Helena C. Maltezou

Guillain-Barré syndrome and Fisher syndrome: case definitions and guidelines for collection, analysis, and presentation of immunization safety data.

ames J. Sejvara,∗, Katrin S. Kohla, Jane Gidudua, Anthony Amatob, Nandini Bakshic, Roger Baxterc, ale R. Burwend, David R. Cornblathe, Jan Cleerbout f, Kathryn M. Edwardsg, Ulrich Heiningerh, ichard Hughes i, Najwa Khuri-Bulos j, Rudolf Korinthenbergk, Barbara J. Lawl, Ursula Munrom, elena C. Maltezoun, Patricia Nello,1, James Oleskep, Robert Sparksq, Priscilla Velentgasr, atricia Vermeers, Max Wiznitzer t, The Brighton Collaboration GBS Working Group2

Drug Resistance in Visceral Leishmaniasis

Visceral leishmaniasis remains a public health problem worldwide. This illness was included by the World Health Organization in the list of neglected tropical diseases targeted for elimination by 2015. The widespread emergence of resistance to pentavalent antimonials in India where half cases occur globally and the unavailability of a vaccine in clinical use constitute major obstacles in achieving this goal. The last decade new antileishmanials became available, including the oral agent miltefosine. However, in poor endemic countries their wide use was curtailed because of the high costs, and also due to concerns of toxicity and emergence of resistance. Various mechanisms of antileishmanial resistance were identified recently in field isolates. Their elucidation will boost the design of new drugs and the molecular surveillance of resistance. Combination regimens should be evaluated in large trials. Overall, the development of antileishmanials has been generally slow; new drugs are needed. In order to control visceral leishmaniasis worldwide, treatment advances should become affordable in the poorest countries, where they are needed most.

Crimean-Congo hemorrhagic fever in Europe: current situation calls for preparedness.

During the last decade Crimean-Congo hemorrhagic fever (CCHF) emerged and/or re-emerged in several Balkan countries, Turkey, southwestern regions of the Russian Federation, and the Ukraine, with considerable high fatality rates. Reasons for re-emergence of CCHF include climate and anthropogenic factors such as changes in land use, agricultural practices or hunting activities, movement of livestock that may influence host-tick-virus dynamics. In order to be able to design prevention and control measures targeted at the disease, mapping of endemic areas and risk assessment for CCHF in Europe should be completed. Furthermore, areas at risk for further CCHF expansion should be identified and human, vector and animal surveillance be strengthened.

Leishmaniasis, an emerging infection in travelers

Leishmaniasis is a vector-borne protozoan infection with a wide clinical spectrum, which ranges from asymptomatic infection to fatal visceral leishmaniasis. A review of the recent literature indicates a sharp increase in imported leishmaniasis cases in developed, non-endemic countries over the last decade, in association with increasing international tourism, military operations, and the influx of immigrants from endemic countries. South America is the main area for the acquisition of cutaneous leishmaniasis, and adventure travelers on long-term trips in highly-endemic forested areas are at particular risk. Popular Mediterranean destinations are emerging as the main areas of acquisition of visceral leishmaniasis for European travelers. Leishmaniasis should be considered in patients presenting with a compatible clinical syndrome and a history of travel to an endemic area, even if this occurred several months or years ago. Appropriate counseling should be provided to adventure travelers, military personnel, researchers, and other groups of travelers likely to be exposed to sandflies in endemic areas.

Vaccination policies for health-care workers in acute health-care facilities in Europe

The aim of this study was to evaluate existing policies regarding recommended and mandatory occupational vaccinations for health-care workers (HCWs) in Europe. A standardized questionnaire was sent to experts in Infection Control or Occupational Health in all 27 European Union Member States, as well as Norway, Russia, and Switzerland. All 30 countries have established policies about HCW vaccination against vaccine-preventable diseases. However significant gaps and considerable country-to-country variation were found, in terms of number of recommended vaccines and target subgroups of HCWs and health-care settings. Vaccination against hepatitis B and annual vaccination against seasonal influenza are almost universally recommended for HCWs in Europe (29 countries each, including eight countries where vaccination against hepatitis B is mandatory or required for employment). Policies regarding HCW vaccination also exist against mumps (12 countries), measles or rubella (15 countries), varicella (17 countries), diphtheria-tetanus (14 countries), pertussis (9 countries), poliomyelitis (11 countries), hepatitis A (11 countries), tuberculosis (BCG vaccine) (9 countries), and against meningococcus group C or meningococci groups A, C, W135, Y (tetravalent vaccine) (in 4 countries each). Re-evaluation of occupational vaccine policies for HCWs in Europe on a consensus basis is imperative in order to promote HCW and patient safety.

Crimean–Congo hemorrhagic fever: Risk for emergence of new endemic foci in Europe?

During recent years, new foci of Crimean-Congo hemorrhagic fever (CCHF) have emerged in several Balkan countries, southwest Russia, and Turkey. Starting in 2002, Turkey experiences the largest ever recorded outbreak with more than 2500 cases. Potential reasons for the emergence or re-emergence of CCHF include climate changes which may have a significant impact on the reproduction rate of the vector Hyalomma ticks, as well as anthropogenic factors (e.g. changes in agricultural and hunting activities). Given the abundance of its vector, the numerous animals that can serve as hosts, and the favorable climate and ecologic parameters in other southern Europe Mediterranean countries, CCHF is an example of a vector-borne disease which may be knocking the door in this area. There are models which show probability of CCHF extending to other countries around the Mediterranean basin suggesting that the vector, veterinarian, and human surveillance should be enhanced.

Infection control in the management of highly pathogenic infectious diseases: consensus of the European Network of Infectious Disease

Summary The European Network for Infectious Diseases (EUNID) is a network of clinicians, public health epidemiologists, microbiologists, infection control, and critical-care doctors from the European member states, who are experienced in the management of patients with highly infectious diseases. We aim to develop a consensus recommendation for infection control during clinical management and invasive procedures in such patients. After an extensive literature review, draft recommendations were amended jointly by 27 partners from 15 European countries. Recommendations include repetitive training of staff to ascertain infection control, systematic use of cough and respiratory etiquette at admission to the emergency department, fluid sampling in the isolation room, and analyses in biosafety level 3/4 laboratories, and preference for point-of-care bedside laboratory tests. Children should be cared for by paediatricians and intensive-care patients should be cared for by critical-care doctors in high-level isolation units (HLIU). Invasive procedures should be avoided if unnecessary or done in the HLIU, as should chest radiography, ultrasonography, and renal dialysis. Procedures that require transport of patients out of the HLIU should be done during designated sessions or hours in secure transport. Picture archiving and communication systems should be used. Post-mortem examination should be avoided; biopsy or blood collection is preferred.

Determinants of intention to get vaccinated against novel (pandemic) influenza A H1N1 among health-care workers in a nationwide survey.

A nationwide survey was conducted in October-November 2009 to investigate determinants of intention to get vaccinated against novel (pandemic) influenza A H1N1 among health-care workers (HCWs) in Greece. Out of 12,879 participating HCWs (response rate: 12.1%) working in 152 (40%) of 380 health-care facilities in Greece, 2814 (21.8%) reported that they intend to get vaccinated against novel influenza A N1H1. Intention rates to get vaccinated increased with age, male sex, being a physician, history of vaccination against seasonal influenza, training in use of personal protective equipment and hand hygiene, and training and involvement in the management of novel influenza cases. Main reasons for refusing vaccination were concerns about vaccine safety (43.1%), inadequate information about the vaccine (27.8%), and perception that they were not at risk for contracting novel influenza (10.7%). Given the low rates of acceptance of pandemic vaccination among HCWs, as found in this study, public health bodies should consider the implementation of a mandatory vaccination policy for HCWs for future pandemics, in order to prevent nosocomial transmission and to protect patients at high-risk for influenza-related complications and death, and to assure the continuity of the essential health-care infrastructure. New strategies should be explored to built safety perception towards influenza vaccines and enhance vaccination rates among HCWs.

Vaccination policies for healthcare workers in Europe

Health-care workers (HCWs) are at increased risk for acquisition of vaccine-preventable diseases (VPDs) and vaccination is justified in order to protect them from occupational exposure and to prevent the spread of VPDs that pose a threat to susceptible patients. Review of European vaccination policies for HCWs revealed significant differences between countries in terms of recommended vaccines, implementation frame (mandatory or recommendation), target HCW groups and health-care settings. Further, the few published studies available identified indicate significant immunity gaps among HCWs against VPDs in Europe. In order to achieve higher vaccination coverage against VPDs stronger recommendations are needed. The issue of mandatory vaccination should be considered for diseases that can be transmitted to susceptible patients (influenza, measles, mumps, rubella, hepatitis B, pertussis, varicella). The acceptance of vaccinations and of mandatory vaccinations by HCWs is a challenge and appears to be VPD-specific.

Measles in health-care settings

Despite the availability of an effective and safe vaccine for almost half a century, measles is re-emerging in several developed countries because of the insufficient vaccination coverage among specific subpopulations, the emerging anti-vaccination movement, and the increasing movement of humans across borders. In this context, health-care settings play a critical role in the transmission of infection and generation of numerous cases. Health-care-associated outbreaks may be associated with severe morbidity and mortality among specific groups of patients, disruption of health-care services, and considerable costs. Misdiagnosis or delayed diagnosis of a measles case and inadequate implementation of infection control measures are common in almost all events of nosocomial spread. Measles vaccination of health-care workers is an effective means of prevention of nosocomial measles outbreaks. Eliminating measles by 2010 has not been accomplished. Stronger recommendations and higher vaccination coverage against measles in health-care workers could contribute to eliminate measles in the general population.