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Enhanced surveillance for infectious disease events, with accelerated routine reporting and daily supplementary reports, was undertaken during the 2006 FIFA World Cup in Germany. We evaluated the surveillance outputs, reporting intervals and detection of World Cup-relevant events for the enhanced system. Outbreak numbers for measles, Norovirus and Campylobacter were significantly higher than in previous years, but all increases were explained by prior trends. The median interval (disease onset to receipt at national centre) fell from 17 days in 2005 to 12 days in 2006. Detection of World Cup-relevant events was 44% (8/18) in the routine system and 77% (14/18) in supplementary reports. We did not identify any significant effect on infectious disease epidemiology relating to the FIFA 2006 World Cup. Daily reporting improved timeliness, and supplementary reporting improved relevant event detection. Enhancing existing systems, without the addition of syndromic surveillance, can be an effective approach to mass-event surveillance.
Hypothalamic–pituitary–adrenocortical (HPA) regulation in adults is influenced by early psychosocial adversity, but the role of infectious disease history is poorly understood. We studied the association between cumulative pathogen burden and cortisol profile over the day in a sample of 317 healthy men and women aged 51–72 years. Cumulative pathogen burden was defined as positive serostatus for Chlamydia pneumoniae, cytomegalovirus (CMV) and herpes simplex virus 1 (HSV-1). Salivary cortisol was sampled repeatedly over the day. The cortisol slope was defined as the decrease across the day and evening. Age, gender, grade of employment, body mass index, smoking status, self-rated health, cardiovascular medication, depressed mood and time of waking were included as covariates. The pathogen burden averaged 1·76 (s.d.=0·92). The cortisol slope was inversely associated with pathogen burden after controlling for covariates. When individual pathogens were studied, only CMV was associated with flatter cortisol rhythms in isolation. We conclude that pathogen burden is independently associated with flatter cortisol slopes over the day, and may contribute to disturbed neuroendocrine regulation.