This review examines the current situation of bovine tuberculosis (bTB) in southern African savannah systems, and uses theory on multi-species host–pathogen systems to suggest possible options for future research and management. In southern Africa, the buffalo (Syncerus caffer) and the Kafue lechwe [Marsh antelope] (Kobus leche) have been found to be maintenance hosts for this disease, but the importance of other host species is becoming apparent. The role of other host species in the maintenance and spread of the disease varies, depending on the spatial distribution and resource utilization patterns of the species, disease susceptibility, transmission modes and the ecology of both host(s) and vector(s). Future research needs to identify the pathogenicity of bTB in each of the host species, and the mechanisms and rates of inter- and intra-specific transmission among different species, in order to develop multi-host models to understand the development and spread of the disease.

Between 1992 and 2004, a total of 49 819 confirmed hepatitis C infections have been reported to the Health Protection Agency (HPA) by laboratories in England and Wales; the annual number of reports increased from 241 in 1991 to 8149 in 2004. Most reports with a known risk factor were in injecting drug users (87%, 12 438/14 221), but 71% (35 598/49 819) of the total had no reported identified risk. The age-sex distribution of the latter cases was similar to that in injecting drug users. Using names to assign ethnicity, individuals with South Asian names had an older age distribution and a different risk factor profile from non-South Asians. Using published age-specific prevalence data from 1996, it was estimated that around 281 764 cases of hepatitis C infection exist in England and Wales, and that only 17% of these cases have been reported to the HPA. Surveillance reports continue to provide important information regarding trends in hepatitis C infection in specific risk groups.

The aim of the study was to determine whether rates of hepatitis A infection are higher in people of South Asian origin compared to the general population, to look for evidence of spread to the general population, and to identify ways to improve preventive strategies. Routine laboratory reports of hepatitis A infection in England and Wales in 1992–2004 were analysed. Study participants were patients with confirmed hepatitis A infection reported to the Health Protection Agency by the diagnosing laboratory. Nam Pehchan software was used to identify patients of South Asian ethnicity. Main outcome measures were comparison of incidence of hepatitis A in South Asian and non-South Asian groups, by age and region. Rates of infection were significantly higher in the South Asian group compared to the non-South Asian group (rate ratio 2·68, 95% confidence interval 2·07–3·47). Patients in the South Asian group had a younger age distribution. Travel was an important risk factor with 85% of those of South Asian origin acquiring their infection abroad, most frequently in the Indian subcontinent, compared to less than one third of those in other groups. Health-care professionals should ensure that all travellers to high-risk countries are protected by hepatitis A vaccination. Targeted information campaigns may be indicated in regions of the United Kingdom for people in South Asian minority ethnic groups.

The objective of this study is to evaluate how increasing MMR infant vaccination coverage in recent years has modified the epidemiology of rubella in Italy. A cross-sectional population-based seroprevalence study of rubella antibodies was conducted on 3094 sera, in 2004, and results were compared with data obtained by the same method in 1996. The overall proportion of rubella-seropositive individuals was found to be significantly higher in 2004 with respect to 1996 (84·6% vs. 77·4%). However, an increase in seropositivity was observed only in the 1–19 years age groups. Recent increases in childhood MMR vaccination coverage, therefore, have not had an impact on seroprevalence in women of childbearing age, over 5% of whom remain susceptible to rubella. Preconception screening and postpartum vaccination of susceptible women are fundamental if the WHO target of less than one case of congenital rubella syndrome per 100 000 live births is to be attained.

This investigation was undertaken to provide detailed information on the epidemiology of human parvovirus B19 (B19) infection during pregnancy and childhood in the western part of Germany. Between 1997 and 2004, 40 517 sera from pregnant women aged 17–45 years and 6060 sera from children and young adults were tested for B19 IgG and IgM in our laboratory. In pregnant women, both the history of a ‘specific’ (OR 7·7, 95% CI 5·2–11·4) and a ‘non-specific’ rash (OR 3·3, 95% CI 1·5–7·1) was predictive for B19 IgM positivity. The B19 IgG prevalence was 69·2% (4097/5924) in a subgroup of asymptomatic pregnant women screened for B19 antibodies. In children, the age-specific IgG-positivity rate increased from 12·2% (66/541) at 2 years of age to 71·9% (396/551) in those older than 10 years. In conclusion, the prevalence of B19 IgG in pregnant women from the western part of Germany is higher then previously reported. Contact with children aged 3–10 years is a major risk factor for exposure to B19. Pregnant women with the history of a ‘non-specific’ rash should also be evaluated for acute B19 infection.

The purpose of this work was the molecular study of the virus strain that caused the last measles outbreak in Greece. Twenty-four saliva specimens were obtained from selected patients serologically confirmed as measles cases between December 2005 and March 2006. Measles virus (MV) detection was performed by a nested RT–PCR. The 447-bp segment of the N gene of these MV strains was used for genotyping. The N gene sequences of the Greek MV strains were identical to each other, therefore a phylogenetic tree was constructed using one representative MV (ThesGRE/06). Our data show that the MV strain which caused the 2005–2006 outbreak in Greece belongs to genotype D6, and differs by 0·68% from the New Jersey D6 strain and by 5·5% from the MV vaccine strain Edmonston B (U03656) belonging to genotype A.

It is uncertain whether hospitalization among patients with congestive heart failure (CHF) increases during the influenza season. This retrospective cohort study used influenza surveillance data from the United States (1986–1987 to 1990–1991), clinical information from the Studies of Left Ventricular Dysfunction (SOLVD) database, and daily temperature data from the National Climatic Data Center to assess the effect of influenza season on hospitalizations in this cohort of patients. The overall hospitalization rate was higher during influenza seasons compared to non-influenza seasons [relative risk (RR) 1·08, 95% confidence interval (CI) 1·01–1·16]. Multivariable Cox modelling revealed an adjusted hazard ratio (HR) of 1·11 for hospitalization during the influenza season (95% CI 1·03–1·20, P=0·005). Overall death rates were also higher during influenza seasons than non-influenza seasons (RR 1·09, 95% CI 0·97–1·21), but the corresponding adjusted HR for death was not significant (HR 1·01, 95% CI 0·98–1·24, P=0·11). Patients with CHF have a greater risk of hospitalization during the influenza season than in the non-influenza season, supporting the current belief that patients with CHF should be regarded as a high-risk group.

The United States national mortality statistics and HIV/AIDS surveillance data were analysed to determine trends in encephalitis-associated deaths and to assess the impact of HIV infection on those deaths during 1979–1998, a period when ICD-9 codes were used for coding deaths in the United States. A total of 25 125 encephalitis deaths were reported; 4779 of them (19%) had concurrent HIV infection. Overall encephalitis death rates remained stable, but they increased for groups where HIV infection was common and declined or remained unchanged for others. For persons without HIV infection, the rates declined in all demographic groups. Encephalitis deaths in HIV-infected persons followed general trends for HIV deaths in the United States. The rates in the HIV-infected population were several hundred- to thousand-fold higher than in the HIV-uninfected population. HIV infection was largely responsible for the lack of overall decline in the considerable mortality associated with encephalitis in the United States during 1979–1998.

The aims were to assess the prevalence of HIV infection among young adult heroin users, including injecting heroin users (IHUs) and non-injecting heroin users (NIHUs), and to explore the differences by gender and other factors. The design was a cross-sectional cohort study between April 2001 and December 2003, which included 961 current heroin users (HU), aged 18–30 years: 422 in Madrid, 351 in Barcelona and 188 in Seville; 621 were IHUs and 340 were NIHUs. All were street-recruited by chain referral methods. Face-to-face interviews were conducted using a structured questionnaire with computer-assisted personal interviewing (CAPI). Samples for HIV testing (dried blood spot) were collected and tested with ELISA and Western Blot. Bivariate, logistic regression, and classification and regression tree analyses were performed. The overall prevalence of HIV infection among IHUs was 25·8% (95% CI 22·3–29·3) [32·4% (95% CI 26·6–38·1) in Madrid, 20·5% (95% CI 15·6–25·4) in Barcelona, and 20·6% (95% CI 9·8–31·4) in Seville], whereas in NIHUs it was 4·0% (95% CI 2·1–6·7), with no differences among cities. The prevalence was significantly higher in women than in men in NIHUs (10·9%, 95% CI 4·3–17·5 vs. 1·7%, 95% CI 0·5–4·2) and was non-significantly higher in IHUs (30·4%, 95% CI 23·0–37·8 vs. 24·1%, 95% CI 20·1–28·1). HIV prevalence in short-term IHUs was 12·9% (CI 8·8–17·02), with no differences among cities. In the logistic analysis, the variables associated with infection in IHUs were ever having injected with used syringes (OR 3·4, 95% CI 2·2–5·3), ever having been in prison (OR 2·6, 95% CI 1·6–4·0), and heroin as the first drug injected at least weekly (OR 2·3, 95% CI 1·1–4·5). Factors positively associated with HIV infection in NIHUs were female sex (OR 8·7, 95% CI 2·6–29·2) and age >25 years (OR 3·1, 95% CI 0·9–11·1), while primary educational level was inversely associated (OR 0·26, 95% CI 0·1–0·9). Although there are important geographic differences, HIV prevalence in IHUs remains high, even in short-term IHUs, whereas it was almost six times lower in NIHUs. The prevalence in women is higher than in men, particularly among NIHUs. A wide range of preventive strategies should be developed, aimed primarily at empowering women to negotiate safe sex.

Previous serological studies on the Arara do Laranjal Indian group revealed extensive HTLV-2 infections. A collection of 97 new samples from the Arara were found repeatedly negative using three different commercial enzyme immunoassays. Eight samples that exhibited optical density readings close to the cut-off value were re-evaluated using Western blot (GeneLab 2.4, Singapore) assay. One sample was found to be non-reactive, five exhibited indeterminate patterns, one was classified as HTLV, and one was confirmed as HTLV-2. Peripheral blood mononuclear cell DNA of the eight samples were subjected to nested PCR and restriction fragment length polymorphism (RFLP) analysis of the pX and env regions, and nucleotide sequencing of the 5′-LTR region. All produced amplification products of pX, but env could be amplified in only one sample with the commonly used primers. RFLP analysis of the pX region using TaqI confirmed HTLV-2 infection. Nucleotide sequencing of the 5′-LTR region was performed in three samples (HTLV-2, HTLV and indeterminate based on Western blot pattern). Phylogenetic analysis of a 449-nt fragment using the Neighbour-Joining method clearly demonstrated that the three samples clustered within the HTLV-2c molecular subtype. The present study confirms the wide dissemination of the HTLV-2c subtype among linguistically and culturally distinct Amazonian Indian groups, and emphasizes the unique occurrence of infection by this subtype in Brazil. Moreover, it emphasizes the limitation of employing the present serological screening assays in blood banks, epidemiological studies, and the importance of molecular assays in the confirmatory procedures for the primary detection of HTLV-2 infections.

Ebola is a highly lethal virus, which has caused at least 14 confirmed outbreaks in Africa between 1976 and 2006. Using data from two epidemics [in Democratic Republic of Congo (DRC) in 1995 and in Uganda in 2000], we built a mathematical model for the spread of Ebola haemorrhagic fever epidemics taking into account transmission in different epidemiological settings. We estimated the basic reproduction number (R0) to be 2·7 (95% CI 1·9–2·8) for the 1995 epidemic in DRC, and 2·7 (95% CI 2·5–4·1) for the 2000 epidemic in Uganda. For each epidemic, we quantified transmission in different settings (illness in the community, hospitalization, and traditional burial) and simulated various epidemic scenarios to explore the impact of control interventions on a potential epidemic. A key parameter was the rapid institution of control measures. For both epidemic profiles identified, increasing hospitalization rate reduced the predicted epidemic size.

By mid-2005, less than 17% of smallpox vaccine doses distributed to American states for health-care workers (HCWs) during the CDC campaign had been used. To understand how states responded, vaccination patterns were studied. Metrics were calculated to compare the level of preparedness for a smallpox outbreak in terms of absolute numbers of HCWs vaccinated compared to the percentage of doses distributed to each state, the rate of vaccination per capita population, and the percentage of HCWs vaccinated compared to the number the CDC recommended. States were then ranked. Results showed that rankings for all four metrics were statistically different (P<0·0001). In addition, when ranks were assigned to quartiles, the states directly affected on 9/11/01 ranked lowest and states widely perceived to be at lower terror risk ranked in the top. These results underscore the need to critically examine how to define an appropriate level of preparedness for a smallpox outbreak.

Tuberculosis incidence in New York City (NYC) declined between 1992 and 2000 from 51·1 to 16·6 cases per 100 000 population. In January 2001, universal real-time genotyping of TB cases was implemented in NYC. Isolates from culture-confirmed tuberculosis cases from 2001 to 2003 were genotyped using IS6110 and spoligotype to describe the extent and factors associated with genotype clustering after declining TB incidence. Of 2408 (91·8%) genotyped case isolates, 873 (36·2%) had a pattern indistinguishable from that of another study period case, forming 212 clusters; 248 (28·4%) of the clustered cases had strains believed to have been widely transmitted during the epidemic years in the early 1990s in NYC. An estimated 27·4% (873 minus 212) of the 2408 cases were due to recent infection that progressed to active disease during the study period. Younger age, birth in the United States, homelessness, substance abuse and presence of TB symptoms were independently associated with greater odds of clustering.

Within the European Union (EU), documenting the burden of invasive pneumococcal disease (IPD) in infants and children is important for coordinating effective pneumococcal immunization policies. Our objective was to document the burden of IPD in countries of the EU plus Switzerland and Norway. European affiliates of Wyeth Vaccines made available recent epidemiological data on IPD from local disease surveillance programmes, including unpublished sources. Recent literature and websites were also searched to provide as wide a representation as possible. This included OVID and abstracts from a number of international meetings, dating from the year 2000. The reported rates of paediatric IPD per 100 000 (age) ranged from a low of 1·7 (<2 years) to 4·2 (2–15 years) in Sweden to a high of 93·5 to 174 (<2 years) to 56·2 (<5 years) in Spain. The percentage of circulating serotypes causing IPD that are covered by 7-valent pneumococcal conjugate vaccine (PCV) IPD serotype coverage ranged from 60% to 80% for European children aged <2 years. Under reporting, differences in reporting methods, antibiotic prescribing and disparities in blood-culturing practices may explain the differences in reported disease incidence. Because of the excellent clinical efficacy of the PCV against IPD, national pneumococcal vaccination programmes in Europe have the potential to prevent much morbidity and mortality.

The incidence of invasive meningococcal disease (IMD) in Germany in 2003 was estimated by the two-source capture–recapture method. As a unique personal identifier was unavailable, cases with IMD tested at the National Reference Centre for Meningococci (NRZM) were matched with cases reported to the Robert Koch Institute (RKI) through the statutory surveillance system by using demographic and disease-specific variables common to both datasets. The estimated overall incidence was 1·1 IMD cases/100 000 inhabitants, with a sensitivity of ascertainment of 64·8% for NRZM and 89·4% for RKI. Case-fatality rate was estimated at 8·8%. Adjustment for heterogeneity of capture according to age, region and serogroup observed in the NRZM (but not RKI) source had minimal effect on the estimated incidence. The IMD incidence estimated by capture–recapture analysis is thus only slightly higher than through statutory surveillance data. As a degree of positive dependence between the systems cannot be ruled out, this estimate may still be an underestimate. However, under ascertainment appears insufficient to explain the low incidence of IMD in Germany compared to other European countries.

The minimum inhibitory concentration (MIC) of five antibiotics and the presence of resistance genes was determined in 163 Haemophilus influenzae isolates collected over 13 years (1987–2000) in four two-yearly sampling periods from patients with respiratory tract infections. The prevalence of β-lactamase-negative ampicillin-susceptible strains was approximately 80% over the sampling period although fewer strains (65·9%) were recovered in the period 1995–1997. TEM-1 type β-lactamase-producing strains were less frequent starting at 15·6% and declining to 2·2% in the final sampling period. Low-β-lactamase-negative ampicillin-resistant (BLNAR) strains were uncommon in 1987–1989 (2·2%), peaked to 19·5% in 1995–1997, but fell back to 11·1% by 2000. Fully BLNAR strains were not detected until the last sampling period (6·7%). The MICs of ampicillin, levofloxacin, cefditoren and ceftriaxone remained stable but there was an eight-fold increase in the MIC of cefdinir over the sampling period. Pulsed-field gel electrophoresis of DNA digests showed that three representative BLNAR strains were genetically distinct and 11 DNA profiles were identified among 17 low-BLNAR strains. These data suggest that the number of genetically altered BLNAR and low-BLNAR strains are increasing in Japan.

Fasciolosis, caused by trematodes of the genus Fasciola, is an emerging disease of humans. One of the highest levels of human fasciolosis hepatica is found amongst the indigenous Aymaran people of the Northern Bolivian Altiplano. A meta-analysis of epidemiological surveys from 38 communities in the region demonstrates that fasciolosis has been endemic in the region since at least 1984 and is a zoonosis of rural communities. Human and bovine fasciolosis is associated with the communities lying in the plain from Lake Titicaca to La Paz, predominantly in the Los Andes province. In Los Andes incidences of up to 67% of population cohorts were found, and prevalence is age-related with the highest infection rate in children aged 8–11 years.

This study investigated the identification and antimicrobial susceptibility testing of Salmonella isolates in Northern Ireland during 2001–2003. All six participating hospital laboratories used similar methods. Identification and antimicrobial resistance of human enteric (n=897) Salmonella isolates were analysed by retrospective collation of laboratory records. Resistance of human Salmonella isolates to nalidixic acid was 16% but resistance to ciprofloxacin or cefotaxime was rare (<1%). Minor inter-laboratory variations in sensitivity testing practices make it difficult to compare antimicrobial sensitivity results reliably and also to monitor for epidemic clones such as S. Typhimurium DT104 with the ACSSuT resistance pattern. The outcome of this study was the adoption of a standardized regional approach to the isolation of salmonella antimicrobial resistance. This should improve epidemiological monitoring of epidemic clones and assure optimum treatment options are available. In cases of treatment failure, MICs to third-generation cephalosporins and ciprofloxacin should be determined.

Thirty-five isolates of Shigella sonnei from patients with diarrhoea in three geographic regions of Argentina were examined for genetic diversity by pulsed-field gel electrophoresis (PFGE) and plasmid profile. PFGE of XbaI and BlnI DNA digests confirmed the occurrence of outbreaks in two regions caused by two separate predominant clones of S. sonnei. The third region was characterized by three circulating clones, one of which was possibly associated with an outbreak. Similar plasmids were found in distinct clones and in one outbreak clone five different plasmid profiles were identified. Antimicrobial resistance of the isolates varied from fully susceptible to the agents tested, to resistance to cotrimoxazole, ampicillin and ciprofloxacin. Antibiotic resistance did not correlate with plasmid content. This information will form the basis for active surveillance of shigellosis in Argentina and elsewhere in the region through the PulseNet International Network.

The distribution of three putative adhesin genes in 123 Shiga toxin-producing (STEC) strains was determined by PCR. The STEC strains were isolated from human patients (n=90) and food (n=33) and were characterized by serogroup, virulence markers (eae, stx1, stx2) and adherence factors (efa1, lpfAO157, saa) genes. Serogroups O157 (64·4%) and O26 (28·8%) were the most frequent among human strains and the majority (60·6%) of food strains were serologically non-typable. The adhesin genes efa1 (90%) and lpfAO157 (73·3%) were the most common in humans strains and saa (45·5%) in food strains. The presence of these genes in addition to eae in STEC from different sources may suggest a relevant role in their pathogenesis.