The objective of the study was to provide immunization policy decision makers with a risk–benefit analysis for pre-adolescents vaccination, for various scenarios regarding the existence and the strength of an association between hepatitis B vaccination and the occurrence of first episode of central demyelinating (FECD) disease. The risks were assessed as the attributable risks of FECD for various time intervals between vaccination and onset of FECD and the benefits as the number of acute fulminant hepatitis B and cirrhosis prevented in a vaccinated annual cohort. Even in the worst-case considered, the number of complications prevented by the vaccination outweighs quantitatively the potential risks. Even if both sides of the balance are of different medical and sociological nature, this result is in favor of reinforcing the pre-adolescent vaccination strategy in France.

An outbreak of 538 cases of trichinellosis occurred in France in December 1993. Seven cases developed neurotrichinosis and 23 had cardiologic complications. No deaths were recorded. Two patients had a positive muscle biopsy showing living Trichinella larvae. One of them was typed as Trichinella spiralis. A case-control study showed that horse meat was the only meat associated with illness (odds ratio = 80.7). The risk of illness increased with the amount of horse meat eaten and when it was consumed raw. The cases, which were spread out in five foci, bought horse meat from five butchers who had received parts of a single horse carcass imported in November 1993 from Canada. The Trichinella International Screening Program, implemented since 1985 after two similar episodes involving a thousand cases, failed to detect the incriminated horse carcass. This new horse meat-related outbreak led to modifications of the internationally recommended screening methods whereby the weight of meat samples tested was increased.

Background. - With the recent pertussis vaccine trials, the efficacy of acellular vaccines is now well known, estimated at 85% for multicomponent vaccines. On the other hand, the estimates of whole cell vaccines efficacy varies from 36% to 98% with the different vaccines used. We evaluated the field effectiveness of the French whole cell pertussis vaccine during outbreaks in schools and centers for disabled children.Methods. - Four limited outbreaks between 1993 and 1995 were investigated using a retrospective cohort study design. Vaccine effectiveness (VE) was assessed for the following case definition: clinical pertussis, laboratory-confirmed pertussis, epidemiologically confirmed pertussis (documented contact with a laboratory confirmed case). Immunization history was obtained by reviewing the child health record book. Effectiveness of a whole vaccination (four injections) and of a partial vaccination (one to three injections) were estimated as 1-(attack rare among vaccinated/attack rate among non-vaccinated).Results. - A whole immunization conferred good protection against pertussis with an estimated VE higher than 92% in three surveys, lower in the fourth sun ey (84%) in which antibiotic prophylaxis was set up very rapidly. A partial immunization conferred a mild protection (median: 60%).Conclusions. - These results are consistent with a previous report about the effectiveness of this whole cell vaccine using the screening method in a hospital network survey in France. In the same way, a large efficacy trial in Senegal comparing if with an acellular bivalent vaccine estimated its efficacy at 96%. This high efficacy together with a satisfactory vaccine coverage leads to the current epidemiological profile of pertussis in childhood in France: majority of cases occurring before 6 months of age, limited outbreaks in school children, many of whom being unvaccinated or partially vaccinated.

Since the Maastricht Treaty was signed, public health and disease prevention have become an official competence of the European Community (EC) (1Title X, Article 129, Public HealthMasstricht treaty.Official Journal of the European Communities, Brussels. 31 August 1992; Google Scholar). This political event is important because it recognizes the European dimension of public health and opens new perspectives for prevention in Europe. It also gives a political and official foundation to a European approach towards disease prevention and control which can be applied to infectious diseases. With the free circulation of foods, goods and persons in Europe the potential for disease transmission in Europe will increase (2Bartlett C Gill N Communicable disease after Maastricht germs and subsidiarity.Lancet. 1993; 341: 997-998Abstract PubMed Scopus (5) Google Scholar). In addition new threats are emerging (prions) and old diseases are reemerging (tuberculosis, diphtheria …). In this context the strengthening of infectious disease epidemiology and surveillance at a European level is needed more than ever. This paper will review and discuss some of the current European collaborations in infectious disease epidemiology. Traditionally, global infectious diseases surveillance in the European region has been coordinated by the WHO office in Copenhagen. Collaboration of National Centers designated “WHO collaborating Centers” have contributed to strengthen the WHO regional office approach (e.g. The WHO Collaborating Center on Food-Borne Diseases in Berlin, the WHO Collaborating Center for Health and Disease Surveillance in Rome …). Through meetings of National Institutions responsible for infectious diseases surveillance and control, the WHO regional Office also contributed to a European approach towards topics such as immunization, food-borne and sexually transmitted diseases. However, this approach was passive and, until recently, no real European public health initiatives in infectious diseases have been based on a European-wide infectious diseases surveillance. With the occurrence of the AIDS epidemic a new approach was rapidly implemented in Europe. Based on the principle that prevention and control of infectious diseases depends on the setting of appropriate and timely surveillance mechanisms nationally and internationally, EC and COST (Cooperating On Science and Technology) countries created a European AIDS surveillance system in Europe with the support of the EC (DG XII). The European AIDS surveillance, through the WHO European Centre for the Epidemiological Monitoring of AIDS in Paris, which has been extended to all countries of the WHO European region, provides quarterly updates of the AIDS epidemic and allows meaningful comparisons of trends between countries. This surveillance also permitted the implementation of a common case definition revised over time and concerted research projects on the epidemiology of HIV in Europe. The experience of European AIDS surveillance, an achievement of European concerted collaboration under the auspices of the Project Management Group (PMG) on AIDS Epidemiology of the AIDS Working Party in the EC Medical Research Programme, has been recognized as a possible model for further concerted European surveillance on other infectious diseases of public health importance (3Maynard A Fredrickson D Garattini S Mäkela H Mattheis R Papadimitriou M EUR 13001 — Evaluation of the fourth Medical and Health Research Programme (1987–1991). Commission of the European Communities, Luxemburg1990Google Scholar). Therefore, in 1990, all EC and COST countries explored the possibility of developing surveillance mechanisms similar to the AIDS surveillance for other infectious diseases (3Maynard A Fredrickson D Garattini S Mäkela H Mattheis R Papadimitriou M EUR 13001 — Evaluation of the fourth Medical and Health Research Programme (1987–1991). Commission of the European Communities, Luxemburg1990Google Scholar). Before issuing recommendations and implementing new European surveillance systems, an inventory of EC and COST national infectious diseases surveillance was carried out in 1991 and 1992 by the European Centre for the Epidemiological Monitoring of AIDS (3Maynard A Fredrickson D Garattini S Mäkela H Mattheis R Papadimitriou M EUR 13001 — Evaluation of the fourth Medical and Health Research Programme (1987–1991). Commission of the European Communities, Luxemburg1990Google Scholar). This inventory, which focused on sexually transmitted diseases, hepatitis and tuberculosis surveillance helped conclude that, as far as health care delivery is concerned, surveillance systems vary widely in nature, design and quality from country to country. It also highlighted the need for a coordinated active approach to develop infectious disease prevention and control further at the European level (4Bijkerk H Desenclos JC Huisman J Exploratory Research on the Surveillance of Infectious Diseases in Relation to HIV Infection in EC and COST Countries.Report of the Project Management Group on AIDS Epidemiology of the AIDS Working Party in the EC Medical Research Programme. European Centre for the Epidemiological Monitoring of AIDS, ParisJuly 1992Google Scholar). The results of the inventory were discussed at a workshop of national representatives held in Saint-Maurice on November 19–20, 1992 (5Desenclos JC Bijkerk H Huisman J Variations in national infectious diseases surveillance in Europe.Lancet. 1993; 341: 1003-1006Abstract PubMed Scopus (36) Google Scholar). This workshop issued recommendations on the need for a “European Epidemiological Service (EES) for Communicable Diseases” and identified, within the EES priority activities: the harmonization of case definition, the implementation of a European training course in field epidemiology, the dissemination of information through a European Epidemiological bulletin. … (5Desenclos JC Bijkerk H Huisman J Variations in national infectious diseases surveillance in Europe.Lancet. 1993; 341: 1003-1006Abstract PubMed Scopus (36) Google Scholar) When looking back on the statement of the November 1992 meeting one can see that these recommendations have now been translated into real projects. With the support of the EC Directorate General V, three projects are currently implemented: a European training course in Field Epidemiology followed by a 2-year field assignment for each student in another country (this project is coordinated by the Institute of Hygiene and Epidemiology, Brussels, Belgium); a European Epidemiological Bulletin (bilingual: English and French), coordinated by the European Centre for the Epidemiological Monitoring of AIDS, the Réseau National de Santé Publique (France) and the Communicable Disease Surveillance Centre (CDSC, United Kingdom) and the definition of a charter for infectious diseases surveillance in Europe coordinated by the CDSC. In addition, several operational collaborations have been initiated recently, among which, a salmonellosis network (“Salm-net”) and a legionellosis network. These epidemiological networks, which link together laboratories, reference centres and epidemiological institutions aimed at creating a common data base to analyse trends in Europe and detect outbreaks and/or unusual events. Harmonization of Salmonella phage-typing systems through Europe is also one of the objectives of “Salm-net” which has been able to identify European-wide outbreaks caused by contaminated food distributed in several countries (7AnonymousAn outbreak of Salmonella agona due to contaminated snacks.CDR. 1995; 7: 29-32Google Scholar). In the future, these networks will rely on fast communication technologies. Efforts to strengthen the surveillance, control and prevention of infectious diseases at the European level have started several decades ago. However, with the reemergence of old diseases, the occurrence of new threats and the free exhange of persons, goods and foods, more efforts need to be made to assure a high level of prevention. The review of selected recent developments indicates that there is a clear political and technical will to move towards a European active approach through a close concerted mechanism.

Serum antioxidant vitamins A (retinol) and E (alpha-tocopherol), beta-carotene, zinc and selenium for 418 children with newly diagnosed malignancy were compared with those of 632 cancer-free controls. Incident cancer cases and controls were 1-16 years old and recruited in 1986-1989. Age- and sex-adjusted serum concentrations of retinol, beta-carotene and alpha-tocopherol were significantly inversely associated with cancer. In similar models, the odds ratio (OR) comparing the highest with the lowest quintile was 2.06 (95% confidence interval [CI] 1.40-3.02) for retinol, 3.87 (95% CI: 2.54-5.90) for beta-carotene, 2.15 (95% CI: 1.48-3.10) for alpha-tocopherol, 1.29 (95% CI: 0.75-2.23) for selenium, and 1.94 (95% CI: 1.17-2.23) for zinc. The cancer sites that were associated with serum beta-carotene were, in general, leukaemia, lymphoma, central nervous system, bone and renal tumours. Moreover, leukaemia was associated with low mean serum levels of retinol, selenium and zinc. Subjects with lymphoma, bone and renal tumours also had lower mean retinol and alpha-tocopherol levels than controls. Brain tumour patients had low vitamin E levels. Low serum values of antioxidant vitamins were associated with childhood neoplasm occurrence. Some site-specific effect was reported. Low peripheral nutrient levels are not considered as cancer promoters but rather as an impairment of the body's defence mechanism occurring during the cancer-related metabolic and nutritional disturbances and inflammation processes.

Serum antioxidant vitamins A (retinol) and E (alpha-tocopherol), beta-carotene, zinc and selenium for 418 children with newly diagnosed malignancy were compared with those of 632 cancer-free controls. Incident cancer cases and controls were 1-16 years old and recruited in 1986-1989. Age- and sex-adjusted serum concentrations of retinol, beta-carotene and alpha-tocopherol were significantly inversely associated with cancer. In similar models, the odds ratio (OR) comparing the highest with the lowest quintile was 2.06 (95% confidence interval [CI] 1.40-3.02) for retinol, 3.87 (95% CI: 2.54-5.90) for beta-carotene, 2.15 (95% CI: 1.48-3.10) for alpha-tocopherol, 1.29 (95% CI: 0.75-2.23) for selenium, and 1.94 (95% CI: 1.17-2.23) for zinc. The cancer sites that were associated with serum beta-carotene were, in general, leukaemia, lymphoma, central nervous system, bone and renal tumours. Moreover, leukaemia was associated with low mean serum levels of retinol, selenium and zinc. Subjects with lymphoma, bone and renal tumours also had lower mean retinol and alpha-tocopherol levels than controls. Brain tumour patients had low vitamin E levels. Low serum values of antioxidant vitamins were associated with childhood neoplasm occurrence. Some site-specific effect was reported. Low peripheral nutrient levels are not considered as cancer promoters but rather as an impairment of the body's defence mechanism occurring during the cancer-related metabolic and nutritional disturbances and inflammation processes.