Toscana, West Nile, Usutu and tick-borne encephalitis viruses: external quality assessment for molecular detection of emerging neurotropic viruses in Europe, 2017

BackgroundNeurotropic arboviruses are increasingly recognised as causative agents of neurological disease in Europe but underdiagnosis is still suspected. Capability for accurate diagnosis is a prerequisite for adequate clinical and public health response.AimTo improve diagnostic capability in EVD-La

Results of the 1st external quality assurance for SARS new coronavirus diagnostic PCR and serology : talk

Background The detection of the new Coranavirus (CoV) causing agent of the severe acute respiratory syndrome (SARS) for diagnostic purposes is still a critical step in prevention of secondary hospital infections. In this respect the PCR for SARS diagnostic is the fastest and most sensitive method and was published very early after the description of the new pathogen by different groups. To evaluate the quality and sensitivity of the SARS PCR performed in diagnostic laboratories all over the world an external quality assurance (EQA) for SARS PCR was initiated by the WHO, the European Network for Diagnostics of "Imported" Viral Diseases (ENIVD) and the Robert Koch-Institut. Methods Therefore 10 samples of inactivated SARS CoV strains isolated in Frankfurt and Hong Kong in different dilutions and negative controls were prepared. The freeze dried samples were send by mail to 62 different laboratories, in 37 countries in Europe and Israel (35), Asia (11), The Americas (11), Australia and New Zealand (4) and Africa (1). The results were returned by email or fax 1 week (13), 2 weeks (14), 3 weeks (6) and later (29) after receiving the material which does not mimic at all the possible speed of this fast method. But this was not considered in the evaluation of these first SARS EQA. Results 44 laboratories showed good or excellent results (26 = 100%, 18 = 90%) and even the 14 laboratories which archived only 80% (10) or 70% (4) correct results are mostly lacking sensitivity. The results of the other 4 laboratories show basic problems in regard to sensitivity, specificity and consistency of results and must be overcome as soon as possible. 4 laboratories seem to have problems with the specificity finding a positive signal in negative samples. The different methods used for preparation of the SARS CoV genome and diagnostic PCR test procedure used by the participating laboratories will be discussed in more detail in the presentation. Conclusion However, in contrast to previous EQAs for Ebola, Lassa and Orthopoxviruses the quality of PCR results was rather good which might be caused by the early publication and distribution of well developed PCR methods. An EQA for evaluation of SARS specific serology is still ongoing, first results will be available beginning of April 2004

Lack of SARS Transmission among Public Hospital Workers, Vietnam

The severe acute respiratory syndrome (SARS) outbreak in Vietnam was amplified by nosocomial spread within hospital A, but no transmission was reported in hospital B, the second of two designated SARS hospitals. Our study documents lack of SARS-associated coronavirus transmission to hospital B workers, despite variable infection control measures and the use of personal protective equipment

Clinical Description of a Completed Outbreak of SARS in Vietnam, February–May, 2003

We investigated the clinical manifestations and course of all probable severe acute respiratory syndrome (SARS) patients in the Vietnam outbreak. Probable SARS cases were defined by using the revised World Health Organization criteria. We systematically reviewed medical records and undertook descriptive statistical analyses. All 62 patients were hospitalized. On admission, the most prominent symptoms were malaise (82.3%) and fever (79.0%). Cough, chest pain, and shortness of breath were present in approximately one quarter of the patients; 79.0% had lymphopenia; 40.3% had thrombocytopenia; 19.4% had leukopenia; and 75.8% showed changes on chest radiograph. Fever developed on the first day of illness onset, and both respiratory symptoms and radiographic changes occurred on day 4. On average, maximal radiographic changes were observed on day 10, and fevers subsided by day 13. Symptoms on admission were nonspecific, although fever, malaise, and lymphopenia were common. The complications of SARS included invasive intubation and ventilation (11.3%) and death (9.7%)

Factors associated with nosocomial SARS-CoV transmission among healthcare workers in Hanoi, Vietnam, 2003

BACKGROUND: In March of 2003, an outbreak of Severe Acute Respiratory Syndrome (SARS) occurred in Northern Vietnam. This outbreak began when a traveler arriving from Hong Kong sought medical care at a small hospital (Hospital A) in Hanoi, initiating a serious and substantial transmission event within the hospital, and subsequent limited spread within the community. METHODS: We surveyed Hospital A personnel for exposure to the index patient and for symptoms of disease during the outbreak. Additionally, serum specimens were collected and assayed for antibody to SARS-associated coronavirus (SARS-CoV) antibody and job-specific attack rates were calculated. A nested case-control analysis was performed to assess risk factors for acquiring SARS-CoV infection. RESULTS: One hundred and fifty-three of 193 (79.3%) clinical and non-clinical staff consented to participate. Excluding job categories with <3 workers, the highest SARS attack rates occurred among nurses who worked in the outpatient and inpatient general wards (57.1, 47.4%, respectively). Nurses assigned to the operating room/intensive care unit, experienced the lowest attack rates (7.1%) among all clinical staff. Serologic evidence of SARS-CoV infection was detected in 4 individuals, including 2 non-clinical workers, who had not previously been identified as SARS cases; none reported having had fever or cough. Entering the index patient's room and having seen (viewed) the patient were the behaviors associated with highest risk for infection by univariate analysis (odds ratios 20.0, 14.0; 95% confidence intervals 4.1–97.1, 3.6–55.3, respectively). CONCLUSION: This study highlights job categories and activities associated with increased risk for SARS-CoV infection and demonstrates that a broad diversity of hospital workers may be vulnerable during an outbreak. These findings may help guide recommendations for the protection of vulnerable occupational groups and may have implications for other respiratory infections such as influenza

Guidance for contact tracing of cases of Lassa fever, Ebola or Marburg haemorrhagic fever on an airplane: results of a European expert consultation

Background: Travel from countries where viral haemorrhagic fevers (VHF) are endemic has increased significantly over the past decades. In several reported VHF events on airplanes, passenger trace back was initiated but the scale of the trace back differed considerably. The absence of guidance documents to help the decision on necessity and scale of the trace back contributed to this variation. This article outlines the recommendations of an expert panel on Lassa fever, Ebola and Marburg haemorrhagic fever to the wider scientific community in order to advise the relevant stakeholders in the decision and scale of a possible passenger trace back. Method: The evidence was collected through review of published literature and through the views of an expert panel. The guidance was agreed by consensus. Results: Only a few events of VHF cases during air travel are reported in literature, with no documented infection in followed up contacts, so that no evidence of transmission of VHF during air travel exists to date. Based on this and the expert opinion, it was recommended that passenger trace back was undertaken only if: the index case had symptoms during the flight; the flight was within 21 days after detection of the event; and for Lassa fever if exposure of body fluid has been reported. The trace back should only be done after confirmation of the index case. Passengers and crew with direct contact, seat neighbours (+/− 1 seat), crew and cleaning personal of the section of the index case should be included in the trace back. Conclusion: No evidence has been found for the transmission of VHF in airplanes. This information should be taken into account, when a trace back decision has to be taken, because such a measure produces an enormous work load. The procedure suggested by the expert group can guide decisions made in future events, where a patient with suspected VHF infection travelled on a plane. However, the actual decision on start and scale of a trace back always lies in the hands of the responsible people taking all relevant information into account

Die Bedeutung von Sentinels für die Implementierung und Evaluation von Impfstrategien

Ein Sentinel ist ein Instrument der Surveillance, mit dem über spezifische Ereignisse aus dem Vollzug der gesundheitlichen Betreuung zumeist in einer Stichprobe berichtet wird. Im Infektionsschutzgesetz (IfSG) wird die Bedeutung von Sentinels für die Surveillance von Infektionskrankheiten in Deutschland hervorgehoben. Dem Robert Koch-Institut (RKI) wird bei ihrer Durchführung eine besondere Rolle zugewiesen. Unter Beteiligung des RKI werden z. B. die Praxisnetzwerke der Arbeitsgemeinschaft Influenza und der Arbeitsgemeinschaft Masern sowie das Laborsentinel zur Erfassung mikrobiologischer Befunde bei Kindern durchgeführt. Die mit diesen Systemen erhobenen Daten tragen zur Formulierung von Impfempfehlungen und Impfzielen bei, unterstützen die Argumentation zur Förderung der Impfbereitschaft und dienen der Erfolgskontrolle bei der Umsetzung von Empfehlungen sowie zur Überprüfung und Anpassung von Impfstrategien. Die Daten ermöglichen Trendbeobachtungen (z. B. Erkrankungshäufigkeiten nach Saison, Alter und Region), liefern aber auch sehr spezifische Informationen (z. B. zur Definition von Risikogruppen, zur Verteilung und Ausbreitung von Erregertypen). Methodische Probleme von Sentinelerhebungen (Auswahl stabiler Stichproben, Hochrechnung auf die Grundgesamtheit) können durch geeignete Auswertungs- und Analyseverfahren berücksichtigt und ausgeglichen werden. Die im IfSG genannte Rolle von RKI und Sentinelsurveillance ließe sich wirkungsvoller mit einem Gesamtkonzept umsetzen, das die begrenzt vorhandenen Ressourcen bündelt und Strukturen schafft, in denen inhaltliche und organisatorische Fragen aktuell und flexibel gehandhabt werden können.In sentinel surveillance a prearranged sample of reporting sources—often healthcare providers—agrees to report all cases of defined conditions. The German ldquoProtection Against Infection Actrdquo (IfSG) provides a mandate to the Robert Koch-Institute (RKI) to establish sentinel surveillance of not notifiable diseases relevant to public health. Sentinel systems with RKI involvement include two networks of private practitioners reporting cases of influenza and measles (within the Working Groups on Influenza and Measles, respectively). In addition a laboratory-based sentinel system reports cases of certain bacterial infections in children. Results from these systems serve as a basis for framing vaccination recommendations and goals as well as for the evaluation, adjustment and promotion of vaccination strategies. The data indicate time trends (e. g. number of cases by season, age and region) and supply specific information (e. g. for determination of risk factors, distribution of pathogens). Methodological problems of sentinel surveys (e. g. selection of appropriate samples, population-based estimates) can be accounted for with appropriate methods of analysis. More effective implementation of sentinel surveillance in Germany could be achieved through better coordination of existing structures. This would make more effective use of limited resources and better enable timely and flexible investigation of conceptual and organisational questions

Guidance for contact tracing of cases of Lassa fever, Ebola or Marburg haemorrhagic fever on an airplane: results of a European expert consultation

Abstract Background Travel from countries where viral haemorrhagic fevers (VHF) are endemic has increased significantly over the past decades. In several reported VHF events on airplanes, passenger trace back was initiated but the scale of the trace back differed considerably. The absence of guidance documents to help the decision on necessity and scale of the trace back contributed to this variation. This article outlines the recommendations of an expert panel on Lassa fever, Ebola and Marburg haemorrhagic fever to the wider scientific community in order to advise the relevant stakeholders in the decision and scale of a possible passenger trace back. Method The evidence was collected through review of published literature and through the views of an expert panel. The guidance was agreed by consensus. Results Only a few events of VHF cases during air travel are reported in literature, with no documented infection in followed up contacts, so that no evidence of transmission of VHF during air travel exists to date. Based on this and the expert opinion, it was recommended that passenger trace back was undertaken only if: the index case had symptoms during the flight; the flight was within 21 days after detection of the event; and for Lassa fever if exposure of body fluid has been reported. The trace back should only be done after confirmation of the index case. Passengers and crew with direct contact, seat neighbours (+/− 1 seat), crew and cleaning personal of the section of the index case should be included in the trace back. Conclusion No evidence has been found for the transmission of VHF in airplanes. This information should be taken into account, when a trace back decision has to be taken, because such a measure produces an enormous work load. The procedure suggested by the expert group can guide decisions made in future events, where a patient with suspected VHF infection travelled on a plane. However, the actual decision on start and scale of a trace back always lies in the hands of the responsible people taking all relevant information into account.</p

Kommunen, Länder, Bund und Europäische Gemeinschaft. Zuständigkeiten und Aufgaben bei Seuchennotfällen im Kontext der neuen Internationalen Gesundheitsvorschriften

Die weltweite Ausbreitung und Zunahme von Infektionskrankheiten sind wesentliche Herausforderungen für den öffentlichen Gesundheitsdienst. Dies gilt nicht nur für eine möglicherweise drohende Influenzapandemie, sondern auch für andere, bislang kaum oder gar nicht bekannte Infektionskrankheiten, z. B. für das Severe Acute Respiratory Syndrome (SARS), wie die erste Pandemie dieses Jahrtausends eindrücklich zeigte. Zunehmend wird auch die Gefahr bioterroristischer Anschläge mit in die Planungen des Managements von Seuchennotfällen einbezogen. In Deutschland sind die diesbezüglichen politischen und fachlichen Zuständigkeiten komplex, da die Gesetzgebungskompetenz für Gesundheitsfragen bei den Bundesländern liegt. Die Ausführungsorgane für die Maßnahmen bei Seuchennotfällen sind die regional zuständigen Gesundheitsämter. Ihnen übergeordnet sind Fachbehörden der Länder und des Bundes. Da Infektionskrankheiten häufig grenzüberschreitend auftreten, ist mit dem European Centre for Disease Prevention and Control (ECDC) eine europäische Behörde zur Identifizierung und Bewertung von Infektionskrankheiten, einschließlich Seuchennotfällen eingerichtet worden.Pandemic preparedness has become a catch phrase for politicians, government agencies and communities, both nationally and internationally. This is due to the increasing number of infectious diseases emergencies that are important challenges for health protection authorities, which was shown impressively when SARS emerged as the first pandemic in this millennium. In Germany, effective and efficient infection control is complex, with local health protection authorities having their own responsibilities. In the case of an emergency epidemic, regional health departments are responsible. Having authority over these are authorities on the federal state level as well as on the federal level. For the European Community, the European Centre for Disease Prevention and Control (ECDC) was established. The mission of this agency is to identify, assess and communicate current and emerging threats to human health posed by infectious diseases