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Tuesday, June 19, 2012

Communicable disease threats report, 10-16 June 2012, week 24

Annual epidemiological report 2011 - Reporting on 2009 surveillance data and 2010 epidemic intelligence data

Annual epidemiological report 2011
This edition of the Annual Epidemiological Report presents the surveillance data reported to ECDC for 2009 and an analysis of the public health threats detected in 2010 through ECDC’s routine epidemic intelligence.
It provides an overview of communicable diseases in the European Union and describes areas where a more concerted public health response is required in order to decrease the burden of disease on society and healthcare systems.

Tuberculosis surveillance and monitoring in Europe 2012

Monitoring the Emergence of Antiretroviral Resistance

The World Health Organization (WHO) has played a leading role in developing
strategies for the surveillance and containment of antimicrobial resistance in bacterial
and parasitic diseases. The goal has been to optimize patient care and to minimize the
emergence and spread of antimicrobial drug resistance. Just as for bacterial and parasitic diseases, a global resistance monitoring programme is also needed for HIV/AIDS. In the developed world the remarkable reduction of HIVrelated morbidity and mortality produced by potent antiretroviral therapy has been
accompanied by an increase in the prevalence of drug-resistant viruses unresponsive to
available therapies. In the developing world, as access to antiretroviral agents increases,
drug resistance may be enhanced by inappropriate treatment and lack of adherence to
treatment regimens. The need to develop a global antiretroviral resistance monitoring programme was
addressed at the consultation organized by WHO in collaboration with the International
AIDS Society (IAS) and the Istituto Superiore di Sanità (ISS) and held in Rome,
October 2000. It was proposed that WHO, in collaboration with IAS, develop a detailed plan of action
involving partnerships with existing antiretroviral (ARV) resistance monitoring centres
and networks. The plan will be based on the following priorities agreed upon by the
participants at the consultation: 

• to identify sites that are currently involved in HIV-1 drug resistance monitoring
activities and to catalogue these activities
• to develop uniform criteria for the collection and reporting of HIV-1 drug resistance
• to develop and maintain a surveillance system that determines HIV-1 drug resistance
• previously untreated patients
• targeted ARV-experienced populations (e.g. those who have a history of ARV
therapy; those who are receiving active therapy; or those who have received
therapy through perinatal transmission prevention programmes)
• to monitor simultaneously the subtype of circulating HIV-1 strains by using protease
and/or reverse transcripts sequences
• to determine trends in the prevalence of drug resistance in different geographical
areas in relation to the introduction of ARV therapy
• to establish linkages between surveillance sites and quality controlled laboratories
and to promote technology transfer of drug resistance testing methodologies to sites
in the developing world
• to promote education about strategies that reduce the selection of antiretroviral

Implementing Antimicrobial Drug Resistance Surveillance and Containment for HIV, Tuberculosis and Malaria (923K) (2003)

Antimicrobial Resistance Surveillance Questionnaire for Assessment of National Networks DEPARTMENT OF

Comprehensive quality systems are essential in order to ensure the validity of results from
microbiological investigations and epidemiological analyses in antimicrobial resistance
(AMR) surveillance. To be effective such systems should:
be focused on the organisms of greatest public health importance (i.e. with high mortality
and/or morbidity, and where therapeutic options may be severely limited by antimicrobial
include organisms that are readily transmissible (i.e. may give rise to outbreaks and epidemics);
provide information for action at the local, intermediate and national levels.
The laboratories involved must be suitably staffed and equipped in order to produce
meaningful antimicrobial resistance data. The work must be organized in a way that will
detect unacceptable levels of random and systematic errors and initiate remedial actions. The
primary clinical objective of antimicrobial susceptibility testing is to guide the clinician in
the treatment of individual patients. This requires the transmission of valid information to the
decision-maker in a timely manner with appropriate interpretation for the non-expert. For
antimicrobial resistance surveillance networks it is equally important to realize that data
generated for clinical purposes will need to be adapted for epidemiological use. This includes
a precise definition of the population from which the samples are collected. It is also
desirable to include mechanisms to avoid duplicates and to be able to sort isolates according
to specific properties such as specimen type, gender, age, hospital versus community
acquisition of infection, etc. No surveillance programme can fulfil all the suggested criteria,
but a description of the programme needs to address these issues.
The present questionnaire is only one component of a strategy for quality assessment. The
aim is to provide a means for laboratory networks currently active in antimicrobial resistance
surveillance to assess the status of the individual laboratories in the network (Component I)
with respect to basic laboratory capacity and infrastructure (Part 1), the ability to isolate and
identify bacterial isolates (Part 2), and the performance of antimicrobial susceptibility testing
(Part 3). Component II is a tool for evaluation of the network coordinating centre and the
overall functioning of the surveillance network. A comprehensive description of quality
systems specifically tailored for AMR surveillance is presently being prepared by WHO.

Surveillance standards for antimicrobial resistance

The continuing emergence of pathogenic microorganisms that are resistant to first-line antimicrobials is a cause of increasing concern. This emergence is associated with higher levels of mortality
and morbidity which not only impacts on patients but also increases the burden on health care
services as a result of additional diagnostic testing, prolonged hospital stay and increased intensity and
duration of treatment. Although the mechanisms by which organisms acquire resistance are often well understood, including the selective pressures arising from exposure to antimicrobials, the precise role of drug usage in selection of drug resistance has yet to be fully elucidated. Nonetheless, there is evidence to suggest
that more prudent usage of antimicrobials particularly in the treatment of human disease, but also in
veterinary practice, animal husbandry and agriculture, could make a significant impact on the pace
and extent to which resistance emerges in microorganisms pathogenic to man.To be effective, the control and prevention of infection due to resistant microorganisms must be an integral part of the prevention and management of communicable diseases in general. Thus, describing the distribution of infection due to resistant organisms within populations, together with changes in patterns of those infections over time,
provides the basic information for action both to control disease caused by resistant microorganisms
and to contain the emergence of resistance. Used in conjunction with disease prevention and infection
control procedures and data on antibiotic usage, strategies can be developed to protect the public
health now and in the future.

WHO Global Strategy for Containment of Antimicrobial Resistance

In the late 1990s and 2000, WHO convened a series of consultative groups, expert workshops, and consensus meetings to assess the growing public health threat of antimicrobial resistance, to evaluate the impact of containment interventions, and to develop a series of recommendations for action. The culmination of this work was the publication in 2001 of the WHO Global Strategy for Containment of Antimicrobial Resistance and a series of supportive background materials and technical guidelines.

Tuesday, June 5, 2012

Self-report in Youth Health Monitoring: evidence from the Rotterdam Youth Monitor Looij-Jansen, P.M. van de 2010-04-01 Doctoral Thesis

Under Dutch law, preventive youth healthcare organisations have a duty to ensure the early identification of children with health or developmental problems. Similarly, municipalities have a duty to monitor young people’s health at least every four years. For problem identification and monitoring, both individual and collective, these organisations often use self-report questionnaires. The overall aim of this thesis is to study various methodological and validity issues related to the use of self-report questionnaires among young people in a preventive youth healthcare setting. Seven specific research questions are derived from the Rotterdam Youth Monitor (RYM), a longitudinal youth health surveillance system integrated into preventive youth healthcare in the greater Rotterdam area.

Three-Dimensional Vestibulo-Ocular Reflex in Humans: a Matter of Balance Goumans, J. 2010-04-14 Doctoral Thesis

The objective of this thesis was to quantify three-dimensional ocular stability in response to head movements in healthy human subjects and in patients with various types of peripheral vestibular disorders. Despite a large increase in our knowledge from animal and human studies about the neuronal circuitry that regulates three-dimensional (3D) vestibular organization (for a recent review see Angelaki and Cullen 2008), its application to clinical practice is still a long way ahead. In order to bridge this gap, we explored in healthy subjects the naturally occurring variability in 3D vestibulo-ocular stabilization and compared these results with changes that occur in 3D vestibulo-ocular stabilization in patients with various types of unilateral vestibular disorders.