Abstracts from the Annual Regional Epidemiologists’ Meeting, Helsinki, May 2012

  Published: 07.12.12 Updated: 07.12.2012 12:15:28

TBE virus in Southern Norway in Relation to Climatic Factors
AK.Andreassen1, S.Jore2, P.Cuber3, T.Tengs2, S.G.Dudman 1, P.Ottesen4, G.Ånestad1 and K.Vainio1
1 Department of Virology, Norwegian Institute of Public Health
2 Norwegian Veterinary Institute
3 Medical University of Silesia in Katowice, Poland
4 Department of Pest Control, Norwegian Institute of Public Health

Citation: Andreassen AK, Jore S, Cuber P et al. TBE virus in Southern Norway in Relation to Climatic Factors. EpiNorth 2012;13:50-1.

Tick-borne encephalitis (TBE) is endemic in many European countries. In Norway, the annual number of reported cases of TBE has increased during the last ten years according to the Norwegian Surveillance System for Communicable Diseases (MSIS). Information about the distribution and prevalence of TBEV in ticks is limited in Norway. The aims of this study were to evaluate the distribution and the prevalence of TBEV along the coast of Southern Norway and climatic factors such as humidity and temperature, and whether these sites corresponded with the Norwegian recommendations for vaccination against TBEV. In addition, we compared the prevalence between the different collection sites.
Ticks were collected at twelve different locations that were chosen according to the registration of human TBE cases in MSIS. In total 7,220 tick nymphs were collected in 2009 and 2011.The ticks were randomly pooled in groups of ten from each sampling site. All positive pools were verified by pyrosequencing. A positive patient sample was used as a positive virus control in each real-time PCR assay.
In the 2009 study, the estimated pooled prevalence (EPP) of TBEV in pools ranged from 0.1-1.2% between the different locations. The EPP of TBEV was in accordance with previous findings in other endemic European countries. TBEV was detected in all locations by real-time PCR. However, the estimated prevalence varied within and between sites. In this study there is an indication of an association between EPP and saturation deficit.
Preliminary data from the 2011 study indicate that there is a major variation in EPP between sites and within sites on a yearly basis. The locations outside the known sites where TBE cases were reported seem to be TBEV negative.
The TBEV-positive sites detected in ticks correlated well with reported TBE cases. These findings indicate that TBEV is endemic in Norway and that it may depend on microclimatic factors.

Development of an Internal Action Plan for the Expert Group on HIV and Associated Infections in Northern Dimension Area
A. Arsalo, O. Karvonen
National Institute for Health and Welfare, Finland

Citation: Arsalo AK, Karvonen O. Development of an Internal Action Plan for the Expert Group on HIV and Associated Infections in Northern Dimension Area. EpiNorth 2012;13:51-3.

The Northern Dimension Partnership in Public Health and Social Well-being (NDHSP) is a multi-national and multi-organizational initiative including 10 countries and several international organizations (such as e.g. WHO, UNAIDS, etc.) as members. The NDHSP secretariat is in Stockholm. The decision-making bodies are the Committee of Senior Representatives of Partners (CSR) that meets twice a year and a ministerial Partnership Annual Conference (PAC). The operational units consist of International Expert Groups, for example the Expert Group on HIV/AIDS & Associated Infections (EG HIV/AIDS & AI). The objectives of the Expert Groups and, hence, of the whole Partnership contribute to the EU Strategy for the Baltic Sea Region.
The members of the EGs are contact points in their own countries and for their ministries. Other EG tasks include provision of support to policy development, advocacy and distribution of information, support and guidance for planning processes and implementation of projects. However, the EGs are not implementing bodies, i.e. they are not responsible for the practical implementation of projects.
Regarding the EG HIV/AIDS & AI, the current situation calls urgently for multinational and comprehensive actions. Several problems in this field are strongly inter-related and complicated. For example, the spread of HIV, tuberculosis and other infections, drug resistance, social problems, intravenous drugs use (IDU), defects in the service systems, marginalization etc. form a complex entity that is a huge challenge to Partnership and all of Europe.
Currently, the prevalence of HIV among IDUs is continuously increasing, HIV/tuberculosis co- infections are becoming more and more common, drug resistance (MDR and XDR) is rapidly increasing, and current attitudes in Russia do not always favour testing etc. The treatment of MDR tuberculosis is expensive and XDR treatment is extremely expensive. These are only a few of the reasons that require the situation to be taken very seriously. Rapid determined and comprehensive actions are needed.
In addition to the fact that the partners expect added value from the NDPHS, we are also facing serious funding problems. There are fewer opportunities to secure necessary funds needed to address and respond to the current challenges. The EG HIV/AIDS & AI has therefore concluded that we were obliged to rethink the situation from the operational point of view of the functions of the EG.
The planning process of the Barents HIV Programme in 2004 was based on a Modified Logical Framework Approach (MLFA) and the experiences were considered very positive. Therefore, the EG HIV/AIDS & AI decided in the spring 2011 to implement a similar type of internal planning process as was used for the Barents HIV Programme. The objective is the development of an internal strategic and action plan for the EG.
The MLFA consists of several steps: 1) identification and analysis of problems and needs, including the development of the first versions for Problem and Objective Trees, 2) identification of Working Areas and Objectives, 3) definition of activities for concrete projects, 4) definition of priorities and 5) development of a consistent action plan. In all of these phases, different stakeholders and a wide range of experts also outside the EG should be consulted. Eventually, it is intended that in addition to project development, the information and results produced will be used for advocacy and policy recommendations.
The EG HIV/AIDS & AI materialized the planning through an extensive process, including meetings, discussions and consultations, both unofficial brain-storming and as part of official group meetings. The HIV and TB problems within partner countries were discussed from a comprehensive perspective. After the first versions of Problem and Objective Trees, comments, corrections and complementary information was obtained from various stakeholders. New “Tree” versions were developed after meetings and consultations.
Main problem areas were identified and formulated: 1) Existing policies and practices do not fully support the prevention of HIV and AIs, 2) Unsatisfactory monitoring and provision of epidemiological information in the Northern Dimension Area, 3) Continuous spread of HIV, TB and associated infections, 4) Deteriorating infectious disease situation of risk groups, migrants and other minorities, 5) Complexity of the HIV/AIDS-TB situation is not properly addressed by traditional approaches and 6) Insufficient capacity of the health care systems to respond to the burden of HIV, TB and AIs.
Subsequently, based on the identified problem areas, the strategic working areas for the EG HIV/AIDS & AI are: 1) Provision of support to policy development and cooperation, 2) Improved monitoring and data on the epidemiological situation in the Northern Dimension Area, 3) Effective prevention HIV, TB and associated infections, 4) Improved tuberculosis control among risk groups, migrants and other minorities, 5) Complexity of the HIV and TB situation recognized and new approaches developed and 6) Improved capacity of the health care systems in response to the burden of HIV, TB and AIs. In addition, the group has to include a management component in the strategy describing the priorities and plans for the implementation of the Strategy.

Epidemiological Surveillance and Sanitary and Epidemiological Safety of Mass Gathering Events
E. Babura
Directorate of the Federal Service for Surveillance on Consumer Rights Protection and Human Well-Being in Kaliningrad Oblast (Rospotrebnadzor in Kaliningrad Oblast), Kaliningrad, Russia

Citation: Babura E. Epidemiological Surveillance and Sanitary and Epidemiological Safety of Mass Gathering Events. EpiNorth 2012;13:54-5.

Due to the specific geographic location, Kaliningrad oblast is always the first to face the majority of epidemiological risks associated with new (emerging) and old (re-emerging) infections.
Currently, the most significant epidemiological risks associated with mass gathering events are due to activation of infection transmission mechanisms, primarily with fecal-oral and transmission through aspiration, an increased workload on community life-support systems and public catering network, an increased volume of consumed food, a high density of people in a limited territory and active mobility of the population, with a constant danger of infection import by participants and guests of such events.
The primary goal of epidemiological surveillance during mass gathering events is protection from all kinds of epidemiological risks by the implementation of a range of preventive and protective measures including the control of sanitary condition of the site and control of catering arrangements during the event.
In order to provide sanitary and epidemiological safety of mass gathering events and to prevent the risk of infections, a system of collaboration between federal, regional and municipal authorities has been established. In addition, preliminary notification about the intention to hold such an event is required.
For example, in the run-up to the New Year holidays and vacations, a set of preventive measures are taken in order to provide sanitary and epidemiological safety. Considerable attention is paid to providing proper equipment in places where mass gatherings are going to be held. Groups of adults and children participating in the events must be transported in accordance with sanitary rules for transportation. The catering areas and sales points are also subject to inspection. The New Year gifts are packed and sold under proper sanitary control. Hygienic training for the staff involved in the events is provided. The immunization status of participants is also taken into consideration.
Specific protection measures include routine immunization of the population. Additional immunization recommended to people who are going to a country where international mass gathering events are scheduled with regard to the anticipated seasonal epidemiological conditions during the events and relevant epidemiological risks.
The proper training of organizers of mass gathering events and the personnel involved is also of great importance. Proper instruction and sometimes “outreach training” is organized for professionals and managers of the event. The organizers are given briefs on relevant issues of infection prophylaxis and information letters with comments on the sanitary legislation.
The measures taken by the epidemiological service help to provide sanitary and epidemiological safety of mass gathering events and thus prevent the outbreaks of infectious diseases.

Influence of Drug Addiction on the Incidence of Parenteral Infections in St. Petersburg
I.A. Rakitin, N.S. Bashketova, I.G. Chkhindzeriya, G.I. Markovich
Directorate of the Federal Service for Surveillance on Consumer Rights Protection and Human Well-Being in St. Petersburg (Rospotrebnadzor in St. Petersburg), Russia

Citation: Rakitin IA, Bashketova NS, Chkhindzeriya IG et al. Influence of Drug Addiction on the Incidence of Parenteral Infections in St. Petersburg. EpiNorth 2012;13:55-6.

St. Petersburg has faced an increasing incidence of HIV infection as well as acute and chronic viral hepatitis В and С since 2000. The main factor responsible for the increasing incidence of parenteral infections in St. Petersburg during the late 1990s to early 2000s was the rapid increase of drug abuse. The incidence dynamics of parenteral infections is similar to the dynamics of drug addiction, especially in the years when drug addiction increased. Since 2000, the incidence of hepatitis B and C as well as HIV infection in St. Petersburg has been significantly higher than the average incidence of these infections in the Russian Federation.
Currently, St. Petersburg is one of the cities with the highest incidence of HIV. It belongs to one of the five industrial areas highly affected by the infection. As of January 1, 2012, 0.8% of the city population was infected with HIV while the average rate for the country was 0.4%.
A major route for HIV transmission is non-medical administration of drug injections. The injecting drug users and their sexual partners constitute the major part of those affected by epidemic. In 2011, 73.3% of new HIV cases among those with known transmission route were a result of parenteral drug use. In recent years there has also been an increase in sexual transmission of HIV from 5.8% in 2004 to 22.7% in 2011.
HIV infection has had a strong influence on the incidence of tuberculosis in St. Petersburg. In 2011, 42% of HIV patients died because of tuberculosis.
In 1999-2000, the incidence of hepatitis B increased to 84.7 per 100,000 population and of hepatitis C to 94.7 per 100,000 population. Vaccination has become one of the most important measures aimed at reduction of the incidence of hepatitis B. As a result of vaccination, the incidence of hepatitis B during the last decade has decreased by 20 times: from 50.7 per 100,000 in 2001 to 2.6 per 100,000 population in 2011.
The major prevention measures against HIV and parenteral viral hepatitis infections include implementation of the National Priority Project in Public Health (in 2009-2012) and the target program “On Measures of Prevention of the Disease Caused by the Human Immunodeficiency Virus in 2010-2012” approved by the government of St. Petersburg.

HIV in the Russian Federation
A.T. Goliusov
Directorate of Epidemiological Surveillance of the Federal Service for Surveillance on Consumer Rights Protection and Human Well-Being in Moscow (Rospotrebnadzor in Moscow), Russia

Citation: Goliusov AТ. HIV in the Russian Federation. EpiNorth 2012;13:56-8.

In accordance with data of the Directorates of Rospotrebnadzor, as of December 31, 2011 there were 650,231 HIV-infected citizens registered in the Russian Federation, including 5,844 children up to the age of 15 years.
In 2011 62,000 new cases of HIV infection were reported. The incidence increased to 43.4 per 100,000 population, which is 5% higher than in 2010.
Preliminary data from 2011 indicate that the following regions of the Russian Federation had a higher than average HIV incidence: Kemerovo oblast (with 124.4 new HIV cases registered per 100,000 population), Samara oblast (123.9), Irkutsk oblast (115.6), Sverdlovsk oblast (115.5), Novosibirsk oblast (102.5), Khanty-Mansi autonomous district (100.4), Leningrad oblast (90.4), Tyumen oblast (82.8), Perm area (82.3), Ulyanovsk oblast (67.3), Chelyabinsk oblast (65.6), St. Petersburg (64.4), Orenburg oblast (63.8), Altay area (63.3), Krasnoyarsk area (56.7), Kurgan oblast (54.9), Tver oblast (54.0) and Ivanovo oblast (50.9).
In 2011, the majority of new HIV cases were reported in the Siberian Federal District, Privolzhsky Federal District and Ural Federal District, with incidence rates of 73.2, 87.5 and 46.8, respectively.
During 2011 in the Siberian Federal District the greatest number of new HIV cases was registered in Kemerovo, Irkutsk and Novosibirsk oblasts with the incidence ranging from 102.5 to 124.4. The most significant incidence increases in 2011 were in the Republic of Khakassia, Tomsk oblast and Krasnoyarsk area.
In the Ural Federal District, the majority of new HIV cases were found in Sverdlovsk and Chelyabinsk oblasts and in the Khanty-Mansi autonomous district. The highest increase of incidence was observed in Kurgan and Tyumen oblasts.
In the Privolzhsky Federal District, the highest incidence of HIV infection was reported in Samara oblast, Perm area, Ulyanovsk and Orenburg oblasts. The most evident increase in incidence in 2011 was reported in the Republic of Bashkortostan, Penza oblast and the Republic of Tatarstan.
During 2008-2011 in the Central and North-Western Federal Districts the number of new HIV cases remained relatively stable; in 2011 the incidence rates in these districts were 23.1 and 45.5, respectively. During the last decade the HIV incidence rates in the Southern, North-Caucasian and Far Eastern Federal Districts were low; in 2011 the incidence in these parts of the country varied from 7.5 to 16.1 per 100,000 population.
The HIV epidemiological situation in the Russian Federation is characterized by the following features:
1. The main route of HIV transmission in Russia is still intravenous injection of drugs with non-sterile equipment. In 2011 57.6% of new HIV infection сases were due to intravenous drug use.
2. The sexual transmission of HIV infection is becoming more widespread. Heterosexual route of transmission was responsible for 39.9% of new cases of HIV infection in 2011 as compared to 35.1% in 2008. In 2011, in 49 territories of the Russian Federation between 50 and 100% of people with the known route of transmission were reported to be infected through heterosexual contacts.
3. More HIV cases among women in the Russian Federation are registered than before. In 13 territories of the Russian Federation over a half of new HIV cases in 2011 were registered among women.
4. There is a shift in spread of HIV infection towards older age groups. In 2011, 1.8% of all reported new cases were among teenagers and young people from 15 to 20 years of age while in 2001 24.7% of the new HIV сases were among this age group.
5. The most alarming situation with HIV infection is reported in the age group from 30 to 40 years; in 2011, 42.1% of new cases were in this age group. In 2011, HIV spread most quickly among men of 30-35 years. The proportion of men with HIV in this age group was for 2.2% of the total population while the proportion of HIV-positive among women aged 25-34 years represented 1% of the total population.
6. The number of deaths due to HIV continues to increase. Over the whole epidemic period, 109,000 persons with HIV in the Russian Federation have died. In 2011, a total of 18,414 persons with HIV died, which is 17.5% more than in 2010.

The main HIV control measure in the country is the implementation of the National Priority Project in Public Health. During the project implementation from 2006 to 2011, 61 billion 188 million rubles were allocated for HIV/AIDS control in the country, including 3.1 billion in 2006, 7.8 billion in 2007, 7.8 billion in 2008, 9.3 billion in 2009, 13.5 billion in 2010 and 19.6 billion in 2011.
Within the scope of implementation of the National Priority Project in Public Health, the following measures were taken in 2011:
- over 24.7 million tests for HIV infection were performed in the Russian Federation, which is 112.4% of the planned annual rate;
- 97,642 persons with HIV received antiretroviral therapy, which is 97.6% of the total number planned for 2011;
- as in the previous year, 89% of HIV patients received regular medical check-ups;
- to prevent mother-to-child transmission of HIV, 11,105 pregnant women with HIV received antiretroviral treatment. A total of 95.2% of all women with HIV who gave birth at the end of their pregnancy received antiretroviral treatment; 89.3% received a full three-stage therapy course. Chemoprophylaxis was provided to 98.4% of children born to HIV-positive mothers.

Project Cooperation within the Northern Dimension Partnership
O. Karvonen
National Institute for Health and Welfare, Finland

Citation: Karvonen O. Project Cooperation within the Northern Dimension Partnership. EpiNorth 2012;13:58-9.

The Northern Dimension Partnership in Public Health and Social Well-Being (NDPHS) was established in 2003 by thirteen governments, the European Commission and eight international organizations. The priorities of the Partnership are: 1) to reduce the incidence of major communicable diseases, prevent life style-related non-communicable diseases and 2) to enhance social well-being and promote socially rewarding lifestyles. The practical work under the Partnership is implemented through Expert Groups and Task Groups.
NDPHS Expert Group on HIV/AIDS and Associated Infections acts as the focal point for national input from the Partner Countries and Organisations on issues concerning HIV/AIDS and associated infections (AI), i.e. tuberculosis (TB), sexually transmitted infections and viral hepatitis. Priority areas include prevention of HIV/TB co-infections, prevention of HIV and AI among vulnerable populations (IDU, MSM, CSWs, and migrants), enhancing cross-border activities and integration of social and health care for HIV-infected individuals.
More than 40 projects have been completed and 15 are being implemented under the umbrella of the Expert Group.
An example of a completed project is the "Development of low threshold services in the Murmansk region" that was implemented in two phases: in 2005–2007 and 2008–2010. The project was financed by the Ministry for Foreign Affairs, Finland, and coordinated by National Institute for Health and Welfare (THL). Local partners were the Murmansk Regional AIDS Centre and the Kandalaksha District Central Hospital.
Low threshold service centres for drug users, sex workers and their contacts were opened in Murmansk in 2005 and in Kandalaksha in 2007. A wide range of services are offered in order to prevent HIV. The number of visitors has increased annually to approximately 3300 in 2010; 131 “hidden” HIV infections were detected in the Centres during 2008–2010. Peer work and empowerment of clients have been important aspect of the work.
Success factors of the collaboration include the following:
• Planning by Logical Framework Approach,
• Local ownership and enthusiasm,
• Political support,
• Inter-sectoral collaboration,
• Establishment of centres based on existing institutions,
• Collaboration with mass media,
• High confidentiality of services that encourages trust of clients.

Tick-Borne Encephalitis in the Republic of Karelia, Russia
LM. Kotovich
Epidemiological Surveillance Department, Federal Service for Surveillance on Consumer Rights Protection and Human Well-Being in the Republic of Karelia (Rospotrebnadzor in the Republic of Karelia), Russia

Citation: Kotovich LM. Tick-Borne Encephalitis in the Republic of Karelia, Russia. EpiNorth 2012;13:60-1.

The Republic of Karelia is situated in the north-west of the Russian Federation. It borders four regions of the North-Western Federal District; Leningrad and Vologda oblasts in the south, Murmansk oblast in the north and Arkhangelsk oblast in the east. The republic consists of 18 administrative territories with a total population of 684,000. The border with Finland is 723 km.
Eleven territories of the republic are endemic (high-risk) for tick-borne encephalitis (TBE) and Lyme disease. The populations of these territories are at risk for acquisition of these infections.
Annually, approximately 4,500 people bitten by ticks visit the health care facilities in the republic. The epidemic season lasts 6 months, from April to October. The dynamics of TBE and Lyme disease incidence is similar to the dynamics of claim of tick bites registered at the health care facilities of the republic.
In 2011, 36 cases of TBE were registered in the republic, including 1 case among children and teenagers. In 2010, 46 and 5 TBE cases were reported respectively. In 2011 there were 58 reported cases of Lyme disease including 1 case among children and teenagers. In 2010, 29 and 6 Lyme disease cases were reported respectively. There were no lethal outcomes in 2010 and 2011.
The TBE incidence among the population remains high; there were reported 6.7 and 5.3 cases per 100,000 population in 2010 and 2011, respectively. While the TBE incidence has decreased during the last few years, the epidemiological situation remains unfavourable as the annual TBE incidence in the republic is still 2-3 times higher than in the country as a whole.
The incidence of Lyme disease increased twofold; from 4.2 in 2010 to 8.5 cases per 100,000 population in 2011.
In recent years the habitat of ticks that carry TBE and Lyme disease has expanded to the north. In some cases people and animals have been bitten by ticks in more northern areas than usual.
Among 25% of patient with TBE a fever form of the disease was reported. The diagnosis was laboratory confirmed in 93.3% of the TBE cases and in 45.1 % of the Lyme disease cases.
The age structure of patients with TBE and Lyme disease for the 10-year monitoring period shows that the greatest share of patients were among the age group of 60 years and older (32% and 44% of TBE and Lyme disease patients, respectively). The share of patients in the age group from 40 to 49 years was 17% of the total number of patients for TBE and 15% for Lyme disease.
Only 26 patients with TBE (4.3%) had been vaccinated previously against the infection; 68 people (11.1%) had received an immunoglobulin injection as prophylaxis. Eight of these patients had a meningoencephalitis form of the disease (only 2 received vaccination and 6 received an immunoglobulin injection). The remaining patients had а benign form of the disease.
Every year, within the framework of the epidemiological monitoring programme, small mammals on which ticks feed are monitored and entomological investigations are performed in the areas where stations for long-term observation are located. Ticks are examined for viral infectivity and for borrelia. Since 2011 the non-vaccinated population is tested for TBE immunity.
Ticks have been tested for TBE and Lyme disease by PCR since 2009. Ticks are also checked for granulocytic anaplasmosis and monocytic erlichiosis.
TBE was found in 5% of ticks that had bitten people and in 1.5% of ticks in the natural environment. Borrelias were found in 30.6% of ticks removed from people and in 51.8% of ticks in the natural habitat. In 2011, 5% of ticks removed from people and 4% of ticks found in the natural environment were infected with erlichiosis.
In response to expanding tick habitat it is necessary to re-define the endemic areas. For this purpose it is necessary to continue the following measures:
- entomological investigations of the density of tick population in various parts of the republic;
- laboratory monitoring of infection carriage in ticks;
- examination of patients with fever, meningeal conditions and symptoms suggesting a focal damage of the brain or the spinal cord of unknown etiology;
- investigations of TBE immunity among the non-vaccinated population.

Preparations for the 2012 European Football Championship in Ukraine
V.K. Liashko
State Sanitary Epidemiological Service, Kiev, Ukraine

Citation: Liashko VK. Preparations for the 2012 European Football Championship in Ukraine. EpiNorth 2012;13:62-3.

The Concept of Sanitary and Epidemiological Well-Being for the population of the cities where the 2012 European Football Championship was to be held had been approved by Order No.660 of the Ministry of Health of Ukraine dated September 3, 2009 and by other legislative documents.
In accordance with the Concept, the local executive authorities and community government bodies of all participating cities were responsible to take a variety of sanitary and preventive measures. The effectiveness of the measures in relation to the sanitary legislation was controlled by the state sanitary service through preventive and routine epidemiological surveillance.
The routine sanitary and epidemiological surveillance included the following aspects:
— selective sanitary and epidemiological examination of the relevant objects for adherence to the requirements of sanitary legislation;
— laboratory monitoring of the safety of food, drinking water and environment within the scope of legislative competence;
— assessment and analysis of parasitic and infectious disease incidence as well as food poisonings;
— complex analysis of the sanitary and epidemiological situation to design effective preventive measures.
The Plan of Measures aimed at the sanitary and epidemic well-being of the population during the final part of the 2012 European Football Championship was approved by Order No.300 of the Ministry of Health, dated May 20, 2011.
Schemes for information exchange between the institutions of the state sanitary and epidemiological service, health care facilities and local authorities were developed. The population was informed about the sanitary and epidemiological situation in the regions and sites involved in preparation for and conduct of Euro- 2012.
The existing three-level system of epidemiological surveillance (on the local, regional and national level) makes it possible to take the most adequate sanitary and preventive measures in order to prevent the import, occurrence and spread of infections (including isolation) in Ukraine.
The registration and reporting system used for handling data on infections in the country provides timely notification of sanitary and epidemiological institutions, and healthcare bodies about new cases of infections. This helps to establish necessary measures to stop the spread of infection and prevent epidemic spread and outbreaks among the population.
To provide collaboration with the countries participating in Euro 2012 in terms of data exchange about the incidence of infections and harmonization of the national legislation of Ukraine with the International Health Regulations of 2005 in relation to prevention of the importation and spread of dangerous infectious diseases of global importance, such as poliomyelitis, flu caused by a new virus type, cholera, plague, fevers, and malaria, the State Sanitary and Epidemiological Service published a new edition of the Regional Sanitary Control Rules, which was approved by Decree No.893 of the Cabinet of Ministers of Ukraine, dated August 22, 2011.
Thus, Ukraine currently has access to the international network for data exchange about infections of global importance, which allows the implementation of timely and effective measures to prevent the spread of infections in the country.

Infection Incidence Trends as Criterion for Assessment of Probable Impact of Climate Change
L.V. Lyalina
Saint-Petersburg Pasteur Institute of Epidemiology and Microbiology, St. Petersburg, Russia

Citation: Lyalina L.V. Infection Incidence Trends as Criterion for Assessment of Probable Impact of Climate Change. EpiNorth 2012;13:63-4.

At present, many specialists are involved in the investigation of climate changes in terms of impact on the public health. It is very important to address the probable influence of climate changes upon parasitic systems and infection incidence because such information may help to implement appropriate additional preventive measures.
When addressing the assessment of climatic factors and the relevance of climate impact on infection incidence, there are certain challenges associated with the interaction of multiple factors, the development of diagnostics, the details of reporting systems, the duration of monitoring and the implementation of preventive measures.
The purpose of this study is to outline the probable impact of climate changes on infection incidence based on the analysis of long-term monitoring of incidence dynamics in the Russian Federation as a whole and in the North-Western Federal District in particular. The tendencies of incidence have been studied for some infections of viral etiology, with humans as the infection source (measles, hepatitis А), and for zoonotic infections with natural foci (tick-borne encephalitis, Lyme disease, hemorrhagic fever with renal syndrome, tularemia). The length of the study period is 55-65 years; the incidence of Lyme disease and hepatitis A has been studied for 19 and 21 years, respectively. The analyses have been based on state statistical monitoring data.
The incidence of measles has shown a decreasing trend as a result of two-dose immunization of the population in accordance with the national vaccination programme of the Russian Federation. The vaccination coverage is 95% of the population. In 2011 in the north-west of the country the incidence was 0.5 per 1,000,000 population. The incidence of hepatitis A has been also decreasing from 165.5 per 100,000 population in 1991 to 4.3 per 100,000 population in 2011.
The incidence of tick-borne encephalitis is increasing in the Russian Federation and in a number of areas in the North-Western Federal District. Within the monitoring period from 1947 to 2011, there were two cyclic increases in the disease incidence observed in the country as a whole, with the maximum incidence reaching 4.5 and 7.0 per 100,000 population. The Siberian and Ural Federal Districts are the most endemic areas for tick-borne encephalitis. The different regions in the North-Western Federal District vary in disease incidence. The maximum incidence is registered in the following three areas: the Republic of Karelia, Vologda and Arkhangelsk oblasts, with average incidence over the last decade of 8.6, 6.4 and 6.4 cases per 100,000 population, respectively. The average incidence for the district is 2.8 per 100,000 population. The infection incidence tends to grow not only in these parts of the district, but also in less endemic areas, for example in the Republic of Komi.
During the last 15 years, the incidence of Lyme disease in Russia has shown an increasing trend from 4.7 to 6.9 cases per 100,000 population. The growing trends have been also reported for hemorrhagic fever with renal syndrome, though the growth rate for this infection is less pronounced than for tick-borne encephalitis. There was no increase in the incidence of tularemia registered in the Russian Federation during1950-2011.
The growing incidence of tick-borne encephalitis, hemorrhagic fever with renal syndrome and Lyme disease, and the registration of new cases in areas including the north where there had previously been no reported cases of these infections may result from the impact of climate change. To confirm this hypothesis, it is necessary to continue investigations using geo-information technologies and analysis of meteorological, entomological and virological data.

Incidence of Tick-Borne Encephalitis and Lime Disease in Leningrad Oblast
E.A. Mikhaylova
Epidemiological Surveillance Department, Directorate of the Federal Service for Surveillance on Consumer Rights Protection and Human Well-Being (Rospotrebnadzor) in Leningrad Oblast, St. Pe-tersburg, Russia

Citation: Mikhaylova E.A. Incidence of Tick-Borne Encephalitits and Lyme Disease in Lenin-grad Oblast. EpiNorth 2012;13:65-6.

The entire area of Leningrad oblast is a major natural foci of tick-borne infections. In recent years, the foci of tick-borne encephalitis (TBE) have closely approached human settlements in the area. The whole population of Leningrad oblast is a potential risk group.
There are two species of ticks found in Leningrad oblast: I.persulcatus and I.ricinus. During the monitoring period from 2001 to 2011, 51,240 persons residing in the oblast sought medical assistance after being bitten by ticks and this number tends to increase. Data vary between the regions of Lenin-grad oblast. Tikhvin, Gatchina and Kingisepp regions are at highest risk; residents in these regions ac-count for 11%, 10% and 8%, respectively, of the total number of people bitten by ticks.
In Leningrad oblast the epidemic season, during which active transmission of tick-borne infec-tions is possible, lasts from April to October. The greatest number of people with tick bites report to healthcare institutions in May (47.7%). More than 70% of patients with tick bites visit hospitals during May and June. The average infectivity of hungry I.persulcatus ticks for Lyme disease was 20% and 4.5% for TBE. During the monitoring period 1,314 cases of Lyme disease were registered. The average incidence for the eleven years was 8 cases per 100,000 population, which is 1.6 times higher than the average incidence in Russia. In addition, 427 cases of TBE were registered during this period, with an average incidence of 2.3 cases per 100,000 population. This rate is not higher than the average inci-dence of 2.8 per 100,000 population for the country. The incidence of TBE in Leningrad oblast showed various trends within the monitoring period: from 2001 to 2009 the incidence increased with peaks observed in 2003, 2007 and 2009. In contrast, during 2010 and 2011 the incidence decreased each year by 1.8 times. The incidence of TBE among the urban residents is much higher than among the rural population (3.0 and 1.7 cases per 100,000 rural population, respectively). The same correlation is typical of the country as a whole. Most often people get infected with Lyme disease and TBE when they visit recreation areas or gardens inhabited by ticks. Targeted preventive measures are taken in Leningrad oblast in order to reduce the incidence of tick-borne infections.
The incidence of tick-borne infections in Leningrad oblast tends to increase. There are persistent overlapping foci of TBE and Lyme disease in the region.
Currently, TBE poses the major epidemiological threat for the area because it causes significant social and economic burden.
Long-term monitoring of the epidemiological situation in the region shows that the problem tends to increase and the borders of tick-borne infection foci associated with horticultural and related activities of the population expand. The importance of climate change with respect to TBE and Lyme disease warrants further research and investigation.

Direct Cross Border Cooperation – Some Thoughts
A. Nystedt
Department of Communicable Disease Control, Norrbotten, Sweden

Citation: Nystedt A. Direct cross border cooperation – some thoughts. EpiNorth 2012;13:67-8.

At the Department of Communicable Disease Control of the Norrbotten County Council in Northern Sweden we have become more and more aware of the fact that we lack knowledge about how infectious disease control is conducted in our neighbour countries. This is a problem that might even pose a risk in our own work with communicable diseases. Infectious diseases travel over borders with people. Exchange of manpower, trade and a growing tourists’ industry increase cross-border contacts that can enhance the spread of infectious diseases.
The County Medical Officer in Norrbotten therefore proposes to create a network, “Cap of Europe Communicable Disease Control Network” or “Barents Communicable Disease Control Network”, including the different stakeholders working with infectious disease epidemiology in our part of the world. A network that enables us to quickly and easily get in touch with each other in the future, for instance in the event of an outbreak or a new or unexpected epidemic.
We suggest that an e-mail distribution list be established for easy and fast communication between our organisations. We also propose the launch of an annual or biannual meeting between experts working with infectious disease prevention in the Barents Sea region. This meeting will provide the opportunity to learn about each other’s strategies for work with disease prevention and inform each other about the epidemiological situation in our different counties/countries. It would be advantageous to discuss areas of infectious disease control that should be prioritized and plan strategies for future co-operation.
To launch this idea the Department of Communicable Disease Control in Norrbotten extends an invitation for an upstart meeting in April 2013 during which different forms of cooperation may be discussed with our colleagues working regionally with these questions. We will also invite representatives from federal authorities in our different countries to this meeting. We have discussed this suggestion with the National Board of Health and Welfare and the Swedish Institute of Infectious Disease Control in Stockholm, with the National Public Health Institute in Helsinki and the Norwegian Institute of Public Health in Oslo. We have not yet contacted the federal Russian authorities. The European Centre for Disease Prevention and Control has also expressed an interest in participating.

Dirofilariasis Cases Reported in Novgorod Oblast
V.A. Pyanykh
Directorate of the Federal Service for Surveillance on Consumer Rights Protection and Human Well-Being in Novgorod Oblast (Rospotrebnadzor in Novgorod Oblast), Russia

Citation: Pyanykh V.A. Dirofilariasis Cases Reported in Novgorod Oblast. EpiNorth 2012;13:68-9.

Dirofilariasis is the only vector-borne helminthic infection in areas with a moderate climate. Prior to 2010, no cases of human dirofilariasis were reported in Novgorod oblast.
In 2010, the first domestic case of human dirofilariasis was registered in the area. From November 2010 to January 2012, 7 cases of Dirofilaria repens infection were reported among the population. The epidemiological investigation reports show that the age of patients varied from 10 to 62 years. The patients complained to their doctors that they felt something “crawling” on their skin and suffered from appearance of painful and itchy nodules. In 4 cases the parasites were found in the conjunctiva of the eye and periorbital area; one woman had 2 helminthes extracted from subcutaneous tissue of the belly and the thigh; one patient had parasites under the skin of the left hand and one child had helminthes in the scrotum area.
The parasites were identified at the Laboratory of Medical Parasitology and Immunology of the Federal Budgetary Scientific Institution ”Rostov Scientific Research Institute of Microbiology and Parasitology” of Rospotrebnadzor. The helminthes were identified as immature female worms of Dirofilaria repens, 120-140 mm long and 0.4-0.5 mm thick. All patients had been bitten by mosquitoes.
According to data from the Veterinary Service of Novgorod Oblast, from 2005 sporadic cases of Dirofilaria repens infection were registered annually among the police service dogs.
The results of epidemiological investigations show that dirofilariasis may have been imported to Novgorod oblast by service dogs that were regularly sent to the Northern Caucasus to carry out specific missions during the previous years. The abnormally hot summers of 2010 and 2011 with the temperature over 30ºС created favorable conditions for the development of parasites in their hosts. The population of mosquitoes also increased twofold from 30 mosquitoes per 20 minutes of monitoring in 2009 to 66.7 in 2011. These circumstances may contribute to the formation of a dirofilariasis foci in Novgorod oblast and cause domestic cases of infection among the population.

EpiNorth Project web-page use
G. Rimseliene
Norwegian Institute of Public Health, Norway

Citation: Rimseliene G. EpiNorth Project web-page use. EpiNorth 2012;13:69

The EpiNorth project website was established in 2000 and new modules have regularly been introduced. In order to improve the website, an analysis of web-page use was performed using “Google Analytics”, a free web use analysis program that investigated information from June 2008 till May 2012. We looked at visits by page-views, project modules, the official language of viewing country and countries where the views were performed. Over 81,667 visits by 50,858 unique visitors were registered during the study period; of these 62% were new visitors. The number of page views increased in 2009/2010 (5,000 views/week) with peak in 2011 (10,000 views/week). The largest proportion of yearly visits were to the main page (13,000), followed by EpiNorth Journal (4,000), EpiWatch (3,000), EpiNorthData (2,500), and EpiNews (1,800). The website was primarily viewed from English-speaking countries (>49,000 visits). There were 5,875 visits from Russian-speaking countries. The average number of annual visits was highest from Norway (6,046) followed by USA (2,914), and UK (1,500). There were 1,160 visits from the Russian Federation, 971 from Sweden, and 500 to 600 visits from the three Baltic countries. Over 200 visits were reported from Denmark, Finland, Republic of Belarus, Ukraine, and Poland. Based on results of this study we suggest publishing the EpiNorth Journal in an electronic version since it was highly visited online, and continuing with the most viewed modules of the EpiNorth project website.

ECDC Epidemic Intelligence Activities in Mass Gathering Events
E. Szegedi
European Centre for Disease Prevention and Control (ECDC), Sweden

Citation: Szegedi E. ECDC Epidemic Intelligence Activities in Mass Gathering Events. EpiNorth 2012;13:70-1.

Global mass gathering events (MGs) present particular challenges in health security including a theoretical increased risk for outbreaks of infectious diseases arising from international visitors, from opportunistic non-official vending sites for food or other products, and a heightened security threat level. The main objective of ECDC’s work addressing mass gatherings is to strengthen preparedness and response to the public health challenges associated with planned MGs for the EU/EFTA Member States and other stakeholders. The activities are built on the core functions of the agency: preparedness including training, surveillance, epidemic intelligence (EI) and response support, scientific advice and communication. ECDC has provided customised surveillance and response support for several MGs within and outside of the EU in the past in collaboration with international partners such as WHO, other agencies worldwide, and networks such as EpiNorth. During this year’s two major events, the EURO 2012 and the London Olympic and Paralympic Games, ECDC provided to the host countries with tailored daily international epidemic intelligence information, EU-level risk analysis support of public health threats detected, disease-specific and general technical support upon request and support for the implementation of EU-wide measures upon request (e.g. contact tracing).
Epidemic intelligence activities include enhanced screening for specific diseases through customisation of media monitoring tools (MedISys), customisation of other web-based event based surveillance tools (PULS, GPHIN, HealthMap) and specific use of blogs/discussion groups for selected countries and diseases. For EURO 2012, the EpiNorth secretariat and ECDC epidemic intelligence group have been working closely together in the daily undertaking of international epidemic intelligence activities specific for the event. This synergy aims to benefit from the EpiNorth network and avoid duplication of contacts with EU Member States in the validation process of non-verified information.

EpiNorth project – a Small Survey
H. Blystad
Norwegian Institute of Public Health, Oslo, Norway

Citation: Blystad H. EpiNorth project – a small survey. EpiNorth 2012;13:72.

Prior to the annual meeting of EpiNorthproject, a short questionnaire was sent to network members of the project. The aim of this informal study was to get a rough indication of which of the EpiNorth project elements the respondents think are most useful and what elements should be continued in a possible reorganization of the EpiNorth project. The questionnaire was sent by e-mail to 28 network members, and we received 20 (71%) completed forms.
95% of the respondents answered that EpiNorth Journal was useful or very useful, and 100% answered that EpiNorthData was useful or very useful. The corresponding figures for EpiWatch was 90%, EpiNews 80%, EpiVax 75%, EpiTrain 70%, EpiWords 60% and EpiScience 70%.
The respondents were also asked to name three of the elements in the EpiNorth project which they felt was important to continue with in a possible reorganization of the project. 80% of the respondents named EpiNorth Journal as an important element to be continued. The corresponding figures for EpiNorthData was 75%, EpiWatch 50%, EpiTrain 45%, EpiVax 20%, EpiScience 10%, EpiNews 5% and EpiWords 0%. All the respondents answered that it was important to maintain the network developed through the EpiNorth project. 95% answered that it is important to have an annual meeting within the network members. 80% of the respondents expressed the opinion that participation at such meetings would be dependent on all expenses being covered by the EpiNorth project.
The result of this small survey should be interpreted with caution, but it gives indications that EpiNorthJournal, EpiNorthData and EpiWatch are regarded the most wanted elements to be continued in a possible reorganization of the EpiNorth project.