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Public Health in the European Union is mainly a formal competence of the Member States. EU Treaties and Regulations have given EU gradually more mandate in past decades on issues of surveillance, epidemic intelligence, early warning and cross-border response coordination. In this context, sharing timely information on public health threats (fast and slow) to inform interventions at national and EU level, remains of great added value for all Member States. This depends on common standards, compatibility and interoperability of information systems. In this session, panellists will share their experience and recent digital health developments from the perspective of regional, national and international public health and discuss this in the light of developments in digital technology.

Highly specialized professional communities of practice (CoP) inevitably need to operate across geographically dispersed area - members frequently need to interact and share professional content. Crowdsourcing using wiki platforms provides a novel way for a professional community to share ideas and collaborate on content creation, curation, maintenance and sharing. This is the aim of the Field Epidemiological Manual wiki (FEMwiki) project enabling online collaborative content sharing and interaction for field epidemiologists around a growing training wiki resource. However, while user contributions are the driving force for content creation, any medical information resource needs to keep editorial control and quality assurance. This requirement is typically in conflict with community-driven Web 2.0 content creation. However, to maximize the opportunities for the network of epidemiologists actively editing the wiki content while keeping quality and editorial control, a novel structure was developed to encourage crowdsourcing -- a support for dual versioning for each wiki page enabling maintenance of expertreviewed pages in parallel with user-updated versions, and a clear navigation between the related versions. Secondly, the training wiki content needs to be organized in a semantically-enhanced taxonomical navigation structure enabling domain experts to find information on a growing site easily. This also provides an ideal opportunity for crowdsourcing. We developed a user-editable collaborative interface crowdsourcing the taxonomy live maintenance to the community of field epidemiologists by embedding the taxonomy in a training wiki platform and generating the semantic navigation hierarchy on the fly. Launched in 2010, FEMwiki is a real world service supporting field epidemiologists in Europe and worldwide. The crowdsourcing success was evaluated by assessing the number and type of changes made by the professional network of epidemiologists over several months and demonstrated that crowdsourcing encourages user to edit existing and create new content and also leads to expansion of the domain taxonomy.

A seroprevalence study found no transmission of avian influenza H5N1 viruses from patients to hospital employees in Vietnam, 2004., To establish whether human-to-human transmission of influenza A H5N1 occurred in the healthcare setting in Vietnam, we conducted a cross-sectional seroprevalence survey among hospital employees exposed to 4 confirmed and 1 probable H5N1 case-patients or their clinical specimens. Eighty-three (95.4%) of 87 eligible employees completed a questionnaire and provided a serum sample, which was tested for antibodies to influenza A H5N1. Ninety-five percent reported exposure to >1 H5N1 case-patients; 59 (72.0%) reported symptoms, and 2 (2.4%) fulfilled the definition for a possible H5N1 secondary case-patient. No study participants had detectable antibodies to influenza A H5N1. The data suggest that the H5N1 viruses responsible for human cases in Vietnam in January 2004 are not readily transmitted from person to person. However, influenza viruses are genetically variable, and transmissibility is difficult to predict. Therefore, persons providing care for H5N1 patients should continue to take measures to protect themselves.

To survey trends in data on hepatitis A using information from the notification system of the Municipal Medical and Health Services 1993-2002.Retrospective, descriptive.Data collected from the notification system of the Dutch Municipal and Medical Services were analyzed.From 1993 to 2002, 64.4%, 6.5% and 11.5% of infections were contracted in the Netherlands, Turkey and Morocco, respectively. Although the absolute number of cases was highest for young people under the age of 16 infected in the Netherlands, incidence rates showed that the children of immigrants infected in Turkey or Morocco were at highest risk, followed by adult immigrants from Turkey and Morocco. In addition, a seasonal trend was observed starting with an increase in the number of notifications of young travellers infected in Turkey and Morocco during their summer holiday, followed by a steep increase in notifications of young people infected in the Netherlands in autumn. This was followed later in the year by a slight increase in notifications of adults who acquired the infection in the Netherlands. However, between 1993-2002 the total number of notifications was halved. This decrease was mainly restricted to infections acquired in the Netherlands. In recent years, fewer outbreaks have been reported in schools, households and families. In 2001, a peak of notifications from the homosexual scene was observed. There was a continued trend in the rise of the mean age of hepatitis-A onset.Risk of hepatitis A is highest for the children of immigrants travelling to Turkey or Morocco in the summer months. Secondary cases in the Netherlands are in strong decline, especially in schools and families. However, the almost stable incidence of infections among young people of Turkish or Moroccan extraction stresses the continued importance of immunization of this group before they travel. The continuing trend in the rise of the mean age of hepatitis-A onset deserves attention because of the increasing risk of mortality of the disease amongst older people.

Hepatitis B was diagnosed in two homosexual men aged 41 and 31 years. Both had undergone piercing on the same day in the same saloon. The word piercing means application of decorations in the skin which is pierced for the purpose. The breeching of the skin combined with the conditions under which this is performed leads to a risk of transmission of especially viral infections. An assumed connection between the patients was supported by the results of molecular-biological examination of the hepatitis B virus isolates. The piercings were applied with the same pair of pincers, which was not sterilized in between. In view of these findings hygienic measures were taken in the piercing saloon in question to prevent future transmission of infections. Piercing entails health risks that are not always recognized either by those who do it or by those who have it done.

To evaluate costs and benefits of the screening and immunisation policy for hepatitis A virus (HAV) infection among travellers from Rotterdam.Descriptive and cost-benefit analysis.From the data of the Municipal Health Service Rotterdam (GGD), the Netherlands, the details were collected on individuals travelling frequently to HAV endemic countries, who were born before 1950, or had lived for more than 10 years in an HAV endemic country or had ever suffered jaundice. Persons to whom these criteria applied were screened for HAV antibodies at the GGD before immunisation for HAV in the period January 1st 1996-June 30th 1998. Screening and vaccination policies were compared with a cost analysis.Antibodies against HAV were found in 79% of 1466 screened people. The lowest prevalence of antibodies was found among Dutch nationals (67%). A significantly higher prevalence was found amongst individuals from Turkey/Morocco (96%) and from the Cape-Verde Islands (97%). In the cost analysis the break even point, the prevalence level of HAV antibodies in the population at which screening cost as much as blind prophylaxis, lay for passive immunisation between 69% and 93%. For active immunisation this point lay around 17%.The selection criteria for prevaccination screening are effective in identifying individuals with a high probability of being immune against HAV infections. The current screening policy for antibodies against HAV is cost effective.

To assess the extent of a measles epidemic in a secondary school.Retrospective and questionnaire investigation.Secondary school, Bilthoven.Questionnaire followed by laboratory testing for measles and other infectious diseases with exanthema.The response rate was 99% (935/949 pupils, aged 12-21 years, vaccination rate 92%). Seventy-seven students underwent laboratory investigations. Measles virus was isolated in 2 suspected patients. Thirty-three of 37 patients with clinical or laboratory criteria of measles had been vaccinated. Complications of measles were not detected. Infection was also detected in patients with relatively few or atypical symptoms. The protective efficacy of measles vaccine could be determined because the attack rate of the school population was less than 5%.Primary failure of the measles vaccine might be the cause of the minor epidemic but the results do not cast doubt on the efficacy of the current measles vaccination programme.

Three women, aged 21, 20 and 30 years, were cocaine users and pregnant. There had been no prenatal monitoring until they reported with uterine contractions. Blood of the first two women was then tested; serology revealed active syphilis infections: their children had died in utero. The blood of the third woman had been tested as part of a street project; it revealed an active syphilitic infection but she could not be found for treatment. After delivery, the child showed withdrawal symptoms. The first and third women and the child of the third woman were treated with benzylpenicillin. The system for screening and treating drug-addicted pregnant women should be intensified.

An unexpectedly large number of hepatitis A virus (HAV) infections were notified among homosexual men in Rotterdam in the first five months of 1998. A case control study was conducted to investigate the hypothesis that this outbreak was associated with sexual practices and to collect information with which to focus preventive activities. Notified cases and controls selected from male members of a gay sports club completed anonymous questionnaires about known risk factors for HAV infection and sexual behaviour. Single variable analysis showed that HAV infection was associated with sexual contact with anonymous sex partners (odds ratio (OR) 4.6; 95% confidence interval (CI) 1.0-23.2) and with visits to 'darkrooms' in gay bars (OR 6.2; 95% CI 1.5-26.8). A negative association with travel abroad to western countries was observed (OR 0.4; 95% CI 0.1-1.3). The associations with visits to darkrooms (OR = 9.2; 95% CI 1.6-52.4) and travel abroad to western countries (OR 0.1; 95% CI 0.02-0.9) remained significant in a multivariable logistic regression analysis. This risk group was targeted for health education and vaccination and darkroom owners were advised to provide hygiene facilities.

The number of cases of syphilis in Rotterdam has increased dramatically since 1995. The prevalence of early syphilis in 1997 was highest among street prostitutes (16%). Some prostitutes could not be reached for further evaluation and treatment, probably due to their addiction to hard drugs. Prophylactic treatment for syphilis was given to most street prostitutes in a cruising zone during a screening programme for sexually transmitted diseases (STD) in January 1997. Since then, STD checkups were performed regularly in the cruising zone. The prevalence of early syphilis in the cruising zone dropped to 1.3% in 1998. The total number of reported cases of syphilis in Rotterdam also decreased sharply in 1998.

Salmonella remains an important source of food-related outbreaks of gastro-enteritis. In The Netherlands, regional laboratories send cultured Salmonella isolates to the National Institute of Public Health and the Environment (RIVM) for sero- and phage typing. Abnormal increases in the incidence of Salmonella infections are monitored by means of surveillance. Since the middle of September 2005, there has been a sharp increase in Salmonella Typhimurium DT104 (Dutch phage type 506 and 401) isolates, from all parts of the country and mainly from 6- to 20-year-olds. Since a first series of telephone interviews did not yield a clear source of the outbreak, a more extensive, written study has been started in a larger group of patients and corresponding controls.