A Infuso

Monitoring HIV/AIDS in Europe's migrant communities and ethnic minorities.

HIV/AIDS continues to be a major public health challenge in twenty-first century Europe [1,2]. Increasing population movement whether for travel, political or economic purposes, combined with demographic, social and economic transitions create conditions that contribute to the increase of HIV transmission worldwide [3–6]. Inequity, social exclusion, along with cultural, socio-economic and language barriers to HIV/ AIDS prevention and care, make some of Europe’s migrant and ethnic minority populations especially vulnerable to the negative impact of HIV/AIDS [3,7– 9]. Understanding the determinants of HIV/AIDS in Europe’s migrant populations and ethnic minorities is crucial for developing appropriate preventive and healthcare services, and informing public health policy. Although it is acknowledged that health inequalities, including those by race and/or ethnicity, should be monitored, the manner to do it is more controversial. On one hand, the publication of HIV/AIDS data by race/ethnicity will give greater visibility to these problems [10–13], but on the other, there is a real danger of inadvertent promotion of xenophobia and further stigmatization of migrants and ethnic minorities.

European survey of BCG vaccination policies and surveillance in children, 2005.

In 2005, all 25 EU countries, as well as Andorra, Bulgaria, Norway, Romania and Switzerland, participated in a survey on BCG vaccination in children. BCG was recommended nationally for children under 12 months in 12 countries, in older children in five countries and in children at risk (from origin, contact or travel) in 10 countries. Seven countries did not use BCG systematically. Revaccination was practised in four countries. In countries with universal vaccination, BCG coverage was high (83.0% to 99.8%). TB cases commonly occurred in vaccinated children (at least 30%-98% in five countries using universal or high-risk approach). Disseminated infection due to BCG was rarely reported in recent years (0-1/100 000 vaccinated). There is a wide variation among BCG recommendations in Europe, and nearly half the countries surveyed were considering revisions, at a time when the European Centre for Disease Prevention and Control (ECDC) is advocating for harmonised vaccine strategies. Data on monitoring of BCG coverage in target groups is important but often lacking in Europe. Information on BCG status and eligibility should be collected routinely through TB case notification. The incidence of severe adverse effects of BCG in children should be monitored. Given lack of evidence to its efficacy, revaccination should be discontinued.

Current situation and regional perspective on HIV/AIDS surveillance in europe.

&NA; AIDS reporting has been the principal means of monitoring the HIV/AIDS situation in Europe since 1989. HIV reporting was set up at the European level in 1999, although it has existed in most European countries since the 1980s. Anonymous individual data on AIDS and, if available, new HIV diagnoses, and data on HIV prevalence in various populations are reported from the 51 countries of the WHO European Region to EuroHIV. Aggregate data on HIV prevalence in various populations. Data are presented after grouping the 51 countries into three geographic areas: the West, Center, and East. At end of 2000, in the West, AIDS incidence continued to decline except among those infected heterosexually; numbers of newly diagnosed HIV infections are relatively stable, but rising among heterosexually infected persons, many of whom originate from countries with generalized HIV epidemics. In the East, numbers of newly diagnosed HIV cases (mostly injection drug users) continue to rise steeply, particularly in the Russian Federation, Latvia, and Estonia. In the Center, levels of HIV and AIDS remain low. HIV reporting is becoming a central element of HIV/AIDS surveillance in Europe. Heterogeneity between countries in health care systems, HIV testing patterns and surveillance systems remain challenging for data standardization at the European level. Efforts should be made to use surveillance data for evaluating the effectiveness of HIV/AIDS prevention interventions.

Surveillance of anti-tuberculosis drug resistance in Europe, 1999

With the exception of Israel, representative data from Western and Central Europe indicate consistently low levels of resistance to isoniazid (0-9,3%) or rifampicin (0-2,1%) and of multidrug resistance (0-2,1%) among new tuberculosis (TB) cases. Resistance is more frequent among previously treated cases, but comparisons of data should be done cautiously, as criteria for inclusion in TB notifications may vary across countries. In Western Europe, drug resistance is more frequent among cases of foreign origin, a group with high TB incidence. In 1999, cases of foreign origin accounted for over 90% of the MDR cases in the West, and for all MDR cases notified in Israel. The majority of foreign born cases notified originated from Africa or Asia. In the East, representative data from the Baltic States show that overall, 15% of TB cases notified in 1999 were MDR, among the highest proportion worldwide and indicating inadequacies in previous treatment programmes. In the other countries of the former Soviet Union, non-representative data show high levels of resistance which, along with data from the Baltic states and results of surveys, are very alarming.