The incidence of rabies has decreased in Turkey during recent years. However, an increasing number of rabies cases have been reported in the Aegean (western) region of Turkey. The virus appears to have maintained a foothold in the urban areas of the province of Izmir with only three cases per year being reported during the mid-1990s. Since 2001, the virus has been recorded in the previously rabies-free provinces of Manisa and Aydin. During this epizootic, cases have been reported in both dogs and foxes, and there has been an unusually high incidence of rabies in domestic livestock, especially cattle. This report describes the development of this epizootic and a preliminary phylogenetic study which suggests that the source of this epizootic was likely to have been the residual cases within Izmir rather than a fresh introduction of rabies from foci to the north (Istanbul) and the Eastern provinces of Turkey.

An epidemic of meningococcal disease caused by serogroup B meningococci expressing the P1.7-2,4 PorA protein began in New Zealand in 1991. The PorA type has remained stable. Different porB have been found in association with the P1.7-2,4 PorA, although type 4 has been most common. The clonal origins of B:P1.7-2,4 meningococci isolated from cases during 1990 to the end of 2003 were analysed. In 1990, the year immediately preceding the recognized increase in disease rates, all three subclones (ST-41, ST-42, and ST-154) of the ST-41/44 clonal complex occurred among the five isolates of B:P1.7-2,4. The two sequence types, ST-42 and ST-154, continued to cause most disease throughout New Zealand. Isolates belonging to subclone ST-41 were mostly identified early in the epidemic and in the South Island. 16S rRNA typing indicated that isolates belonging to the subclones ST-41 and ST-154 share a common ancestor, with those typing as ST-42 more distantly related with some genetically ambiguous. It is possible that ST-41 and ST-154 may have evolved one from the other but evolution to ST-42 is more difficult to explain. It is possible that one or more of the ST types could have been introduced into New Zealand prior to the first detection of clinical cases in 1990. Genetic diversity may have occurred during carriage in the community.

In January 2003, two cases of Legionnaires' disease associated with a ship's cruise were registered in the database of National Epidemiological Surveillance of Infectious Diseases. A 70-year-old male heavy smoker with mild emphysema contracted the disease during a cruise. Legionella pneumophila serogroup (sg) 5 was isolated from the patient's sputum and the ship's indoor spa. The isolate from the spa matched the patient's isolate by genotyping performed by pulsed-field gel electrophoresis (PFGE). The second case was in a 73-year-old female. During epidemiological investigation, a third case of Legionnaire's disease in a 71-year-old male was subsequently diagnosed among passengers on the same ship on the following cruise. Environmental investigation revealed that porous natural stones (Maifanshi) in the filters of the spas had harboured L. pneumophila, a phenomenon which has not been reported except in Japan. This is the first documented evidence of L. pneumophila sg 5 infection on a ship and of porous stones as a source of Legionella infection.

Routine surveillance systems capture only a fraction of infectious intestinal disease (IID) that is actually occurring in the community. Different methodologies utilized among various international studies in the field were reviewed in order to devise an appropriate survey to obtain current estimates of prevalence of IID in Malta. An age-stratified retrospective cross-sectional telephone study was selected for the study due to its feasibility in terms of limited resources necessary (funds, time and human). The disadvantages of this type of study include the inherent biases such as selection bias (sampling, ascertainment and participation bias) and information bias (recall and observer bias). A pilot study was carried out using a random age-stratified sample of 100 persons over a 3-month period. A total of 5·0% (95% CI ±4·27) of the population was estimated to have suffered from IID during that period. This estimate was used in order to assist in sample size calculations for a large-scale community study. It also served to test the survey instrument and methodology and to identify operational problems.

This report describes an outbreak of gastroenteritis of 5 months' duration in a farming family, associated with the consumption of unpasteurized cows' milk, where Campylobacter jejuni was implicated. A total of six individuals in the family acquired the illness, and two had several episodes of diarrhoea within the 5-month period. Identical PFGE genotypes of C. jejuni were isolated from human and bovine faeces, and bulk tank milk samples. Incompletely sealed rubber liners fitted to a milking machine shortly before the outbreak started was the probable reason, allowing faecal material to contaminate the milk over the period concerned.

The concomitant occurrence of a case of haemolytic–uraemic syndrome (HUS) and 62 cases of mild gastroenteritis in schools of a small rural community in southern Italy induced the health authorities to suspect a foodborne outbreak of shiga-toxin-producing Escherichia coli (STEC) infection. The schools were closed and the catering service involved was investigated. However, STEC were not isolated from the HUS case or from the 56 cases of gastroenteritis examined, and the HUS case and the outbreak of gastroenteritis were probably just coincidental. A retrospective cohort study failed to show any correlation with consumption of school meals and suggested that the outbreak probably started outside the school setting and then spread within the schools by person-to-person transmission. All the cases examined were negative for common enteric pathogens and the responsible agent for the cases of gastroenteritis was not identified. The concern raised in the small community by the occurrence of a severe case of HUS and the lack of a rapid epidemiological assessment excluding the occurrence of a STEC outbreak, turned an epidemic episode of mild gastroenteritis into a public health emergency with relevant socioeconomic consequences. Prompt intervention in outbreaks following timely and effective risk communication are crucial for taking the most appropriate control measures and avoiding the spread of fear and panic in the community.

A study on the prevalence of the faecal carriage of Escherichia coli O157 in lambs was performed in the major slaughterhouse in Rome, central Italy, during 2002. A total of 643 animals, consisting of 378 weaned and 265 suckling lambs, were assayed for the presence of E. coli O157. Five O157-agglutinating E. coli strains were isolated (0·8%, 95% CI 0·3–1·9). Only one was positive to PCR specific for the eae gene and produced verocytotoxin VT2, with a VTEC O157 overall prevalence of 0·2% (95% CI 0·0–1·0), whereas one strain possessed the eae gene only. All the other isolates were negative for the presence of all the virulence genes considered. The animals were either from local farms or imported from Eastern Europe. The results suggest an age-specific difference since the microorganism was isolated only from 0·3% (95% CI 0·0–1·7) of weaned lambs, while all samples from suckling lambs tested negative. From this study, the overall risk of human exposure to pathogenic E. coli O157 from lamb meat consumption derived from the major slaughterhouse in Rome can be considered reasonably low, particularly when suckling lamb meat is considered.

Vero cytotoxin-producing Escherichia coli O157 (VTEC O157) infections are a threat to public health. VTEC O157 has been isolated from gulls but evidence of transmission to humans from birds has not been reported. We recount an incident of VTEC O157 infection affecting two sibling children who had no direct contact with farm animals. An outbreak control team was convened to investigate the source of infection, its likely mode of transmission, and to advise on control measures. Human and veterinary samples were examined and the human isolates were found to be identical to an isolate from a sample of bird (rook) faeces. Cattle, rabbit and environmental samples were negative. This report provides evidence that birds may act as intermediaries for human infection with VTEC O157.

A multidrug-resistant clonal group (CgA) of Escherichia coli was shown to cause half of all trimethoprim–sulphamethoxazole (TMP–SMZ)-resistant urinary tract infections (UTIs) in a college community between October 1999 and January 2000. This second study was conducted to determine the fate of CgA. Urine E. coli isolates from women with UTI, collected between October 2000 and January 2001, were tested for antibiotic susceptibility, O serogroup, ERIC2 PCR and DNA macrorestriction patterns using pulsed-field gel electrophoresis. The proportion of UTIs caused by CgA declined by 38% (P<0·001) but the prevalence of resistance to TMP–SMZ did not change. Six additional clonal groups were identified and these were responsible for 32% of TMP–SMZ-resistant UTIs. The temporal decline in the proportion of UTIs caused by CgA provides evidence that CgA caused a community outbreak of UTI. The fluctuation and occurrence of other E. coli clonal groups in this community suggest that a proportion of community-acquired UTIs may be caused by E. coli disseminated from one or more point sources.

During 1989–2002, we studied the antimicrobial resistance of 3928 blood culture isolates of Salmonella enterica serotype Typhi (S. Typhi) in Dhaka, Bangladesh. Overall 32% (1270) of the strains were multidrug-resistant (MDR, resistant to chloramphenicol, ampicillin and trimethoprim–sulphamethoxazole); first detected in 1990 (rate of 8%), increased in 1994 (44%), declined in 1996 (22%, P<0·01 compared to 1994) and re-emerged in 2001 (36%) and 2002 (42%, P<0·01 compared to 1996). An increased MIC of ciprofloxacin (0·25 μg/ml) indicating decreased susceptibility to ciprofloxacin was detected in 24 (18·2%) out of 132 randomly selected strains during 1990–2002; more frequently in MDR than susceptible strains (46·3% vs. 5·5%, P<0·001), and the proportion of them rose to 47% in 2002 from 8% in 2000 (P<0·01). Ciprofloxacin (5 μg) disk diffusion zone diameters of [les ]24 mm as break-point had 98% sensitivity and 100% specificity when compared with a ciprofloxacin MIC of 0·25 μg/ml as break-point for decreased susceptibility; being a useful and easy screen test. All strains were susceptible to ceftriaxone. The emergence of MDR S. Typhi with decreased ciprofloxacin susceptibility will further complicate the therapy of typhoid fever because of the lack of optimum treatment guidelines.