Eurosurveillance invites authors to submit papers for a special issue on HIV/AIDS and other sexually transmitted infections (STI) in men who have sex with men (MSM). The topic is in line with the main theme of World AIDS Day 2009 events organised by the European Centre for Disease Prevention and Control and aims at drawing attention to the epidemiological importance of MSM in HIV and other STI and directing the ECDC activities to focus on main risk groups.

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The data from 27 European Union countries plus Iceland, Liechtenstein and Norway show that considerable progress has been made in preventing and controlling the disease. The number of newly diagnosed cases and the overall notification rate declined continuously in the past decade, and the notification rate in 2007 was 12% lower than in 2003. In spite of this decline, a total of 84,917 new cases of TB were registered in 2007 and a number of challenges hamper the progress towards the elimination of TB in the EU.

A number of bacterial and viral infections in pregnant women can have serious effects on the unborn child leading to impaired mental and physical health later in life. This week’s issue of Eurosurveillance is dedicated to infectious diseases in pregnancy.

The emergence and spread of antimicrobial resistance (AMR) is a growing problem in many European countries. To mark the very first European Antibiotic Awareness Day, on 18 November, the scientific journal Eurosurveillance runs a series of articles to highlight main aspects of the AMR problem in Europe. They will be published in two issues on 13 and 20 November 2008.

In preparation for the coming influenza season 2008-9, Eurosurveillance publishes a special issue on prevention of influenza by vaccination. Seasonal influenza poses a serious public health threat because of associated serious morbidity and mortality. In Europe, estimates suggest that influenza is responsible for around 40,000 to 220,000 excess deaths, depending on the severity of the epidemic.

Today Eurosurveillance is publishing a special issue dedicated to the widespread advances made in Europe in estimating the real number of newly acquired HIV infections based on an innovative approach called STARHS

To tie in with World Hepatitis Day on 19 May, the scientific journal Eurosurveillance is today publishing a special issue on viral hepatitis, highlighting issues and challenges related to hepatitis B and C.

On 17 April 2008, Eurosurveillance is publishing a special issue with articles on the measles situation in Europe. The publication is linked to European Immunisation Week which runs from 21-27 April.

World Tuberculosis Day on 24 March commemorates the date in 1882 when Robert Koch presented his findings of the causing agent of tuberculosis (TB) – Mycobacterium tuberculosis. In the run up of this day Eurosurveillance publishes a special issue on the situation of TB in Europe.

Today (6 March, 2008), Eurosurveillance, the European peer-reviewed journal of infectious diseases, publishes a special issue on meningococcal disease. It includes two in-depth articles and an editorial by the European Centre for Disease Prevention and Control (ECDC).

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Eurosurveillance, Volume 12, Issue 1, 04 January 2007

Citation style for this article: Epico working group. Modelling scenarios of diffusion and control of pandemic influenza, Italy. Euro Surveill. 2007;12(1):pii=3105. Available online:

Modelling scenarios of diffusion and control of pandemic influenza, Italy

Epico working group* (

The updated Italian national plan for preparedness and response to an influenza pandemic was published in February 2006 [1], in response to recommendations and checklists on national influenza pandemic preparedness plans issued by the World Health Organization [2].
The Italian plan includes the following preventive measures:

vaccination, prioritising the following categories:

1. personnel of health services and other essential services,


2. high risk groups including >=65 years old individuals and all-age individuals with underlying chronic diseases,


3. healthy children and adolescents from 2 to 18 years,


4. healthy adults;

antiviral prophylaxis,
social distancing measures.

To evaluate the impact of these preventive measures on the national population, a mathematical model was developed by a working group that included researchers from the Universities of Trento, Pisa and Rome, and the National Institute of Health (Istituto Superiore di sanità, ISS) The results were published in an ISS report in December 2006 [3] and are summarised here.

Modelling pandemic influenza transmission and control measures
A SEIR (susceptible; infected but not infectious; infectious; resistent, that is, immune to re-infection) deterministic model, with a stochastic simulation component was used. An R0 (the basic reproductive number) of 1.8 was assumed, with a cumulative attack rate (AR) of 35% [4].

We modelled the impact of vaccination, antiviral prophylaxis and measures aimed to increase social distancing. For each measure, various scenarios were considered, assuming different target populations and duration of interventions [3].

As standard parameters, we considered that the target population would receive the first dose of vaccine 12 weeks after the onset of the index case in Italy, and the second dose four weeks after that. This two dose cycle was assumed to be 70% effective, starting 15 days after the administration of the second dose. Vaccine coverage was fixed at 60%.

Antiviral prophylaxis of uninfected individuals was assumed to reduce susceptibility to infection by 30% [5]. We supposed that only household contacts of influenza cases would be treated, limiting the use of antiviral prohlylaxis to a maximum of 8 weeks after the onset of illness in the index case.

School closure lasting 3 weeks was assumed to start 2, 4, or 8 weeks after the onset of the index case. As the same time, it was assumed that public offices not providing essential services would be closed for 4 weeks, and recreational venues such as theatres and cinemas, for 8 weeks.

In absence of control measures, the epidemic peak would be reached approximately 4 months after the first case onset, with a total of 3 million cases during the peak week. The epidemic would be over in 7 months, with a cumulative attack rate of 35% (approximately 20 million cases).

The interventions considered, when implemented singly, would reduce the cumulative attack rate to, at best, approximately 32% (vaccination only). Using either prophylaxis with antiviral drugs or social distancing measures alone would have no effect in reducing the cumulative AR, but would delay the epidemic peak by approximately one and three weeks, respectively.

Multiple interventions involving vaccination, antiviral prophylaxis and social distancing measures, would reduce the cumulative attack rate to 20% at a minimum [range: 20% - 24%], with 8 millions cases avoided.

Modelling results confirm the need to respond to a pandemic with multiple preventive measures [6-8]. None of the interventions looked at is highly effective when implemented independently.

These results, which evaluated interventions included in the national prepardness plan, also show that preparedness is crucial, in order to organise all the control measures necessary to face an emergency. Timing is also essential, and measures which at first glance appear to be less important, such as increasing social distancing, could be extremely useful for delaying the epidemic peak, allowing time for greater availability of a vaccine, and thus optimising its impact.

The implementation of multiple measures, including closure of schools and workplaces requires the involvment of various medical and non-medical structures. It is therefore essential to properly communicate them the importance of such actions. Mathematical modelling based on national data are a relevant tool to assist public health decisors in preparing for responding to a new influenza pandemic.

*EPICO working group:
M L Ciofi degli Atti1, C Rizzo1, A Bella1, M Massari1, M Iannelli2, A Lunelli2, A Pugliese2, J Ripoll2, P Manfredi3, G Scalia Tomba4, S Merler5, G Jurman5, C Furlanello5

1Istituto Superiore di Sanità, Centro nazionale di Epidemiologia, Sorveglianza e Promozione della Salute, Reparto Epidemiologia delle Malattie infettive, Rome, Italy
2Università degli Studi di Trento; Dipartimento di matematica, Trento, Italy
3Università degli Studi di Pisa, Dipartimento di Statistica e Matematica Applicata all'Economia, Pisa, Italy
4Università degli Studi di Roma Tor Vergata; Dipartimento di matematica, Rome, Italy
5Istituto Trentino di Cultura, Istituto per la ricerca scientifica e tecnologica (ITC-IRST), Trento, Italy

  1. Ministero della Salute. Piano Nazionale di preparazione e risposta ad una pandemia influenzale 2006. Available at: (
  2. WHO global influenza preparedness plan: the role of WHO and recommendations for national measures before and during pandemics. WHO/CDS/CSR/GIP/2005.5. Geneva: World Health Organization; March 2005. (
  3. Epico working Group. Scenarios of diffusion and control of influenza pandemic in Italy In Italian, English abstract available. Rapporto Istisan 2006; 33/06. (
  4. Glezen WP. Emerging infections: pandemic influenza. Epidemiol Rev 1996;18(1):64-76.
  5. Monto AS. Vaccines and antiviral drugs in pandemic preparedness. Emerg Infect Dis 2006 Jan;12(1):55-60. (
  6. Ferguson NM, Cummings DA, Fraser C, Cajka JC, Cooley PC, Burke DS. Strategies for mitigating an influenza pandemic. Nature 2006 Jul 27;442(7101):448-52
  7. Longini IM Jr, Nizam A, Xu S, Ungchusak K, Hanshaoworakul W, Cummings DA, et al. Containing pandemic influenza at the source. Science 2005 Aug 12;309(5737):1083-7.
  8. Germann TC, Kadau K, Longini IM, Jr., Macken CA. Mitigation strategies for pandemic influenza in the United States. Proc Natl Acad Sci U S A 2006 Apr 11;103(15):5935-40

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