Highly pathogenic avian influenza A(H5N8) outbreaks: protection and management of exposed people in Europe, 2014/15 and 2016.

Introduction of highly pathogenic avian influenza (HPAI) virus A(H5N8) into Europe prompted animal and human health experts to implement protective measures to prevent transmission to humans. We describe the situation in 2016 and list public health measures and recommendations in place. We summarise critical interfaces identified during the A(H5N1) and A(H5N8) outbreaks in 2014/15. Rapid exchange of information between the animal and human health sectors is critical for a timely, effective and efficient response.

Vaccine Effectiveness against GP-Attended Symptomatic COVID-19 and Hybrid Immunity among Adults in Hungary during the 2022-2023 Respiratory Season Dominated by Different SARS-CoV-2 Omicron Subvariants.

Hungary provides the opportunity to evaluate the effectiveness of COVID-19 vaccination in a setting where naturally acquired immunity and hybrid immunity are likely to play a greater role due to suboptimal vaccination coverage. METHODS: A test-negative study was conducted during the 2022-2023 respiratory season at the primary care level to determine the effectiveness of at least one COVID-19 booster dose in preventing medically attended symptomatic RT-PCR-confirmed SARS-CoV-2 infection in adults. Unvaccinated patients were used as a reference group. RESULTS: A total of 247 cases and 1073 controls were included in the analysis. CVE was 56.8% (95% CI: 11.9-78.8%) in the population aged 60 years and older and 2.3% (95% CI: -50.0-36.3%) in the younger adults against COVID-19 caused by Omicron subvariants, mainly BA.5, BQ.1, and XBB.1. Self-reported COVID-19 in the 60-365 days prior to the current illness did not confer protection against reinfection without vaccination, but together with booster vaccination, it reduced the risk of COVID-19 by 63.0% (95% CI: -28.0-89.3%) and 87.6% (95% CI: 26.4-97.9%) among the 18-59 and 60+ age groups, respectively. CONCLUSIONS: CVE against COVID-19 was moderately high in the 60+ age groups. Because of the benefit of hybrid immunity, persons with previous SARS-CoV-2 infection should still be considered for vaccination campaigns.

Environmental health aspects of drinking water-borne outbreak due to karst flooding: case study.

Climate change may increase the incidence of waterborne diseases due to extreme rainfall events, and consequent microbiological contamination of the water source and supply. As a result of the complexity of the pathways from the surface to the consumer, it is difficult to detect an association between rainfall and human disease. The water supply of a Hungarian city, Miskolc (174,000 inhabitant), is mainly based on karstic water, a vulnerable underground water body. A large amount of precipitation fell on the catchment area of the karstic water source, causing an unusually strong karstic water flow and flooding, and subsequent microbiological contamination. The presence of several potential sources of contamination in the protective zone of the karstic water source should be emphasized. The water supplier was unprepared to treat the risk of waterborne outbreak caused by an extreme weather event. Public health intervention and hygienic measures were taken in line with epidemiological actions, focusing on the protection of consumers by providing safe drinking water. The contamination was identified, and measures were taken for risk reduction and prevention. This case study underlines the increasing importance of preparedness for extreme water events in order to protect the karstic water sources and to avoid waterborne outbreaks.

Generalized tularemia in a vervet monkey (Chlorocebus aethiops) and a patas monkey (Erythrocebus patas) in a zoo.

Generalized tularemia was diagnosed in a vervet monkey (Chlorocebus aethiops) and a patas monkey (Erythrocebus patas), both of which died suddenly in the Szeged Zoo, Szeged, Hungary. Macroscopic lesions in each animal included disseminated, grayish-white foci in the lungs, lymph nodes, spleen, liver, and kidney. All focal lesions were characterized microscopically as purulent to pyogranulomatous to granulomatous inflammation with necrosis. Francisella tularensis subsp. holarctica strains were isolated from tissue samples on modified Francis agar after mouse passage and identified by a commercial carbon-source utilization test and polymerase chain reaction-based amplification and sequencing of a portion of the 16S ribosomal RNA gene.

[Malaria in Hungary: origin, current state and principles of prevention]. / A maláriakérdés Magyarországon: elózmények, aktuális állapot és védekezési elvek.

Malaria was an endemic disease in Hungary for many centuries. A country-wide survey of the epidemiologic situation on malaria started in the year of 1927. That was done by the Department of Parasitology of the Royal State Institute of Hygiene (presently: Johan Béla National Center for Epidemiology). The notification of malaria was made compulsory in 1930. Free of charge laboratory examination of the blood of persons suffering from malaria or suspected of an infection have been carried out. Anti-malarial drugs were also distributed free of charge, together with appropriate medical advise given at the anti-malarial sanitary stations. Between 1933 and 1943, the actual number of malaria cases was estimated as high as 10-100,000 per year. The major breakthrough came in 1949 by the organized antimalarial campaign applying DDT for mosquito eradication. The drastic reduction of the vectors resulted in the rapid decline of malaria cases. Since 1956, there have not been reported any indigenous case in Hungary. In 1963, Hungary entered on the Official Register of the WHO to the areas where malaria eradication has been achieved. During the period of 1963-2001, 169 Hungarians acquired the malaria in abroad and 263 foreigners infected in abroad were registered in Hungary. More than half of the cases (230) were caused by Plasmodium falciparum. Further 178 cases were caused by Plasmodium vivax and 24 cases by other Plasmodium species. During that period, 7 fatal cases were reported (Plasmodium falciparum). The expansion of migration (both the increase of the number of foreigners travelling into Hungary and of Hungarians travelling abroad) favours to the appearance of imported cases. Attention is called of all the persons travelling to malaria endemic countries to the importance of malaria prevention by the International Vaccination Stations located in the National Center for Epidemiology and in the Public Health Institutes of 19 counties and of Budapest. The Johan Béla National Center for Epidemiology issued a protocol in 2001, the title of which is: "Antimalarial defence". This helps the information activity of the International Vaccination Stations. To prevent malaria infections, systemic mosquito eradication is organized and supervised by the Office of the Chief Medical Officer at the touristically important areas in the summer season.

Association between incidence of Lyme disease and spring-early summer season temperature changes in Hungary--1998-2010.

The increase of Lyme borreliosis (LB) can be expected due to climate change, while the distribution of the disease and annual activity of the vector and host animals depend on several factors of the environment. The presented study aimed to assess expressly the spring season temperature dependence on the incidence of LB in Hungary. The weekly LB data were obtained from the National Epidemiologic and Surveillance System for a period of 13 years--1998-2010. Daily temperature data were derived from the European Climate Assessment and Dataset. The association was studied at national level, descriptive statistics and linear regression models were applied. A significant increasing trend was observed in the mean temperature of the analysed years (0.052°C per year). The annual LB incidence doubled during the 13 year period. The incidence rates of the periods 1998-2001 and 2007-2010 were 11.1 resp. 17.0 per 100,000. The start of a steep increase in weekly LB incidence (0.1 per 100,000) shifted significantly by 3 weeks earlier, the start date of spring showed similar trend (p=0.0041). LB incidence increased more steadily in spring than in summer, with 79% of the increase being reported during weeks 15-28, with maximum rates of increase occurring in weeks 23-25. The trend was significant between the weeks 15-28. In the warmer years with 19.02°C mean temperature in May and June, the LB incidence curve reached the annual peak 2-3 weeks earlier, and the descending phase of the curve started earlier than in the colder years with 17.06°C of the same period.

Susceptibility of the common hamster (Cricetus cricetus) to Francisella tularensis and its effect on the epizootiology of tularemia in an area where both are endemic.

Francisella tularensis is a highly infectious zoonotic agent causing the disease tularemia. The common hamster (Cricetus cricetus) is considered a pest in eastern Europe, and believed to be a source of human tularemia infections. We examined the role of the common hamster in the natural cycle of tularemia using serologic methods on 900 hamsters and real-time polymerase chain reaction (PCR) on 100 hamsters in an endemic agricultural area. We collected 374 Ixodes acuminatus ticks from the hamsters and tested them by real-time PCR. All tests were negative. To examine clinical signs, pathology, and histopathology of acute tularemia infection similar to the natural infection, two hamsters were infected with a large dose of a wild strain of F. tularensis ssp. holarctica. After a short period of apathy, the animals died on the eighth and ninth days postinfection. The pathologic, histopathologic, and immunohistochemical examination contributed to the diagnosis of septicemia in both cases. Our results confirmed previous findings that common hamsters are highly sensitive to F. tularensis. We conclude that although septicemic hamsters may pose substantial risk to humans during tularemia outbreaks, hamsters in interepizootic periods do not act as a main reservoir of F. tularensis.

Evidence of the etiological predominance of norovirus in gastroenteritis outbreaks--emerging new-variant and recombinant noroviruses in Hungary.

Between January 2001 and December 2003, stool specimens from 262 (45%) of 581 reported outbreaks of gastroenteritis were investigated for noroviruses in Hungary. Specimens collected from outbreaks of non-bacterial gastroenteritis were examined by reverse-transcription polymerase chain reaction and enzyme immunoassay. In 253 (97%) of 262 outbreaks, norovirus was detected and confirmed by sequencing in 211 (81%). Hospitals (35%), day care centers (30%), and elderly homes (27%) were the most common settings. Diversity and frequency of the genotypes changed over time but with predominance (95%) of genogroup (GG) II strains. Strains grouped into 11 genotypes including an epidemic spread of new-variant GGII4 (Lordsdale virus) and a recently emerged group of natural recombinant strains (GGIIb/Hilversum polymerase) with four capsid types (Hawaii, Mexico, Snow Mountain, and Lordsdale). Clusters of epidemics including food-borne outbreaks were detected. According to this study, noroviruses are the predominant etiological agents causing gastroenteritis outbreaks in Hungary.