The purpose of this study was to assess and describe the current spectrum of emerging zoonoses between 2000 and 2006 in European countries. A computerized search of the Medline database from January 1966 to August 2006 for all zoonotic agents in European countries was performed using specific criteria for emergence. Fifteen pathogens were identified as emerging in Europe from 2000 to August 2006: Rickettsiae spp., Anaplasma phagocytophilum, Borrelia burgdorferi, Bartonella spp., Francisella tularensis, Crimean Congo Haemorrhagic Fever Virus, Hantavirus, Toscana virus, Tick-borne encephalitis virus group, West Nile virus, Sindbis virus, Highly Pathogenic Avian influenza, variant Creutzfeldt–Jakob disease, Trichinella spp., and Echinococus multilocularis. Main risk factors included climatic variations, certain human activities as well as movements of animals, people or goods. Multi-disciplinary preventive strategies addressing these pathogens are of public health importance. Uniform harmonized case definitions should be introduced throughout Europe as true prevalence and incidence estimates are otherwise impossible.

We observed an outbreak of necrotizing fasciitis associated with Streptococcus agalactiae infection in a group of juvenile saltwater crocodiles (Crocodylus porosus). We undertook screening of crocodiles and the environment to clarify the source of the outbreak and evaluated the isolates cultured from post-mortem specimens with molecular methods to assess clonality and the presence of known group B streptococcal virulence determinants. The isolates were indistinguishable by pulsed-field gel electrophoresis. They were a typical serotype Ia strain with the Cα-like protein gene, epsilon (or alp1), the mobile genetic elements IS381 ISSag1 and ISSag2, and belonged to multi-locus sequence type (ST) 23. All of these characteristics suggest they were probably of human origin. We review the medical and veterinary literature relating to S. agalactiae necrotizing fasciitis, epidemiology and virulence determinants.

Francisella tularensis was identified as the cause of a die-off which occurred among a colony of semi-free-living common marmosets (Callithrix jacchus). During the outbreak 5 out of 62 animals died of tularaemia in a research facility located in the district of Goettingen, Germany. All animals had been born at the facility suggesting an endemic infection. A total of five culture isolates were recovered and characterized as F. tularensis holarctica, biovar I. These cultures represent the first isolates obtained in the Federal Republic of Germany for more than 45 years. The outbreak area shows several geographical and ecological characteristics known to favour long-term presence of F. tularensis. Persistence of the pathogen in the remote region along the former German–German border, continuous re-introduction from eastern European countries after destruction of the ‘Iron curtain’ or introduction through migrating birds are testable hypotheses which could explain the emergence of tularaemia in this particular region.

A phylogenetic tree, which distinguishes between the serovars and serogroups of leptospires common in Central Europe was constructed using an established RAPD procedure together with digital reading and evaluation (using different computer software programs) of the generated amplified DNA patterns. The application of this procedure has revealed a consistent correspondence between serogroup and genotype (position in constructed tree) in 69 cases, and serovar and genotype in 72 cases, of wild strains of leptospires. There was an agreement between serovar and genotype in cases of strains of Grippotyphosa, Pomona, Mozdok, Arborea and Sorexjalna as well as between serogroup and genotype in cases of Australis, Bataviae and Sejroe. With the procedure used in this study, it was not possible to distinguish between reference strains of serovars Jalna, Bratislava and Lora (all serogroup Australis) as well as between serovars Icterohaemorrhagiae and Copenhageni (both of serogroup Icterohaemorrhagiae). In contrast to this, wild strains belonging to serogroup Sejroe were distributed between Polonica, Istrica, Saxkoebing and Sejroe serovars. Endemic strains of leptospires tested, were also distinguishable.

Salmonella is one of the most common causes of foodborne infection in Europe with Salmonella enterica serovar Enteritidis (S. Enteritidis) being the most commonly identified serovar. The predominant phage type for S. Enteritidis is phage type (PT) 4, although PT 8 has increased in incidence. Within these phage types, pulsed-field gel electrophoresis (PFGE) provides a method of further subdivision. The international project, Salm-gene, was established in 2001 to develop a database of PFGE profiles within nine European countries and to establish criteria for real-time pattern recognition. It uses DNA fingerprints of salmonellas to investigate outbreaks and to evaluate trends and emerging issues of foodborne infection within Europe. The Salm-gene database contains details of about 11 700 S. Enteritidis isolates, demonstrating more than 65 unique PFGE profiles. The clonal nature of S. Enteritidis is evidenced by the high similarity and distribution of PFGE profiles. Over 56% (6603/11 716) of the submitted isolates of several different phage types were profile SENTXB.0001, although this profile is most closely associated with PT 4. The next most common profiles, SENTXB.0002 and SENTXB.0005, were closely associated with PT 8 and PT 21 respectively. Studies to investigate the relationship of profile types with outbreaks and possible vehicles of infection suggest that the incidence of PFGE profile SENTXB.0002, and thus PT 8, in some countries may be due to importation of foods or food production animals from Eastern Europe, where PT 8 is amongst the most frequently identified phage types. Collation of subtyping data, especially in the commonly recognized phage types, is necessary in order to evaluate trends and emerging issues in salmonella infection.

Routine sources of information on infectious intestinal disease (IID) capture a fraction of the actual disease burden. Population studies are required to measure the burden of illness. A retrospective age-stratified cross-sectional telephone study was carried out in Malta in order to estimate the magnitude and distribution of IID at population level. A random sample of 3504 persons was interviewed by a structured questionnaire between April 2004 and December 2005. The response rate was 99·7%. From the study, the observed standardized monthly prevalence was 3·18% (95% CI 0·7–5·74) with 0·421 (95% CI 0·092–0·771) episodes of IID per person per year. The monthly prevalence was higher in the <5 years age group and in females aged 31–44 years. The mean duration of illness was 6·8 days and a median duration of 3 days. A bimodal seasonal distribution was observed with peaks in June–July and October–November.

The aim of this study was to estimate the burden of infectious intestinal disease (IID) and cost of illness at the community level from a societal aspect. A retrospective, age-stratified cross-sectional telephone study was carried out in Malta in 2004–2005. The number of cases, resources used and cost of resources were computed. The resources involved direct costs (health-care services, stool culture tests, medicines and personal costs) and indirect costs (costs from lost employment by cases and caregivers). This study estimated 0·421 (95% CI 0·092–0·771) separate episodes of IID per person per year in Malta which corresponds to 164 471 (95% CI 35 941–301 205) episodes of IID per year or 450 (95% CI 98–825) episodes of IID each day. The largest proportion of cost is due to provision of health-care services with €10 454 901 [Maltese liri (Lm) 4 558 970] per year; followed by €963 295 (Lm 2 209 393) in lost productivity; €1 286 286 (Lm 561 078) in medicines; €152 335 (Lm 66 452) in stool culture testing and €71 487 (Lm 31 183) in personal costs, giving a total cost of illness of over €16 million (7 million Lm) per year. The burden and cost of IID are high enough to justify efforts to control the illness. Such estimates are important to assess the cost-effectiveness of proposed specific interventions.

This study investigated fluoroquinolone, macrolide resistances and serotype distributions among Campylobacter jejuni and Campylobacter coli isolated from children in Bangkok and rural settings during 1991–2000. Phenotypic identification, serotyping, and susceptibility testing were performed by standard microbiological procedures. The predominant serotypes of C. jejuni were Lior 36, 2 and 4 and of C. coli were Lior 8, 29 and 55. Resistance to nalidixic acid increased significantly during 1991–2000 and the frequency of isolates resistant to both nalidixic acid and ciprofloxacin in Bangkok was significantly greater than in rural settings. In 1996–2000, a significant trend was observed in C. jejuni isolates resistant to ciprofloxacin from Bangkok but not for macrolide resistance from both settings. In summary, fluoroquinolone resistance among C. jejuni and C. coli isolates became widespread in both Bangkok and rural settings in Thailand in the 1990s while widespread resistance to macrolides was undetected.

We determined the incidence of cryptosporidiosis in children aged <5 years presenting with diarrhoea in an urban and rural hospital-based setting in Malawi. Stools were collected over a 22-month period during both rainy and dry seasons. A range of microscopic methods were used to determine the presence of Cryptosporidium spp. oocysts. Species determination was by polymerase chain reaction–restriction fragment length polymorphism (PCR–RFLP) of oocyst-extracted DNA using 18S rRNA and COWP gene loci. Cryptosporidium spp. oocysts were seen in 5·9% (50/848) of samples, of which 43 amplified by PCR–RFLP indicated the following species: C. hominis, C. parvum, C. hominis/C. parvum, C. meleagridis and C. andersoni. Seven samples could not be amplified by PCR. Wider species diversity was found in the rural setting, and may be a result of increased malnutrition and zoonotic exposure in this area. Improvements in water, sanitation, household hygiene and animal control are required to reduce the incidence of infection in this population.

Mathematical models are constructed to investigate the population dynamics of Verocytotoxin-producing Escherichia coli (VTEC) serogroups O26 and O103 in two different calf cohorts. We compare the epidemiological characteristics of these two serogroups within the same calf cohort as well as the same serogroups between the two calf cohorts. The sources of infection are quantified for both calf cohort studies. VTEC serogroups O26 and O103 mainly differ in the rate at which calves acquire infection from sources other than infected calves, while infected calves typically remain infectious for less than 1 week regardless of the serogroups. Fewer than 20% of VTEC-positive samples are the result of calf-to-calf transmission. PFGE typing data are available for VTEC-positive samples to further subdivide the serogroup data in one of the two calf cohort studies. For serogroup O26 but not O103, there is evidence for unequal environmental exposure to infection with different PFGE types.

During a surveillance study (2003–2005) in a cattle market in Kolkata city, state of West Bengal, Eastern India, 34 (13·0%) of 260 calves with diarrhoea were positive for group B rotaviruses (GBR) by RNA electrophoresis in polyacrylamide gels. Analysis of the partial VP7 gene sequence of 28 of the 34 GBR strains revealed maximum identities (97·7–99·5% at nucleotide level and 97·8–100% at amino-acid level) with the novel bovine GBR ‘Kolkata strains’ reported in an earlier surveillance study (1·5%, n=192, 2001–2002) from the same cattle market, and shared low identities of 73·7–78·9% and 80·8–89·6%; 62·6–66·2% and 59·8–65·4%; 58·9–62·2% and 48·6–54·9% at nucleotide and amino-acid level with other bovine, human, and murine GBR. The GBR-infected calves were traced to districts in neighbouring states of West Bengal. Therefore, the present study reports a rapid increase in prevalence (13·0% in 2003–2005 against 1·5% in 2001–2002) of novel GBR strains among calves with diarrhoea, and provides evidence for interstate transmission of GBR.

There are no data on the serotypes of rotaviruses prevalent in Kuwait, which has a large expatriate population and hence a focal point for transmission of pathogens. The serotype information will contribute to the fund of knowledge on the world epidemiology of rotavirus serotypes and will predict the outcome of vaccination in Kuwait. Of the 75 rotavirus-positive samples from 172 children (aged <5 years) with severe diarrhoea, 69 were genotyped. The distribution of genotypes was G1 (63·8%) followed by G9 (10·2%), G2 (7·3%), G4 (7·3%) and G3 (4·4%). Among the P types, P[8] was the most common type found across all G types. By fluorescent focus neutralization test, serum antibodies to genotypes G1 (94%), G4 (68%) and G9 (46%) were found in 120 other children. These results show that G1 is the predominant serotype in Kuwait and that a vaccine that contains G1 will be most effective.

Hepatitis B virus (HBV) infection is a worldwide health problem. The aim of the present study was not only to determine the prevalence of HBsAg in children of HBV-infected parents but also to identify all HBSAg-positive family members to protect as many children, in the present and future, as possible. The study was carried out with the participation of 2113 family members (1205 children, 453 mothers, and 455 fathers) at Sivas SSK Hospital, Turkey. They were screened for HBV markers using standard enzyme immunoassay between September 2001 and March 2005. The prevalence of any HBV markers and HBsAg among family members of index cases was 50·5% and 30·5% respectively. HBsAg carrier rate was higher among fathers (61%) than mothers (47%), (P<0·05). The children of mother index cases had higher rates of HBsAg compared with the children of father index cases (P<0·01). Our results suggest that intra-familial childhood horizontal transmission (especially mother-to-child) is important for HBV transmission in the Turkish community, and highlights the need for screening of adult siblings and mothers of adult HBsAg carriers in addition to their spouses and children.

We investigated the comparative seroepidemiology of varicella zoster virus (VZV) in pregnant women of two ethnic groups, white British and Bangladeshi, living in an inner city area of London, United Kingdom. Women aged 16–45 years were recruited from antenatal clinics of the Royal London Hospital in the Borough of Tower Hamlets. Complete data were obtained from 275 white British and 765 Bangladeshi women. VZV antibody prevalence was 93·1% (95% CI 89·4–95·8) and 86·0% (95% CI 83·3–88·4) respectively. Women who were born in Bangladesh and lived there at least until the age of 15 years had the lowest odds of being immune (OR 0·37, 95% CI 0·22–0·63). This implies they will have an increased risk of varicella during pregnancy. Women arriving in the United Kingdom in adulthood should be screened routinely during pregnancy and vaccination offered postpartum if they are susceptible.

A serological survey has been used to investigate the epidemiology of parvovirus B19 infection in England and Wales. A total of 2835 sera representing the complete age range were selected from a convenience collection obtained in 1996 that reflects the general population and screened for parvovirus B19-specific IgG. Antibody prevalence rose nonlinearly with age from 21% in those aged 1–4 years to >75% in adults aged ⩾45 years. Force-of-infection estimates were similar to those previously made in 1991, being highest in those aged <15 years. There was no association between evidence of previous infection and sex or region. Quantitatively strongest antibody responses were found in those aged 15–34 years and IgG levels in females were 28·5% higher than those found in males (P=0·004, 95% CI 8·2–52·6). Applying the upper 95% confidence interval for the force of infection to maternity estimates for England and Wales in 1996, parvovirus infection in pregnancy was estimated to occur on average in up to 1 in every 512 pregnancies each year. This represents 1257 maternal infections, causing up to an estimated 59 fetal deaths and 11 cases of hydrops fetalis annually. An analysis of all available laboratory-confirmed parvovirus infections found a mean of 944 infections per year in women aged 15–44 years highlighting a need for enhanced surveillance of maternal parvovirus B19 infection in England and Wales, including information on both pregnancy and outcome of pregnancy.

For jurisdictions implementing measles elimination strategies, a minimum surveillance benchmark of 1/100 000 population per year measles-like illness (MLI) cases initially notified, but then rejected based on laboratory testing was proposed. We used this standard to assess the quality of the Victorian enhanced measles surveillance between 1998 and 2003. Victorian enhanced measles surveillance includes interviews with notified cases and confirmatory laboratory testing for notifications. We found 72% (918/1281) of measles notifications were discarded after testing. The median annual rate of discard was 2·9/100 000. The annual discard rate was inversely associated with the age of the notifications, and measles negative with no other diagnosis made was the most common laboratory outcome. The annual rates of discarded notifications in Victoria were consistently above the minimum recommended standard. The rate of discarded MLIs as a surveillance threshold should be useful in measles endemic regions, but may require modification where disease elimination has occurred.

Vaginal complaints compel an evaluation of bacterial vaginosis (BV), however, many cases of BV are asymptomatic. We evaluated the sensitivity and specificity of vaginal symptoms in the diagnosis of BV and examined the utility of creating a BV screening tool using clinical, behavioural and demographic characteristics. A total of 1916 pregnant women were included in this analysis. In total, 757 women screened positive for BV and over one third of BV-positive women presented without any lower genital tract symptoms (39·4%). African American race, abnormal vaginal odour, and smoking were independently related to BV positivity. A BV screening tool including these three factors was fairly predictive of BV status with the area under the ROC curve equal to 0·669. This three-item prediction rule may be useful in identifying high- risk pregnant women in need of BV screening and, given the high specificity, accurately identify the group of BV-negative pregnant women.

We used Western Australian emergency department data linked to hospital morbidity, death and microbiology data to describe the bacteriology of pneumonia according to age. The ‘atypical’ organisms and viruses were not assessed. A total of 6908 patients over a 3-year period were given an emergency department diagnosis of pneumonia, 76·9% were admitted and 6·3% died in hospital. Blood was cultured from 52·9% of patients with 6·4% growing potential pathogens. Streptococcus pneumoniae was the most common organism isolated and accounted for 92% of pathogens in those aged <15 years. Isolation of Enterobacteriaceae species tended to increase with age and accounted for around 25% of isolates from the elderly. Sputum was cultured from 25·3% of patients and bacteria were isolated from 30·3% of samples, commonly Haemophilus influenzae and S. pneumoniae. Isolates from sputum showed no distinct trend across age groups. These patterns question the value of routine blood and sputum cultures and have implications for empiric therapy for the elderly.

Acute respiratory infections (ARIs) are the most important infectious cause of death, but there is less information of their burden in the community. This study describes the burden of ARI in a cohort of 50 Iranian families visited weekly over 2 months. Eighty-one out of 113 (72%) children and 29/103 (28%) adults had a total of 124 episodes of ARI. Seventy-five per cent of the episodes occurring in children were primary/co-primary compared to 40% of those in adults (P<0·01). Children were more likely to be the first symptomatic cases and infections were frequently transmitted within the family. Frequencies were lowest among adults, low among infants aged <6 months and highest among children aged <5 years (P<0·01). Winter episodes occurred more frequently in January (P<0·01). The high frequency and apparent transmissibility of ARI in this cohort highlights its enormous burden in the community.

The objective of this case-control study was to identify the main risk factors for community-acquired pneumonia (CAP) in a German adult population. A self-administered questionnaire was given to CAP cases provided by the German competence network CAPNETZ and population-based, randomly selected controls (sex- and age-matched). Multivariate analysis showed that in addition to known risk factors such as previous CAP [odds ratio (OR) 1·6, 95% confidence interval (CI) 1·3–2·1], more than one respiratory infection during the previous year (OR 3·6, 95% CI 2·9–4·5), chronic pulmonary diseases (OR 2·3, 95% CI 1·7–3·0), number of comorbidities (OR 1·6, 95% CI 1·4–1·9), and number of children in the household (2 children: OR 2·2, 95% CI 1·5–3·4; ⩾3 children: OR 3·2, 95% CI 1·5–7·0) were independent risk factors for CAP. This was pronounced in particular in people aged ⩽65 years. The most likely explanation for this finding is higher exposure to infectious agents.