Eurosurveillance - Volume 14, Issue 34, 27 August 2009

The analysis of the first 10,000 cases of influenza A(H1N1)v in Germany confirms findings from other sources that the virus is currently mainly causing mild diseases, affecting mostly adolescents and young adults. Overall hospitalisation rate for influenza A(H1N1)v was low (7%). Only 3% of the cases had underlying conditions and pneumonia was rare (0.4%). Both reporting and testing requirements have been adapted recently, taking into consideration the additional information available on influenza A(H1N1)v infections.

Following the detection of imported cases of pandemic influenza A(H1N1)v on 25 April 2009, New Zealand implemented containment measures that appeared to slow establishment of the pandemic during May. The pandemic accelerated markedly in June, reaching a peak within four to six weeks, and has been declining since mid-July. By 23 August there had been 3,179 recorded cases (97.8% reported as confirmed), including 972 hospitalisations, 114 intensive care admissions, and 16 deaths. Influenza-like illness (ILI) surveillance in general practice suggests that 7.5% (95% CI: 3.4-11.2) of the population of New Zealand had symptomatic infection, giving a case fatality ratio of 0.005%. Hospitalisations were markedly higher for M?ori (age standardised relative risk (RR)=3.0, 95% CI: 2.9-3.2) and Pacific peoples (RR=6.7, 95% CI: 6.2-7.1) compared with Europeans and others. The apparent decline of the pandemic (shown by all surveillance systems) cannot be fully explained. New Zealand remains in the middle of its traditional influenza season, the influenza A(H1N1)v virus appears relatively infectious, and we estimate that only about 11% of the population have been infected by this novel agent. .

During the month of June 2009, Mauritius experienced a short-lived outbreak of dengue fever localised in its capital city Port Louis. Aedes albopictus, a secondary vector of dengue viruses, was the probable vector. We introduce a method which combines Google Earth images, stochastic cellular automata and scale free network ideas to map this outbreak. The method could complement other techniques to forecast the evolution of potential localised mosquito-borne viral outbreaks in Mauritius and in at-risk locations elsewhere for public health planning purposes.

Patients with recurrent Clostridium difficile infections (CDI) in hospitals and the community constitute an increasing treatment problem. While most patients with a first infection respond to either metronidazole or oral vancomycin, therapy in recurrent C. difficile infections tends to fail repeatedly. Lack of alternative treatment options can be a tremendous burden, both to patients and their treating physicians. Most guidelines recommend prolonged oral vancomycin pulse and or tapering schedules, but evidence-based treatment strategies are lacking. The role of immunoglobulins, whey prepared from vaccinated cows, probiotics or other antibiotics is unclear. Since 1958 several case series and case reports describe a treatment strategy where faecal infusions are successfully given for the treatment of recurrent CDI. Restoring intestinal flora has been historically thought of as the mechanism responsible for cure in these patients. In the literature, more than 150 patients have received faeces from a healthy donor, either infused through an enema, or through a nasoduodenal or nasogastric tube. We summarise the literature regarding treatment with donor faeces for recurrent CDI, and introduce the FECAL trial, currently open for inclusion.

Gonorrhoea is on the rise in Sweden and in many other European countries. The present report describes and evaluates the gonorrhoea trends in Sweden from 2001 to 2008 when an increase of 32% was reported. Up to 86% of the cases were reported in men, with the highest proportion among heterosexually infected men (41-59% during these years). Heterosexually infected men more often acquired gonorrhoea abroad, especially in Thailand, whereas women and men who have sex with men were more likely to acquire the infection within Sweden. The recent increase in gonorrhoea cases in Sweden is most likely due to adoption of more risky sexual behaviour (e.g. an increase in the number of sexual partners and the number of new/casual sexual partners and/or low use of condoms) in the Swedish population. Further research regarding more effective identification and description of sexual transmission chains and sexual networks is needed in order to follow the spread of infection and to recognise more effective interventions to prevent the spread of gonorrhoea and also other sexually transmitted infections.