Infokiri

Surveillance Atlas of Infectious Diseases FWD (2023 data)
Information about the Data

Anthrax 2
Botulism 6
Brucellosis 10
Campylobacteriosis 14
Antimicrobial resistance in Campylobacter jejuni and C. coli 19
Cholera 23
Cryptosporidiosis 27
Echinococcosis 31
Giardiasis (lambliasis) 35
Hepatitis A 39
Leptospirosis 43
Listeriosis 47
Salmonellosis and typhoid/paratyphoid fever 52
Antimicrobial resistance in Salmonella spp. 59
Shigellosis 63
Antimicrobial resistance in Shigella spp. 67
STEC/VTEC infection 70
Congenital toxoplasmosis 75
Trichinellosis 79
Variant Creutzfeldt-Jakob disease (vCJD) 83
Yersiniosis 87

Anthrax
Last updated: 13 August 2024
Data retrieval from TESSy: 13 August 2024

Anthrax is a zoonotic disease caused by the spore-producing bacterium Bacillus anthracis. Humans may acquire the infection after exposure to spores in the soil or in animals. For a more detailed description of the disease and its epidemiology, please click here.
Data
The Surveillance Atlas of Infectious Diseases displays data on anthrax reported by the EU/EEA countries. Cases are to be reported according to the 2018 EU case definition for anthrax1:
Clinical criteria
Any person with at least one of the following clinical forms:
Cutaneous anthrax
At least one of the following two:
— Papular or vesicular lesion
— Depressed black eschar with surrounding oedema
Gastrointestinal anthrax
— Fever or feverishness
AND at least one of the following two:
— Severe abdominal pain
— Diarrhoea
Inhalational anthrax
— Fever or feverishness
AND at least one of the following two:
— Acute respiratory distress
— Radiological evidence of mediastinal widening
Meningeal/meningoencephalitic anthrax
— Fever
AND at least one of the following three:
— Convulsions
— Loss of consciousness
— Meningeal signs
Anthrax septicaemia
Laboratory criteria
At least one of the following two:
— Isolation of Bacillus anthracis from a clinical specimen
— Detection of Bacillus anthracis nucleic acid in a clinical specimen
Positive nasal swab without clinical symptoms does not contribute to a confirmed diagnosis of a case
Epidemiological criteria
At least one of the following three epidemiological links:
— Animal to human transmission
— Exposure to a common source
— Exposure to contaminated food/drinking water

Case classification
A. Possible case: NA
B. Probable case: Any person meeting the clinical criteria with an epidemiological link
C. Confirmed case: Any person meeting the clinical and the laboratory criteria

Note: If the national surveillance system is not capturing clinical symptoms, all laboratory-confirmed individuals should be reported as confirmed cases.

------------------------
(The note is the only difference between the 2018 EU case definition of anthrax and the 2012 and 2008 EU case definitions.)
Data collection and analysis
Data are collected on an annual basis for the previous year. Countries can also update their data at any time. Before analysis, data are validated with nominated data providers in EU/EEA countries. Note that data published in the Surveillance Atlas might differ from figures in national reports due to different times of reporting, inclusion of cases by different case definitions and use of different denominators.
Indicators were displayed as “–” and not calculated for variables with more than 50% of cases with undocumented information (unknown or missing) for a given geographical resolution (e.g. country, EU/EEA) and time period.
Surveillance systems across the EU/EEA countries are heterogeneous and a surveillance systems overview is displayed in Annex 1.
Surveillance Atlas indicators
The Surveillance Atlas indicator for confirmed anthrax is:
1. Number of reported cases;

For this indicator, the data may be displayed in a bar chart or a pie chart by proportion of:
• Age groups (< 1 year, 1-4, 5-14, 15-24, 25-44, 45-64, 65 years and above);

Symbols used in the Surveillance Atlas table:
Symbol
Comment
–
Indicator is not calculated for a given geographical resolution and time period.
.
Missing data. Data are not reported to TESSy for a given time period.

Data quality
EU/EEA countries reporting data on anthrax as displayed in the Annex 1. For data quality, reporting completeness of variables used to calculate Surveillance Atlas indicators was analysed for reported, confirmed cases. For countries reporting data only in aggregated format, the analysis of data completeness is allowed only for data reported such as age.
The Surveillance Atlas indicator for data quality of confirmed anthrax cases is:
• Completeness age (%).

Interpretation
The data shown in the Surveillance Atlas should be interpreted carefully as national surveillance systems differ from each other.
The notification of anthrax is mandatory and surveillance systems have full national coverage in all EU/EEA countries. In Belgium, full national coverage was established in 2015. In Spain, not all regions have reported data for 2020 and 2021 and case numbers might therefore not be complete. All countries provide case-based data.
Reports published by ECDC on anthrax
More information is available in ECDC reports. Note that later retrieval of data related to the same period may result in slightly different numbers as countries have the possibility to update data in TESSy retrospectively. Therefore, the data presented in the reports might slightly differ from the data presented in the Surveillance Atlas.
Annual epidemiological report for 2021 – Anthrax:
https://www.ecdc.europa.eu/sites/default/files/documents/anthrax-annual-epidemiological-report-for-2021.pdf


Annex 1. Surveillance systems overview, 2023
Country
Data source
Compulsory (Cp), voluntary (V), other(O)
Comprehensive (Co), sentinel (Se), other(O)
Active (A), passive (P)
Case-based (C), aggregated (A)
Data reported by
Case definition used






Laboratories
Physicians
Hospitals
Others

Austria
AT-Epidemiegesetz
Cp
Co
P
C
Y
Y
Y
Y
EU-2008
Belgium
BE-REFLAB
Cp
Co
P
C
Y
N
N
N
EU-2018
Bulgaria
BG-NATIONAL_SURVEILLANCE
Cp
Co
P
A
Y
Y
Y
Y
EU-2018
Croatia
HR-CNIPH
Cp
Co
P
C
Y
Y
Y
Y
EU-2012
Cyprus
CY-NOTIFIED_DISEASES
Cp
Co
P
C
N
Y
N
N
EU-2008
Czechia
CZ-ISIN
Cp
Co
A
C
Y
Y
Y
N
EU-2008
Denmark
DK-MIS
Cp
Co
P
C
N
Y
N
N
Other
Estonia
EE-NAKIS
Cp
Co
P
C
Y
Y
Y
N
EU-2018
Finland
FI-NIDR
Cp
Co
P
C
Y
Y
N
N
EU-2012
France
FR-MANDATORY_INFECTIOUS_DISEASES
Cp
Co
P
C
Y
Y
Y
Y
Not specified/unknown
Germany
DE-SURVNET@RKI-7.1/6
Cp
Co
P
C
Y
Y
Y
Y
Other
Greece
EL-NOTIFIABLE_DISEASES
Cp
Co
P
C
Y
Y
Y
.
EU-2018
Hungary
HU-EFRIR
Cp
Co
P
C
Y
Y
Y
N
EU-2012
Iceland
IS-SUBJECT_TO_REGISTRATION
Cp
Co
P
C
Y
Y
.
.
EU-2018
Ireland
IE-CIDR
Cp
Co
P
C
Y
Y
Y
N
EU-2008
Italy
IT-NRS
Cp
Co
P
C
N
Y
Y
N
Other
Latvia
LV-BSN
Cp
Co
P
C
Y
Y
Y
N
EU-2018
Liechtenstein
LI-ANTH
Cp
Co
P
C
Y
Y
Y
.
EU-2018
Lithuania
LT-COMMUNICABLE_DISEASES
Cp
Co
P
C
Y
Y
N
N
EU-2018
Luxembourg
LU-SYSTEM1
Cp
Co
P
C
Y
Y
N
N
EU-2018
Malta
MT-DISEASE_SURVEILLANCE
Cp
Co
P
C
Y
Y
Y
Y
EU-2018
Netherlands
NL-OSIRIS
Cp
Co
P
C
Y
Y
N
N
EU-2018
Norway
NO-MSIS_A
Cp
Co
P
C
Y
Y
Y
N
EU-2018
Poland
PL-NATIONAL_SURVEILLANCE
Cp
Co
P
C
Y
Y
Y
N
EU-2008
Portugal
PT-ANTRAX
Cp
Co
P
C
.
Y
N
N
EU-2018
Romania
RO-RNSSy
Cp
Co
P
C
N
N
Y
N
EU-2018
Slovakia
SK-EPIS
Cp
Co
A
C
Y
Y
Y
N
EU-2018
Slovenia
SI-SURVIVAL
Cp
Co
P
C
Y
Y
Y
N
EU-2008
Spain
ES-STATUTORY_DISEASES
Cp
Co
P
C
Y
Y
Y
N
EU-2018
Sweden
SE-SMINET
Cp
Co
P
C
Y
Y
N
N
EU-2012

Botulism
Last updated: 13 August 2024
Data retrieval from TESSy: 13 August 2024

Botulism is a serious paralytic illness caused by a preformed nerve toxin produced in most cases by Clostridium botulinum. Three forms of botulism are distinguished according to the site of toxin production: foodborne, wound and intestinal (infant and adult) botulism. For a more detailed description of the disease and its epidemiology, please click here.
Data
The Surveillance Atlas of Infectious Diseases displays data on botulism reported by the EU/EEA countries. Cases are to be reported according to the 2018 EU case definition for botulism2:
Clinical criteria
Any person with at least one of the following clinical forms:
Food-borne and wound botulism
At least one of the following two:
— Bilateral cranial nerve impairment (e.g. diplopia, blurred vision, dysphagia, bulbar weakness);
— Peripheral symmetric paralysis.
Infant botulism
Any infant with at least one of the following six:
— Constipation;
— Lethargy;
— Difficulty in sucking or feeding;
— Ptosis;
— Dysphagia;
— General muscle weakness.
The type of botulism usually encountered in infants (< 12 months of age) can affect children also over 12 months of age and occasionally adults, with altered gastrointestinal anatomy and microflora.
Laboratory criteria
At least one of the following three:
— Isolation of BoNT-producing clostridia (for example, Clostridium botulinum, C. baratii, C. butyricum) for infant botulism (stool) or wound botulism (wound);
— Detection of botulinum neurotoxins in a clinical specimen;
— Detection of genes encoding for botulinum neurotoxins in a clinical specimen.
Epidemiological criteria
At least one of the following two epidemiological links:
— Exposure to a common source (e.g. food, sharing of needles or other devices)
— Exposure to contaminated food/drinking water

Case classification
A. Possible case: NA
B. Probable case: Any person meeting the clinical criteria with an epidemiological link
C. Confirmed case: Any person meeting the clinical and the laboratory criteria
------------------------
(Compared to the 2008 and 2012 EU case definition of botulism, the 2018 EU case definition covers also other species of BoNT-producing Clostridium and allows genotypic tests for laboratory confirmation.)
Data collection and analysis
Data are collected on an annual basis for the previous year. Countries can also update their data at any time. Before analysis, data are validated with nominated data providers in EU/EEA countries. Country population denominators by age group for the calculation of notification rates were obtained from Eurostat3. Note that data published in the Surveillance Atlas might differ from figures in national reports due to different times of reporting, inclusion of cases by different case definitions and use of different denominators.
Indicators were displayed as “–” and not calculated for variables with more than 50% of cases with undocumented information (unknown or missing) for a given geographical resolution (e.g. country, EU/EEA) and time period. The age-standardised rate and the notification rate for domestic cases were calculated when age and travel history were known for at least 90% of cases.
Surveillance systems across the EU/EEA countries are heterogeneous and a surveillance systems overview is displayed in Annex 1.

Surveillance Atlas indicators
The Surveillance Atlas indicators for confirmed botulism are:
2. Number of reported cases;
3. Notification rate per 100 000 population;
4. Age-standardised rate per 100 000 population;
5. Number of hospitalised cases;
6. Proportion of hospitalised cases among confirmed cases with known history of hospitalisation (%);
7. Number of deaths derived from reporting of disease outcome;
8. Case fatality calculated as proportion of deaths among confirmed cases with known disease outcome (%);
9. Notification rate for domestic cases per 100 000 population;
10. Proportion of travel associated cases among confirmed cases with known travel history outside the reporting country (%);

For notification rate indicators, the data may be displayed in a bar chart as:
• Age-specific notification rate (for age groups < 1 year, 1-4, 5-14, 15-24, 25-44, 45-64, 65 years and above);
• Gender-specific notification rate.

For all other indicators, the data may be displayed in a bar chart or a pie chart by proportion of:
• Age groups (< 1 year, 1-4, 5-14, 15-24, 25-44, 45-64, 65 years and above);
• Gender;
• Neurotoxin type.

Symbols used in the Surveillance Atlas table:
Symbol
Comment
–
Indicator is not calculated for a given geographical resolution and time period.
.
Missing data. Data are not reported to TESSy for a given time period.

Data quality
EU/EEA countries reporting data on botulism as displayed in the Annex 1. For data quality, reporting completeness of variables used to calculate Surveillance Atlas indicators was analysed for reported, confirmed cases. For countries reporting data only in aggregated format, the analysis of data completeness is allowed only for data reported such as age and gender.

The Surveillance Atlas indicators for data quality of confirmed botulism cases are:
• Completeness age (%);
• Completeness gender (%);
• Completeness disease outcome (%);
• Completeness travel-associated (%);
• Completeness hospitalisation (%);
• Completeness neurotoxin type (%);

Interpretation
The data shown in the Surveillance Atlas should be interpreted carefully as national surveillance systems differ from each other.
The notification of botulism is mandatory and the surveillance systems have full national coverage in all EU/EEA countries. In Belgium, full national coverage was established in 2015 and rates before this date are not displayed. For 2020, Spain has not received data from all regions and rates are therefore not displayed for these years. All countries provide case-based data.
The completeness of some variables such as hospitalisation, outcome or travel history varies between countries and years; some countries are able to collect and integrate these data from different sources, other countries are not. Even if overall data completeness is high for some variables, the reader should refrain from directly comparing countries without taking into account limitations.

Reports published by ECDC on botulism
More information is available in ECDC reports. Note that later retrieval of data related to the same period may result in slightly different numbers as countries have the possibility to update data in TESSy retrospectively. Therefore, the data presented in the reports might slightly differ from the data presented in the Surveillance Atlas.

Annual epidemiological report for 2022 – Botulism:
Annual Epidemiological Report, Botulism, 2022 (europa.eu)

Epidemiological update on iatrogenic botulism cases in Europe (3 April 2023):
Update on iatrogenic botulism cases in Europe (europa.eu)

Epidemiological update 14 March 2023: Botulism cases in Europe following medical interventions with botulinum neurotoxin:
Botulism cases in Europe following medical interventions with botulinum neurotoxin (europa.eu)
Annex 1. Surveillance systems overview, 2023
Country
Data source
Compulsory (Cp), voluntary (V), other(O)
Comprehensive (Co), sentinel (Se), other(O)
Active (A), passive (P)
Case-based (C), aggregated (A)
Data reported by
Case definition used






Laboratories
Physicians
Hospitals
Others

Austria
AT-Epidemiegesetz
Cp
Co
P
C
Y
Y
Y
Y
EU-2008
Belgium
BE-REFLAB
Cp
Co
P
C
Y
N
N
N
EU-2018
Bulgaria
BG-NATIONAL_SURVEILLANCE
Cp
Co
P
C
Y
Y
Y
Y
EU-2018
Croatia
HR-CNIPH
Cp
Co
P
C
Y
Y
Y
Y
EU-2012
Cyprus
CY-NOTIFIED_DISEASES
Cp
Co
P
C
N
Y
N
N
EU-2008
Czechia
CZ-ISIN
Cp
Co
A
C
Y
Y
Y
N
EU-2008
Denmark
DK-MIS
Cp
Co
P
C
N
Y
N
N
Other
Estonia
EE-NAKIS
Cp
Co
P
C
Y
Y
Y
N
EU-2018
Finland
FI-NIDR
Cp
Co
P
C
Y
Y
N
N
EU-2012
France
FR-MANDATORY_INFECTIOUS_DISEASES
Cp
Co
P
C
Y
Y
Y
Y
Not specified/unknown
Germany
DE-SURVNET@RKI-7.1/6
Cp
Co
P
C
Y
Y
Y
Y
Other
Greece
EL-NOTIFIABLE_DISEASES
Cp
Co
P
C
Y
Y
Y
.
EU-2018
Hungary
HU-EFRIR
Cp
Co
P
C
Y
Y
Y
N
EU-2012
Iceland
IS-SUBJECT_TO_REGISTRATION
Cp
Co
P
C
Y
Y
.
.
EU-2018
Ireland
IE-CIDR
Cp
Co
P
C
Y
Y
Y
N
EU-2008
Italy
IT-NRS
Cp
Co
P
C
N
Y
Y
N
Other
Latvia
LV-BSN
Cp
Co
P
C
Y
Y
Y
N
EU-2018
Liechtenstein
LI-BOTU
Cp
Co
P
C
Y
Y
Y
.
EU-2018
Lithuania
LT-COMMUNICABLE_DISEASES
Cp
Co
P
C
Y
Y
N
N
EU-2018
Luxembourg
LU-SYSTEM1
Cp
Co
P
C
N
Y
N
N
EU-2018
Malta
MT-DISEASE_SURVEILLANCE
Cp
Co
P
C
Y
Y
Y
Y
EU-2018
Netherlands
NL-OSIRIS
Cp
Co
P
C
Y
Y
N
N
EU-2018
Norway
NO-MSIS_A
Cp
Co
P
C
Y
Y
Y
N
EU-2018
Poland
PL-NATIONAL_SURVEILLANCE
Cp
Co
P
C
Y
Y
Y
N
Other
Portugal
PT-BOTULISM
Cp
Co
P
C
N
Y
N
N
EU-2018
Romania
RO-RNSSy
Cp
Co
P
C
N
N
Y
N
EU-2018
Slovakia
SK-EPIS
Cp
Co
A
C
Y
Y
Y
Y
EU-2018
Slovenia
SI-SURVIVAL
Cp
Co
P
C
Y
Y
Y
N
EU-2008
Spain
ES-STATUTORY_DISEASES
Cp
Co
P
C
Y
Y
Y
N
EU-2018
Sweden
SE-SMINET
Cp
Co
P
C
Y
Y
N
N
Other

Brucellosis
Last updated: 13 August 2024
Data retrieval from TESSy: 13 August 2024

Brucellosis is a systemic infection caused by bacteria of the genus Brucella. For a more detailed description of the disease and its epidemiology, please click here.
Data
The Surveillance Atlas of Infectious Diseases displays data on brucellosis reported by the EU/EEA countries. Cases are to be reported according to the 2018 EU case definition for brucellosis4:
Clinical criteria
Any person with fever
And at least one of following seven:
— Sweating (profuse, malodorous, specially nocturnal);
— Chills;
— Arthralgia;
— Weakness;
— Depression;
— Headache;
— Anorexia.
Laboratory criteria
At least one of the following three:
— Isolation of human pathogenic Brucella spp. from a clinical specimen;
— Human pathogenic Brucella specific antibody response (Standard Agglutination Test, Complement Fixation, ELISA);
— Detection of human pathogenic Brucella spp. nucleic acid in a clinical specimen.
Epidemiological criteria
At least one of the following five epidemiological links:
— Exposure to contaminated food/drinking water;
— Exposure to products from a contaminated animal (milk or milk products);
— Animal to human transmission (contaminated secretions or organs e.g. vaginal discharge, placenta);
— Exposure to a common source;
— Laboratory exposure.

Case classification
A. Possible case: NA
B. Probable case: Any person meeting the clinical criteria with an epidemiological link
C. Confirmed case: Any person meeting the clinical and the laboratory criteria

Note: If the national surveillance system is not capturing clinical symptoms, all laboratory-confirmed individuals should be reported as confirmed cases.

------------------------
(Compared to the 2008 and 2012 EU case definition, the 2018 EU case definition allows genotypic tests for laboratory confirmation and has laboratory exposure as a possible epidemiological link. The note is also a new addition.)

Data collection and analysis
Data are collected on an annual basis for the previous year. Countries can also update their data at any time. Before analysis, data are validated with nominated data providers in EU/EEA countries. Country population denominators by age group for the calculation of notification rates were obtained from Eurostat5. Note that data published in the Surveillance Atlas might differ from figures in national reports due to different times of reporting, inclusion of cases by different case definitions and use of different denominators.
Indicators were displayed as “–” and not calculated for variables with more than 50% of cases with undocumented information (unknown or missing) for a given geographical resolution (e.g. country, EU/EEA) and time period. The age-standardised rate and the notification rate for domestic cases were calculated when age and travel history were known for at least 90% of cases.
Surveillance systems across the EU/EEA countries are heterogeneous and a surveillance systems overview is displayed in Annex 1.

Surveillance Atlas indicators
The Surveillance Atlas indicators for confirmed brucellosis cases are:
1. Number of reported cases;
2. Notification rate per 100 000 population;
3. Age-standardised rate per 100 000 population;
4. Number of hospitalised cases;
5. Proportion of hospitalised cases among confirmed cases with known history of hospitalisation (%);
6. Number of deaths derived from reporting of disease outcome;
7. Case fatality calculated as proportion of deaths among confirmed cases with known disease outcome (%);
8. Notification rate for domestic cases per 100 000 population;
9. Proportion of travel-associated cases among confirmed cases with known travel history outside the reporting country (%);

For notification rate indicators, the data may be displayed in a bar chart as:
• Age-specific notification rate (for age groups 0-4, 5-14, 15-24, 25-44, 45-64, 65 years and above);
• Gender-specific notification rate;

For all other indicators, the data may be displayed in a bar chart or a pie chart by proportion of:
• Age groups (0-4, 5-14, 15-24, 25-44, 45-64, 65 years and above);
• Gender;
• Pathogen species.

Symbols used in the Surveillance Atlas table:
Symbol
Comment
–
Indicator is not calculated for a given geographical resolution and time period.
.
Missing data. Data are not reported to TESSy for a given time period.
Data quality
EU/EEA countries reporting data on brucellosis as displayed in the Annex 1. For data quality, reporting completeness of variables used to calculate Surveillance Atlas indicators was analysed for reported, confirmed cases. For countries reporting data only in aggregated format, the analysis of data completeness is allowed only for data reported such as age and gender.
The Surveillance Atlas indicators for data quality of confirmed brucellosis cases are:
• Completeness age (%);
• Completeness gender (%);
• Completeness disease outcome (%);
• Completeness travel-associated (%);
• Completeness hospitalisation (%);
• Completeness pathogen species (%).
•
Interpretation
The data shown in the Surveillance Atlas should be interpreted carefully. National surveillance systems differ from each other and so does case under-ascertainment and under-reporting between countries.
The notification of brucellosis in humans is mandatory in all EU/EEA countries, except in Belgium. In Denmark, brucellosis is neither notifiable nor under surveillance. The surveillance systems have full national coverage in all reporting countries also in the voluntary surveillance system in Belgium. In Belgium, full national coverage was established in 2015 and rates before this date are not displayed. For 2020-2021, Spain has not received data from all regions and rates are therefore not displayed for these years. All reporting countries report case-based data except Bulgaria, which reported aggregate data. Aggregated reporting format was included to calculate numbers of cases and notification rates, as well as disease trends, age and gender distributions when this data was available. The COVID-19 pandemic seems to have impacted on brucellosis surveillance data in 2020-2021. Factors mentioned by countries resulting in lower case numbers were e.g. people avoiding to seek medical care for mild symptoms due to risk of exposure to COVID-19 in health care facilities and less travel due to travel restriction etc.
The completeness of some variables such as hospitalisation, outcome or travel history varies between countries and years; some countries are able to collect and integrate this type of information from different sources, other countries are not. Even if overall data completeness is high for some variables, the reader should refrain from directly comparing countries without taking into account limitations.

Reports published by ECDC on brucellosis
More information is available in ECDC reports. Note that later retrievals of data related to the same period may result in slightly different numbers as countries have the possibility to update data in TESSy retrospectively. Therefore, the data presented in the reports might slightly differ from the data presented in the Surveillance Atlas.

Annual epidemiological report for 2022 – Brucellosis:
Brucellosis - Annual epidemiological report (europa.eu)

EFSA and ECDC (European Food Safety Authority and European Centre for Disease Prevention and Control), 2023. The European Union One Health 2022 Zoonoses Report (December 2023):
https://efsa.onlinelibrary.wiley.com/doi/epdf/10.2903/j.efsa.2023.8442
Annex 1. Surveillance systems overview, 2023
Country
Data source
Compulsory (Cp), voluntary (V), other(O)
Comprehensive (Co), sentinel (Se), other(O)
Active (A), passive (P)
Case-based (C), aggregated (A)
Data reported by
Case definition used






Laboratories
Physicians
Hospitals
Others

Austria
AT-Epidemiegesetz
Cp
Co
P
C
Y
Y
Y
Y
EU-2008
Belgium
BE-REFLAB
O
Co
P
C
Y
N
N
N
EU-2018
Bulgaria
BG-NATIONAL_SURVEILLANCE
Cp
Co
P
A
Y
Y
Y
Y
EU-2018
Croatia
HR-CNIPH
Cp
Co
P
C
Y
Y
Y
Y
EU-2012
Cyprus
CY-NOTIFIED_DISEASES
Cp
Co
P
C
N
Y
N
N
EU-2008
Czechia
CZ-ISIN
Cp
Co
A
C
Y
Y
Y
N
EU-2008
Estonia
EE-NAKIS
Cp
Co
P
C
Y
Y
Y
N
EU-2018
Finland
FI-NIDR
Cp
Co
P
C
Y
N
N
N
EU-2012
France
FR-MANDATORY_INFECTIOUS_DISEASES
Cp
Co
P
C
Y
Y
Y
Y
Not specified/unknown
Germany
DE-SURVNET@RKI-7.1
Cp
Co
P
C
Y
N
N
N
Other
Greece
EL-NOTIFIABLE_DISEASES
Cp
Co
P
C
Y
Y
Y
.
EU-2018
Hungary
HU-Zoonoses
Cp
Co
P
C
Y
Y
Y
N
EU-2012
Iceland
IS-SUBJECT_TO_REGISTRATION
Cp
Co
P
C
Y
Y
.
.
EU-2018
Ireland
IE-CIDR
Cp
Co
P
C
Y
Y
Y
N
EU-2008
Italy
IT-NRS
Cp
Co
P
C
N
Y
Y
N
Other
Latvia
LV-BSN
Cp
Co
P
C
Y
Y
Y
N
EU-2018
Liechtenstein
LI-BRUC
Cp
Co
P
C
Y
Y
Y
.
EU-2018
Lithuania
LT-COMMUNICABLE_DISEASES
Cp
Co
P
C
Y
Y
N
N
EU-2018
Luxembourg
LU-SYSTEM1
Cp
Co
P
C
Y
Y
N
N
EU-2018
Malta
MT-DISEASE_SURVEILLANCE
Cp
Co
P
C
Y
Y
Y
Y
EU-2018
Netherlands
NL-OSIRIS
Cp
Co
P
C
Y
Y
N
N
EU-2018
Norway
NO-MSIS_A
Cp
Co
P
C
Y
Y
Y
N
EU-2018
Poland
PL-NATIONAL_SURVEILLANCE
Cp
Co
P
C
Y
Y
Y
N
EU-2018
Portugal
PT-BRUCELLOSIS
Cp
Co
P
C
N
Y
N
N
EU-2018
Romania
RO-RNSSy
Cp
Co
P
C
N
N
Y
N
EU-2018
Slovakia
SK-EPIS
Cp
Co
A
C
Y
Y
Y
N
EU-2018
Slovenia
SI-SURVIVAL
Cp
Co
P
C
Y
Y
Y
N
EU-2008
Spain
ES-STATUTORY_DISEASES
Cp
Co
P
C
Y
Y
Y
N
EU-2018
Sweden
SE-SMINET
Cp
Co
P
C
Y
Y
N
N
EU-2018

Campylobacteriosis

Last updated: 13 August 2024
Data retrieval from TESSy: 13 August 2024

Campylobacteriosis is an infectious disease caused by bacteria of the genus Campylobacter. For a more detailed description of the disease and its epidemiology, please click here.
Data
The Surveillance Atlas of Infectious Diseases displays data on campylobacteriosis reported by the EU/EEA countries. Cases should be reported according to the 2018 EU case definition for Campylobacter enteritis6:

Clinical criteria
Any person with the following three:
— Diarrhoea;
— Abdominal pain;
— Fever.
Laboratory criteria
At least one of the following two:
— Isolation of human pathogenic Campylobacter spp. from a clinical specimen;
— Detection of Campylobacter spp. nucleic acid in a clinical specimen.
Note: Antimicrobial susceptibility testing of Campylobacter spp. should be performed on a representative subset of isolates
Epidemiological criteria
At least one of the following five epidemiological links:
— Animal to human transmission;
— Human to human transmission;
— Exposure to a common source;
— Exposure to contaminated food/drinking water;
— Environmental exposure.

Case classification
A. Possible case: NA
B. Probable case: Any person meeting the clinical criteria with an epidemiological link
C. Confirmed case: Any person meeting the clinical and the laboratory criteria

Note: If the national surveillance system is not capturing clinical symptoms, all laboratory-confirmed individuals should be reported as confirmed cases.

Antimicrobial resistance
The results of antimicrobial susceptibility tests must be reported according to the methods and criteria agreed between ECDC and Member States as specified in the EU protocol for harmonised monitoring of antimicrobial resistance in human Salmonella and Campylobacter isolates7


------------------------
(Compared with the 2008 and 2012 EU case definition, the 2018 EU case definition allows genotypic tests for laboratory confirmation and includes a requirement for antimicrobial susceptibility testing and reporting of results. The note is also a new addition.)

Data collection and analysis
Data are collected on an annual basis for the previous year. Countries can also update their data at any time. Before analysis, data are validated with nominated data providers in EU/EEA countries. Country population denominators by age group for the calculation of notification rates were obtained from Eurostat8. Note that data published in the Surveillance Atlas might differ from figures in national reports due to different times of reporting, inclusion of cases by different case definitions and use of different denominators.
Indicators were displayed as “–” and not calculated for variables with more than 50% of cases with undocumented information (unknown or missing) for a given geographical resolution (e.g. country, EU/EEA) and time period. The age-standardised rate and the notification rate for domestic cases were calculated when age and travel history were known for at least 90% of cases.
Surveillance systems across the EU/EEA countries are heterogeneous and a surveillance systems overview is displayed in Annex 1.

Surveillance Atlas indicators
The Surveillance Atlas indicators for confirmed campylobacteriosis cases are:
1. Number of reported cases;
2. Notification rate per 100 000 population;
3. Age-standardised rate per 100 000 population;
4. Number of hospitalised cases;
5. Proportion of hospitalised cases among confirmed cases with known history of hospitalisation (%);
6. Number of deaths derived from reporting of disease outcome;
7. Case fatality calculated as proportion of deaths among confirmed cases with known disease outcome (%);
8. Notification rate for domestic cases per 100 000 population;
9. Proportion of travel-associated cases among confirmed cases with known travel history outside the reporting country (%);

For notification rate indicators, the data may be displayed in a bar chart as:
• Age-specific notification rate (for age groups 0-4, 5-14, 15-24, 25-44, 45-64, 65 years and above);
• Gender-specific notification rate;

For all other indicators, the data may be displayed in a bar chart or a pie chart by proportion of:
• Age groups (0-4, 5-14, 15-24, 25-44, 45-64, 65 years and above);
• Gender;
• Pathogen species.

Symbols used in the Surveillance Atlas table:
Symbol
Comment
–
Indicator is not calculated for a given geographical resolution and time period.
.
Missing data. Data are not reported to TESSy for a given time period.

Data quality
EU/EEA countries reporting data on campylobacteriosis as displayed in the Annex 1. For data quality, reporting completeness of variables used to calculate Surveillance Atlas indicators was analysed for reported, confirmed cases. For countries reporting data only in aggregated format, the analysis of data completeness is allowed only for data reported such as age and gender.
The Surveillance Atlas indicators for data quality of confirmed campylobacteriosis cases are:
• Completeness age (%);
• Completeness gender (%);
• Completeness disease outcome (%);
• Completeness travel-associated (%);
• Completeness hospitalisation (%);
• Completeness pathogen species (%).

Interpretation
The results shown in the Surveillance Atlas should be interpreted carefully. National surveillance systems differ from each other and so does the number of samples tested.
The notification of campylobacteriosis is mandatory in 26 EU/EEA countries. In four EU Member States (Belgium, France, Italy and the Netherlands) notification is voluntary. The surveillance systems for campylobacteriosis have full national coverage in all EU Member States except four (France, Italy, the Netherlands and Spain). The coverage of the surveillance system in is estimated to be 20% in France, 64% in the Netherlands in 2021-2023 (58% in 2019-2020 and 52% in 2016-2018) and 80% and 73% in 2023 and 2021-2022, respectively in Spain. These proportions were used when calculating the national notification rates for these Member States. No estimate of population coverage in Spain was provided prior 2021, so notification rates were not calculated. No estimate of population coverage in Italy was provided for any year, so notification rate was not calculated. In Belgium, full national coverage was established in 2015 and rates before this date are not displayed. The drop in cases in Luxembourg in 2019 is a surveillance artefact caused by a change to non-culture-based methods (PCR) in private laboratories, resulting in reduced number of isolates sent to the national reference laboratory. From 2020, laboratory confirmation with PCR is included in the notification system which along with a new electronic laboratory notification system resulted in an increase in Campylobacter notifications. Greece reports data on laboratory-confirmed cases collected from public hospitals from 2018 onwards. All countries reported case-based data except Belgium and Bulgaria which reported aggregated data. Aggregated reporting format was included to calculate numbers of cases and notification rates, as well as disease trends, age and gender distributions when this data was available.
The COVID-19 pandemic significantly impacted on campylobacteriosis surveillance data in 2020-2022. Factors mentioned by countries resulting in lower case numbers were e.g. people avoiding seeking medical care for mild symptoms due to risk of exposure to COVID-19 in health care facilities, limited laboratory capacity due to reallocation of resources to SARS-CoV-2, fewer restaurant visits, increased hand washing, less travel due to travel restriction etc.
The completeness of some variables such as outcome or travel history varies between countries and years; some countries are able to collect and integrate this type of information from different sources, other countries are not.

Reports published by ECDC on campylobacteriosis
More information is available in ECDC reports. Note that later retrievals of data related to the same period may result in slightly different numbers as countries have the possibility to update data in TESSy retrospectively. Therefore, the data presented in the reports might slightly differ from the data presented in the Surveillance Atlas.

Annual epidemiological report for 2022 – Campylobacteriosis:
Annual epidemiological report for 2022 - Campylobacteriosis (europa.eu)

EFSA and ECDC (European Food Safety Authority and European Centre for Disease Prevention and Control), 2023. The European Union One Health 2022 Zoonoses Report (December 2023):
https://efsa.onlinelibrary.wiley.com/doi/epdf/10.2903/j.efsa.2023.8442

Fourth external quality assessment on species identification and antimicrobial susceptibility testing of Campylobacter, 2018:
https://www.ecdc.europa.eu/sites/default/files/documents/fourth-campylobacter-external-quality-assessment.pdf

Annex1. Surveillance systems overview, 2023
Country
Data source
Compulsory (Cp), voluntary (V), other(O)
Comprehensive (Co), sentinel (Se), other(O)
Active (A), passive (P)
Case-based (C), aggregated (A)
Data reported by
Case definition used






Laboratories
Physicians
Hospitals
Others

Austria
AT-Epidemiegesetz
Cp
Co
P
C
Y
Y
Y
Y
EU-2008
Belgium
BE-LABNET
V
Se
P
A
Y
N
.
.
EU-2018
Bulgaria
BG-NATIONAL_SURVEILLANCE
Cp
Co
P
A
Y
Y
Y
Y
EU-2018
Croatia
HR-CNIPH
Cp
Co
P
C
Y
Y
Y
Y
EU-2012
Cyprus
CY-NOTIFIED_DISEASES
Cp
Co
P
C
N
Y
N
N
EU-2008
Czechia
CZ-ISIN
Cp
Co
A
C
Y
Y
Y
N
EU-2008
Denmark
DK-LAB
Cp
Co
P
C
Y
N
N
N
EU-2018
Estonia
EE-NAKIS
Cp
Co
P
C
Y
Y
Y
N
EU-2018
Finland
FI-NIDR
Cp
Co
P
C
Y
N
N
N
EU-2012
France
FR-NATIONAL_REFERENCE_CENTRES
V
Co
P
C
Y
N
N
N
Other
Germany
DE-SURVNET@RKI-7.1
Cp
Co
P
C
Y
N
N
N
Other
Greece
EL-NOTIFIABLE_DISEASES
Cp
Co
P
C
Y
Y
Y
.
EU-2018
Hungary
HU-Zoonoses
Cp
Co
P
C
Y
Y
Y
N
EU-2012
Iceland
IS-SUBJECT_TO_REGISTRATION
Cp
Co
P
C
Y
Y
.
.
EU-2018
Ireland
IE-CIDR
Cp
Co
P
C
Y
Y
Y
N
EU-2008
Italy
IT-ENTERNET
V
Se
P
C
Y
N
N
N
Other
Latvia
LV-BSN
Cp
Co
P
C
Y
Y
Y
N
EU-2012
Liechtenstein
LI-SEPI
Cp
Co
P
C
Y
Y
Y
.
EU-2018
Lithuania
LT-COMMUNICABLE_DISEASES
Cp
Co
P
C
Y
Y
N
N
EU-2018
Luxembourg
LU-SYSTEM1
Cp
Co
P
C
Y
N
N
N
EU-2018
Malta
MT-DISEASE_SURVEILLANCE
Cp
Co
P
C
Y
Y
Y
Y
EU-2018
Netherlands
NL-AMR
V
Se
P
C
Y
N
N
N
Not specified/unknown
Norway
NO-MSIS_A
Cp
Co
P
C
Y
Y
Y
N
EU-2018
Poland
PL-NATIONAL_SURVEILLANCE
Cp
Co
P
C
Y
Y
Y
N
EU-2018
Portugal
PT-CAMP
Cp
Co
P
C
N
Y
N
N
EU-2018
Romania
RO-RNSSy
Cp
Co
P
C
Y
N
Y
N
EU-2018
Slovakia
SK-EPIS
Cp
Co
A
C
Y
Y
Y
Y
EU-2018
Slovenia
SI-SURVIVAL
Cp
Co
P
C
Y
Y
Y
N
EU-2008
Spain
ES-STATUTORY_DISEASES
Cp
Co
P
C
Y
Y
Y
N
EU-2018
Sweden
SE-SMINET
Cp
Co
P
C
Y
Y
N
N
EU-2018




Antimicrobial resistance in Campylobacter jejuni and C. coli
Last updated: 20 February 2024
Data retrieval from TESSy: 26 September 2023

Campylobacteriosis is an infection caused by Campylobacter bacteria, with the most common species being C. jejuni and C. coli. Campylobacteriosis usually causes self-limiting gastroenteritis but antimicrobial treatment may be needed in case of severe illness. For a more detailed description of the disease and its epidemiology, please click here.
Data
The Surveillance Atlas of Infectious Diseases displays data on antimicrobial resistance (AMR) in Campylobacter jejuni and C. coli reported by the EU/EEA countries. According to the 2018 EU case definition for Campylobacter enteritis9, antimicrobial susceptibility testing of Campylobacter spp. should be performed on a representative subset of isolates. The results of antimicrobial susceptibility tests must be reported according to the methods and criteria agreed between ECDC and Member States as specified in the EU protocol for harmonised monitoring of antimicrobial resistance in human Salmonella and Campylobacter isolates10. The panel of antimicrobial agents to test is also defined in the EU protocol.
AMR data are collected as part of the case-based datasets for salmonellosis and, since the 2013 data collection, as part of the molecular surveillance of Campylobacter isolates. The case-based dataset contains data from clinical treatment of patients and the results are therefore by default interpreted using clinical breakpoints for assessing treatment options. Most countries apply clinical breakpoints from the European Committee on Antimicrobial Susceptibility Testing (EUCAST) but some also use national breakpoints or breakpoints from the French Society of Microbiology (CA-SFM) when no EUCAST criteria are available. The isolate-based data are submitted by the National Public Health Reference Laboratories (NPHRLs) who do reference testing of isolates and can report the actual results of the antimicrobial susceptibility testing (AST) as minimum inhibitory concentration (MIC) or inhibition zone diameter. Such data are interpreted both with EUCAST clinical breakpoints, where available, but also with EUCAST epidemiological cut-off values where possible, to detect acquired resistance. Since 2019, data can also be reported as phenotypes predicted from sequencing of the bacterial genome and since 2023, Campylobacter sequences can be reported which are analysed for both genes/mutations and predicted resistance with ResFinder at ECDC. Data from genetic typing are categorised as predicted wild type or predicted non-wild type and presented in the Atlas with the data interpreted with epidemiological cut-off values.
Data collection and analysis
Data are collected on an annual basis for the previous year. Before analysis, data are validated with nominated data providers in EU/EEA countries. Note that data published in the Surveillance Atlas might differ from figures in national reports due to different times of reporting, application of other interpretive criteria/breakpoints and use of different denominators. For quantitative data reported as MIC values or zone diameters, the criteria applied to categorise the data are listed in table 1.
Surveillance systems across the EU/EEA countries are heterogeneous and a surveillance systems overview is displayed in Annex 1.

Criteria used to interpret quantitative data:
Antimicrobial
Clinical breakpoint applied
Epidemiological cut-off applied
Gentamicin
CA-SFM 2022
EUCAST Aug 2023
Erythromycin
EUCAST 2022
EUCAST Aug 2023
Ciprofloxacin
EUCAST 2022
EUCAST Aug 2023
Tetracycline
EUCAST 2022
EUCAST Aug 2023
Ciprofloxacin+erythromycin
Resistance to both agents, see criteria for respective agent
Non-wild type to both agents, see criteria for respective agent

Surveillance Atlas indicators
The Surveillance Atlas indicators for Campylobacter antimicrobial resistance are:
1. Non-wild type (NWT) isolates percentage;
2. Non-wild type or I+R isolates percentage;
3. Clinically resistant (R) isolates percentage
4. Total tested isolates

For the resistance indicators, the data may be displayed in a bar chart as:
• Proportion resistant isolates by age-group (for age groups 0-4, 5-14, 15-24, 25-44, 45-64, 65 years and above);
• Proportion resistant isolates by gender;
• Proportion resistant isolates by geographical region, in case of travel-associated infections

Indicators are displayed as “–” and not calculated for when fewer than 10 isolates had been tested for the selected combination (e.g. Campylobacter specie, importation status and antimicrobial) and time period.
Indicators by age group and gender are not displayed if more than 50% of cases have undocumented information (unknown or missing) for a given geographical resolution (e.g. country, EU/EEA) and time period.

The Surveillance Atlas indicators were calculated from 2013 up to the end of 2022.

Symbols used in the Surveillance Atlas table:
Symbol
Comment
–
Indicator is not calculated for a given geographical resolution and time period.
.
Missing data. Data are not reported to TESSy for a given time period.

Interpretation
The data shown in the Surveillance Atlas should be interpreted carefully. National surveillance systems differ from each other and so does case under-ascertainment and under-reporting between countries.
All data provided as measured MIC or zone mm values were results of antimicrobial susceptibility testing at the NPHRLs, with the exception of Finland where the quantitative data had been collected from regional laboratories. The NPHRLs participate in external quality assessments arranged by ECDC to maintain a high data quality. The submission of isolates to the NPHRLs however vary by country – in some countries, most Campylobacter isolated from human infections are sent to the NPHRL while in others, isolates may be sent only when further typing is deemed necessary, in outbreak situations or is focused on specific serotypes. Data interpreted with clinical breakpoints are normally from local or regional laboratories and reported together with the information on the clinical case. In these cases, the antimicrobial susceptibility testing has primarily been performed with the purpose of treatment of the case rather than AMR monitoring. For this reason, the number of tests per antimicrobial varies.
The guidelines for clinical breakpoints vary among countries in Europe, and in some instances even between laboratories in the same country. By now, most European laboratories have changed to EUCAST clinical guidelines. As a result, the interpretation of results may have changed over time. In addition, clinical breakpoints may change over time, as breakpoints may be revised. For information on the test method and criteria used by country, see the Materials and methods section in the respective EFSA-ECDC AMR report for the year in question. For data submitted as quantitative values, the current breakpoints are applied also to historical data.
The completeness of the travel history varies between countries and years; some countries are able to collect and integrate this type of information from different sources, other countries are not. For Campylobacter AMR data, information on travel status is lacking from many countries. For that reason, the category ‘domestic or unknown’ can be selected as it is anticipated that a missing value is more likely to represent no travel as travel-related infections are more likely to be notified as such by the doctor.
For 2022, information on AMR in Campylobacter isolates from human clinical cases was reported by 24 EU/EEA countries. No data were reported by the United Kingdom from 2020 data onwards due to its withdrawal from the EU on 30 January 2020.

Reports published by ECDC on Campylobacter AMR
More information is available in ECDC reports. Note that later retrievals of data related to the same period may result in slightly different numbers as countries have the possibility to update data in TESSy retrospectively. Therefore, the data presented in the reports might slightly differ from the data presented in the Surveillance Atlas.
Annual Epidemiological Report for 2022 - Campylobacteriosis:
https://www.ecdc.europa.eu/en/publications-data/campylobacteriosis-annual-epidemiological-report-2022
EFSA and ECDC, 2023. The European Union Summary Report on Antimicrobial Resistance in zoonotic and indicator bacteria from humans, animals and food in 2020/2021 (March 2023):
https://www.ecdc.europa.eu/en/publications-data/european-union-summary-report-antimicrobial-resistance-zoonotic-and-indicator-7
Fourth external quality assessment on species identification and antimicrobial susceptibility testing of Campylobacter, 2018
https://www.ecdc.europa.eu/sites/default/files/documents/fourth-campylobacter-external-quality-ssessment.pdf


Annex 1. Campylobacter AMR surveillance data overview, 2013-2022

Country
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
Austria
Q
Q
Q
Q
Q
Q
Q
Q
Q
Q
Belgium
-
-
-
-
-
-
-
-
-
-
Bulgaria
SIR
-
-
SIR
-
-
-
-
-
-
Cyprus
Q
Q
Q
Q
Q
Q
Q
Q
-
-
Croatia
-
-
-
-
-
-
-
-
-
-
Czechia
-
-
-
-
-
-
-
-
-
-
Denmark
Q
Q
Q
Q
Q
Q
Q
Q
-
Q
Estonia
Q
Q
Q
Q
Q
Q
Q
Q
Q
SIR
Finland
Q
Q
Q
Q
Q
Q
Q
Q
-
-
France
SIR
SIR
SIR
SIR
SIR
SIR
SIR
SIR
SIR
SIR
Germany
Q
Q
-
-
-
-
-
-
-
-
Greece
Q
-
-
-
-
-
-
-
-
-
Hungary
SIR
SIR
-
-
-
-
-
-
-
-
Iceland
Q
Q
SIR
SIR
SIR
SIR
SIR
SIR
-
SIR
Ireland
WGS
WGS
-
-
SIR
SIR
-
-
-
-
Italy
Q
Q
Q
Q
Q
Q
Q
Q
Q
SIR
Latvia
-
-
-
-
-
-
-
-
-
-
Lithuania
SIR
SIR
-
SIR
SIR
SIR
SIR
SIR
SIR
SIR
Luxembourg
Q
Q
Q
Q
Q
Q
Q
Q
Q
Q
Malta
Q
Q
Q
Q
Q
Q
Q
Q
SIR
SIR
Netherlands
WGS
SIR
SIR
SIR
SIR
SIR
SIR
SIR
SIR
SIR
Norway
Q
Q
Q
Q
-
Q
Q
Q
Q
Q
Poland
Q
SIR
SIR
SIR
SIR
SIR
-
-
-
-
Portugal
Q
Q
Q
Q
Q
Q
Q
Q
Q
-
Romania
Q
Q
-
Q
Q
Q
Q
Q
Q
Q
Slovakia
SIR
SIR
SIR
SIR
SIR
SIR
SIR
SIR
SIR
SIR
Slovenia
Q
Q
Q
Q
Q
Q
Q
Q
Q
SIR
Spain
Q
Q
Q
Q
Q
Q
Q
Q
SIR
SIR
Sweden
-
WGS
WGS
-
-
-
-
-
-
-
United Kingdom
-
-
-
SIR
SIR
SIR
SIR
SIR
SIR
SIR
Q – quantitative data, MIC or zone mm; SIR – data interpreted with clinical breakpoints; WGS – resistance predicted from genotypic methods; - no data reported
Cholera
Last updated: 13 August 2024
Data retrieval from TESSy: 13 August 2024

Cholera is a highly infectious acute enteric illness caused by the bacterium Vibrio cholerae, serogroups O1 or O139. For a more detailed description of the disease and its epidemiology, please click here.
Data
The Surveillance Atlas of Infectious Diseases displays data on cholera reported by the EU/EEA countries. Cases are to be reported according to the 2018 EU case definition for cholera11:

Clinical criteria
Any person with at least one of the following two:
— Diarrhoea;
— Vomiting.
Laboratory criteria
— Isolation of Vibrio cholerae from a clinical specimen;
AND
— Demonstration of O1 or O139 antigen in the isolate;
AND
— Demonstration of cholera-enterotoxin or the cholera-enterotoxin gene in the isolate.
Epidemiological criteria
At least one of the following four epidemiological links:
— Exposure to a common source;
— Human to human transmission;
— Exposure to contaminated food/drinking water;
— Environmental exposure.

Case classification
A. Possible case: NA
B. Probable case: Any person meeting the clinical criteria with an epidemiological link
C. Confirmed case: Any person meeting the clinical and the laboratory criteria

Note: If the national surveillance system is not capturing clinical symptoms, all laboratory-confirmed individuals should be reported as confirmed cases.

------------------------
(The note is the only difference between the 2018 EU case definition and the 2012 and 2008 EU case definitions.)

Data collection and analysis
Data are collected on an annual basis for the previous year. Countries can also update their data at any time. Before analysis, data are validated with nominated data providers in EU/EEA countries. Country population denominators by age group for the calculation of notification rates were obtained from Eurostat12. Note that data published in the Surveillance Atlas might differ from figures in national reports due to different times of reporting, inclusion of cases by different case definitions and use of different denominators.
Indicators were displayed as “–” and not calculated for variables with more than 50% of cases with undocumented information (unknown or missing) for a given geographical resolution (e.g. country, EU/EEA) and time period. The age-standardised rate and the notification rate for domestic cases were calculated when age and travel history were known for at least 90% of cases.
Surveillance systems across the EU/EEA countries are heterogeneous and a surveillance systems overview is displayed in Annex 1.

Surveillance Atlas indicators
The Surveillance Atlas indicators for confirmed cholera cases are:
1. Number of reported cases;
2. Notification rate per 100 000 population;
3. Age-standardised rate per 100 000 population;
4. Number of hospitalised cases;
5. Proportion of hospitalised cases among confirmed cases with known history of hospitalisation (%);
6. Number of deaths derived from reporting of disease outcome;
7. Case fatality calculated as proportion of deaths among confirmed cases with known disease outcome (%);
8. Notification rate for domestic cases per 100 000 population;
9. Proportion of travel-associated cases among confirmed cases with known travel history outside the reporting country (%);

For notification rate indicators, the data may be displayed in a bar chart as:
• Age-specific notification rate (for age groups 0-4, 5-14, 15-24, 25-44, 45-64, 65 years and above);
• Gender-specific notification rate;

For all other indicators, the data may be displayed in a bar chart or a pie chart by proportion of:
• Age groups (0-4, 5-14, 15-24, 25-44, 45-64, 65 years and above);
• Gender;
• Probable country of infection.

Symbols used in the Surveillance Atlas table:
Symbol
Comment
–
Indicator is not calculated for a given geographical resolution and time period.
.
Missing data. Data are not reported to TESSy for a given time period.

Data quality
EU/EEA countries reporting data on cholera as displayed in the Annex 1. For data quality, reporting completeness of variables used to calculate Surveillance Atlas indicators was analysed for reported, confirmed cases. For countries reporting data only in aggregated format, the analysis of data completeness is allowed only for data reported such as age and gender.
The Surveillance Atlas indicators for data quality of confirmed cholera cases are:
• Completeness age (%);
• Completeness gender (%);
• Completeness disease outcome (%);
• Completeness travel-associated (%);
• Completeness hospitalisation (%);
• Completeness probable country of infection (%).

Interpretation
The data shown in the Surveillance Atlas should be interpreted carefully. National surveillance systems differ from each other and so does case under-ascertainment between countries.
The notification of cholera is mandatory and the surveillance systems have full national coverage in all EU/EEA countries. In Belgium, full national coverage was established in 2015 and rates before this date are not displayed. For 2020 and 2021, Spain has not received data from all regions and rates are therefore not displayed for these years. All reporting countries report case-based data except Bulgaria, which reported aggregate data. Aggregated reporting format was included to calculate numbers of cases and notification rates, as well as disease trends, age and gender distributions when this data was available.
The COVID-19 pandemic significantly impacted on cholera surveillance data in 2020-2021 as no laboratory-confirmed cases were reported. This most likely due to the travel restrictions implemented.
The completeness of some variables such as outcome or importation varies between countries and years; some countries are able to collect and integrate this type of information from different sources, other countries are not. Even if overall data completeness is high for some variables, the reader should refrain from directly comparing countries without taking into account limitations.

Reports published by ECDC on cholera
More information is available in ECDC reports. Note that later retrieval of data related to the same period may result in slightly different numbers as countries have the possibility to update data in TESSy retrospectively. Therefore, the data presented in the reports might slightly differ from the data presented in the Surveillance Atlas.

Annual epidemiological report for 2021 – Cholera:
Cholera Annual Epidemiological Report for 2021 (europa.eu)
Monthly global cholera outbreak report
https://www.ecdc.europa.eu/en/all-topics-z/cholera/surveillance-and-disease-data/cholera-monthly.

Annex 1. Surveillance systems overview, 2023
Country
Data source
Compulsory (Cp), voluntary (V), other(O)
Comprehensive (Co), sentinel (Se), other(O)
Active (A), passive (P)
Case-based (C), aggregated (A)
Data reported by
Case definition used






Laboratories
Physicians
Hospitals
Others

Austria
AT-Epidemiegesetz
Cp
Co
P
C
Y
Y
Y
Y
EU-2008
Belgium
BE-REFLAB
Cp
Co
P
C
Y
N
N
N
EU-2018
Bulgaria
BG-NATIONAL_SURVEILLANCE
Cp
Co
P
C
Y
Y
Y
Y
EU-2018
Croatia
HR-CNIPH
Cp
Co
P
C
Y
Y
Y
Y
EU-2012
Cyprus
CY-NOTIFIED_DISEASES
Cp
Co
P
C
N
Y
N
N
EU-2008
Czechia
CZ-ISIN
Cp
Co
A
C
Y
Y
Y
N
EU-2008
Denmark
DK-MIS
Cp
Co
P
C
N
Y
N
N
Other
Estonia
EE-NAKIS
Cp
Co
P
C
Y
Y
Y
N
EU-2018
Finland
FI-NIDR
Cp
Co
P
C
Y
Y
N
N
EU-2012
France
FR-MANDATORY_INFECTIOUS_DISEASES
Cp
Co
P
C
Y
Y
Y
N
EU-2018
Germany
DE-SURVNET@RKI-7.1/6
Cp
Co
P
C
Y
Y
Y
Y
Other
Greece
EL-NOTIFIABLE_DISEASES
Cp
Co
P
C
Y
Y
Y
.
EU-2018
Hungary
HU-EFRIR
Cp
Co
P
C
Y
Y
Y
N
EU-2012
Iceland
IS-SUBJECT_TO_REGISTRATION
Cp
Co
P
C
Y
Y
.
.
EU-2018
Ireland
IE-CIDR
Cp
Co
P
C
Y
Y
Y
N
EU-2008
Italy
IT-NRS
Cp
Co
P
C
N
Y
Y
N
Other
Latvia
LV-BSN
Cp
Co
P
C
Y
Y
Y
N
EU-2018
Liechtenstein
LI-CHOL
Cp
Co
P
C
Y
Y
Y
.
EU-2018
Lithuania
LT-COMMUNICABLE_DISEASES
Cp
Co
P
C
Y
Y
N
N
EU-2018
Luxembourg
LU-SYSTEM1
Cp
Co
P
C
Y
Y
N
N
EU-2018
Malta
MT-DISEASE_SURVEILLANCE
Cp
Co
P
C
Y
Y
Y
Y
EU-2018
Netherlands
NL-OSIRIS
Cp
Co
P
C
Y
Y
N
N
EU-2018
Norway
NO-MSIS_A
Cp
Co
P
C
Y
Y
Y
N
EU-2018
Poland
PL-NATIONAL_SURVEILLANCE
Cp
Co
P
C
Y
Y
Y
N
EU-2008
Portugal
PT-CHOLERA
Cp
Co
P
C
N
Y
N
N
EU-2018
Romania
RO-RNSSy
Cp
Co
P
C
N
N
Y
N
EU-2018
Slovakia
SK-EPIS
Cp
Co
A
C
Y
Y
Y
N
EU-2018
Slovenia
SI-SURVIVAL
Cp
Co
P
C
Y
Y
Y
N
EU-2008
Spain
ES-STATUTORY_DISEASES
Cp
Co
P
C
Y
Y
Y
N
EU-2018
Sweden
SE-SMINET
Cp
Co
P
C
Y
Y
N
N
EU-2012


Cryptosporidiosis
Last updated: 13 August 2024
Data retrieval from TESSy: 13 August 2024
Cryptosporidiosis is an acute diarrhoeal disease caused by an intracellular protozoan parasite Cryptosporidium spp. For a more detailed description of the disease and its epidemiology, please click here.
Data
The Surveillance Atlas of Infectious Diseases displays data on cryptosporidiosis reported by the EU/EEA countries. Cases should be reported according to the 2018 EU case definition for cryptosporidiosis13:
Clinical criteria
Any person with at least one of the following two:
— Diarrhoea;
— Abdominal pain.
Laboratory criteria
At least one of the following four:
— Demonstration of Cryptosporidium oocysts in stool;
— Demonstration of Cryptosporidium in intestinal fluid or small-bowel biopsy specimens;
— Detection of Cryptosporidium nucleic acid in stool;
— Detection of Cryptosporidium antigen in stool.
Epidemiological criteria
At least one of the following five epidemiological links:
— Human to human transmission;
— Exposure to a common source;
— Animal to human transmission;
— Exposure to contaminated food/drinking water;
— Environmental exposure.

Case classification
A. Possible case: NA
B. Probable case: Any person meeting the clinical criteria with an epidemiological link
C. Confirmed case: Any person meeting the clinical and the laboratory criteria

Note: If the national surveillance system is not capturing clinical symptoms, all laboratory-confirmed individuals should be reported as confirmed cases.

------------------------
(Requirements for only one of two clinical criteria and the note are the changes in the 2018 EU case definition compared to the 2012 and 2008 EU case definitions.)

Data collection and analysis
Data are collected on an annual basis for the previous year. Countries can also update their data at any time. Before analysis, data are validated with nominated data providers in EU/EEA countries. Country population denominators by age group for the calculation of notification rates were obtained from Eurostat14. Note that data published in the Surveillance Atlas might differ from figures in national reports due to different times of reporting, inclusion of cases by different case definitions and use of different denominators.
Indicators were displayed as “–” and not calculated for variables with more than 50% of cases with undocumented information (unknown or missing) for a given geographical resolution (e.g. country, EU/EEA) and time period. The age-standardised rate and the notification rate for domestic cases were calculated when age and travel history were known for at least 90% of cases.
Surveillance systems across the EU/EEA countries are heterogeneous and a surveillance systems overview is displayed in Annex 1.

Surveillance Atlas indicators
The Surveillance Atlas indicators for confirmed cryptosporidiosis cases are:
1. Number of reported cases;
2. Notification rate per 100 000 population;
3. Age-standardised rate per 100 000 population;
4. Number of hospitalised cases;
5. Proportion of hospitalised cases among confirmed cases with known history of hospitalisation (%);
6. Number of deaths derived from reporting of disease outcome;
7. Case fatality calculated as proportion of deaths among confirmed cases with known disease outcome (%);
8. Notification rate for domestic cases per 100 000 population;
9. Proportion of travel-associated cases among confirmed cases with known travel history outside the reporting country (%);

For notification rate indicators, the data may be displayed in a bar chart as:
• Age-specific notification rate (for age groups 0-4, 5-14, 15-24, 25-44, 45-64, 65 years and above);
• Gender-specific notification rate;

For all other indicators, the data may be displayed in a bar chart or a pie chart by proportion of:
• Age groups (0-4, 5-14, 15-24, 25-44, 45-64, 65 years and above);
• Gender.

Symbols used in the Surveillance Atlas table:
Symbol
Comment
–
Indicator is not calculated for a given geographical resolution and time period.
.
Missing data. Data are not reported to TESSy for a given time period.

Data quality
EU/EEA countries reporting data on cryptosporidiosis as displayed in the Annex 1. For data quality, reporting completeness of variables used to calculate Surveillance Atlas indicators was analysed for reported, confirmed cases. For countries reporting data only in aggregated format, the analysis of data completeness is allowed only for data reported such as age and gender.
The Surveillance Atlas indicators for data quality of confirmed cryptosporidiosis cases are:
• Completeness age (%);
• Completeness gender (%);
• Completeness disease outcome (%);
• Completeness travel-associated (%);
• Completeness hospitalisation (%).

Interpretation
The results shown in the Surveillance Atlas should be interpreted carefully. National surveillance systems differ from each other and so does the number of samples tested.
The notification of cryptosporidiosis is mandatory in 23 EU/EEA countries. In three countries (Belgium, France and Greece) the notification is voluntary. France and Italy report cryptosporidiosis data from 2023 onwards. No surveillance system exists in Austria, Denmark, , Liechtenstein and the Netherlands. The surveillance systems for cryptosporidiosis have full national coverage in all reporting countries except in Spain and no information on coverage from France. For 2020, not all regions in Spain have reported and case numbers might therefore be lower than expected. The coverage of the surveillance system in 2023 and in 2021-2022 is estimated to be 92% and 91%, respectively in in Spain. These proportions were used when calculating notification rates for these years. No estimate of population coverage in Spain was provided prior 2021, so notification rates were not calculated. In Belgium, full national coverage was established in 2015 and rates before this date are not displayed. In the Netherlands, a cryptosporidiosis project was performed, and available data was reported to ECDC from 2013 to 2018. Greece reports data on laboratory-confirmed cases collected from public hospitals from 2018 onwards. In Luxembourg in 2020, the notification system changed to include all electronic laboratory reports and not only reports from general practitioners and this change resulted in a major increase in cases.
All reporting countries report case-based data except Belgium, Bulgaria, and Greece which reports aggregate data. Aggregated reporting format was included to calculate numbers of cases and notification rates, as well as disease trends, age and gender distributions when this data was available.
The COVID-19 pandemic resulted in a significant drop in cases in 2020-2021 at the EU level. Reasons for this could be due to less travel due to travel restrictions, people avoiding seeking medical care for mild symptoms due to risk of exposure to COVID-19 in health care facilities, limited laboratory capacity due to reallocation of resources to SARS-CoV-2 and regions not having sufficient resources to report data to the national level.
The completeness of some variables such as outcome or travel history varies between countries and years; some countries are able to collect and integrate this type of information from different sources, other countries are not.

Reports published by ECDC on cryptosporidiosis
More information is available in ECDC reports. Note that later retrievals of data related to the same period may result in slightly different numbers as countries have the possibility to update data in TESSy retrospectively. Therefore, the data presented in the reports might slightly differ from the data presented in the Surveillance Atlas.
Annual epidemiological report for 2021 – Cryptosporidiosis:
Cryptosporidiosis – Annual Epidemiological Report 2021 (europa.eu)


Annex 1. Surveillance systems overview, 2023
Country
Data source
Compulsory (Cp), voluntary (V), other(O)
Comprehensive (Co), sentinel (Se), other(O)
Active (A), passive (P)
Case-based (C), aggregated (A)
Data reported by
Case definition used






Laboratories
Physicians
Hospitals
Others

Belgium
BE-LABNET
V
Se
P
C
Y
N
.
.
EU-2012
Bulgaria
BG-NATIONAL_SURVEILLANCE
Cp
Co
P
A
Y
Y
Y
Y
EU-2018
Croatia
HR-CNIPH
Cp
Co
P
C
Y
Y
Y
Y
EU-2012
Cyprus
CY-NOTIFIED_DISEASES
Cp
Co
P
C
N
Y
N
N
EU-2008
Czechia
CZ-ISIN
Cp
Co
A
C
Y
Y
Y
N
EU-2008
Estonia
EE-NAKIS
Cp
Co
P
C
Y
Y
Y
N
EU-2018
Finland
FI-NIDR
Cp
Co
P
C
Y
N
N
N
EU-2012
France

V
.
.
C
.
.
.
.
Not specified/Unknown
Germany
DE-SURVNET@RKI-7.1
Cp
Co
P
C
Y
N
N
N
Other
Greece
EL-Lab_Hospital
V
O
A
A
Y
N
Y
N
Other
Hungary
HU-EFRIR
Cp
Co
P
C
Y
Y
Y
N
EU-2012
Iceland
IS-SUBJECT_TO_REGISTRATION
Cp
Co
P
C
Y
Y
.
.
EU-2018
Italy
IT-NRS
Cp
Co
P
C
N
Y
Y
N
Other
Ireland
IE-CIDR
Cp
Co
P
C
Y
Y
Y
N
EU-2012
Latvia
LV-BSN
Cp
Co
P
C
Y
Y
Y
N
EU-2018
Lithuania
LT-COMMUNICABLE_DISEASES
Cp
Co
P
C
Y
Y
N
N
EU-2018
Luxembourg
LU-SYSTEM1
Cp
Co
P
C
Y
Y
N
N
EU-2018
Malta
MT-DISEASE_SURVEILLANCE
Cp
Co
P
C
Y
Y
Y
Y
EU-2018
Norway
NO-MSIS_A
Cp
Co
P
C
Y
Y
Y
N
EU-2018
Poland
PL-NATIONAL_SURVEILLANCE
Cp
Co
P
C
Y
Y
Y
N
EU-2008
Portugal
PT-CRYP
Cp
Co
P
C
N
Y
N
N
EU-2018
Romania
RO-RNSSy
Cp
Co
P
C
N
N
Y
N
EU-2018
Slovakia
SK-EPIS
Cp
Co
A
C
Y
Y
Y
N
EU-2018
Slovenia
SI-SURVIVAL
Cp
Co
P
C
Y
Y
Y
N
EU-2008
Spain
ES-STATUTORY_DISEASES
Cp
Co
P
C
Y
Y
Y
N
EU-2018
Sweden
SE-SMINET
Cp
Co
P
C
Y
Y
N
N
EU-2018

Echinococcosis
Last updated: 13 August 2024
Data retrieval from TESSy: 13 August 2024

Echinococcosis is a zoonotic disease caused by the larval stage of Echinococcus tapeworms. For a more detailed description of the disease and its epidemiology, please click here.
Data
The Surveillance Atlas of Infectious Diseases displays data on echinococcosis reported by the EU/EEA countries. Cases should be reported according to the 2018 EU case definition for echinococcosis15:

Clinical criteria
Not relevant for surveillance purposes.
Diagnostic criteria
At least one of the following five:
— Histopathology or parasitology compatible with Echinococcus multilocularis or granulosus (e.g. direct visualisation of the protoscolex in cyst fluid);
— Detection of Echinoccocus granulosus pathognomonic macroscopic morphology of cyst(s) in surgical specimens;
— Typical organ lesions detected by imaging techniques (e.g. computerised tomography, sonography, MRI) AND confirmed by a serological test;
— Echinococcus spp. specific serum antibodies by high-sensitivity serological test AND confirmed by a high specificity serological test;
— Detection of Echinococcus multilocularis or granulosus nucleic acid in a clinical specimen.
Epidemiological Criteria NA

Case classification
A. Possible case: NA
B. Probable case: NA
C. Confirmed case: Any person meeting the diagnostic criteria

------------------------
(There are no differences between the 2018 and previous versions of the EU case definitions for echinococccosis.)

Data collection and analysis
Data are collected on an annual basis for the previous year. Countries can also update their data at any time. Before analysis, data are validated with nominated data providers in EU/EEA countries. Country population denominators by age group for the calculation of notification rates were obtained from Eurostat16. Note that data published in the Surveillance Atlas might differ from figures in national reports due to different times of reporting, inclusion of cases by different case definitions and use of different denominators.
Indicators were displayed as “–” and not calculated for variables with more than 50% of cases with undocumented information (unknown or missing) for a given geographical resolution (e.g. country, EU/EEA) and time period. The age-standardised rate and the notification rate for domestic cases were calculated when age and travel history were known for at least 90% of cases.
Surveillance systems across the EU/EEA countries are heterogeneous and a surveillance systems overview is displayed in Annex 1.

Surveillance Atlas indicators
The Surveillance Atlas indicators for confirmed echinococcosis are:
1. Number of reported cases;
2. Notification rate per 100 000 population;
3. Age-standardised rate per 100 000 population;
4. Number of hospitalised cases;
5. Proportion of hospitalised cases among confirmed cases with known history of hospitalisation (%);
6. Number of deaths derived from reporting of disease outcome;
7. Case fatality calculated as proportion of deaths among confirmed cases with known disease outcome (%);
8. Notification rate for domestic cases per 100 000 population;
9. Proportion of travel-associated cases among confirmed cases with known travel history outside the reporting country (%);

a) Indicators for confirmed cases of E. granulosus cases are:
1. Number of reported cases;
2. Notification rate per 100 000 population;
3. Number of deaths derived from reporting of disease outcome;
4. Case fatality calculated as proportion of deaths among confirmed cases with known information on disease outcome (%);

b) Indicators for confirmed cases of E. multilocularis cases are:
1. Number of reported cases;
2. Notification rate per 100 000 population;
3. Number of deaths derived from reporting of disease outcome;
4. Case fatality calculated as proportion of deaths among confirmed cases with known information on disease outcome (%);

For notification rate indicators, the data may be displayed in a bar chart as:
• Age-specific notification rate (for age groups 0-4, 5-14, 15-24, 25-44, 45-64, 65 years and above);
• Gender-specific notification rate;

For all other indicators, the data may be displayed in a bar chart or a pie chart by proportion of:
• Age groups (0-4, 5-14, 15-24, 25-44, 45-64, 65 years and above);
• Gender;
• Pathogen species.

Symbols used in the Surveillance Atlas table:
Symbol
Comment
–
Indicator is not calculated for a given geographical resolution and time period.
.
Missing data. Data are not reported to TESSy for a given time period.

Data quality
EU/EEA countries reporting data on echinococcosis as displayed in the Annex 1. For data quality, reporting completeness of variables used to calculate Surveillance Atlas indicators was analysed for reported, confirmed cases. For countries reporting data only in aggregated format, the analysis of data completeness is allowed only for data reported such as age and gender.
The Surveillance Atlas indicators for data quality of confirmed echinococcosis cases are:
• Completeness age (%);
• Completeness gender (%);
• Completeness disease outcome (%);
• Completeness travel-associated (%);
• Completeness hospitalisation (%);
• Completeness pathogen species (%).

Interpretation
The data shown in the Surveillance Atlas should be interpreted carefully. National surveillance systems differ from each other and so does case under-ascertainment between countries.
Cases of cystic and alveolar echinococcosis are reported to ECDC as ‘echinococcosis’ since the EU case definition does not distinguish between the two forms of the disease. ECDC can differentiate between the two forms by analysing the reported species. The notification of echinococcosis in humans is mandatory in 25 EU/EEA countries. In three countries, the notification is voluntary (Belgium, France, and the Netherlands). Italy reports echinococcosis data from 2023 onwards. No surveillance system exists for echinococcosis in Denmark, and Liechtenstein. The surveillance systems for echinococcosis have full national coverage in all reporting countries. In Belgium, a change in the surveillance was made in 2015 and rates before this date are not displayed. For 2020 and 2021, Spain has not received data from all regions and rates are therefore not displayed for these years. All reporting countries provide case-based data except Bulgaria and the Netherlands, which report aggregate data. Aggregated reporting format was included to calculate numbers of cases and notification rates, as well as disease trends, age and gender distributions when this data was available.
The completeness of some variables such as hospitalisation, outcome or travel history varies between countries and years; some countries are able to collect and integrate this type of information from different sources, other countries are not. Even if overall data completeness is high for some variables, the reader should refrain from directly comparing countries without taking into account limitations.

Reports published by ECDC on echinococcosis
More information is available in ECDC reports. Note that later retrievals of data related to the same period may result in slightly different numbers as countries have the possibility to update data in TESSy retrospectively. Therefore, the data presented in the reports might slightly differ from the data presented in the Surveillance Atlas.

Annual epidemiological report for 2022 – Echinococcosis:
Echinococcosis - Annual Epidemiological Report for 2022 (europa.eu)

EFSA and ECDC (European Food Safety Authority and European Centre for Disease Prevention and Control), 2023. The European Union One Health 2022 Zoonoses Report (December 2023):
https://efsa.onlinelibrary.wiley.com/doi/epdf/10.2903/j.efsa.2023.8442



Annex 1. Surveillance systems overview, 2023
Country
Data source
Compulsory (Cp), voluntary (V), other(O)
Comprehensive (Co), sentinel (Se), other(O)
Active (A), passive (P)
Case-based (C), aggregated (A)
Data reported by
Case definition used






Laboratories
Physicians
Hospitals
Others

Austria
AT-Epidemiegesetz
Cp
Co
P
C
Y
Y
Y
Y
EU-2008
Belgium
BE-REFLAB
V
O
P
C
Y
N
N
N
EU-2018
Bulgaria
BG-NATIONAL_SURVEILLANCE
Cp
Co
P
A
Y
Y
Y
Y
EU-2018
Croatia
HR-CNIPH
Cp
Co
P
C
Y
Y
Y
Y
EU-2012
Cyprus
CY-NOTIFIED_DISEASES
Cp
Co
P
C
N
Y
N
N
EU-2008
Czechia
CZ-ISIN
Cp
Co
A
C
Y
Y
Y
N
EU-2008
Estonia
EE-NAKIS
Cp
Co
P
C
Y
Y
Y
N
EU-2018
Finland
FI-NIDR
Cp
Co
P
C
Y
Y
N
N
EU-2012
France
FR-NATIONAL_REFERENCE_CENTRES
V
Co
P
C
Y
Y
Y
.
Not specified/unknown
Germany
DE-SURVNET@RKI-7.3
Cp
Co
P
C
Y
N
N
N
Other
Greece
EL-NOTIFIABLE_DISEASES
Cp
Co
P
C
Y
Y
Y
.
EU-2018
Hungary
HU-Zoonoses
Cp
Co
P
C
Y
Y
Y
N
EU-2012
Iceland
IS-SUBJECT_TO_REGISTRATION
Cp
Co
P
C
.
Y
.
.
EU-2018
Ireland
IE-CIDR
Cp
Co
P
C
Y
Y
Y
N
EU-2008
Italy
IT-NRS
Cp
Co
P
C
N
Y
Y
N
Other
Latvia
LV-BSN
Cp
Co
P
C
Y
Y
Y
N
EU-2018
Lithuania
LT-COMMUNICABLE_DISEASES
Cp
Co
P
C
Y
Y
N
N
EU-2018
Luxembourg
LU-SYSTEM1
Cp
Co
P
C
Y
Y
N
N
EU-2018
Netherlands
NL-LIMS
V
Co
P
A
Y
N
N
U
EU-2018
Malta
MT-DISEASE_SURVEILLANCE
Cp
Co
P
C
Y
Y
Y
Y
EU-2018
Norway
NO-MSIS_A
Cp
Co
P
C
Y
Y
Y
N
EU-2018
Poland
PL-NATIONAL_SURVEILLANCE
Cp
Co
P
C
Y
Y
Y
N
EU-2008
Portugal
PT-ECHINOCOCCOSIS
Cp
Co
P
C
N
Y
N
N
EU-2018
Romania
RO-RNSSy
Cp
Co
P
C
N
N
Y
N
EU-2018
Slovakia
SK-EPIS
Cp
Co
A
C
Y
Y
Y
N
EU-2018
Slovenia
SI-SURVIVAL
Cp
Co
P
C
Y
Y
Y
N
EU-2008
Spain
ES-STATUTORY_DISEASES
Cp
Co
P
C
Y
Y
Y
N
EU-2018
Sweden
SE-SMINET
Cp
Co
P
C
Y
Y
N
N
EU-2018

Giardiasis (lambliasis)
Last updated: 13 August 2024
Data retrieval from TESSy: 13 August 2024

Giardiasis is an intestinal infection caused by ingestion of cysts from the protozoan Giardia lamblia (Giardia intestinalis and Giardia duodenalis are synonyms). For a more detailed description of the disease and its epidemiology, please click here.
Data
The Surveillance Atlas of Infectious Diseases displays data on giardiasis reported by the EU/EEA countries. Cases should be reported according to the 2018 EU case definition for giardiasis lambliasis17:

Clinical criteria
Any person with at least one of the following four:
— Diarrhoea;
— Abdominal pain;
— Bloating;
— Signs of malabsorption (e.g. steatorrhoea, weight loss).
Laboratory criteria
At least one of the following two:
— Demonstration of Giardia lamblia cysts or trophozoites in stool, duodenal fluid or small-bowel biopsy;
— Demonstration of Giardia lamblia antigen in stool, duodenal fluid or small-bowel biopsy
— Detection of Giardia lamblia nucleic acid in stool, duodenal fluid or small-bowel biopsy
Epidemiological criteria
At least one of the following four epidemiological links:
— Exposure to contaminated food/drinking water;
— Human to human transmission;
— Exposure to a common source;
— Environmental exposure.

Case classification
A. Possible case: NA
A. Probable case: Any person meeting the clinical criteria with an epidemiological link
B. Confirmed case: Any person meeting the clinical and the laboratory criteria

Note: If the national surveillance system is not capturing clinical symptoms, all laboratory-confirmed individuals should be reported as confirmed cases.

------------------------
(Compared to the 2008 and 2012 EU case definition, the 2018 EU case definition allows genotypic tests for laboratory confirmation and includes more clinical specimens in the laboratory criteria. The note is also a new addition.)


Data collection and analysis
Data are collected on an annual basis for the previous year. Countries can also update their data at any time. Before analysis, data are validated with nominated data providers in EU/EEA countries. Country population denominators by age group for the calculation of notification rates were obtained from Eurostat18. Note that data published in the Surveillance Atlas might differ from figures in national reports due to different times of reporting, inclusion of cases by different case definitions and use of different denominators.
Indicators were displayed as “–” and not calculated for variables with more than 50% of cases with undocumented information (unknown or missing) for a given geographical resolution (e.g. country, EU/EEA) and time period. The age-standardised rate and the notification rate for domestic cases were calculated when age and travel history were known for at least 90% of cases.
Surveillance systems across the EU/EEA countries are heterogeneous and a surveillance systems overview is displayed in Annex 1.

Surveillance Atlas indicators
The Surveillance Atlas indicators for confirmed giardiasis cases are:
1. Number of reported cases;
2. Notification rate per 100 000 population;
3. Age-standardised rate per 100 000 population;
4. Number of hospitalised cases;
5. Proportion of hospitalised cases among confirmed cases with known history of hospitalisation (%);
6. Number of deaths derived from reporting of disease outcome;
7. Case fatality calculated as proportion of deaths among confirmed cases with known disease outcome (%);
8. Notification rate for domestic cases per 100 000 population;
9. Proportion of travel-associated cases among confirmed cases with known travel history outside the reporting country (%);

For notification rate indicators, the data may be displayed in a bar chart as:
• Age-specific notification rate (for age groups 0-4, 5-14, 15-24, 25-44, 45-64, 65 years and above);
• Gender-specific notification rate;

For all other indicators, the data may be displayed in a bar chart or a pie chart by proportion of:
• Age groups (0-4, 5-14, 15-24, 25-44, 45-64, 65 years and above);
• Gender;
• Probable country of infection.

Symbols used in the Surveillance Atlas table:
Symbol
Comment
–
Indicator is not calculated for a given geographical resolution and time period.
.
Missing data. Data are not reported to TESSy for a given time period.

Data quality
EU/EEA countries reporting data on giardiasis as displayed in the Annex 1. For data quality, reporting completeness of variables used to calculate Surveillance Atlas indicators was analysed for reported, confirmed cases. For countries reporting data only in aggregated format, the analysis of data completeness is allowed only for data reported such as age and gender.

The Surveillance Atlas indicators for data quality of confirmed giardiasis cases are:
• Completeness age (%);
• Completeness gender (%);
• Completeness disease outcome (%);
• Completeness travel-associated (%);
• Completeness hospitalisation (%);
• Completeness probable country of infection (%).


Interpretation
The results shown in the Surveillance Atlas should be interpreted carefully. National surveillance systems differ from each other and so does case under-ascertainment between countries.
The notification of giardiasis is mandatory in 22 EU/EEA countries. In two Member States (Belgium and Greece) the notification is voluntary. No surveillance system exists in Austria, Denmark, France, Italy, Liechtenstein, and the Netherlands. The surveillance systems for giardiasis have full national coverage in all reporting countries except in Romania and Spain. For 2020, not all regions in Spain have reported and case numbers might therefore be lower than expected. The coverage of the surveillance system in 2023 and in 2021-2022 is estimated to be 92% and 91%, respectively in in Spain. These proportions were used when calculating notification rates for these years. No estimate of population coverage in Spain was provided prior 2021, so notification rates were not calculated. For Romania, no estimates were provided for any years as well as for Spain prior 2021, so notification rates were not calculated. In Belgium, full national coverage was established in 2015 and rates before this date are not displayed. Greece reports data on laboratory-confirmed cases collected from public hospitals from 2018 onwards. Most countries report case-based data except Belgium, Bulgaria, Greece and Romania which report aggregate data. Aggregated reporting format was included to calculate numbers of cases and notification rates, as well as disease trends, age and gender distributions when this data was available.
The COVID-19 pandemic significantly impacted on the giardiasis surveillance data in 2020-2021. Countries have mentioned several factors resulting in lower case numbers, e.g. people avoiding to seek medical care for mild symptoms due to risk of exposure to COVID-19 in health care facilities, travel restrictions, limited capacity for diagnosis of mild diseases in health care, lack of medical personnel due to re-allocation to COVID-19 work etc. In Romania, the marked drop was due to that the seasonal surveillance of giardiasis in summer-autumn could not take place.
The completeness of some variables such as outcome or travel history varies between countries and years; some countries are able to collect and integrate this type of information from different sources, other countries are not. Even if overall data completeness is high for some variables, the reader should refrain from directly comparing countries without taking into account limitations.

Reports published by ECDC on giardiasis
More information is available in ECDC reports. Note that later retrievals of data related to the same period may result in slightly different numbers as countries have the possibility to update data in TESSy retrospectively. Therefore, the data presented in the reports might slightly differ from the data presented in the Surveillance Atlas.
Annual epidemiological report for 2019 – Giardiasis:
https://www.ecdc.europa.eu/sites/default/files/documents/giardiasis-%20annual-epidemiological-report-019_0.pdf

Annex 1. Surveillance systems overview, 2023
Country
Data source
Compulsory (Cp), voluntary (V), other(O)
Comprehensive (Co), sentinel (Se), other(O)
Active (A), passive (P)
Case-based (C), aggregated (A)
Data reported by
Case definition used






Laboratories
Physicians
Hospitals
Others

Belgium
BE-LABNET
V
Se
P
C
Y
N
.
.
EU-2018
Bulgaria
BG-NATIONAL_SURVEILLANCE
Cp
Co
P
A
Y
Y
Y
Y
EU-2018
Croatia
HR-CNIPH
Cp
Co
P
C
Y
Y
Y
Y
EU-2012
Cyprus
CY-NOTIFIED_DISEASES
Cp
Co
P
C
N
Y
N
N
EU-2008
Czechia
CZ-ISIN
Cp
Co
A
C
Y
Y
Y
N
EU-2008
Estonia
EE-NAKIS
Cp
Co
P
C
Y
Y
Y
N
EU-2018
Finland
FI-NIDR
Cp
Co
P
C
Y
N
N
N
EU-2012
Germany
DE-SURVNET@RKI-7.1
Cp
Co
P
C
Y
N
N
N
Other
Greece
EL-Lab_Hospital
V
O
A
A
Y
N
Y
N
Other
Hungary
HU-EFRIR
Cp
Co
P
C
Y
Y
Y
N
EU-2012
Iceland
IS-SUBJECT_TO_REGISTRATION
Cp
Co
P
C
Y
Y
.
.
EU-2018
Ireland
IE-CIDR
Cp
Co
P
C
Y
Y
Y
N
EU-2008
Latvia
LV-BSN
Cp
Co
P
C
Y
Y
Y
N
EU-2018
Lithuania
LT-COMMUNICABLE_DISEASES
Cp
Co
P
C
Y
Y
N
N
EU-2018
Luxembourg
LU-SYSTEM1
Cp
Co
P
C
Y
N
N
N
EU-2018
Malta
MT-DISEASE_SURVEILLANCE
Cp
Co
P
C
Y
Y
Y
Y
EU-2018
Norway
NO-MSIS_A
Cp
Co
P
C
Y
Y
Y
N
EU-2018
Poland
PL-NATIONAL_SURVEILLANCE
Cp
Co
P
C
Y
Y
Y
N
EU-2018
Portugal
PT-GIAR
Cp
Co
P
C
N
Y
N
N
EU-2018
Romania
RO-RNSSy
Cp
Se
P
A
N
Y
Y
N
EU-2018
Slovakia
SK-EPIS
Cp
Co
P
C
Y
Y
Y
N
EU-2018
Slovenia
SI-SURVIVAL
Cp
Co
P
C
Y
Y
Y
N
EU-2008
Spain
ES-STATUTORY_DISEASES
Cp
Co
P
C
Y
Y
Y
N
EU-2018
Sweden
SE-SMINET
Cp
Co
P
C
Y
Y
N
N
EU-2018

Hepatitis A
Last updated: 13 August 2024
Data retrieval from TESSy: 13 August 2024
Hepatitis A is an acute inflammation of the liver caused by hepatitis A virus. For a more detailed description of the disease and its epidemiology, please click here.
Data
The Surveillance Atlas of Infectious Diseases displays data on hepatitis A reported by the EU/EEA countries. Cases should be reported according to the 2018 EU case definition for acute hepatitis A19:

Clinical criteria
Any person with a discrete onset of symptoms (e.g. fatigue, abdominal pain, loss of appetite, intermittent nausea and vomiting)
AND at least one of the following three:
— Fever;
— Jaundice;
— Elevated serum aminotransferase levels.
Laboratory criteria
At least one of the following three:
— Detection of hepatitis A virus nucleic acid in serum or stool;
— Hepatitis A virus specific antibody response;
— Detection of hepatitis A virus antigen in stool.
Epidemiological criteria
At least one of the following four:
— Human to human transmission;
— Exposure to a common source;
— Exposure to contaminated food/drinking water;
— Environmental exposure.

Case classification
A. Possible case: NA
B. Probable case: Any person meeting the clinical criteria with an epidemiological link
C. Confirmed case: Any person meeting the clinical and the laboratory criteria

Note: If the national surveillance system is not capturing clinical symptoms, all laboratory-confirmed individuals should be reported as confirmed cases.

------------------------
(The note is the only difference between the 2018 EU case definition and the 2012 and 2008 EU case definitions.)

Data collection and analysis
Data are collected on an annual basis for the previous year. Countries can also update their data at any time. Before analysis, data are validated with nominated data providers in EU/EEA countries. Country population denominators by age group for the calculation of notification rates were obtained from Eurostat20. Note that data published in the Surveillance Atlas might differ from figures in national reports due to different times of reporting, inclusion of cases by different case definitions and use of different denominators.
Indicators were displayed as “–” and not calculated for variables with more than 50% of cases with undocumented information (unknown or missing) for a given geographical resolution (e.g. country, EU/EEA) and time period. The age-standardised rate and the notification rate for domestic cases were calculated when age and travel history were known for at least 90% of cases.
Surveillance systems across the EU/EEA countries are heterogeneous and a surveillance systems overview is displayed in Annex 1.

Surveillance Atlas indicators
The Surveillance Atlas indicators for confirmed hepatitis A cases are:
1. Number of reported cases;
2. Notification rate per 100 000 population;
3. Age-standardised rate per 100 000 population;
4. Number of hospitalised cases;
5. Proportion of hospitalised cases among confirmed cases with known history of hospitalisation (%);
6. Number of deaths derived from reporting of disease outcome;
7. Case fatality calculated as proportion of deaths among confirmed cases with known disease outcome (%);
8. Notification rate for domestic cases per 100 000 population;
9. Proportion of travel-associated cases among confirmed cases with known travel history outside the reporting country (%);

For notification rate indicators, the data may be displayed in a bar chart as:
• Age-specific notification rate (for age groups 0-4, 5-14, 15-24, 25-44, 45-64, 65 years and above);
• Gender-specific notification rate;

For all other indicators, the data may be displayed in a bar chart or a pie chart by proportion of:
• Age groups (0-4, 5-14, 15-24, 25-44, 45-64, 65 years and above);
• Gender;
• Probable country of infection.

Symbols used in the Surveillance Atlas table:
Symbol
Comment
–
Indicator is not calculated for a given geographical resolution and time period.
.
Missing data. Data are not reported to TESSy for a given time period.

Data quality
EU/EEA countries reporting data on hepatitis A as displayed in the Annex 1. For data quality, reporting completeness of variables used to calculate Surveillance Atlas indicators was analysed for reported, confirmed cases. For countries reporting data only in aggregated format, the analysis of data completeness is allowed only for data reported such as age and gender.
The Surveillance Atlas indicators for data quality of confirmed hepatitis A cases are:
• Completeness age (%);
• Completeness gender (%);
• Completeness disease outcome (%);
• Completeness travel-associated (%);
• Completeness hospitalisation (%);
• Completeness probable country of infection (%).

Interpretation
The results shown in the Surveillance Atlas should be interpreted carefully. National surveillance systems differ from each other and so does case under-ascertainment and under-reporting between countries.
The notification of hepatitis A is mandatory, and the surveillance systems have full national coverage in all 30 EU/EEA countries and in three candidate countries (Albania, North Macedonia and Serbia). For 2020, Spain has not received data from all regions and rate is therefore not displayed for that year. In Belgium, full national coverage was established in 2015 and rates before this date are not displayed. All reporting countries provide case-based data except Albania, Belgium and Bulgaria which report aggregate data. Aggregated reporting format was included to calculate numbers of cases and notification rates, as well as disease trends, age and gender distributions when this data was available.
The COVID-19 pandemic significantly impacted on the hepatitis A surveillance data in 2020-2022. Factors mentioned by countries resulting in lower case numbers were e.g. less travel due to travel restrictions, fewer social interactions, people avoiding to seek medical care for mild symptoms due to risk of exposure to COVID-19 in health care facilities, limited laboratory capacity due to reallocation of resources to SARS-CoV-2, fewer restaurant visits, etc.
The completeness of some variables such as outcome or travel history varies between countries and years. Some countries are able to collect and integrate this type of information from different sources, other countries are not. Even if overall data completeness is high for some variables, the reader should refrain from directly comparing countries without taking into account limitations.

Reports published by ECDC on hepatitis A
More information is available in ECDC reports. Note that later retrievals of data related to the same period may result in slightly different numbers as countries have the possibility to update data in TESSy retrospectively. Therefore, the data presented in the reports might slightly differ from the data presented in the Surveillance Atlas.
Annual epidemiological report for 2022 – Hepatitis A:
Annual epidemiological report 2022 - Hepatitis A (europa.eu)

Severi E, Tavoschi L, Carrillo-Santisteve P, Westrell T, Gaetano Marrone G et al. Hepatitis A notifications in the EU/EEA, 2010–2019: what can we learn from case reporting to the European Surveillance System? Eurosurveillance 2023. Vol 28. https://www.eurosurveillance.org/content/10.2807/1560-7917.ES.2023.28.19.2200575

Epidemiological update 29 September 2022: Spread of hepatitis A virus strains of genotype IB in several EU countries and the United Kingdom:
https://www.ecdc.europa.eu/en/news-events/spread-hepatitis-virus-strains-genotype-ib-several-eu-countries-and-united-kingdom

Rapid risk assessment: Hepatitis A outbreak in the EU/EEA mostly affecting men who have sex with men, 3rd update (28 June 2017):
https://ecdc.europa.eu/en/publications-data/rapid-risk-assessment-hepatitis-outbreak-eueea-mostly-affecting-men-who-have-sex
Epidemiological update 12 September 2018: Hepatitis A outbreak in the EU/EEA mostly affecting men who have sex with men:
https://ecdc.europa.eu/en/news-events/epidemiological-update-hepatitis-outbreak-eueea-mostly-affecting-men-who-have-sex-men-2

Hepatitis A virus in the EU/EEA, 1975-2014: A systematic review of seroprevalence and incidence comprising European surveillance data and national vaccination recommendations:
https://ecdc.europa.eu/sites/portal/files/media/en/publications/Publications/hepatitis-a-virus-EU-EEA-1975-2014.pdf
Annex 1. Surveillance systems overview, 2023
Country
Data source
Compulsory (Cp), voluntary (V), other(O)
Comprehensive (Co), sentinel (Se), other(O)
Active (A), passive (P)
Case-based (C), aggregated (A)
Data reported by
Case definition used






Laboratories
Physicians
Hospitals
Others

Albania
AL-HEPA
Cp
Co
P
A
Y
N
Y
N
Not specified/unknown
Austria
AT-Epidemiegesetz
Cp
Co
P
C
Y
Y
Y
Y
EU-2008
Belgium
BE-LABNET
Cp
O
P
A
Y
N
.
.
EU-2018
Bulgaria
BG-NATIONAL_SURVEILLANCE
Cp
Co
P
A
Y
Y
Y
Y
EU-2018
Croatia
HR-CNIPH
Cp
Co
P
C
Y
Y
Y
Y
EU-2012
Cyprus
CY-NOTIFIED_DISEASES
Cp
Co
P
C
N
Y
N
N
EU-2008
Czechia
CZ-ISIN
Cp
Co
A
C
Y
Y
Y
N
EU-2008
Denmark
DK-MIS
Cp
Co
P
C
N
Y
N
N
Other
Estonia
EE-NAKIS
Cp
Co
P
C
Y
Y
Y
N
EU-2018
Finland
FI-NIDR
Cp
Co
P
C
Y
Y
N
N
EU-2012
France
FR-MANDATORY_INFECTIOUS_DISEASES
Cp
Co
P
C
Y
Y
Y
Y
Not specified/unknown
Germany
DE-SURVNET@RKI-7.1/6
Cp
Co
P
C
Y
Y
Y
Y
Other
Greece
EL-NOTIFIABLE_DISEASES
Cp
Co
P
C
Y
Y
Y
.
EU-2018
Hungary
HU-EFRIR
Cp
Co
P
C
Y
Y
Y
N
EU-2012
Iceland
IS-SUBJECT_TO_REGISTRATION
Cp
Co
P
C
Y
Y
.
.
EU-2018
Ireland
IE-CIDR
Cp
Co
P
C
Y
Y
Y
N
EU-2008
Italy
IT-NRS
Cp
Co
P
C
N
Y
Y
N
Other
Latvia
LV-BSN
Cp
Co
P
C
Y
Y
Y
N
EU-2018
Liechtenstein
LI-HEPA
Cp
Co
P
C
Y
Y
Y
.
EU-2018
Lithuania
LT-COMMUNICABLE_DISEASES
Cp
Co
P
C
Y
Y
N
N
EU-2018
Luxembourg
LU-SYSTEM1
Cp
Co
P
C
Y
Y
N
N
EU-2018
Malta
MT-DISEASE_SURVEILLANCE
Cp
Co
P
C
Y
Y
Y
Y
EU-2018
Netherlands
NL-OSIRIS
Cp
Co
P
C
Y
Y
N
N
EU-2018
Norway
NO-MSIS_A
Cp
Co
P
C
Y
Y
Y
N
EU-2018
Poland
PL-NATIONAL_SURVEILLANCE
Cp
Co
P
C
Y
Y
Y
N
EU-2008
Portugal
PT-HEPATITISA
Cp
Co
P
C
N
Y
N
N
EU-2018
Republic of North Macedonia
MK-HEPA
Cp
Co
P
C
Y
Y
Y
N
EU-2018
Romania
RO-RNSSy
Cp
Co
P
C
N
N
Y
N
EU-2012
Serbia
RS-IPHS-pilot
Cp
Co
P
A
Y
Y
Y
 .
EU-2018
Slovakia
SK-EPIS
Cp
Co
A
C
Y
Y
Y
Y
EU-2018
Slovenia
SI-SURVIVAL
Cp
Co
P
C
Y
Y
Y
N
EU-2008
Spain
ES-STATUTORY_DISEASES
Cp
Co
P
C
Y
Y
Y
N
EU-2018
Sweden
SE-SMINET
Cp
Co
P
C
Y
Y
N
N
EU-2018
Leptospirosis
Last updated: 13 August 2024
Data retrieval from TESSy: 13 August 2024

Leptospirosis is a zoonotic disease caused by pathogenic spirochetes belonging to the genus Leptospira. For a more detailed description of the disease and its epidemiology, please click here.
Data
The Surveillance Atlas of Infectious Diseases displays data on leptospirosis reported by the EU/EEA countries. Cases are to be reported according to the 2018 EU case definition for leptospirosis21:

Clinical criteria
Any person with
— Fever;
OR at least two of the following eleven:
— Chills;
— Headache;
— Myalgia;
— Conjunctival suffusion;
— Haemorrhages into skin and mucous membranes;
— Rash;
— Jaundice;
— Myocarditis;
— Meningitis;
— Renal impairment;
— Respiratory symptoms such as haemoptysis.
Laboratory criteria
At least one of the following four:
— Isolation of Leptospira interrogans or any other pathogenic Leptospira spp. from a clinical specimen;
— Detection of Leptospira interrogans or any other pathogenic Leptospira spp. nucleic acid in a clinical specimen;
— Demonstration of Leptospira interrogans or any other pathogenic Leptospira spp. by immunofluorescence in a clinical specimen;
— Leptospira interrogans or any other pathogenic Leptospira spp. specific antibody response.
Epidemiological criteria
At least one of the following three epidemiological links:
— Animal-to-human transmission;
— Environmental exposure;
— Exposure to a common source.

Case classification
A. Possible case: NA
B. Probable case: Any person meeting the clinical criteria with an epidemiological link
C. Confirmed case: Any person meeting the clinical and the laboratory criteria


Note: If the national surveillance system is not capturing clinical symptoms, all laboratory-confirmed individuals should be reported as confirmed cases.

------------------------
(The note is the only difference between the 2018 EU case definition and the 2012 and 2008 EU case definitions.)

Data collection and analysis
Data are collected on an annual basis for the previous year. Countries can also update their data at any time. Before analysis, data are validated with nominated data providers in EU/EEA countries. Country population denominators by age group for the calculation of notification rates were obtained from Eurostat22. Note that data published in the Surveillance Atlas might differ from figures in national reports due to different times of reporting, inclusion of cases by different case definitions and use of different denominators.
Indicators were displayed as “–” and not calculated for variables with more than 50% of cases with undocumented information (unknown or missing) for a given geographical resolution (e.g. country, EU/EEA) and time period. The age-standardised rate and the notification rate for domestic cases were calculated when age and travel history were known for at least 90% of cases.
Surveillance systems across the EU/EEA countries are heterogeneous and a surveillance systems overview is displayed in Annex 1.

Surveillance Atlas indicators
The Surveillance Atlas indicators for confirmed leptospirosis cases are:
1. Number of reported cases;
2. Notification rate per 100 000 population;
3. Age-standardised rate per 100 000 population;
4. Number of hospitalised cases;
5. Proportion of hospitalised cases among confirmed cases with known history of hospitalisation (%);
6. Number of deaths derived from reporting of disease outcome;
7. Case fatality calculated as proportion of deaths among confirmed cases with known disease outcome (%);
8. Notification rate for domestic cases per 100 000 population;
9. Proportion of travel-associated cases among confirmed cases with known travel history outside the reporting country (%);

For notification rate indicators, the data may be displayed in a bar chart as:
• Age-specific notification rate (for age groups 0-4, 5-14, 15-24, 25-44, 45-64, 65 years and above);
• Gender-specific notification rate;

For all other indicators, the data may be displayed in a bar chart or a pie chart by proportion of:
• Age groups (0-4, 5-14, 15-24, 25-44, 45-64, 65 years and above);
• Gender;
• Transmission mode.

Symbols used in the Surveillance Atlas table:
Symbol
Comment
–
Indicator is not calculated for a given geographical resolution and time period.
.
Missing data. Data are not reported to TESSy for a given time period.

Data quality
EU/EEA countries reporting data on leptospirosis as displayed in the Annex 1. For data quality, reporting completeness of variables used to calculate Surveillance Atlas indicators was analysed for reported, confirmed cases. For countries reporting data only in aggregated format, the analysis of data completeness is allowed only for data reported such as age and gender.
The Surveillance Atlas indicators for data quality of confirmed leptospirosis cases are:
• Completeness age (%);
• Completeness gender (%);
• Completeness disease outcome (%);
• Completeness travel-associated (%);
• Completeness hospitalisation (%);
• Completeness transmission mode (%).

Interpretation
The results shown in the Surveillance Atlas should be interpreted carefully. National surveillance systems differ from each other and so does the amount of samples tested.
The notification of leptospirosis is mandatory in 26 EU/EEA countries. In two countries, the notification is voluntary (France) or organised differently (Belgium). There is no surveillance system for leptospirosis in Liechtenstein and Norway. The surveillance systems for leptospirosis have full national coverage in all reporting countries except in Spain. No notification rate is calculated for Spain, as no estimated population coverage is provided. For 2020 and 2021, Spain has not received data from all regions and the case numbers for these years are therefore lower than could be expected. In Belgium, full national coverage was established in 2015 and rates before this date are not displayed. All reporting countries provide case-based data except Belgium and Bulgaria which report aggregate data. Aggregated reporting format was included to calculate numbers of cases and notification rates, as well as disease trends, age and gender distributions when this data was available.
The COVID-19 pandemic significantly impacted on the leptospirosis surveillance data in 2020. Decrease of cases may be associated with changes in population behaviours (e.g., less travel), people avoiding to seek medical care for mild symptoms due to risk of exposure to COVID-19 in health care facilities, limited laboratory capacity due to reallocation of resources to SARS-CoV-2 and/or with more limited or impaired surveillance activities resulting from the COVID-19 pandemic.
The completeness of some variables such as outcome or travel history varies between countries and years; some countries are able to collect and integrate this type of information from different sources, other countries are not.

Reports published by ECDC on leptospirosis
More information is available in ECDC reports. Note that later retrievals of data related to the same period may result in slightly different numbers as countries have the possibility to update data in TESSy retrospectively. Therefore, the data presented in the reports might slightly differ from the data presented in the Surveillance Atlas.

Annual epidemiological report for 2022 – Leptospirosis:
https://www.ecdc.europa.eu/sites/default/files/documents/LEPT_AER_2022_Report.pdf
Beauté J, Innocenti F, Aristos Aristodimou A, Michaela Špačková M, Eves C, et al. Epidemiology of reported cases of leptospirosis in the EU/EEA, 2010 to 2021. Eurosurveillance 2024. Vol 29. https://www.eurosurveillance.org/content/10.2807/1560-7917.ES.2024.29.7.2300266
Annex 1. Surveillance systems overview, 2023
Country
Data source
Compulsory (Cp), voluntary (V), other(O)
Comprehensive (Co), sentinel (Se), other(O)
Active (A), passive (P)
Case-based (C), aggregated (A)
Data reported by
Case definition used






Laboratories
Physicians
Hospitals
Others

Austria
AT-Epidemiegesetz
Cp
Co
P
C
Y
Y
Y
Y
EU-2008
Belgium
BE-REFLAB
O
Co
P
A
Y
N
N
N
EU-2018
Bulgaria
BG-NATIONAL_SURVEILLANCE
Cp
Co
P
A
Y
Y
Y
Y
EU-2018
Croatia
HR-CNIPH
Cp
Co
P
C
Y
Y
Y
Y
EU-2012
Cyprus
CY-NOTIFIED_DISEASES
Cp
Co
P
C
N
Y
N
N
EU-2008
Czechia
CZ-ISIN
Cp
Co
A
C
Y
Y
Y
N
EU-2008
Denmark
DK-MIS
Cp
Co
P
C
N
Y
N
N
Other
Estonia
EE-NAKIS
Cp
Co
P
C
Y
Y
Y
N
EU-2018
Finland
FI-NIDR
Cp
Co
P
C
Y
N
N
N
EU-2012
France
FR-NATIONAL_REFERENCE_CENTRES
V
Co
P
C
Y
N
N
N
Other
Germany
DE-SURVNET@RKI-7.1
Cp
Co
P
C
Y
N
N
N
Other
Greece
EL-NOTIFIABLE_DISEASES
Cp
Co
P
C
Y
Y
Y
.
EU-2018
Hungary
HU-EFRIR
Cp
Co
P
C
Y
Y
Y
N
EU-2012
Iceland
IS-SUBJECT_TO_REGISTRATION
Cp
Co
P
C
Y
Y
.
.
EU-2018
Ireland
IE-CIDR
Cp
Co
P
C
Y
Y
Y
N
EU-2008
Italy
IT-NRS
Cp
Co
P
C
N
Y
Y
N
Other
Latvia
LV-BSN
Cp
Co
P
C
Y
Y
Y
N
EU-2018
Lithuania
LT-COMMUNICABLE_DISEASES
Cp
Co
P
C
Y
Y
N
N
EU-2018
Luxembourg
LU-SYSTEM1
Cp
Co
P
C
Y
Y
N
N
EU-2018
Malta
MT-DISEASE_SURVEILLANCE
Cp
Co
P
C
Y
Y
Y
Y
EU-2018
Netherlands
NL-OSIRIS
Cp
Co
P
C
Y
Y
N
N
EU-2018
Poland
PL-NATIONAL_SURVEILLANCE
Cp
Co
P
C
Y
Y
Y
N
EU-2018
Portugal
PT-LEPTOSPIROSIS
Cp
Co
P
C
N
Y
N
N
EU-2018
Romania
RO-RNSSy
Cp
Co
P
C
N
N
Y
N
EU-2018
Slovakia
SK-EPIS
Cp
Co
A
C
Y
Y
Y
N
EU-2018
Slovenia
SI-SURVIVAL
Cp
Co
P
C
Y
Y
Y
N
EU-2008
Spain
ES-STATUTORY_DISEASES
Cp
Co
P
C
Y
Y
Y
N
EU-2018
Sweden
SE-SMINET
Cp
Co
P
C
Y
Y
N
N
EU-2018


Listeriosis
Last updated: 13 August 2024
Data retrieval from TESSy: 13 August 2024

Listeriosis is an infection caused by the bacterium Listeria monocytogenes. For a more detailed description of the disease and its epidemiology, please click here.
Data
The Surveillance Atlas of Infectious Diseases displays data on listeriosis reported by the EU/EEA countries. Cases should be reported according to the 2018 EU case definition for listeriosis23:

Clinical criteria
Any person with at least one of the following five:
— Fever
— Meningitis, meningoencephalitis, or encephalitis
— Influenza-like symptoms
— Septicaemia
— Localized infections such as arthritis, endocarditis, endophthalmitis, and abscesses
Listeriosis in pregnancy:
— Pregnancy-related consequences of Listeria infection defined as: miscarriage, stillbirth or premature birth during the pregnancy
— Listeriosis of newborns defined as one of the following
— Stillbirth (fetal death after 20 weeks of gestation)
— Premature birth (before 37 gestational weeks)
OR
At least one of the following five in the first month of life (neonatal listeriosis):
— Meningitis or meningoencephalitis
— Septicaemia
— Dyspnoea
— Granulomatosis infantiseptica
— Lesions on skin, mucosal membranes or conjunctivae
Laboratory criteria
At least one of the following two:
— Isolation of Listeria monocytogenes or detection of nucleic acid of Listeria monocytogenes from a normally sterile site
— In a pregnancy-associated case also: Isolation of Listeria monocytogenes or detection of nucleic acid from Listeria monocytogenes in a normally non-sterile site (for example, placental tissue, amniotic fluid, meconium, vaginal swab) or from a foetus, stillborn, newborn or the mother
Epidemiological criteria
At least one of the following four epidemiological links:
— Exposure to a common source
— Human to human transmission (vertical transmission)
— Exposure to contaminated food
— Animal to human transmission

Case classification
A. Possible case: NA
B. Probable case: Any person meeting the clinical criteria with an epidemiological link
C. Confirmed case: Any person meeting the laboratory criteria for a normal sterile site
OR
In a pregnancy-associated case (mother or newborn in the first month of life) meeting the laboratory criteria, only the mother is to be reported as a case.

Note: If the national surveillance system is not capturing clinical symptoms, all laboratory-confirmed individuals should be reported as confirmed cases.

------------------------
(The EU case definitions 2018 have been simplified in relation to pregnancy-associated listeriosis where now only the mother should be reported as a case. Compared to the 2008 and 2012 EU case definitions, genotypic methods are now allowed for laboratory confirmation of listeriosis and the note is also new.)

Data collection and analysis
Data are collected on an annual basis for the previous year. Countries can also update their data in TESSy at any time. Before analysis, data are validated with nominated data providers in EU/EEA countries. Country population denominators by age group for the calculation of notification rates were obtained from Eurostat24. Note that data published in the Surveillance Atlas might differ from figures in national reports due to different times of reporting, inclusion of cases by different case definitions and use of different denominators.
Indicators were displayed as “–” and not calculated for variables with more than 50% of cases with undocumented information (unknown or missing) for a given geographical resolution (e.g. country, EU/EEA) and time period. The age-standardised rate and the notification rate for domestic cases were calculated when age and travel history were known for at least 90% of cases.
Surveillance systems across the EU/EEA countries are heterogeneous and a surveillance systems overview is displayed in Annex 1.

Surveillance Atlas indicators
The Surveillance Atlas indicators for confirmed listeriosis cases are:
1. Number of reported cases;
2. Notification rate per 100 000 population;
3. Age-standardised rate per 100 000 population;
4. Number of hospitalised cases;
5. Proportion of hospitalised cases among confirmed cases with known history of hospitalisation (%);
6. Number of deaths derived from reporting of disease outcome;
7. Case fatality calculated as proportion of deaths among confirmed cases with known disease outcome (%);
8. Notification rate for domestic cases per 100 000 population;
9. Proportion of travel-associated cases among confirmed cases with known travel history outside the reporting country (%);

Indicators for confirmed listeriosis 65 years of age and above are:
1. Number of reported cases;
2. Notification rate per 100 000 population;
3. Number of deaths derived from reporting of disease outcome;
4. Case fatality calculated as proportion of deaths among confirmed cases with known disease outcome (%);

For notification rate indicators, the data may be displayed in a bar chart as:
• Age-specific notification rate (for age groups <1, 1-4, 5-14, 15-24, 25-44, 45-64, 65 years and above);
• Age-specific notification rate for confirmed cases 65 years of age and above (for age groups 65-69, 70-74, 75-79, 80-84, 85 years and above);
• Gender-specific notification rate;

For all other indicators, the data may be displayed in a bar chart or a pie chart by proportion of:
• Age groups (<1, 1-4, 5-14, 15-24, 25-44, 45-64, 65 years and above);
• Age groups for confirmed cases 65 years of age and above (65-69, 70-74, 75-79, 80-84, 85 years and above);
• Gender;
• Serogroup (data from both traditional serotyping and serotyping with molecular methods).

Symbols used in the Surveillance Atlas table:
Symbol
Comment
–
Indicator is not calculated for a given geographical resolution and time period.
.
Missing data. Data are not reported to TESSy for a given time period.

Data quality
EU/EEA countries reporting data on listeriosis as displayed in the Annex 1. For data quality, reporting completeness of variables used to calculate Surveillance Atlas indicators was analysed for reported, confirmed cases. For countries reporting data only in aggregated format, the analysis of data completeness is allowed only for data reported such as age and gender.
The Surveillance Atlas indicators for data quality of confirmed listeriosis cases are:
• Completeness age (%);
• Completeness gender (%);
• Completeness disease outcome (%);
• Completeness travel-associated (%);
• Completeness hospitalisation (%);
• Completeness serogroup (%).

Interpretation
The results shown in the Surveillance Atlas should be interpreted carefully. National surveillance systems differ from each other and so does case under-ascertainment between countries.
The notification of listeriosis in humans is mandatory in all EU/EEA countries, except in Belgium. The surveillance systems for listeriosis have full national coverage in all reporting countries except in Belgium and Spain. The population coverage is estimated to be 80% in Belgium since 2015 and 97% in Spain in 2021-2023. These proportions were used when calculating the national notification rates for these two Member States. No estimate of population coverage in Spain was provided prior 2021, so notification rates were not calculated. All countries provide case-based data except Bulgaria, which reported aggregate data. Aggregated reporting format was included to calculate numbers of cases and notification rates, as well as disease trends, age and gender distributions when this data was available.
Listeriosis infections are most commonly reported in the elderly population (>65 years old) with hospitalisation and case fatality increasing with age.
The completeness of some variables such as outcome or travel history varies between countries and years; some countries are able to collect and integrate this type of information from different sources, other countries are not. Even if overall data completeness is high for some variables, the reader should refrain from directly comparing countries without taking into account all these limitations.

Reports published by ECDC on listeriosis
More information is available in ECDC reports. Note that later retrievals of data related to the same period may result in slightly different numbers as countries have the possibility to update data in TESSy retrospectively. Therefore, the data presented in the reports might slightly differ from the data presented in the Surveillance Atlas.

Annual epidemiological report for 2022 – Listeriosis:
Listeriosis Annual Epidemiological Report 2022 (europa.eu)

EFSA and ECDC (European Food Safety Authority and European Centre for Disease Prevention and Control), 2023. The European Union One Health 2022 Zoonoses Report (December 2023):
https://efsa.onlinelibrary.wiley.com/doi/epdf/10.2903/j.efsa.2023.8442

Ninth external quality assessment scheme for Listeria monocytogenes typing (November 2023):
Ninth external quality assessment scheme for Listeria monocytogenes typing (europa.eu)

European listeria typing exercise ELiTE joint report (February 2021):
https://www.ecdc.europa.eu/sites/default/files/documents/European-listeria-typing-exercise-ELiTE-joint-report.pdf

Proficiency test for Listeria monocytogenes whole genome assembly 2018:
http://ecdc.europa.eu/sites/portal/files/documents/Listeria-WGA-2019.pdf

Rapid Outbreak Assessment: Prolonged multi-country outbreak of Listeria monocytogenes ST173 linked to consumption of fish products (19 June 2024):
https://efsa.onlinelibrary.wiley.com/doi/pdf/10.2903/sp.efsa.2024.EN-8885

Rapid Outbreak Assessment: Prolonged multi-country outbreak of Listeria monocytogenes ST1607 linked to smoked salmon products (25 April 2024):
https://www.ecdc.europa.eu/sites/default/files/documents/ROA_2023-FWD-00003-Lm-ST1607_DK.pdf

Rapid outbreak assessment: Prolonged multi country cluster of Listeria monocytogenes ST155 infections (13 December 2023):
Prolonged mulit-country cluster of Listeria monocytogenes ST155 infections linked to ready-to-ead fish products (europa.eu)



Annex 1. Surveillance systems overview, 2023
Country
Data source
Compulsory (Cp), voluntary (V), other(O)
Comprehensive (Co), sentinel (Se), other(O)
Active (A), passive (P)
Case-based (C), aggregated (A)
Data reported by
Case definition used






Laboratories
Physicians
Hospitals
Others

Austria
AT-Epidemiegesetz
Cp
Co
P
C
Y
Y
Y
Y
EU-2008
Belgium
BE-REFLAB
V
Co
P
C
Y
N
N
N
EU-2018
Bulgaria
BG-NATIONAL_SURVEILLANCE
Cp
Co
P
A
Y
Y
Y
Y
EU-2018
Croatia
HR-CNIPH
Cp
Co
P
C
Y
Y
Y
Y
EU-2012
Cyprus
CY-NOTIFIED_DISEASES
Cp
Co
P
C
N
Y
N
N
EU-2008
Czechia
CZ-ISIN
Cp
Co
A
C
Y
Y
Y
N
EU-2008
Denmark
DK-LAB
Cp
Co
P
C
Y
N
N
N
EU-2018
Estonia
EE-NAKIS
Cp
Co
P
C
Y
Y
Y
N
EU-2018
Finland
FI-NIDR
Cp
Co
P
C
Y
Y
N
N
EU-2012
France
FR-MANDATORY_INFECTIOUS_DISEASES
Cp
Co
P
C
Y
Y
Y
Y
Not specified/unknown
Germany
DE-SURVNET@RKI-7.1
Cp
Co
P
C
Y
N
N
N
Other
Greece
EL-NOTIFIABLE_DISEASES
Cp
Co
P
C
Y
Y
Y
.
EU-2018
Hungary
HU-EFRIR
Cp
Co
P
C
.
Y
Y
N
EU-2012
Iceland
IS-SUBJECT_TO_REGISTRATION
Cp
Co
P
C
Y
Y
.
.
EU-2018
Ireland
IE-CIDR
Cp
Co
P
C
Y
Y
Y
N
EU-2008
Italy
IT-NRS
Cp
Co
P
C
N
Y
Y
N
EU-2018
Latvia
LV-BSN
Cp
Co
P
C
Y
Y
Y
N
EU-2018
Liechtenstein
LI-SEPI
Cp
Co
P
C
Y
Y
Y
.
EU-2018
Lithuania
LT-COMMUNICABLE_DISEASES
Cp
Co
P
C
Y
Y
N
N
EU-2018
Luxembourg
LU-SYSTEM1
Cp
Co
P
C
N
Y
N
N
EU-2018
Malta
MT-DISEASE_SURVEILLANCE
Cp
Co
P
C
Y
Y
Y
Y
EU-2018
Netherlands
NL-OSIRIS
Cp
Co
P
C
Y
Y
N
N
EU-2018
Norway
NO-MSIS_A
Cp
Co
P
C
Y
Y
Y
N
EU-2018
Poland
PL-NATIONAL_SURVEILLANCE
Cp
Co
P
C
Y
Y
Y
N
EU-2018
Portugal
PT-LIST
Cp
Co
P
C
N
Y
N
N
EU-2018
Romania
RO-RNSSy
Cp
Co
P
C
Y
N
Y
N
EU-2018
Slovakia
SK-EPIS
Cp
Co
A
C
Y
Y
Y
N
EU-2018
Slovenia
SI-SURVIVAL
Cp
Co
P
C
Y
Y
Y
N
EU-2008
Spain
ES-STATUTORY_DISEASES
Cp
Co
P
C
Y
Y
Y
N
EU-2018
Sweden
SE-SMINET
Cp
Co
P
C
Y
Y
N
N
EU-2018

Salmonellosis and typhoid/paratyphoid fever

Last updated: 13 August 2024
Data retrieval from TESSy: 13 August 2024

Salmonellosis is an infection caused by bacteria belonging to the genus Salmonella. Non-typhoidal salmonellosis (Salmonella spp. other than S. Typhi and S. Paratyphi) usually causes gastroenteritis whereas typhoid and paratyphoid fever are systemic infections. For a more detailed description of the disease and its epidemiology please click on the salmonellosis page and the typhoid/parathyphoid page.
Data
The Surveillance Atlas of Infectious Diseases displays data on salmonellosis reported to TESSy by the EU/EEA countries since 2007.

Case definition of non-typhoidal salmonellosis
The Surveillance Atlas of Infectious Diseases displays data on salmonellosis reported by the EU/EEA countries. Cases should be reported according to the 2018 EU case definition for Salmonella enteritis25:

Clinical criteria
Any person with at least one of the following four:
— Diarrhoea;
— Fever;
— Abdominal pain;
— Vomiting.
Laboratory criteria
At least one of the following two:
— Isolation of Salmonella (other than S. Typhi or S. Paratyphi) in a clinical specimen
— Detection of nucleic acid from Salmonella (other than S. Typhi or S. Paratyphi) in a clinical specimen

Note: Antimicrobial susceptibility testing of Salmonella enterica should be performed on a representative subset of isolates
Epidemiological criteria
At least one of the following five epidemiological links:
— Human to human transmission;
— Exposure to a common source;
— Animal to human transmission;
— Exposure to contaminated food/drinking water;
— Environmental exposure.

Case classification
A. Possible case NA
B. Probable case: any person meeting the clinical criteria with an epidemiological link
C. Confirmed case: any person meeting the clinical and the laboratory criteria

Note: If the national surveillance system is not capturing clinical symptoms, all laboratory-confirmed individuals should be reported as confirmed cases.
Antimicrobial resistance
The results of antimicrobial susceptibility tests must be reported according to the methods and criteria agreed between ECDC and Member States as specified in the EU protocol for harmonised monitoring of antimicrobial resistance in human Salmonella and Campylobacter isolates.26
------------------------
(Compared with the 2008 and 2012 EU case definition, the 2018 EU case definition allows genotypic tests for laboratory confirmation and includes a requirement for antimicrobial susceptibility testing and reporting of results. The note is also a new addition.)

Case definition of typhoid/paratyphoid fever (Salmonella Typhi/Paratyphi)
The Surveillance Atlas of Infectious Diseases displays data on salmonellosis reported by the EU/EEA countries. Cases should be reported according to the 2018 EU case definition for typhoid and paratyphoid fever26:
Clinical criteria
Any person with at least one of the following two:
— Onset of sustained fever
OR
— At least two of the following four:
• Headache;
• Relative bradycardia;
• Non-productive cough;
• Diarrhoea, constipation, malaise or abdominal pain.
Laboratory criteria
At least one of the following two:
— Isolation of Salmonella Typhi or Paratyphi from a clinical specimen
— Detection of Salmonella Typhi or Paratyphi nucleic acid in a clinical specimen
Epidemiological criteria
At least one of the following three epidemiological links:
— Exposure to a common source;
— Human to human transmission;
— Exposure to contaminated food/drinking water.

Case classification
A. Possible case: NA
B. Probable case: any person meeting the clinical criteria with an epidemiological link
C. Confirmed case: any person meeting the clinical and the laboratory criteria

Note: If the national surveillance system is not capturing clinical symptoms, all laboratory-confirmed individuals should be reported as confirmed cases.

--------------------------
(Inclusion of genotypic tests for laboratory confirmation and the note are the differences between the 2018 EU case definition of typhoid and paratyphoid fevers and the 2012 and 2008 EU case definitions.)

Data collection and analysis
Data are collected on an annual basis for the previous year. Countries can also update their data at any time. Before analysis, data are validated with nominated data providers in EU/EEA countries. For the calculation of notification rates, country population denominators by age group were obtained from Eurostat27 and adjusted according to the percent coverage of the surveillance system generating reports, where this information was available. Note that the data published in the Surveillance Atlas might differ from figures in national reports and in official ECDC and EFSA reports due to different dates of reporting, inclusion of cases reflecting different case definitions and the use of different denominators.
When information for a collected variable was unknown for more than 50% of cases in a given geographical region and time period, the corresponding indicator was not calculated and is displayed as “-” in the Surveillance Atlas Table. The exceptions to this rule are the age-standardised rate and the notification rate for domestic cases, which were calculated when the completeness the age resp. travel information was at least 90%.
Surveillance systems across the EU/EEA countries are heterogeneous and an overview is displayed in Annex 1.

Surveillance Atlas indicators
The Surveillance Atlas indicators for confirmed non-typhoidal salmonellosis cases are:
1. Number of reported cases;
2. Notification rate per 100 000 population;
3. Age-standardised rate per 100 000 population;
4. Number of hospitalised cases;
5. Proportion of hospitalised cases among confirmed cases (%);
6. Number of deaths derived from reporting of outcome of the disease;
7. Case-fatality calculated as proportion of deaths among cases with known information on outcome of the disease (%);
8. Notification rate for domestic cases per 100 000 population;
9. Proportion of travel associated cases among confirmed cases (%);

a) Indicators for confirmed cases of Salmonella Enteritidis, Salmonella Typhimurium and typhoid and paratyphoid fever cases are:
5. Number of reported cases;
6. Notification rate per 100 000 population;
7. Age-standardised rate per 100 000 population;
8. Proportion of travel-associated cases among all reported confirmed cases (%).

b) Indicators for cases of a selected Salmonella serotypes are:
1. Number of reported cases;
2. Notification rate per 100 000 population;
3. Number of deaths.
For all indicators, the data may be displayed in a bar chart or a pie chart by proportion of:
• age groups (0-4, 5-14, 15-24, 25-44, 45-64, 65 years and above);
• gender;

In addition, the data may be displayed in the bar or pie chart as follows:
• for salmonellosis confirmed cases by:
• most frequent serotypes;
• for Salmonella Enteritidis and Salmonella Typhimurium confirmed cases by:
• phagetype;
• travel-associated cases;
• for typhoid and paratyphoid fever cases by:
• serotype;
• probable country of infection.

Symbols used in the Surveillance Atlas:
Symbol
Comment
-
Indicator is not calculated for a given geographical resolution and time period.
.
Missing data. Data are not reported to TESSy for the related time period.

Data quality
EU/EEA countries reporting data on salmonellosis as displayed in the Annex 1. For data quality, reporting completeness of variables used to calculate Surveillance Atlas indicators was analysed for reported, confirmed cases. For countries reporting data only in aggregated format, the analysis of data completeness is allowed only for data reported such as age and gender.

The Surveillance Atlas indicators for data quality of confirmed salmonellosis cases are:
• Completeness age (%);
• Completeness gender (%);
• Completeness disease outcome (%);
• Completeness travel-associated (%);
• Completeness hospitalisation (%);
• Completeness serotype (%).

Interpretation
The results shown in the Atlas should be interpreted with caution and taking into account data quality issues and differences between Member State surveillance systems. Particular caution is required when interpreting data on e.g. hospitalisation, outcome, importation or serotype for which completeness varies between countries and years. Even if data completeness is high for some variables, this does not reflect the level of case under-ascertainment or under-reporting which may differ between countries depending on the characteristics of their surveillance systems. Hence, the reader should refrain from making direct comparisons between countries without considering all these limitations in the data.

Non-typhoidal salmonellosis
Notification of non-typhoidal salmonellosis is mandatory in 27 of EU-EEA countries. In three EU Member States, reporting is voluntary (Belgium, France, and the Netherlands). The surveillance systems for salmonellosis have full national coverage in all Member States except in three (Belgium, the Netherlands and Spain). The population coverage in 2022-2023 is estimated to be 85% in Belgium, 64% in the Netherlands in all reporting years, and 80% and 73% in Spain in 2023 and 2021-2022, respectively. These proportions were used when calculating the national notification rates for these Member States. In Belgium, a change in the surveillance was made in 2015 and rates before this date are not displayed. No information on estimated coverage was provided by Spain prior 2021, so notification rates were not calculated. All countries report case-based data except Bulgaria which reports aggregated data. Aggregated reporting format was included to calculate numbers of cases and notification rates, as well as disease trends, age and gender distributions when this data was available.
The COVID-19 pandemic significantly impacted on the surveillance data for salmonellosis in 2020-2022. Factors mentioned by countries resulting in lower case numbers were e.g. people avoiding to seek medical care for mild symptoms due to risk of exposure to COVID-19 in health care facilities, limited laboratory capacity due to reallocation of resources to SARS-CoV-2, fewer restaurant visits, increased hand washing, less travel due to travel restriction etc.
The observed differences in hospitalisation rates across the EU/EEA countries are more likely to reflect the diversity in national healthcare and surveillance systems than differences in the severity of the disease. Interestingly, the countries reporting the highest proportions of hospitalised cases (>80%) also reported the lowest notification rates of salmonellosis, which suggests that surveillance systems in those countries primarily focus on the more severe cases.

Typhoid and paratyphoid fever
Typhoid and paratyphoid fever is under mandatory notification in all EU/EEA countries. The surveillance systems have full national coverage in all but two EU Member States (Belgium and the Netherlands). The population coverage is estimated to be 85% in Belgium in 2022-2023, 64% in the Netherlands for all reporting years. These proportions were used when calculating the national notification rates for these two Member States. . No information on estimated coverage was provided by Spain prior 2021, so notification rates were not calculated. All countries report case-based data except Bulgaria which reports aggregated data for salmonellosis from which typhoid and paratyphoid cases cannot be distinguished.
The COVID-19 pandemic and the withdrawal of the United Kingdom from the EU in 2020 significantly impacted on the surveillance data for typhoid and paratyphoid fever in 2020-2021. Travel restrictions most likely had the highest impact on reducing the case numbers in the EU/EEA.

Reports published by ECDC on salmonellosis and typhoid/paratyphoid fever
More information is available in ECDC reports. Later retrievals of data related to the same period may result in slightly different numbers as countries have the possibility to update data retrospectively. Therefore, the data presented in the reports might slightly differ from those presented in the Surveillance Atlas.
Annual epidemiological report for 2022 – Salmonellosis:
Annual epidemiological report 2022 - Salmonellosis (europa.eu)

Annual epidemiological report for 2021 – Typhoid and paratyphoid fever:
https://www.ecdc.europa.eu/sites/default/files/documents/AER-Typhoid-paratyphoid-2021.pdf

EFSA and ECDC (European Food Safety Authority and European Centre for Disease Prevention and Control), 2023. The European Union One Health 2022 Zoonoses Report (December 2023):
https://efsa.onlinelibrary.wiley.com/doi/epdf/10.2903/j.efsa.2023.8442

EFSA and ECDC (European Food Safety Authority and European Centre for Disease Prevention and Control), 2024. The European Union Summary Report on Antimicrobial Resistance in zoonotic and indicator bacteria from humans, animals and food in 2021-2022 (February 2024):
https://efsa.onlinelibrary.wiley.com/doi/epdf/10.2903/j.efsa.2024.8583

Thirteenth external quality assessment scheme for Salmonella typing (June 2024):
https://www.ecdc.europa.eu/en/publications-data/thirteenth-external-quality-assessment-salmonella-typing

Fourth external quality assessment on antimicrobial susceptibility testing and detection of ESBL-, acquired AmpC-, and carbapenemase-production of Salmonella, 2018 (May 2021): https://www.ecdc.europa.eu/en/publications-data/fourth-external-quality-assessment-antimicrobial-susceptibility-testing-salmonella
Rapid Outbreak Assessment: Multi-country outbreak of Salmonella Mbandaka ST413 linked to consumption of chicken meat products in the EU/EEA and the UK – first update (21 March 2024):
Multi-country outbreak of Salmonella Mbandaka ST413 linked to consumption of chicken meat products in the EU/EEA and the UK – first update (europa.eu)

Rapid outbreak assessment: Three clusters of Salmonella Enteritidis ST11 infections linked to chicken meat and chicken meat products (26 October 2023):
Three clusters of Salmonella Enteritidis ST11 infections linked to chicken meat and chicken meat products (europa.eu)

Multi-country outbreak of Salmonella Senftenberg ST14 infections, possibly linked to cherry-like tomatoes (27 July 2023)
https://www.ecdc.europa.eu/sites/default/files/documents/ROA_S_Senftenberg-ST15_2023-FWD-00009.pdf

Rapid outbreak assessment: Multi-country outbreak of Salmonella Virchow ST16 infections linked to the consumption of meat products containing chicken meat (30 March 2023):
Multi-country outbreak of Salmonella Virchow ST16 infections linked to the consumption of meat products containing chicken meat (europa.eu)



Annex 1. Surveillance systems overview, 2023
Country
Data source
Compulsory (Cp), voluntary (V), other(O)
Comprehensive (Co), sentinel (Se), other(O)
Active (A), passive (P)
Case-based (C), aggregated (A)
Data reported by
Case definition used
Non-typhoidal (N) / Typhoid, Paratyphoid (T) / Serotype (S)






Laboratories
Physicians
Hospitals
Others


Austria
AT-Epidemiegesetz
Cp
Co
P
C
Y
Y
Y
Y
EU-2008
N, T, S
Belgium
BE-REFLAB
V
Co
P
C
Y
N
N
N
EU-2018
N, T, S
Bulgaria
BG-NATIONAL_SURVEILLANCE
Cp
Co
P
A
Y
Y
Y
Y
EU-2018
N
Croatia
HR-CNIPH
Cp
Co
P
C
Y
Y
Y
Y
EU-2012
N, T, S
Cyprus
CY-NOTIFIED_DISEASES
Cp
Co
P
C
N
Y
N
N
EU-2008
N, T, S
Czechia
CZ-ISIN
Cp
Co
A
C
Y
Y
Y
N
EU-2008
N, T, S
Denmark
DK-LAB
Cp
Co
P
C
Y
N
N
N
EU-2018
N, T, S
Estonia
EE-NAKIS
Cp
Co
P
C
Y
Y
Y
N
EU-2018
N, T, S
Finland
FI-NIDR
Cp
Co
P
C
Y
N
N
N
EU-2012
N, T, S
France
FR-NATIONAL_REFERENCE_CENTRES
V
Co
P
C
Y
N
N
N
Other
N, T, S
Germany
DE-SURVNET@RKI-7.1
Cp
Co
P
C
Y
N
N
N
Other
N, T, S
Greece
EL-NOTIFIABLE_DISEASES
Cp
Co
P
C
Y
Y
Y
.
EU-2018
N, T, S
Hungary
HU-Zoonoses
Cp
Co
P
C
Y
Y
Y
N
EU-2012
N, T, S
Iceland
IS-SUBJECT_TO_REGISTRATION
Cp
Co
P
C
Y
Y
.
.
EU-2018
N, T, S
Ireland
IE-CIDR
Cp
Co
P
C
Y
Y
Y
N
EU-2008
N, T, S
Italy
IT-ENTERNET
V
Se
P
C
Y
N
N
N
Other
S
Italy
IT-NRS
Cp
Co
P
C
N
Y
Y
N
Other
N,T
Latvia
LV-BSN
Cp
Co
P
C
Y
Y
Y
N
EU-2018
N, T, S
Liechtenstein
LI-SEPI
Cp
Co
P
C
Y
Y
Y
.
EU-2018
N, S
Lithuania
LT-COMMUNICABLE_DISEASES
Cp
Co
P
C
Y
Y
N
N
EU-2018
N, T, S
Luxembourg
LU-SYSTEM1
Cp
Co
P
C
Y
N
N
N
EU-2018
N, T, S
Malta
MT-DISEASE_SURVEILLANCE
Cp
Co
P
C
Y
Y
Y
Y
EU-2018
N, T, S
Netherlands
NL-LSI
V
Se
P
C
Y
N
N
N
EU-2018
N, S
Netherlands
NL-OSIRIS
Cp
Co
P
C
Y
Y
N
Y
EU-2018
T
Norway
NO-MSIS_A
Cp
Co
P
C
Y
Y
Y
N
EU-2018
N, T, S
Poland
PL-NATIONAL_SURVEILLANCE
Cp
Co
P
C
Y
Y
Y
N
EU-2018
N, T, S
Portugal
PT-SALMONELLOSIS
Cp
Co
P
C
N
Y
N
N
EU-2018
N, T, S
Romania
RO-RNSSy
Cp
Co
P
C
Y
N
Y
N
EU-2018
N, T, S
Slovakia
SK-EPIS
Cp
Co
A
C
Y
Y
Y
Y
EU-2018
N, T, S
Slovenia
SI-SURVIVAL
Cp
Co
P
C
Y
Y
Y
N
EU-2008
N, T, S
Spain
ES-STATUTORY_DISEASES
Cp
Co
P
C
Y
Y
Y
N
EU-2018
N, T
Spain
ES-NRL
VOLO
Se
P
C
Y
N
N
N
EU-2008
S
Sweden
SE-SMINET
Cp
Co
P
C
Y
Y
N
N
EU-2018
N, T, S

Antimicrobial resistance in Salmonella spp.
Last updated: 21 February 2024
Data retrieval from TESSy: 9 October 2023

Salmonellosis is an infection caused by Salmonella bacteria. Non-typhoidal salmonellosis (Salmonella spp. other than S. Typhi and S. Paratyphi) usually causes gastroenteritis whereas typhoid and paratyphoid fever are systemic infections. Typhoid and paratyphoid fevers are routinely treated with antimicrobials while for infections with non-typhoidal Salmonella, antimicrobial treatment is only required in case of severe illness. For a more detailed description of the disease and its epidemiology please click on the salmonellosis page and the typhoid/parathyphoid page.
Data
The Surveillance Atlas of Infectious Diseases displays data on antimicrobial resistance (AMR) in Salmonella spp. reported by the EU/EEA countries. According to the 2018 EU case definition for Salmonella enteritis28, antimicrobial susceptibility testing of Salmonella spp. should be performed on a representative subset of isolates.
The results of antimicrobial susceptibility tests must be reported according to the methods and criteria agreed between ECDC and Member States as specified in the EU protocol for harmonised monitoring of antimicrobial resistance in human Salmonella and Campylobacter isolates29. The panel of antimicrobial agents to test is also defined in the EU protocol.
AMR data are collected as part of the case-based datasets for salmonellosis and, since the 2013 data collection, as part of the molecular surveillance of Salmonella isolates. The case-based dataset contains data from clinical treatment of patients and the results are therefore by default interpreted using clinical breakpoints for assessing treatment options. Most countries apply clinical breakpoints from the European Committee on Antimicrobial Susceptibility Testing (EUCAST) but some also use national breakpoints or breakpoints from the Clinical and Laboratory Standards Institute (CLSI) when no EUCAST criteria are available. The isolate-based data are submitted by the National Public Health Reference Laboratories (NPHRLs) who do reference testing of isolates and can report the actual results of the antimicrobial susceptibility testing (AST) as minimum inhibitory concentration (MIC) or inhibition zone diameter. Such data are interpreted both with EUCAST clinical breakpoints, where available, but also with EUCAST epidemiological cut-off values where possible, to detect acquired resistance. Since 2019, data can also be reported as phenotypes predicted from sequencing of the bacterial genome and since 2023, Salmonella sequences can be reported which are analysed for both genes/mutations and predicted resistance with ResFinder at ECDC. Data from genetic typing are categorised as predicted wild type or predicted non-wild type and presented in the Atlas with the data interpreted with epidemiological cut-off values.

Data collection and analysis
Data are collected on an annual basis for the previous year. Before analysis, data are validated with nominated data providers in EU/EEA countries. Note that data published in the Surveillance Atlas might differ from figures in national reports due to different times of reporting, application of other interpretive criteria/breakpoints and use of different denominators. For quantitative data reported as MIC values or zone diameters, the criteria applied to categorise the data are listed in table 1.
Surveillance systems across the EU/EEA countries are heterogeneous and a surveillance systems overview is displayed in Annex 1.

Criteria used to interpret quantitative data:
Antimicrobial
Clinical breakpoint applied
Epidemiological cut-off applied
Ampicillin
EUCAST 2022
EUCAST Aug 2023
Azithromycin
NA
EUCAST Aug 2023
Cefotaxime
EUCAST 2022
EUCAST Aug 2023
Ceftazidime
EUCAST 2022
EUCAST Aug 2023
Chloramphenicol
EUCAST 2022
EUCAST Aug 2023
Ciprofloxacin/pefloxacin
EUCAST 2022
Previous EUCAST ECOFF applied, according to Commission Implementing Decision (EU) 2020/1729
Colistin1
EUCAST 2022
NA
(Fluoro)quinolones
Resistance to either ciprofloxacin, pefloxacin or nalidixic acid
Non-wild type to either ciprofloxacin, pefloxacin or nalidixic acid
Gentamicin
EUCAST 2022
EUCAST Aug 2023
Meropenem
EUCAST 2022
Previous EUCAST ECOFF applied, according to Commission Implementing Decision (EU) 2020/1729
Nalidixic acid
NA
EUCAST Aug 2023
Sulfamethoxazole
NA
CLSI M100-S32 clinical breakpoint
Tetracycline
NA
EUCAST Aug 2023
Tigecycline
NA
EUCAST ECOFF removed. ECOFF defined by EFSA for reporting 2022 data2 .
Trimethoprim
EUCAST 2022
EUCAST Aug 2023
Trimethoprim-sulfa
EUCAST 2022
EUCAST Aug 2023 for disk diffusion, old EUCAST ECOFF for MIC
Ciprofloxacin+cefotaxime
Resistance to both agents, see criteria for respective agent
Non-wild type to both agents, see criteria for respective agent
NA – not applicable; 1 colistin only applicable for dilution method; 2 EFSA Manual for reporting 2022 antimicrobial resistance data within the framework of Directive 2003/99/EC and Decision 2020/1729/EU.

Surveillance Atlas indicators
The Surveillance Atlas indicators for Salmonella antimicrobial resistance are:
5. Non-wild type (NWT) isolates percentage;
6. Non-wild type or I+R isolates percentage;
7. Clinically resistant (R) isolates percentage
8. Total tested isolates
For the resistance indicators, the data may be displayed in a bar chart as:
• Proportion resistant isolates by age-group (for age groups 0-4, 5-14, 15-24, 25-44, 45-64, 65 years and above);
• Proportion resistant isolates by gender;
• Proportion resistant isolates by geographical region, in case of travel-associated infections

Indicators are displayed as “–” and not calculated for when fewer than 10 isolates had been tested for the selected combination (e.g. Salmonella serotype, importation status and antimicrobial) and time period.
Indicators by age group and gender are not displayed if more than 50% of cases have undocumented information (unknown or missing) for a given geographical resolution (e.g. country, EU/EEA) and time period.

The Surveillance Atlas indicators were calculated from 2013 up to the end of 2022.

Symbols used in the Surveillance Atlas table:
Symbol
Comment
–
Indicator is not calculated for a given geographical resolution and time period.
.
Missing data. Data are not reported to TESSy for a given time period.

Interpretation
The data shown in the Surveillance Atlas should be interpreted carefully. National surveillance systems differ from each other and so does case under-ascertainment and under-reporting between countries.
All data provided as measured MIC or zone mm values were results of antimicrobial susceptibility testing at the NPHRLs, with the exception of Italy for Salmonella where two regional laboratories also contributed. The NPHRLs participate in external quality assessments arranged by ECDC to maintain a high data quality. The submission of isolates to the NPHRLs however vary by country – in some countries, all Salmonella isolated from human infections are sent to the NPHRL while in others, isolates may be sent only when further typing is deemed necessary, in outbreak situations or is focused on specific serotypes. Data interpreted with clinical breakpoints are normally from local or regional laboratories and reported together with the information on the clinical case. In these cases, the antimicrobial susceptibility testing has primarily been performed with the purpose of treatment of the case rather than AMR monitoring. For this reason, the number of tests per antimicrobial varies.
The guidelines for clinical breakpoints vary among countries in Europe, and in some instances even between laboratories in the same country. By now, most European laboratories have changed from CLSI to EUCAST clinical guidelines. As a result, the interpretation of results may have changed over time. In addition, clinical breakpoints may change over time, as breakpoints may be revised. This is particularly the case for ciprofloxacin where the EUCAST clinical breakpoint for Salmonella was significantly lowered in 2014. As countries implemented this change at different times, a combined resistance to fluoroquinolones and quinolones is also presented to circumvent this problem. For data submitted as quantitative values, the current breakpoints are applied also to historical data.
In Salmonella, clonal spread is occurring and certain resistance patterns are commonly associated with specific Salmonella serotypes, e.g. resistance to ampicillin, streptomycin, sulfonamides and tetracycline (ASSuT) in monophasic S. Typhimurium DT193 and highly-ciprofloxacin resistant and multidrug-resistant S. Kentucky ST198. As the serovar distribution within Salmonella spp. varies by country depending on their frequency among human cases and/or specific sampling strategies for further typing and susceptibility testing at the NPHRLs, comparisons between countries should be avoided at the level of Salmonella spp.
The completeness of the travel history varies between countries and years; some countries are able to collect and integrate this type of information from different sources, other countries are not. For Salmonella AMR data, information on travel status is lacking from many countries. For that reason, the category ‘domestic or unknown’ can be selected as it is anticipated that a missing value is more likely to represent no travel as travel-related infections are more likely to be notified as such by the doctor.
For 2022, information on AMR in Salmonella isolates from human clinical cases was reported by 29 EU/EEA countries. No data from 2020 onwards were reported by the United Kingdom due to its withdrawal from the EU on 30 January 2020.

Reports published by ECDC on Salmonella AMR
More information is available in ECDC reports. Note that later retrievals of data related to the same period may result in slightly different numbers as countries have the possibility to update data in TESSy retrospectively. Therefore, the data presented in the reports might slightly differ from the data presented in the Surveillance Atlas.
EFSA and ECDC, 2023. The European Union Summary Report on Antimicrobial Resistance in zoonotic and indicator bacteria from humans, animals and food in 2020/2021 (March 2023):
https://www.ecdc.europa.eu/en/publications-data/european-union-summary-report-antimicrobial-resistance-zoonotic-and-indicator-7
Salmonellosis - Annual Epidemiological Report for 2022:
https://www.ecdc.europa.eu/en/publications-data/salmonellosis-annual-epidemiological-report-2022

Fourth external quality assessment on antimicrobial susceptibility testing and detection of ESBL-, acquired AmpC-, and carbapenemase-production of Salmonella, 2018 (May 2021):
https://www.ecdc.europa.eu/en/publications-data/fourth-external-quality-assessment-antimicrobial-susceptibility-testing-salmonella

Annex 1. Salmonella AMR surveillance data overview, 2013-2022
Country
2022
2021
2020
2019
2018
2017
2016
2015
2014
2013
Austria
Q
Q
Q
Q
Q
Q
Q
Q
Q
Q
Belgium
Q
Q
Q
Q
Q
Q
Q
Q
SIR
SIR
Bulgaria
SIR
Q
-
-
-
-
-
-
-
-
Croatia
Q
-
-
-
-
-
-
-
-
-
Cyprus
Q
Q
Q
Q
Q
Q
Q
Q
-
-
Czech Republic
Q
-
-
-
-
-
-
-
-
-
Denmark
Q
Q
Q
Q
Q
Q
Q
Q
Q
Q
Estonia
Q
Q
Q
Q
Q
Q
Q
Q
Q
SIR
Finland
Q
Q
Q
Q
Q
Q
Q
Q
Q
Q
France
Q
Q
Q
Q
Q
Q
Q
Q
SIR
SIR
Germany
Q
Q
-
SIR*
SIR*
SIR*
SIR*
SIR*
SIR*
SIR
Greece
Q
Q
-
Q
-
Q
Q
Q
Q
SIR
Hungary
SIR
SIR
SIR
-
SIR
SIR
SIR
SIR
SIR
SIR
Iceland
Q
Q
SIR
SIR
SIR
SIR
SIR
SIR
-
SIR
Ireland
WGS
-
WGS
WGS
Q
Q
Q
Q
Q
Q
Italy
Q
Q
Q
Q
Q
Q
Q
Q
Q
SIR
Latvia
SIR
SIR
SIR
SIR
SIR
SIR
SIR
SIR
SIR
SIR
Lithuania
SIR
SIR
-
SIR
SIR
SIR
SIR
SIR
SIR
SIR
Luxembourg
Q
Q
Q
Q
Q
Q
Q
Q
Q
Q
Malta
Q
Q
Q
Q*
SIR*
SIR*
SIR*
SIR*
SIR*
SIR
Netherlands
Q
Q
Q
Q
Q
Q
Q
Q
Q
SIR
Norway
Q
Q
Q
Q
-
Q
Q
Q
Q
Q
Poland
Q
Q
-
SIR*
SIR*
SIR*
-
-
-
-
Portugal
Q
Q
Q
Q
Q
Q
Q
Q
Q
-
Romania
Q
Q
Q
Q
Q
Q
Q
Q
Q
Q
Slovakia
SIR
SIR
SIR
SIR
SIR
SIR
SIR
SIR
SIR
SIR
Slovenia
Q
Q
Q
Q
Q
Q
Q
SIR
SIR
SIR
Spain
Q
Q
Q
Q
Q
Q
Q
SIR
SIR
SIR
Sweden
WGS
WGS
WGS
WGS
-
-
-
-
-
-
United Kingdom
-
-
-
SIR
SIR
SIR
SIR
SIR
SIR
SIR
Q – quantitative data, MIC or zone mm; SIR – data interpreted with clinical breakpoints; WGS – acquired resistance predicted from genotypic methods; - no data reported; * Enterobacterales breakpoints used for ciprofloxacin instead of Salmonella breakpoints
Shigellosis
Last updated: 13 August 2024
Data retrieval from TESSy: 13 August 2024

Shigellosis is an acute bacterial infection caused by bacteria of the genus Shigella. For a more detailed description of the disease and its epidemiology, please click here.
Data
The Surveillance Atlas of Infectious Diseases displays data on shigellosis reported by the EU/EEA countries. Cases are to be reported according to the 2018 EU case definition for shigellosis30:
Clinical criteria
Any person with at least one of the following four:
— Diarrhoea;
— Fever;
— Vomiting;
— Abdominal pain;
Laboratory criteria
For a confirmed case:
— Isolation of Shigella spp. from a clinical specimen
For a probable case:
— Detection of Shigella spp. nucleic acid in a clinical specimen
Note: Antimicrobial susceptibility testing of Shigella should be performed, if possible
Epidemiological criteria
At least one of the following five epidemiological links:
— Human to human transmission;
— Exposure to a common source;
— Anima to human transmission;
— Exposure to contaminated food/drinking water;
— Environmental exposure.

Case classification
A. Possible case NA
B. Probable case: Any person meeting the clinical criteria with an epidemiological link
OR
Any person meeting the clinical criteria and laboratory criteria for a probable case
C. Confirmed case: Any person meeting the clinical and the laboratory criteria for a confirmed case

Note: If the national surveillance system is not capturing clinical symptoms, all laboratory-confirmed individuals should be reported as confirmed cases

Antimicrobial resistance
The results of antimicrobial susceptibility tests must be reported according to the methods and criteria agreed between ECDC and Member States.

------------------------
(Compared with the 2008 and 2012 EU case definition, the 2018 EU case definition allows genotypic tests for laboratory confirmation of a probable case and includes a recommendation for antimicrobial susceptibility testing and reporting to ECDC. The note is also a new addition.)

Data collection and analysis
Data are collected on an annual basis for the previous year. Countries can also update their data at any time. Before analysis, data are validated with nominated data providers in EU/EEA countries. Country population denominators by age group for the calculation of notification rates were obtained from Eurostat31. Note that data published in the Surveillance Atlas might differ from figures in national reports due to different times of reporting, inclusion of cases by different case definitions and use of different denominators.
Indicators were displayed as “–” and not calculated for variables with more than 50% of cases with undocumented information (unknown or missing) for a given geographical resolution (e.g. country, EU/EEA) and time period. The age-standardised rate and the notification rate for domestic cases were calculated when age and travel history were known for at least 90% of cases.
Surveillance systems across the EU/EEA countries are heterogeneous and a surveillance systems overview is displayed in Annex 1.

Surveillance Atlas indicators
The Surveillance Atlas indicators for confirmed cases of shigellosis are:
1. Number of reported cases;
2. Notification rate per 100 000 population;
3. Age-standardised rate per 100 000 population;
4. Number of hospitalised cases;
5. Proportion of hospitalised cases among confirmed cases with known history of hospitalisation (%);
6. Number of deaths derived from reporting of disease outcome;
7. Case fatality calculated as proportion of deaths among confirmed cases with known disease outcome (%);
8. Notification rate for domestic cases per 100 000 population;
9. Proportion of travel-associated cases among confirmed cases with known travel history outside the reporting country (%);

For notification rate indicators, the data may be displayed in a bar chart as:
• Age-specific notification rate (for age groups 0-4, 5-14, 15-24, 25-44, 45-64, 65 years and above);
• Gender-specific notification rate;

For all other indicators, the data may be displayed in a bar chart or a pie chart by proportion of:
• Age groups (0-4, 5-14, 15-24, 25-44, 45-64, 65 years and above);
• Gender;
• Pathogen species;
• Probable country of infection.

Symbols used in the Surveillance Atlas table:
Symbol
Comment
–
Indicator is not calculated for a given geographical resolution and time period.
.
Missing data. Data are not reported to TESSy for a given time period.

Data quality
The Surveillance Atlas indicators were calculated up to the end of 2022. EU/EEA countries reporting data on shigellosis as displayed in the Annex 1. For data quality, reporting completeness of variables used to calculate Surveillance Atlas indicators was analysed for reported, confirmed cases. For countries reporting data only in aggregated format, the analysis of data completeness is allowed only for data reported such as age and gender.
The Surveillance Atlas indicators for data quality of confirmed shigellosis cases are:
• Completeness age (%);
• Completeness gender (%);
• Completeness disease outcome (%);
• Completeness travel-associated (%);
• Completeness hospitalisation (%);
• Completeness pathogen species (%);
• Completeness probable country of infection (%);

Interpretation
The results shown in the Surveillance Atlas should be interpreted carefully. National surveillance systems differ from each other and so does case under-ascertainment between countries.
The notification of shigellosis is mandatory in 27 EU/EEA countries. Three Member States have voluntary notification (Belgium, France and Italy). The surveillance systems for shigellosis have full national coverage in all reporting countries except in France and Italy. In France, the coverage of the surveillance system is estimated to 44% of the population and this proportion was used when calculating the national notification rate. No estimate of population coverage in Italy was provided, so notification rate was not calculated. In Belgium, full national coverage was established in 2015 and rates before this date are not displayed. For 2020, Spain has not received data from all regions and rate is therefore not calculated. All countries provide case-based data except Bulgaria which report aggregate data. Aggregated reporting format was included to calculate numbers of cases and notification rates, as well as disease trends, age and gender distributions when this data was available.
The COVID-19 pandemic and the withdrawal of the United Kingdom from the EU in 2020 significantly impacted on the surveillance data for shigellosis in 2020-2021. Factors mentioned by countries resulting in lower case numbers were e.g. less travel due to travel restriction, fewer social interactions, people avoiding seeking medical care for mild symptoms due to risk of exposure to COVID-19 in health care facilities, limited capacity for diagnosis of mild diseases in health care, etc.
The completeness of some variables such as outcome or travel history varies between countries and years; some countries are able to collect and integrate this type of information from different sources, other countries are not. Even if overall data completeness is high for some variables, the reader should refrain from directly comparing countries without taking into account limitations.

Reports published by ECDC on shigellosis
More information is available in ECDC reports. Note that later retrievals of data related to the same period may result in slightly different numbers as countries have the possibility to update data in TESSy retrospectively. Therefore, the data presented in the reports might slightly differ from the data presented in the Surveillance Atlas.

Annual epidemiological report for 2022– Shigellosis:
Shigellosis - Annual epidemiological report 2022 (europa.eu)

Epidemiological update 18 July 2023: Spread of multidrug-resistant Shigella in EU/EEA among gay, bisexual and other men who have sex with men:
Spread of multidrug-resistant Shigella in EU/EEA among gay, bisexual and other men who have sex with men (europa.eu)

Rapid risk assessment: Outbreak of Shigella sonnei in the EU/EEA, the United Kingdom, and the United States among travellers returning from Cabo Verde (17 February 2023):
https://www.ecdc.europa.eu/sites/default/files/documents/shigella-sonnei-risk-assessment-february-2023.pdf
Rapid risk assessment: Increase in extensively-drug resistant Shigella sonnei infections in men who have sex with men in the EU/EEA and the UK (23 February 2022):
https://www.ecdc.europa.eu/en/publications-data/rapid-risk-assessment-increase-extensively-drug-resistant-shigella-sonnei

Annex 1. Surveillance systems overview, 2023
Country
Data source
Compulsory (Cp), voluntary (V), other(O)
Comprehensive (Co), sentinel (Se), other(O)
Active (A), passive (P)
Case-based (C), aggregated (A)
Data reported by
Case definition used






Laboratories
Physicians
Hospitals
Others

Austria
AT-Epidemiegesetz
Cp
Co
P
C
Y
Y
Y
Y
EU-2008
Belgium
BE-REFLAB
Vo
Co
P
C
Y
N
N
N
EU-2018
Bulgaria
BG-NATIONAL_SURVEILLANCE
Cp
Co
P
A
Y
Y
Y
Y
EU-2018
Croatia
HR-CNIPH
Cp
Co
P
C
Y
Y
Y
Y
EU-2012
Cyprus
CY-NOTIFIED_DISEASES
Cp
Co
P
C
N
Y
N
N
EU-2008
Czechia
CZ-ISIN
Cp
Co
A
C
Y
Y
Y
N
EU-2008
Denmark
DK-LAB
Cp
Co
P
C
Y
N
N
N
Other
Estonia
EE-NAKIS
Cp
Co
P
C
Y
Y
Y
N
EU-2018
Finland
FI-NIDR
Cp
Co
P
C
Y
Y
N
N
EU-2012
France
FR-NATIONAL_REFERENCE_CENTRES
V
Co
P
C
Y
N
N
N
Other
Germany
DE-SURVNET@RKI-7.1
Cp
Co
P
C
Y
N
N
N
Other
Greece
EL-NOTIFIABLE_DISEASES
Cp
Co
P
C
Y
Y
Y
.
EU-2018
Hungary
HU-EFRIR
Cp
Co
P
C
Y
Y
Y
N
EU-2012
Iceland
IS-SUBJECT_TO_REGISTRATION
Cp
Co
P
C
Y
Y
.
.
EU-2018
Ireland
IE-CIDR
Cp
Co
P
C
Y
Y
Y
N
EU-2008
Italy
IT-ENTERNET
V
Se
P
C
Y
N
N
N
Other
Latvia
LV-BSN
Cp
Co
P
C
Y
Y
Y
N
EU-2018
Liechtenstein
LI-SEPI
Cp
Co
P
C
Y
Y
Y
.
EU-2018
Lithuania
LT-COMMUNICABLE_DISEASES
Cp
Co
P
C
Y
Y
N
N
EU-2018
Luxembourg
LU-SYSTEM1
Cp
Co
P
C
Y
N
N
N
EU-2018
Malta
MT-DISEASE_SURVEILLANCE
Cp
Co
P
C
Y
Y
Y
Y
EU-2018
Netherlands
NL-OSIRIS
Cp
Co
P
C
Y
Y
N
Y
EU-2018
Norway
NO-MSIS_A
Cp
Co
P
C
Y
Y
Y
N
EU-2018
Poland
PL-NATIONAL_SURVEILLANCE
Cp
Co
P
C
Y
Y
Y
N
EU-2018
Portugal
PT-SHIGELLOSIS
Cp
Co
P
C
N
Y
N
N
EU-2018
Romania
RO-RNSSy
Cp
Co
P
C
Y
N
Y
N
EU-2018
Slovakia
SK-EPIS
Cp
Co
A
C
Y
Y
Y
Y
EU-2018
Slovenia
SI-SURVIVAL
Cp
Co
P
C
Y
Y
Y
N
EU-2008
Spain
ES-STATUTORY_DISEASES
Cp
Co
P
C
Y
Y
Y
N
EU-2018
Sweden
SE-SMINET
Cp
Co
P
C
Y
Y
N
N
EU-2018
Antimicrobial resistance in Shigella spp.
Last updated: 21 February 2024
Data retrieval from TESSy: 1 December 2023

Shigellosis is a gastrointestinal infection caused by one of four species of Shigella bacteria: Shigella sonnei, S. flexneri, S. boydii and S. dysenteriae. Rehydration therapy is given to people who are ill with shigellosis to stop them from becoming dehydrated. Antibiotics are used to treat severe illness and will shorten the duration of illness and reduce the risk of spread to other people. For a more detailed description of the disease and its epidemiology, please click here.
Data
The Surveillance Atlas of Infectious Diseases displays data on antimicrobial resistance (AMR) in Shigella spp. reported by the EU/EEA countries. According to the 2018 EU case definition for shigellosis32, antimicrobial susceptibility testing of Shigella should be performed, if possible and the results of antimicrobial susceptibility tests must be reported according to the methods and criteria agreed between ECDC and Member States.
AMR data for Shigella are collected as part of the case-based datasets for shigellosis since the 2017 data collection. The case-based dataset contains data from clinical treatment of patients and the results are therefore by default interpreted using clinical breakpoints for assessing treatment options.
Data collection and analysis
Data are collected on an annual basis for the previous year. Before analysis, data are validated with nominated data providers in EU/EEA countries. Note that data published in the Surveillance Atlas might differ from figures in national reports due to different times of reporting or use of different denominators.
Surveillance systems across the EU/EEA countries are heterogeneous and a surveillance systems overview is displayed in Annex 1.

Antibiotics reported for Shigella AMR:
Antimicrobial
Type of breakpoints
Ampicillin
Clinical breakpoints
Ciprofloxacin
Clinical breakpoints
Cefotaxime
Clinical breakpoints
Ceftazidime
Clinical breakpoints
Trimethoprim-sulfa
Clinical breakpoints
Azithromycin
Epidemiological cut-off value (clinical breakpoints not available)

Surveillance Atlas indicators
The Surveillance Atlas indicators for Shigella antimicrobial resistance are:
9. Non-wild type (NWT) isolates percentage;
10. Non-wild type or I+R isolates percentage;
11. Clinically resistant (R) isolates percentage
12. Total tested isolates

For the resistance indicators, the data may be displayed in a bar chart as:
• Proportion resistant isolates by age-group (for age groups 0-4, 5-14, 15-24, 25-44, 45-64, 65 years and above);
• Proportion resistant isolates by gender;
• Proportion resistant isolates by geographical region, in case of travel-associated infections

Indicators are displayed as “–” and not calculated for when fewer than 10 isolates had been tested for the selected combination (e.g. Shigella specie, importation status and antimicrobial) and time period.
Indicators by age group and gender are not displayed if more than 50% of cases have undocumented information (unknown or missing) for a given geographical resolution (e.g. country, EU/EEA) and time period.

The Surveillance Atlas indicators are calculated from 2017 up to the end of 2021.

Symbols used in the Surveillance Atlas table:
Symbol
Comment
–
Indicator is not calculated for a given geographical resolution and time period.
.
Missing data. Data are not reported to TESSy for a given time period.

Interpretation
The data shown in the Surveillance Atlas should be interpreted carefully. National surveillance systems differ from each other and so does case under-ascertainment and under-reporting between countries.
The shigella AMR data is normally from local or regional laboratories and reported together with the information on the clinical case. Since the antimicrobial susceptibility testing has primarily been performed with the purpose of treatment of the case rather than AMR monitoring, the number of tests per antimicrobial can vary according to local practices.
The guidelines for clinical breakpoints applied may vary among countries in Europe, and possibly also between laboratories in the same country. Clinical breakpoints from one organisation may also change over time, as breakpoints may be revised.
The completeness of the travel history varies between countries and years; some countries are able to collect and integrate this type of information from different sources, other countries are not. For that reason, the category ‘domestic or unknown’ can be selected as it is anticipated that a missing value is more likely to represent no travel as travel-related infections are more likely to be notified as such by the doctor.
Reports published by ECDC on Shigella AMR
More information is available in ECDC reports. Note that later retrievals of data related to the same period may result in slightly different numbers as countries have the possibility to update data in TESSy retrospectively. Therefore, the data presented in the reports might slightly differ from the data presented in the Surveillance Atlas.
Annual epidemiological report for 2022 – Shigellosis:
https://www.ecdc.europa.eu/en/publications-data/shigellosis-annual-epidemiological-report-2022
Epidemiological update18 Jul 2023: Spread of multidrug-resistant Shigella in EU/EEA among gay, bisexual and other men who have sex with men:
https://www.ecdc.europa.eu/en/news-events/spread-multidrug-resistant-shigella-eueea-among-gay-bisexual-and-other-men-who-have-sex
Rapid risk assessment: Increase in extensively-drug resistant Shigella sonnei infections in men who have sex with men in the EU/EEA and the UK (23 February 2022):
https://www.ecdc.europa.eu/en/publications-data/rapid-risk-assessment-increase-extensively-drug-resistant-shigella-sonnei
Annex 1. Surveillance systems overview, 2022
Country
Data source
Compulsory (Cp), voluntary (V), other(O)
Comprehensive (Co), sentinel (Se), other(O)
Active (A), passive (P)
Case-based (C), aggregated (A)
Data reported by
Case definition used






Laboratories
Physicians
Hospitals
Others

Austria
AT-Epidemiegesetz
Cp
Co
P
C
Y
Y
Y
Y
EU-2008
Belgium
BE-REFLAB
Cp
Co
P
C
Y
N
N
N
EU-2018
Cyprus
CY-NOTIFIED_DISEASES
Cp
Co
P
C
N
Y
N
N
EU-2008
Estonia
EE-NAKIS
Cp
Co
P
C
Y
Y
Y
N
EU-2018
France
FR-MANDATORY_INFECTIOUS_DISEASES
Cp
Co
P
C
Y
Y
Y
Y
Not specified/unknown
Italy
IT-NRS
Cp
Co
P
C
N
Y
Y
N
Other
Lithuania
LT-COMMUNICABLE_DISEASES
Cp
Co
P
C
Y
Y
N
N
EU-2018

STEC/VTEC infection
Last updated: 13 August 2024
Data retrieval from TESSy: 13 August 2024
STEC/VTEC infection is caused by bacteria from a group of pathogenic Escherichia coli capable of producing Shiga toxins or verocytotoxins. Some STEC/VTEC strains have been linked with a potentially fatal haemolytic-uraemic syndrome (HUS), affecting renal function and requiring hospital care. For a more detailed description of the disease and its epidemiology, please click here.
Data
The Surveillance Atlas of Infectious Diseases displays data on human infection with STEC/VTEC reported to TESSy by EU/EEA countries since 2007. Cases are to be reported according to the 2018 EU case definition for Shiga toxin/verocytotoxin-producing E. coli infection (STEC/VTEC), including haemolytic-uraemic syndrome (HUS)33:
Clinical criteria
STEC/VTEC diarrhoea
Any person with at least one of the following two:
— Diarrhoea;
— Abdominal pain.
HUS
Any person with acute renal failure and at least one of the following two:
— Microangiopatic haemolytic anaemia;
— Thrombocytopenia.
Laboratory criteria
At least one of the following four:
— Isolation/cultivation of Escherichia coli that produces Shiga toxin/verocytotoxin or harbours stx1/vtx1 or stx2/vtx2 gene(s)
— Isolation of non-sorbitol-fermenting (NSF) Escherichia coli O157 (without testing for the toxin or toxin-producing genes)
— Direct detection of stx1/vtx1 or stx2/vtx2 gene(s) nucleic acid
— Direct detection of free Shiga toxin/verocytotoxin in faeces
Only for HUS the following can be used as a laboratory criterion to confirm STEC/VTEC:
— Escherichia coli serogroup-specific (LPS) antibody response
Epidemiological criteria
At least one of the following five epidemiological links:
— Human to human transmission;
— Exposure to a common source;
— Animal to human transmission;
— Exposure to contaminated food/drinking water;
— Environmental exposure.
Case classification:
A. Possible case of STEC-associated HUS: Any person meeting the clinical criteria for HUS
B. Probable case of STEC/VTEC: Any person meeting the clinical criteria and with an epidemiological link
C. Confirmed case of STEC/VTEC: Any person meeting the clinical and the laboratory criteria

Note: If the national surveillance system is not capturing clinical symptoms, all laboratory-confirmed individuals should be reported as confirmed cases

------------------------
(The note is the only difference between the 2018 EU case definition and the 2012 EU case definition.)

Data collection and analysis
Data for STEC/VTEC infections are collected on an annual basis for the previous year. Countries can also update their data at any time. Before analysis, data are validated with nominated data providers in each EU/EEA country. For the calculation of notification rates, country population denominators by age group were obtained from Eurostat34. Note that the data published in the Surveillance Atlas might differ from figures in national reports and in official reports published by ECDC and EFSA due to different times of data extraction, inclusion of cases by different case definitions and use of different denominators.
Indicators were displayed as “–” and not calculated for variables with more than 50% of cases with undocumented information (unknown or missing) for a given geographical resolution (e.g. country, EU/EEA) and time period. The age-standardised rate and the notification rate for domestic cases were calculated when age and travel history were known for at least 90% of cases.
Surveillance systems across the EU/EEA countries are heterogeneous. An overview is displayed in Annex 1.

Surveillance Atlas indicators
The Surveillance Atlas indicators for confirmed cases of STEC/VTEC infection are:
1. Number of reported cases;
2. Notification rate per 100 000 population;
3. Age-standardised rate per 100 000 population;
4. Number of hospitalised cases;
5. Proportion of hospitalised cases among confirmed cases (%);
6. Number of deaths derived from the reported outcome of the disease.
7. Case fatality calculated as proportion of deaths among cases with known information on outcome of the disease (%);
8. Notification rate for domestic cases per 100 000 population;
9. Proportion of travel associated cases among confirmed cases (%).

a) Indicators for for HUS cases are:
1. Number of reported cases;
2. Notification rate per 100 000 population;
3. Number of deaths.
4. Case fatality (%);

b) Indicators for cases of a selected serogroup/antigen O are:
1. Number of reported cases;
2. Notification rate per 100 000 population;
3. Number of reported HUS cases;
4. Number of deaths;

For notification rate indicators, the data may be displayed in a bar chart as:
• Age-specific notification rate (for age groups 0-4, 5-14, 15-24, 25-44, 45-64, 65 years and above);
• Gender-specific notification rate;

For all other indicators, the data may be displayed in a bar chart or a pie chart by proportion of:
• Age groups (0-4, 5-14, 15-24, 25-44, 45-64, 65 years and above);
• Gender;

In addition, the data may be displayed in the bar or pie chart as follows:
• for confirmed cases by:
◦ O-group;
◦ HUS;
◦ Vtx1, vtx2, eae presence;

• for HUS cases by:
• O-group;
• Vtx1, vtx2, eae presence.

Symbols used in the Surveillance Atlas Table:
Symbol
Comment
-
Indicator is not calculated for the related geographical resolution and time period.
.
Missing data. Data are not reported to TESSy for a given time period.

Data quality
EU/EEA countries reporting data on STEC/VTEC infections as displayed in the Annex 1. For data quality, reporting completeness of variables used to calculate Surveillance Atlas indicators was analysed for reported, confirmed cases. For countries reporting data only in aggregated format, the analysis of data completeness is allowed only for data reported such as age and gender.

The Surveillance Atlas indicators for data quality of the reported data for confirmed STEC/VTEC infections cases are:
• Completeness age (%);
• Completeness gender (%);
• Completeness disease outcome (%);
• Completeness travel-associated (%);
• Completeness hospitalisation (%);
• Completeness Antigen O (%);
• Completeness HUS (%);
• Completeness vtx1 + vtx2 + eae (%);
• Completeness aggR + aaiC (%).

Interpretation
The results shown in the Surveillance Atlas should be interpreted carefully. Surveillance systems used for reporting data to ECDC are heterogeneous; some are based on clinical syndromes such as bloody diarrhoea or HUS, some are based on laboratory results only. Heterogeneity also exists in the amount of samples tested and isolates typed.
The notification of VTEC infections is mandatory in 27 EU/EEA countries. In four Member States notification is based on a voluntary system (Belgium and France) or other system (Italy). The surveillance systems for STEC/VTEC infections have full national coverage in all reporting countries except in three (France, Italy and Spain). The VTEC surveillance in France is centred on paediatric haemolytic uraemic syndrome (HUS) surveillance (coverage estimated at 85% from 2016-2017), and in Italy is primarily based on the National registry of HUS. Therefore, no notification rates are calculated for these two countries. The coverage of the surveillance system is estimated to be 97% in Spain in 2021-2023, so that proportion was used when calculating the national notification rate. No estimate of population coverage in Spain was provided prior 2021, so notification rates were not calculated. In Belgium, full national coverage was established in 2015 and rates before this date are not displayed. All countries provide case-based data.
STEC/VTEC infections had a dominant peak in the summer of 2011, which was attributed to a large enteroaggregative STEC/VTEC O104:H4 outbreak associated with the consumption of contaminated raw sprouted seeds affecting more than 3 800 persons in Germany and linked cases in an additional 15 countries. In the years following the outbreak, the EU/EEA notification rate was higher than before the outbreak. This is likely to result from increased awareness and a higher number of laboratories with a capacity to test for the presence of serogroups other than O157. Increased use of PCR in primary diagnostics has also resulted in an increase in the case numbers in many countries in recent years.
The COVID-19 pandemic significantly impacted on the surveillance data for STEC/VTEC infections in 2020-2021. Factors mentioned by countries resulting in lower case numbers were e.g. people avoiding to seek medical care for mild symptoms due to risk of exposure to COVID-19 in health care facilities, limited laboratory capacity due to reallocation of resources to SARS-CoV-2, fewer restaurant visits, increased hand washing, less travel due to travel restriction etc.
The completeness of some variables such as e.g. hospitalisation, outcome, importation, serogroup or virulence genes vary between countries and years; some countries are able to collect and integrate this type of information from different sources, other countries are not. Even if overall data completeness is high for some variables, the reader should refrain from directly comparing countries without taking into account limitations.

Reports published by ECDC on STEC/VTEC infection
More information on the disease epidemiology is available in ECDC reports. Note that later retrievals of data related to the same period may result in slightly different numbers as countries have the possibility to update data retrospectively. Therefore, the data presented in the reports might slightly differ from those presented in the Surveillance Atlas.
Annual epidemiological report for 2022 – Shiga-toxin-producing Escherichia coli (STEC) infection:
STEC infection Annual Epidemiological Report 2022 (europa.eu)

EFSA and ECDC (European Food Safety Authority and European Centre for Disease Prevention and Control), 2023. The European Union One Health 2022 Zoonoses Report (December 2023):
https://efsa.onlinelibrary.wiley.com/doi/epdf/10.2903/j.efsa.2023.8442

Twelfth external quality assessment scheme for typing of Shiga toxin-producing Escherichia coli: (June 2024):
https://www.ecdc.europa.eu/en/publications-data/twelfth-external-quality-assessment-scheme-typing-shiga-toxin-producing

Rapid risk assessment: Increase in OXA-244 -producing Escherichia coli in the European Union/European Economic Area and the UK since 2013, first update (20 July 2021):
OXA-244 producing E. coli in the EU EEA and the UK since 2013 - first update (europa.eu)

Increase in OXA-244-producing Escherichia coli in the European Union/European Economic Area
and the UK since 2013 (18 February 2020):
Increase in OXA-244-producing Escherichia coli in the European Union/European Economic Area and the UK since 2013 (europa.eu)

Annex 1. Surveillance systems overview, 2023
Country
Data source
Compulsory (Cp), voluntary (V), other(O)
Comprehensive (Co), sentinel (Se), other(O)
Active (A), passive (P)
Case-based (C), aggregated (A)
Data reported by
Case definition used






Laboratories
Physicians
Hospitals
Others

Austria
AT-Epidemiegesetz
Cp
Co
P
C
Y
Y
Y
Y
EU-2008
Belgium
BE-REFLAB
V
Co
P
C
Y
N
N
N
EU-2018
Bulgaria
BG-NATIONAL_SURVEILLANCE
Cp
Co
P
C
Y
Y
Y
Y
EU-2018
Croatia
HR-CNIPH
Cp
Co
P
C
Y
Y
Y
Y
EU-2012
Cyprus
CY-NOTIFIED_DISEASES
Cp
Co
P
C
N
Y
N
N
EU-2008
Czechia
CZ-ISIN
Cp
Co
A
C
Y
N
N
N
EU-2008
Denmark
DK-LAB
Cp
Co
P
C
Y
N
N
N
EU-2018
Estonia
EE-NAKIS
Cp
Co
P
C
Y
Y
Y
N
EU-2018
Finland
FI-NIDR
Cp
Co
P
C
Y
Y
N
N
EU-2012
France
FR-NATIONAL_REFERENCE_CENTRES
V
Co
P
C
Y
N
N
N
Other
France
FR-RENASHU
V
Co
P
C
Y
N
N
N
Other
Germany
DE-NRZ-VTEC
V
Co
P
C
Y
N
N
N
Not specified/unknown
Germany
DE-SURVNET@RKI-7.1
Cp
Co
P
C
Y
N
N
N
Other
Greece
EL-NOTIFIABLE_DISEASES
Cp
Co
P
C
Y
Y
Y
.
EU-2018
Hungary
HU-Zoonoses
Cp
Co
P
C
Y
Y
Y
N
EU-2012
Iceland
IS-SUBJECT_TO_REGISTRATION
Cp
Co
P
C
Y
Y
.
.
EU-2018
Ireland
IE-VTEC
Cp
Co
P
C
Y
Y
Y
N
EU-2012
Italy
IT-NRL E.coli
O
Se
P
C
Y
N
N
N
EU-2018
Latvia
LV-BSN
Cp
Co
P
C
Y
Y
Y
N
EUCD2018
Liechtenstein
LI-VTEC
Cp
Co
P
C
Y
Y
Y
.
EU-2018
Lithuania
LT-COMMUNICABLE_DISEASES
Cp
Co
P
C
Y
Y
N
N
EU-2018
Luxembourg
LU-SYSTEM1
Cp
Co
P
C
Y
Y
Y
N
EU-2018
Malta
MT-DISEASE_SURVEILLANCE
Cp
Co
P
C
Y
Y
Y
Y
EU-2018
Netherlands
NL-ENTEROHAEMORHAGIC_ECOLI
Cp
Co
A
C
Y
Y
N
N
Other
Norway
NO-MSIS_A
Cp
Co
P
C
Y
Y
Y
N
EU-2018
Poland
PL-NATIONAL_SURVEILLANCE
Cp
Co
P
C
Y
Y
Y
N
EU-2018
Portugal
PT-VTEC
Cp
Co
P
C
N
Y
N
N
EU-2018
Romania
RO-RNSSy
Cp
Co
P
C
N
N
Y
N
EU-2018
Slovakia
SK-EPIS
Cp
Co
A
C
Y
Y
Y
N
EU-2018
Slovenia
SI-SURVIVAL
Cp
Co
P
C
Y
Y
Y
N
EU-2008
Spain
ES-STATUTORY_DISEASES
Cp
Co
P
C
Y
Y
Y
N
EU-2018
Spain
ES-NRL
VOLO
Co
P
C
Y
Y
Y
N
EU'08
Sweden
SE-SMINET
Cp
Co
P
C
Y
Y
N
N
EU-2018

Congenital toxoplasmosis
Last updated: 13 August 2024
Data retrieval from TESSy: 13 August 2024

Congenital toxoplasmosis is an infection caused by the parasite Toxoplasma gondii and transmitted by acutely infected pregnant women through placenta to their unborn fetus. For a more detailed description of the disease and its epidemiology, please click here.
Data
The Surveillance Atlas of Infectious Diseases displays data on congenital toxoplasmosis reported by the EU/EEA countries. Cases are to be reported according to the 2018 EU case definition for congenital toxoplasmosis35:

Clinical criteria
Not relevant for surveillance purposes.
Laboratory criteria
At least one of the following four:
— Demonstration of Toxoplasma gondii in body tissues or fluids;
— Detection of Toxoplasma gondii nucleic acid in a clinical specimen;
— Toxoplasma gondii specific antibody response (IgM, IgG, IgA) in a new-born;
— Persistently stable IgG Toxoplasma gondii titres in an infant (< 12 months of age).
Epidemiological Criteria NA

Case classification
A. Possible case NA
B. Probable case NA
C. Confirmed case: Any infant meeting the laboratory criteria

------------------------------
(There are no differences between the 2018 EU case definition and those of 2008 and 2012.)

Data collection and analysis
Data are collected on an annual basis for the previous year. Countries can also update their data at any time. Before analysis, data are validated with nominated data providers in EU/EEA countries. Country population denominators by age group for the calculation of notification rates were obtained from Eurostat36. Note that data published in the Surveillance Atlas might differ from figures in national reports due to different times of reporting, inclusion of cases by different case definitions and use of different denominators.
Indicators were displayed as “–” and not calculated for variables with more than 50% of cases with undocumented information (unknown or missing) for a given geographical resolution (e.g. country, EU/EEA) and time period. The age-standardised rate and the notification rate for domestic cases were calculated when age and travel history were known for at least 90% of cases.
Surveillance systems across the EU/EEA countries are heterogeneous. Overviews of surveillance systems and of the screening policies for pregnant women are displayed in Annexes 1&2.

Surveillance Atlas indicators
The Surveillance Atlas indicators for confirmed congenital toxoplasmosis are:
1. Number of reported cases;
2. Notification rate per 100 000 live birth;
3. Number of deaths derived from reporting of disease outcome;
4. Case fatality calculated as proportion of deaths among confirmed cases with known disease outcome (%);

For notification rate indicators, the data may be displayed in a bar chart as:
• Gender-specific notification rate;

For all other indicators, the data may be displayed in a bar chart or a pie chart by proportion of:
• Gender.

Symbols used in the Surveillance Atlas table:
Symbol
Comment
–
Indicator is not calculated for a given geographical resolution and time period.
.
Missing data. Data are not reported to TESSy for a given time period.

Data quality
EU/EEA countries reporting data on congenital toxoplasmosis as displayed in the Annex 1. For data quality, reporting completeness of variables used to calculate Surveillance Atlas indicators was analysed for reported, confirmed cases. For countries reporting data only in aggregated format, the analysis of data completeness is allowed only for data reported such as age and gender.
The Surveillance Atlas indicators for data quality of confirmed congenital toxoplasmosis cases are:
• Completeness gender (%);
• Completeness disease outcome (%);

Interpretation
The data shown in the Surveillance Atlas should be interpreted carefully. National surveillance systems differ from each other and so does case under-ascertainment between countries.
The notification of toxoplasmosis is mandatory in 21 EU/EEA countries. Austria, Belgium, Denmark, Greece, Italy, Liechtenstein, the Netherlands, Norway and Sweden do not have surveillance systems for toxoplasmosis (Annex 1). The surveillance systems for toxoplasmosis have full national coverage in all reporting countries. In Spain, full national coverage was established in 2023 and rates before this date are not displayed. Six countries (Austria, Belgium, Greece, France, Slovakia and Slovenia) have active surveillance of congenital toxoplasmosis cases with compulsory screening of pregnant women (Annex 2). Austria, Belgium and Greece however do not report to TESSy. Four countries have voluntary screening while another eight has no screening policies and/or surveillance of congenital toxoplasmosis. France regularly reports the highest number of cases in the EU, most likely due to its sensitive surveillance system which includes screening of pregnant women, follow-up of those that are negative to detect infection during pregnancy and laboratory confirmation of any congenital toxoplasmosis cases detected during this process, including asymptomatic cases. The French data are reported to TESSy with one year delay compared to other countries.
The completeness of some variables such as outcome varies between countries and years; some countries are able to collect and integrate this type of information from different sources, other countries are not. Even if overall data completeness is high for some variables, the reader should refrain from directly comparing countries without taking into account limitations.

Reports published by ECDC on congenital toxoplasmosis
More information is available in ECDC reports. Note that later retrievals of data related to the same period may result in slightly different numbers as countries have the possibility to update data in TESSy retrospectively. Therefore, the data presented in the reports might slightly differ from the data presented in the Surveillance Atlas.

Annual epidemiological report for 2021 – Congenital toxoplasmosis:
https://www.ecdc.europa.eu/sites/default/files/documents/congenital-toxoplasmosis-annual-epidemiological-report-2021.pdf

EFSA and ECDC (European Food Safety Authority and European Centre for Disease Prevention and Control), 2022. The European Union One Health 2021 Zoonoses Report (December 2023):
https://www.ecdc.europa.eu/sites/default/files/documents/EFS2_7666_Rev3.pdf


Annex 1. Surveillance systems overview, 2023
Country
Data source
Compulsory (Cp), voluntary (V), other(O)
Comprehensive (Co), sentinel (Se), other(O)
Active (A), passive (P)
Case-based (C), aggregated (A)
Data reported by
Case definition used






Laboratories
Physicians
Hospitals
Others

Bulgaria
BG-NATIONAL_SURVEILLANCE
Cp
Co
P
C
Y
Y
Y
Y
EU-2018
Croatia
HR-CNIPH
Cp
Co
P
C
Y
Y
Y
Y
EU-2012
Cyprus
CY-NOTIFIED_DISEASES
Cp
Co
P
C
N
Y
N
N
EU-2008
Czechia
CZ-ISIN
Cp
Co
A
C
Y
Y
Y
N
EU-2008
Estonia
EE-NAKIS
Cp
Co
P
C
Y
Y
Y
N
EU-2018
Finland
FI-NIDR
Cp
Co
P
C
Y
N
N
N
EU-2012
France
FR-NATIONAL_REFERENCE_CENTRES
VOLO
Co
A
C
Y
N
N
N
Other
Germany
DE-SURVNET@RKI-7.1
Cp
Co
P
C
Y
N
N
N
Other
Hungary
HU-EFRIR
Cp
Co
P
C
Y
Y
Y
N
EU-2012
Iceland
IS-SUBJECT_TO_REGISTRATION
Cp
.
P
C
Y
Y
.
.
EU-2018
Ireland
IE-CIDR
Cp
Co
P
C
Y
Y
Y
N
EU-2008
Latvia
LV-BSN
Cp
Co
P
C
Y
Y
Y
N
EU-2018
Lithuania
LT-COMMUNICABLE_DISEASES
Cp
Co
P
C
Y
Y
N
N
EU-2018
Luxembourg
LU-SYSTEM1
Cp
Co
P
C
N
Y
N
N
EU-2018
Malta
MT-DISEASE_SURVEILLANCE
Cp
Co
P
C
Y
Y
Y
Y
EU-2018
Poland
PL-NATIONAL_SURVEILLANCE
Cp
Co
P
C
Y
Y
Y
N
EU-2018
Portugal
PT-TOXO
Cp
Co
P
C
Y
Y
.
.
EU-2018
Romania
RO-RNSSy
Cp
Co
P
C
Y
N
Y
N
EU-2018
Slovakia
SK-EPIS
Cp
Co
A
C
Y
Y
Y
N
EU-2018
Slovenia
SI-SURVIVAL
Cp
Co
P
C
Y
Y
Y
N
EU-2008
Spain
ES-STATUTORY_DISEASES
Cp
Co
P
C
Y
Y
Y
N
EU-2018

Annex 2. Screening policies for pregnant women, overview
Country  
No screening  
Compulsory screening   
Voluntary screening   
 
Report to TESSy

Comments  
Austria 
  
 
x  
  
 
 
No 
Serological screening starting in first trimester since 1974. Monthly follow-up during pregnancy of seronegative women.  
Belgium 
  
 
x  
  
 
No 
Serological screening starting in first trimester. No consensus on follow-up during pregnancy of seronegative women.  
Bulgaria 
  
  
x  
Yes 
  
Czechia 
  
  
x  
 
 
Yes 
Serological screening only offered in certain regions and gynaecological outpatient wards. Screening not covered by statutory health insurance.  
Denmark 
x  
  
  
 
No 
Surveillance and screening active from 1999–2007.  
Estonia 
x  
  
  
Yes 
  
France 
  
x  
  
 
Yes 
Serological screening starting in first trimester. Follow-up during pregnancy of seronegative women.  
Germany  
  
  
x  
 
Yes 

Screening not covered by statutory health insurance.  

Greece

x



No
Congenital toxoplasmosis is under surveillance through the mandatory notification form (but not toxoplasmosis in general). Screening is performed during pregnancy through serological and ultrasound testing to pregnant women and if there is such indication and compatible symptoms in the fetus.
Hungary 
  
  
x  
Yes 
  
Iceland  
x  
  
  
Yes 
Suspected cases tested on individual basis.  
Ireland 
x  
  
  
 
 
 
Yes 
Testing for Toxoplasma requested if there are clinical indications e.g. a woman is symptomatic, for investigation of late miscarriage or if there are ultrasound findings consistent with congenital toxoplasmosis.  
Malta 
x  
  
  
No 
  
Netherlands 
x  
  
  
 
No 
  
Norway 
x  
  
  
No 
  
Slovakia 
  
x  
  
 
Yes 
Serological screening starting in first trimester. Follow-up during pregnancy of seronegative women.  
Slovenia 
  
x  
  
Yes 
  
Sweden 
x  
  
  
 
No 
Suspected cases or women at high risk of infection tested on individual basis.  
United Kingdom 
x  
  
  
 
Yes  
(until 2020) 
 







Trichinellosis
Last updated: 13 August 2024
Data retrieval from TESSy: 13 August 2024
Trichinellosis is a disease caused by an infection with the intestinal parasite Trichinella, most commonly the species T. spiralis. For a more detailed description of the disease and its epidemiology, please click here.

Data
The Surveillance Atlas of Infectious Diseases displays data on trichinellosis reported by the EU/EEA countries. Cases are to be reported according to the 2018 EU case definition for trichinellosis37:
Clinical criteria
Any person with at least three of the following six:
— Fever;
— Muscle soreness and pain;
— Diarrhoea;
— Facial oedema;
— Eosinophilia;
— Subconjunctival, subungual and retinal haemorrhages.
Laboratory criteria
At least one of the following two:
— Demonstration of Trichinella larvae in tissue obtained by muscle biopsy;
— Trichinella specific antibody response (IFA test, ELISA or Western Blot).
Epidemiological criteria
At least one of the following two epidemiological links:
— Exposure to contaminated food (meat);
— Exposure to a common source.
Case classification
A. Possible case NA
B. Probable case: Any person meeting the clinical criteria with an epidemiological link
C. Confirmed case: Any person meeting the clinical and the laboratory criteria

Note: If the national surveillance system is not capturing clinical symptoms, all laboratory-confirmed individuals should be reported as confirmed cases.

--------------------------
(The note is the only difference between the 2018 EU case definition of anthrax and the 2012 and 2008 EU case definitions.)

Data collection and analysis
Data are collected on an annual basis for the previous year. Countries can also update their data at any time. Before analysis, data are validated with nominated data providers in EU/EEA countries. Country population denominators by age group for the calculation of notification rates were obtained from Eurostat38. Note that data published in the Surveillance Atlas might differ from figures in national reports due to different times of reporting, inclusion of cases by different case definitions and use of different denominators.
Indicators were displayed as “–” and not calculated for variables with more than 50% of cases with undocumented information (unknown or missing) for a given geographical resolution (e.g. country, EU/EEA) and time period. The age-standardised rate and the notification rate for domestic cases were calculated when age and travel history were known for at least 90% of cases.
Surveillance systems across the EU/EEA countries are heterogeneous and a surveillance systems overview is displayed in Annex 1.

Surveillance Atlas indicators
The Surveillance Atlas indicators for confirmed trichinellosis cases are:
1. Number of reported cases;
2. Notification rate per 100 000 population;
3. Age-standardised rate per 100 000 population;
4. Number of hospitalised cases;
5. Proportion of hospitalised cases among confirmed cases with known history of hospitalisation (%);
6. Number of deaths derived from reporting of disease outcome;
7. Case fatality calculated as proportion of deaths among confirmed cases with known disease outcome (%);
8. Notification rate for domestic cases per 100 000 population;
9. Proportion of travel-associated cases among confirmed cases with known travel history outside the reporting country (%);

For notification rate indicators, the data may be displayed in a bar chart as:
• Age-specific notification rate (for age groups 0-4, 5-14, 15-24, 25-44, 45-64, 65 years and above);
• Gender-specific notification rate;

For all other indicators, the data may be displayed in a bar chart or a pie chart by proportion of:
• Age groups (0-4, 5-14, 15-24, 25-44, 45-64, 65 years and above);
• Gender;
• Pathogen species (T. spiralis or other species).

Symbols used in the Surveillance Atlas table:
Symbol
Comment
–
Indicator is not calculated for a given geographical resolution and time period.
.
Missing data. Data are not reported to TESSy for a given time period.

Data quality
EU/EEA countries reporting data on trichinellosis as displayed in the Annex 1. For data quality, reporting completeness of variables used to calculate Surveillance Atlas indicators was analysed for reported, confirmed cases. For countries reporting data only in aggregated format, the analysis of data completeness is allowed only for data reported such as age and gender.

The Surveillance Atlas indicators for data quality of confirmed trichinellosis are:
• Completeness age (%);
• Completeness gender (%);
• Completeness disease outcome (%);
• Completeness travel-associated (%);
• Completeness hospitalisation (%);
• Completeness pathogen species (%);

Interpretation
The results shown in the Surveillance Atlas should be interpreted carefully. National surveillance systems differ from each other and so does the amount of samples tested.
The notification of trichinellosis is mandatory in 27 EU/EEA countries. Two countries have voluntary notification (Belgium and France). No surveillance system for trichinellosis exists in Denmark. The surveillance systems for trichinellosis have full national coverage in all reporting countries. For 2020 and 2021, Spain did not receive data from all regions normally reporting. The case numbers are therefore lower than expected and notification rates were not calculated for these two years. Most of the countries provide case-based data except Belgium, Bulgaria and the Netherlands, which report aggregate data. Aggregated reporting format was included to calculate numbers of cases and notification rates, as well as disease trends, age and gender distributions when this data was available.
The completeness of some variables such as outcome or travel history varies between countries and years; some countries are able to collect and integrate this type of information from different sources, other countries are not.

Reports published by ECDC on trichinellosis
More information is available in ECDC reports. Note that later retrievals of data related to the same period may result in slightly different numbers as countries have the possibility to update data in TESSy retrospectively. Therefore, the data presented in the reports might slightly differ from the data presented in the Surveillance Atlas.
Annual epidemiological report for 2022 – Trichinellosis:
https://www.ecdc.europa.eu/sites/default/files/documents/trichinellosis-annual-epidemiological-report-2022.pdf


EFSA and ECDC (European Food Safety Authority and European Centre for Disease Prevention and Control), 2023. The European Union One Health 2022 Zoonoses Report (December 2023):
https://efsa.onlinelibrary.wiley.com/doi/epdf/10.2903/j.efsa.2023.8442

Annex 1. Surveillance systems overview, 2023
Country
Data source
Compulsory (Cp), voluntary (V), other(O)
Comprehensive (Co), sentinel (Se), other(O)
Active (A), passive (P)
Case-based (C), aggregated (A)
Data reported by
Case definition used






Laboratories
Physicians
Hospitals
Others

Austria
AT-Epidemiegesetz
Cp
Co
P
C
Y
Y
Y
Y
EU-2008
Belgium
BE-REFLAB
V
Co
A
C
Y
N
N
N
EU-2018
Bulgaria
BG-NATIONAL_SURVEILLANCE
Cp
Co
P
A
Y
Y
Y
Y
EU-2018
Croatia
HR-CNIPH
Cp
Co
P
C
Y
Y
Y
Y
EU-2012
Cyprus
CY-NOTIFIED_DISEASES
Cp
Co
P
C
N
Y
N
N
EU-2008
Czechia
CZ-ISIN
Cp
Co
A
C
Y
Y
Y
N
EU-2008
Estonia
EE-NAKIS
Cp
Co
P
C
Y
Y
Y
N
EU-2018
Finland
FI-NIDR
Cp
Co
P
C
Y
N
N
N
EU-2012
France
FR-NATIONAL_REFERENCE_CENTRES
V
Co
P
C
Y
N
N
N
Other
Germany
DE-SURVNET@RKI-7.1
Cp
Co
P
C
Y
N
N
N
Other
Greece
EL-NOTIFIABLE_DISEASES
Cp
Co
P
C
Y
Y
Y
.
EU-2018
Hungary
HU-Zoonoses
Cp
Co
P
C
Y
Y
Y
N
EU-2012
Iceland
IS-SUBJECT_TO_REGISTRATION
Cp
Co
P
C
Y
Y
.
.
EU-2018
Ireland
IE-CIDR
Cp
Co
P
C
Y
Y
Y
N
EU-2008
Italy
IT-NRS
Cp
Co
P
C
N
Y
Y
N
Other
Latvia
LV-BSN
Cp
Co
P
C
Y
Y
Y
N
EU-2018
Liechtenstein
LI-TRIC
Cp
Co
P
C
Y
Y
Y
.
EU-2018
Lithuania
LT-COMMUNICABLE_DISEASES
Cp
Co
P
C
Y
Y
N
N
EU-2018
Luxembourg
LU-SYSTEM1
Cp
Co
P
C
Y
Y
N
N
EU-2018
Malta
MT-DISEASE_SURVEILLANCE
Cp
Co
P
C
Y
Y
Y
Y
EU-2018
Netherlands
NL-OSIRIS
Cp
Co
P
C
Y
Y
N
Y
EU-2018
Norway
NO-MSIS_A
Cp
Co
P
C
Y
Y
Y
N
EU-2018
Poland
PL-NATIONAL_SURVEILLANCE
Cp
Co
P
C
Y
Y
Y
N
EU-2008
Portugal
PT-TRICHINOSIS
Cp
Co
P
C
N
Y
N
N
EU-2018
Romania
RO-RNSSy
Cp
Co
P
C
Y
N
Y
N
EU-2018
Slovakia
SK-EPIS
Cp
Co
A
C
Y
Y
Y
N
EU-2018
Slovenia
SI-SURVIVAL
Cp
Co
P
C
Y
Y
Y
N
EU-2008
Spain
ES-STATUTORY_DISEASES
Cp
Co
P
C
Y
Y
Y
N
EU-2018
Sweden
SE-SMINET
Cp
Co
P
C
Y
Y
N
N
EU-2018

Variant Creutzfeldt-Jakob disease (vCJD)

Last updated: 13 August 2024
Data retrieval from TESSy: 13 August 2024

Variant Creutzfeldt-Jakob disease (vCJD) is a relatively new and rare neurological disease, classified as a Transmissible Spongiform Encephalopathy. Causative agents of vCJD are prions which form aggregates in neurological tissue leading to progressive brain damage and characteristic signs and symptoms of the disease. For a more detailed description of the disease and its epidemiology, please click here.

Data
The Surveillance Atlas of Infectious Diseases displays data on vCJD reported by the EU/EEA countries. Cases are to be reported according to the 2018 EU case definition for CJD39:
Preconditions
— Any person with a progressive neuropsychiatric disorder with a duration of illness of at least six months
— Routine investigations do not suggest an alternative diagnosis
— No history of exposure to human pituitary hormones or human dura mater graft
— No evidence of a genetic form of transmissible spongiform encephalopathy
Clinical criteria
Any person with at least four of the following five:
— Early psychiatric symptoms (depression, anxiety, apathy, withdrawal, delusions)
— Persistent painful sensory symptoms (this includes both frank pain and/or dysaesthesia)
— Ataxia
— Myoclonus or chorea or dystonia
— Dementia
Diagnostic Criteria
Diagnostic criteria for case confirmation:
— Neuropathological confirmation: spongiform change and extensive prion protein deposition with florid
plaques throughout the cerebrum and cerebellum
Diagnostic criteria for a probable or a possible case:
— EEG does not show the typical appearance of sporadic CJD40 in the early stages of the illness. (The typical appearance of the EEG in sporadic CJD consists of generalised periodic complexes at approximately one per second. These may occasionally be seen in the late stages of vCJD.)
— Bilateral pulvinar high signal on MRI brain scan
— A positive tonsil biopsy. (Tonsil biopsy is not recommended routinely nor in cases with EEG appearances typical of sporadic CJD, but may be useful in suspect cases in which the clinical features are compatible with vCJD and MRI does not show pulvinar high signal.)

Epidemiological Criteria
An epidemiological link by human to human transmission (e.g. blood transfusion).
Case classification
A. Possible case:
Any person fulfilling the preconditions
AND
— meeting the clinical criteria
AND
— a negative EEG for sporadic CJD

B. Probable case
Any person fulfilling the preconditions
AND
— meeting the clinical criteria
AND
— a negative EEG for sporadic CJD
AND
— a positive MRI brain scan
OR
— Any person fulfilling the preconditions
AND
— a positive tonsil biopsy

C. Confirmed case
Any person fulfilling the preconditions
AND
meeting the diagnostic criteria for case confirmation.
------------------------
(There are no differences between the 2018 EU case definition and those of 2008 and 2012.)

Data collection and analysis
The clinical presentation and associated diagnostic criteria for vCJD are relatively unusual, and hence suspected cases are typically identified and reported to national surveillance centres in each Member State. It is common for such expert centres to offer diagnostic support and post mortem analysis. Ultimately, successful vCJD diagnosis requires the identification of patients as suspect CJD cases. Such cases can then be investigated further using prescribed diagnostic approaches as defined in the vCJD case definition in order to provide accurate differential diagnosis between vCJD and other more common forms of CJD (sporadic, iatrogenic, and familial).
Data are collected on an annual basis for the previous year. Countries can also update their data at any time. Before analysis, data are validated with nominated data providers in EU/EEA countries. Note that data published in the Surveillance Atlas might differ from figures in national reports due to different times of reporting, inclusion of cases by different case definitions and use of different denominators.
Indicators were displayed as “–” and not calculated for variables with more than 50% of cases with undocumented information (unknown or missing) for a given geographical resolution (e.g. country, EU/EEA) and time period.
Surveillance systems across the EU/EEA countries are heterogeneous and a surveillance systems overview is displayed in Annex 1.

Surveillance Atlas indicators
For reasons stated above, the Surveillance Atlas indicators for vCJD cases are the number of confirmed and probable cases in combination;
The Surveillance Atlas indicators for confirmed and probable vCJD cases are:
1. Number of reported cases;

For these indicators, the data may be displayed in a bar chart or a pie chart by proportion of:
• Age groups (0-4, 5-14, 15-24, 25-44, 45-64, 65 years and above).
Symbols used in the Surveillance Atlas table:
Symbol
Comment
–
Indicator is not calculated for a given geographical resolution and time period.
.
Missing data. Data are not reported to TESSy for a given time period.

Data quality
The Surveillance Atlas indicators were calculated up to the end of 2022. EU/EEA countries reporting data on vCJD as displayed in the Annex 1. For data quality, reporting completeness of variables used to calculate Surveillance Atlas indicators was analysed for reported, confirmed and probable cases.
The Surveillance Atlas indicator for data quality of confirmed and probable vCJD is:
• Completeness age (%).
Interpretation
The notification of vCJD is mandatory in all EU/EEA countries except in Belgium where reporting is voluntary. No surveillance system exists for vCJD in Finland, Germany and Spain. The surveillance systems have full national coverage in all reporting countries. Most countries use the EU case definition while four countries (Denmark, France and Ireland41) use another definition. However, the results shown in the Surveillance Atlas should be interpreted carefully. In terms of diagnosis and reporting of vCJD, the initial case ascertainment of CJD as a potential cause of illness is a critical element. Subsequently a diagnostic constraint is the need to obtain appropriate tissue samples postmortem to determine characteristic neuropathology associated with vCJD. In many cases such tissue is not available, and in these situations, cases can only be classified as ‘possible’ or ‘probable’ based on the clinical and diagnostic criteria available. The cases reported here are restricted to ‘confirmed’ and ‘probable’ cases of vCJD; cases classified as ‘possible’ are not included. Countries which did not provide an official “zero reporting” for the entire year are represented with ‘.’ in the Atlas.

Reports published by ECDC on vCJD
More information is available in ECDC reports. Note that later retrievals of data related to the same period may result in slightly different numbers as countries have the possibility to update data in TESSy retrospectively. Therefore, the data presented in the reports might slightly differ from the data presented in the Surveillance Atlas.
Annual epidemiological report for 2021 – Variant Creutzfeldt-Jakob disease:
https://www.ecdc.europa.eu/sites/default/files/documents/AER-vCJD-2021.pdf

Risk assessment: The risk of variant Creutzfeldt-Jakob disease transmission via blood and plasma-derived medicinal products manufactured from donations obtained in the United Kingdom (3 August 2021):
The risk of variant Creutzfeldt-Jakob disease transmission via blood and plasma-derived medicinal products (europa.eu)
Annex 1. Surveillance systems overview, 2023
Country
Data source
Compulsory (Cp), voluntary (V), other(O)
Comprehensive (Co), sentinel (Se), other(O)
Active (A), passive (P)
Case-based (C), aggregated (A)
Data reported by
Case definition used






Laboratories
Physicians
Hospitals
Others

Austria
AT-Epidemiegesetz
Cp
Co
P
C
Y
Y
Y
Y
EU-2008
Belgium
BE-REFLAB
V
Co
P
C
N
Y
Y
N
EU-2018
Bulgaria
BG-NATIONAL_SURVEILLANCE
Cp
Co
P
C
Y
Y
Y
Y
EU-2018
Croatia
HR-CNIPH
Cp
Co
P
C
Y
Y
Y
Y
EU-2012
Cyprus
CY-NOTIFIED_DISEASES
Cp
Co
P
C
N
Y
N
N
EU-2008
Czechia
CZ-ISIN
Cp
Co
A
C
Y
Y
Y
N
EU-2008
Denmark
DK-MIS
Cp
Co
P
C
N
Y
N
N
Other
Estonia
EE-NAKIS
Cp
Co
P
C
Y
Y
Y
N
EU-2018
France
FR-NATIONAL_REFERENCE_CENTRES
Cp
Co
P
C
Y
N
N
N
Not specified/unknown
Greece
EL-NOTIFIABLE_DISEASES
Cp
Co
P
C
Y
Y
Y
.
EU-2018
Hungary
HU-EFRIR
Cp
Co
P
C
Y
Y
Y
N
EU-2012
Ireland
IE-Beaumont-vCJD
Cp
Co
P
C
Y
Y
Y
N
Other
Ireland
IE-CIDR
Cp
Co
P
C
Y
Y
Y
N
Other
Italy
IT-CJD
Cp
Co
P
C
Y
Y
Y
N
EUCD
Latvia
LV-BSN
Cp
Co
P
C
Y
Y
Y
N
EU-2018
Liechtenstein
LI-vCJD
Cp
Co
P
C
Y
Y
Y
.
EU-2018
Lithuania
LT-COMMUNICABLE_DISEASES
Cp
Co
P
C
Y
Y
N
N
EU-2018
Luxembourg
LU-SYSTEM1
Cp
Co
P
C
Y
Y
N
N
EU-2018
Malta
MT-DISEASE_SURVEILLANCE
Cp
Co
P
C
Y
Y
Y
Y
EU-2018
Netherlands
NL-OSIRIS
Cp
Co
P
C
Y
Y
N
Y
EU-2008
Norway
NO-MSIS_A
Cp
Co
P
C
Y
Y
Y
N
EU-2018
Poland
PL-NATIONAL_SURVEILLANCE
Cp
Co
P
C
N
Y
Y
N
EU-2008
Portugal
PT-TRANS_SPONGIFORM_ENCEPHALOPATHIES
Cp
Co
P
C
N
Y
N
N
EU-2018
Romania
RO-RNSSy
Cp
Co
P
C
N
N
Y
N
EU-2018
Slovakia
SK-EPIS
Cp
Co
A
C
Y
Y
Y
N
EUCD2018
Slovenia
SI-SURVIVAL
Cp
Co
P
C
Y
Y
Y
N
EU-2008
Sweden
SE-SMINET
Cp
Co
P
C
Y
Y
N
N
EU-2018

Yersiniosis

Last updated: 13 August 2024
Data retrieval from TESSy: 13 August 2024

Yersiniosis is a bacterial infection caused by zoonotic enteropathogenic species of Yersinia enterocolitica and Y. pseudotuberculosis. For a more detailed description of the disease and its epidemiology, please click here.
Data
The Surveillance Atlas of Infectious Diseases displays data on yersiniosis reported by the EU/EEA countries. Cases should be reported according to the 2018 EU case definition for enteritis due to Yersinia enterocolitica or Yersinia pseudotuberculosis42:

Clinical criteria
Any person with at least one of the following five:
— Fever;
— Diarrhoea;
— Vomiting
— Abdominal pain (pseudoappendicitis);
— Rectal tenesmus
Laboratory criteria
At least one of the following two:
— Isolation of human pathogenic Yersinia enterocolitica or Yersinia pseudotuberculosis from a clinical specimen
— Detection of Y. enterocolitica or Y. pseudotuberculosis virulence genes in a clinical specimen
Epidemiological criteria
At least one of the following four epidemiological links:
— Human to human transmission;
— Exposure to a common source;
— Animal to human transmission;
— Exposure to contaminated food/drinking water.
Case classification
A. Possible case NA
B. Probable case: Any person meeting the clinical criteria with an epidemiological link
C. Confirmed case: Any person meeting the clinical and the laboratory criteria

Note: If the national surveillance system is not capturing clinical symptoms, all laboratory-confirmed individuals should be reported as confirmed cases.

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(Compared to the 2008 and 2012 EU case definitions, the 2018 EU case definition allows detection of virulence genes for laboratory confirmation and the note is also new.)

Data collection and analysis
Data are collected on an annual basis for the previous year. Countries can also update their data at any time. Before analysis, data are validated with nominated data providers in EU/EEA countries. Country population denominators by age group for the calculation of notification rates were obtained from Eurostat43. Note that data published in the Surveillance Atlas might differ from figures in national reports due to different times of reporting, inclusion of cases by different case definitions and use of different denominators.
Indicators were displayed as “–” and not calculated for variables with more than 50% of cases with undocumented information (unknown or missing) for a given geographical resolution (e.g. country, EU/EEA) and time period. The age-standardised rate and the notification rate for domestic cases were calculated when age and travel history were known for at least 90% of cases.
Surveillance systems across the EU/EEA countries are heterogeneous and a surveillance systems overview is displayed in Annex 1.

Surveillance Atlas indicators
The Surveillance Atlas indicators for confirmed yersiniosis cases are:
1. Number of reported cases;
2. Notification rate per 100 000 population;
3. Age-standardised rate per 100 000 population;;
4. Number of hospitalised cases;
5. Proportion of hospitalised cases among confirmed cases with known history of hospitalisation (%);
6. Number of deaths derived from reporting of disease outcome;
7. Case fatality calculated as proportion of deaths among confirmed cases with known disease outcome (%);
8. Notification rate for domestic cases per 100 000 population;
9. Proportion of travel-associated cases among confirmed cases with known travel history outside the reporting country (%);

a) Indicators for confirmed cases of Y. enterocolitica are:
1. Number of reported cases;
2. Notification rate per 100 000 population;
3. Number of deaths derived from reporting of disease outcome;
4. Case fatality calculated as proportion of deaths among confirmed cases with known disease outcome (%);

b) Indicators for confirmed cases of Y. pseudotuberculosis are:
1. Number of reported cases;
2. Notification rate per 100 000 population;
3. Number of deaths derived from reporting of disease outcome;
4. Case fatality calculated as proportion of deaths among confirmed cases with known disease outcome (%);

For notification rate indicators, the data may be displayed in a bar chart as:
• Age-specific notification rate (for age groups 0-4, 5-14, 15-24, 25-44, 45-64, 65 years and above);
• Gender-specific notification rate;

For other indicators, the data may be displayed in a bar chart or a pie chart by proportion of:
• Age groups (0-4, 5-14, 15-24, 25-44, 45-64, 65 years and above);
• Gender;
• Pathogen species;

In addition, for Y. enterocolitica indicators, the data may be displayed in a bar chart or a pie chart by proportion of:
• Bio-serotype.

Symbols used in the Surveillance Atlas table:
Symbol
Comment
–
Indicator is not calculated for a given geographical resolution and time period.
.
Missing data. Data are not reported to TESSy for a given time period.

Data quality
EU/EEA countries reporting data on yersiniosis as displayed in the Annex 1. For data quality, reporting completeness of variables used to calculate Surveillance Atlas indicators was analysed for reported, confirmed cases. For countries reporting data only in aggregated format, the analysis of data completeness is allowed only for data reported such as age and gender.
The Surveillance Atlas indicators for data quality of confirmed yersiniosis are:
• Completeness age (%);
• Completeness gender (%);
• Completeness disease outcome (%);
• Completeness travel-associated (%);
• Completeness hospitalisation (%).

Interpretation
The results shown in the Surveillance Atlas should be interpreted carefully. National surveillance systems differ from each other and so does case under-ascertainment between countries.
The notification of yersiniosis is mandatory in 24 EU/EEA countries. Four countries have voluntary notification (Belgium, France, Greece and Italy). No surveillance system exists in the Netherlands and Liechtenstein. The surveillance systems for yersiniosis have full national coverage except in France, Italy and Spain. No estimate for population coverage was provided for France and Italy, so notification rates were not calculated for these two countries. The coverage of the surveillance system in 2023 and in 2021-2022 is estimated to be 92% and 91%, respectively in in Spain. These proportions were used when calculating notification rates for these years. No estimate of population coverage in Spain was provided prior 2021, so notification rates were not calculated. In Belgium, full national coverage was established in 2015 and rates before this date are not displayed. Greece reports data on laboratory-confirmed cases collected from public hospitals from 2018 onwards. Most reporting countries provide case-based data except Bulgaria and Greece which report aggregate data. Aggregated reporting format was included to calculate numbers of cases and notification rates, as well as disease trends, age and gender distributions when this data was available.
The COVID-19 pandemic significantly impacted on the surveillance data for yersiniosis in 2020. Factors mentioned by countries resulting in lower case numbers were e.g. people avoiding seeking medical care for mild symptoms due to risk of exposure to COVID-19 in health care facilities, limited laboratory capacity due to reallocation of resources to SARS-CoV-2, fewer restaurant visits, increased hand washing, less travel due to travel restriction etc.

The completeness of some variables such as outcome or travel history varies between countries and years; some countries are able to collect and integrate this type of information from different sources, other countries are not. Even if overall data completeness is high for some variables, the reader should refrain from directly comparing countries without taking into account limitations.

Reports published by ECDC on yersiniosis
More information is available in ECDC reports. Note that later retrievals of data related to the same period may result in slightly different numbers as countries have the possibility to update data in TESSy retrospectively. Therefore, the data presented in the reports might slightly differ from the data presented in the Surveillance Atlas.

Annual epidemiological report for 2022 – Yersiniosis:
Annual epidemiological report 2022 - Yersiniosis (europa.eu)

EFSA and ECDC (European Food Safety Authority and European Centre for Disease Prevention and Control), 2023. The European Union One Health 2022 Zoonoses Report (December 2023):
https://efsa.onlinelibrary.wiley.com/doi/epdf/10.2903/j.efsa.2023.8442


Annex 1. Surveillance systems overview, 2023
Country
Data source
Compulsory (Cp), voluntary (V), other(O)
Comprehensive (Co), sentinel (Se), other(O)
Active (A), passive (P)
Case-based (C), aggregated (A)
Data reported by
Case definition used






Laboratories
Physicians
Hospitals
Others

Austria
AT-Epidemiegesetz
Cp
Co
P
C
Y
Y
Y
Y
EU-2008
Belgium
BE-REFLAB
V
Co
P
C
Y
N
N
N
EU-2018
Bulgaria
BG-NATIONAL_SURVEILLANCE
Cp
Co
P
A
Y
Y
Y
Y
EU-2018
Croatia
HR-CNIPH
Cp
Co
P
C
Y
Y
Y
Y
EUCD2012
Cyprus
CY-NOTIFIED_DISEASES
Cp
Co
P
C
N
Y
N
N
EU-2008
Czechia
CZ-ISIN
Cp
Co
A
C
Y
Y
Y
N
EU-2008
Denmark
DK-LAB
Cp
Co
P
C
Y
N
N
N
Other
Estonia
EE-NAKIS
Cp
Co
P
C
Y
Y
Y
N
EU-2018
Finland
FI-NIDR
Cp
Co
P
C
Y
N
N
N
EU-2012
France
FR-NATIONAL_REFERENCE_CENTRES
V
Co
P
C
Y
N
N
N
Other
Germany
DE-SURVNET@RKI-7.1
Cp
Co
P
C
Y
N
N
N
Other
Greece
EL-Lab_Hospital
V
O
A
A
Y
N
Y
N
Other
Hungary
HU-Zoonoses
Cp
Co
P
C
Y
Y
Y
N
EU-2012
Iceland
IS-SUBJECT_TO_REGISTRATION
Cp
Co
P
C
Y
Y
.
.
EU-2018
Ireland
IE-CIDR
Cp
Co
P
C
Y
Y
Y
N
EU-2008
Italy
IT-ENTERNET
V
Se
P
C
Y
N
N
N
Other
Latvia
LV-BSN
Cp
Co
P
C
Y
Y
Y
N
EU-2018
Lithuania
LT-COMMUNICABLE_DISEASES
Cp
Co
P
C
Y
Y
N
N
EU-2018
Luxembourg
LU-SYSTEM1
Cp
Co
P
C
Y
N
N
N
EU-2018
Malta
MT-DISEASE_SURVEILLANCE
Cp
Co
P
C
Y
Y
Y
Y
EU-2018
Norway
NO-MSIS_A
Cp
Co
P
C
Y
Y
Y
N
EU-2018
Poland
PL-NATIONAL_SURVEILLANCE
Cp
Co
P
C
Y
Y
Y
N
EU-2018
Portugal
PT-YERS
Cp
Co
P
C
N
Y
N
N
EU-2018
Romania
RO-RNSSy
Cp
Co
P
C
Y
N
Y
N
EU-2018
Slovakia
SK-EPIS
Cp
Co
A
C
Y
Y
Y
N
EU-2018
Slovenia
SI-SURVIVAL
Cp
Co
P
C
Y
Y
Y
N
EU-2008
Spain
ES-STATUTORY_DISEASES
Cp
Co
P
C
Y
Y
Y
N
EU-2018
Sweden
SE-SMINET
Cp
Co
P
C
Y
Y
N
N
EU-2018