Travel-associated hepatitis A in Europe, 2009 to 2015 Beauté, Julien; Westrell, Therese; Schmid, Daniela ...
Euro surveillance : bulletin européen sur les maladies transmissibles,
05/2018, Letnik:
23, Številka:
22
Journal Article
Recenzirano
Odprti dostop
BackgroundTravel to countries with high or intermediate hepatitis A virus (HAV) endemicity is a risk factor for infection in residents of countries with low HAV endemicity.
The objective of this ...study was to estimate the risk for hepatitis A among European travellers using surveillance and travel denominator data.
We retrieved hepatitis A surveillance data from 13 European Union (EU)/ European Economic Area (EEA) countries with comprehensive surveillance systems and travel denominator data from the Statistical Office of the European Union. A travel-associated case of hepatitis A was defined as any case reported as imported.
From 2009 to 2015, the 13 countries reported 18,839 confirmed cases of hepatitis A, of which 5,233 (27.8%) were travel-associated. Of these, 39.8% were among children younger than 15 years. The overall risk associated with travel abroad decreased over the period at an annual rate of 3.7% (95% confidence interval (CI): 0.7-2.7) from 0.70 cases per million nights in 2009 to 0.51 in 2015. The highest risk was observed in travellers to Africa (2.11 cases per million nights). Cases more likely to be reported as travel-associated were male and of younger age (< 25 years).
Travel is still a major risk factor for HAV infection in the EU/EEA, although the risk of infection may have slightly decreased in recent years. Children younger than 15 years accounted for a large proportion of cases and should be prioritised for vaccination.
The intensity and extent of transmission of arboviruses such as dengue, chikungunya, and Zika virus have increased markedly over the last decades. Autochthonous transmission of dengue and chikungunya ...by
has been recorded in Southern Europe where the invasive mosquito was already established and viraemic travelers had imported the virus.
populations are spreading northward into Germany. Here, we model the current and future climatically suitable regions for
establishment in Germany, using climate data of spatially high resolution. To highlight areas where vectors and viraemic travellers are most likely to come into contact, reported dengue and chikungunya incidences are integrated at the county level. German cities with the highest likelihood of autochthonous transmission of
-borne arboviruses are currently located in the western parts of the country: Freiburg im Breisgau, Speyer, and Karlsruhe, affecting about 0.5 million people. In addition, 8.8 million people live in regions considered to show elevated hazard potential assuming further spread of the mosquito: Baden-Württemberg (Upper Rhine, Lake Constance regions), southern parts of Hesse, and North Rhine-Westphalia (Lower Rhine). Overall, a more targeted and thus cost-efficient implementation of vector control measures and health surveillance will be supported by the detailed maps provided here.
•Experts suggest primary objectives for national HEV surveillance in EU/EEA countries.•to monitor the incidence of acute HEV cases.•to monitor chronic HEV infections.•to describe the epidemiology of ...acute and chronic HEV infections.•Suggested secondary objectives for national HEV surveillance in EU/EEA countries:•to monitor HEV phylotypes/subtypes.•to identify potential clusters/outbreaks.•to collect information on possible routes of transmission.•Overall, the majority of EU/EEA countries collect the suggested data and meet the outlined requirements to confirm an acute case.
Hepatitis E virus (HEV) infection is not notifiable at EU/EEA level, therefore surveillance relies on national policies only. Between 2005 and 2015, more than 20,000 cases were reported in EU/EEA countries. HEV testing is established in 26 countries and 19 countries sequence HEV viruses.
WHO's European Action plan for viral hepatitis recommends harmonised surveillance objectives and case definitions. ECDC's HEV expert group developed minimal and optimal criteria for national hepatitis E surveillance to support EU/EEA countries in enhancing their capacity and to harmonise methods.
The experts agreed that the primary objectives of national surveillance for HEV infections should focus on the basic epidemiology of the disease: to monitor the incidence of acute cases and chronic infections. The secondary objectives should be to describe viral phylotypes or subtypes and to identify potential clusters/outbreaks and possible routes of transmission. Seventeen of 20 countries with existing surveillance systems collect the minimal data set required to describe the epidemiology of acute cases. Eleven countries test for chronic infections. Twelve countries collect data to identify potential clusters/outbreaks and information on possible routes of transmission.
Overall, the majority of EU/EEA countries collect the suggested data and meet the outlined requirements to confirm an acute case.
Am 27.01.2020 wurde in Deutschland der erste Fall mit einer SARS-CoV-2-Infektion diagnostiziert. Für die Beschreibung des Pandemieverlaufs im Jahr 2020 wurden 4 epidemiologisch verschiedene Phasen ...betrachtet und Daten aus dem Meldesystem gemäß Infektionsschutzgesetz (IfSG) sowie hospitalisierte COVID-19-Fälle mit schwerer akuter respiratorischer Infektion aus der Krankenhaus-Surveillance eingeschlossen.
Phase 0
umfasst den Zeitraum von Kalenderwoche (KW) 5/2020 bis 9/2020, in dem vor allem sporadische Fälle <60 Jahre und regional begrenzte Ausbrüche beobachtet wurden. Insgesamt wurden 167 Fälle übermittelt, die vorwiegend mild verliefen. Dem schloss sich in
Phase 1
(KW 10/2020 bis 20/2020) die erste COVID-19-Welle mit 175.013 Fällen im gesamten Bundesgebiet an. Hier wurden vermehrt Ausbrüche in Krankenhäusern, Alten- und Pflegeheimen sowie ein zunehmender Anteil an älteren und schwer erkrankten Personen verzeichnet. In
Phase 2
, dem „Sommerplateau“ mit eher milden Verläufen (KW 21/2020 bis 39/2020), wurden viele reiseassoziierte COVID-19-Fälle im Alter von 15–59 Jahren und einzelne größere, überregionale Ausbrüche in Betrieben beobachtet. Unter den 111.790 Fällen wurden schwere Verläufe seltener beobachtet als in
Phase 1
.
Phase 3
(KW 40/2020 bis 8/2021) war gekennzeichnet durch die zweite COVID-19-Welle in Deutschland, die sich zum Jahresende 2020 auf dem Höhepunkt befand. Mit 2.158.013 übermittelten COVID-19-Fällen und insgesamt deutlich mehr schweren Fällen in allen Altersgruppen verlief die zweite Welle schwerer als die erste Welle. Unabhängig von den 4 Phasen waren v. a. Ältere und auch Männer stärker von einem schweren Krankheitsverlauf betroffen.
From January to June 2018, two ongoing hepatitis A outbreaks affected travellers returning from Morocco and cases in Europe without travel history, resulting in 163 patients in eight European ...countries. Most interviewed travel-related cases were unaware of the hepatitis A risk in Morocco. Molecular analysis revealed two distinct hepatitis A virus (HAV) strains (subgenotype IA DK2018_231; subgenotype IB V18-16428). Vaccination recommendations should be emphasised to increase awareness among non-immune travellers to Morocco and HAV-endemic countries.
We report an ongoing, protracted and geographically dispersed outbreak of haemolytic uraemic syndrome (HUS) and gastroenteritis in Germany, involving 30 cases since December 2016. The outbreak was ...caused by the sorbitol-fermenting immotile variant of Shiga toxin-producing (STEC) Escherichia coli O157. Molecular typing revealed close relatedness between isolates from 14 cases. One HUS patient died. Results of a case-control study suggest packaged minced meat as the most likely food vehicle. Food safety investigations are ongoing.
Introduction Sequence-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. Aim The 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. Methods In 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. Results Of 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. Conclusions While HAV sequences in EU/EEA countries are comparable for surveillance, collaboration in sharing and comparing these can be further strengthened.
Zusammenfassung
Von Mai bis Juli 2011 ereignete sich vor allem in Norddeutschland der bisher größte Ausbruch von Infektionen durch enterohämorrhagische
Escherichia coli
(EHEC) O104:H4 und von ...hämolytisch-urämischem Syndrom (HUS) mit insgesamt über 3.800 Erkrankten und 53 Todesfällen. Bei den Erkrankten handelte es sich überwiegend um Erwachsene. Dies steht im Gegensatz zu den in den Meldedaten der letzten Jahre beobachteten Erkrankungsfällen an EHEC-Gastroenteritis und HUS, als vor allem Kinder betroffen waren. Der Ausbruch begann, bezogen auf den Erkrankungsbeginn (Durchfallsymptomatik) der übermittelten Fälle, am 08. Mai 2011, gipfelte am 22. Mai und klang danach ab. Am 26. Juli 2011 wurde der Ausbruch vom Robert Koch-Institut (RKI) für beendet erklärt, da zu diesem Zeitpunkt drei Wochen lang keine neuen, offensichtlich dem Ausbruch zugehörigen Erkrankungsfälle übermittelt worden waren, die nach dem 4. Juli erkrankt waren. Epidemiologische Studien des RKI in Kooperation mit dem Öffentlichen Gesundheitsdienst von Ländern und Kommunen und Kliniken sowie Ermittlungen der Lebensmittelüberwachungsbehörden identifizierten mit großer Wahrscheinlichkeit kontaminierte Sprossen aus einem Gartenbaubetrieb in Niedersachsen bzw. importierte Bockshornkleesamen als Infektionsvehikel im Ausbruchsgeschehen. Die enge Kooperation der Gesundheits- und Lebensmittelüberwachungsbehörden ermöglichte die zeitnahe Aufklärung des Ausbruchsgeschehens.
The cytochrome P450 enzyme CYP1A2 mediates the rate-limiting step in the metabolism of many drugs including theophylline, clozapine, and tacrine as well as in the bioactivation of procarcinogens. ...CYP1A2 activity shows both pronounced intra- and interindividual variability, which is, among other factors, related to smoking causing enzyme induction, to drug intake and to dietary factors which may result in induction or inhibition. In contrast to these exogenous factors, genetic influences on enzyme activity seem to be less pronounced. Therefore, phenotyping of CYP1A2, i.e. the determination of the actual activity of the enzyme in vivo, represents a useful approach both for scientific and clinical applications. CYP1A2 is almost exclusively expressed in the liver. Since liver tissue cannot be obtained for direct phenotyping, a probe drug which is metabolized by CYP1A2 has to be given. Proposed probe drugs include caffeine, theophylline, and melatonin. Caffeine is most often used because of the predominating role of CYP1A2 in its overall metabolism and the excellent tolerability. Various urinary, plasma, saliva, and breath based CYP1A2 caffeine metrics have been applied. While caffeine clearance is considered as the gold standard, the salivary or plasma ratio of paraxanthine to caffeine in a sample taken approximately 6 hr after a defined dose of caffeine is a more convenient, less expensive but also fully validated CYP1A2 phenotyping metric. CYP1A2 phenotyping is applied frequently in epidemiologic and drug-drug interaction studies, but its clinical use and usefulness remains to be established.
PDF
