Eurosurveillance - Volume 13, Issue 11, 13 March 2008

On 26 February 2008, the National Reference Centre for Rabies at the Institut Pasteur in Paris, France, confirmed the diagnosis of rabies in a domestic dog living in Grandpuits, Seine-et-Marne district, a suburb of Paris. The dog was a nine-month-old mixed-breed female, named Cracotte (pictures available at http://www.invs.sante.fr/display/?doc=surveillance/rage/actu.htm). It developed its first symptoms on 15 February, had bitten its owner and one neighbour and had been euthanized on 19 February. The viral strain was identified by the National Reference Centre for Rabies as a strain belonging to Lyssavirus genotype 1, Africa 1 lineage, originating from Morocco. According to its owner, Cracotte had never been outside France. France has been declared officially rabies-free since 2001. An investigation was undertaken to identify the source of infection and modes of transmission for Cracotte in order to identify potentially exposed individuals and animals and to carry out an assessment of the risk of rabies virus transmission in France.

As highlighted in the above article by a multidisciplinary investigation team from France, there have been previous reports of dogs being illegally introduced to France and subsequently identified with rabies infection. No human cases related to these events have been identified to date. Although exposure to rabies from animals in the European Union (EU) remains a rare event, in the absence of post-exposure prophylaxis before symptoms rabies is invariably a deadly infection in humans. The French authorities have implemented extensive measures, including the tracing of humans and animals possibly in contact with the suspected rabid dogs, and awareness of the event has been relayed to the general public through the media in order to assist in identifying other possible human or animal contacts.

Vibrio parahaemolyticus is a halophilic bacterium capable of causing food- and waterborne gastroenteritis, wound infections, and septicaemia in humans. The wide distribution of V. parahaemolyticus in the marine and estuarine environments is known to depend on the water temperature: it has been suggested that the bacterium might survive in sediments during the winter and be released into the water column in late spring or early summer when the temperature rises to 15°C or higher [1]. .

This paper highlights findings from the first quarterly report on food- and waterborne diseases produced by the European Centre for Disease Prevention and Control (ECDC). In the past such reports had been generated by Enter-net, a Europe-based international surveillance network for the enteric infections. The quarterly reports are an important surveillance tool for the network participants and other public health professionals to use in order to identify emerging trends and changes taking place in a shorter interval than one year.

The Netherlands' Infectious diseases Surveillance Information System (ISIS) was developed 12 years ago as an early warning system for the country. The initial objective was to establish a surveillance system that gathered the test results of all micro-organisms from all medical microbiology laboratories (MMLs) in the Netherlands on a daily basis in order to create an early warning system. This paper analyses the most important results of a recent evaluation of the system. The evaluation was based on an analysis of early warning signals to detect outbreaks, number of visits to the ISIS website, and interviews with stakeholders, documentation on the ISIS system, and analyses of the ISIS MML database. While the daily collection of data on all micro-organisms for early warning has been achieved, the connection of all 85 MMLs in the Netherlands to the central ISIS MML database has not been achieved - only 18 MMLs have been connected. This has resulted in a low coverage and non-representative selection of MMLs for the Netherlands and therefore national outbreaks were missed. Data were used to determine trends in antimicrobial resistance over time. The ISIS system was not found suitable for early warning since outbreaks were detected via other systems. However, with some adaptations the ISIS system could be suitable for the surveillance of antimicrobial resistance. Furthermore, the discontinuation of this network would cause the loss of the most important data system for antimicrobial resistance in the Netherlands, since there is no other national system that gathers data on this topic. This evaluation resulted in a restart of the network. .

The contribution of public health officers is of crucial importance in both the preparedness planning process and the response to health threats since the implementation of public health measures lies within the competence of the public health system. Thus, public health officers on regional and district level have to be involved in every stage of the planning process for crisis management. Federal structures of health systems as equivalent to the political structure of a country pose specific challenges for both the planning process and the response itself. The most important instrument for the evaluation of crisis plans, including the assessment of the public health officers' preparedness, is the performance of exercises. The success of a simulation exercise depends mainly on careful planning process, clear evaluation criteria and a work plan, that allows for necessary improvements of crisis plans of all involved organisations. Simulation exercises are an integrated element of preparedness activities on all administrative levels of the public health system. Depending on the nature of the exercise public health officers on regional and district level are involved as planners or as players. .