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equires substantial resources, which may not be available in many EU countries. An important basis for effective prevention and control measures is a good and reliable analysis of the epidemiological situation. However, reliable epidemiological data on hepatitis B and C in the EU are not available. EU-wide surveillance of hepatitis B and C is urgently needed to gain a better understanding of its changing transmission patterns and to identify the most effective ways to contain the disease. The harmonisation and strengthening of EUwide surveillance is a priority, as reported by Rantala and van de Laar in their review of European systems. Considering the wide heterogeneity in surveillance systems, data sources and healthcare systems in EU Member States, this will be a major challenge for the coming years. This article was published on 22 May 2008. Citation style for this article: van de Laar MJ, Lopalco PL. World Hepatitis Day: a timely reminder of the challenges ahead. Euro Surveill. 2008;13(21):pii=18883. Available online: http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=18883 138 EUROSURVEILLANCE Vol. 13 · Issues 14–26 · Apr–Jun 2008 · www.eurosurveillance.org
Editorials M o l e c u l a r t y p i n g f o r p u b l i c h e a lt h p u r p o s e s A Ammon (andrea.ammon@ecdc.europa.eu) 1 1. European Centre for Disease Prevention and Control, Stockholm, Sweden In this issue, seven networks/projects are presented that are dedicated to the molecular typing of bacteria (SeqNet: Staphylococcus aureus; MLVA-Net: Salmonella Typhimurium, Enterobacter sakazakii, Listeria monocytogenes; HARMONY: Staphylococcus aureus; DIPNET: Corynebacterium diphtheriae) or viruses (HepSEQ: hepatitis B virus; FBVE: noroviruses and other gastrointestinal viruses; MeaNS: measles). They represent only a few of an increasing number of typing networks. However, they illustrate a couple of relevant issues that need to be considered before implementing these methods for different public health purposes. By providing appropriate discriminatory analyses, molecular typing can foster rapid and – depending on the method – even realtime early detection of dispersed international clusters/outbreaks, the detection and investigation of transmission chains, the relatedness of strains, and the emergence of antimicrobial resistance and new evolving pathogenic strains. Molecular typing of infectious diseases, if routinely applied, can also complement traditional epidemiological surveillance. Moreover, analysis of molecular typing data can aid in studying the characteristics of a particular pathogen and its behaviour in a community of hosts, such as its spread over time and space, disease transmission dynamics, virulence factors influencing recurrence of infections, mutations and antigenic drifts of strains over time, and the development of drug resistance across strain generations. Whereas the application of molecular typing during outbreaks and for the investigation of transmission chains is widely accepted, the use of these methods for routine surveillance is more debated, although there are successful examples, such as PulseNet in the United States [1]. However, before transferring a typing method from a research setting into wider use, a number of criteria proposed for the evaluation and validation must be considered. Among those criteria are typeability, discriminatory power, epidemiological concordance and reproducibility. These characterise the “technical” appropriateness of a method for the typing of a specific pathogen [2]. For the implementation of an appropriate method into practice, a number of aspects need to be taken into consideration: the flexibility (to be used for more than one species); the rapidity; accessibility and overall cost; the ease of use, which includes the workload but also the interpretation of results; the amenability to computerised analysis and incorporation in electronic Molecular typing of infectious diseases, if routinely applied, can also complement traditional epidemiological surveillance. databases, which is important to combine the typing data with other epidemiological information [2]. For the inclusion of molecular typing data into surveillance at EU level, a few additional considerations are required before a typing method could be suggested for routine application: • Typing data should provide essential information to achieve the surveillance objectives for the specific disease. • The typing method should provide real-time information. • The specific typing method/pathogen combination needs to be agreed upon among the laboratory experts. • The molecular typing method is standardised in terms of the typing protocol and the nomenclature (or this standardisation is feasible), which allows comparison of data across laboratories and countries. • External Quality Control needs to be established and regularly carried out. • All Member States should have access to the agreed molecular typing method/ pathogen, either by building up the capacity in their own country or by getting support from those Member States who have already developed the capacity. The full synergy of combining molecular typing data and routine surveillance information and interpreting them jointly can contribute to improving and better targeting existing infectious disease prevention and control measures, and thus presents a clear benefit for public health and public health policy. However, the introduction of any of these methods will require a careful discussion between all involved stakeholders, which the European Centre for Disease Prevention and Control will encourage and foster, according to its mandate. References 1. Tauxe RV. Molecular subtyping and the transformation of public health. Foodborne Pathog Dis. 2006 Spring;3(1):4-8. 2. Van Belkum A, Tassios PT, Dijkshoorn L, Haeggman S, Cookson B, Fry NK, et al; European Society of Clinical Microbiology and Infectious Diseases (ESCMID) Study Group on Epidemiological Markers (ESGEM). Guidelines for the validation and application of typing methods for use in bacterial epidemiology. Clin Microbiol Infect. 2007;13 Suppl 3:1-46. This article was published on 8 May 2008. Citation style for this article: Ammon A. Molecular typing for public health purposes. Euro Surveill. 2008;13(19):pii=18864. Available online: http://www.eurosurveillance.org/ ViewArticle.aspx?ArticleId=18864 EUROSURVEILLANCE Vol. 13 · Issues 14–26 · Apr–Jun 2008 · www.eurosurveillance.org 139
Page 1 and 2: EUROPEAN CENTRE FOR DISEASE PREVENT
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Page 5 and 6: oth measles and mumps in certain ag
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The questionnaire was structured ac
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Table 2 HIV and hepatitis C testing
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to be paid regarding HCV. The repor
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Table 1 Summary of hepatitis B surv
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of the different genotypes vary bot
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Figure The incidence of reported he
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33. Veldhuijzen IK, Smits LJ, van d
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Figure 1 The natural history of HCV
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successful engagement with and trea
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Table 1 Definitions of HCV infectio
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not available for surveillance purp
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Special Issue: World Hepatitis Day
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Surveillance and outbreak reports E
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Distributed information about the e
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Surveillance and outbreak reports A
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Table 1 Survey data regarding surve
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For the presented period of the pas
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or individuals who acquired the inf
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Surveillance and outbreak reports A
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analysable fragment of 457 bp, and
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the application of HNIG to close co
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HCV co-infection was defined as pos
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[18] had been observed in HIV-HBV c
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Microbiological investigation All h
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References 1. American Public Healt
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Telephone calls are handled by a tw
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At that time, the daily monitoring
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Research articles S u r v e i l l a
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It has been suggested that longer d
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Virological data collection Stool s
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Discussion Our combined epidemiolog
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Acknowledgements We are grateful to
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The total study sample consisted of
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Table Multivariate model of associa
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Euroroundups S u r v e y o f eu r o
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event. The survey included question
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Laboratories report anonymised case
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8. European Union. Commission decis
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two females aged six years and 56 y
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Table 2 Salmonella infections with
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17. The Community Summary Report on
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the number of registered cases in E
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protected vaccinees annually) [6].
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Romania Risk of tick-borne encephal
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34. Pavlidou V, Geroy S, Diza E, An
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European Commission and the EU Memb
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10. Strauss R, Muchl R, Kunze M, Hr
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Existing monitoring efforts in Euro
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with existing efforts in influenza
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Obtaining a true picture of the bur
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of being too clean, concerns about
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single case of the disease while in
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Rapid communications E m E rg E n c
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Development and Food. More specific
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Rapid communications I n c r e a s
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immunity was high enough to prevent
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Control measures Information about
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• The importance of ensuring that
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Letters A u t h o r s r e p ly : pr
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UNITED KINGDOM England and Wales He
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