What is the definition of a suspected case in Europe ?

[german-docter]

What is the definition of a suspected case in Europe ?

I?d like to point out, that there is some difference in the definition of a suspected case of swine flu, published by CDC for the United States of America and by ECDC for Europe (and by Robert Koch Institut for Germany, respectively)

These differences may contribute to an underestimation or failure in detecting new cases in Europe.

First, in both definitions, there is the clinical aspect of an Influenza like illness (ILI) or a acute febrile respiratory illness.

Second, in both definitions, there is the epidemiologic aspect.

USA (CDC): ILI + ??has traveled to a state or country where there are one or more confirmed or probable cases ?

(source:[CDC-] Interim Guidance on Case Definitions to be Used For Investigations of Novel Influenza A (H1N1) Cases* ; May 11, 2009, 7:42 PM ET: http://www.cdc.gov/h1n1flu/casedef.htm )

Europe (ECDC (1)): ILI + ?? Travellers from an area where there is sustained transmission of influenza A (H1N1) virus who develop fever (38?C or higher) and influenza-like symptoms ??

(source: ECDC: Persons who return from an area where there is sustained transmission of influenza A(H1N1) virus; http://www.ecdc.europa.eu/en/files/pdf/Health_topics/090502_NIV_Info_for_travellers.pdf)

Europe (ECDC (2)): "Persons presenting with [? ILI?] and [?] who has travelled to an area where there is a sustained human-to-human transmission of the influenza".

(source: ECDC short-term guidance on public health case and contact management for influenza A(H1N1); Update 30 April 2009, Part I Management guide for persons defined below: http://ecdc.europa.eu/en/files/pdf/Health_topics/090501_AH1N1_case_management_annexes.pdf)

Germany (RKI): ILI + ?? stay in a well-defined area of risk of novel Influenza A (H1N1)... [??in accordance with the ECDC??, actually i.e. Mexico alone] OR [?] OR [?] simultanous stay in an area with one or more confirmed cases??

(Source: [RKI-] Falldefinition f?r Neue Influenza (A/H1N1) beim Menschen; Stand 07.05.2009 19:00 Uhr;http://www.rki.de/cln_116/nn_200120/DE/Content/InfAZ/I/Influenza/IPV/Schweineinfluenza__Falldef.html )
(Source: [RKI-] Risikogebiete f?r die Neue Grippe (Influenza A/H1N1; Stand 02.05.2009, 19:00 Uhr; http://www.rki.de/cln_116/nn_200120...nza/IPV/Schweineinfluenza__Risikogebiete.html )

I guess that most of the confirmed case had been suspected case before. So, you?ll only find, what you are looking for. But how do Health Authorities in Europe deal with travelers from the USA, who come back with some flu like symptoms ? The majority of them would?nt be tested at all.

Today, there are more than 2600 confirmed cases within the United States. Dr. Anne Schuchat, a deputy director with the federal Centers for Disease Control and Prevention, said: ?I think the cases we?re confirming are the tip of the iceberg here?.

As the CDC pointed out earlier: ?As the situation evolves, the ability to use epidemiologic links to identify potentially infectious patients may be lost and these recommendations may need to be applied to all patients with febrile respiratory illness.?

(source: [CDC-] Interim Guidance for Infection Control for Care of Patients with Confirmed or Suspected Novel Influenza A (H1N1) Virus Infection in a Healthcare Setting; May 3, 2009 2:00 PM ET; http://www.cdc.gov/h1n1flu/guidelines_infection_control.htm )

Up to the latest report from the ECDC (12 May 2009, 08:00 hours (CEST)) the cumulative number of confirmed cases in Europe is 210 and the cumulative number of in-country transmission is 46, that?s 21.9 per cent.

So what is Europe going to do, to face the rising number of persons, returning from all parts of America who meet the definition of suspected cases ?

 

[HenryN]

Re: What is the definition of a suspected case in Europe ?

What is the definition of a suspected case in Europe ?

I?d like to point out, that there is some difference in the definition of a suspected case of swine flu, published by CDC for the United States of America and by ECDC for Europe (and by Robert Koch Institut for Germany, respectively)

These differences may contribute to an underestimation or failure in detecting new cases in Europe.

First, in both definitions, there is the clinical aspect of an Influenza like illness (ILI) or a acute febrile respiratory illness.

Second, in both definitions, there is the epidemiologic aspect.

USA (CDC): ILI + ??has traveled to a state or country where there are one or more confirmed or probable cases ?

(source:[CDC-] Interim Guidance on Case Definitions to be Used For Investigations of Novel Influenza A (H1N1) Cases* ; May 11, 2009, 7:42 PM ET: http://www.cdc.gov/h1n1flu/casedef.htm )

Europe (ECDC (1)): ILI + ?? Travellers from an area where there is sustained transmission of influenza A (H1N1) virus who develop fever (38?C or higher) and influenza-like symptoms ??

(source: ECDC: Persons who return from an area where there is sustained transmission of influenza A(H1N1) virus; http://www.ecdc.europa.eu/en/files/pdf/Health_topics/090502_NIV_Info_for_travellers.pdf)

Europe (ECDC (2)): "Persons presenting with [? ILI?] and [?] who has travelled to an area where there is a sustained human-to-human transmission of the influenza".

(source: ECDC short-term guidance on public health case and contact management for influenza A(H1N1); Update 30 April 2009, Part I Management guide for persons defined below: http://ecdc.europa.eu/en/files/pdf/Health_topics/090501_AH1N1_case_management_annexes.pdf)

Germany (RKI): ILI + ?? stay in a well-defined area of risk of novel Influenza A (H1N1)... [??in accordance with the ECDC??, actually i.e. Mexico alone] OR [?] OR [?] simultanous stay in an area with one or more confirmed cases??

(Source: [RKI-] Falldefinition f?r Neue Influenza (A/H1N1) beim Menschen; Stand 07.05.2009 19:00 Uhr;http://www.rki.de/cln_116/nn_200120/DE/Content/InfAZ/I/Influenza/IPV/Schweineinfluenza__Falldef.html )
(Source: [RKI-] Risikogebiete f?r die Neue Grippe (Influenza A/H1N1; Stand 02.05.2009, 19:00 Uhr; http://www.rki.de/cln_116/nn_200120...nza/IPV/Schweineinfluenza__Risikogebiete.html )

I guess that most of the confirmed case had been suspected case before. So, you?ll only find, what you are looking for. But how do Health Authorities in Europe deal with travelers from the USA, who come back with some flu like symptoms ? The majority of them would?nt be tested at all.

Today, there are more than 2600 confirmed cases within the United States. Dr. Anne Schuchat, a deputy director with the federal Centers for Disease Control and Prevention, said: ?I think the cases we?re confirming are the tip of the iceberg here?.

As the CDC pointed out earlier: ?As the situation evolves, the ability to use epidemiologic links to identify potentially infectious patients may be lost and these recommendations may need to be applied to all patients with febrile respiratory illness.?

(source: [CDC-] Interim Guidance for Infection Control for Care of Patients with Confirmed or Suspected Novel Influenza A (H1N1) Virus Infection in a Healthcare Setting; May 3, 2009 2:00 PM ET; http://www.cdc.gov/h1n1flu/guidelines_infection_control.htm )

Up to the latest report from the ECDC (12 May 2009, 08:00 hours (CEST)) the cumulative number of confirmed cases in Europe is 210 and the cumulative number of in-country transmission is 46, that?s 21.9 per cent.

So what is Europe going to do, to face the rising number of persons, returning from all parts of America who meet the definition of suspected cases ?

Drag their heels as long as possible.

 

[WTB]

Re: What is the definition of a suspected case in Europe ?

Hello

Tha case definition for Canada has changed about 5 times during the first week.... And two times since! We know now that the definition we have may not be accurate by the fact that the country affected is always evolving and that the disease is sometime milder that thought.

The definition we have for suspect case for epidemiology is fever and cought with at least one of the following: myalgia, fatigue, sore throat, arthralgia. The patient have to have travelled in suspected area in the last 7 days or being in close contact with a confirmed case.

But... The clinicians can test who ever the want base on their jugements. So we see know confirmed cases that were never a suspect one... In fact, there is more cases being tested that don't fit the definition that cases who do.

What is bugging me more is if they stop testing for H1N1, then we gone have a lot of probable cases ( influanza A non typable...)

WTB

 

[HenryN]

Re: What is the definition of a suspected case in Europe ?

Hello

Tha case definition for Canada has changed about 5 times during the first week.... And two times since! We know now that the definition we have may not be accurate by the fact that the country affected is always evolving and that the disease is sometime milder that thought.

The definition we have for suspect case for epidemiology is fever and cought with at least one of the following: myalgia, fatigue, sore throat, arthralgia. The patient have to have travelled in suspected area in the last 7 days or being in close contact with a confirmed case.

But... The clinicians can test who ever the want base on their jugements. So we see know confirmed cases that were never a suspect one... In fact, there is more cases being tested that don't fit the definition that cases who do.

What is bugging me more is if they stop testing for H1N1, then we gone have a lot of probable cases ( influanza A non typable...)

WTB

In the US, 97% of influenza A positive and non-typable are confirmed as swine H1N1.