Neisseria meningitidis is transmitted through the inhalation of large human respiratory droplets, but the risk from contaminated environmental surfaces is controversial. Compared to Streptococcus pneumoniae and Acinetobacter baumanni, meningococcal viability after desiccation on plastic, glass or metal surfaces decreased rapidly, but viable meningococci were present for up to 72 h. Encapsulation did not provide an advantage for meningococcal environmental survival on environmental surfaces.

This study aimed to investigate the distribution of congenital toxoplasmosis in the state of Minas Gerais, Southeastern Brazil and describe the demographic and socioeconomic profile of the municipalities associated with the disease. An ecological study was conducted using socioeconomic indicators of a database (MGSSRI) created by Fundação João Pinheiro (a government technical support agency of Minas Gerais), in order to show the development of the municipalities in the state. The prevalence of toxoplasmosis was the outcome and the items of the MGSSRI were the explanatory variables. Of 146 307 newborns screened (November 2006 to May 2007), 190 had congenital toxoplasmosis, yielding a prevalence of 1·3/1000, ranging from 0 to 76·9/1000 in the municipalities. The multivariate model indicated a higher occurrence of toxoplasmosis in municipalities with smaller populations and worse indexes of tax performance. Congenital toxoplasmosis appears to be a neglected disease in the state of Minas Gerais, given the high prevalence found and its concentration in municipalities with worse socioeconomic indexes.

Little is known about the main routes of human cytomegalovirus (HCMV) transmission in young adult populations. This study investigated risk factors for HCMV transmission in young adults attending university over a 3-year period. Blood samples were tested for HCMV specific viral capsid antigen IgG by enzyme immunoassay. Being born in a developing country and having lived in Africa were associated with HCMV seropositivity at study onset. No risk factors were associated with HCMV seroconversion over the 3-year follow-up. In contrast to previous reports, sexual activity was not associated with HCMV seroprevalence or seroconversion.

Several studies have evaluated the association between mannose-binding lectin (MBL) polymorphisms and sepsis. However, the results are inconclusive and conflicting. To better understand the roles of MBL polymorphisms in sepsis, we conducted a comprehensive meta-analysis. All relevant studies were searched from PubMed, EMBASE and Web of Knowledge databases, with the last report up to 7 May 2013. Twenty-nine studies addressing four MBL polymorphisms (–550G/C, –221G/C, structure variant A/O, Gly54Asp) were analysed for susceptibility to sepsis and one study for sepsis-related mortality. Overall, significant associations between structure variant A/O and susceptibility to sepsis were observed for AO + OO vs. AA [odds ratio (OR) 1·27, 95% confidence interval (CI) 1·05–1·52, P = 0·01] and O vs. A (OR 1·19, 95% CI 1·02–1·40, P = 0·03). In subgroup analysis based on age group, increased risk was found in the paediatric group in the dominant model (OR 1·72, 95% CI 1·16–2·56, P = 0·007). Moreover, there was a slight association between the +54A/B polymorphism and susceptibility to sepsis in Caucasians (recessive model: OR 10·64, 95% CI 1·24–91·65, P = 0·03). However, no association was observed for –550G/C and –221G/C polymorphisms both overall and in subgroup analysis. For sepsis-related mortality, only one study suggested AO/OO was associated with in-hospital mortality in pneumococcal sepsis patients after controlling for confounding variables. Our meta-analysis indicated that MBL structure variants might be associated with susceptibility to sepsis but further studies with a large sample size should be conducted to confirm these findings.

Human leptospirosis is found throughout the world, albeit with a higher incidence in tropical regions. In temperate regions it is associated with certain occupational and recreational activities. This paper reports both on the incidence of human leptospirosis in Ireland and on possible associated exposures, using leptospirosis case notification, enhanced surveillance, hospital discharge data and death registrations. Based on official notification data, there was a threefold increase in the reported incidence of leptospirosis in Ireland between 1995–1999 and 2004–2009, which appears partially to be due to improved reporting. The exposures most associated with infection were those involving contact with livestock or water-based recreational sports, in particular kayaking. Advice on prevention should continue to be targeted in the first instance at these groups. The variety of potential transmission routes reported should inform clinicians to consider leptospirosis in individuals with a compatible clinical profile who were not from occupational groups historically considered at risk.

This study analysed the spatio-temporal distribution and propagation of hand-foot-and-mouth disease (HFMD) in Shenzhen from 2008 to 2010. Specifically, we examined the epidemiological data, temporal distribution and spatial distribution, and then the relationship between meteorological, social factors and the number of reported HFMD cases was analysed using Spearman's rank correlation. Finally, a geographically weighted regression model was constructed for the number of reported HFMD cases in 2009. It was found that three independent variables, i.e. the number of reported HFMD cases in 2008 and, annual average temperature and precipitation, had different spatial impacts on the number of reported HFMD cases in 2009. In addition, these variables accounted for the propagation mechanism of HFMD in the centre and east of Shenzhen, where the high incidence rate areas are located. These results will be of great help in understanding the spatio-temporal distribution of HFMD and developing approaches to prevent this disease.

Tuberculosis (TB) remains as an important public health problem worldwide. Therefore, the rapid detection of M. tuberculosis is of primary importance to effectively reduce transmission in patients. The aims of this study were to evaluate two in-house molecular tests: nested PCR (nPCR) and real-time PCR (rtPCR) to detect M. tuberculosis complex directly from clinical samples. The results were compared to the culture results and to the culture results plus clinical data of patients. The rtPCR and nPCR presented high sensitivity (Se) and specificity (Sp) (rtPCR 97·6% and 91·5%, nPCR 85·7% and 92·7%, respectively) compared to culture. When the results of the molecular tests were compared to the culture plus clinical data the Se and Sp were 90·2% and 97·3% for rtPCR and 80·4% and 98·6% for the nPCR, respectively. The results demonstrated that molecular assays of M. tuberculosis can provide a sensitive and rapid diagnostic of TB, and when used in addition to the clinical data of TB patients will help to improve the Sp of the diagnosis of pulmonary TB.

We assessed the role of tuberculosis (TB) disease and HIV infection on the level of physical activity. A combined heart rate and movement sensor was used to assess habitual physical activity in TB patients and non-TB controls. The association between sputum-negative TB, sputum-positive TB, HIV and physical activity estimates were assessed in multivariable linear regression models adjusted for age, sex, haemoglobin and alpha-1-acid glycoprotein (AGP). Sputum-positive [eB 0·43, 95% confidence interval (CI) 0·29–0·64] and sputum-negative (eB 0·67, 95% CI 0·47–0·94) TB as well as HIV infection (eB 0·59, 95% CI 0·46–0·75) were associated with reduced activity compared to controls. Anaemia accounted for a substantial part of the effects of HIV, while elevated AGP primarily mediated the TB effect. The level of physical activity is highly influenced by TB and HIV, and mainly mediated through anaemia of infection and associated with elevated acute phase response.

This nationwide population-based cohort study investigated the risk of tuberculosis (TB) in patients with end-stage renal disease (ESRD) and receiving dialysis. The evaluations included 4131 incident ESRD patients receiving dialysis and 16 524 age- and gender-matched controls, recruited between 1998 and 2009. We used Cox proportional hazards regression analysis to measure the association between TB and ESRD. Compared to the controls, the ESRD cohort had a significantly higher risk of TB within 1 year [incident rate ratio (IRR) 4·13], and 1–2 years (IRR 2·12), of occurrence of ESRD. The Cox proportional hazards model revealed that ESRD [hazard ratio (HR) 2·40], age >65 years (HR 2·41), male sex (HR 1·94), diabetes mellitus (HR 1·36), silicosis (HR 7·70) and chronic obstructive pulmonary disease (HR 1·61) are independent risk factors for TB. Patients with ESRD are associated with an increased risk of TB, and should thus be monitored more carefully for TB, especially within 2 years of onset of ESRD.

Few population-based data are available on factors associated with pneumonic and ulceroglandular type B tularaemia. We conducted a case-control study during a large epidemic in 2000. Laboratory-confirmed case patients were identified through active surveillance and matched control subjects (age, sex, residency) from the national population information system. Data were collected using a self-administered questionnaire. A conditional logistic regression model addressing missing data with Bayesian full-likelihood modelling included 227 case patients and 415 control subjects; reported mosquito bites [adjusted odds ratio (aOR) 9·2, 95% confidence interval (CI) 4·4–22, population-attributable risk (PAR) 82%] and farming activities (aOR 4·3, 95% CI 2·5–7·2, PAR 32%) were independently associated with ulceroglandular tularaemia, whereas exposure to hay dust (aOR 6·6, 95% CI 1·9–25·4, PAR 48%) was associated with pneumonic tularaemia. Although the bulk of tularaemia type B disease burden is attributable to mosquito bites, risk factors for ulceroglandular and pneumonic forms of tularaemia are different, enabling targeting of prevention efforts accordingly.

Models describing dengue epidemics are parametrized on disease incidence data and therefore high-quality data are essential. For Thailand, two different sources of long-term dengue data are available, the hard copy data from 1980 to 2005, where hospital admission cases were notified, and the electronic files, from 2003 to the present, where clinically classified forms of disease, i.e. dengue fever, dengue haemorrhagic fever, and dengue shock syndrome, are notified using separate files. The official dengue notification data, provided by the Bureau of Epidemiology, Ministry of Public Health in Thailand, were cross-checked with dengue data used in recent publications, where an inexact continuous time-series was observed to be consistently used since 2003, affecting considerably the model dynamics and its correct application. In this paper, numerical analysis and simulation techniques giving insights on predictability are performed to show the effects of model parametrization by using different datasets.

In this study, epidemiological factors of sparganosis cases reported in mainland China from 1959 to December 2012 were analysed. A total of 1061 valid cases were distributed throughout most of the provinces of mainland China, with most cases occurring in Southern and Eastern China. The average age of patients was 29 years (range 0–80 years). Modes of transmission to humans were via contact (54·6%), mainly by application of frog meat as a poultice, foodborne (33·8%), mainly through ingesting frogs or snakes, and waterborne (11·5%) through drinking raw water. The tissue/organs involved were subcutaneous/muscle (43·1%), eyes (31·0%), central nervous system (CNS) (17·9%), urogenital system (3·9%) and visceral organs (3·2%). Obvious differences existed in main risk factors for different areas. Close correlation was found between tissue/organs and risk factors. Main modes of transmission changed during the past decades, from contact (83·8% pre-1979) to foodborne (63·9% post-2000). The tissue/organs involved also changed at the same time. Cases involving eyes fell from 50·0% pre-1979 to 8·3% post-2000, and cases involving CNS increased from 0% pre-1979 to 47·8% post-2000. These results illustrate that China is one of the main epidemic countries of sparganosis in the world. Consumption of frog/snake meat was the main risk factor, although application of frog flesh as a poultice was the main risk factor before 2000. Sparganosis has become one of the neglected but important foodborne/waterborne parasitic diseases in mainland China.

In June 2011, a cluster of suspected cases of Guillain–Barré syndrome (GBS), which can follow Campylobacter jejuni infection, was identified in San Luis Río Colorado (SLRC), Sonora, Mexico and Yuma County, Arizona, USA. An outbreak investigation identified 26 patients (18 from Sonora, eight from Arizona) with onset of GBS 4 May–21 July 2011, exceeding the expected number of cases (n = 1–2). Twenty-one (81%) patients reported antecedent diarrhoea, and 61% of 18 patients tested were seropositive for C. jejuni IgM antibodies. In a case-control study matched on age group, sex, ethnicity, and neighbourhood of residence, all Arizona GBS patients travelled to SLRC during the exposure period vs. 45% of matched controls (matched odds ratio 8·1, 95% confidence interval 1·5–∞). Exposure information and an environmental assessment suggested that GBS cases resulted from a large outbreak of C. jejuni infection from inadequately disinfected tap water in SLRC. Binational collaboration was essential in investigating this cross-border GBS outbreak, the first in mainland North America since 1976.

This study assessed the correlations between the incidence of melioidosis and rainfall, wind strength and wind direction in both the flat and hilly regions of Taiwan. Data from the melioidosis and climate databases from 2005 to 2011 were combined and analysed. With the inclusion of a lag time accounting for a possible incubation period for melioidosis, the daily rainfall and wind-speed data were correlated with the number of confirmed melioidosis cases. The incidence of melioidosis in the flat region was related to the wind speed (>19 m/s) and the specific angle (150°, 220°, 280°) of the wind direction. Rainfall is a common environmental factor that contributes to an increase in the incidence of melioidosis in both areas; however, the contribution of wind strength or wind direction to the spread of melioidosis was restricted to areas with specific topographical characteristics, such as hills.

Analysis of the Dutch national invasive pneumococcal disease (IPD) surveillance data by sex reveals an increase in the incidence of serotype-1 disease in young female adults in The Netherlands after the introduction of the 7-valent pneumococcal conjugate vaccine (PCV7) in the national immunization schedule. This has led to an overall increase in IPD in women aged 20–45 years, which was not observed in men of the same age. No other differences in serotype shifts possibly induced by the introduction of PCV7 were observed between the sexes in this age group. Serotype 1 is a naturally fluctuating serotype in Europe and it has been associated with disease in young healthy adults before. It remains uncertain whether or not there is an association between the observed increase in serotype-1 disease in young female adults and the implementation of PCV7 in The Netherlands.

This study aimed to describe Toxoplasma gondii prevalence in Polish pregnant women and the incidence rates of congenital infections in their neonates observed between 2004 and 2012. Serological tests for T. gondii-specific IgG and IgM antibodies were performed on serum samples of 8281 pregnant women treated at the Polish Mother's Memorial Hospital Research Institute in Lodz. The yearly seroconversion rate for T. gondii IgG antibodies was estimated using a mathematical model to determine the dependency between age and prevalence. Mean prevalence of IgG antibodies between 2004 and 2012 in pregnant women was 40·6% [95% confidence interval (CI) 39·6–41·7] and increased with age with a yearly seroconversion rate of 0·8% (95% CI 0·6–1·0, P < 0·001). Assuming a T. gondii materno-fetal transmission rate of 30% gave an estimate of 1·80/1000 neonates as congenitally infected. The increased mean age (28·7 vs 26·7 years, P < 0·001) of pregnant women was probably the most important factor in abolishing the effect of falling prevalence rates.

Neisseria meningitidis is the main cause of bacterial meningitis and sepsis in the UK, and can potentially be lethal or cause long-term sequelae. Bexsero® (4CMenB) is a new multi-component vaccine approved by the European Commission for use in individuals aged ⩾2 months. A theoretical transmission model was constructed to assess the long-term effectiveness of Bexsero compared to standard care. The model was populated with UK-specific demographic data and calibrated to ensure that the transmission dynamics of meningococcal disease in the UK were adequately simulated. The model showed the best strategy to be a routine vaccination programme at ages 2, 3, 4, 12 months and 14 years combined with a 5-year catch-up programme in toddlers aged 12–24 months and adolescents aged 15–18 years. This would lead to a 94% reduction in meningococcal cases or 150 000 cases and 15 000 deaths over a 100-year time-frame.

An outbreak of Microsporum canis infection affected 12 persons in two elementary schools over a period of 48 days in 2012 in Slovenia. Epidemiological, microbiological, and animal investigations were conducted. We defined cases as pupils or employees with skin lesions and confirmed or probable M. canis infection, attending one of the implicated elementary schools. Two clusters of six primary and six secondary cases were included in an unmatched case-control study. Contact with an adopted stray kitten at a birthday party was identified as the most probable source of infection. Secondary cases were more likely to have participated in gymnastic classes with a primary case than controls and were also more likely to have touched an infected child. Prompt communication and implementation of adequate control measures after the primary cases occurred would have prevented the secondary cases in another school.

We previously revealed that Japanese encephalitis virus (JEV) seroprevalence was 4·5% in pigs on Ishigaki Island from 2005 to 2007. However, a partial E gene sequence (151 bp) of the JEV genome (JEV/sw/Ishigaki/1/2005) was detected in one pig. Phylogenetic analysis showed that JEV/sw/Ishigaki/1/2005 belonged to genotype III and to the same lineages isolated in Taiwan from 2006 to 2008. Serum samples were collected from 128 pigs on Ishigaki from 2009 to 2010, 24 wild boars on Ishigaki from 2008 to 2010, and 117 wild boars on Iriomote Island from 2008 to 2010. Four (3·1%) pigs on Ishigaki were positive for JEV antibody, but all wild boars on the island were negative. Fifty-two (44·4%) wild boars on Iriomote were positive for JEV antibody, in contrast to a seroprevalence of 3·7% in 2000 and 2004. JEV on Iriomote and/or in Taiwan might be related to transmission on Ishigaki.