serogroup 1, monoclonal antibody (mAb) subgroup 'Knoxville' was isolated from clinical and environmental samples. DNA sequence-based typing revealed that these isolates were indistinguishable from each other. The investigation showed the importance of an interdisciplinary approach of microbiology and epidemiology as not all sites on the ship that tested positive for L. pneumophila actually posed a relevant risk for the passengers.

[Surveillance of acute respiratory illnesses (ARI) in Lower Saxony: first experience from the years 2005-2006]. / Surveillance akuter respiratorischer Erkrankungen (ARE) in Niedersachsen: Erste Erfahrungen aus den Jahren 2005-2006.

In the context of influenza pandemic preparedness planning, a surveillance system for influenza and other acute respiratory illnesses was implemented in Lower Saxony at the beginning of the influenza season 2004/2005 and coordinated by the Governmental Institute of Public Health of Lower Saxony. This surveillance system represents an addition to already existing national monitoring systems. The goal of this surveillance system is to have available prompt information on the beginning, course and end of the influenza season and to recognise the spectrum of pathogens and identify outbreaks of other viral acute respiratory illnesses (ARI). For this purpose an all-season surveillance was established consisting of two supplementary modules. The first module is a symptom-oriented surveillance of acute respiratory illnesses in children of pre-school day care facilities. In the second module a virological surveillance in co-operation with selected medical practices was established. While the temporal course and burden of ARI in all Lower Saxony can be assessed by the surveillance of children in the day-care facilities in a sensitive, but less specific way, the virological surveillance provides highly specific information on the prevailing pathogens in ARI patients at a certain time. This information, in return, gives an indication about the responsible pathogens causing ARI in children of the day-care facilities. The first experience with these two complementary surveillance modules shows that in Lower Saxony a well accepted, prompt and meaningful monitoring system is available for the recognition and description of the occurrence of ARI and concomitantly of influenza. An extension of this surveillance to other pathogens or disease scenarios is possible.

[Poliomyelitis--why we must continue to vaccinate!]. / Poliomyelitis weltweit vor der Eradikation. Warum wir jetzt unbedingt weiterimpfen müssen.

The eradication of polio--that is the worldwide elimination of the wild poliovirus--is now within reach. The current success of this international project is due largely to the rigorous immunization of the general population. Both live oral polio vaccine (OPV) and inactivated vaccine (IPV) administered by injection are applied, the pros and cons of each having to be weighed up. Since 1998, only the dead IPV vaccine has been recommended in Germany. It is essential that the acceptance of the need for immunization should not decline, and that the inoculation rate in countries in which polio has apparently been eliminated, should not fall below the critical threshold of about 85-80%. If in the future this figure is not reached, the population would be put at risk by the re-introduction of the polio virus into the country. Even when global elimination has been achieved, vaccination must be continued for several years. The recommended immunization schedule covers three vaccinations for basic immunization plus a booster vaccination in adolescence.

[Surveillance system for assessing central nervous infections in Lower Saxony 1998-2000]. / Surveillance-System zur Erfassung zentralnervöser Infektionen in Niedersachsen 1998-2000.

OBJECTIVE AND METHOD: In cooperation with the district public health authorities in Lower Saxony a surveillance system for infections of the central nervous system was established from 1998 to 2000. Reporting was based on special questionnaires. It was the objective of this system to obtain information on the pathogens responsible for these infections and the corresponding age distribution. RESULTS: An increased risk was found for children under the age of 15. About two-thirds of all reported central nervous infections were observed in this age group. The most frequent bacteria identified had been Meningococci, Pneumococci and Borrellia burgdorferi. They accounted for about 56 % of the reported bacterial infections. With respect to viral meningitis/encephalitis, enteroviruses were isolated in about 66 % of these cases. Twenty-five of all 628 reported cases had a lethal outcome which was more often associated with bacterial than viral infections. CONCLUSIONS: Infections of the central nervous system still play an important role in clinical and public health medicine. For the future an intensive and ongoing surveillance of these infectious diseases is required and should exceed the regulations of the official notification system. To this end, a prospective register for meningitis and encephalitis cases will be set up in Lower Saxony in cooperation with hospitals and laboratories.

How to cope with radiation accidents: the medical management.

A concerted action, termed METREPOL, was accepted by the Commission of the European Communities and was started in December 1997. Its purpose was to develop a new approach to the medical management of radiation accident victims with respect to diagnostic procedures and therapeutic options, based on recognition and evaluation of health impairments after acute radiation exposure. The result of this interdisciplinary project is a manual entitled "Medical management of radiation accidents: manual on the acute radiation syndrome". The manual compiles recommendations for assessing the state and outcome of a radiation accident victim in the shortest possible time. Furthermore, it provides guiding support for the medical management of patients accidentally exposed to ionising radiation, based on a new strategic approach for the diagnosis of the acute radiation syndrome: the response category concept. This commentary outlines the background for the development of such a manual and the realisation of the response category concept.

SEARCH: a system for evaluation and archiving of radiation accidents based on case histories.

Overexposure of humans to ionizing radiation has occurred worldwide in the past and will surely occur again in the future. In order to allow an effective radiation accident management, it is consequently necessary to be prepared for such emergency situations and to improve means and ways to help people suffering from radiation-induced health impairments. Such approaches should rely on knowledge and experience gained from previous radiation incidents. A prerequisite for any scientific evaluation and comparison of information related to radiation accidents is to collect data in a standardized way. Therefore, the SEARCH database (System for Evaluation and Archiving of Radiation accidents based on Case Histories) has been developed in our department and implemented as an Oracle 8.0 database containing to date more than 800 case histories. The use of this registry is so far limited to active contributors and requires each contributor to sign a cooperation agreement. More information is available under http://www.faw.uniulm.de/radmed/.

Light on population health status.

A new approach to illustrating and analysing health status is presented which allows comparisons of various aspects of health in a population at different times and in different populations during given periods. Both quantitative and qualitative elements can be represented, the impact of interventions can be monitored, and the extent to which objectives are achieved can be assessed. The practical application of the approach is demonstrated with reference to the health profiles to Tunisia in 1966 and 1994.

PIP: In response to a World Health Organization's Global Advisory Committee on Health Research initiative, a "visual health information profile" was developed that provides a quantitative description of and an assessment of multidimensional aspects of health in a population. The profile uses a hierarchy of indicators, with first-level domains covering: 1) disease conditions and health impairments, 2) the health care system, 3) sociocultural characteristics, 4) environmental determinants, and 5) food and nutrition. Indicators at all levels can be disaggregated. A decile reference method can be used to display indicators by country and to rank performance for specific years, thus allowing country and time comparisons. The circular visual health information profile has radial sectors representing health domains (with sectors representing the indicators in each domain). Scaling is arranged so that situations needing urgent attention are displayed on the periphery. With fixed reference points, comparisons can be made over time. A prototype of this profile is available via the World Wide Web at http://faw.uni-ulm.de/planet/health-profile/circle.html. The profile was evaluated by superimposing indicators for Tunisia for 1994 over those for 1966. Because of the immediate impact of the visual display of information, the profile, which can be applied to indicators at various levels, can contribute to the improvement of public health.

Telematics in research planning processes: an example from global health.

It is increasingly recognized that the appropriate application of information and communication technology can substantially improve communication and cooperative work processes in terms of quantity, quality and cost-effectiveness. Within large organizations, strategic decision making is one of the key cooperative processes which have to be faced. In this paper the authors discuss one example of this class of cooperative processes: research planning within the World Health Organization (WHO). The paper presents conceptual details of a process designed to assist in creating global networks of scientists, planners and field workers interested in cooperating to promote health development activities of WHO. The implementation of this process was realized in an Internet-based system to support global research planning. In particular, this application shows that the utilization of information and communication technology can not only quantitatively change existing processes, but can create new ones--and on a qualitatively improved level.

Visual Health Information Profile (VHIP). A quantitative approach for analysing the health status of a population.

A new approach for illustrating and analysing the health status of a given population is presented. The concept takes the multi-dimensional nature of health into account. It is based on a clearly out-lined indicator hierarchy, a decile reference system and a computerised information system. The instrument displays the health status of a population and allows comparisons to be made of various health aspects for a given population at different times and allows comparisons to be made of different populations during given time periods. It is possible to represent quantitative and qualitative aspects of health, to monitor the impact of interventions, and to assess the extent to which objectives in the health field have been achieved. Therefore, it can serve as an instrument for communication between policy makers and scientists to manage and to co-ordinate programs that aim at an improvement of the health status and to assist in the priority setting process. The method was applied to several countries using the World Health Organisation's (WHO) "Health For All Global Indicator Database" as the main data source. Country and region specific health status patterns could be generated showing the practicability of the approach. Using a computerised information system, a high degree of transparency and flexibility with respect to the input data and the choices of measurables was achieved.