In April 2004, increased numbers of hepatitis A were noted in six neighbouring districts in Germany. Exploratory interviews showed that patients had consumed bakery products from company X where two employees had been diagnosed with hepatitis A in February. A case-control study of consumption of products of company X was carried out through telephone interviews. Altogether, 64 cases were identified. Fifty-two cases and 112 controls aged [ges ]16 years were included in the case-control study. In total, 46/52 cases and 37/112 controls had consumed company X products [odds ratio (OR) 15·5, 95% confidence interval (CI) 6·1–39·7]. Of these, 36/46 cases and 16/37 controls had consumed pastries (OR 4·7, 95% CI 1·8–12·3), 25/46 cases and 12/37 controls had consumed filled doughnuts (OR 2·5, 95% CI 1·0–6·1). Sequence analysis of the VP1-2A junction region indicated 100% strain homology between cases and an infected employee of company X. We recommended reinforcement of hygiene precautions, and consideration of a prolongation of compulsory work absence after post-exposure vaccination.

Underreporting of hepatitis A infection in England may be high and a number of outbreaks have occurred undetected by routine surveillance. We evaluated surveillance of hepatitis A cases by employing capture–recapture analysis on data from two distinct outbreaks of hepatitis A. The overall reporting of cases of hepatitis A was 81·7% (95% CI 55·3–95) in the first outbreak in North East England and reporting through Lab Base was 65·7% (95% CI 42·8–76·4). In the second outbreak in the East Midlands the overall reporting of hepatitis A cases was 27·8% (95% CI 19–38·7) and through Lab Base 16·6% (95% CI 11·4–23·1). Underreporting of hepatitis A cases is high. Public health interventions exist to prevent and control outbreaks of hepatitis A. The lack of reliable data on incidence and prevalence hampers effective public health management of this disease.

A mixture modelling technique is applied to age-specific frequency distributions of quantitative results from serological surveys for measles, mumps and rubella using samples collected across the age range in England and Wales in 2000. In accordance with previous studies the analysis suggests that the antibody response to natural infection is stronger than that produced by vaccination, that vaccine-induced antibody levels wane with time and that levels of vaccine-induced antibody response vary for each virus infection being strongest for rubella and weakest for mumps. The current mumps epidemic in the United Kingdom is focused in cohorts born during 1982–1987 who were too old to have received routine MMR vaccination. In the cohort born in 1981–1985 the model estimates that 7·5% have no evidence of mumps specific IgG and 24·9% have the lowest level of detectable antibody. The similar proportions of mumps antibody in these categories among cohorts with opportunity for 1 or 2 doses of vaccine is a concern, as the degree to which these individuals are protected is unclear. Investigations into the efficacy of two doses of a mumps containing vaccine should be a priority during the current epidemic.

To investigate the emergence and current situation of terrestrial rabies in Cuba, a collection of rabies virus specimens was employed for genetic characterization. These data supported the monophyletic nature of all terrestrial rabies viruses presently circulating in Cuba but additionally delineated several distinct variants exhibiting limited spatial distribution which may reflect the history of rabies spread on the island. The strain of rabies currently circulating in Cuba, which emerged on the island in the early 20th century, has very close evolutionary ties to the Mexican dog type and is a member of the cosmopolitan lineage widely distributed during the colonial period. The Cuban rabies viruses, which circulate predominantly within the mongoose population, are phylogenetically distant from viruses circulating in mongooses in other parts of the world. These studies illustrate, at a global level, the adaptation of multiple strains of rabies to mongoose species which should be regarded as important wildlife hosts for rabies re-emergence. Given the recent emergence of human cases due to bat contact in Cuba, this study also included a single insectivorous bat specimen which was found to most closely resemble the rabies viruses known to circulate in Mexican vampire bats.

We conducted a nested case-control study to determine potential risk factors for developing encephalitis from West Nile virus (WNV) infection. Retrospective medical chart reviews were completed for 172 confirmed WNV cases hospitalized in Houston between 2002 and 2004. Of these cases, 113 had encephalitis, including 17 deaths, 47 had meningitis, and 12 were fever cases; 67% were male. Homeless patients were more likely to be hospitalized from WNV compared to the general population. A multiple logistic regression model identified age [odds ratio (OR) 1·1, P<0·001], history of hypertension, including those cases taking hypertension-inducing drugs (OR 2·9, P=0·012), and history of cardiovascular disease (OR 3·5, P=0·061) as independent risk factors for developing encephalitis from WNV infection. After adjusting for age, race/ethnicity (being black) (OR 12·0, P<0·001), chronic renal disease (OR 10·6, P<0·001), hepatitis C virus (OR 23·1, P=0·0013), and immunosuppression (OR 3·9, P=0·033) were identified as risk factors for death from WNV infection.

A micro-epidemic of hantavirus infections occurred in Lower Bavaria, South-East Germany, starting in April 2004. While only three cases were registered from 2001 to 2003, a dramatically increased number of clinically apparent human hantavirus infections (n=38) was observed in 2004, plus seven additional cases by June 2005. To determine the reservoir responsible for the infections, a total of 43 rodents were trapped in Lower Bavaria. Serological and genetic investigations revealed that Puumala virus (PUUV) is dominant in the local population of bank voles. Partial PUUV S segment nucleotide sequences originating from bank voles at four different trapping sites in Lower Bavaria showed a low divergence (up to 3·1%). This is contrasted by a nucleotide sequence divergence of 14–16% to PUUV strains detected in Belgium, France, Slovakia or North-Western Germany. PUUV sequences from bank voles in Lower Bavaria represent a new PUUV subtype which seems to be responsible for the observed increase of human hantavirus infections in 2004–2005.

We estimated the number of deaths in France for the year 2000 in HIV-infected adults using three sources. The sources were (1) the ‘Mortalité 2000’ survey (M2000): 964 deaths were documented by 185 hospital wards involved in HIV management; (2) 1288 death certificates with a mention of HIV infection (INSERM-CepiDc) and (3) the French hospital database on HIV infection (FHDH) identified 654 deaths. The capture–recapture method was used with log-linear modelling. Overall 1559 deaths were observed. Estimation of the number of deaths in France was 1699 (95% CI 1671–1727). The completeness of M2000, CepiDc and FHDH were 55%, 76% and 38% respectively. Diversification of diseases and of causes of death in HIV-infected adults may explain: (1) the diversification of physicians involved in their management and incomplete coverage of M2000 and FHDH, and (2) why HIV infection was not mentioned in all death certificates.

The aim of this study is to assess the effects of immigration from countries with a high prevalence of tuberculosis (HPCs), of HIV/AIDS prevalence, and the ageing of the indigenous population, on tuberculosis distribution in a low-prevalence area (LPCs), the Piedmont Region of Italy. Tuberculosis incidence and HIV cases were identified by linking records from the surveillance systems. Overall, 640 tuberculosis cases were identified and crude annual incidence was found to be 17·3/100000. The incidence rate ratio for HIV infection as a risk factor for tuberculosis (11·4 and 51·9 among individuals from HPCs and LPCs respectively) was greater than that for immigration from HPCs (6·7 and 30·9 among HIV+ and HIV− individuals). Immigration accounted for a larger number of incident cases [population attributable risk % (PAR %): 31·8 and 52·8% among HIV+ and HIV− individuals] than did HIV infection (PAR %: 5·4 and 11·1% among individuals from HPCs and LPCs). Efforts should be made to identify and treat young immigrants from HPCs.