The unexpected appearance of fatal encephalitis in six elderly people living in New York in 1999, heralded the re-birth of arbovirology in the United States of America. The subsequent rapid spread through North America and impact of the disease on humans, birds, horses and a wide range of other species including alligators and frogs, has brought West Nile virus (WNV) to the attention of governments and the media, worldwide. The response of the public in the United Kingdom has not been hysterical, despite being fuelled by press reports that scientists have demonstrated the presence of WNV antibodies in birds in the UK. Nevertheless, concern has been expressed by government bodies either directly or indirectly connected with the potential health problems that could arise if WNV was introduced and caused the same degree of morbidity and mortality as that seen in the USA. Is the concern justified and are we likely to see significant health problems associated with WNV if this virus is confirmed to be present and circulating amongst birds in the UK? In this review I shall try to put the virus in its true context and assess the risks that WNV might pose both to animals and humans in the United Kingdom.

When applicable, case-crossover studies may be quicker and cheaper to complete than case-control studies. Because time is a major issue in outbreak investigations, we evaluated the interest of this design during a continuous common source food-borne outbreak of salmonellosis for which the vehicle (hamburgers) was also implicated by environmental and laboratory investigations. Seventeen of the 35 cases identified in the outbreak were included in the study according to the availability of menu records with detailed information on food consumed at each meal. Food exposures during a 3-day risk period before onset of illness were compared to those of a control time-interval of the same duration that preceded the risk period by two days. Seventy-seven per cent of the cases (13/17) had consumed hamburgers in the three days preceding onset of illness compared with 29% (5/17) during the control period (P=0·04, odds ratio=5, 95% CI: 1·1–46·9). In this investigation the case-crossover design proved to be a useful and efficient alternative to the case-control approach. However, further evaluation of this design in outbreak investigation is needed.

In Europe, two bat lyssaviruses referred to as European bat lyssaviruses (EBLVs) types 1 and 2 (genotypes 5 and 6 respectively) which are closely related to classical rabies virus are responsible for an emerging zoonosis. EBLVs are host restricted to bats, and have been known to infect not only their primary hosts but also in rare circumstances, induce spillover infections to terrestrial mammals including domestic livestock, wildlife and man. Although spillover infections have occurred, there has been no evidence that the virus adapted to a new host. Since 1977, four human deaths from EBLVs have been reported. None of them had a record of prophylactic rabies immunization. Only fragmentary data exist about the effectiveness of current vaccines in cross-protection against EBLVs. It is clear that EBLV in bats cannot be eliminated using conventional strategies similar to the control programmes based on vaccine baits used for fox rabies in Europe during the 1980s. Due to the protected status of bats in Europe, our knowledge of EBLV prevalence and epidemiology is limited. It is possible that EBLV is under-reported and that the recorded cases of EBLV represent only a small proportion of the actual number of infected bats. For this reason, any interaction between man and bats in Europe must be considered as a possible exposure. Human exposure through biting incidents, especially unprovoked attacks, should be treated immediately with rabies post-exposure treatment and the bat, where possible, retained for laboratory analysis. Preventative measures include educating all bat handlers of the risks posed by rabies-infected animals and advising them to be immunized. This review provides a brief history of EBLVs, their distribution in host species and the public health risks.

A sustained increase in Salmonella enterica serovar Virchow notifications in South Eastern Australia between September 1997 and May 1998 instigated a case-control study and environmental investigations. Cases were defined as having locally acquired culture-confirmed S. Virchow phage-type 8 infection and diarrhoeal disease. Matched controls were selected by progressive digit dialling based on cases' telephone numbers. An exposure and food history questionnaire was administered by telephone. Phage typing and pulse field gel electrophoresis were performed on case and environmental isolates. Thirty-two notifications of S. Virchow infection met the case definition, 37% reported bloody diarrhoea and S. Virchow was isolated from blood in 13% of cases. Twelve patients were admitted to hospital and one died. Fresh garlic (OR 4·1, 95% CI 1·3–12·8) and semi-dried tomatoes (OR 12·6, 95% CI 1·5–103·1) were associated with these cases. The associations remained significant after adjusting for sex and age. S. Virchow (PT 8) was cultured from two brands of semi-dried tomatoes associated with cases in two different states. We provide sufficient evidence for semi-dried tomatoes and fresh garlic to be considered as potential risk foods in future Salmonella outbreak investigations.

In 1999–2000 we conducted a one-year, retrospective population-based survey in Norway to estimate the incidence of gastroenteritis and study the association with selected exposures. A self-administered questionnaire was mailed to 3000 persons selected at random from the population registry, with 250 persons being contacted each month. The response rate was 61%. The incidence of acute gastroenteritis was 1·2 per person-year. The incidence was higher for women than for men. Of the total of 171 cases, 29 (17%) consulted a physician, 13 (8%) reported that a stool sample was taken, and 7 (4%) were admitted to hospital. Among children aged less than 15 years, drinking water from a private water supply was associated with illness, while using chlorinated water was protective. Among adults aged 20–40 years, travelling abroad was associated with illness. The incidence in our survey is similar to rates found by FoodNet in United States.

A total of 102 Escherichia coli strains belonging to serogroups O127 and O142 were examined for genotypic and phenotypic characteristics. The most frequent serotypes found were O127[ratio ]H21, O127[ratio ]H40 and O142[ratio ]H34. The virulence properties were evaluated by adhesion to HeLa cells and hybridization with gene probes for diarrhoeagenic E. coli. Most strains in the two serogroups were categorized as enteropathogenic E. coli, but enteroaggregative E. coli was also detected in both serogroups. All strains that carried the eae sequence presented the LEE region inserted in selC. Five ribotypes were detected in serogroup O127 and four in serogroup O142 and a correlation between serotypes and ribotypes was observed mainly in serogroup O142.

In winter 2001, an outbreak of pertussis involving an estimated 75 people occurred among soldiers serving in an infantry regiment of the Israeli Defense Forces (IDF). Nasopharyngeal swabs were obtained from patients and contacts for culture and PCR. Serum samples were obtained and assayed by ELISA for the presence of IgA, IgM and IgG antibodies to a lysate antigen of Bordetella pertussis. The calculated attack rate was 21% based on clinical signs alone (cough lasting 30 days or longer) and 9·5% based on clinical signs with laboratory confirmation (by PCR, IgA or IgM). A high carriage rate was observed; 20% of the asymptomatic and previously symptomatic subjects were PCR-positive for B. pertussis. These findings emphasize the importance of B. pertussis as a causative agent of epidemic respiratory infections in young adults and reveal the occurrence of a significant proportion of pertussis transient carriers during an outbreak of the disease.

Blood samples were taken from 50 finishing pigs at 90–105 kg in each of 59 randomly selected farrow-to-finish herds. The sera were tested for antibodies to Salmonella enterica by the Danish mix-ELISA. Samples with an optical density of >10% were considered to be positive. Associations between the odds of seropositivity of pigs and possible risk factors were evaluated in multivariable logistic regression models. The results of the analysis indicated that pigs fed non-pelleted dry or wet ration had 11 (P=0·0004) or 9 (P=0·02) times, respectively, lower odds of seropositivity than those fed pelleted ration. The risk of seropositivity was 4 (P=0·0006) times higher in pigs fed a combination of chlortetracycline, procaine penicillin and sulphamethazine during fattening than in those fed an approved growth promotor or a probiotic.

Group B streptococcal isolates (n=159) from the three Dublin maternity hospitals, were serotyped and analysed for the bac, bca, hylB, pepB, and rib genes. The serotype distribution of the isolates was Ia, 19·5%; Ib, 18·9%; II, 10·7%; III, 29·5%; IV, 1·9%; V, 15·1%; non-typeable, 4·4%. There was a statistically significant association between the serotype and invasive status (carriage or infection) of isolates (P<0·005), but no significant association between serotype and degree of invasiveness was demonstrated. The presence or absence of each analysed gene was not associated with the invasive status of isolates. Statistically significant associations were revealed between bca and hylB (IS1548) (P=0·0004) and between bac and bca (P=0·0l4). The bac, bca, hylB (IS1548) and rib genes and the numbers of tandem repeats in the bca gene showed significant associations with serotype. Almost 50% of serotype III isolates possessed at least one of the bac and bca genes and 55–65% of strains of serotypes Ia, Ib and II possessed the rib gene. Most serotype III isolates had IS1548 in their hylB genes. Serotype Ib was the only serotype in which more than half of the strains contained more tandem repeats in the bca gene than the overall mean for the GBS population studied of 7·4 repeats. These findings indicate that some previously reported associations between putative virulence factors and GBS disease require further study and clarification.

Salmonella enterica serotype Enteritidis is an important serovar comprising 76% of salmonella isolates in Portugal in 2001.

For better understand the epidemiology of salmonellosis, a total of 47 isolates of S. Enteritidis phage type (PT) 1b and 6a were analysed by pulsed-field gel electrophoresis (PFGE) and genomic DNA was subjected to macro restriction with XbaI. For PT1b isolates, only three different patterns were observed, and PT6a showed a total of 10 digestion patterns. Curiously, the main pattern among PT1b isolates seams quite similar to main pattern of PT6a isolates, but when the two patterns were analysed with Bionumerics, we observed that they exhibited some differences. It was concluded that, in 2001, there was one predominant pattern for PT1b and PT6a and, possibly, we were in presence of clonal strains that exists all over the country.

The Veterans Health Administration (VHA) of the Department of Veterans Affairs tracks legionella disease in the system of 172 medical centres and additional outpatient clinics using an annual census for reporting. In fiscal year 1999, 3·62 million persons were served by the VHA. From fiscal year 1989–1999, multiple intense interventions were carried out to decrease the number of cases and case rates for legionella disease. From fiscal year 1992–1999, the number of community-acquired and healthcare-associated cases decreased in the VHA by 77 and 95·5% respectively (P=0·005 and 0·01). Case rates also decreased significantly for community and healthcare-associated cases (P=0·02 and 0·001, respectively), with the VHA healthcare-associated case rates decreasing at a greater rate than VHA community-acquired case rates (P=0·02). Over the time of the review, the VHA case rates demonstrated a greater decrease compared to the case rates for the United States as a whole (P=0·02). Continued surveillance, centrally defined strategies, and local implementation can have a positive outcome for prevention of disease in a large, decentralized healthcare system.

Escherichia coli O157 infections cause an estimated 60 deaths and 73000 illnesses annually in the United States. A marked summer peak in incidence is largely unexplained. We investigated an outbreak of E. coli O157 infections at an agricultural fair in Ohio and implicated consumption of beverages made with fairground water and sold by a geographically localized group of vendors who were all on the same branch of the fairground water distribution system. To examine county fair attendance as a risk factor for infection, we conducted two further epidemiological studies. In the first, we enhanced surveillance for E. coli O157 infections in 15 Northeast Ohio counties during the 2000 agricultural fair season and showed increased risk of E. coli O157 infection among fair attendees. In the second study, we examined Ohio Public Health Laboratory Information Service (PHLIS) data for 1999 using a time-varying covariate proportional hazards model and demonstrated an association between agricultural fairs and E. coli O157 infections, by county. Agricultural fair attendance is a risk factor for E. coli O157 infection in the United States and may contribute to the summer peak in incidence. Measures are needed to reduce transmission of enteric pathogens at agricultural fairs.

The number of registered leprosy patients world-wide has decreased dramatically after extensive application of WHO recommended Multiple Drug Therapy (MDT). The annual number of new cases has, however, been almost unchanged in several populations, indicating that the infection is still present at community level. Nasal carriage of Mycobacterium leprae DNA was studied in Lega Robi village in Ethiopia. MDT had been applied for more than ten years, and 718 residents over 5 years old were eligible for the study. During the first survey nasal swab samples were collected from 664 (92·5%) individuals. The results of a Peptide Nucleic Acid-ELISA test for M. leprae DNA interpreted by stringent statistical criteria were available for 589 (88·7%) subjects. Thirty-five (5·9%) individuals without clinical signs of leprosy were positive for M. leprae DNA. Seven PCR positive individuals lived in a household where one or two other members were also positive for M. leprae DNA. During a second survey 8 (4·6%) of 175 interpretable PNA-ELISA tests were positive. Of 137 individuals tested twice, only two were positive on both occasions whereas 10 were PCR positive only once. The study confirms the widespread distribution of M. leprae DNA in healthy individuals. The feasibility of curbing possible transmission of subclinical infection needs further consideration.

The survey of Vibrio cholerae O1 in marine area was carried out in the Port of Osaka, Japan in 1987–2001, and 51 V. cholerae O1 strains were isolated. All strains were identified to be of El Tor biotype, Ogawa serotype and classic Ubon Kappa-phage type, and were cholera toxin (CT)-negative and CT gene-negative. In order to clarify certain ecological aspects of V. cholerae O1 in the marine environment of the temperate zone, we performed molecular analysis of the isolated strains using pulsed-field gel electrophoresis (PFGE) with NotI and SfiI restriction enzymes. We found the indistinguishable strains by DNA analysis using PFGE with strains passed for 1 year, and also found the closely related strains with that passed for 3 and 12 years. Those results indicated that V. cholerae O1 can survive over one winter at least, and that it survives in marine water for a long time by undergoing continuous mutation.

In May 2000 a scout camp was held on an agricultural showground in New Deer, Aberdeenshire. There were 337 campers at the event, comprising 233 cubs, scouts, and venture scouts, and 104 adults. The event was abandoned early because of heavy rainfall. Twenty campers who became ill between 28 May and 3 June were confirmed as having E. coli O157 infection. Preliminary investigation did not suggest a food vehicle but did indicate environmental exposure at the camp as a risk factor. Subsequent investigations supported the hypothesis that transmission of E. coli O157 was from the environment to cases by contaminated hands, either directly from hand to mouth, or via food. As a result of the investigation the Aberdeenshire Council and the Scout Association jointly prepared interim guidelines to reduce the risk of E. coli O157 infection at scout camps.

To establish the frequency of infectious aetiology in Mexican adult patients with cervical lymphadenopathies (CLAs), 87 consecutive patients with enlarged cervical lymphatic nodes, HIV negative and without anti-tuberculous treatment, were selected from a tertiary-level speciality concentration hospital. Histopathological studies, investigation of acid-fast bacilli, cultures in Löwenstein–Jensen and Mycobacterium growth indicator tube (MGIT) media, and in-house polymerase chain reaction (PCR) with IS6110-based primers for Mycobacterium tuberculosis complex were performed in resected lymphatic nodes. Non-infectious aetiology corresponded to 45 cases (52%). Tuberculosis was suspected in 42 cases (48%) by histology and confirmed positive results were obtained by staining in 8 (19%), by culture in 23 (55%), and by PCR in 34 (81%) patients. All were confirmed after therapeutic success. In addition to the epidemiological transition process occurring in Mexico, tuberculosis remains an important cause of CLA. Histopathology with confirmatory studies including PCR can detect tuberculous aetiology.

Occurrences of ciguatera fish poisoning (CFP) and Vibrio cholerae infected patients in Hong Kong were reviewed for the 13-year period 1989–2001. Peak activity of CFP preceded peak activity of cholera in nine of the years except in 4 years (1990, 1991, 1992, 1996) where it was observed that the total number of cholera cases were all less than or equal to five per year (P<0·05). Average time interval was 2·4 months between peaks of CFP and Vibrio cholerae outbreaks. Findings suggested that the factors that affect cholera and ciguatera occurrences may not be operating in some years but when they are operating, they will affect both cholera and CFP. CFP peaks have consistently occurred before Vibrio cholerae peaks in our locality so much so that the occurrence of the latter can now be almost accurately predicted since 1998. CFP peaks served as an early warning for public measures to be in place before occurrence of cholera outbreaks.

Instituting air travel restrictions to slow the geographical spread of smallpox cases would have significant consequences and present serious logistical concerns. Public health decision makers must weigh the potential benefits of such restrictions against their negative impact. The goal of this research is to provide a basic analytical framework to explore some of the issues surrounding the use of air travel restrictions as a part of an overall containment strategy. We report preliminary results of a compartmental model for the inter-city spread of smallpox cases resulting from US domestic air travel. Although air traffic can be halted within hours as was shown following the terrorist attacks of 11 September 2001, these results suggest that the consequences of halting domestic air travel may not be outweighed by public health benefits.

Pneumonia causes significant morbidity and mortality in Aboriginal populations in Australia's Northern Territory (NT). Kava, consumed in Arnhem Land since 1982, may be a risk factor for infectious disease including pneumonia. A case–control study (n=115 cases; n=415 controls) was conducted in 7001 Aboriginal people (4217 over 15 years). Odds ratios (OR) were calculated by conditional logistic regression with substance use and social factors as confounders. Pneumonia was not associated with kava use. Crude OR=1·26 (0·74–2·14, P=0·386), increased after controlling for confounders (OR=1·98, 0·63–6·23, P=0·237) but was not significant. Adjusted OR for pneumonia cases involving kava and alcohol users was 1·19 (0·39–3·62, P=0·756). In communities with longer kava-using histories, adjusted OR was 2·19 (0·67–7·14, P=0·187). There was no kava dose–response relationship. Crude ORs for associations between pneumonia and cannabis use (OR=2·27, 1·18–4·37, P=0·014) and alcohol use (OR=1·95, 1·07–3·53, P=0·026) were statistically significant and approached significance for petrol sniffing (OR=1·98, 0·99–3·95, P=0·056).

We studied the association that exists between the epidemiological type clustering of isolates of Mycobacterium tuberculosis and certain clinical, epidemiological and socio-economic characteristics of tuberculosis patients in the Elche health district of Spain. A total of 144 patients diagnosed between 1993 and 1999 and whose isolates had been genotyped by IS6110–RFLP in an earlier study were included. Multivariate analysis showed that the independent variables associated with clustering of strain types were: age (1–25 years, OR 2·92, 95% CI 0·83–10·3), a high percentage of infection in the first circle of contacts (OR 2·89, 95% CI 0·96–8·68), urban dwelling (OR 2·12, 95% CI 0·73–6·2), use of bronchoscopy to obtain samples (OR 16·3, 95% CI 2·3–11·5) and working contact with many people (OR 2·81, 95% CI 0·94–8·3). These data contribute to a better understanding of the epidemiology of tuberculosis and improved systems of control.