Infectious Diseases A-Ö

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Acute disease symptoms caused by toxic chemicals and radioactive substances are diseases subject to registration by the Chief Epidemiologist. Diseases subject to registration include diseases that can threaten public health.

When a suspicion or confirmation of such infection is raised, physicians, directors of laboratories, hospital wards, and other healthcare facilities shall promptly send information to the Chief Epidemiologist with further instructions.

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Adenoviruses are the most common cause of conjunctivitis and, in addition, can cause infections with symptoms from, for example, airway, gastrointestinal, and central nervous system (CNS) pathways. Adenovirus infections are ongoing throughout the year, and a temporary increase in community cases is often observed. Outbreaks due to adenoviruses are also well known, especially with close contact between several individuals. The primary examples are children's summer camps and military and training camps.

At least 51 human adenovirus serotypes have been described, divided into six subtypes from A-F. Many serotypes are associated with certain infections and depend on the patient's age; therefore, some serotypes are more common in children than in adults or vice versa. Infection with a particular serotype protects against future infections with the same serotype.

Primary adenovirus infections and serotype linkage

• Epidemic keratoconjunctivitis is associated with serotypes 8, 19, and 37.

• Pharyngoconjunctival fever is associated with serotypes 3 and 7.

• Upper and lower respiratory infections with cold symptoms, sore throats, cough, and fever are associated with serotypes 1, 2, and 4 in children and 3, 4, and 7 in adults.

• Diarrhea is associated with serotypes 2, 3, 5, 40, and 41.

• Cystitis is associated with serotypes 7, 11, and 21.

• Central nervous system infections are related to serotypes 2, 6, 7, and 12.

Transmission

The most common modes of transmission are:

• With hands.

• Direct contact with infected fluids from an individual's eye.

• Indirect contact with infected fluids through contaminated surfaces, instruments, or fluids.

Initial infection among factory workers can often be traced back to fluids used for eyewash after minor eye accidents; such infections occur with fingers, instruments, or other contaminated objects. Similar outbreaks have also appeared in ophthalmological wards and clinics, and infection among staff can perpetuate the outbreak. Infections occur commonly within families, especially when children are in the home. Even if it is minimal, an injury to the eye can increase the risk of infection.

• Incubation period: The period from infection to onset of symptoms is usually 4 to 12 days but may be longer.

• The period during which an infected individual is infectious: An infected individual may be contagious from shortly before symptoms appear up to 14 days from the start of symptoms.

• Diagnosis: Adenovirus diagnosis is made at the National University Hospital of Iceland virus laboratory, usually with a diagnosis of the virus's genetic material. It is also possible to culture the virus and measure antibodies.

Prevention and control of possible or confirmed infection.

The infected person:

• Carriers should be instructed to wash their hands frequently and avoid contact with the eye.

• Disposable paper towels should be used. If this is not possible, the infected person shall keep his/her towel until the paper towels have been provided.

• Infectious persons must not share eye medications, drop-ons, cosmetics, or other eye contact materials.

Healthcare/ophthalmological center infection

• Patients and healthcare professionals with a possible infection should avoid contact with other patients.

• Workers shall wash their hands before and after any contact with any patient. Gloves should be worn if contamination is suspected, and hands should be thoroughly wiped with disposable paper towels after washing hands.

• Repeated devices used for eye examination must be carefully cleaned and sterilised (by an approved procedure) after use.

• Any eye medications or drops that have come in contact with the eyelids or mucous membranes must be discarded after use.

• Preventive measures must be taken if the epidemic persists, including the reception of potentially infected patients in special reception rooms.

• All surroundings of the infected person must be cleaned thoroughly with soap and water and disinfected by mild surface chlorine, which is contaminated with ocular or nasal fluids.

• In outbreaks, the transmission route must be traced back to the source of the contaminated eye medicines or wash-out fluids, and appropriate measures must be taken to prevent further spread.

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Does HIV infect your daily contact?

HIV is not a factor in everyday contact. Therefore, living in the same home or having daily contact with someone infected with HIV/AIDS is entirely safe.

How can I prevent infection?

The condom is the ONLY protective against infection. To provide maximum protection, it must be used correctly. Syringe addicts should never share their syringes or needles.

Is HIV a dangerous disease?

HIV is a severe and life-threatening disease or infection that develops without treatment. There is no cure, and it is not in sight either.

What are the symptoms of HIV, and when do they appear?

Some newly infected will develop symptoms in the days to weeks after infection. The main symptoms are general weakness, sore throat, enlarged lymph nodes, rash, headache, and muscle and joint pain that usually lasts 1–2 weeks. After that, most people do not suffer symptoms for years. The virus slowly attacks the body's defences and damages the immune system.

What is AIDS?

AIDS is the final stage of the disease and refers to illnesses and symptoms that HIV-positive people experience when their immune system fails. This usually happens many years after infection. Once people have AIDS, they get diseases that uninfected people rarely get, as their immune systems have lost their ability to fight disease. Those who have acquired AIDS usually die within a few years if no drug treatment is applied, but it does improve their prospects considerably.

How can HIV/AIDS be detected?

HIV infection is diagnosed by a blood test that any doctor can take. The blood test is free of charge and is handled in confidence. When HIV enters the blood, the body develops antibodies that can be detected by HIV antibody testing up to three months after infection. A positive HIV test means that you have been found to have antibodies to HIV in your blood, and therefore, you are infected with HIV. A negative HIV test, by contrast, means that you do not have HIV. The results of the HIV test are obtained a few days after the blood test is taken.

Is it possible to get treatment for HIV/AIDS?

Taking HIV medicines daily for the rest of your life may reduce the amount of the virus in your body, thereby improving your well-being and prolonging your life as an HIV-positive. Taking the medication may be associated with adverse effects.

What about the ones I have sex with?

If you have slept with someone since you became infected, someone may have become infected with HIV. It is, therefore, essential to inform the previous partners. You can tell them yourself or ask the doctor to write them without mentioning your name. In all cases, however, information on sexual partners must be given. By encouraging those you have slept with to get checked up, you can prevent them from infecting those they have sex with in the future. This way, you can prevent the spread of this severe disease.

Diseases subject to registration

Diseases subject to registration are those that can spread widely in society and, at the same time, threaten public health. Doctors are required to notify The Chief Epidemiologist of persons sickened by HIV/AIDS with the personal identification number of the infected person, but reports to the Chief Epidemiologist are also received from laboratories that confirm the diagnosis. The purpose of reporting an infectious disease is to prevent the spread of infection through targeted measures, e.g. isolation, treatment of the infected, and tracking of transmission between individuals. Information about the probable transmission place, transmission time, and symptoms must accompany notifications to satisfy these conditions. In this way, infected persons can be linked epidemiologically, the effects of the infection can be assessed, and a response can be taken.

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Anisakiasis is a notifiable disease to the Chief Epidemiologist. Notifiable diseases include diseases that may threaten public health.

When an anisakiasis infection is suspected or confirmed, physicians, directors of laboratories, hospital wards, and other healthcare facilities shall promptly send information to the Chief Epidemiologist with further instructions from the Chief Epidemiologist.

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Icelanders are not entirely unfamiliar with anthrax because it first came to the country in the 19th century and caused several outbreaks and infections among humans. The disease is caused by a bacterium called Bacillus anthracis. It is mainly herbivorous animals that get this disease, but humans can occasionally get infected with it. Diseases that are found in animals but can also affect humans are called zoonoses.

The pathogen can form dormant spores or spores that can survive for decades in the soil. When spores reach a host where conditions are favourable, they change into the form the pathogen has when it is growing. The pathogen carries a poison or toxin that is very harmful and causes death.

Sources on the landfilling of infected animals in Iceland either do not exist or need to be more accurate. Therefore, it is not ruled out that the disease will reappear in this country, especially during landslides where infected animals are buried.

The anthrax pathogen has long been considered ideal for use in warfare and terrorism. Most people are aware of the letters in the USA in the fall of 2001 that contained anthrax spores. It is also possible to spread anthrax over a larger area, indoors or outdoors; in that way, many people can be infected in a short time.

Anthrax has almost completely disappeared as a human disease in the Western world. In developing countries, cases occur in both animals and humans.

Symptoms

The symptoms of anthrax depend to some extent on how the infection is transmitted. The most common route of transmission of the pathogen to humans is through broken skin. Those who handle infected animals or products of infected animals are at the greatest risk. The pathogen causes pustules that later rupture and have a black wound base due to necrosis. Skin infection is the mildest form of the infection, leading to death in 20% of cases if it is not treated. The incubation period of a skin infection is 3-5 days.

Consuming contaminated food can lead to an infection in the digestive tract or throat. Symptoms at the beginning are general but can then develop into severe symptoms from the digestive system or throat with accompanying drops in blood pressure and death. The infection usually occurs in humans after eating meat from an infected animal. The incubation period of infection is 3-7 days.

Finally, the pathogen's spores can enter the respiratory tract and, from there, enter the lymph tissue, causing infection, necrosis, and sepsis. This is the main route of transmission used to spread anthrax in warfare and terrorism. In natural respiratory infections, workers in the wool industry are at the highest risk.

The first symptoms of lung infection are flu-like with fever, muscle aches, headache, dry cough, and slight chest discomfort lasting just a few days. For the next 1-3 days after the initial symptoms, the patient feels better but then suddenly worsens with high fever, shortness of breath, and shock. Edema of the chest can often be seen, and patients may develop hemorrhagic meningitis. The incubation period from a lung infection, until symptoms appear, is usually 1-6 days but can be longer up to 43 days.

Routes of transmission

The pathogen is transmitted to humans and animals from contaminated soil, tissue from infected animals, wool, animal skins, and other things that can be contaminated with anthrax spores. Laboratory infections have occurred. The disease does not spread from person to person.

Treatment and prognosis

The initial symptoms of the disease are general, delaying the start of treatment. Anyone with a lung infection who does not receive appropriate treatment dies, and it is estimated that up to 95% of those infected die if more than 48 hours pass from the onset of symptoms to the start of treatment. The pathogen is sensitive to various common antibiotics. However, it can be expected that strains used in biological weapons may be resistant to antibiotics.

Prevention

Prophylactic antibiotics can be given until the risk of infection has passed. There is a vaccine against this disease, but the duration of the protective effect from vaccination is short.

Diseases subject to registration

Diseases subject to registration are those that can spread widely in society and, at the same time, threaten public health. Doctors must notify The Chief Epidemiologist of persons sickened by anthrax with the personal identification number of the infected person. Still, reports to the Chief Epidemiologist are also received from laboratories that confirm the diagnosis. The purpose of reporting an infectious disease is to prevent the spread of infection through targeted measures, e.g., isolation, treatment of the infected, and tracking of transmission between individuals. Information about the probable transmission place, transmission time, and symptoms must accompany notifications to satisfy these conditions. In this way, infected persons can be linked epidemiologically, the effects of the infection can be assessed, and a response can be taken.

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Bacillus has been found in grain, rice, spices, meat dishes, milk, ice cream, and various ready-to-eat dishes. The pathogen may produce a resident spore. Infections are often caused by poor refrigeration of prepared food. The resident spores survive the heating. They transform themselves into toxin-producing pathogens.

Two strains of the pathogen are known. One of these produces a toxin that causes acute nausea, vomiting, and stomach aches 1–5 hours after consumption of contaminated food. Diarrhea may come later. The other strain produces a toxin that causes acute diarrhoea and abdominal pain 8–16 hours after consumption of contaminated food. Both symptoms resolve in 24–36 hours.

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The Black Death is a disease subject to registration by the Chief Epidemiologist, which includes diseases that may threaten public health.

When such an infection is suspected, doctors, directors of research laboratories, hospital departments, and other health institutions must send information to the Chief Epidemiologist immediately and according to further instructions.

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Borrelia burgdorferi bacteria cause the disease borreliosis or Lyme disease in humans. The bacteria are transmitted to humans by bites of a tick (Ixodes ricinus in Europe, Ixodes scapularis, and pacificus in the United States) when it feeds on blood.

The optimal conditions for the tick are wooded areas and the wildlife there, which provides the tick with blood. Over the last thirty years, this disease has spread significantly, linked to the increased spread of woodlands and wild mammals, climate change, and increased outdoor activities by people with more free time.

Lyme disease is most common in New England, the Midwest, California, and Oregon in the United States. The disease is most common in Europe in Germany, Austria, Slovenia, Sweden, Finland, and the Baltic countries. The disease is also present locally in Russia, China, and Japan. The disease has been increasingly introduced to the British Isles in recent years.

Ixodes ricinus
According to information from the Icelandic Institute of Natural History, the tick was first found in Iceland on a migratory bird in 1967. It has been found from time to time, especially in recent years, and the Institute believes it is in all likelihood endemic, as its distribution area has shifted northwards with a warming climate. Since the tick travels with migratory birds, it has likely been introduced to Iceland from time to time for centuries but has yet to take root here. No one, however, is known to have been infected with Lyme disease in Iceland.

Life conditions of ticks in Iceland are poorly researched, but unsteady weather conditions and limited woodland habitats have been linked to the risk of its establishing roots in Iceland. This may change if the weather is warming and woodland is growing in Iceland. A woodpecker, an arthropod, is a vector that transmits the virus from mammals to birds. It may concern humans because it can carry bacteria (Borrelia burgdorferi) and viruses that cause encephalitis (see section TBE). It stays in vegetation, especially on the forest floor, and clings to the blood donor.

There are three life stages of the mite. After hatching from an egg, it becomes a six-legged larva, which remains dormant over the winter. In spring, the larvae crawl upwards along the vegetation and are subject to an opportunity to reach a host to suck blood. If all is successful, the mite is switched to an eight-legged juvenile in late summer, who will again be dormant during the winter.

In spring, it adopts the same mode, changes into an adult mite after a successful blood meal, hibernates another winter, and repeats the game in spring. The male dies, but the female lays eggs before accompanying her partner. Adult mites are 0.5 to 11.1 cm long, while juveniles are much smaller.

An adult mite is distended after a blood meal, reaching the size of a coffee bean.

Symptoms
After a bite leading to infection, erythema migrans that spread into a circle can form. It can take 3–30 days for the erythema to spread.

Soon, fatigue, fever, chills, headaches can begin, and muscle and joint pain that may last for weeks. A widespread infection occurs when the bacteria spread through the body and settle in the skin, central nervous system, heart, or joints. This may happen in the weeks after infection if treatment is not given. However, your infection usually clears up after a few weeks to a month of treatment. In some cases, the infection causes persistent joint inflammation. Uncommon complications include memory loss, fatigue, and heart rhythm problems that remain even after the bacteria has been eliminated.

Diagnosis
Diagnosis is usually made by a blood test for antibodies, sometimes in the spinal fluid (the intrathecal fluid). The antibodies are often only found a few weeks after infection. However, the bacteria can sometimes be found in skin samples from erythema. It was also likely that due to the unclear symptoms of other diseases, the disease may be overdiagnosed in many cases.

Treatment
Antibiotics are given for Lyme disease. Generally, doxycycline, penicillin, amoxicillin, or cephalosporin are given for 2-4 weeks, depending on the severity of the disease. If the infection does not respond well to antibiotic treatment, anti-inflammatory treatment must sometimes be administered.

Preventive measures

• It is sensible to gather information on whether ticks are in the area where the animals stay.

• Learn what a tick looks like.

• If there is a tick in the area, you should be equipped with a pointed pin tweezer.

• Wear clothing that covers the body well, such as long trousers and a long-sleeved T-shirt or shirt, especially if you go through woods or scrubland. Use light-coloured clothes so that mites are more easily seen.

• Use a chironomid fertiliser.

• When you come from a spare area, you must examine your body carefully to see if a mite has bitten itself firmly on the skin.

• If the tick has been firmly sucked to feed on blood, care should be taken when removing the tick. This is best done by pinpointing the mite's mouthparts and lifting it straight up from the skin. Rotating the wound shall be avoided. This prevents tick contents from being spiked into the wound or part of it remaining.

• It is generally considered that infection may only be prevented after the mite has been retained for a day in the skin.

Puffin lice, Ixodes uriae
Another type of tick is the so-called puffin lice (Ixodes uriae). The lice are found in seabirds in Iceland. It has been shown that they contain bacteria from the genus Borrelia. It has not been demonstrated that puffin hunters have been infected with Borrelia even though puffin lice have bitten them.

Notifiable diseases
Lyme disease is a notifiable disease. Notifiable diseases are diseases that can spread in society but which do not have practical significance. The Chief Epidemiologist is, therefore, sent non-personal information about these diseases from treating physicians and health clinics.

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The botulinum bacterium has been found in homemade sour blood sausages. It can produce dormant spores that are resistant to high temperatures. Infections can often be caused by low salting or too little acid in canned vegetables or fish. The pathogen grows in an oxygen-poor environment, and there are strains of it that can reproduce at 3°C. Cans that appear bulge because of internal pressure should not be opened because the pathogen can sometimes form gas inside the cans.

Symptoms of the disease appear 6–36 hours after consumption of food products containing the pathogen. The pathogen produces a toxin that causes breathing difficulties, vision problems, and paralysis. Symptoms are double vision, difficulty swallowing, nausea, dry mouth, and constipation, but sometimes diarrhoea.

The botulism-induced poisoning is known as botulism. It is very dangerous and, in some cases, can be fatal. Children can get botulism and become seriously ill from eating honey. Therefore, parents are warned against honey for children under 12 months. Honey may contain the resident spores of the Clostridium botulinum pathogen. The resident spores can colonise the digestive tract of such young children due to the special conditions in which they are found. Suppose the spores are converted to live bacteria. In that case, they produce a toxin that can cause severe, even fatal, poisoning that can manifest in drowsiness, impaired reflexes, difficulty swallowing, paralysis, and difficulty breathing. A child with such symptoms should be doctored immediately. Botulism is very rare in Iceland.

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Broad-spectrum beta-lactamase-producing pathogens are diseases subject to registration by the Chief Epidemiologist. Diseases subject to registration can threaten public health.

When such an infection is suspected or confirmed, directors of laboratories shall promptly send information to the Chief Epidemiologist by further instructions.

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Brucellosis is a disease subject to registration by the Chief Epidemiologist, which includes diseases that can threaten public health.

When such an infection is suspected or confirmed, physicians, laboratory directors, hospital wards, and other healthcare facilities must promptly send information to the Chief Epidemiologist for further instructions.

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Campylobacter is a common bacterium worldwide and can cause infection in humans and animals. It is most often found in chickens and ducks. There are many species of the bacterium, but Campylobacter jejuni is the most common cause of human infections. Other much rarer species are Campylobacter coli and Campylobacter lari.

The number of individuals diagnosed in Iceland every year is high, and the disease is either from domestic or foreign sources. In 1999, an outbreak occurred in Iceland caused by Campylobacter contamination in chickens. As a result, intensive campaigns against Campylobacter infections began, and cases have dropped significantly. Much has been achieved with improved production hygiene, control, and freezing of contaminated chickens. The decrease in infections can also be attributed to improved handling of food. Group infections due to contaminated water have also occurred in Iceland.

The incubation period of the infection, i.e. the time from infection to onset of symptoms, is 2–4 days in most cases but can range from 1–7 days.

Transmission routes

The main route of infection is through contaminated food, and waterborne infections are also well known. Direct human-to-human transmission can occur but is most common when caring for diapered infants with Campylobacter infection.

Symptoms

Diarrhea (may be bloody), nausea, vomiting, abdominal pain, and fever, which usually goes on for 4–5 days without treatment.

Complications

Occasionally, the bacteria enter the bloodstream and cause a blood infection.

Diagnosis

Diagnosis is obtained by culturing the bacteria in a stool sample and, in rare cases, in the blood, in the case of sepsis.

Treatment

Usually, no antibiotic treatment is needed, but sometimes intravenous fluids must be given to compensate for fluid loss.

Prevention

There is no vaccine against Campylobacteriosis.

The best and most effective preventive measures are good work practices in the kitchen to prevent cross-contamination from meat products to other foods. When you know about infections, please take the following into account:

• Good hand hygiene is essential and reduces the risk of spreading the infection to other individuals.

• Preparation of food for others during illness should be avoided. An infected individual is most infectious when they have diarrhoea; therefore, it is advisable to stay at home while symptoms are present.

• Using one's own toilet is preferable but optional.

• Follow-up is only needed if the infected person works in food production.

Campylobacter is a disease subject to registration and must be notified to the Chief Epidemiologist.

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Chickenpox is caused by a varicella zoster (herpes zoster) virus related to the herpes simplex (cell) virus. This is usually a mild disease but can, in rare cases, cause chickenpox to become a severe illness. Following infection with chickenpox, the virus takes hold of the nerves in the body and lies hidden.  It can later recur and cause herpes zoster, which is characterised by painful local rashes.

Epidemiology

In Iceland, almost everyone gets chickenpox at some point, but the disease is less common in the southern part of the world. An Icelandic study published in 2009 revealed that 97.5% of Icelandic children develop varicella (chickenpox) antibodies at 1–10 years and 50% at 1–4 years old. It is, therefore, clear that many Icelandic children receive varicella during their preschool years.

Chickenpox does not seem to be a large epidemic like many other childhood diseases, but it persists in the community throughout the year. Seasonal fluctuations are often on the disease rate, and most cases occur in the middle of winter until spring.

Symptoms

The disease lasts 7–10 days in children but longer in adults. Most of the time, the infection is not dangerous, and most people get chickenpox once.

The disease starts with a skin rash that affects the body and face but can also affect the scalp and extremities. Sometimes, the rash spreads to mucous membranes and genitals. Weakness and mild fever are often observed for one to two days before the onset of the rash, and the fever continues in children and adolescents for 2–3 days concurrently with the rash. The rash starts as tiny red bubbles that become oozing blisters in a few hours; the blisters then become sores in 1–2 days, forming scabs and drying up. New bubbles may be added for 3–6 days. The severity of a rash that each person experiences varies greatly. Other symptoms may include headache, sore throat, loss of appetite, and possibly vomiting.

The main complications that can follow chickenpox are skin infections and pneumonia. In some cases, chickenpox can cause encephalitis and myocarditis. Severe varicella infections are more common in adolescents and adults than younger children. Deaths are but occur even in previously healthy children. Immunosuppressive disorders such as leukaemia, steroid therapy (e.g. for asthma; non-inhaled steroids), and immunosuppressive therapy, such as after organ transplantation or because of cancer, significantly increase the risk of severe varicella and complications.

In 2009, an article was published about the epidemiology of chickenpox in Iceland and the complications seen in Icelandic children (Icelandic). It revealed that 58 children had been admitted to Landspítali Hospital over a 20-year period with severe complications from varicella.

Shingles can appear anytime after chickenpox disease, even repeatedly and often in the same place on the body. The large intestine rash is mainly localised to one local skin nerve. They are usually itchy but can also be very painful and are called hellfire (helvetesild in Norwegian). Symptoms typically resolve after a few weeks, but very few develop persistent neuropathy. If shingles appear on the head or face, they can cause blindness.

Diagnosis

Rash of varicella is a disease characteristic and is diagnosed as such. The virus can also be differentiated by culture from rash or blood analysis in case of doubt, as does the shingles.

Transmission routes and incubation period

Chickenpox is a highly infectious disease most common in children. It is transmitted from person to person by aerosols from the respiratory tract and by direct contact with the fluids from rashes.

The incubation period of the disease, i.e. the period between infecting the individual and the onset of symptoms, can be 10–21 days. People can infect others for up to three days before they develop a rash and remain infectious until all the bubbles have burst and dried up. Individuals with shingles can transmit chickenpox to others.

If an individual has not had chickenpox, there is a 90% chance that they will contract the disease, and someone in the home will get sick, while there is a 10–35% chance that children in a school environment will get infected. Individuals with shingles can also spread the virus, but the risk of infection for susceptible individuals in the household is around 20%, much lower than for chickenpox.

Treatment is mainly staying still, drinking well, and reducing the itch. The itch can be relieved by cold bakes or baths. Oatmeal, diet, soda, and potato flour have been used in baking or bathing to reduce itching. Drugs are also available to apply and foam for external use, which reduces the itching. These medicines will only temporarily relieve the itching, and when they are used, it should be kept in mind that they may cause a brief stinging sensation. If the itch becomes so severe that it interferes with the child's sleep, itch-resistant antihistamines can be given to the child, although they may have a drowning effect. The physician should provide advice about the choice of such a medicinal product and the appropriate dose for the child. Antipyretics may be administered, but care must be taken not to contain acetylsalicylic acid (aspirin).

Varicella can also be treated with specific antiviral drugs, and it is best to start the treatment in the first 1–2 days of the illness. This treatment is most appropriate for immunosuppressed individuals or those who treat immunosuppressed individuals or others at risk for severe infections and complications of varicella.

Prevention

In 1995, a live varicella vaccine was introduced, which is very effective and safe. There has been considerable interest in its use. Vaccination against varicella is now part of the general vaccination of children in Iceland born in 2019 or later. Vaccines may continue to be administered to older children and adults who do not have severe immunosuppression at the expense of the individuals themselves.

Chickenpox is a disease subject to registration by the Chief Epidemiologist, as it is a public health threat.

When chickenpox is suspected or confirmed, doctors, directors of laboratories, hospital wards, and other healthcare facilities must send the Chief Epidemiologist information, but only if the patient is hospitalised.

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Chlamydia is a sexually transmitted disease (STI) caused by Chlamydia trachomatis. The bacteria colonise mucous membranes of the genitals, urinary tract, or rectum and can cause inflammation in these locations. The bacteria can also enter the mucous membranes of the eyes and throat, causing infection. About 2000 Icelanders are diagnosed with chlamydia every year.

Transmission

Transmission occurs during sexual intercourse when infected mucous membranes of one individual come into contact with the mucous membranes of the other. Transmission may also occur through anal and oral contact.

There is a risk that Chlamydia could be transmitted to the eyes if an infected person touches the genitals and then rubs the eyes. Therefore, hand hygiene is essential, e.g., after the toilet. Newborns can get an eye infection during birth if the mother is infected with Chlamydia.

Prevention of infection

The condom is the ONLY protection against infection. It provides maximum protection, but it must be used correctly.

Is chlamydia dangerous?

The chlamydia bacterium is dangerous because it can cause infertility in women due to inflammation of the fallopian tubes, which may then close. Chlamydia is one of the most common causes of infertility in young women. Because of this risk, it is essential to treat the disease promptly. Chlamydia is easy to treat, but it can be hard to know whether you are infected or not because the disease is often asymptomatic.

Symptoms

As with many sexually transmitted diseases, many people are infected with Chlamydia without having any symptoms.

When symptoms appear, they are as follows:

Women

• Changes in discharge or bleeding between menstrual periods.

• Burning sensation when passing urine and frequent urination.

• Pain in the pelvis. You should seek medical attention on the same day if you also develop a fever.

Men

• Clear fluid, yellow or white discharge from the urethra (there should never be discharge from the male urethra).

• Burning sensation when passing urine and frequent urination.

• Soreness and pain in your scrotum.

• Chlamydia infection can occasionally cause joint pain and arthritis in both men and women.

When do Chlamydia symptoms start after infection?

If you have symptoms on one side, they often appear 1-3 weeks after the sex that resulted in the infection. In some cases, symptoms may develop within a few days after infection.

Chlamydia diagnosis

Men who sleep with women submit a urine sample. Examination in women is a vaginal smear. Depending on the circumstances, it is sometimes necessary to take more samples.

Treatment of chlamydia

Chlamydia can be treated with antibiotics. You must take all the given tablets and follow your doctor's instructions. It is essential that your partner is treated simultaneously, or you could pass the infection on to each other again. The other person could also pass on the disease to others with whom they have sex if they are not treated. Do not have sex until the treatment is completed (up to one week to 10 days after starting treatment, depending on the treatment). If one of the patients continues to have any symptoms, a new test must be performed, but not until 3–4 weeks after the end of treatment. It is recommended that sexually transmitted infections be monitored routinely by a full-time specialist.

What about those I have had sex with?

If you have been told you have chlamydia, there is a high probability that some of your intimate partners in the last 6-12 months have the disease. It is, therefore, important that everyone you have had sex with over the previous 12 months is informed so they can receive treatment if needed. This is called infection tracking.

You can personally tell them or ask their doctor to contact them without mentioning your name. In all cases, however, information on sexual partners must be given. By encouraging those you have had sex with to get checked up, you can prevent them from infecting others in the future. This way, you can prevent the spread of this severe disease.

Diseases subject to registration

Diseases subject to registration are those that can spread widely in society and, at the same time, threaten public health. Doctors must notify The Chief Epidemiologist of persons sickened by chlamydia with the personal identification number of the infected person. Still, reports to the Chief Epidemiologist are also received from laboratories that confirm the diagnosis. The purpose of reporting an infectious disease is to prevent the spread of infection through targeted measures, e.g., isolation, treatment of the infected, and tracking of transmission between individuals. Information about the probable transmission place, transmission time, and symptoms must accompany notifications to satisfy these conditions. In this way, infected persons can be linked epidemiologically, the effects of the infection can be assessed, and a response can be taken.

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Cholera is a digestive tract infection caused by the bacterium Vibrio cholera of serotypes O1 and O139. V. cholera 01 has two biotypes, called classic and El Tor.

Infections caused by V. cholerae are extremely rare in the West, but the disease is endemic in developing countries where hygiene is lacking. In the period 1817–1961, there were seven pandemics that most often originated in Asia and slowly spread to Europe and America. The last one appeared in 1961 in Indonesia and spread worldwide in the following decades. All seven of these pandemics are believed to be caused by Vibrio cholerae O1. In 1992, infections caused by Vibrio cholerae O139 were observed for the first time in India. Since then, this strain has been identified in at least 11 Southeast Asian countries and is likely to spread further.

In recent years, cholera has broken out in many places, most often in connection with poor sanitation and insufficient access to clean water. Such situations can arise during disasters that break water pipes and destroy sanitation systems. Another example is migration, which results in large numbers of people staying in poor conditions for long periods in refugee camps with limited access to clean water and adequate sanitation. In addition, cholera is endemic in many places where sanitation is lacking. The World Health Organization estimates that each year, between 1.3 and 4 million people become ill with cholera, resulting in 21,000–143,000 deaths annually.

V. cholera thrives in water bodies. It can live for years and reproduce outside the human body. The bacterium produces a toxin that causes the symptoms of cholera.
The infectious dose is large, i.e. large numbers of bacteria are needed to cause an infection.

Routes of transmission

The main transmission route is through water and food contaminated with faeces from infected individuals. When drinking water is contaminated, infections can be prevalent. Foods most commonly associated with infections are leftover rice, seafood, raw fish, raw oysters, and vegetables.
Direct human-to-human transmission is rare.

Incubation period

The incubation period, i.e., the time from infection until symptoms are noticed, is 12-72 hours.

Symptoms

Most of those infected with cholera are asymptomatic but can carry the bacteria in their stools for 1–2 weeks. Most people with symptoms have a mild illness that is difficult to distinguish from other infectious intestinal infections. Fewer than 10% of patients have the typical cholera presentation of profuse watery diarrhea and vomiting, but acute infection can lead to hypotension and death in a very short time.

Analysis

Fecal sample in culture.

Treatment

Treatment focuses on replacing fluid and salt losses caused by diarrhoea and vomiting. If adequately treated, less than 1% of those infected die. Antibiotic treatment is also considered, but it shortens the time the symptoms last and the time the person has the bacteria in the stool.

Prevention

Travelers in areas of the country where cholera is endemic should drink boiled or bottled water and avoid foods linked to infections caused by V. cholerae. There is a vaccine with reasonable protection against infections caused by V.cholerae O1 and some protection against travellers' diarrhoea caused by E. coli.

The vaccine is not registered in Iceland.

Cholera infection is a disease subject to registration by the Chief epidemiologist.

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Clostridium perfringens has been found in spices, meat, meat dishes, and various prepared dishes. The pathogen can form dormant spores that can withstand high temperatures.

Perfringens toxins are produced when the spores are formed from many pathogens that enter the intestines. Infection can often be attributed to poor cooling of hot meat dishes. The dormant spores can wake up and become live germs that multiply quickly if the dish is not adequately cooled. Symptoms appear 6–24 hours after consuming foods containing the pathogen. Symptoms of the disease are diarrhoea and abdominal pain, which last for one day.

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Coronavirus SARS-CoV, MERS are a disease subject to registration by the Chief Epidemiologist. Diseases subject to registration may threaten public health.

When a suspected or confirmed Coronavirus SARS-CoV or MERS infection arises, physicians, laboratory directors, hospital wards, and other healthcare facilities must send the Chief Epidemiologist information without delay and by further instructions.

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Creutzfeldt Jacob fever and its variants are diseases subject to registration by the chief epidemiologist. Diseases subject to registration can threaten public health.

When such an infection is suspected or confirmed, physicians, laboratory directors, hospital wards and other healthcare facilities must promptly send information to the Chief Epidemiologist by further instructions.

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Cryptosporidium is a worldwide parasite of protozoa, which can cause intestinal infections in both humans and animals. Many Cryptosporidium species exist, but only two of them are known to cause infections in humans. Cryptosporidium parvum causes infections in animals and humans, and Cryptosporidium hominis has only been detected in humans.

The pathogen was first identified as a human pathogen in 1976, and its mechanism of infection was first described in 1984. Immunocompromised individuals, e.g. those with AIDS, may become seriously ill from this disease.

Transmission routes

Cryptosporidium lives in the small intestine of infected humans and animals (mainly calves). The pathogen is excreted in the faeces, can contaminate the hands and surface, and therefore spread from person to person. The pathogen can also be found in soil, food, and water where infected humans or animals have been present. Water is often considered a likely source of infection. The infection dose for humans is estimated at 100 animals in an atmosphere of resistance but may be much lower for those with suppressed immune systems.

Incubation period

The incubation period, i.e., the time from infection to onset of symptoms, is 1-12 days, usually 2-10 days after infection.

Symptoms

Symptoms vary, but some are asymptomatic. The main symptoms are diarrhoea, loose, watery stools, stomach cramps, upset stomach, and mild hyperthermia. Healthy individuals get rid of the pathogen and become asymptomatic in three to four weeks. Immunocompromised individuals are less likely to get rid of the infection. They may have a long-term infection that does not improve, particularly among AIDS patients, where the infection can be severe.

Diagnosis

A stool sample in a microscope to look for parasites. The infection can be difficult to diagnose; sometimes, more than one sample one to two days apart is needed to confirm the disease.

Treatment

There is no specific treatment; the infection is passed on automatically in healthy people. It is important to drink well if you have diarrhoea.

Preventive measures

Good hygiene is essential.

• Wash hands with soap and water after using the toilet, after contact with animals, and before handling food. Wash your hands after changing diapers, even if gloves have been worn.

• Cryptosporidium is protected by an external coating that allows it to survive for a long time outside the body and makes it resistant to chlorine-containing disinfectants.

• Avoid swallowing untreated surface water in swimming pools, hot tubs, fountains, rivers, streams, and ponds.

• If Cryptosporidium contamination in water is suspected, the infection can be avoided by boiling the drinking water for at least one minute.

• It is preferable to wash and peel raw vegetables and fruits before consumption.

Responses to individual cases of infection or outbreaks

• Those with a confirmed infection must not go swimming or to the tub while symptoms are present (especially important for babies in diapers).

• It is necessary to check whether more people have symptoms and to take samples from those who have symptoms of Cryptosporidium infection.

• If a child is diagnosed with Cryptosporidium at daycare, the child should be contacted if the child spent the days before the illness or had symptoms of the infection at daycare.

• If a cluster or outbreak is suspected, contact the district/regional doctor in the area, e.g. if two or more cases are diagnosed.

• Individuals diagnosed with Cryptosporidium and are in a job with an increased risk of infection (see below) should not work while symptomatic and for two days after the last symptoms (diarrhoea). Taking a control sample is unnecessary to confirm that the person is free of infection before returning to work.
  

Jobs with increased risk of infection

• Those who work in the production, transport, or serving of food and who are in direct contact with unpackaged food.

• Healthcare workers who are in direct contact with patients who are severely immunocompromised or who are in the intensive care unit.

Children with confirmed infection may not be in daycare while symptomatic until two days have passed since the last symptoms (diarrhoea). Taking a control sample is unnecessary to ensure that the child is free of infection before returning to daycare.

Cryptosporidium infection is a disease subject to registration by the Chief Epidemiologist. When such an infection is suspected or confirmed, directors of laboratories shall send information to the Chief Epidemiologist by further instructions.

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Cysticercosis is a notifiable disease to the Chief Epidemiologist. Notifiable diseases include diseases that may threaten public health.

When cysticercosis is suspected or confirmed, physicians, laboratory directors, hospital wards, and other healthcare facilities shall promptly send information to the Chief Epidemiologist with further instructions from the Chief Epidemiologist.

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Diphtheria is a disease caused by bacteria that is very infectious and starts on the upper airways. The disease manifests as a severe sore throat with an oblique oral and nasal mucosa covering. The bacteria produce a toxin that is absorbed into the bloodstream and harms the body's tissues, such as the heart muscle, kidneys and nervous system. Antibiotics kill the bacteria but do not prevent the toxic effect. Diphtheria can become a severe disease and can lead to death, but 40-50% of those who do not receive treatment for the disease die from it.

The epidemiology

Diphtheria was a common disease in the past but is rare today because of its intensity and extensive nature. The last diphtheria was diagnosed in Iceland in 1953. The disease is easily transmissible between humans and shows the experience of many Eastern European countries that this disease, like other diseases, can spread if vaccinations are relaxed. Unvaccinated children under five years of age and adults over 60 years of age are the most exposed to infection.

Pathways of infection and incubation

Diphtheria is highly infectious. Transmission of the bacterium occurs via droplet or aerosol infestation from the respiratory tract, i.e. coughing, sneezing and laughing, which then spreads via hand to mucous membranes of the mouth or nose. It takes only 2-4 days after infection and until symptoms of the disease appear. The bacteria can also spread to the body through skin wounds. There are examples of asymptomatic individuals being able to carry the disease without getting sick.

Symptoms

The symptoms of the disease can vary for individuals. The most common symptoms are a severe sore throat with a grey coat covering the mucous membranes of the mouth and throat and possible difficulty in swallowing and breathing. Add to this enlarged lymph nodes in the neck, hoarse voice and blurred voice, rapid heartbeat, sore nasal mucosa, swollen upper gums, low temperature, double vision and discomfort.

The disease can become severe. A thick film accompanying the infection can lie over the airways and prevent the person from breathing. The bacteria then release a toxin that can be carried by the blood to various organs, including the kidneys, heart, and nervous system, impairing their function or causing permanent damage, even paralysis.
If the diphtheria bacteria penetrates the body through the skin, symptoms are usually milder, but in addition to other symptoms, yellow patches or tenderness of the skin may develop.

Diagnosis

In the beginning, the symptoms of diphtheria resemble severe throat inflammation with heat congestion and swollen lymph glands. But what distinguishes diphtheria from other similar diseases is a toxin that the bacteria releases that form thick grey plates that sit on the nasal, pharyngeal and respiratory membranes and can cause breathing and swallowing problems. The disease can be diagnosed by taking samples from the neck and putting them in culture.

Treatment

It almost always requires hospitalisation of those who become ill with diphtheria and are kept in isolation. When the analysis is available, antibodies are given to the toxic bacteria, as well as penicillin. Other consequences of bacterial toxin release, such as cardiac muscle and kidney, are explicitly treated. The patient may need to be ventilated when the disease is severe. Vaccination of the infected person in their immediate environment is necessary to prevent further spread. Once the patient has recovered from the illness at 4-6 weeks, they need vaccination to prevent them from contracting the disease again later.

Prevention

Vaccination is the only defence against the disease. Diphtheria is very rare today because of its intensity and widespread nature. Vaccination against diphtheria must be repeated every ten years if there is a risk of infection. The chance of transmission may occur when travelling to underdeveloped countries or regions where diphtheria is endemic.

Diseases subject to registration

Diseases subject to registration are those that can spread widely in society and, at the same time, threaten public health. Doctors must notify The Chief Epidemiologist of persons sickened by rubella with the personal identification number of the infected person. Still, reports to the Chief Epidemiologist are also received from laboratories that confirm the diagnosis. The purpose of reporting an infectious disease is to prevent the spread of infection through targeted measures, e.g. isolation, treatment of the infected, and tracking of transmission between individuals. Information about the probable transmission place, transmission time, and symptoms must accompany notifications to satisfy these conditions. In this way, infected persons can be linked epidemiologically, the effects of the infection can be assessed, and a response can be taken.

• Please also look at the information about diphtheria on the European Centre for Disease Prevention and Control (ECDC) website.

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Dengue fever/Dengue hemorrhagic fever/Dengue shock syndrome.
Dengue fever is an endemic disease in the following geographical areas: South and Central America, Africa, the Middle East, Asia, Australia, and the Western Pacific Islands. There are occasional reports of outbreaks in these areas. Rare cases of dengue fever are diagnosed in Nordic countries by travellers returning home after a stay in regions where dengue fever is endemic.

Pathogenic agent

The infectious agent belongs to Flaviviruses, with four known virus serotypes (Dengue 1, 2, 3, and 4). All serotypes can cause hemorrhagic dengue, but serotype 2 is responsible for most cases. Infection with one serotype confers lifelong immunity to the corresponding serotype but does not protect against others.

Transmission routes and incubation periods

Transmission is through the bite of Aedes mosquitoes, either Aedes Egyptpti or Aedes albopictus. The virus is transmitted to the fly when it sucks blood from infected monkeys or humans. Dengue fever is not spread between people. The gestation period is 2–14 days and usually 4–7 days.

Symptoms and complications

The main symptoms of dengue fever are headache, bone and joint pain, and a maculopapular rash that develops after a few days. The disease usually progresses, and the patient recovers. Sometimes, mild fever is the only symptom, and infection may be asymptomatic.

Hemorrhagic dengue is a more severe disease. The main symptoms are high fever, mucosal bleeding, and skin bleeding, often accompanied by an enlarged liver. In extreme cases, hypotension can occur due to the loss of plasma from the tissue. This is a dangerous condition that can lead to death in 40–50% of cases if left untreated. In adequate rehydration, mortality drops to 1–2%.

The clinical picture depends on the age and immune response of the person with the serotype responsible for the infection. A previous infection with one serotype increases the risk of severe symptoms when infected with another. Children and adolescents living in areas endemic to dengue are at the highest risk of severe infections.

Diagnosis

Diagnosis is made by measuring antibodies in a blood sample from the person in question.

Treatment

There is no specific treatment for dengue fever.

Prevention measures

There is no vaccine available against the disease. The risk of transmission can be reduced by protecting itself from mosquito bites. The Aedes mosquitoes that spread the infection both sting by day and night. However, the most likely to bite in the evening should be topped with fertiliser repellent for mosquitoes and worn with long-sleeved shirts and long-sleeved trousers. Fumes can be sprayed in the bedroom, and sleeping under the mosquito net is essential.

• No isolation is required for cases of dengue. The disease is not transmitted between humans.

• Dengue fever is a disease subject to registration.

Diseases subject to registration

Diseases subject to registration are those that can spread widely in society and, at the same time, threaten public health. Doctors must notify The Chief Epidemiologist of persons sickened by dengue fever with the personal identification number of the infected person. Still, reports to the Chief Epidemiologist are also received from laboratories that confirm the diagnosis. The purpose of reporting an infectious disease is to prevent the spread of infection through targeted measures, e.g., isolation, treatment of the infected, and tracking of transmission between individuals. Information about the probable transmission place, transmission time, and symptoms must accompany notifications to satisfy these conditions. In this way, infected persons can be linked epidemiologically, the effects of the infection can be assessed, and a response can be taken.

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Ebola is a viral infection that causes severe illness, resulting in death in about 60% of cases. The virus was first identified in 1976, leading to infection outbreaks in Central and West Africa. The virus causes human and monkey disease, and although the origin of the virus is not fully known, fruit bats are considered asymptomatic carriers of the virus.

Symptoms of Ebola

The initial symptoms of Ebola are similar to symptoms of influenza and malaria: fever, muscle ache, tiredness, headache, and throat pain, but may progress to nausea, vomiting, diarrhoea, stomach ache, a rash with bleeding from the skin, mucous membranes, eyes, nose, gastrointestinal tract, and urinary tract and lead to multi-organ failure.

The incubation period, i.e., the time from infection to illness, can range from 2–21 days, but most people become ill after 4–10 days. During this time, the person is without symptoms and is not infectious.

Modes of transmission

Transmission occurs through contact with body fluids such as blood, sweat, saliva, and urine. Sexual transmission can also occur through unprotected sexual contact and consumption of raw and poorly cooked wild animals or so-called "bush meat". Infection is not carried by air, i.e. it is not transmitted by air or breath. An infected individual first becomes infectious when visibly ill, i.e., develops disease symptoms. At the beginning of the illness, during the first three days after symptoms appear, the infected person is not very infectious.

Diagnosis

In case of suspected Ebola infection in a patient in Iceland, a sample is sent to the high-risk laboratory (Biosafety level 4) in Stockholm. Ebola diagnostic samples are only taken in consultation with infectious disease doctors.

Treatment

There are no approved vaccines or drugs for the disease. Treatment is based on general supportive care.

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Echinococcosis is a disease subject to registration by the Chief Epidemiologist, which includes diseases that may threaten public health.

When a suspicion of echinococcosis arises or such an infection is confirmed, doctors, heads of laboratories, hospital departments, and other health institutions must send information to the Chief Epidemiologist immediately and according to further instructions.

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Enterohemorrhagic E. coli (EHEC) infection is caused by Escherichia coli (E.coli) bacteria, which produces a specific toxin responsible for many of the harmful symptoms of the infection. The types of E. coli bacteria that cause these infections are known as verotoxin-producing E. coli (VTEC) or Shiga toxin-producing E. coli (STEC). They can be divided into STEC 1 and 2, where they carry the genes stx1 and stx2 that produce the toxins that cause the illness. stx1 and stx2 can be identified in subtypes with varying degrees of pathogenic effects, with subtypes 2a, 2c, and 2d, as well as 1a, considered the most pathogenic with the highest probability of Hemolytic Uremic Syndrome (HUS), see explanation under "Complications". In addition, bacteria carrying the eae gene, which increases bacterial adhesion to the intestinal mucosa, are more likely to cause HUS.

Incubation period

The incubation period of the infection, i.e., the time from infection to gastrointestinal symptoms, is generally 2–4 days, with a longer time until symptoms of HUS develop or 1–2 weeks later.

Origins and routes of infections

Ruminants, mainly cattle, are the reservoir for EHEC. Infection is classified as a zoonosis, whereas infections are spread between humans and animals. Food and water contaminate the main channel of infection in humans but also possible direct contact between people, especially among small children. Direct transmission from animals to humans is also well known. In the first half of 2019, it was demonstrated that the EHEC is found in both cattle and sheep in Iceland. In the summer of that year, an extensive group infection occurred, linked to visits to a farm in south Iceland where homemade ice cream could be purchased.

Foodborne infections are often linked to poorly cooked cattle products such as roast beef, burgers, and unpasteurised milk and its products. Infestation with lettuce and cider is also known. In other countries, infections have occurred following swimming trips in lakes and swimming pools with EHEC-contaminated water. A large outbreak in Germany in 2011 was traced to bean sprout seeds from Egypt. More than 4000 people were diagnosed with the infection in that outbreak, over 800 received Hemolytic Uremic Syndrome (HUS), and 54 died.

Symptoms

Symptoms can vary from person to person, and an infected person may be without symptoms. One of the main symptoms is diarrhoea. In some cases, severe abdominal pain and vomiting may occur, and usually, a low fever may not be present. These initial symptoms typically resolve over 5–7 days. Some infected patients develop bloody diarrhoea, sometimes immediately following the first gastrointestinal symptoms and in some cases, diarrhoea may be temporarily stopped for a few days, followed by bloody diarrhoea.

Complications

A severe complication of the EHEC is Hemolytic Uremic Syndrome (HUS), which most often affects children under the age of 10 (6–10%). The main symptoms are kidney failure, hematopoietic anaemia, and low platelet count, which may lead to bleeding. Gastrointestinal symptoms usually start at around 1–2 weeks, rarely later. In many cases, HUS stay in the intensive care unit, and dialysis (blood or abdominal clean-up) is necessary for renal insufficiency. This complication can cause irreversible damage to the kidneys and even death.

Diagnosis

The faecal sample is sent to stx1 and stx2 and its microbiology department for analysis and also to the ease gene. The bacteria quickly disappear from the stool and may be gone when HUS symptoms appear, but genetic testing can be helpful for a longer time, even if culture is not successful.

Treatment

The infection itself goes away quickly, and antibiotic treatment is unnecessary to eliminate the bacteria. In addition, antibiotic treatment can increase the risk of HUS.

Preventive measures

Good hygiene is essential.

• Wash hands with soap and water after using the toilet, after contact with animals, and before handling food.

• Welsh fried lamb and beef, especially if minced, reduces the risk of infection.

• Avoid the consumption of unpasteurised milk and its products.

• It is essential to wash vegetables and fruits thoroughly before consuming them.

• Avoid swallowing untreated surface water in swimming pools, hot tubs, fountains, rivers, streams, and ponds.

• If water contamination with STEC is suspected, transmission by boiling the drinking water for at least one minute can be avoided.

• Washing and peeling raw vegetables and fruits before consumption is desirable.

• No vaccine is available against STEC.

Reaction to individual cases of infection or a cluster infection/a burst of infections

Before subtypes stx1 and stx2 are known, it should be assumed that any STEC infection could lead to HUS, and procedures should be consistent with this. Measures may be reduced when the results of sub-analyses are available, and the strain does not belong to the most pathogenic sub-species. So, until a final diagnosis is made, it is best to follow the following instructions.

• Those with a confirmed infection must not go swimming or to the tub while symptoms are present (especially important for babies in diapers).

• It is necessary to check whether more people have symptoms and take samples from those who have symptoms of STEC infection.

• If a child in daycare is diagnosed with STEC, contact the daycare if the child stayed there in the days before the illness or had symptoms of the infection in the daycare.

• Suppose there is a suspicion of a group infection or a series of infections. In that case, the district/regional doctor in the relevant area should be contacted, for example, if two or more cases are detected.

• STEC is a disease subject to registration by the Chief epidemiologist.

• Those who are diagnosed with STEC and are not in a job with an increased risk of infection or risk should not be at work while they have symptoms. They can return to work when they have been symptom-free for two days. It is necessary to have good hand hygiene in the first weeks after infection and not to prepare food for others until three weeks after symptoms disappear.

Jobs with increased risk of infection or childcare

The following groups, considered to be at increased risk of infection or employed in the care of critically ill patients, may return to work or childcare when they have returned two negative faecal samples. The first sample may be taken three days after symptom relief, and sampling may be repeated 24 hours later.

• Those who work in the production, transport, or preparation of foodstuffs and who are in direct contact with unpackaged foodstuffs.

• Healthcare professionals who are in direct contact with patients who are severely immunocompromised or who are in the neonatal intensive care unit (NICU) or intensive care unit (ICU).

• Children in daycare.

• Healthcare professionals not directly cared for by the above patient groups may come to work once symptom-free for two days. Still, they may only prepare food for patients once they have delivered negative faecal samples, as described above.

Enterohemorrhagic E. coli (EHEC) infection is a disease subject to registration by the Chief Epidemiologist. Diseases subject to registration can threaten public health.

When such an infection is suspected or confirmed, physicians, laboratory directors, hospital wards, and other healthcare facilities must promptly send information to the Chief Epidemiologist for further instructions.

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Various types of coliforms can cause diarrhoea. Coliform bacteria are prevalent, and all individuals have them in their intestines. Some of their strains produce toxins that can cause diarrhoea. They can also cause foodborne infections.

These germs are the most common cause of diarrhoea in tourists in sunny countries and are very difficult to prevent. In particular, raw food of all kinds and contaminated water are blamed.

Travellers should exercise extreme caution regarding diet in countries where diarrhoea is most common. Most of the time, these are relatively mild symptoms but can be painful and last long. In recent years, such infections have been noticed in this country. In some places abroad, there has been a growing number of infections caused by special coliforms (E. coli O157:H7). They form toxins that cause, i.e. severe intestinal bleeding. This pathogen has mainly been transmitted to humans through contaminated meat that is insufficiently cooked or fried.

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Giardia is a protozoan found all over the world. There are many different species of Giardia, but Giardia lamblia is the one that causes infections in humans. Giardia lamblia also lives in animals and has been found in mice, sheep, cattle, dogs, and cats, among other things. This is one of the first intestinal infections children in developing countries are exposed to. The children are then likely to create resistance, and in countries where the disease is common, the infection rate in adults is lower than in children. In the short term, there was almost nothing about indigenous transmission in Iceland, but it seems that Giardia lamblia has now become endemic in Iceland.

The Giardia lamblia life cycle is a two-way, dynamic stage and an endurance envelope. The endothelium is the resting phase of the protozoa, but when it reaches the duodenum, it passes into a mobile stage, which proliferates and causes disease. When the lower intestinal tract becomes unfavourable, the conditions become more complex, taking the form of a tolerance envelope to be restored. The infectious dose is low, and the incubation period, i.e. the period from infection to onset of symptoms, is one to two weeks.

Transmission routes

Water contaminated with Giardia lamblia is one of the most common routes of infection, particularly in the former European Middle and Eastern Early Countries and developing countries. Surface waters are easily contaminated; therefore, infections occur in specific regions of the Western world. Infestations with vegetables that have been transferred to vegetables through contaminated water are also well known. It can also be transmitted directly from person to person, the most common way of transmission of infection in childcare. Direct transmission also occurs among homosexual men.

Symptoms

The main symptoms are diarrhoea with foul-smelling stools, often fatty, flatulence, abdominal pain, nausea, and, in isolated cases, vomiting. The severity of symptoms can vary between individuals, with some infected experiencing no symptoms, others experiencing acute diarrhoea that spontaneously goes on for a few days, and a third group experiencing chronic illness with repeated episodes of diarrhoea and associated risk of malnutrition and weight loss if antibiotic treatment is not administered.

Complications

Malnutrition, growth inhibition, and weight loss are problems in developing countries where the infection is frequent and treatment is inadequate. Some severe disease has occurred in pregnant women and children under the age of 5, resulting in temporary hospitalisation. An infrequent complication is an infection of the gallbladder with pain and jaundice.

Diagnosis

Fecal samples by microscopic examination. Irregular excretion can make analysis difficult, and often, more than one sample should be analysed at intervals of one to two days to obtain a diagnosis. In exceptional cases, if a faecal biopsy is unavailable, duodenal aspiration or biopsy is carried out from the duodenum for analysis.

Treatment

Antibiotic therapy (metronidazole).

Prevention

Good hygiene is essential.

• Wash hands with soap and water after using the toilet, after contact with animals, and before handling food. Wash your hands after changing diapers, even if gloves have been worn.

• Giardia is resistant to chlorine in the concentrations found in swimming pools and, therefore, does not die from conventional chlorine use.

• Avoid swallowing untreated surface water in swimming pools, hot tubs, fountains, rivers, streams, and ponds.

• If water is suspected to be contaminated with giardia, the infection can be avoided by boiling the drinking water for at least one minute.

• Washing and peeling of raw vegetables and fruits before consumption is desirable.

• Responses to individual infections or outbreaks.

• Those with a confirmed infection must not go swimming or to the tub while symptoms are present (especially important for babies in diapers).

• Those with symptoms of giardiasis should be investigated for additional symptoms, and samples should be taken from those with transmission symptoms.

• If a child in daycare is diagnosed with giardia, the daycare shall be contacted if the child resided there in the days before the illness or had symptoms of the infection in the daycare.

• If a cluster infection or outbreak is suspected, contact the district doctor, e.g. if two or more individuals are diagnosed.

• Individuals who have been diagnosed with giardia and are in employment with an increased risk of infection (see below) should not be employed while suffering symptoms. They may return to work after the initiation of treatment and two days after their last symptoms (diarrhoea). Taking a control sample is unnecessary to confirm that the person is free of infection before returning to work.

Jobs with increased risk of infection

• Those who work in the production, transport, or serving of food and who are in direct contact with unpackaged food.

• Healthcare workers who are in direct contact with patients who are severely immunocompromised or who are in the intensive care unit.

Children with a confirmed infection may not be in daycare while they have symptoms. They may return to daycare after starting treatment and two days after the last symptoms (diarrhoea). The child does not need to be tested before returning to daycare. A vaccine against Giardia lamblia is not available.

Giardia infection is a disease subject to registration by the Chief Epidemiologist. When such an infection is suspected or confirmed, directors of laboratories shall send information to the Chief Epidemiologist by further instructions.

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What is gonorrhoea?

Gonorrhoea is a sexually transmitted disease caused by the bacterium Neisseria gonorrhoeae, but the bacterium takes up residence in the genitals, urethra, rectum, or throat.

How is gonorrhoea transmitted?

Transmission occurs during sexual intercourse when an infected mucous membrane comes into contact with the mucous membrane of an infected partner. Transmission can also happen during anal and oral sex. Infection can also occur during birth and cause an eye infection in newborns.

How can I prevent infection?

The condom is the ONLY protection against infection. For it to provide maximum protection, it must be used correctly.

Is gonorrhoea dangerous?

Gonorrhea is a severe disease because it can cause infertility, like chlamydia. This applies to both women and men. Gonorrhea can also cause infection and inflammation in the joints, eye infections, and, in the worst cases, the fallopian tubes in women and the abdominal cavity.

What are the symptoms of gonorrhoea?

The bacterium causes inflammation in the cervix and urethra in women and men. Still, it can also infect the uterus and fallopian tubes in women and the testicles and testicles in men. There are also examples of the bacterium entering the blood and causing infection in the skin and joints. Gonorrhea is a known cause of infertility among women and men.

The symptoms of gonorrhoea are similar to those of chlamydia, but the symptoms and inflammation are often more severe than in chlamydia. Gonorrhea can also be asymptomatic. Common symptoms include changes in the colour and odour of vaginal or urethral discharge, increased urethral discharge, pain when urinating (like peeing razor blades), or pelvic pain, in both women and men. Infection can also occur in the throat and anus.

When do the symptoms appear after infection?

If you develop symptoms, they usually appear 1-7 days after infection but can arise later.

How can gonorrhoea be diagnosed?

Gonorrhea can be confirmed with a urine sample in men who sleep with women. Women return a vaginal swab. Depending on the circumstances, a swab from the urethra, vagina, throat, or rectum is sometimes required. Samples can be taken at all health clinics and Landspítali's dermatology and venereal disease outpatient department.

Treatment of gonorrhea

Antibiotics are used for gonorrhoea. Many strains of gonorrhoea bacteria are resistant to various antibiotics. Therefore, cultures are taken samples to check the sensitivity of the bacteria to antibiotics so that it is possible to ensure that the correct antibiotic has been chosen. You must always have a check-up after treatment to ensure its success.

What about those I have had sex with?

If you have had sex with someone in the last year since infection, there is a high probability that some of them have contracted gonorrhoea. Therefore, you must notify everyone you have had sex with recently so they can receive treatment if needed. This is called infection tracking.
You can let them know yourself or ask the doctor to contact you anonymously. In all cases, however, it is possible to provide information about roommates.
By encouraging those you have had sex with to get tested, you can prevent them from infecting others. This way, you can prevent the spread of this severe disease.

Diseases subject to registration

Diseases subject to registration are those that can spread widely in society and, at the same time, threaten public health. Doctors must notify The Chief Epidemiologist of persons sickened by gonorrhoea with the personal identification number of the infected person. Still, reports to the Chief Epidemiologist are also received from laboratories that confirm the diagnosis. The purpose of reporting an infectious disease is to prevent the spread of infection through targeted measures, e.g. isolation, treatment of the infected, and tracking of transmission between individuals. Information about the probable transmission place, transmission time, and symptoms must accompany notifications to satisfy these conditions. In this way, infected persons can be linked epidemiologically, the effects of the infection can be assessed, and a response can be taken.

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Hemorrhagic fevers are diseases subject to registration by the Chief Epidemiologist. Diseases subject to registration can threaten public health.

When hemorrhagic fever is suspected or confirmed, physicians, laboratory directors, hospital wards, and other healthcare facilities shall promptly send information to the Chief Epidemiologist by further instructions.

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Enterovirus cystic stomatitis with a rash

Epidemiology

A common disease in young children (under 10 years of age) but adults may also be infected. The disease is caused by viruses, usually Coxackievevirus A16, but some other types of enterovirus can cause it. It is common to breed in small migratory waters, especially in the autumn. The disease is usually mild and almost all people recover without treatment in 7–10 days. In rare cases, the virus can cause meningitis.

Symptoms

Symptoms of the disease include fever, mouth ulcers and skin rashes with blisters on the hands and feet. The disease usually starts with a mild increase in temperature, loss of appetite, general weakness, and sore throat. One to two days after the start of the fever, mouth ulcers develop. They start as red spots that develop into blisters followed by ulcers on the tongue, gums, and inside of the cheeks, but are usually most prominent in the pharynx. Skin rashes develop over 1–2 days with red plaques, some with blisters, usually on the palms of the hands and soles of the feet. Rascals may also be affected by the rash. Some people get only a rash in the mouth without a skin rash or only a skin rash without ulcers in the mouth.

The incubation period of infection

The period from infection until symptoms appear is usually 3–7 days.

Transmission routes

The disease can be transmitted from infected individuals through direct contact with nose and throat secretions, blister fluids, and feces. The virus may be excreted in the feces for several weeks after the symptoms have stopped. The spread of the disease cannot be prevented.

Treatment

There is no specific treatment for the virus, but the disease is cured spontaneously over days.

Infection prevention

• Careful and frequent hand washing reduces the risk of infection substantially, especially after changing diapers in children.

• Hygiene in the environment of infected patients should be carefully observed by careful cleaning of contact surfaces, use of clean soapy water, and possibly chlorine mixtures in case of spillage of infective agents (e.g. feces) into the environment.

The decision to stay at home depends on the general feelings of the child; if the child is at least healthy, it need not be excluded from other children. Some of those children who become infected do not develop any symptoms, and keeping children with symptoms away from asymptomatic children does not eliminate the risk of transmission.

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Head lice are a tiny insect that has adapted to man and lives a parasitic life in the hair of a human on its head and feeding on sucking blood from its scalp. It is considered to bear no diseases and, therefore, harmless to the host. All can be infected, but confirmed infection is most common in children 3–12 years old. Head lice infection is not considered a witness to uncleanliness.

• Those diagnosed with head lice or guardians must respond to the infection immediately, using the recommended methods, to prevent the spread to others.

• Since 1999, head lice have been a notifiable disease, and health centres and school nurses collect information on lice infections and send them to the Chief Epidemiologist once a month. The public is asked to report lice infection to their clinic.

The life cycle
Adult head lice are 2–3 millimetres in size (similar to sesame seeds), greyish white or light brown. Its life cycle begins in an egg called a nit. In six to ten days, a tiny nymph hatches from the nit, which in 9-12 days develops into an adult male or female louse. Within 24 hours from copulation, which takes place once, the female louse begins to lay and attach nits to hair and can lay up to ten eggs per day.

The lice have six legs and specially designed claws to get around in their hair and can crawl 6–30 cm per minute. Lice cannot fly, jump or swim. The lifespan of female and male head lice is up to 30 days, but if they fall from the hair to the surroundings further away from the warm, moist, and bloody scalp, they will wash up and die in 15–20 hours.

Nit - the eggs of lice
The louse's eggs are called nits and can lay up to ten eggs daily. The louse 'sticks' them to head hair using a particular substance it produces, about 1cm from the scalp, but for them to hatch, the temperature must be about 22°C.

The nit is 0.8 mm long, can be seen with the human eye, and can look like dandruff, but unlike dandruff, it is stuck in the hair. Once hatched, empty egg capsules remain in the hair, and it may be difficult to see if they are full or empty, but if they are far from the scalp, they are likely to be empty, or the lice in them are dead. Nits are most commonly found in the hair above the ears and at the hairline at the back of the head.

The presence of nit in the hair does not necessarily indicate the presence of lice.

Ways of transmission
Lice can spread between heads if there is direct hair-to-hair contact long enough for them to crawl between, but they cannot jump, fly or swim.

Head lice dropped into an environment will immediately become damaged and weak and, therefore, cannot crawl on another head and settle there. Consequently, transmission via clothing and intra-cellular components is considered highly unlikely. However, it cannot be excluded that combs, brushes, hats, and the like, used by more than one person within a short period, may be possible transmission sources.

Symptoms of infection
Two in three people infected with head lice have no symptoms. One in three people gets itching. Itching is an allergy that develops over time (from a few weeks to three months) against the louse's saliva. It spits on the scalp when it sucks blood. It can become severe, and skin redness and swelling can occur when the person scratches. In some cases, ulcers that can become infected with bacteria can occur.

Analysis

• Looking for lice in the head hair with a careful examination is best done with a comb with a piece of lumber over a white surface or mirror and good light.

• Many people find it more convenient to comb wet hair, which contains hair conditioner, while others find it more comfortable to comb their hair dry.

• If a louse is found, even just one, it is a sign that the person has head lice and requires treatment. The treatment can consist of combing (once daily for 14 days) or treatment with anti-lute preparations.

• Nit looks like a bottle in a hurry, but unlike a bottle, it is attached to the hair and is preferred to be found above the ears and at the hairline at the back of the neck.

The lice comb
It is important to use a good lice comb. The gap between the rails must not be more than 0–3 mm. It is best to use combs with rigid rails.

Combing in search of head lice in wet hair

• Wash hair using the normal method, rinse, and apply normal hair conditioner which is kept in the hair and the hair is wet.

• Comb out all tangles - hair is still wet.

• Divide the hair up into smaller areas to facilitate the examination of all the hair.

• Switch from comb/brush to a lice comb and have a white sheet or a mirror under it to make it easier to see if lice fall from the hair.

• Pull the comb from the scalp to the ends of the hair and repeat until the hair has been thoroughly combed.

• After each combing, check if lice have entered the comb and wipe with a tissue before the next combing.

• Nit of the lice, which resembles dandruff, is often found above the ears and at the hairline at the back of the neck. Nit is not a clear sign of infection, especially if it is far from the scalp, as the lice in it are probably dead.

• After combing the hair, rinse out the conditioner.

• Comb again to see if any lice have remained.

• If lice are found during combing, the conditioner should be washed and the hair dried before treatment with lice medicine is started.

• Clean the comb with warm, soapy water and dry it.

Treatment of head lice

• To detect head lice in the hair, comb the hair with a good louse comb.

• Only those who have live lice in their hair should be treated with lice medicine.

Head lice removal with 'natural' chemicals

• Research has shown that herbal extracts and various old house advice (such as putting udder ointments or vaseline in the hair, mayonnaise, olive oil, vegetable oil, etc.) do not kill head lice, although some benefits have been found with tea tree oil.

• The use of aromatics in the fight against head lice cannot be recommended and is likely to do no good - no studies support the use of such chemicals.

• Never put flammable and toxic substances in your hair, such as gasoline or kerosene, or substances intended for use on animals.

• If the treatment is not successful, it is most likely that it was not carried out properly, such as that the correct material was not used, that not enough material was used, that the material was not kept in the hair long enough or that there will be re-infection from infected persons in the environment such as family members or close friends.

Cleaning the environment
There is no need for special environmental cleaning to control head lice infestation. Head lice in the environment have little potential when they are not in the warmth of scalp hair and have access to human blood. They die within 15–20 hours, within a day.

If it is considered necessary, for example where there is a shared comb or brush, it is correct to wash such utensils with hot soapy water or pour hot water over them and let them stand for a few minutes.

See also Liceworld

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Infections in connection with health services are notifiable diseases to the Chief Epidemiologist, but they are considered diseases that may threaten public health.

When infections are suspected in connection with the provision of health services or such an infection is confirmed, doctors, heads of laboratories, medical wards, and other health institutions must send information to the Chief Epidemiologist without delay and according to further instructions of an epidemiologist.

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Haemophilus influenzae is a group of bacteria that are classified according to their type. Haemophilus influenzae b or Hib can cause severe conditions such as meningitis, tracheitis, pneumonia, sepsis, and arthritis, as well as other mild infections that may persist, including upper respiratory, sinus, and ear infections. The most severe infections due to the bacteria are tracheitis, blood infections, and meningitis, which can be life-threatening, and this is the type of infection mainly discussed here.

Epidemiolog

Hib was the most common cause of bacterial meningitis in children from two months to five years of age. About 10% of those who developed Hib meningitis died. Vaccination against this bacteria has been very effective. Since the vaccination against Hib began in Iceland in 1989, no cases of meningitis or other serious bacterial infections have been reported. Still, before that time, approximately ten children per year were diagnosed with meningitis. Children who have not been vaccinated are at particular risk, especially if they are of preschool age. Adults can also become infected with the bacteria.

Transmission and incubation periods

Haemophilus influenzae bacteria are most often transmitted by respiratory droplets (e.g. coughs and sneezing), and persons who carry the bacteria can still pass the virus on to others despite not having symptoms.

Symptoms

The symptoms of Hib meningitis are similar to those of other bacterial or viral meningitis. The main symptoms can be fever, headache, photophobia, stiff neck, joint pain, vomiting, reduced level of consciousness, seizures, agitation in young children, and refusal of food. Hib-associated blood infections can occur at all ages. Tracheitis is most common in the age group 5–10 years.

Diagnosis

Diagnosing Haemophilus influenzae B infection early is essential so treatment can start as soon as possible. Samples from the site of infection identify the bacteria.

Treatment

The primary treatment for Haemophilus influenza B is antibiotics. Other treatments look at rest, fluid intake, and nutrition.

Prevention

A vaccine against Haemophilus influenza b has been in use since the 1980s. The vaccine is part of a vaccine against pertussis, diphtheria, tetanus, and poliomyelitis (given as a single injection). Children are vaccinated at 3, 5, and 12 months of age, and the vaccination coverage offers about 95% protection. The participation in vaccination against these diseases in Iceland has been decent in recent years, at 95%. Parents are encouraged to continue good participation in vaccinations because this is the only way to keep this severe infectious disease out of the country. Individuals exposed to infection can be given appropriate antibiotics as a preventative measure.

Diseases subject to registration

Diseases subject to registration are those that can spread widely in society and, at the same time, threaten public health. Doctors must notify the chief epidemiologist of persons infected by Haemophilus influenzae B with the personal identification number of the infected person. Still, reports to the chief epidemiologist are also received from laboratories that confirm the diagnosis. The purpose of reporting an infectious disease is to prevent the spread of infection through targeted measures, e.g. isolation, treatment of the infected, and tracking of transmission between individuals. Information about the probable transmission place, transmission time, and symptoms must accompany notifications to satisfy these conditions. In this way, infected persons can be linked epidemiologically, the effects of the infection can be assessed, and a response can be taken.

See more on ECDC's website.

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Hepatitis A is a disease caused by a virus (hepatitis A virus). It is endemic to Africa, South America, and most of Asia.

Hepatitis A is a rare disease in Iceland, and the cases are usually due to an infection that the person is exposed to abroad.

Routes of transmission

The main route of transmission is fecal-oral transmission, either directly or indirectly. The virus is excreted in the faeces of infected and contagious individuals who are contagious from two weeks before symptoms appear until one week after the onset of symptoms.

The virus lives for a long time in water and can, e.g. reproduce in oysters and mussels. The virus can also be transmitted by other foods that have either been contaminated by an infectious person or by contaminated water. The infection can also be transmitted directly between people during close contact, e.g. between those who live in the same household, in daycare for children, or during sexual intercourse.

Symptoms

Initially, the preceding symptoms of jaundice predominate with flu-like symptoms, upper abdominal discomfort, loss of appetite and nausea, fever up to 39°C, and occasional muscle and joint pain. A few days later, yellowing and darkening of the urine and faeces may occur. Jaundice and itching can last for weeks or months. Not everyone infected develops symptoms, but most people feel tired and have little appetite for weeks or months. Children get symptoms less often than adults, and most children under six are asymptomatic, but they can easily pass the infection on. Hepatitis A always resolves, i.e. the infection never becomes chronic.

The gestation period of hepatitis A, i.e. the time from infection to the onset of symptoms, is usually around four weeks but can be anywhere from two to six weeks.

Analysis

Hepatitis A is diagnosed by measuring antibodies in the blood. Results are available within a few days of taking the test.

Treatment

Hepatitis A resolves spontaneously without any treatment.

Prevention

Great care should be taken when choosing food and water in countries lacking sanitation. Hepatitis A can be prevented by vaccination or injecting antibodies into the muscle. The antibodies protect for only 2-3 months. The vaccine is given in two injections 6–12 months apart to persons one year of age and older, and it is believed to protect for at least 20 years. When an infection is known, the person should remember that good hand washing after using the toilet and before handling food is the most effective protection against infecting others.

Diseases subject to registration

Diseases subject to registration are those that can spread widely in society and, at the same time, threaten public health. Doctors must notify The Chief Epidemiologist of persons sickened by hepatitis A with the personal identification number of the infected person. Still, reports to the Chief Epidemiologist are also received from laboratories that confirm the diagnosis. The purpose of reporting an infectious disease is to prevent the spread of infection through targeted measures, e.g., isolation, treatment of the infected, and tracking of transmission between individuals. To satisfy these conditions, information about the probable transmission place, transmission time, and symptoms must accompany notifications. In this way, infected persons can be linked epidemiologically, the effects of the infection can be assessed, and a response can be taken.

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Hepatitis B is common in many parts of the world. The virus is transmitted between people through close contact (sexual intercourse, from mother to child during childbirth, or even if an infected person bites another) or through needle injuries, blood transfusions if the blood is not screened for the virus, and similar situations.

What is Hepatitis B?

Hepatitis B means inflammation of the liver caused by the Hepatitis B virus, which is one of many viruses that can cause liver inflammation. The first symptoms of the infection are due to acute hepatitis, which resolves over time, but not everyone develops symptoms. Some infected individuals develop chronic hepatitis, especially if the infection occurs in childhood.

How is Hepatitis B transmitted?

The virus is found in body fluids such as blood, semen, and vaginal fluids/mucus, even before symptoms appear and in asymptomatic individuals. During sexual intercourse, the virus is transmitted through these body fluids via the genitals, mouth, and rectum. The virus can also spread through blood contamination and needle sharing. A child can become infected during childbirth if the mother is infectious.

How can I prevent transmission?

Vaccination against Hepatitis B is an effective way to prevent infection. Hepatitis B vaccination is not part of the routine childhood vaccination schedule in this country, but it can be received at health clinics, hospitals, and places offering travel vaccinations.

Two doses with a minimum of 4 weeks apart are needed for short-term protection (up to 18 months), and a third dose is required 6-12 months after the first dose for long-term protection. No booster shots are needed after completing the recommended 3-dose series.

Correct use of condoms can prevent transmission. People who use injectable drugs should avoid sharing syringes or needles with others.

Is Hepatitis B dangerous?

Acute Hepatitis B can, in rare cases, lead to death. Chronic Hepatitis B can be severe and life-threatening. It may develop into cirrhosis of the liver and liver cancer.

What are the symptoms of Hepatitis B?

Acute Hepatitis B often causes abdominal pain and jaundice (yellowing of the skin). Nausea, fever, and fatigue are also common, along with dark urine and light-colored stools. Some people may also experience joint pain. Hepatitis can also be completely asymptomatic.

When do symptoms appear after exposure?

Symptoms of acute Hepatitis B usually appear 2 to 3 months after exposure.

How is Hepatitis B diagnosed?

Hepatitis B is diagnosed with a blood test, which can be done by any doctor, and the results are typically available within a few days.

Is there treatment for Hepatitis B?

Treatment is available for acute Hepatitis B but is only used in severe cases. Individuals who contract the virus as adults often recover from the infection, while children often develop chronic infections. If Hepatitis B develops into chronic hepatitis, treatment may be available in some cases.

Preventive treatment is available through vaccination, and individuals at risk but not yet infected can be vaccinated. It is recommended that newborns receive the vaccine immediately after birth if their mother has a chronic infection.

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Hepatitis C is an inflammatory liver disease caused by an infectious virus called Hepatitis C. The virus is one of several known to attack and cause inflammation in the liver. Other viruses known to cause hepatitis include hepatitis viruses A and B. Individuals can be reinfected with hepatitis C. In Iceland, close to two thousand people have been diagnosed with hepatitis C.

How is hepatitis C transmitted?

Hepatitis C is primarily transmitted by mixing blood. The most common way of transmission is when infected blood passes from one person to another. The most common transmission is when drug users share dirty syringes and other equipment and waste materials that have been contaminated with infected blood. People can get infected if the utmost hygiene is not observed when tattooing and piercing. Infection can occur through a needlestick accident (sticking yourself with a needle from an infected person). Before 1992, infections occurred during blood donations, but since then, all blood has been screened, and the chance of infection is limited. The virus can be transmitted between people during sexual intercourse, but this is considered rare (less than 5%). It is also rare for the virus to pass from an infected mother to the fetus (about a 5% chance). In some people, no obvious risk factors for the disease can be found.

Hepatitis C is not transmitted through sexual intercourse and contact between people, including kissing. Hepatitis C is not transmitted by food containers, cooking, or eating together. Not contagious in swimming pools or during breastfeeding. You can do all the routine work that requires human interaction, such as caring for children and the sick.

How can I prevent infection?

People who use intravenous drugs should be careful not to share syringes or needles with others. Correct use of condoms can prevent infection.

Is hepatitis C a severe disease?

Most people who become infected with the virus develop chronic hepatitis. Often, the inflammation is mild and asymptomatic for years or decades. When hepatitis C persists, it can be severe and life-threatening. It can then develop into cirrhosis, liver failure, and liver cancer. Although most people do not feel acute hepatitis, some people get sick from it but then fully recover in a few weeks or months. However, this is an exception.

Symptoms

Jaundice (yellow skin), fever, loss of appetite, fatigue, itching, nausea, vomiting, abdominal pain, diarrhoea, dark urine, and joint pain. Most people have no symptoms, no idea that they are infected, and the disease is discovered by chance, usually during blood tests. Symptoms often do not appear until many years or decades later, when cirrhosis and liver failure have already occurred.

Analysis

The disease is diagnosed with a blood test that can be taken at any doctor's office. It is checked whether the virus itself or antibodies against it are present. Inflammation of the liver causes an increase in the blood of the so-called liver tests (AST, ALAT). These tests are used to assess how much inflammation the virus is causing.

Treatment

There is a drug treatment for hepatitis C that can lead to recovery in 80-95% of cases. It is recommended that those infected are vaccinated against hepatitis A and B. Alcohol consumption can cause the disease to worsen. There is no vaccine against the virus. Hepatitis C can be re-infected (re-infected).

Monitoring and drug treatment for hepatitis C are carried out at the Outpatient Department of Infectious Diseases A-3 at Landspítali.

Recommendations for patients with hepatitis C

There are several things you can do to reduce liver damage caused by the virus and to reduce the chance of infecting others:

• Avoid alcohol.

• Eat varied and healthy food.

• Get vaccinated against hepatitis A and B.

• Do not take medicine except in consultation with a doctor. Even over-the-counter medications can be harmful to those with liver disease.

• Drug users (intravenous) should be careful never to share syringes or needles with others.

• Being responsible for sex and using a condom correctly can prevent infection.
  
  In the case of a recent injection accident, you should follow the instructions of Landspítali's infection control department for healthcare workers or the Chief Epidemiologist's instructions regarding injection accidents in the community.
  
  Information about liver diseases and related issues can be found on the Liver Disease Association website.
  
  You can also seek advice on hepatitis C from the nurses at the Outpatient Department of Infectious Diseases A-3 Fossvogur Tel. +354 824 5857, Email: smita3@landspitali.is

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Hepatitis D and E are diseases subject to registration by the Chief Epidemiologist, but they are considered diseases that may threaten public health.

When such an infection is suspected or confirmed, doctors, heads of laboratories, hospital departments, and other health institutions must send information to the Chief Epidemiologist without delay and by further instructions.

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Genital herpes is an infection caused by the virus Herpes simplex, type 2, which causes small blisters and sores on the genitals. The virus spreads from the skin infection and settles in a ganglion near the spinal cord. It can lie dormant there for years, usually harmless to the infected person. However, the virus can travel back along the nerve to the skin or mucous membrane, usually to the same place it started. It can often take a long time for the infection to reappear. The symptoms diminish and typically disappear entirely over time. Genital herpes is a common disease.

How is genital herpes transmitted?

Genital herpes is found in infected wounds and wound fluids. The virus is mainly transmitted when a wound or wound fluid touches the mucous membrane of the partner's genitals, anus, eyes, lips, or mouth.

Infection can also occur if a person gets infected with wound fluid on their hands and then touches their mucous membranes or the mucous membranes of others.

Prevent infection

The condom can only protect the parts of the genitals it covers. A virus in a wound that is not covered by a condom can, therefore, be transmitted during intercourse. The transmission rate is highest when the disease has visible blisters and sores and just before the blisters appear. You should, therefore, not have intercourse when your condition is like that. The risk of infection is lower when there are no blisters or sores on the skin or mucous membranes.

Good hand washing when sores and blisters appear can prevent you from infecting others with your hands.

Is genital herpes dangerous?

Genital herpes can be painful, especially at the beginning of the infection, and can cause considerable discomfort. It is still harmless to the woman, but the virus can cause severe infections in newborn babies whom the mother can infect during childbirth. Therefore, pregnant women need to inform their doctor about a genital tract infection.

Symptoms

The first symptoms are burning, or pain in the skin or mucous membrane, but then cysts of different sizes appear. The cysts often burst quickly and become painful sores. At the same time, there is often soreness in the groin due to enlarged lymph nodes if the infection is in the genitals. In addition, the infection can cause fever, headache, weakness, and, in exceptional cases, meningitis.

The first time blisters and sores form, they usually heal within three weeks. When re-infection occurs, the sores usually appear in the same place as before but are milder, less painful, and usually heal faster.

When do the symptoms appear after infection?

Symptoms usually appear one to three weeks after infection. Some people get the symptoms later, and it can take a long time to appear. Most people who get infected never actually get sores and cysts, and many people never know that they are infected with genital warts.

Analysis

Genital herpes is easy to diagnose if the symptoms are present, with a doctor's examination and taking a sample for research.

Treatment

There is still no cure for genital herpes. On the other hand, some treatments can reduce symptoms and shorten the time you have blisters and sores. For the treatment to work, it must be started as soon as possible. You do not need treatment if the sores are not bothering you.

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Herpes zoster is a disease seen after infection with chickenpox (Varicella Zoster/Herpes Zoster Virus; HZV, below) that occurs years to decades earlier. The virus is related to cold sores (Herpes Simplex viruses) and, like those, becomes permanently lodged in nervous tissue once chickenpox has gone on. The body's immune system keeps the virus at bay, but shingles can appear when the immune system is not fully able to control it.

Epidemiology
All individuals who have had chickenpox can develop HZV, but about one-third are considered to create HZV that have had chickenpox if they are not vaccinated. Almost all adults who grew up in Iceland are at some risk of developing HZV because of the high prevalence of varicella and the high prevalence of varicella. The risk of colon increases with age during periods of immune deficiency. Still, it may occur in childhood or younger adults, e.g. following immunosuppressive therapy, from steroidal uraemic asthma to cancer therapy or immunosuppressive therapy to prevent organ transplant rejection. Stress, various illnesses, and so on can also interfere with the function of the immune system, and HZV can manifest in otherwise healthy people.

Symptoms
In most cases, HZV appears where one nerve is infested (the area of the otic nerve), for example, in a semicircle around the chest from the back to the chest. The disease first appears as a skin discomfort, often numb or burning sensation, before the onset of a rash. Then, a rash develops into pimples or blisters that break and heal. New acne can appear 5–7 days after the first, and healing usually takes 2–4 weeks. The wallet from the cysts is infectious, and individuals who are not immune to varicella virus can receive varicella jab 2–3 weeks after contact with the herpes zoster virus. Therefore, people with HZV should cover the rash with an impermeable dressing while it is drying to prevent transmission to children and others. HZV is highly infectious in the air if it eases from the rash. Therefore, individuals susceptible to varicella virus should not apply the rash, come into close contact with it, or be in contact with virus-contaminated linen and the like.

Treatment
HZV can be treated with antivirals with activity against HZV, such as valaciclovir. It would be best if you took the medicines by mouth. The dose and duration of treatment are not the same as for cold sores; packages sold separately cannot be used to complete the treatment. A doctor's advice and prescription should be sought, e.g. in primary healthcare. Treatment is recommended for all patients with HZV in the presence of the eye, older adults, and those with immunodeficiency syndromes to reduce the risk of complications. A dose adjustment is needed for people with renal impairment. Treatment should preferably start within 72 hours of the onset of the rash to have the desired effect on preventing complications.

Complications of the disease
HZV-associated pain can be severe and is one of the most common causes of HZV inpatient inpatients.

The main complications are prolonged nerve pain (for more than three months) in the area of the large bowel (postherpetic neuralgia, PHN) and blindness if HZV appears in the eye. Individuals with impaired immune function may develop extensive herpes zoster, similar to varicella disease, with the associated complications that are likely to occur with varicella-associated immunocompromised diseases, such as hepatitis, pneumonia, and meningitis/encephalitis. Systemic herpes zoster is a life-threatening disease.

As with chickenpox, infections of the wounds are common due to bacteria, usually skin bacteria such as Staphylococcus aureus or group A streptococci. To reduce the risk of infection, it is best to leave the rash alone and let go of fertilisers, except in consultation with your doctor. Packaging may reduce unconscious contact with the rash. If you need to change the dressing or apply the rash, you must do so with clean hands or disposable gloves.

A less common but recognised complication is chronic neuropathy, even paralysis, of motor neurons.

Repeated herpes zoster is a well-known problem and is most likely to repeatedly appear in the same place. Therefore, people with herpes zoster in the eye or the brain must receive appropriate advice on managing symptoms if they develop new symptoms and preventive treatment.

HZV prevention
Vaccination against varicella in childhood reduces the risk of developing HZV later in life and has been offered to all children born in 2019 or later.

Vaccination against HZV has been possible for decades, but the first vaccine was live and undesirable for the immunosuppressed. A newer vaccine that can be used for immunosuppressants has been on the European market for several years and can be ordered from the marketing authorisation holder here through the primary healthcare setting. It is relatively expensive, and the cost falls on the individual. The Chief Epidemiologist is preparing (Dec. 2023) to issue guidelines on its use in connection with a Nordic project on the most efficient vaccine use.

Herpes zoster is a disease subject to registration by the Chief Epidemiologist, as it is a public health threat to diseases.

When herpes zoster is suspected or confirmed, doctors, directors of laboratories, hospital wards, and other healthcare facilities must send the Chief Epidemiologist information, but only if the patient is hospitalised.

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Is HIV transmitted in daily contact?

HIV is not transmitted through daily contact. It is, therefore, completely safe to live in the same household or be in daily contact with a person who is infected with HIV/AIDS.

How can I prevent infection?

The condom is the ONLY protection against infection. For it to provide maximum protection, it must be used correctly. People with an addiction should be careful never to share needles with others.

Is HIV a dangerous disease?

HIV is a severe and life-threatening disease; the disease progresses without treatment. There is no cure for it, and there is none in sight.

What are the symptoms of HIV?

Some newly infected people develop symptoms a few days or weeks after infection. The main symptoms are general weakness, sore throat, enlarged lymph nodes, rash, headache and muscle and joint pain, which usually resolve within 1–2 weeks. After that, most people are asymptomatic for many years, but the virus gradually works on the body's defences and damages the immune system.

What is AIDS?

AIDS is the final stage of the disease, and the word refers to the diseases and symptoms that HIV-positive people get when the immune system begins to fail. This usually happens many years after infection. When people have AIDS, they get diseases that uninfected people rarely get, as their immune systems have lost the ability to fight disease. A person who has AIDS usually dies within a few years without medication, but it improves the prognosis significantly.

How can HIV/AIDS be diagnosed?

HIV infection is diagnosed with a blood test that any doctor can take. The blood test is free and confidential. When HIV enters the blood, the body develops antibodies that can be detected with an HIV antibody test up to three months after infection. A positive HIV test means that antibodies against HIV have been found in your blood and that you are therefore HIV infected. A negative HIV test, on the other hand, means that you are not infected with HIV. HIV test results are available a few days after the blood test.

Can HIV/AIDS be treated?

Daily intake of HIV drugs for the rest of your life can reduce the multiplication of the virus in the body and thereby improve the well-being and prolong the life of HIV-positive people. Side effects may accompany the medication.

What about the ones I've slept with?

If you have slept with someone since you were infected, one of them may have been infected with HIV. It is, therefore, important that previous roommates are informed. You can inform them yourself or ask the doctor to write anonymously. In all cases, however, it is mandatory to provide information about roommates. By encouraging those you have slept with to get tested, you can prevent them from infecting those they sleep with in the future. This way, you can prevent the spread of this severe disease.

HIV is a disease subject to registration by the Chief Epidemiologist, as it is a threat to public health.

When HIV infection is suspected or confirmed, doctors, directors of laboratories, hospital wards, and other healthcare facilities must send the Chief Epidemiologist information without delay and by further instructions.

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HPV and vaccination against HPV infections and cervical cancer

The Human Papilloma Virus (HPV) is the primary cause of premalignant cervical lesions and cancers. The virus is widespread, and it is estimated that around 80% of women become infected at some point in their lives. The virus is sexually transmitted and is mainly common in sexually active young people.

HPV has more than 100 subtypes. Approximately 40 of these can cause genital infections in both men and women, of which 15–17 are strains associated with cancer (high-risk strains). Infection with high-risk strains of HPV can lead to premalignant cervical disease and cervical cancer. These same species can also cause infections in other organs that can progress to cancer, such as the rectum, vagina, and external genitals of both women and men. Still, the virus can also cause cancer of the oral cavity, throat, and bronchi and can be transmitted through oral sex. HPV of other types (low-risk strains) may cause, for example, genital mutilation.

Epidemiology

Cervical cancer is the second most common cancer in women worldwide. About 1700 women with premalignant cervical lesions are diagnosed each year in Iceland, and 15-20 women with cervical cancer. The average age of women with pre-cancerous lesions is around 30 years, and women with cervical cancer are about 45 years, with 80% of the latter surviving for five years or more from diagnosis.

The incidence of HPV in other cancers in Iceland is not as well known but has been increasing in Iceland and many parts of the world in recent decades. It has been confirmed that HPV 16 is the most common type of virus in pharyngeal cancers. HPV is estimated to contribute to the development of 5% of all cancers worldwide.

Symptoms

Infections caused by the virus can be persistent, but in most cases, the body's immune system destroys them within a few months without any consequences. If an infection becomes established and persists, the risk of pre-cancerous changes and subsequent cancer increases if nothing is done.

Premature cervical lesions do not cause noticeable symptoms of infection, but if the lesions progress to cancer, symptoms are:

• Vaginal bleeding after sex

• Abnormal vaginal discharge

• Genital pain

These symptoms are not just limited to cervical cancer. Infections from other causes can cause the same kind of symptoms. If you notice these symptoms, you must seek medical attention, even though the last cervical smear may have been as expected.

HPV-related cancers, such as those of the rectum, oropharynx, or external genitals, may present as rounds or thicknesses and may cause pain and bleeding.

Treatment

There is no treatment for HPV infections,  but precancerous changes can be detected with a smear from the cervix. If the precursor changes are mild, their development is monitored, and the body's immune system works on the infection. This is done by regular medical check-ups, which take a cell roar from the cervix, which is sent to the Cancer Society's cell laboratory for further examination of cell changes under a microscope and for a specific search for HPV.

Severe and persistent premalignant changes are treated with cone cutting, but if cancer has already developed, three primary methods are used, i.e. surgery, radiation, and chemotherapy.

The vaccine

In Iceland, two vaccines have been used against the types of HPV that mainly cause cervical cancer. The vaccines are Cervarix and Gardasil 9. The latter vaccine contains antigens against the types of virus (HPV-6/11) that cause genital warts.

The vaccine Cervarix contains antigens HPV-16 and HPV-18, which are by far the most common high-risk strains of the HPV virus. In addition, the vaccine has shown significant cross-immunity against type 31/33/45, which can also cause cancer. Cervarix was used in general vaccinations for girls in 2011–2023. Gardasil 9 also contains antigen HPV-16/18 and antigen high-risk strains 31/33/45/52/58. It is now used regardless of gender for all 12-year-olds. The HPV vaccines do not protect against all strains of the virus that can cause cervical cancer, but vaccination can prevent the majority of cancer cases. The duration of the vaccine's effects cannot be certain, but all indications are that this period is many years, possibly lifelong.

Vaccination

With parliament's approval at the end of 2010, health authorities began vaccinations against the HPV in the autumn of 2011. Girls born in 1998 and 1999 were the first to be vaccinated, but in the beginning, the vaccination only applied to 12-year-old girls to prevent the development of cervical cancer. From 2023, the vaccination covers all 12-year-olds, regardless of gender, making the HPV vaccination part of the general vaccination scheme for all children.

Vaccination is primarily preventive but does not cure diseases caused by HPV infection. The vaccine is given in two injections at least six months apart. A single dose provides considerable protection, and vaccinations in some countries are now targeted at one dose. In Iceland, information on the benefits of vaccination to reduce the spread of HPV infections is still emerging, and it has not been considered timely to reduce the dose from two to one.

Older individuals have the option to receive the vaccine by prescription and by paying for it.

Since vaccination does not provide complete protection against oncogenic HPV, women need to have regular cervical cancer screening with cervical smears for diagnosis of premalignant lesions or early cancer. Broader spectrum vaccines and more widespread vaccinations globally will potentially reduce the usefulness of screening in the future. However, screening is still essential in preventing cancer development, while HPV is still widespread in the community.

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Impetigo is an infection of the outermost layers of the skin, which in most cases is caused by group A streptococci. In about a third of cases, Staphylococcus aureus (cocci) can be found alone or with streptococci. Staphylococci and streptococci can also be in the throat and on unbroken skin without causing any symptoms. The infection usually takes hold after a minor skin break.

Symptoms

Impetigo usually starts as tiny blisters that break easily and form a yellowish crust that sticks. The rash is most common on the face and hands. Many small blisters may occasionally merge, and a large area covered with a yellowish scab may form. Often, it is accompanied by itching, and the infection can spread if the person scratches. There is no pain in the area of infection, and general symptoms are minimal or absent. The infection resolves without scarring.

Routes of transmission

Impetigo is easily infected, and transmission within families and in child care is a well-known problem. The bacteria gets on the fingers when the outbreaks are over and spread through the hands to others. Infection can also be spread through objects, such as toys and towels.

Analysis

Diagnosis is obtained in most cases during the examination. Cultures can be taken from the rash and thus provide knowledge of which bacteria are causing the infection and information about antibiotic sensitivity.

Treatment

Often, there is no need for antibiotic treatment, but it is enough to wash with soap and water, soften the scab and gently remove it. If that treatment is not enough, you can use a germicidal cream (Fucidin or Topicin), but resistance to the drugs is well known. If impetigo is widespread, antibiotic treatment with tablets or oral solution may be necessary.

Prevention

There is no vaccine against Impetigo.
The best prevention is hygiene and good hand washing.

Procedures for group infections in children's daycare

Good hand washing together with own towels for everyone, employees and children, or disposable paper towels is a significant factor in stopping the spread of the infection. It is also essential to cut the children's nails.

In case of a widespread infection, parents are advised to keep the child out of daycare until the scab has fallen off and the area is dry. If the child has received antibiotics (cream or oral), the child can come 24 hours after the first antibiotic dose has passed. If there are only isolated blisters in a small area, covering them with a bandage may be sufficient so the child cannot put his fingers in the rash.

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Each winter, influenza sweeps through the northern hemisphere from October to March, taking 2–3 months to complete the season. A similar outbreak then occurs in the southern hemisphere between June and October. In a severe epidemic, the healthcare system is under increased pressure, and in the community, there is a noticeable increase in absence due to illness, work, and school.

Annual influenza is most severe in the older generation and individuals with underlying diseases, with increased numbers of deaths following influenza due to its serious complications. For most people, however, the flu is an unpleasant illness that lasts a few days without serious consequences.

The flu symptoms usually develop suddenly with a high fever, shivering, headache, bone pain, dry cough, and sore throat.

The flu can be prevented by an annual vaccination, providing approximately 60–90% protection from infection. It is possible to develop influenza despite vaccination, but vaccination reduces severe complications of the infection and mortality among those vaccinated.

Therefore, the Chief Epidemiologist recommends that high-risk groups be given priority in flu vaccination and receive vaccination free of charge.

Influenza is a disease subject to registration by the Chief Epidemiologist. When such an infection is suspected or confirmed, directors of laboratories shall send information to the Chief Epidemiologist by further instructions.

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An infection caused by Legionella pneumophila was first diagnosed after a convention of American veterans held at a hotel in Philadelphia in 1976. More than 200 people became ill, and many died. During the autopsy, the bacterium was found in a lung sample and named Legionella pneumophila.

Over 40 species of Legionella are now known, but only a few are pathogenic in humans.

The bacteria's natural home is in water; it can withstand temperatures from 0–63°C, but its ideal temperature is approx. 30–40°C. Legionella can survive for years in water tanks at 2–8°C and often settles in the closed ends of pipes in large buildings where the water is still and the temperature is not high.

Single cases have been diagnosed in Iceland, either of domestic origin or after staying in hotels abroad.

Symptoms

Healthy young people can get the bacteria in the respiratory tract without getting sick, which is not dangerous. Severe illness usually occurs in individuals with underlying risk factors. The main risk factors are old age, smoking, chronic lung diseases, immunodeficiency, alcoholism, and kidney failure.

An infection caused by Legionella manifests itself in the following disease forms:

Pontiac fever

Young people without underlying medical conditions can have acute flu-like symptoms with bone pain, fever, chills, and headache without pneumonia. Symptoms resolve in 2–5 days without treatment. The gestation period of the infection, i.e. time from infection until symptoms appear, is 1-2 days.

Legionnaires' disease

The main symptoms are fever, chills, cough, bone pain, headache, loss of appetite, and sometimes diarrhoea. Pneumonia is always part of the disease. The course of the infection is different, and death occurs in 5–30% of cases.

The incubation period of legionnaires disease, i.e. time from infection until symptoms appear, is 2–10 days.

Routes of transmission

Infection occurs when an aerosol is generated from water pipes or water tanks. Such aerosol formation most often occurs from air conditioners and cooling towers intended for cooling large industrial buildings, hotels, and shopping centres. There are known cases of aerosol formation from hot tubs and steam and humidity sources in greengrocers. Nosocomial infections in inpatients have also occurred. Human-to-human transmission does not occur.

Analysis

Three different methods are used for the diagnosis of Legionella infection:

• Detection of antigens in urine.

• Airway sample for analysis of the bacterial genetic material (PCR)

• Samples from the lower respiratory tract in culture.

• Measurement of antibodies in the blood.

Treatment

There is no need to treat Pontiac fever because the disease disappears without treatment. However, legionnaires disease is a severe disease that should always be treated with antibiotics, and in many cases, hospitalisation is required.

Prevention

Legionella pneumophila infection is, by law, a disease subject to registration by the Chief Epidemiologist. If a case of domestic origin is suspected, it is essential to investigate to find the source of the infection and to take samples from the possible source. There is no vaccine against the disease.

• The water pipes of large buildings must be constructed so that water does not stand in the pipes.

• A water temperature >65°C reduces the number of bacteria in the water.

• Specific procedures must be followed in hospitals, e.g., treating patients on ventilators and cleaning breathing tubes.

• Chlorination of water has little success.

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Leishmaniasis is a tropical disease caused by a protozoa that is transmitted to humans by infected sandflies.

There are several forms of Leishmaniasis in humans. The disease can cause skin sores that usually heal on their own within a few months but can leave an ugly scar.

The disease is found in many parts of the world, i.e., Mediterranean countries. Leishmaniasis can affect internal organs and cause fever, sickness, weight loss, anaemia, swollen spleen, liver, and lymphadenitis. Most cases are detected in Bangladesh, Brazil, India, Nepal and Sudan.

There are no vaccines or other drugs against this disease. The best advice for travellers is to avoid sand fly bites.

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Leprosy is a disease subject to registration by the Chief Epidemiologist since it is a threat to public health.

When a suspicion of leprosy or such infection is confirmed, physicians, directors of laboratories, hospital wards, and other healthcare facilities must send the Chief Epidemiologist information without delay and by further instructions.

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Leptospirosis is a zoonosis, i.e., a disease that infects animals and humans and is common in animals worldwide. In the Nordic countries, however, leptospirosis is a rare disease in animals, but despite this, antibody measurements show that infection occurs among animals and probably originates in rodents. In the first half of the 19th century, leptospirosis was a well-known human infection in the Nordic countries. Still, in recent decades, all cases have been among tourists infected with contaminated water on foreign soil.

Infectious agents

The causative agent is a bacterium called Leptospira interrogans. The bacterium has many serotypes (serovars). The main ones are i) serotype icterohaemorrhagiæ, which is the leading cause of the most severe form of the disease, Weil's disease; ii) serotype canicola, which was mainly transmitted from dogs but causes a milder disease than the serotype mentioned above and iii) serotype serve, which was mainly in cows in the past and caused disease in farmers. Leptospira belongs to the spirochetes, which is a generic term for bacteria.

Modes of transmission and incubation period

Transmission is mainly through contact with urine or water contaminated with urine from rats or other infected animals. Rodents most commonly transmit the infection, but other wild animals and domestic animals can also carry the disease. The bacterium enters through small wounds or cracks in the skin but can also enter the mucous membranes of the eyes, nose and mouth. The bacterium can live for months in water and moist soil. Contagion does not spread from person to person.

The incubation period, i.e. the time from infection until symptoms appear, is one to two weeks.

Symptoms and complications

The clinical presentation is variable. The most common is an asymptomatic infection or an infection with fever and flu-like symptoms that go undiagnosed. In Weil's disease, which is the most severe form, bacteria enter the blood. The main symptoms are high fever, chills, headache and bone pain. After 4 to 5 days, liver and kidney function is affected with associated jaundice and fluid retention in the body. There may also be bleeding in the mucous membranes and lungs. This is a life-threatening condition that can lead to death.

Analysis

Clear medical history with information about foreign travel and contact with dirty water or urine from animals. Blood and urine cultures from the patient Leptospira interrogans. Antibodies can also be measured in a blood sample from the person concerned.

Treatment

Antibiotic treatment, usually penicillin.

Preventive measures

Use rubber boots and gloves at work where there is an increased risk of infection, e.g., when working in a sewer. Bathing in water should be avoided if there is a possibility that it may be contaminated with Leptospira.

There is no vaccine against the disease.

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Listeria monocytogenes is a bacterium that is widespread and is found in many animal species. In this country, miscarriages have caused problems in sheep. There are 13 species of Listeria, but only Listeria monocytogenes are pathogenic in humans. The main route of transmission of the bacteria is through food.

Listeria monocytogenes rarely cause disease in healthy young people, even though they consume foods contaminated with bacteria. Certain factors significantly increase the likelihood of invasive infection: old age, heavy alcohol consumption, and immunosuppression (e.g. cancer patients and patients on immunosuppressive drugs). Newborn babies and fetuses in the womb are at increased risk of infection, which can lead to miscarriage or death.

The gestation period of the infection, i.e., the time that passes from infection to disease symptoms, is usually around three weeks but can be anything from 3 to 70 days.

Routes of transmission

Listeria monocytogenes are transmitted by food that has either been contaminated from the beginning or has been contaminated during the production process. The main food types linked to infections are soft and unpasteurised cheeses and cold-smoked and smoked salmon, and in the United States, the bacteria has been found in ready-to-eat turkey and ready-to-eat chicken.

Symptoms

In case of an invasive infection caused by Listeria monocytogenes, the bacterium can spread into the blood and cause sepsis. Still, it also infects the central nervous system and, in those cases, leads to meningitis. Symptoms can vary at the beginning of the disease and manifest as poor hygiene and poor appetite in newborn babies. The symptoms can also be acute with fever, headache, nausea, vomiting, and severe drop in blood pressure. In fetuses that are infected in the womb, the infection can spread to many organs, and the prognosis is not good. Pregnant women are often asymptomatic or have a mild fever, but despite this, the infection can lead to premature birth or miscarriage.

Analysis

Diagnosis is obtained by culturing the bacteria from blood, spinal fluid, amniotic fluid, or placenta.

Treatment

The infection can be treated with antibiotics. Recovery prospects for adults are good but are worse for newborns and fetuses.

Prevention

Education for pregnant women and adults about risk factors and foods to avoid during pregnancy.

There is no vaccine against Listeria monocytogenes.

Listeria monocytogenes is a disease subject to registration by the Chief Epidemiologist.

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Malaria is a common disease in warm temperate and tropical countries. According to information from the World Health Organization, it is estimated that around 300 million people are infected with malaria every year, and it leads to at least a million deaths each year. About 90% of deaths are among children, and the situation is worst in sub-Saharan Africa.

Malaria was an endemic infection in Europe but disappeared in the second half of the 19th century. There were no targeted efforts to eradicate it. Still, the destruction of wetlands, improved animal care, improved housekeeping, and anti-malarial drugs made it no longer an endemic disease. Malaria is not known to have ever been endemic in Iceland, as there are no mosquitoes here. Single cases are diagnosed every year in Iceland, all among tourists coming from countries where malaria is endemic.

Infectious agents

Malaria is caused by protozoa of the genus Plasmodium and causes four types of malaria: Plasmodium falciparum, Plasmodium vivax, Plasmodium ovale, and Plasmodium malariae. The most common are P. falciparum and P. vivax, and P. falciparum causes almost all deaths from malaria. Plasmodium protozoa first reproduce in the liver but then enter the blood and infect red blood cells, where asexual reproduction occurs. The blood cells burst, and the protozoa are released into the bloodstream, infecting other red blood cells. After several such cycles, male and female protozoa (gametocytes) are formed, which can be transmitted to the Anopheles mosquito when it bites and sucks blood from an infected person.

Modes of transmission and incubation period

The bite of the Anopheles mosquito transmits the infection. The protozoan enters the bloodstream, and their life cycle in humans begins. Transmission does not occur between humans.

The incubation period, i.e. the time from infection until symptoms appear, is usually 1–4 weeks, but this time varies depending on the Plasmodium protozoan involved. In exceptional cases, the gestation period can extend to several years, as P. ovale and P. vivax can lie dormant in the liver for years.

Symptoms and complications

The main symptoms are hot flashes with chills and sweats, headache and bone pain, diarrhoea, and cough. Infection with P. falciparum can lead to severe central nervous system symptoms, including confusion, loss of consciousness, and convulsions; other severe symptoms of falciparum malaria include anaemia, coagulation disorders, splenomegaly, jaundice, kidney failure, and hypotension. It often leads to death if not treated. Malaria is especially dangerous for pregnant women.

Analysis

Diagnosis is obtained by microscopic examination of a blood sample.

Treatment

Several treatment options are available, but the resistance of Plasmodium protozoa to drugs is a widespread problem and varies between regions. Knowing about immunity in the area where the patient was infected before treatment started is necessary.

Preventive measures

You can reduce the risk of infection by protecting yourself from mosquito bites. The most likely time to be bitten by the Anopheles mosquito is from sunset to sunrise, and you should lubricate your skin with mosquito repellants and wear long-sleeved shirts and pants with long sleeves. Mosquito repellent can be sprayed in the bedroom, and sleeping under a mosquito net is essential.

When travelling to areas where malaria is endemic, medication should be given for preventive purposes. The selection of drugs is vast, so it is essential to have a good knowledge of the resistance of the protozoa to different medications, as well as the prevalence of malaria in the area of the country to be travelled to. General practitioners and infectious disease doctors can obtain more information about preventive treatment for malaria. Malaria infection is less likely in big cities than in the countryside. Mosquitoes avoid ventilated rooms. Isolation of malaria cases is not required as the disease is not contagious among humans.

There is no vaccine against the disease.

Diseases subject to registration

Malaria is a disease subject to registration by the Chief Epidemiologist. When such an infection is suspected or confirmed, directors of laboratories shall send information to the Chief Epidemiologist by further instructions.

More information about malaria can be found on the following websites:

• Denmark: Udlandsvaccinationen

• United States: CDC Travelers' Health

• WHO - International Travel and Health

• International Society of Travel Medicine

• Travel Health Online

Measles is a highly contagious viral disease with flu-like symptoms that usually appear 7–12 days after infection, followed by a measles rash a few days later.

The illness typically lasts 7–10 days.

The best protection against measles is vaccination with two doses of the MMR vaccine (measles, rubella, and mumps), given at 18 months and again at 12 years in Iceland. Pregnant women should avoid vaccination and pregnancy for one month after vaccination.

• Preventing Measles Infection

Could I have measles?

If you have had measles before or had two vaccinations of the MMR vaccine you are unlikely to have measles.

Initial symptoms of measles include:

• cold symptoms

• red and watery eyes

• fever over 38°C

• small white dots on the inside of the cheeks

• loss of appetite

• fatigue, and irritability.

A rash usually appears 2–4 days after the first symptoms and disappears within a week.

Measles rash

A rash usually appears 2–4 days after the first symptoms and fades and then disappears within a week.

The worst feeling is usually during the 1–2 days after the rash appears.

• The rash consists of small reddish-brown areas or slightly raised spots, which may coalesce into larger spots.

• Appear first on the head and neck, then spread over the whole body.

• Sometimes itch.

• Can resemble rashes that accompany other childhood diseases, e.g. rubella, fifth disease (roseola), etc.

• The rash is very unlikely measles if you have been vaccinated with two doses of measles vaccine.

How to treat measles?

To treat measles symptoms:

• Take paracetamol or ibuprofen to reduce fever and aches. Feeling better promotes increased fluid intake and lowering temperature reduces fluid loss.

• Drink plenty of water to prevent dehydration.

• Dim the lights to reduce sensitivity to light.

• Clean around the eyes with a damp cotton pad.

• Ensure good ventilation.

In severe cases, a person with measles may need to be hospitalized:

• If the person does not drink enough, especially children

• If the person is short of breath

• Sharp chest pain

• Coughing up blood

• Drowsiness

• Confusion

• Convulsions/seizures

Preventing the spread of measles

Isolate yourself for at least 5 days from when the rash started to prevent the spreading of the infection. Avoid work, school, gatherings, and close contact with young children and pregnant women.

Infected persons are generally infectious for 4 days before symptoms and for 4 days after the rash appears, but can be infectious for longer if still symptomatic.

If a child in daycare or school has measles the school needs to be notified so the appropriate measures can be taken.

How to prevent measles

• Measles can be prevented by vaccination with two doses of the MMR vaccine. The vaccine is safe and protects against measles, mumps and rubella.

• In Iceland, the MMR vaccine is given at 18 months and 12 years

• Pregnant women should not be vaccinated

• Those with a history of measles are protected and do not need vaccination

If a person cannot be vaccinated but has been exposed to an infection, it is possible to give them immunoglobulin, which is a blood product. This applies to:

• Children under 6 months of age.

• Pregnant women who are not fully vaccinated or who have not had measles before.

• People with a weakened immune system.

Complications of measles

Most of the time, measles gets better without causing additional problems. Those who are most at risk of developing complications are:

• Children under 1 year of age.

• Malnourished children.

• Children with a weakened immune system, e.g. due to leukemia.

• Teenagers and adults.

The lowest risk of complications is in school-age children.

If a pregnant person gets measles, there is a high risk of miscarriage, premature birth, and other problems in the mother and fetus/newborn.

Common complications

• Diarrhea and vomiting can lead to dehydration.

• Middle ear infections can cause ear pain.

• Other infections, e.g. eye infections, pneumonia, etc.

• Increased frequency of various bacterial infections for a few months after.

Rare complications

• Blindness and other visual problems

• Meningitis or encephalitis (a life-threatening condition)

• Measles pneumonia (a life-threatening condition)

• Liver failure

• Subacute sclerosing panencephalitis can occur late in about 1 in 1000 people who get measles, usually 7–10 years after the measles infection, and is fatal.

Further information

• Measles infection prevention Published February 2024

• European Centre for Disease and Prevention - ECDC. Measles

• World Health Organization - WHO. Measles

• A case of measles in Iceland. News 3.2.2024

Diseases subject to registration

Diseases subject to registration are those that can spread widely in society and, at the same time, threaten public health. Doctors must notify The Chief Epidemiologist of persons sickened by measles with the personal identification number of the infected person. Still, reports to the Chief Epidemiologist are also received from laboratories that confirm the diagnosis. The purpose of reporting an infectious disease is to prevent the spread of infection through targeted measures, e.g., isolation, transmission place, treatment of the infected, and tracking of transmission between individuals. Information about the probable transmission place, transmission time, and symptoms must accompany notifications to satisfy these conditions. In this way, infected persons can be linked epidemiologically, the effects of the infection can be assessed, and a response can be taken.

-Automatic translation

Meningitis and sepsis caused by meningococcal bacteria, Neisseria meningitides, cause so-called meningococcal disease. Such infections usually lead to death if not treated quickly with appropriate diagnosis and treatment. The disease is most common in children but can occur at any age. Its spread is often random, but it can sometimes become an epidemic. It is, therefore, essential to monitor the disease closely so that action can be taken if the number of cases becomes high.

Epidemiology and prevention

The disease has historically been a serious health problem in Iceland. In the last decade of the 20th century, meningococcal disease was particularly prevalent here, with an incidence of about three times higher than in the other Nordic countries due to unknown causes. The highest incidence rose to 11 cases per 100,000 inhabitants per year. The mortality rate in the region has been about 8.6% of diagnosed cases, but generally, about 10% mortality is expected in meningococcal disease, despite treatment. Meningococci are divided into many different types, but the most pathogenic ones are types A, B, C, W, X, and Y. The serotypes have different geographical distributions. In Iceland, types B and C have mainly caused disease, but since vaccination against meningococcal C began in Iceland in 2002, this serotype has disappeared from view in Iceland. Several European countries have had outbreaks of serotype C in the last 5 years, but the vaccine is not widely used in most European countries. Serotype B has been the most common cause of meningococcal disease in many parts of the West, including Iceland after 2002. A Type B vaccine was in development for a long time, but now there are 2 vaccines on the European market. One is used in infants, e.g. in the United Kingdom, and can also be given to adolescents, while the other is for use only in older people. Currently, meningococcal B is very low in Iceland and vaccines are therefore not included in our vaccination program. They are available with a prescription at an individual's expense.

Infections due to serotypes X and W have been on the rise in Europe in recent years. Serotype W vaccine is currently used in infant vaccinations and is also available where tourist vaccinations are carried out, but a type X vaccine has not been developed. There are indications that one of the envelope type B vaccines may have cross-immunological activity against envelope type X, but further studies are needed.

A vaccine against serotypes A, B, C, W, and Y (pentavalent vaccine) is under development, at least for older children and adults.

Symptoms

The symptoms of the disease can be subtle and initially resemble the common cold or flu. Infants often become ill with nonspecific symptoms such as decreased consciousness, restlessness, refusal to feed, nausea or diarrhoea, and fever.

Specific symptoms include occiput stiffness or bulging of the occiput if they are still open and punctate and reddish rashes that do not clear when pressure is applied. Late symptoms include high-pitched screams, loss of consciousness, head tilt, shock, widespread bruises and obvious bleeding into the skin.

In older children and adults, nonspecific symptoms include headache, nausea, and back and joint pain. Specific symptoms include occiput, photophobia, confusion, and spotting or bruising.

Meningitis or sepsis should always be considered in a child with unexplained fever and illness. Neck stiffness is not always present, so looking for skin bleeding or bruising is essential. If fever and skin bleeding occur together, the patient must go to the hospital immediately.

Treatment

Patients with meningococcal disease need to be treated with antibiotics as soon as possible in the hospital. Despite powerful modern medicine, the death rate of the disease is high, almost 9% in this country.

When a person is diagnosed with a severe meningococcal infection, people in the immediate environment may need prophylactic medication. If an outbreak occurs due to a coat type for which vaccination is available, it is essential to use appropriate vaccinations to control the spread.

Diseases subject to registration

Diseases subject to registration are those that can spread widely in society and, at the same time, threaten public health. Doctors must notify The Chief Epidemiologist of persons sickened by meningococcal bacteria with the personal identification number of the infected person. Still, reports to the Chief Epidemiologist are also received from laboratories that confirm the diagnosis. The purpose of reporting an infectious disease is to prevent the spread of infection through targeted measures, e.g. isolation, treatment of the infected, and tracking of transmission between individuals. Information about the probable transmission place, transmission time, and symptoms must accompany notifications to satisfy these conditions. In this way, infected persons can be linked epidemiologically, the effects of the infection can be assessed, and a response can be taken.

-Automatic translation

Prevention and measures against methicillin-resistant Staphylococcus aureus (MRSA)

Methicillin-resistant Staphylococcus aureus (MRSA) has spread widely around the world, causing infections that can be difficult to treat and leading to increased costs within the healthcare system. Much has been done to stop their spread in the Nordic countries and the Netherlands, and the frequency of mosses has been lower in these countries than in other countries.
In collaboration with the Department of Infection Control and the Department of Bacteriology and Virology of Landspitali, the Chief Epidemiologist has published guidelines on "Screening, infection tracking, and infection prevention due to antibiotic-resistant bacteria in health care". Representatives from working groups from long-term care facilities and health care have also read and commented. The guidelines are written to coordinate actions against moss nationally and to reduce its spread within the health services in Iceland.

MRSA is a disease subject to registration by the Chief Epidemiologist. When such an infection is suspected or confirmed, directors of laboratories shall send information to the Chief Epidemiologist by further instructions.

-Automatic translation

What is mpox?

Mpox (formerly monkeypox) is a viral disease endemic to Central and West Africa, where the virus is mainly transmitted from animals (rodents) to people. The virus was first diagnosed in monkeys in 1958 and thus first got its name (monkeypox), but the first case in humans was seen in 1970. The virus is an orthopox virus closely related to the smallpox virus. The disease has so far been rare outside of Africa.

In 2022, however, mpox (variant 2b) was diagnosed in many other countries, inside and outside Europe, including Iceland. Cases continue to be detected in many parts of the world. Since the beginning of 2024, there has been a large increase in new cases of variant 1b in Central Africa, and there is concern that it may spread to more countries, e.g. European countries. The spread of these infections is between people, which is unusual but not unknown. Anyone can get infected, but it has been prevalent among men who have sex with men.

Reaction

The disease is reportable to the epidemiologist cf. regulation no. 677/2022. Several cases have been diagnosed in Iceland, and those individuals had a travel history to continental Europe, where the infections occurred. The public and health professionals are asked to be alert to the symptoms of the disease to ensure a quick and safe diagnosis. Individuals with symptoms and suspicion of mpox should contact the health service (health care or outpatient department of infectious diseases at Landspitali Hospital) by phone as soon as possible for diagnosis and infection tracing. It is not recommended that samples be taken outside the hospital and always in consultation with the infectious disease doctor on duty. Appropriate measures prevent the spread of the disease in Iceland and its transmission to vulnerable groups. Vaccination against the disease is available in this country. Individuals at risk of infection interested in vaccination can contact the Outpatient Department of Infectious Diseases at Landspitali Hospital.

Routes of transmission

The transmission routes of mpox are from the skin, mucous membranes, and the respiratory tract. Transmission is mainly through contact. Infectious agents in rashes can be transmitted by close contact with others through broken skin and mucous membranes. The virus can also live for a long time on dry surfaces (weeks, months) and thus be transmitted by clothing, bedding, or towels from an infected person. During close contact, droplet infection can also be transmitted from the infected person's respiratory tract (saliva, cough, sneeze). It is unknown if the virus hangs in the air and is thus transmitted by aerosol.

Symptoms

It usually takes 1-2 weeks from infection to the onset of symptoms but can be up to 3 weeks. Typically, symptoms are flu-like at the beginning (fever, fatigue, muscle pain, headache, backache), but 2-3 days later, a rash appears, which is often accompanied by itching and discomfort. Painful and enlarged, swollen lymph nodes (e.g. in the groin or on the neck) may also be present. The rash is flat at first, but then pimples and cysts, filled with fluid, form. The rash can be few and localised or widespread and then also on the hands and feet. In the current outbreak, rashes around the genitals have been reported, even before flu symptoms. The blisters eventually dry out and form scabby sores. The person is no longer contagious when the blisters dry and the rash heals. The process can take up to 4 weeks. The rash may resemble chicken pox or syphilis. Severe illness is rare (<10%); most of the time, the disease resolves independently without treatment.

Diagnosis

Diagnosis is made by taking a fluid sample from a cyst or a wound. A sample is sent to a laboratory for PCR testing. The person taking the sample should wear a virus-proof mask and disposable gloves as a minimum, and preferably a protective gown and face shield or goggles. As mentioned, samples should not be taken outside of Landspitali Hospital and always in consultation with the on-duty infectious disease doctor. See detailed instructions on sampling and research from Landspitali's bacteriology and virology department. Infection tracing is done to find those exposed to infection, and they are given special instructions. Those in close contact with an infected person with symptoms or a rash are considered exposed.

Vulnerable groups

Pregnant women, young children, older adults, and immunocompromised individuals may be at increased risk for severe illness from mpox.

Treatment

Isolation and aseptic

The illness is usually mild, and treatment is primarily supportive. The infected person needs to be isolated until the rash has healed, which can take up to 4 weeks, but 2-3 weeks is the most common.

In isolation shall:

• Stay in your room or apartment. Use a private bathroom, if possible, if in housing with others.

• Use your food containers and utensils, and clean up after yourself. See below for disinfection and cleaning.

• Do not share clothing, towels, or bedding. See below for disinfection and cleaning.

• Keep your distance from others, including avoiding hugs, kisses, and sex.

• Wash your hands and wear a face mask if others are around.

• Avoid contact with sensitive groups.

• Avoid close contact with animals because contagion can be transmitted from people to animals; see guidelines for the treatment of animals.

• Keep your distance from others and cover rashes if you leave the house (e.g. for walks).

Therefore, those in close contact with an infected person and are considered exposed need to take a break as much as possible for three weeks (sanitisation).

In aseptic technique:

• Be aware of the symptoms of mpox, including rashes. It can take up to 3 weeks for symptoms to appear.

• Pay close attention to personal quarantine, e.g. wash and sanitise hands often and take good care of all hygiene.

• Keep your distance from others as much as possible, including do not have sex.

• Only socialise as necessary.

• Do not share food containers, utensils, clothing, bedding, towels, etc. with others.

• Avoid close contact with animals as much as possible; see animal handling instructions.

• Go into isolation if symptoms appear and contact healthcare/health care.

Treatment

In general, treatment is primarily supportive. Antipyretics and painkillers are used as needed. In more severe cases, more specialised treatment options may be required.

Vaccines

The vaccine Imvanex is registered for use in smallpox and mpox infections in Europe. A similar vaccine by the same manufacturer registered in the USA is called Jynneos; that vaccine has been used in this country since the middle of 2022. The vaccine can be used following exposure if symptoms have not occurred. The vaccine is mainly used to reduce the risk of infection in individuals with risk factors, including infection, incl. people at increased risk of sexually transmitted diseases and health workers involved in diagnosing mpox infection. The vaccine can be administered subcutaneously according to the package insert. Still, it has generally been given to the skin to make the best use of the material unless there is a particular reason not to do so due to a skin disease. Two doses are used for most people who receive the vaccination, but medical and vaccination history may give rise to another. Immunocompromised individuals may receive this vaccine. Pregnant people and children, who are at increased risk of serious illness from mpox compared to most people who are not immunocompromised, can be vaccinated if warranted.

Disinfection and cleaning

The mpox virus tolerates dryness well and can survive for a long time on scabs from the rashes of infected people, e.g. on sheets and towels and in the environment. However, the virus is sensitive to common disinfectants, e.g. chlorine mixtures, hand sanitiser, and peracids. Conventional washing machines also kill it at a temperature of 60°C.

When cleaning premises where a person with mpox has stayed, the cleaner must wear a virus mask (FFP2), disposable gloves, and a long-sleeved protective gown if he has not been infected with mpox. Care must be taken not to swirl up infectious agents, e.g. by shaking dirty linen; it should be collected and put directly into the washing machine. If insulation is done in an apartment building with a shared laundry room, you can put the rolled-up bedclothes inside a clean sheet, put everything together in the washing machine, and wash at 60°C. There is no risk of the washing machine being contaminated by the virus and thus contaminating another laundry that is then washed in it.

Clean, soapy water should be used, and particular emphasis should be placed on cleaning joint contact surfaces and toilets. Then, disinfect surfaces after cleaning with a surface-active disinfectant. It is recommended to use disposable rags that are thrown away after use. Curtains, soft furnishings, and carpets can be cleaned with hot steam.

Dressings from infected wounds or gauze/plasters with fluid from rashes must be treated as contaminated waste. This means disposable gloves should be used when removing the packaging, then put directly in a plastic bag and tied up. The bag and gloves are then placed in a secure, closable storage container (e.g., a box with a lid). Finally, hands are washed and disinfected afterwards. The same applies to used paper towels and similar disposable materials contaminated with bodily fluids. The collection container must be stored in a cool place, e.g., on the balcony. After isolation, the relevant party can take the box to Terra or call +354 535 2500 and request that the box be picked up and destroyed.

Prevention

To reduce the chance of infection and the spread of disease, you should:

• Avoid sex with many strangers.

• Go into isolation if you develop symptoms suggestive of mpox and contact healthcare by phone.

• Follow aseptic precautions if you have been in close contact with a person with symptoms or a rash subsequently diagnosed with mpox.

• Information regarding vaccination in Icelandic and English (18.04.2023)

• Guidelines for treating animals for mpox (18.04.2023)

• Poster, in Icelandic and English (18.04.2023)
  

For healthcare professionals:

• Use of vaccine MVA-BN (Jynneos/Imvanex) against mpox in Iceland 2022 (13.09.2022)

• Sampling instructions (23.06.2022)

• Guidance for healthcare professionals on mpox

More:

• World Health Organization (WHO)

• European Centre for Disease Prevention and Control (ECDC)

-Automatic translation

Mumps is an acute and highly contagious viral infection that affects children more often than adults. The infection is usually safe and resolves quickly, but is known to cause serious complications, especially in adolescents and adults. Most people only get mumps once in their lives.

• Infection Prevention

Epidemiology

In 2005/2006 and 2015, an epidemic of mumps occurred in Iceland, mainly individuals in their twenties who had not been infected with mumps as children or had received adequate vaccination against the disease. The prevalence of the disease has decreased in Iceland since vaccination against it began in 1989. It is preferably those born before that time who have not had the disease who are prone to contracting it, and then unvaccinated individuals.

Infection routes and incubation periods

Mumps are transmitted through saliva and respiratory droplets and contact with them, but the droplets are large enough to spread close to the infected person (<1 meter). A person who develops mumps is contagious from two days before and for five days after symptoms appear.

To break the transmission routes, it is recommended that a person with mumps avoid being around others from the time the disease is diagnosed until 5 days have elapsed from the onset of the inflammation by staying home from work or school, preferably alone in a room if others in the household are susceptible to mumps. If those caring for the sick person are susceptible to the mumps (have not had mumps or are not vaccinated), they should wear a protective mask to their senses if they are nearby (less than 1 meter), wear gloves if saliva or mucus needs to be touched from the airways, and wash their hands after contact with contaminated surfaces during the infectious period. Routine cleaning with soap and water and wiping the main environmental contact surfaces of the infected person with a surface-active disinfectant (e.g. 70 % environmental alcohol) during illness.

Symptoms of the disease

The symptoms of the disease are usually mild in children but affect adolescents and adults more heavily. The main symptoms are fever, weakness, inflammation and sore salivary glands, headache, difficulty chewing, and loss of appetite. Teenagers and adults have more complications than children. Serious complications may include encephalitis, hearing loss, and inflammation of the breast, pancreas, ovaries, or testicles. Inflammation of the last counted organs can cause infertility.

Diagnosis

Suspicion of the disease is obtained by physical examination, but confirmation is obtained by blood antibody testing or culture of the virus in saliva.

Treatment

There is no specific treatment for the mumps virus. Individuals with mumps are advised to drink well, stay at rest, and use painkillers. Children should be kept at home until symptoms of the disease have resolved. In more severe cases, patients may need to be hospitalized.

Prevention

Vaccination against mumps began in Iceland in 1989 as part of childhood vaccinations. Today, children are vaccinated with MMR (mumps, measles, and rubella vaccine together in one shot) at 18 months and 12 years of age as part of a general childhood vaccination program, providing good protection against the disease.

Post-exposure vaccination is not beneficial in preventing mumps illness, therefore vaccination of people with known exposure is not recommended until at least 3 weeks after last contact with an infectious person. However, it is appropriate that unvaccinated or under-vaccinated household members, schoolmates, and colleagues of the exposed receive vaccination as soon as possible, to reduce the risk of further spread. Vaccination is not recommended for those who have had mumps unless they lack measles vaccination.

Who should receive MMR vaccination for mumps in the local area without direct exposure:

Who should not get MMR vaccination:

Diseases subject to registration

Diseases subject to registration are those that can spread widely in society and, at the same time, threaten public health. Doctors must notify The Chief Epidemiologist of persons sickened by mumps with the personal identification number of the infected person. Still, reports to the Chief Epidemiologist are also received from laboratories that confirm the diagnosis. The purpose of reporting an infectious disease is to prevent the spread of infection through targeted measures, e.g., isolation, treatment of the infected, and tracking of transmission between individuals. Information about the probable transmission place, transmission time, and symptoms must accompany notifications to satisfy these conditions. In this way, infected persons can be linked epidemiologically, the effects of the infection can be assessed, and a response can be taken.

Norovirus is a leading cause of gastrointestinal infections worldwide. It was first identified in connection with an outbreak at an elementary school in Norwalk, Ohio, in 1972, and became the first virus linked to gastrointestinal symptoms.

Along with sapoviruses, noroviruses are part of the calicivirus family. There are five different genotypes of norovirus, but only three infect humans.

Norovirus outbreaks are most common in winter, particularly in settings where people are in close contact, such as hospitals, nursing homes, kindergartens, cruise ships, and hotels. Outbreaks in healthcare settings can be especially serious, making infection control crucial to prevent its spread.

The virus has a short incubation period of one to two days from exposure to symptom onset.

Symptoms

Norovirus can affect people of all ages. Common symptoms include vomiting and/or diarrhea, often accompanied by abdominal pain, body aches, headaches, and sometimes a mild fever. The illness typically lasts one to two days and resolves without treatment. However, young children and the elderly are more vulnerable to dehydration due to vomiting and diarrhea.

Transmission

Norovirus is highly contagious. The primary risk of infection comes from contact with infected individuals experiencing symptoms, but the virus can also spread just before symptoms appear and for several days after recovery. The virus can survive on surfaces like doorknobs for extended periods, making indirect environmental transmission possible.

There are multiple ways the virus can spread:

• Direct contact: from person to person, through physical touch or droplet transmission.

• Airborne: during vomiting, the virus may become airborne, increasing the risk of transmission.

• Contaminated food and water: Food can become contaminated during production, packaging, serving, or sharing. A well-known route is through raw oysters contaminated by norovirus-infected water.

Diagnosis

Norovirus is most commonly detected by analyzing the virus's genetic material using a PCR test on a stool sample from an infected person. The virus can also be identified through rectal swabs or vomit samples.

Treatment

Antibiotics will not help treat norovirus, as it is a viral infection. Over-the-counter pain relievers like paracetamol can help alleviate symptoms, especially if accompanied by body aches or headaches. It is crucial to stay hydrated during the illness. In rare cases, hospitalization may be required for intravenous fluids to treat severe dehydration.

Complications

Norovirus infection can lead to more severe symptoms in individuals with pre-existing health conditions.

Prevention

People with norovirus are contagious during their illness, and most stop being infectious two to three days after symptoms subside. However, in some cases, individuals can remain contagious for up to 10 days after recovery.

Currently, there is no vaccine for norovirus.

Preventing infection primarily involves practicing good hand hygiene, which is the most effective measure.

When cleaning up after someone with norovirus, it is important to be cautious, as vomiting and diarrhea are highly contagious.

Surfaces in the infected person's environment should be thoroughly cleaned with soap and water, followed by disinfection (e.g., using a chlorine-based solution). Laundry, such as clothes, bedding, and towels, should be washed at high temperatures. Those with norovirus symptoms should avoid preparing or serving food for others and refrain from sharing food.

It is important to thoroughly cook shellfish and wash fruits and vegetables before consumption.

In healthcare settings, infected individuals should be isolated during their illness and for at least two days after symptoms have cleared. Healthcare workers should remain at home for at least two days after recovery before returning to work.

The Chief Epidemiologist has published a brochure outlining how to reduce the spread of norovirus. This brochure, available as a printable trifold, explains the symptoms and offers guidance on preventing infection.

• Brochure: Preventing infection with noroviruses

• See also information about noroviruses at Heilsuvera

-Automatic translation

Whooping cough is a severe respiratory infection in children, especially in the first months of life, but in adolescents and adults the disease is known by chronic and persistent coughing, but it is more common that the infection simply causes cold symptoms in these age groups. The infection is caused by a toxin-producing bacterium that causes severe coughing fits that can be life-threatening in children within the first six months of life.

Epidemiology

In the years around 1930-1940, thousands of people died from whooping cough, but the introduction of a vaccine against the disease has dramatically reduced the mortality rate from it. The spread of the disease has been increasing in the last 20 years, however, and the World Health Organization believes that between 20–40 million cases occur every year in the world, mostly in developing countries.

Despite good participation in pertussis vaccination, outbreaks have occurred every 3–5 years in many countries among adults and older children. The reason is that the protective effect of the vaccination is greatest in the first years following vaccination and repeated booster doses are needed to maintain the protection. Moreover, vaccination does not completely protect against infection, but primarily against serious illness.

Transmission routes and incubation periods

Human-to-human transmission occurs via respiratory (e.g. coughing, sneezing) techniques. Individuals are infectious from the onset of symptoms and generally for two weeks after the onset of cough. The incubation period of the disease, the period between the time an individual becomes infected and the onset of symptoms, is usually around 2–3 weeks.

Symptoms of the disease

Symptoms are, at first, mild colds, followed by a growing cough, mucus build-up, and severe coughing fits, especially at night. After about two weeks, symptoms progress to growth with an intense coughing fit accompanied by characteristic sucking sounds upon inhalation. Other symptoms include sneezing, runny nose and fever. Symptoms of the disease may persist for up to 10 weeks. Young children in the first six months of life are particularly prone to severe consequences of the infection, which may include respiratory arrest, seizures, pneumonia, brain dysfunction and death.

Diagnosis

Confirmation of the disease can be achieved by nasopharyngeal biopsy and bacterial DNA search (PCR test). Samples should be taken as soon as possible after the onset of illness. The throat smear is a much smaller sample for pertussis detection than the nasopharyngeal smear.

Culture of the bacteria from the nose/nasopharynx and serological testing are possible tests that are currently under-represented.

Treatment

Treatment depends on the severity of the disease. Antibiotics do little good, except very early on in the disease process, primarily to reduce the transmission of the bacteria to others. Other treatments include rest, fluid intake, and nutrition. Small children with pertussis often need to remain in the hospital for long periods.

Prevention

Vaccination is effective in preventing the disease in young children. It is essential to start vaccinating young children because the disease is most dangerous in children under six months of age. In Iceland, children are vaccinated at 3, 5 and 12 months of age and revaccinated at ages 4 and 14. The vaccine does not protect for longer than ten years, so there is a chance of infection later in life. Regular immunisation of adults has been recommended in many countries, but routine revaccination of health care workers is recommended only for health care professionals in Iceland.

Vaccination of pregnant women significantly reduces the disease in children in the first year, especially children under three months of age who have not been vaccinated themselves. Since 2019, all pregnant women have been offered pertussis vaccination in antenatal care.

Stopping pertussis spread

Once symptoms start, individuals with pertussis should reduce contact with infants to a minimum of two weeks after the start of coughing (if vaccinated within ten years) or longer (unvaccinated or more than ten years after the last dose). People with whooping cough are generally contagious when symptoms appear and for 2 weeks after the cough starts, often total about 4 weeks. Unvaccinated people can be contagious for longer.

• Avoid being around young children (<1 year old) and pregnant women while you are contagious.

• Avoid large gatherings for approx. two weeks and use a face mask if you have to go places where there are others while symptoms are severe.

If a child in kindergarten or school gets pertussis, it is right for the child's family to alert the school so that other children's relatives can be informed about pertussis infection at school. Families in a vulnerable position due to whooping cough can then receive advice from their doctor on measures to reduce the risk of infection within the family.

How to Avoid Children from Whooping Cough?

• Vaccination against pertussis with the two-dose vaccine is a safe protection.

• In Iceland, pertussis vaccinations are given at 3, 5, and 12 months of age and revaccinated at 4 and 14 years of age.

Complications of pertussis

Most of the time, whooping cough improves without causing significant problems. Those at highest risk of complications are children under one year of age, especially under six months of age and unvaccinated.

The risk of complications is reduced in older children and adults and in the vaccinated population in general.

Vaccination of pregnant women significantly reduces the disease in children in the first year, especially children under three months of age who have not been vaccinated themselves. Vaccination against pertussis is recommended during each pregnancy.

In children under six months of age and particularly under three months of age who are not vaccinated, there is a high risk of serious illness with complications such as respiratory arrest, seizures, pneumonia, encephalitis and even death.

Common complications

Under one year of age:

• Respiratory arrest

• Pneumonia

• Seizures

Older children and adolescents (in relation to coughing fits):

• Fainting

• Broken rib

Uncommon complications

Under one year of age:

• Encephalitis

• Death

See more:

• European Centre for Disease Prevention and Control (ECDC)

• World Health Organization (WHO)

• Pertussis (whooping cough) diagnosed in Iceland - First cases since 2019. News published on April 10, 2024

Diseases subject to registration

Diseases subject to registration can spread widely in society and, at the same time, threaten public health. Doctors must notify The Chief Epidemiologist of persons sickened by whooping cough with the personal identification number of the infected person. Still, reports to the Chief Epidemiologist are also received from laboratories that confirm the diagnosis. The purpose of reporting an infectious disease is to prevent the spread of infection through targeted measures, e.g., isolation, treatment of the infected, and tracking of transmission between individuals. Information about the probable transmission place, transmission time, and symptoms must accompany notifications to satisfy these conditions. In this way, infected persons can be linked epidemiologically, the effects of the infection can be assessed, and a response can be taken.

-Automatic translation

Pinworm is a tiny, white roundworm that is a common infection in people of all ages, but most common in children and institutions where many children gather, e.g., in kindergartens and schools, and with the relatives of those who become infected. It is considered one of the few endemic parasites in humans in Iceland that has been here since settlement. Keeping pinworms under control requires strict hygiene and medication. Pinworm infection is a registrable disease, which means that The Chief Epidemiologist collects information about its incidence without personally identifying those who become infected.

Risk factors and epidemiology

The people most likely to get pinworm infections are children under 18, their caregivers, and people who stay in institutions. Man is its only host. Pets, e.g. dogs and cats, cannot be infected.

Life cycle

After the eggs are swallowed, they hatch in the small intestine, mature into adults, and then migrate to the large intestine. This developmental cycle takes one month, but the total lifespan of the nymph is estimated to be two months. In appearance, the stem is a white, small, and delicate pinworm. An adult female is 8–13 mm long and 0.5 mm thick. An adult male is 2–5 mm long and 0.2 mm thick. After mating, the males die, while the females move down into the colon and anus. There they surface, usually during sleep at night, and lay large numbers of eggs in the area around the anus. After that, they die. The eggs are oblong, translucent with a thick shell with a flat side, and cannot be seen with the human eye. Each egg contains a larva that can be infective for 4–6 hours after hatching. In some cases, eggs hatch in the area around the anus and the larvae then crawl through the anus, up the colon, and into the small intestine, where they mature before returning to the colon. During shedding, the anus becomes irritated and itchy, and the infected person starts scratching and can thus get eggs on the fingers and spread them into the environment by contact.

Transmission

Infection occurs when nymph eggs enter the digestive tract after entering the mouth and being swallowed. Self-infection and maintenance of infection occurs when eggs enter the mouth through hands that have scratched the reoccur or acquire eggs through contact with other contaminated areas. The eggs can be transferred to underwear, bedding, doorknobs, toys, and the environment and are easily transmitted between family members and playmates through contact. In some cases, individual eggs can be airborne and thus enter the respiratory tract and mouth and, from there, into the digestive tract by swallowing. How long nits are contagious depends on the temperature and humidity of the environment. In a damp and cold environment, the larvae can live for up to 2-3 weeks in the eggs, but they die much sooner in hot and dry air. Studies have shown that 90% of nymph egg larvae are dead after two days at room temperature.

Symptoms of infection

Pinworm infection is often asymptomatic (one in three), but itching around the anus is the main symptom. The itching worsens at night and can cause sleep disturbances. If the infected person scratches a lot, the skin can become red, sore, and infected with bacteria. If the pinworm infection is severe, i.e., with many worms, it can manifest in loss of appetite, abdominal pain and vomiting. Other symptoms that may occur are irritability, restlessness, teeth grinding, sleep disturbances, and decreased appetite.

Diagnose

When a pinworm infection is suspected, there are three ways to diagnose the infection:

• In the case of a child, parents can examine the area around the anus for 2–3 hours after the child is asleep, e.g. by shining a flashlight on the area or examining the anus early in the morning before the child wakes up. Worms can often be seen near the anus, and sometimes they can be seen on the stool. However, the eggs cannot be seen with your own eyes.

• Another diagnostic method is to press an adhesive tape on the skin near the anus immediately after waking up to capture eggs and then examine the tape under a microscope. If the person is infected, you can see eggs on the table. The tape test should be repeated three mornings in a row, as soon as the person wakes up and before washing because the number of worms and eggs in the rectum can vary between days.

• The third method of diagnosis would be to take scrapings from the nails of infected people and examine them under a microscope in search of eggs.

A stool sample does not help diagnose a pinworm infection because few worms and eggs are in the stool. There is no way to diagnose pinworm infection with a blood test.

Treatment

Drug therapy is needed to control ringworm, and two drugs are registered in this country, Vermox and Vanquin. Both drugs are available as tablets or oral solutions and are sold in pharmacies without a prescription, except if Vermox needs to be given to children under the age of two or to pregnant women, it must be done in consultation with a doctor. Vanquin has not been available in Iceland for a long time (written in Dec. 2023). The medicine must be taken in two doses, i.e. first one dose and then another dose approx. 2 weeks later.

Vermox (mebendazole) blocks the worms' metabolism, causing the worms to die. Vermox also inhibits the development of worm eggs and is a broad-spectrum drug that works against more types of worms than roundworms, but is used in different doses. Dosages for the treatment of ringworm are the same for children and adults, 100 mg (1 tablet or 5 ml of oral solution (20 mg/ml)) as a single dose. The treatment should be repeated after approx. 2 weeks to prevent re-infection. It is recommended that everyone in the same family receive treatment at the same time to prevent the spread of the infection. The treatment can be repeated at 2-3 week intervals if it is not successful in the first attempt. Since there is little experience with the use of the medicine in children under 2 years of age and the effect of the medicine on pregnant women is not sufficiently well known, they are not advised to use the medicine without medical advice. The drug may cause temporary abdominal pain and allergic reactions have been described.

Vanquin (pyruvine embonate) has not been available for a long time in Iceland (Dec. 2023). Vanquin has a specialized action against shingles. The medicine kills both the gnat and its larvae and thus prevents the creation of infectious eggs. The drug does not affect the eggs that are already present, and this is important to keep in mind during treatment, because reinfection is common because live eggs continue to be passed out of the body in the stool for up to 2 weeks after administration of the drug. Due to the tick's life cycle, it is recommended that all family members and close playmates be treated at the same time and that everyone repeat the treatment 2–3 weeks later to prevent further transmission. The dosage of the medicine is based on 1 tablet or 5 ml of oral solution per 10 kg of body weight. An adult person takes a maximum of 8 tablets and they should all be taken in one dose. The active ingredient in Vanquin is a strong dye and colors stools red. The color easily sticks to clothes and furniture if the oral solution is spilled or thrown up. The tablets should be swallowed but not chewed as they can stain the teeth and mouth. Side effects of the drug are mainly nausea and occasionally vomiting, and then more so after taking the oral solution. Stomach pain and diarrhea are known side effects. Allergic reactions are rare.

Repeated infections should be treated like the first ones i.e. take one dose of the medicine and repeat the treatment for approx. two weeks ago. In households where more than one member of the household is infected and infections even reoccur, it is recommended that all family members be treated at the same time. The same applies to children's playmates. If nail infections manifest themselves in schools and kindergartens, the children's guardians must be notified. There are no fixed rules on how to respond to such situations, but it is desirable that a health center in the immediate vicinity of the school attend to such matters, give advice and keep track of actions.

Actions to reduce the spread of pinworm infection and re-infection
Hand washing with soap and water, drying with a clean towel after using the toilet, changing diapers, and handling food are the most effective ways to prevent pinworm transmission and further transmission. Teaching children to wash their hands and ensure they do it is essential.

Other necessary measures to control infection:

• Bathe in the morning because it reduces the chance of spreading eggs from the anus. A shower is better than a bath in a tub because bath water can be contaminated with eggs.

• Clean underwear daily and frequently change pyjamas and sheets. Do not shake the rope; wash it directly in the washing machine at ≥ 40°C. Preferably dry in a dryer.

• Do not scratch the skin near the anus.

• Keep your nails short and clean. Do not bite your nails.

• Good general hygiene in the environment.

• After each chemotherapy treatment, underwear, pyjamas, and bedclothes must be changed.
  

Sources

• Skírnisson K. About the skunk and its biology. Læknablaðð, 1998;84: 208–2013

• Pinworm infection. Centers for Disease Control and Prevention (CDC)

• Drug information from the Special Drug Register.

-Automatic translation

Pneumococci (Streptococcus pneumoniae) are bacteria that can cause severe and life-threatening diseases, especially in young children and adults over 60. The bacterium is found in the nose and throat mucous membranes in all age groups, especially young children, without causing any symptoms. The bacteria can infect, spread throughout the body, and cause disease.

The most common infections caused by pneumococci are acute and persistent otitis media, sinus infections, and pneumonia in young children. The most dangerous infections are meningitis and sepsis, which can occur as separate diseases or together and are called invasive infections. Today, pneumococci are the most common cause of bacterial meningitis.

Epidemiology
Diseases caused by pneumococci have been a persistent health problem in this country. The frequency of serious infections caused by these bacteria is higher in this country than in many neighbouring countries. Invasive pneumococcal infections have been relatively stable recently. Still, as a general rule, about 50 people a year are diagnosed with a severe infection, of which about 10 are children under the age of 5, and then it is mainly adults over sixty who get infected. Invasive infections are rare in children and adults in other age groups. After general vaccination against pneumococci was included in childhood vaccinations in 2011, the number of invasive infections in children decreased. The mortality rate caused by these diseases is about 10% in this country.

Modes of transmission and gestation period
The bacterium is transmitted from person to person through aerosols from the respiratory tract. It is believed that only 1-3 days pass from infection until symptoms of the disease appear.

Symptoms
Infections caused by pneumococci often follow the common cold or flu; therefore, the symptoms often resemble infections caused by other bacteria or viruses. Common infections caused by pneumococci are middle ear infections, inflammation of the sinuses, mucous membranes of the eyes, and pneumonia. Symptoms of meningitis or sepsis can come on very quickly with high fever, neck stiffness, restlessness, and lethargy, followed by convulsions, loss of consciousness, and shock. This should always be kept in mind in children under three years of age with unexplained fever and apparent illness.

Diagnosis
Pneumococci can be diagnosed under a microscope and by the culture of samples.

Treatment
Patients with severe pneumococcal infections should be treated with antibiotics as soon as possible in a hospital. There are about a hundred pneumococcal serotypes, most of whom are sensitive to penicillin, but antibiotic resistance has become more prevalent in Iceland. It is important to follow your doctor's advice when taking antibiotics and finish the recommended dose.

Prevention
Vaccination against the disease is the most potent prevention. Vaccinating against the most dangerous strains of the bacterium can prevent up to 90% of infections caused by pneumococci in children under five. Vaccination can also be expected to reduce acute and persistent otitis media in children by up to 30% and pneumonia in the same age group by up to 37%. It is also expected that the annual use of antibiotics in this group will decrease by up to a quarter, which would reduce the risk of the spread of antibiotic-resistant pneumococci. Since 2011, children in this country have been vaccinated against pneumococci at 3, 5, and 12 months of age.

Vaccines
Today, there are two types of pneumococcal vaccines: polysaccharide and protein-based. Polysaccharide vaccines have been on the market for some time and have been recommended for use in individuals over 60 and with immunosuppressive diseases. Please have a look here for instructions on how to use pneumococcal vaccines (in Icelandic). However, polysaccharide vaccines do not benefit children under two, so protein-based vaccines are on the market for this age group.

The side effects of both vaccines are mild and similar to the side effects of other vaccines.
Serious side effects have not been described.

Diseases subject to registration
Diseases subject to registration are those that can spread widely in society and, at the same time, threaten public health. Doctors must notify The Chief Epidemiologist of persons sickened by pneumococci with the personal identification number of the infected person. Still, reports to the Chief Epidemiologist are also received from laboratories that confirm the diagnosis. The purpose of reporting an infectious disease is to prevent the spread of infection through targeted measures, e.g. isolation, treatment of the infected, and tracking of transmission between individuals. Information about the probable transmission place, transmission time, and symptoms must accompany notifications to satisfy these conditions. In this way, infected persons can be linked epidemiologically, the effects of the infection can be assessed, and a response can be taken.

See also information about pneumococci on the website of the European Center for Disease Control (ECDC)

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Polio

Polio is an infectious disease caused by a virus that can affect the body's nervous system and cause paralysis, leading to death. Those most at risk of contracting the disease are newborns, young children, and unvaccinated individuals. The risk of being paralysed by the disease increases with age.

Epidemiology

Since the vaccination against the disease began in 1955, significant success has been achieved, and the disease has almost been eradicated worldwide. However, polio still threatens young children in poorer countries where access to vaccines is limited.

Modes of transmission and incubation period

The polio virus is highly contagious and can be transmitted to humans by aerosol transmission, i.e., by spray from the respiratory system (e.g., sneezing) and faecal contamination in drinking water and food. The virus can be present for weeks in the stools of infected people. Hygiene is essential to prevent infection, and good hand washing is the most important.

Symptoms

The vast majority of those who get sick, about 90-95%, get mild flu-like symptoms, manifesting as general weakness, fever, decreased appetite, nausea, vomiting, sore throat, constipation, and stomach pain. More severe symptoms include pain and reduced strength in the body's musculoskeletal system, neck stiffness, muscle atrophy, hoarseness, difficulty breathing, and swallowing. In the most severe cases, there will be muscle paralysis, paralysis of the bladder, and symptoms such as restlessness, involuntary drooling, and a distended abdomen.

Analysis

In addition to a medical examination, the polio virus can be diagnosed by measuring antibodies against the virus in the blood and cerebrospinal fluid. The virus can also be detected in a stool or urine sample and a throat swab.

Treatment

No treatment or medication can cure the disease. In general, treatment is aimed at reducing symptoms.

Prevention

Vaccination is effective in preventing disease in young children. It is essential to start vaccinating young children because the disease is most dangerous for the youngest children. In this country, children are vaccinated at the ages of 3, 5, and 12 months and revaccinated at the age of 14. The vaccine does not protect for more than ten years, so there is a possibility of getting infected later in life. It is recommended that adults get vaccinated against polio every ten years if they travel to countries with a risk of infection.

Diseases subject to registration

Diseases subject to registration are those that can spread widely in society and, at the same time, threaten public health. Doctors must notify The Chief Epidemiologist of persons sickened by polio with the personal identification number of the infected person. Still, reports to the Chief Epidemiologist are also received from laboratories that confirm the diagnosis. The purpose of reporting an infectious disease is to prevent the spread of infection through targeted measures, e.g. isolation, treatment of the infected, and tracking of transmission between individuals. Information about the probable transmission place, transmission time, and symptoms must accompany notifications to satisfy these conditions. In this way, infected persons can be linked epidemiologically, the effects of the infection can be assessed, and a response can be taken.

See also:

Polio and Post-Polio Syndrome

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What are pubic lice?

Pubic lice (Phthirus pubis) is an insect mainly found in the hairs around the genitals. It can also be in the armpit, sternum, eyebrow, and eyelashes. Pubic lice are rare on the scalp.

How do pubic lice spread?

Pubic lice are transmitted through close contact and by towels, bedding, and clothes.

What are the symptoms of pubic lice?

In most cases, pubic lice cause severe local itching.

Is it possible to get treatment for pubic lice?

Lice creme may be purchased without a prescription in pharmacies. It is applied to all hairy locations except the scalp. Follow the instructions in the packet strictly. The sexual partner and family members must also be treated so that infection does not occur again. Bed linen and clothes should be washed in the usual way.

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Q-fever is a disease subject to registration by the Chief Epidemiologist since it may pose a threat to public health.

When such an infection is suspected or confirmed, physicians, laboratory directors, hospital wards and other healthcare facilities must promptly send information to the Chief Epidemiologist by further instructions.

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Rabies is a deadly disease caused by viruses that probably originate in bats but can infect many other mammals that may transmit it to humans, such as foxes, dogs, and cats. The virus is found in body fluids and tissues of infected animals. It is contaminated by bites, chlorine, or by the action of infected animals, which lick wounds or mucous membranes, such as eyes or mouth. The disease is not present in Iceland but exists in every continent. If a person is infected with rabies, the incubation period can range from 4 days to a few years, although symptoms usually appear within three months. The first symptom of the disease in humans tends to be a numb feeling in the area where the wound was, in the case of a bite. Various symptoms can follow this, typical of swallowing reluctance, leading to the inability to drink water (hydrophobia) and drooling (foaming). Hypotonic-hypo paralysis, behavioural changes, and high fever are common symptoms, eventually cessation of breathing and death. It is rare for people to become violent and bite, but those who treat people with rabies may need to be vaccinated as a preventative measure. If an individual is exposed to a bite or scratch from an animal that may be infected with rabies, it is essential to react quickly. The person should immediately go to the hospital:

A person who has received a rabies vaccination before escapes antibodies and only needs two more doses of vaccine at most (days 0, 3), but it is still essential to see a doctor immediately for appropriate treatment.

If there is a delay in going to the hospital, for example, if a child does not immediately report a bite or it is not possible to get to the hospital quickly, it is right to go as soon as possible. If symptoms have appeared, it is often too late to try to save the person.

Rabies vaccination

Rabies vaccination is available, but there is no reason to vaccinate all short-term visitors to an area where rabies is present. The disease is hazardous, and no time can be lost in seeking treatment if someone is suspected of having been exposed. Therefore, there may be a reason to vaccinate those who travel through remote areas where treatment after a bite might not be available or to travel a few days to receive treatment. Also, all those working with animals should be vaccinated. Children who travel in areas where rabies is prevalent are less likely than adults to tell about bites and, therefore, have a lower threshold for vaccination.

Rabies is a disease subject to registration by the Chief Epidemiologist. Diseases subject to registration may pose a threat to public health.

When rabies is suspected or confirmed, doctors, laboratory directors, hospital wards and other healthcare facilities must promptly send information to the Chief Epidemiologist by further instructions.

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RS-virus is a cold virus that infects the upper and lower respiratory tract. The infection causes colds and often inflammation and narrowing of the small bronchi of the lungs with breathing difficulties and wheezing, especially in very young children. This is a common disease that affects all age groups but can affect premature babies and young children under six months.

Epidemiology
The virus is so common that most children under the age of two have been infected with it. Epidemics caused by the RS virus are annual, occur in winter, and usually last 2–3 months. About 20% of children under one-year-old are regularly brought to the doctor due to acute RS virus infection. Of these, it can be calculated that 2–3% may require hospitalisation.

Both adults and children can get the infection again in new outbreaks as the virus does not induce long-term immunity.

Modes of transmission and gestation period
The RS virus is mainly transmitted by direct contact between individuals but can also be transmitted by aerosol transmission when coughing or sneezing. The virus can live for several hours on toys or a tabletop and can be infected this way and enter the body through the nose, mouth, and eyes.

An infected person is most contagious in the first few days after becoming ill but can remain contagious for several weeks. Symptoms of the disease appear four to six days after infection.

Symptoms
Infections caused by the RS virus can become very serious, especially in premature babies, infants, and children with underlying heart and lung diseases. The symptoms of the disease can be breathing difficulties due to pneumonia or bronchitis, high fever, severe cough, wheezing, nasal congestion, rapid, difficult breathing, bluish skin due to lack of sufficient oxygen, and often accompanied by ear infections. Patients who become seriously ill from the RS virus may need to be hospitalised.

The infection usually peaks in 3-5 days and resolves within a week. Most children recover fully, but some develop asthma symptoms with a cold later in life.

In adults and older children, symptoms are usually mild and resemble the mild flu, i.e. runny nose, dry cough, fever, sore throat, and mild headache.

The virus can also cause severe symptoms in older people, people with underlying heart and lung disease, or those with suppressed immune systems.

Diagnosis
Diagnosis is primarily based on symptoms, medical history, and medical examination, but the virus can also be detected in mucus from the nasopharynx.

Treatment
The treatment is mainly based on supportive treatment due to the child's symptoms, e.g. fluid and oxygen administration. Asthma medicines can reduce breathing difficulties in young children.

Mild symptoms of the disease do not require any special treatment. Most children make a full recovery.

Prevention
After contact with an infected person, it is essential to maintain the utmost hygiene and wash your hands well to avoid infection. There are antibodies against the RS virus that can be given in hospitals to very young children to prevent infection.

RS infection is a disease subject to registration by the Chief Epidemiologist. When such an infection is suspected or confirmed, directors of laboratories shall send information to the Chief Epidemiologist by further instructions.

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Rotavirus diarrhea is one of the most common causes of intestinal infections worldwide, especially among children under 5 years of age. It is also the most likely of all viruses to be diagnosed if a child needs treatment in hospital for diarrhea, and is a major contributor to deaths from diarrhea among young children worldwide, or linked to a quarter of deaths from diarrhea in children before the introduction of vaccines. Almost all children get a rotavirus infection in the first 5 years of life.

Rotavirus has many different genotypes, but only five of them are common in humans. Rearrangement of genetic material can occur between genotypes if more than one type infects the same person, similar to the influenza virus. Even so, the first infection is always the most severe, and chronic protection against further rotavirus infections is present thereafter.

In Iceland, the infection most often comes in the winter and into the spring, and it is most contagious in an environment where young children gather together, such as in kindergartens. Frail older people are the most likely to get sick among adults.
The gestation period of the infection, i.e. time from infection to symptoms is one to three days.

Symptoms

The most common symptoms are vomiting and/or severe watery diarrhea, which may be accompanied by abdominal pain, loss of appetite, and sometimes a mild fever. In a study of Icelandic children, illness lasted an average of 6 days, but the duration of illness varied greatly.

Routes of transmission

There are many ways of transmission, and the virus can be transmitted directly from person to person by contact and as a droplet infection, but there is also a chance that there may be aerosol transmission during vomiting. Transmission is most likely from people who have symptoms of the infection, but the virus can be present in the stool for at least a week after the acute illness is over. Hand washing with soap (preferably not hand sanitizer*) is key to reducing transmission from sick and recovering individuals after all contact with vomit and stool.

The virus can also survive for weeks on surfaces, e.g. on contact surfaces such as doorknobs and contamination from the environment is therefore possible. Cleaning and disinfection of surfaces (e.g. with chlorine, preferably not alcohol disinfection*) are therefore important to break transmission lines when infections occur in kindergartens and other indoor places where there are many common contact surfaces.

Diagnosis

The virus is most easily detected by analyzing its genetic material in a stool sample from an infected person.

Treatment Antibiotics are not helpful. Painkillers (paracetamol) can reduce symptoms, especially if the infection is accompanied by pain and fever, but young children often have difficulty expressing pain. It is important to drink well during illness. The discomfort in young children often reduces interest in drinking and eating, and antipyretic pain medication in appropriate doses can promote better intake. In rare cases, it is necessary to resort to anti-nausea treatment and even intravenous fluids.

Complications

Drought is the most common cause of hospitalizations for rotavirus infections and deaths where hospital treatment is not available. Young children who do not retain fluids, do not urinate at least every 8-10 hours, or have died by more than 10% need food and perhaps treatment at a health facility. Following an acute intestinal infection, the absorption of nutrients may decrease only after the illness, and diarrhea often continues after the acute illness due to infection is over. Proper nutrition is key to speeding up recovery, but it can often be good to avoid foods rich in sorbitol, e.g. pears and applesauce, and use lactose-free dairy products for approx. two weeks after illness for children who otherwise normally tolerate milk.

Prevention

Individuals with rotavirus infection are contagious during the acute illness and for a few days afterward, a week may be the target. However, there are examples of infectious individuals up to 10 days after recovery. There are no rules about when children can return to kindergarten, etc. but children who feel well, can eat, and participate in preschool activities can return to preschool if the risk of infection from feces can be kept to a minimum.

Care should be taken when cleaning up after individuals with rotavirus infection as vomiting and diarrhea are highly contagious.

Good hand washing with soap and water is always important and the most effective way to prevent infection.

Active vaccines exist against rotavirus infection and have given good results in many countries abroad. They must be given in the first months of a baby's life, and may not be used after approx. 6 months of age, and have not been included in general vaccinations here.

*70% alcohol inactivates rotavirus but is ineffective against many other diarrheal viruses. It is therefore preferable to use other disinfectants in connection with the treatment of children with diarrhea or cleaning in kindergartens where diarrheal plague is present, even if rotavirus has been confirmed in one of the children. Children quite often have more than one virus at the same time, and it is not possible to break the transmission lines of all of them with the use of alcohol.

Rotavirus infection is a disease subject to registration by the Chief Epidemiologist, as it is a public health threat to diseases.

When rotavirus infection is suspected or confirmed, doctors, directors of laboratories, hospital wards, and other healthcare facilities must send the Chief Epidemiologist information, but only if the patient is hospitalized.

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Rubella is a viral disease that usually causes mild symptoms in children but can be more severe in adults. In rare cases, this viral infection can cause arthritis and encephalitis in healthy individuals. If a woman gets sick from rubella during pregnancy, there is a risk of severe fetal damage, especially if it happens in the first three months of pregnancy. Fetal damage can include hearing loss, blindness, deformities, heart defects, growth retardation, and even miscarriage. If a girl has not been vaccinated, it is considered an advantage that she will get the disease before she reaches puberty.

Epidemiology
General vaccination against rubella in recent decades has prevented epidemics caused by the disease in this country. From time to time, however, cases occur among the unvaccinated. Those most at risk of getting the disease are a relatively large group of unvaccinated men who were born before 1988 and have not had the disease.

Modes of transmission and gestation period
The disease is transmitted through the atmosphere (aerosol transmission) between people, and it can take two to three weeks for symptoms to appear. The disease is most contagious when it has peaked, but it is also infectious the week before the rash appears and the week after it disappears.

Symptoms
Symptoms can vary from person to person, but the most common symptom is a red or brownish rash that often starts around the ears or on the face but quickly spreads over the body and can almost become one continuous slab. It is also usually accompanied by a mild fever, enlarged lymph nodes on the neck, and a headache. The symptoms typically go away in three days. These symptoms can resemble other viral diseases, such as measles and chicken pox. There are examples where disease symptoms can be so mild that the person will not be aware of them.

Diagnosis
It is possible to determine whether it is rubella by taking a swab from the throat or with a blood sample that looks for antibodies.

Treatment
There is no special treatment for the disease; other than that, people are advised to take it easy while it progresses. Everyone in the immediate environment of the sick person is at risk of infection if they have not been vaccinated against rubella or have contracted the disease.

Prevention
By vaccinating everyone in society, it is possible to prevent an outbreak of rubella. Vaccination against rubella began in Iceland in 1977 for women of childbearing age who did not have antibodies against the virus, but that system was discontinued in 2001. General vaccination of all 18-month-old children began in 1989 with the MMR vaccine. Revaccination began in 9-year-old children in 1997, but in 2001, the revaccination was raised to 12 years. Therefore, for both sexes, full vaccination is at 18 months and 12 years.

Pregnant women who do not have antibodies against rubella are advised to get vaccinated after the birth of the child so that almost all women of childbearing age in this country are immune to rubella. It is estimated that 90% of fetuses can be harmed if the mother becomes infected during the first trimester. Girls vaccinated against rubella should avoid becoming pregnant in the following three months.

Diseases subject to registration
Diseases subject to registration are those that can spread widely in society and, at the same time, threaten public health. Doctors must notify The Chief Epidemiologist of persons sickened by rubella with the personal identification number of the infected person. Still, reports to the Chief Epidemiologist are also received from laboratories that confirm the diagnosis. The purpose of reporting an infectious disease is to prevent the spread of infection through targeted measures, e.g., isolation, treatment of the infected, and tracking of transmission between individuals. Information about the probable transmission place, transmission time, and symptoms must accompany notifications to satisfy these conditions. In this way, infected persons can be linked epidemiologically, the effects of the infection can be assessed, and a response can be taken.

See also information about rubella on The European Center for Disease Control website (ECDC).

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Salmonella is a bacterium with over 2000 variants (serotypes). The most common in this country are S. Enteritidis and S. Typhimurium, and the source of infection is usually foreign. In 1996, S. Enteritidis caused the most significant group infection in Iceland in recent years in cream puffs and in 2000 when S. Typhimurium was transmitted by iceberg lettuce.

Many serotypes infect humans and several animal species; the most common are cattle, pigs, and chickens, but turtles and snakes often carry the bacteria. In many countries, eggs contaminated with S. Enteritidis cause infections in people.

Routes of transmission
The main route of infection is through contaminated food. Direct human-to-human transmission is relatively rare but mainly occurs in persons who care for patients with Salmonella infection if hand washing is insufficient.

Symptoms
Diarrhea, nausea, vomiting, abdominal pain, and fever, which in most cases resolves within 4–5 days. If the infection has spread to organs outside the digestive system, symptoms may come from the site of the infection.

The gestation period of infection, i.e. time from infection until symptoms are noticed, is 1–3 days in most cases but can be anything from 6 hours—up to 10 days.

Complications
Sometimes, the bacteria enter the blood and cause infections in organs outside the digestive system, e.g., the cardiovascular system, spleen, liver, and bile ducts.
The average carriage time (when the bacteria is in the faeces) after infection is 5–6 weeks but it can be many months and even years.

Diagnosis
Most often, a stool sample is sent for culture. In the case of infections in the blood or other living organisms, samples must be sent for culture from the site of infection.

Treatment
Antibiotic treatment is usually unnecessary, but sometimes intravenous fluids are necessary to replace fluid loss.

Preventive measures
Good hygiene is essential.

• Wash hands with soap and water after using the toilet, after contact with animals, and before handling food.

• Well-cooked meat, especially minced meat, reduces the chance of infection.

• Avoid the consumption of unpasteurised milk and its products.

• It is preferable to wash and peel raw vegetables and fruits before consumption.

Response to individual cases of infection or series of infections

• Those with a confirmed infection must not go swimming or to the tub while symptoms are present (especially important for babies in diapers).

• It is necessary to check whether more people have symptoms and to take samples from those who have symptoms of salmonella infection.

• If a child in daycare is diagnosed with salmonella, contact the daycare if the child stayed there in the days before the illness or had symptoms in the daycare.

• If there is a suspicion of a group infection or a series of infections, contact the district/regional doctor of epidemiology and health control in the relevant area, e.g. if two or more cases are detected.

• Salmonella infection is a disease subject to registration by the Chief Epidemiologist.
  
  Jobs with increased risk of infection or risk daycare for children
  The following groups, who are considered to have an increased risk of infection or work in the care of very sick patients, may return to work once they have returned one negative stool sample. The sample can be taken at the earliest three days after the symptoms disappear, and the sample can be repeated 24 hours later.

• Those who work in the production, transport, or serving of food and are in direct contact with unpackaged food.

• Healthcare workers in direct contact with severely immunosuppressed patients or the intensive care unit.
  
  Children in daycare can return when they have been symptom-free for two days, but care should be taken to clean their hands in the first weeks after infection. Healthcare workers who do not belong to the risk groups mentioned above may return to work after being symptom-free for two days. However, they should pay close attention to hand hygiene, especially if they prepare food for patients in the first weeks after infection.

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What are Scabies?

Scabies is a parasite that lives in human skin. This is a common skin disease that can be transmitted through sexual contact.

How does the mite infect?

Scabies are transmitted by close contact but also in other ways, such as sleeping in the bed of an infected person where the sheets have not been changed or the same towels are used. It is doubtful that infection can occur even if an infected person greets you with a handshake, but if you hold hands for a long time and the skin is hot and clammy, the mite will come to the surface and can become infected. Infection on toilet seats is extremely unlikely. The ant can live for two to three days outside the body. It takes four to six weeks from infection until symptoms appear if the person has never had scabies, but if they have had scabies before, symptoms may appear after a few days.

What are the symptoms?

Scabies causes rashes and itching. The rash tends to appear in those parts of the body where the mite is most at home: between the fingers, on the wrists, in the waist, on the back, and around the genitals. It is highly unusual for scabies to come to the face. The itching is often worse at night under a warm blanket.

Can scabies be treated?

The treatment involves smearing the whole body (except the face and scalp) with a fertiliser that kills the scabies. The fertiliser can be bought without a prescription in drugstores, and instructions are included in the package.

An infected partner and family members must be treated simultaneously to prevent re-infection. Bedding and clothes are washed in the usual way. The itching may continue for several weeks after the treatment ends, even if the mite is gone.

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Scarlet fever is a disease caused by the bacterium Streptococcus pyogenes. The bacterium is commonly called simply streptococci or group A streptococci (GAS). The most common manifestation of such infections is strep throat. Streptococci are transmitted by droplet infection, e.g. when coughing or sneezing and also during close contact with infected people (droplet and contact infection).

Scarlet fever is most common in children and adolescents under 18 and sometimes accompanies a sore throat.

The gestation period of the disease, i.e. the time that elapses from when a person is infected until they start to develop symptoms, is often 2–5 days. It can take several hours to 1–2 days from the onset of illness to the appearance of the rash.

Symptoms
The main symptoms are sore throat, rash, fever, weakness, headache, and sometimes earache and vomiting.

Rashes associated with scarlet fever are often characterised by considerable redness of the face, with paler skin around the mouth and rashes around the genitals, the chest, the nape, and the groin. The rash is often reddish raised dots on the chest and stomach that are slightly rough to the touch, like fine sandpaper. Later, the rash can spread over the body and become more extensive. The tongue often becomes very red, and the characteristic rash on the tongue is the so-called "strawberry tongue". It is common for the skin to peel in the palms of the hands and under the soles of the feet 1-2 weeks after the disease begins.

Diagnosis
Diagnosis is often based on symptoms, but the disease can resemble certain viral infections, e.g. adenovirus infections. Therefore, confirming the diagnosis with at least one family member is desirable if several have similar symptoms. It is often done by taking a throat swab for a rapid test at a doctor and health institution. Sometimes, culture is taken from the throat with a throat swab.

Treatment
Treating scarlet fever with antibiotics (usually penicillin) is essential. GAS can cause serious infections, so a doctor should be contacted immediately if the patient's condition worsens, even if treatment has been started. It is essential to take the antibiotics according to the doctor's instructions, both in dose and duration of therapy.

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A new strain of the so-called coronavirus causes Severe Acute Respiratory Syndrome (SARS).

At the beginning of February 2003, there were reports that pneumonia of unknown origin had been observed in the Guangdong province of China and that several people had died as a result. This illness is called severe acute respiratory syndrome (SARS) and is caused by a new strain of the so-called coronavirus. Coronavirus is previously known as one of the many causes of colds.

The main symptoms of the disease are fever, bone pain, dry cough and difficulty breathing. The first signs of improvement come after 5–6 days, but the infection worsens in about 10–20% of cases, and ventilator treatment may be necessary. In 4–5% of cases, the pneumonia leads to death.

The epidemic spread, first in China, Hong Kong, Hanoi, and Vietnam, and later in other countries of Asia and around the world. By the time the epidemic had passed, 8445 people had become infected, and 812 had died. In Western countries, all infected patients were prevented from spreading the disease through the isolation of infected patients and by contact tracing.

In Iceland, the recommendations of the World Health Organization were followed, and tourists were advised to postpone their trips to infected areas. Other measures in Iceland included improvements to the isolation facilities at Landspitali Hospital, the purchase of more ventilators, and the publication of guidelines for the health services on how to respond to and care for patients with SARS. Air passengers were informed of the characteristics of the SARS, and instructions were issued to aircraft crews.

With a tight network of instructions and information and good isolation facilities, it was possible to prevent the spread of infection.

Related material:

• World Health Organization (WHO)

• Centers for Disease Control and Prevention USA (CDC)

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There are four species of shigella: S. dysenteriae, S. flexneri, S. boydii, and S. sonnei. Cases of illness caused by Shigella are rarely diagnosed in Iceland and are always associated with travel abroad. The frequency of infections in Western countries is generally low. Still, Shigella infections are a much bigger problem in developing countries, leading to the death of hundreds of thousands of children there every year. Infection is a significant problem where overcrowding and sanitation are lacking. S. dysenteriae and S. boydii, which cause the most severe symptoms, are the most common infections in countries with poor hygiene. In contrast, S. sonnei and S. flexneri, which cause milder symptoms, are more common in Western countries.

Infectious dose, i.e. the number of bacteria that the person needs to ingest for an infection to occur, is small or only 10-100. The gestation period of infection, i.e., the time from infection until symptoms are noticed, is 1–3 days in most cases but can be from ½–4 days. The bacteria usually disappear from the stool without treatment in 1-4 weeks.

Routes of transmission
Due to the low infectious dose, the infection is easily transmitted directly from person to person and can be transmitted during sexual intercourse. If hand washing is insufficient, the bacteria remains on the hands and under the nails and is thus passed on to others. The most common is direct transmission within the family, in kindergartens, between homosexual men, and in institutions for the mentally ill. The infection can also spread in overcrowded refugee camps and prisons.
The pathogen can also be transmitted from infected persons to water and food, and the spread is much more significant than direct infection. Water and food-borne infections are bigger problems in the developing world than in the Western world. Water pollution usually occurs when the hygiene around the water source is insufficient, and faeces enter the water. Food contamination comes from an infected person's hands or during washing, e.g., vegetables with contaminated water.

Symptoms
Diarrhea that is often bloody and slimy, abdominal pain, nausea, vomiting, and fever, which in most cases resolves within seven days. Significant fluid loss through stool and vomiting can lead to severe dehydration.

Complications
Relatively rare complications include severe dehydration and sepsis. Some strains produce toxins that can lead to kidney failure.

Diagnosis
Fecal sample in culture.

Treatment
When a shigella infection is known, it should be treated with antibiotics. Still, the treatment reduces the symptoms, shortens the time the person is a carrier and reduces the risk of infection to others.

Prevention
This applies to stays in countries where shigella is more common, and hygiene may be lacking.

• Buy bottled drinking water.

• Wash hands before cooking, eating, using the toilet, and after contact with animals.

• Well-cooked meat, especially minced meat, reduces the chance of infection.

• Avoid the consumption of unpasteurised milk and its products.

• It is essential to wash vegetables and fruits well before eating them.

• Avoid swallowing untreated surface water in swimming pools, hot tubs, fountains, rivers, streams, and ponds.

• If water is suspected to be contaminated with Shigella, the infection can be avoided by boiling the drinking water for at least one minute.

• It is preferable to wash and peel raw vegetables and fruits before consumption.

There is no vaccine against Shigella.


Response to individual cases of infection or group infection/epidemic

• Those with a confirmed infection must not go swimming or to the tub while symptoms are present (especially important for babies in diapers).

• It is necessary to check whether more people have symptoms and take samples from those who have symptoms of shigella infection.

• If a child in daycare is diagnosed with shigella, contact the daycare if the child stayed there the days before the illness or had symptoms of the infection while at the daycare.

• If there is a suspicion of a group infection or a series of infections, contact the district/regional doctor of epidemiology and health control in the relevant area, e.g. if two or more cases are detected.

• Those who are diagnosed with shigella and are not in a job with an increased risk of infection or risk should not be at work while they have symptoms. They can return to work when they have been symptom-free for two days. It is necessary to have good hand hygiene in the first weeks after infection and not to prepare food for others until three weeks after symptoms disappear.

• Shigella infection is a disease subject to registration by the Chief Epidemiologist.
  

Jobs with an increased risk of infection or risk and daycare for children

The following groups, considered at increased risk of infection or working in the care of very sick patients, may return to work or daycare for children once they have received appropriate antibiotic treatment and returned one negative stool sample. If no treatment is given, two negative stool samples must be submitted. The first sample can be taken at the earliest three days after the symptoms disappear or a week after antibiotic treatment, and the sampling can be repeated 24 hours later.

• Those who work in the production, transport, or serving of food and are in direct contact with unpackaged food.

• Healthcare workers in direct contact with severely immunosuppressed patients or the intensive care unit.

• Children daycare.
  
  Healthcare workers who do not directly care for the above patient groups may come to work when they have been asymptomatic for two days. However, they may only prepare food for patients once they have returned negative stool samples, as described above.

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Smallpox is a disease subject to registration by the Chief Epidemiologist. Diseases subject to registration may threaten the public good.

When smallpox is suspected or confirmed, doctors, directors of laboratories, hospital wards, and other healthcare facilities shall send the Chief Epidemiologist information without delay and by further instructions.

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Staphylococcus aureus has been found in meat and fish products, anointed bread, and sandwiches. Most often, the bacteria are transferred from food processors. The most common causes are finger ulcers (bumps, abscesses) and nasal infections, but many individuals have staphylococcus aureus infections.

Poor refrigeration is often the cause of increased infection. Heat-resistant toxins do not form below seven °C, and the refrigeration of food products is a good protection against this disease.

Symptoms of the disease appear 2–4 hours after consuming food products containing the pathogen and toxins it produces. The pathogen produces toxins in food that cause nausea, vomiting, abdominal pain, and diarrhoea and may last for 1–2 days.

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Strongyloides stercoralis is a nematode common in tropical regions and limited areas in Europe and the United States. With the prevailing climate and hygiene in Iceland, it is almost impossible for the worm to become widespread in humans in this country.

Life cycle
Humans are the primary host of this parasite, but it is also found in dogs and cats. The main route of infection in humans is through bare skin, from where the larvae travel through the bloodstream to the lungs, where they enter the alveoli. From the alveoli, they go up into the pharynx, where they are swallowed and passed down into the small intestine. The females attach themselves to the small intestine lining and lay eggs there that develop into larvae that are then released into the digestive tract. The larvae are either passed out with faeces or re-infect the host (man) by crawling through the mucous membrane of the digestive tract or the skin at the anus. The same person can, therefore, be repeatedly infected.

Modes of transmission and gestation period
Humans are usually infected through bare skin, by walking barefoot in soil contaminated with the larva. Human-to-human and dog-to-human transmission are known but rare. The time from infection until the larva can be detected in feces is usually two to four weeks.

Symptoms
The infection is often asymptomatic, but the main symptoms during the first infection are local itching with redness and inflammation that can develop where the larva enters the skin. A few days later, symptoms may appear in the lungs with a cough, and two weeks after the infection, symptoms may appear in the digestive tract (diarrhoea, constipation, loss of appetite, and abdominal pain).
With chronic infection, abdominal pain, diarrhoea, and hives can sometimes be experienced. Other possible symptoms include nausea, weight loss, vomiting, and even constipation. A rash can be detected, especially on the buttocks, thighs, and legs, following re-infections with the larva. In chronic infections, eosinophilia can be seen in many cases.
The infection can be severe in isolated cases, especially with certain types of immunosuppression. The most common immunosuppression is steroid therapy, but chemotherapy, hematologic malignancies, and malnutrition are also risk factors for severe infection. The number of larvae in the digestive system and lungs increases and can even spread to other organs. The main symptoms are from the respiratory system and the digestive tract; rupture of the mucous membranes can lead to bleeding and increase the chance of bacteria spreading into the blood, with the risk of sepsis, pneumonia, and meningitis.

Diagnosis
Diagnosis is made by microscopic examination of stool samples. If the infection is strongly suspected, a blood sample can be taken to measure antibodies against the worm.

Treatment
Treatment for confirmed infections is ivermectin or thiabendazole; doses are adjusted to the severity of the infection.

Prevention
Animals can carry various pathogens, so hygiene should always be observed when handling and caring for animals. Frequent hand washing is the most critical infection prevention, especially before meals and food preparation. Avoid letting dogs lick people's faces. Dog excrement should be cleaned, put in a plastic bag, and then in a garbage can.

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The bacterium (Treponema pallidum) that causes syphilis is transmitted during unprotected sex and from mother to fetus. Infected individuals are mainly contagious when they have sores. In the past, people feared syphilis, most of all sexually transmitted diseases. In this country, syphilis has been a rare disease, but there has been an increase in recent years. Sometimes, it is an old infection, and the individuals are not contagious.

How can I prevent infection?
The use of condoms during sexual intercourse can prevent the transmission of syphilis. The condom only protects the part of the genitals that it covers.
Mucous membranes and skin that are not covered can, therefore, become infected.

Is syphilis dangerous?
If adequate treatment is not given in the early stages of the disease, the bacterium can cause various diseases later in life, such as heart, brain, and neurological diseases. Untreated syphilis during pregnancy can cause fetal damage and miscarriage.

What are the symptoms of syphilis?
The first symptoms of syphilis are sores where the bacteria came into contact, usually on the genitals, in the rectum, or the mouth, along with enlarged lymph nodes. Sometime later, a rash may develop on the skin. In advanced untreated syphilis, symptoms arise from the central nervous system and the cardiovascular system.

When do symptoms appear after infection?
The first symptoms of syphilis appear ten days to 10 weeks (usually three weeks) after infection.

How can syphilis be diagnosed?
Syphilis is diagnosed with a blood test that can be taken at any doctor's office and Landspítali's dermatology and venereal disease outpatient department.

Can syphilis be treated?
An antibiotic (usually penicillin) is given for syphilis and cures the disease.

What about those I have had sex with?
If you have slept with someone in the last year since infection, there is a high probability that some of them have been infected with syphilis. It is, therefore, important that previous roommates are informed so that they can receive treatment if needed. You can tell them yourself or ask the doctor to write anonymously. In all cases, however, it is mandatory to provide information about roommates.
By encouraging those you have slept with to get tested, you can prevent them from infecting those they sleep with in the future. This way, you can prevent the spread of this severe disease.
Syphilis is a disease subject to registration.

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Tetanus is a severe infection caused by a bacterium called Clostridium tetani. This bacterium is present in nature, such as in soil and livestock droppings, but it is found in the intestines of humans and animals (herbivores) without causing harm. When the bacterium enters a wound, it produces a toxin that affects the human central nervous system, causing stiffness and convulsions that can be life-threatening.

Epidemiology
The tetanus bacterium is found in all countries. It is most common in hot countries but also in this country, especially in the summer. Infections caused by the bacterium are rare in countries where vaccination against it is standard, but the death rate is high in countries where vaccination is not carried out.

Modes of transmission and gestation period
Infection occurs due to dirt entering puncture wounds or open wounds. The bacterium takes residence in the wound and begins to produce a toxin that travels through the body through the bloodstream, mainly affecting the central nervous system and muscles. From the time of infection, it can take anywhere from one day to one month for symptoms to appear, but it is most common for them to appear after 6-8 days. Contagion does not spread between people.

Symptoms
The first symptoms of infection may be fever, sweating, rapid pulse, irritability, and localised pain in the muscles closest to the wound. Jaw stiffness, contraction of facial muscles, and difficulty swallowing and breathing may also be seen. The spasms and stiffness can spread throughout the body, e.g. to the abdominal and back muscles, and cause respiratory and cardiac arrest.

Diagnosis
The disease is usually diagnosed by history and symptoms. The bacteria can also be detected in a swab from the wound.

Treatment
There is an antidote that works if acted upon quickly enough. Other treatments include wound care, antibiotics, and anti-convulsions. A severe infection caused by tetanus requires hospitalisation.

Prevention
The only sure protection is vaccination. In this country, children are vaccinated at 3, 5, and 12 months of age and revaccinated at 4 and 14 years of age. Since the protective effect of vaccination does not last a lifetime, revaccination is recommended if more than ten years have passed since the last vaccination in a person who gets dirt in a wound. Periodic revaccination of adults is not recommended.

Tetanus is a disease subject to registration.

See more:
http://www.ecdc.europa.eu/en/healthtopics/tetanus/Pages/index.aspx

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Tick-borne viral encephalitis (TBE) is caused by a viral infection that affects the central nervous system. The disease has grown over the past three decades and is found in many parts of Europe and Asia. It is transmitted to humans when infected wood ticks (Ixodes ricinus and Ixodes persulcatus) bite to feed on blood.

In Europe, the disease is mainly found in Austria, Germany, southern and central Sweden, France (Alsace region), Switzerland, Norway, Denmark, Poland, Russia, and elsewhere.

The disease has never been observed in the British Isles or Iceland.

Symptoms

Encephalitis is described as a disease that comes in two phases. Symptoms of the first attack include fever, fatigue, headache, muscle aches, and nausea. The symptoms of the second episode, which occur 1-20 days after the first episode ends, are rooted in an infection of the central nervous system (inflammation of the brain, spinal cord, and meninges). The symptoms can manifest themselves as headaches, convulsions, paralysis, and, in the long term, memory loss and mental disorders. In Europe, the death rate is about 1% for those who get sick, but many more can have chronic symptoms from the central nervous system.

This infestation can be avoided by using mosquito-repellent fertilisers and covering clothing. There is no specific treatment, but vaccines against the disease can be used where the disease is endemic.

Geographic distribution of wood ticks (Ixodes species) in Europe and Asia

Ixodes ricinus is found in Western Europe, while Ixodes persulcatus is located in Asia.

Source: Lindquist L & Olli Vapalahti O. Lancet 2008; 371: 1861-71.

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Congenital toxoplasma infection is a disease subject to registration by the chief epidemiologist, but it is considered a disease that may threaten public health.

When such an infection is suspected or confirmed, doctors, heads of laboratories, hospital departments, and other health institutions must send information to the Chief Epidemiologist immediately and according to further instructions.

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Trichinosis is a disease subject to registration by the Chief Epidemiologist, which includes diseases that may threaten public health.

When a trichinosis infection is suspected, or such an infection is confirmed, doctors, heads of laboratories, hospital wards, and other health institutions must send information to the Chief Epidemiologist without delay and by further instructions.

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What is trichomoniasis?
Trichomonas infection is caused by the parasite Trichomonas vaginalis.

How is the trichomonas parasite transmitted?
The parasite is transmitted through unprotected intercourse.

Is the infection dangerous?
Trichomonas infection is harmless.

What are the symptoms of trichomoniasis?
It can cause soreness in the vagina and cervix of women, increased discharge that smells bad is yellow-green, and "bubbles". At the same time, the swollen mucosa in the vagina and cervix can cause soreness during intercourse and burning during urination.
Men can also experience burning during urination but usually have little or no symptoms.

Can trichomoniasis be treated?
The infection can be treated effectively with a short course of antibiotics. The bed partner should also be treated.

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Tuberculosis is a severe infectious disease caused by the bacterium Mycobacterium tuberculosis. Mycobacterium bovis, which causes bovine tuberculosis, can also cause human infections. The bacteria are transmitted from one organism to another by airborne respiratory tract infections, which spread through the body through the bloodstream and can nest in various organs. Lung infection is most common, but the bacteria can also spread to other organs such as the kidneys, the central nervous system, and bones. It is estimated that 10% of those who become infected develop a disease with active tuberculosis in the first two years after infection. Those who have been infected but do not develop symptoms of the disease have secret tuberculosis. With the secret of TB, the bacteria is present in the body but does not cause infection, and the person is not infectious.

You can carry the TB bacteria for the rest of your life without the onset of the disease, as your immune system can keep the infection at bay. The bacteria can multiply with a weakened immune system, and the disease can take over. In the case of latent tuberculosis, treatment is given to prevent the bacteria from spreading in the body later.

The epidemiology

TB was most likely introduced to Iceland during the settlement age, but it was in the 1900s that it became prevalent in Iceland. About 150-200 people died annually between 1912-1920. In the 1950s, TB was significantly reduced by introducing anti-tuberculosis drugs. In recent years, cases of TB have been diagnosed in Iceland between 10–20 per year.

The rate of TB increased again in the mid-nineties, mainly due to the spread of HIV and the impact of the AIDS epidemic on the prevalence of TB in poor countries and, therefore, worldwide.

HIV-infected people are at greater risk of active tuberculosis. The HIV weakens the immune system and prevents it from working on the tuberculosis bacteria. Thus, TB and HIV co-infection are life-threatening.

The TB bacterium is widespread worldwide, and it is believed that 1/3 of the world population has secret TB, meaning it is not contagious. Still, when immunosuppressed, the infection can become active.

Transmission routes and incubation periods

Tuberculosis is most commonly transmitted by aerosols and droplets produced by coughing and sneezing of persons with tuberculosis bacteria in the sputum. Tuberculosis in vocal cords, which is rare, is the most contagious. Although TB is an infectious bacterium, it is not spread as quickly as influenza and measles viruses. It is more likely to be transmitted between individuals who are in close contact, such as family members and work colleagues, and infection in tight-knit prisons has also been a problem.

Symptoms

The main symptoms of tuberculosis infection are cough, weight loss, weakness, fever, night sweats, chills, and lack of appetite.

The TB bacteria mainly affects the lungs, causing symptoms such as chronic cough with or without bloody sputum, chest pain, and pain when breathing and coughing. Tuberculosis can also affect other body parts, such as the kidneys, spinal cord, and bone. The symptoms of infection depend on the location in the body. Spinal cord infection causes back pain; kidney infection causes blood in the urine, and bone infection causes musculoskeletal pain.

Diagnosis

The diagnosis of tuberculosis is multifactorial and is based on the disease picture, skin test (PPD), or blood test that measures cellular resistance to tuberculosis bacteria. Sputum samples/other specimens should be obtained from the lower respiratory tract or other infection sites by microscopic examination and tuberculin culture. However, PCR (the DNA of the tuberculosis bacteria) should also be analyzed. Image analysis is also an important research method for the diagnosis of tuberculosis.

Treatment

To eradicate infectious tuberculosis, individuals must undergo continuous multi-drug treatment for at least six months to prevent the bacteria from developing drug resistance. In a standard treatment, four drugs are administered for the first two months and then two drugs for four months. The treatment results are excellent if the patient is adherent and takes medication as directed. A person who has been treated for tuberculosis for two weeks should not be infectious any longer. In multidrug-resistant TB, the treatment is longer and more complex; drugs must be selected for bacterial sensitivity, and, if possible, at least four active drugs must be available for treatment. In the case of latent tuberculosis, treatment is given to prevent the bacteria from spreading in the body later. The standard minimum treatment for latent tuberculosis is one anti-tuberculosis drug for at least six months.

Prevention

Prevention is a crucial priority for TB prevention and control and is good healthcare that provides fast diagnosis and early treatment to prevent infection. The environment of vectors is used to provide preventive management to those who have become infected.

The latter year is mainly responsible for two factors affecting the spread of tuberculosis. On the one hand, HIV/AIDS is common in countries where TB is endemic, but HIV infection increases the risk of TB in individuals at least one hundredfold. However, multidrug-resistant strains of the bacteria have developed; these strains have developed resistance to antibiotics, so the drugs do not work on the disease.

Multidrug-resistant tuberculosis (TB) bacteria are a growing threat worldwide. New anti-tuberculosis drugs have not been introduced for some time, and treatment prospects are much lower for infections caused by multidrug-resistant TB, in addition to which the treatment is many times more expensive. To prevent the development of resistance, physicians and patients must follow minimum standards for treating tuberculosis.

Vaccination

BCG vaccine was introduced in the market in the first half of the 20th century but has not been included in general vaccinations in Iceland. The vaccine is used worldwide and is very effective in preventing life-threatening tuberculosis infection in infants.

Other languages:

Icelandic: Leiðbeiningar fyrir sjúklinga með smitandi berkla utan sjúkrahúss
Polish: Instrukcje dla pacjentów z gruźlicą zakaźną poza szpitalem
Lithuanian: Instrukcijos užkrečiamąja tuberkulioze sergantiems pacientams, kurie gydosi ne
Ukrainian: Інструкція для хворих на заразний туберкульоз поза стаціонаром
Filipino: Mga tagubilin para sa mga pasyenteng may nakakahawang tuberkulosis sa labas ng ospital

Diseases subject to registration

Diseases subject to registration are those that can spread widely in society and, at the same time, threaten public health. Doctors must notify The Chief Epidemiologist of persons sickened by tuberculosis with the personal identification number of the infected person. Still, reports to the Chief Epidemiologist are also received from laboratories that confirm the diagnosis. The purpose of reporting an infectious disease is to prevent the spread of infection through targeted measures, e.g. isolation, treatment of the infected, and tracking of transmission between individuals. Information about the probable transmission place, transmission time, and symptoms must accompany notifications to satisfy these conditions. In this way, infected persons can be linked epidemiologically, the effects of the infection can be assessed, and a response can be taken.

For further details:

Tuberculosis - Mayo Clinic
What is tuberculosis? - The Icelandic Web of Science (Icelandic)

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Tularemia is a severe infectious disease caused by a bacterium named Francisella tularensis. The infection is transmitted from animals to humans, and the main vectors of the bacteria are hares, ticks, flies and mosquitoes. This bacterium has two subspecies: type B, which is found in Europe, Asia and North America and type A, which is more dangerous than type A but is only found in North America.

Epidemiology

Tularemia is not an endemic disease in Iceland, and infections of domestic origin have not been diagnosed in Iceland. The infection is endemic in Finland, Norway, and Sweden but less common in Denmark. Tularemia is relatively common in many parts of the United States, Europe, and Asia. The infection is more common during the summer months in connection with hunting and outdoor activities, although it can also occur at other times of the year.

Routes of transmission and incubation period

Tularemia can be transmitted from animals to humans, not from person to person. The main modes of transmission are:

• With an insect bite,

• by contact with infected animals,

• when inhaling dust contaminated with urine or faeces from an infected animal,

• by consuming contaminated food and water.

Symptoms usually appear 3-5 days after infection but can range from 2-14 days. A person infected with Tularemia once develops lifelong resistance to the bacteria.

Symptoms

Symptoms usually come on quickly and resemble flu symptoms, with a high temperature, chills, feeling of weakness, widespread body pain, headache, and nausea. Insect bites can cause an ugly wound, swelling around the wound, and swelling of the nearby lymph nodes with associated pain. The bacterium can cause suppurative cystitis with or without ulceration. If infection with contaminated food enters the digestive tract, it causes severe stomach pain, belching and diarrhoea. Infection can spread through the respiratory tract and cause pneumonia.

Diagnosis

Diagnosis is based on clinical signs and blood tests.

Treatment

Antibiotics are used to eradicate infection. Special care should be taken when treating open wounds, including hygiene and infection prevention.

Prevention

Prevention is mainly by avoiding insect bites, such as through clothing or repellent treatments. Be careful when handling and consuming food that could be contaminated. Avoid inhaling any aerosols that may contain the bacteria.

Diseases subject to registration

Diseases subject to registration are those that can spread widely in society and, at the same time, threaten public health. Doctors must notify The Chief Epidemiologist of persons sickened by tularemia with the personal identification number of the infected person. Still, reports to the Chief Epidemiologist are also received from laboratories that confirm the diagnosis. The purpose of reporting an infectious disease is to prevent the spread of infection through targeted measures, e.g., isolation, treatment of the infected, and tracking of transmission between individuals. Information about the probable transmission place, transmission time, and symptoms must accompany notifications to satisfy these conditions. In this way, infected persons can be linked epidemiologically, the effects of the infection can be assessed, and a response can be taken.

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Typhoid fever is a disease subject to registration by the Chief Epidemiologist. When such an infection is suspected or confirmed, directors of laboratories shall send information to the Chief Epidemiologist by further instructions.

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Unexpected events that may threaten human health with an unexpected increase in cases of disease or deaths due to disease must be reported to The Chief Epidemiologist.

When suspicions of such infections arise, or such infections are confirmed, doctors, heads of laboratories, hospital wards, and other health institutions must send information to the Chief Epidemiologist without delay and with further instructions from him.

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Vancomycin-resistant enterococci is a disease subject to registration by the Chief Epidemiologist. When they are suspected or confirmed, directors of laboratories shall send information to the Chief Epidemiologist by further instructions.

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West Nile virus infection is a disease subject to registration by the Chief Epidemiologist. When such an infection is suspected or confirmed, directors of laboratories shall send information to the Chief Epidemiologist by further instructions.

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Yellow fever is a disease subject to registration by the Chief Epidemiologist. Diseases subject to registration are a public health threat.

When yellow fever is suspected or confirmed, doctors, directors of laboratories, hospital wards, and other healthcare facilities must send the Chief Epidemiologist information without delay and by further instructions.

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Yersinia has yet to be searched for in food in Iceland. Infections can often be caused by the pathogen being transferred from raw to cooked product, stored for a long time in a refrigerator. The pathogen can reproduce at cooling temperatures. Symptoms of the disease appear 3–7 days after consumption of foods containing the pathogen. Symptoms of the disease include fever, diarrhoea, abdominal pain, and vomiting.

The symptoms of the disease can last for 1–3 weeks. Complications such as arthritis and rheumatism can last for months or even years.

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Zika virus was first discovered in Central Africa in the fifth decade of the last century. Infection with the virus was considered rare and restricted to Africa and Asia. Mosquitoes transmit the viruses and usually cause little or no symptoms. The symptoms manifest as fever, rash, joint pain, and conjunctivitis. Their duration is from a few days to a week, rarely leading to hospitalisation. But in the spring of 2015, a widespread outbreak of zinc virus occurred in Brazil, and simultaneously an increase in fetal injury resulting in growth retardation of the brain (microencephaly) and Guillain-Barre-Syndrome (GBS) was observed.

Subsequent studies showed an association of CIT infections in the first and second trimesters of pregnancy with congenital CNS malformations and headaches in fetuses and newborns. With less knowledge about Zika virus infections in the last trimester of pregnancy, it is appropriate to consider Zika virus infection as a threat during the entire pregnancy. The association between Zika virus infections and GBS has simultaneously become increasingly stronger, and it is now considered inevitable that GBS can follow Zika virus infection.

No travel ban is encouraged, and no general travel ban is encouraged for countries where the Zika virus spreads. Still, it is recommended that everyone avoid mosquito bites around the clock, especially in the morning and late in the day to the evening. Zika virus can be sexually transmitted, so there are special instructions for travellers from countries where the virus is spread. There are also particular recommendations for women who are pregnant and for those who are planning to have a child. In addition, blood donors are advised to comply with the requirements of the Icelandic Blood Bank after returning from countries where Zika and other tropical viruses are common.

Zika virus infection, acquired or inborn, is a disease subject to registration by the Chief Epidemiologist, which includes diseases that may threaten public health.