2006 News Archive

World AIDS Day, December 1st 2006

World AIDS day is commemorated around the globe on December 1st. The theme of World AIDS day 2006 is Accountability and the World AIDS campaign for 2005-2010  is “Stop AIDS. Keep the Promise”. Further information on the World AIDS campaign and World AIDS Day 2006 can be found at http://www.worldaidscampaign.info/

Twenty  five years after the first reported case of AIDS, the global AIDS epidemic continues to grow. According to the latest figures published by  UNAIDS and the WHO in their 2006 AIDS Epidemic Update, an estimated 4.3 million people were newly infected in 2006 and there are now 39.5 million people living with HIV worldwide. In 2006, 2.9 million people died of AIDS-related illnesses.  While Africa remains the global epicentre, no country is unaffected by the AIDS pandemic.  Further information on the global HIV and AIDS pandemic can be found on the UNAIDS website www.unaids.org.

Reports on HIV and AIDS in Ireland can be accessed on the HPSC website at
http://www.hpsc.ie/hpsc/A-Z/HepatitisHIVAIDSandSTIs/HIVandAIDS/ . The latest report relates to Quarter 1&2 2006.

Additional Evidence for the Safety of MMR and DTP Vaccines

In a large case-control study, researchers found no increase in risk for encephalitis or encephalopathy from MMR or DTP vaccination.

The results of this study are published in the September edition of the Journal of Pediatric Infectious Diseases (Ray P et al. Encephalopathy after whole-cell pertussis or measles vaccination: Lack of evidence for a causal association in a retrospective case-control study. Pediatr Infect Dis J 2006 Sep; 25:768-73.). These results lend further evidence to support the safety of these vaccines.

Summary
Whole-cell pertussis (wP) and measles vaccines are effective in preventing whooping cough and measles respectively. However, in the past there have been concerns expressed about a suspected increase in the risk of encephalopathy or encephalitis following vaccination with these vaccines. In many countries this led to a decline in these vaccination rates and subsequent outbreaks of the pertussis or measles were reported. Many developed countries switched to using an acellular pertussis vaccine (aP) which is less reactogenic and was perceived to be safer. DTP is still widely used in developing areas.

Previous studies have sought to assess whether there was an association between these vaccines and the development of encephalopathies. Many studies produced indeterminate results or failed to prove an association. Some experts who evaluated the data felt that because these neurologic outcomes are rare, the studies lacked sufficient statistical power to identify associated risk. This new study has addressed this issue by looking at a paediatric population of more than 2 million children, giving it sufficient statistical power. The results of this research conclude that there was no increased risk of encephalopathy among recipients of whole-cell pertussis or measles vaccines.

How the study was done
The researchers carried out a retrospective case-control study among children registered with four medical insurance companies in the western part of the United States. The researchers looked at hospital records of children aged 0-6 years for a 15-year period (from January 1, 1981, through December 31, 1995). They identified all children between 0-6 years of age who had been hospitalised with encephalopathy or related conditions during this time. The cause of the encephalopathy was categorised as known, unknown or suspected but unconfirmed. Up to 3 controls were matched to each case. Conditional logistic regression (specialised statistical analysis method) was used to analyse the relative risk of encephalopathy after vaccination with DTP or MMR vaccines in the 90 days before disease onset as defined by chart review compared with an equivalent period among controls.

Results
Among a population of more than 2 million children, the researchers identified 452 cases of encephalopathy. Cases were no more likely than controls to have received either vaccine < 90 days before disease onset. No distinct pattern of symptoms was seen in the children who developed encephalitis/encephalopathy < 14 days after DTP vaccination, or < 30 days after MMR vaccination.

Conclusions
In this study of more than 2 million children, DTP and MMR vaccines were not associated with an increased risk of encephalopathy after vaccination. This study provides strong evidence for the safety of MMR and DTP vaccines.

Case of Foodborne Botulism in Ireland

HPSC has been made aware of a case of botulism in a non-national individual resident in Ireland. The case has been fully investigated and there are no implications as regards food on sale in Ireland.

Foodborne Botulism
Cases of foodborne botulism are very rare in Ireland. This is the first case reported to HPSC since botulism was made a notifiable disease in 2004.

Botulism is a neurological condition produced by ingestion of a toxin produced by a bacterium Clostridium botulinum.  Illness usually occurs when the bacteria have reproduced in an environment outside the body and produced toxin - this environment is usually a foodstuff. The individual then consumes the toxin itself when they eat the food, and this makes them ill with weakness and paralysis. Clostridium botulinum is an "anaerobic bacterium" which means it can only grow in the absence of oxygen, so botulism in adults tends to occur when the spores have somehow got into an airtight environment such as tins or jars, particularly home-preserved foods which have been preserved in oil. The toxin is destroyed by normal cooking processes.

More information on botulism is available at http://www.hpsc.ie/hpsc/A-Z/Gastroenteric/Botulism/Factsheet/

Outbreak of Legionnaires’ Disease in Venice

Outbreak of Legionnaires’ Disease in Paris

EWGLINET (The European Working Group for Legionella Infection) has alerted the Health Protection Surveillance Centre (HPSC) of an outbreak of legionnaires’ disease in Paris.

 As of September 8th 2006, 15 cases of community-acquired legionnaires’ disease have been confirmed. One patient has died. The date of onset of symptoms ranges from 28th July to 31st August 2006. These cases have all occurred in two southern districts of Paris (near Austerlitz and Lyon railway stations).

Environmental investigations are currently in progress to identify the potential source of the outbreak. At present, two cooling towers are suspected.

Legionnaires’ Disease
Legionnaires’ disease is a type of pneumonia caused by Legionella bacteria. The early symptoms include a 'flu-like illness with muscle aches, tiredness, headaches, dry cough and fever. Some people develop diarrhoea or may become confused. Deaths occur in 10-15% of otherwise healthy individuals and may be higher in some groups of patients. The incubation period ranges from 2 to 10 days but is usually 5 to 6 days. In rare cases people may develop symptoms as late as three weeks after exposure.

It is advisable that any persons who visited Paris from 18th July 2006 onwards who develop symptoms similar to those outlined above would seek medical advice and visit their GP. In particular they should inform him/her that they have visited Paris and that an outbreak of legionnaires’ disease has occurred there.

Clinicians should consider the possibility of legionnaires' disease in all patients with a diagnosis of community-acquired pneumonia and in those developing symptoms as outlined above within 14 days of returning from an area where legionnaires’ disease has been reported.

More information on legionellosis is available at http://www.hpsc.ie/hpsc/A-Z/Respiratory/Legionellosis/

Polio cases in Nigeria double

As of 30th August, the Global Polio Eradication Initiative reports 746 polio cases have occurred in Nigeria in 2006, compared to 349 cases for the same period in 2005. Most polio cases in the world are occurring in Nigeria. WHO estimates that in the five northern states of Nigeria (Bauchi, Jigawa, Kaduna, Kano and Katsina) which have the highest rates of polio, 40% of children are non-immune.

Nigeria, India, Pakistan and Afghanistan are the only four countries in the world which are still polio-endemic. This is an all-time low.  In addition to the endemic countries, nine countries have reported polio cases in 2006 due to importations - Somalia, Yemen, Indonesia, Bangladesh, Ethiopia, Namibia, Niger, Nepal and DR Congo.

According to the Global Polio Eradication Initiative the five remaining challenges to a polio-free world are:

- Curbing the intense transmission in the high-priority states in Northern Nigeria and western Uttar Pradesh, India
- Sustaining campaigns to break the final polio chains in the other two endemic countries
- Rapidly stopping polio outbreaks in previously polio-free countries
- Addressing the low routine immunisation rates and surveillance gaps in polio-free areas
- Maintaining funding and political committment.

For more information on the Global Polio Eradication Initiative click here.

Q Fever Outbreak Investigated in Scotland

Local public health authorities in Scotland are investigating an outbreak of Q fever in workers in a meat processing plant. The investigation was launched after almost a quarter of the plant’s staff fell ill mostly with two or more of the following symptoms: fever, headache, muscle pain, dry cough and joint pain. As of 4th August 2006, 51 cases had been identified and nine patients were admitted to hospital.

As Q fever can be contracted by airborne spread, enhanced surveillance was undertaken to identify cases in the community living in the vicinity of the meat processing plant. So far no cases have been identified in individuals who do not work at the plant.

Q fever is an uncommon zoonotic infection caused by an organism called Coxiella burnetii. The organism is most commonly found in infected farm animals, especially sheep, cattle and goats, it may also be found in cats and wild animal species such as birds, rodents or bats; in some countries it is also carried by ticks. Transmission of C. burnetii to humans occurs primarily through inhalation of aerosols or dust contaminated with faeces or urine, or from direct contact with infected animals or their products of conception, or at slaughter. It may also be acquired from drinking unpasteurised milk. It is extremely rare for the infection to be passed from person to person and does not typically occur. The infective dose can be as low as one organism, and so large outbreaks can be caused by a small source. C. burnetii can survive for many years as a spore-like form before being inhaled and causing infection.

The human form of Q fever is divided into acute and chronic Q fever. Usually the symptoms of Q fever occur two or three weeks after exposure and illness is typically self limiting and influenza-like. Symptoms include:

·        Fever (high temperature)

·        Headache

·        Muscle pains

·        Fatigue (tiredness)

·        Dry cough

·        Pneumonia

Q fever is diagnosed by a blood test but a positive result is obtained two to four weeks after onset of the illness.

Full recovery usually occurs, even without treatment, but in some cases symptoms can be serious or prolonged, especially with pneumonia or pre-existing heart disease, and may require hospital admission. Acute Q fever is treatable with antibiotics. The chronic Q fever form, particularly endocarditis (inflammation of the inner lining of the heart), is a more serious complication which occurs in about 10% of cases and may not appear until several years later.

Outbreaks are frequently reported worldwide, but sources of infection in sporadic cases are often difficult to pinpoint. There were 10 cases of Q fever reported in Ireland in 2005.

For more detailed information on this outbreak go to:

Eurosurveillance, Volume 11, Issue 8

HPS Weekly Report, Volume 40, Issue 2006/29

For further information on Q Fever go to:

CDC, US: Q Fever

HPA, UK: Q Fever

HPSC is monitoring the situation regarding Avian Influenza

On the 7th August 2006, the Ministry of Public Health in Thailand confirmed the country's 24th case of human infection with the H5N1 avian influenza virus. The case, which was fatal, occurred in a 27-year-old man from the central province of Uthai Thani. He developed symptoms on the 24th July, was hospitalised on the 30th July, and died on the 3rd August. Investigation of his source of infection revealed contact with household chickens, which began dying around one week prior to symptom onset. This is Thailand's second case of H5N1 infection, and second fatality, within the past two weeks. Confirmation of these cases follows an 8-month period in which no human cases were reported in the country. Recent outbreaks in poultry have been officially reported in two provinces, Phichit and Nakhon Phanom, both located in the northern part of the country.

H5N1 avian influenza remains predominantly a disease of birds. A small number of human cases have been reported in South East Asia, Africa and Eastern Europe, all of which have been associated with close contact with dead or dying poultry. In all human cases to date there has been no evidence of efficient human-to-human transmission. Human infections remain a rare event.

The advice from the Department of Agriculture and Food in Ireland is not to handle dead wild birds unless necessary. For further information please consult the Department of Agriculture and Food website. For queries relating to dead birds please contact the Department of Agriculture and Food on the Avian Influenza Hotline: 1890 252 283.

At present, recommendations on travel, personal protection and food safety remain unchanged.  Current travel advice is available here. The WHO level of pandemic alert remains unchanged at phase 3. This is defined as a virus new to humans that is causing infections, but does not spread easily from one person to another. The latest updates from the WHO are available on the WHO website.

Further information on avian influenza is also available on the HPSC website.

Lassa Fever Imported into Germany

A 68 year old man who recently travelled from Sierra Leone to Germany via Belgium has been diagnosed with Lassa fever.

The patient had a history of progressive neurological deterioration over several months in Sierra Leone. On 5th July, the patient’s neurological symptoms worsened and he developed a high fever. On 10th July, the patient travelled by air from Freetown (Sierra Leone) via Abijian (Ivory Coast) to Brussels, Belgium. In Brussels, the patient changed planes for a connecting flight to Frankfurt, where he arrived on 11th July.

On arrival in Frankfurt, the patient was taken to the university hospital in Münster where his condition worsened. The patient was intubated and treated in isolation and on 20th July additional tests for tropical infectious disease showed positive for Lassa virus.

While the risk to co-passengers on the patient’s flights is judged to be low, passengers on the following flights are being traced and contacted to inform them about the risk.

• SN Brussels Airlines flight SN 207 on 10 July from Brussels (Belgium) via Freetown (Sierra Leone) to Abidjan (Cote d'Ivoire) in seat rows 23 to 29
• SN Brussels Airlines flight SN 207 on 10 July from Freetown (Sierra Leone) via Abidjan (Cote d'Ivoire) to Brussels (Belgium) in seat rows 23 to 29
• SN Brussels Airlines flight SN 2607 on 11 July, which departed Brussels (Belgium) to Frankfurt (Germany) at 0630, all seats

The patient has been transferred to a special treatment centre in Frankfurt. Flight crew members as well as aeroplane cleaning personnel are being contacted by public health authorities.

Lassa Fever
Since 1970, at least 16 cases of Lassa fever have been imported into Europe or North America; in none of these has onward transmission to another person been reported. The last reported imported case into Europe was in 2003 in a soldier from the United Kingdom who had been serving in Sierra Leone.

The World Health Organization has produced a Lassa fever fact sheet which can be found here: http://www.who.int/mediacentre/factsheets/fs179/en/

Information on the management of Lassa fever is available at:
http://www.ndsc.ie/hpsc/A-Z/Vectorborne/ViralHaemorrhagicFever/Guidance/

Further information on this case is available at: http://www.eurosurveillance.org/ew/2006/060720.asp#e

Outbreak of Legionnaires’ Disease in Amsterdam

EWGLINET (The European Working Group for Legionella Infection) has alerted the Health Protection Surveillance Centre (HPSC) of an outbreak of Legionnaires’ disease in Amsterdam.

As of July 14th 2006, 24 cases of legionnaires’ disease have been confirmed and one patient has died.  The date of onset of symptoms ranges from 27th June to 9th July 2006.

All the cases either live or work in Amsterdam city centre and active case finding is underway. No cases have been reported so far from other countries. The most likely source of the outbreak is believed to be a cooling tower located in the central-eastern part of the city.

Legionnaires’ Disease
Legionnaires’ disease is a type of pneumonia caused by legionella bacteria.  The early symptoms include a 'flu-like' illness with muscle aches, tiredness, headaches, dry cough and fever. Some people develop diarrhoea or may become confused. Deaths occur in 10-15% of otherwise healthy individuals and may be higher in some groups of patients. The incubation period ranges from 2 to 10 days but is usually 5 to 6 days. In rare cases some people may develop symptoms as late as three weeks after exposure.

It is advisable that any persons who visited Amsterdam from 8th June 2006 onwards who develop symptoms similar to those outlined above would seek medical advice and visit their GP.  In particular they should inform him/her that they have visited Amsterdam and that an outbreak of legionnaires’ disease has occurred there.

Clinicians should consider the possibility of legionnaires' disease in all patients with a diagnosis of community-acquired pneumonia and in those developing symptoms as outlined above within 14 days of returning from an area where legionnaires’ disease has been reported.

Further information on the outbreak (in Dutch) is available at http://www.rivm.nl/

More information on Legionellosis is available at http://www.ndsc.ie/hpsc/A-Z/Respiratory/Legionellosis/

Crimean-Congo Haemorrhagic Fever (CCHF) activity in Turkey

Turkey is currently experiencing an increase in Crimean-Congo Haemorrhagic Fever (CCHF) activity. Between 1st January and 30th June 2006, 323 individuals were investigated for CCHF. Of these, 150 cases were laboratory confirmed and included 11 fatal cases. The number of cases and fatalities observed in 2006 to date is suggestive of increased disease activity.

Most of the persons investigated for CCHF were infected through tick bites. Public awareness campaigns in Turkey are ongoing, stressing the adoption of personal protective measures to avoid tick bites, and targeting the rural population through television, radio, posters and leaflets.

WHO and the Turkish Ministry of Health are working together closely to monitor CCHF disease activity in Turkey.

WHO media report of increased CCHF activity in Turkey: http://www.euro.who.int/surveillance/outbreaks/20060706_2

For general information on Crimean-Congo Haemorrhagic Fever go to: http://www.who.int/mediacentre/factsheets/fs208/en/

For information on avoidance of insect bites go to http://www.dnsc.ie/hpsc/A-Z/Vectorborne/TravelAdviceforInternationalTravellers/

HPSC is monitoring the situation regarding Avian Influenza

On the 7th of July 2006, the Spanish Ministry of Agriculture announced that the National Reference Laboratory for Avian influenza had confirmed the presence of a highly pathogenic avian influenza virus H5N1 in a sample from a dead wild duck (Great Crested Grebe - Podiceps cristatus) found in a lake in Vitoria in the Basque Country. Samples will be sent to the EU Community Reference Laboratory for avian influenza in Weybridge for further tests.

No other cases in birds have been detected so far in Spain and there are no other suspicious cases among wild flocks. The Spanish Ministry of agriculture is implementing measures in accordance with Commission Decision 2006/115/EC including establishing a 3 km protection zone and a 10 km surveillance zone. In this area there are no commercial farms and all the back yard poultry is being inspected.

Spain is the 14th EU Member State to report a case of highly pathogenic avian influenza H5N1 in wild birds. The other countries are Greece, Italy, Slovenia, Hungary, Austria, Germany, France, Slovakia, Sweden, Poland, Denmark, Czech Republic and the UK. Avian influenza H5N1 was confirmed in poultry in five EU Member States: France, Sweden, Germany, Denmark and Hungary.

H5N1 avian influenza remains predominantly a disease of birds. A small number of human cases have been reported in South East Asia, Africa and Eastern Europe, all of which have been associated with close contact with dead or dying poultry. In all human cases to date there has been no evidence of efficient human-to-human transmission. Human infections remain a rare event.

The advice from the Department of Agriculture and Food in Ireland is not to handle dead wild birds unless necessary. For further information please consult the Department of Agriculture and Food website. For queries relating to dead birds please contact the Department of Agriculture and Food on the Avian Influenza Hotline: 1890 252 283.

At present, recommendations on travel, personal protection and food safety remain unchanged.  Current travel advice is available here . The WHO level of pandemic alert remains unchanged at phase 3. This is defined as a virus new to humans that is causing infections, but does not spread easily from one person to another. The latest updates from the WHO are available on the WHO website.

Further information on avian influenza is also available on the HPSC website.

Measles in Germany

Since January 2006, two large, and apparently unlinked, measles outbreaks have been reported in Germany, one in South Germany, and the other in West Germany.

The outbreak in South Germany occurred in the greater Stuttgart area between January – March 2006. A total of 64 cases were reported.  Most cases occurred among young unvaccinated children, between the ages of 1-9 years (77%).

The other outbreak is in the Northrhine-Westphalia region (West Germany). A total of 1,406 cases have been notified since January, particularly from cities of the Ruhr region and from the Lower Rhine region which borders the Netherlands. Most cases are children less than 9 years of age (40%) or older children/ teenagers aged 10-19 years (42%). An additional 17% of cases were among adults aged 20 years or older. Fifteen percent of cases have been hospitalised as a result of measles infection. This outbreak is on-going. 

German health authorities are investigating and managing the outbreaks. In the affected regions, parents, care persons, doctors, schools and child care facilities have been alerted and reminded of the need for all children to be fully immunised with MMR.

Travellers to Germany

All individuals travelling to Germany from Ireland, and born after 1978, should ensure that they have been vaccinated against measles, preferably with 2 doses of measles containing vaccine such as MMR. Any individuals who develop rash illness following travel to Germany should seek medical attention. 

Outbreak of Legionnaires' Disease in Pamplona, Spain

The Health Protection Surveillance Centre (HPSC) has been alerted by EWGLINET (The European Working Group for Legionella Infection) of an outbreak of Legionnaires’ disease in the Spanish City of Pamplona, notified by the Health Authorities in Navarre.  Pamplona is located in Northern Spain in the western part of the Pyrenees.

As of June 6th 2006, 122 cases of Legionnaires’ disease have been confirmed and over half of these cases have been hospitalised.  No deaths have been reported to date and no cases have been reported in tourists or other non-Spanish citizens. Those affected range between 21 and 97 years.  Health Authorities in Navarre were first alerted to the outbreak on June 1st. 

Investigation of the outbreak revealed that most early cases were associated with a particular area of the city and legionella bacteria was found in four cooling towers in this area.    These cooling towers were shut down on June 5th thereby removing the risk to the public of exposure to legionella bacteria.

Legionnaires’ Disease
Legionnaires’ Disease is a bacterial disease, which can cause pneumonia. The early symptoms include a 'flu-like' illness with muscle aches, tiredness, headaches, dry cough and fever. Sometimes diarrhoea occurs and confusion may develop. Deaths occur in 10-15% of otherwise healthy individuals and may be higher in some groups of patients. The incubation period ranges from 2 to 10 days but is usually 5 to 6 days. In rare cases some people may develop symptoms as late as three weeks after exposure.

It is advisable that any persons who visited Pamplona from mid May 2006 onwards who develop symptoms similar to those outlined above would seek medical advice and visit their GP.  In particular they should inform him/her that they have visited Pamplona and that an outbreak of Legionnaires’ disease has occurred there.

More information on Legionellosis is available at http://www.ndsc.ie/hpsc/A-Z/Respiratory/Legionellosis/

The HPSC is monitoring the situation regarding Avian Influenza

The WHO has confirmed a family cluster of H5N1 avian influenza cases in the Karo District, of Northern Sumatra, Indonesia. On the 23rd May 2006, the Ministry of Health in Indonesia confirmed the seventh member of an extended family to become infected with the H5N1 virus and the sixth to die. The first member of this family to fall ill died of respiratory disease on the 4th May. No specimens were taken prior to her burial and the cause of her death cannot be determined. However, as her clinical course was compatible with H5N1 infection, epidemiologists at the outbreak site include this woman as the initial case in the cluster. The newly confirmed case, is a brother of the initial case, and was closely involved in caring for his 10-year-old son, who died of H5N1 infection on the 13th May and this contact is considered a possible source of infection.

All confirmed cases in this family cluster can be directly linked to close and prolonged exposure to a patient during a phase of severe illness. Although human-to-human transmission cannot be ruled out, the search for a possible alternative source of exposure is continuing.

Both the Ministry of Health in Indonesia and WHO are concerned about the situation in Northern Sumatra and have intensified investigation and response activities. Priority is now being given to the search for additional cases of influenza-like illness in other family members, close contacts, and the general community. To date, the investigation has found no evidence of spread within the general community and no evidence that efficient human-to-human transmission has occurred.

WHO H5 reference laboratories in Hong Kong and the USA have completed full genetic sequencing of two viruses isolated from cases in this cluster. There is no evidence of genetic reassortment with human or pig influenza viruses and no evidence of significant mutations. The human viruses from this cluster are genetically similar to viruses isolated from poultry in Northern Sumatra during a previous outbreak. For further information, please consult the WHO website.

H5N1 avian influenza remains predominantly a disease of birds. A small number of human cases have been reported in South East Asia, Africa and Eastern Europe, all of which have been associated with close contact with dead or dying poultry. In all human cases to date there has been no evidence of efficient human-to-human transmission. Human infections remain a rare event.

The advice from the Department of Agriculture and Food in Ireland is not to handle dead wild birds unless necessary. For further information please consult the Department of Agriculture and Food website. For queries relating to dead birds please contact the Department of Agriculture and Food on the Avian Influenza Hotline: 1890 252 283.

At present, recommendations on travel, personal protection and food safety remain unchanged.  Current travel advice is available here. The WHO level of pandemic alert remains unchanged at phase 3. This is defined as a virus new to humans that is causing infections, but does not spread easily from one person to another. The latest updates from the WHO are available on the WHO website.

Further information on avian influenza is also available on the HPSC website.

Increase in measles cases in the UK

The Health Protection Agency UK recently reported an increase in measles cases in England and Wales. More than 70 cases were reported in the first three months of 2006. Cases are occurring among infants, children and adults. Nine cases were hospitalized and there was one measles related death in a 13-year-old child with an underlying lung condition who was taking immunosuppressive drugs.

Since 2005 there have been a number of outbreaks of measles among the travelling community across England, with the majority of the cases associated with the travelling community.

Current situation in Ireland
Although the HPSC has not seen an increase in measles cases in Ireland compared to previous years, there is concern. Ireland experienced a large outbreak in 2000, with over 1600 measles cases reported. Three children died as a result of infection acquired during that outbreak. Low levels of MMR vaccination among children meant that large numbers of children were susceptible to infection, and the virus spread rapidly throughout the country.

MMR vaccination uptake in Ireland (Q3 2005)
Most recent figures indicate that on average, only 84% of Irish children at 24 months of age have received one dose of MMR (Immunisation report Q3 2005). A sustained MMR uptake rate of at least 95% is needed to prevent measles outbreaks occurring in the community.

Measles is a highly infectious disease that can cause serious complications, particularly among children less than 5 years of age and adults. The infection is characterized by a general body rash, a fever, and one or more of the following; cough, conjunctivitis, and runny nose.  Measles is a notifiable disease.

MMR to protect against measles
MMR vaccine protects against measles. The vaccine is safe and effective. It is routinely given when children are 12-15 months of age, and a booster is given at 4-5 years of age.

All parents are encouraged to ensure that their children are vaccinated with MMR at the appropriate age to protect against measles infection. MMR vaccine is available from the GP.

For more information on the measles in Ireland please see:
http://www.ndsc.ie/hpsc/A-Z/VaccinePreventable/Measles/Factsheet/

For more information on the measles outbreak in the UK please see: http://www.hpa.org.uk/cdr/archives/2006/cdr1206.pdf

Recent reports on national immunisation uptake statistics are available at: http://www.ndsc.ie/hpsc/A-Z/VaccinePreventable/Vaccination/ImmunisationUptakeStatistics/

World TB Day 2006

World TB Day is held on March 24th each year and provides people around the world with an opportunity to raise awareness about the international health threat presented by tuberculosis (TB). It is a day to recognise the collaborative efforts of all countries involved in fighting TB.  TB can be cured, controlled, and with diligent efforts and sufficient resources, eventually eliminated.

The first World TB Day was sponsored by the World Health Organization (WHO) and the International Union Against Tuberculosis and Lung Disease (IUATLD) in 1982 a century after Dr. Robert Koch discovered the organism, which causes TB.

The theme for World TB Day 2006 - “Actions for Life: Towards a World free of TB” – aims to mobilise support for the fight against TB and to work towards a TB-free world.   By mobilising communities, raising awareness, encouraging governments and donors to invest in TB control and calling for strengthened commitment, countries can ensure that TB is placed prominently on the global agenda and is eliminated by 2050.

In January 2006, the “Stop TB Partnership” released The Global Plan to Stop TB 2006-2015.  The plan outlines what needs to be done to make an impact on the global burden of TB and to achieve the Partnership’s goal of cutting TB deaths and disease by half by 2015. 

In order to accelerate social and political action to stop the unnecessary spread of TB around the world, World TB Day 2006 aims to:

• Promote TB control and care
• Serve as an advocacy and educational opportunity
• Increase public awareness, engagement, and support in the fight against TB
• Engage governments and donor agencies for strengthened commitments
• Place TB higher on the international agenda.

TB remains a leading cause of death worldwide with up to 8 million cases and 2 million deaths reported per year.  In Ireland in 2003 (the latest validated figures) there were 407 cases of TB reported giving a notification rate of 10.4 cases per 100,000 population.  The number of TB cases reported in Ireland has declined in the last decade with 612 cases reported in 1991, a rate of 18.2 per 100,000. The decline has been considerable since the early 1950s when 7,000 cases of TB were notified annually.

However we must remain vigilant regarding TB treatment and control and must strive to reach the targets of the Global Plan to Stop TB.

More information on TB is available at:

HPSC website at http://www.ndsc.ie/A-Z/VaccinePreventable/TuberculosisTB/

The Global Plan to Stop TB 2006-2015 at
http://www.stoptb.org/globalplan/

CDC website for World TB Day, 2006 at http://www.cdc.gov/nchstp/tb/WorldTBDay/2006/default.htm

WHO Factsheet on TB at http://www.who.int/mediacentre/factsheets/fs104/en/index.html

Chikungunya Fever on the Island of Réunion

The island of Réunion, a French Overseas Department in the Indian Ocean is experiencing an extensive outbreak of Chikungunya fever, a viral infection carried by mosquitoes, Aedes aegypti.  Since the outbreak was first recognised in March 2005, French Authorities estimate that 157 000 cases of the illness have occurred.  This represents more than 20% of the entire population of 750 000.  This appears to be part of a larger upsurge in Chikungunya activity in the Indian Ocean area  – there were large outbreaks in the Comoros Islands, the Seychelles and Mauritius at the beginning of 2005.

Chikungunya fever is commonly found in East Africa, Southeast Asia and in the Indian sub-continent.  Illness generally follows 4-7 days after the bite of an infected mosquito and presents with sudden onset of fever with joint and muscle pain (that can at times be very severe) with headache and conjunctivitis.  The joints of the wrists, ankles, hands and feet are most commonly affected.  Rashes on the chest and abdomen are common and in the current outbreak on Réunion almost a quarter of patients had bleeding from the nose or gums.  Fortunately, it tends to be a mild illness and most patients recover fully; in Réunion, fewer than 1 in 20 patients needed to be hospitalised.  There have, however been 77 deaths reported in elderly Chikungunya patients who had other medical conditions.  It is not clear if Chikungunya was the cause of death in these patients and this possibility is currently being investigated.There is currently no vaccine against the virus responsible for causing Chikungunya. Travellers to affected areas are advised to take sensible precautions against mosquito bites (advice on protecting yourself from mosquito can be found on HPSC’s website http://www.ndsc.ie/hpsc/A-Z/Vectorborne/TravelAdviceforInternationalTravellers).  In addition, the particular mosquito responsible for this outbreak had a tendency to appear during daylight hours so precautions should be used throughout daylight hours as well.   

Although the risk of serious disease is low, certain groups are at higher risk, including:

• Pregnant women
• People with weakened immune systems (such as patients living with cancer or HIV/AIDS) and
• People suffering from severe chronic illness (such as heart, lung or kidney disease and diabetes).
  

Until this outbreak is over, such people should postpone all non-essential travel to the affected areas of Réunion, Comoros Islands, the Seychelles and Mauritius. 

Training Fellowships for Intervention Epidemiology

The European Programme for Intervention Epidemiology Training started in 1995.

The programme is funded by the European Centre for Disease Prevention and Control and by various EU member states as well as WHO, Switzerland and Norway. Subject to agreement for another round of funding, the twelfth cohort of fellows is planned, starting in September 2006.

The programme invites applications for up to sixteen fellowships for this 24-month training programme in communicable disease field epidemiology.

Further details may be found here