The incidence of rabies has decreased in Turkey during recent years. However, an increasing number of rabies cases have been reported in the Aegean (western) region of Turkey. The virus appears to have maintained a foothold in the urban areas of the province of Izmir with only three cases per year being reported during the mid-1990s. Since 2001, the virus has been recorded in the previously rabies-free provinces of Manisa and Aydin. During this epizootic, cases have been reported in both dogs and foxes, and there has been an unusually high incidence of rabies in domestic livestock, especially cattle. This report describes the development of this epizootic and a preliminary phylogenetic study which suggests that the source of this epizootic was likely to have been the residual cases within Izmir rather than a fresh introduction of rabies from foci to the north (Istanbul) and the Eastern provinces of Turkey.

The clinical features and microbiological characteristics of 315 patients with definite or possible infective endocarditis (IE) from January 1995 to December 2003 were evaluated. There were 187 males and 128 females with a mean age of 51 years (range, 1 month to 92 years). Ninety-three patients (30%) had a diagnosis of valvular heart disease and 24 (8%) had received prosthetic valve replacement. Blood culture was negative in 62 patients (20%). Staphylococci (91 patients, 32%), including methicillin-susceptible Staphylococcus aureus (15%), methicillin-resistant S. aureus (11%), and coagulase-negative staphylococci (6%), were the most commonly encountered pathogens followed by viridans group streptococci (77 patients, 24%). Eight patients (25%) had various neurological, renal, embolic, and cardiac complications. Patients with neurological complications [odds ratio (OR) 8·175, P<0·001], nosocomial IE (OR 6·661, P<0·001), underlying malignancy (OR 4·993, P<0·001), elevated serum creatinine level (OR 3·132, P=0·001), or elevated WBC count (>15000/mm3) (OR 2·537, P=0·007) were at significantly increased risk of mortality. This study found mortality from IE was associated with several factors, among which neurological complications were the most hazardous. Patients with more than one risk factor had poorer prognosis. These results suggest the need for more aggressive management in patients with IE when multiple risk factors for mortality are identified.

A prospective seroepidemiological survey was carried out in Luxembourg in 2000–2001 to determine the antibody status of the Luxembourg population against hepatitis A virus (HAV) and hepatitis B virus (HBV). One of the objectives of this survey was to assess the impact of the hepatitis B vaccination programme, which started in May 1996 and included a catch-up campaign for all adolescents aged 12–15 years. Venous blood from 2679 individuals was screened for the presence of antibodies to HAV antigen and antibodies to hepatitis B surface antigen (anti-HBs) using an enzyme immunoassay. Samples positive for anti-HBs were tested for antibody to hepatitis B core antigen (anti-HBc) using a chemiluminiscent microparticle immunoassay to distinguish between individuals with past exposure to vaccine or natural infection. The estimated age-standardized anti-HAV seroprevalence was 42·0% [95% confidence interval (CI) 39·8–44·1] in the population >4 years of age. Seroprevalence was age-dependent and highest in adult immigrants from Portugal and the former Yugoslavia. The age-standardized prevalence of anti-HBs and anti-HBc was estimated at 19·7% (95% CI 18·1–21·3) and 3·16% (95% CI 2·2–4·1) respectively. Anti-HBs seroprevalence exceeding 50% was found in the cohorts targeted by the routine hepatitis B vaccination programme, which started in 1996. Our study illustrates that most young people in Luxembourg are susceptible to HAV infection and that the hepatitis B vaccination programme is having a substantial impact on population immunity in children and teenagers.

We evaluated the association between typhoid fever and Helicobacter pylori infection, as the latter microorganism may influence gastric acid secretion and consequently increase susceptibility to Salmonella typhi infection. Anti-H. pylori IgG and IgA antibody titres (ELISA) and gastrin concentration (RIA) were determined in the plasma of 87 blood culture-confirmed typhoid fever cases (collected after clinical recovery) and 232 random healthy controls without a history of typhoid fever, in the Jatinegara district, Jakarta. Patients with typhoid fever more often than controls were seropositive for H. pylori IgG (67% vs. 50%, P<0·008), when antibody titres were dichotomized around median titres observed in controls. H. pylori IgA seropositivity was not associated with typhoid fever. Plasma gastrin concentrations indicative of hypochlorhydria (i.e. gastrin ⩾25 or ⩾100 ng/l) were not significantly elevated in typhoid fever cases compared to controls (P=0·54 and P=0·27 respectively). In a multivariate analysis, typhoid fever was independently associated with young age (<33 years, median age of the controls) [odds ratio (OR) 7·93, 95% confidence interval (CI) 3·90–16·10], and H. pylori IgG seropositivity (OR 1·93, 95% CI 1·10–3·40). Typhoid fever was independently associated with H. pylori IgG seropositivity, but not with elevated gastrin concentration. Therefore, the association suggests a common risk of environmental exposure to both bacteria, e.g. poor hygiene, rather than a causal relationship via reduced gastric acid production.

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.

The objective of the study was to determine the prevalence of smear-positive tuberculosis (TB) in a rural area in Bangladesh at Matlab. A TB surveillance system was established among 106000 people in rural Bangladesh at Matlab. Trained field workers interviewed all persons aged [ges ]15 years to detect suspected cases of TB (cough>21 days) and sputum specimens of suspected cases were examined for acid-fast bacilli (AFB). Of 59395 persons interviewed, 4235 (7·1%) had a cough for >21 days. Sputum specimens were examined for AFB from 3834 persons, 52 (1·4%) of them were positive for AFB. The prevalence of chronic cough and sputum positivity were significantly higher among males compared to females (P<0·001). The population-based prevalence rate of smear-positive TB cases was 95/100000 among persons aged [ges ]15 years. Cases of TB clustered geographically (relative risk 5·53, 95% CI 3·19–9·59). The high burden of TB among rural population warrants appropriate measures to control TB in Bangladesh. The higher prevalence of persistent cough and AFB-positive sputum among males need further exploration. Factors responsible for higher prevalence of TB in clusters should be investigated.

An epidemic of meningococcal disease caused by serogroup B meningococci expressing the P1.7-2,4 PorA protein began in New Zealand in 1991. The PorA type has remained stable. Different porB have been found in association with the P1.7-2,4 PorA, although type 4 has been most common. The clonal origins of B:P1.7-2,4 meningococci isolated from cases during 1990 to the end of 2003 were analysed. In 1990, the year immediately preceding the recognized increase in disease rates, all three subclones (ST-41, ST-42, and ST-154) of the ST-41/44 clonal complex occurred among the five isolates of B:P1.7-2,4. The two sequence types, ST-42 and ST-154, continued to cause most disease throughout New Zealand. Isolates belonging to subclone ST-41 were mostly identified early in the epidemic and in the South Island. 16S rRNA typing indicated that isolates belonging to the subclones ST-41 and ST-154 share a common ancestor, with those typing as ST-42 more distantly related with some genetically ambiguous. It is possible that ST-41 and ST-154 may have evolved one from the other but evolution to ST-42 is more difficult to explain. It is possible that one or more of the ST types could have been introduced into New Zealand prior to the first detection of clinical cases in 1990. Genetic diversity may have occurred during carriage in the community.

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 total of 1873 strains from human origin and 4283 strains from non-human origin of Salmonella enterica serotypes Typhimurium, Enteritidis, Heidelberg, Hadar and Virchow, collected over three years 1993, 1997 and 2000, were examined in order to determine the rate of antimicrobial resistance to 12 antimicrobial drugs. The objective of the study was to describe and to compare the evolution of the main resistance types in human and non-human isolates, focusing on the poultry sector. The evolution and the rates of antimicrobial resistances for the five serotypes, with the exception of Virchow, were almost comparable in strains isolated from human and non-human sources over the period studied. The most striking result concerning single resistance was the spectacular increase of the resistance frequency to nalidixic acid for the strains belonging to serotypes Hadar and Virchow, especially in the poultry food sector (14% in 1993 vs. 72% in 2000 for Salmonella Virchow, 4% in 1993 vs. 70% in 2000 for Salmonella Hadar) and also in human isolates (24% in 1997 vs. 48% in 2000 for S. Virchow, 31% in 1997 vs. 78% in 2000 for S. Hadar). In addition to the classical resistance to ampicillin, streptomycin, sulphonamide, chloramphenicol and tetracycline (ASSuCT resistance type), which stabilized between 1997 and 2000, the emergence of a new resistance type was observed.

In August 2002 an outbreak of Shigella sonnei infection occurred in a Spanish town of 6343 inhabitants. In total, 756 people developed acute gastroenteritis and 181 cases were shigella-confirmed. The peak incidence was during 5–6 August 2002. The estimated primary attack rate was 9·97%; the attack rate for secondary cases was 38%. The <15 years ago group was most affected (16·49%). The town and its surroundings were served by two water systems, A and B. The cases had consumed water provided by system A (attack rate 164 cases/1000 population). Microbiological analysis of water from system A did not show the presence of coliform bacteria or shigella. This shigellosis outbreak was the largest reported in Spain. The impact of the epidemic was probably greater than the incidence detected.

From January 1997 to December 2003, all patients with non-tuberculous mycobacteria (NTM) isolation who were treated at a university hospital in Taiwan were evaluated. Among the 2650 NTM isolates, 1225 (46·2%) were from 412 patients with clinically significant diseases. The annual incidence (per 100000 patients) of disease caused by NTM was 8·96 in 1997, 21·53 in 2002, and 16·55 in 2003. The major types of infections caused by NTM included isolated pulmonary infection and pleurisy (59·5%), skin/soft-tissue infections and osteomyelitis (13·8%), and disseminated diseases (13·3%). The two most common groups of organisms involved were rapidly growing mycobacteria (RGM) (41·4%) and Mycobacteriumavium complex (MAC) (39%). The most common organism involved in isolated pulmonary infection and pleurisy was MAC (44·1%). RGM predominated in keratitis (94%), skin/soft-tissue infections and osteomyelitis (43·9%), and lymphadenitis (66·7%). This retrospective 7-year study demonstrated an increase in the incidence of NTM disease in a university hospital.

In two prisons in Berlin, Germany, provision of sterile injection equipment for injecting drug users (IDUs) started in 1998. To assess the programme's impact, the frequency of injecting drug use and syringe sharing, and the incidence of HIV, HBV, and HCV infection were determined in a follow-up study. Of all IDUs (n=174), 75% continued to inject. After the project start the level of syringe sharing declined from 71% during a 4-month period of previous imprisonment to 11% during the first 4 months of follow-up, and to virtually zero thereafter. Baseline seroprevalences for HIV, HBV, and HCV were 18, 53, and 82%. HIV and HCV seroprevalence at baseline was significantly associated with drug injection in prison prior to the project start. No HIV and HBV seroconversions, but four HCV seroconversions occurred. The provision of syringes for IDUs in appropriate prison settings may contribute to a substantial reduction of syringe sharing. However, the prevention of HCV infection requires additional strategies.

In January 2003, two cases of Legionnaires' disease associated with a ship's cruise were registered in the database of National Epidemiological Surveillance of Infectious Diseases. A 70-year-old male heavy smoker with mild emphysema contracted the disease during a cruise. Legionella pneumophila serogroup (sg) 5 was isolated from the patient's sputum and the ship's indoor spa. The isolate from the spa matched the patient's isolate by genotyping performed by pulsed-field gel electrophoresis (PFGE). The second case was in a 73-year-old female. During epidemiological investigation, a third case of Legionnaire's disease in a 71-year-old male was subsequently diagnosed among passengers on the same ship on the following cruise. Environmental investigation revealed that porous natural stones (Maifanshi) in the filters of the spas had harboured L. pneumophila, a phenomenon which has not been reported except in Japan. This is the first documented evidence of L. pneumophila sg 5 infection on a ship and of porous stones as a source of Legionella infection.

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.

Fifty-seven Salmonella Typhimurium strains isolated from poultry, swine and animal feed in Poland during the years 1979–1998 and 2000–2002 were analysed with conventional and molecular techniques. Antimicrobial resistance as well as multiresistance was found, respectively, in 80·1% and 56·1% of the isolates and most frequently among isolates from 2000–2002. Of several phage types noted, DT104 was prevalent among poultry, swine and feed isolates. DT104, U302 and non-typable strains had a multiple resistant profile (ACSSuT) due to the presence of class I integrons. Pulse-field gel electrophoresis of XbaI and BlnI digest showed high genomic similarity between the strains and confirmed clonal spread of S. Typhimurium infections. Plasmid profiling allowed further differentiation of the strains. We have, therefore, confirmed the appearance of S. Typhimurium DT104 showing genome integrated integron-mediated antimicrobial resistance in Poland. These findings are significant for public and animal health risks and document the dissemination of DT104 epidemic strains into new geographical regions.

IgM- and IgG-capture ELISAs are widely used as diagnostic tests for confirmation of dengue virus infection. The positive rate of anti-dengue IgM and IgG detection was examined in primary and secondary dengue virus infections in the setting of a provincial hospital using IgM- and IgG-capture ELISAs. Disease day 1 was defined as the day of onset of symptoms. In total, 232 plasma samples were collected from 106 confirmed dengue cases consisting of 12 primary and 94 secondary infections. In primary infection, anti-dengue IgM was detected in 4 out of 5 samples collected on disease day 5 and in all the 21 samples collected on disease day 6 or later. Specific IgG was detected in 2 out of 5 samples collected on day 12, and in 5 out of 6 samples collected on disease days 13–15, but was not detected in samples collected on disease day 10 or earlier. In secondary infection, IgM was not detected in the samples on disease days 2 and 3, but detected in 20 out of 79 samples collected on days 4–6, in 44 out of 65 on disease days 7–11 and in 40 out of 51 samples on disease days 12–14. In contrast, specific IgG was detected in 21 out of 60 samples on disease days 4 and 5, in 13 out of 19 on disease day 6, in 62 out of 65 on disease days 7–11 and in all the samples collected on disease day 12 or later. The result indicate that seroconversion rates of IgM and IgG are different between primary and secondary infections, and suggest that detection of specific IgM and IgG is necessary for determining dengue virus infection and for differentiating primary and secondary dengue infections.

New Zealand has a large reservoir of Mycobacterium bovis infection in wild and farmed animals. This study aimed to assess the extent of human infection with this organism and the potential contribution of these animal sources. Combined epidemiological and laboratory investigation of human tuberculosis cases over the period 1995–2002 showed that M. bovis accounted for 2·7% (54/1997) of laboratory-confirmed human tuberculosis cases, a rate of 0·2/100000 population. M. bovis isolates from humans (23) were typed using restriction endonuclease analysis (REA) and compared with isolates from wild and domestic animals (2600). Fourteen (61%) of the human isolates had REA patterns that were identical to patterns for isolates from cattle, deer, possums, ferrets, pigs, and occasionally cats. These results suggest a low level of ongoing M. bovis transmission from animal reservoirs to humans in New Zealand.

Pulsed-field gel electrophoresis (PFGE) is commonly used in molecular epidemiology. However, this technique has never been used in studying intra-family spread of enteric diseases in Bangladesh. Our objective was to evaluate the intra-familial transmission of shigella infection using PFGE. Children of either sex, less than 10 years old, who were family contacts of shigella-infected index cases were the study population. PFGE was applied if the same serotypes/sub-serotypes of shigella were isolated from both the index case and the family contact children. In total, 227 index cases were studied. Shigella was isolated from 61 (27%) contact children on day 1 of enrolment, among which Shigella flexneri (41%) and S. boydii (41%) were dominant, followed by S. dysenteriae (10%), S. sonnei (3%), and shigella-like organisms (5%). Seventeen (28%) of the asymptomatic infections in contact children were caused by the same serotype of shigella as that found in the index case. The intra-familial shigella transmission rate was 8% (17/227). Of the 227 contact children, eight (4%) developed diarrhoea during a 10-day follow-up and shigella was isolated from five (2%) of these children, and three of them (S. flexneri 3a, 1b, and 3a) were identical to the strains from their respective index cases. Compared to children without asymptomatic carriage of shigella (2/166), the risk (odds ratio) of developing diarrhoea for the children with asymptomatic carriage of shigella identical to their cases (3/17) was 9·0 (95% CI 1·5–49·0, P=0·01). The attributable risk for symptomatic shigella infection by intra-familial transmission was 50%. Results of this study demonstrated that intra-familial transmission of shigella carries a higher risk for diarrhoea.

In this study, the sera collected from a variety of mammalian species (ass-mules, cat, cattle, dog, horse, human and sheep) in 10 representative provinces of Turkey, were surveyed for the presence of neutralizing antibodies to West Nile virus (WNV). Overall, 1 of 40 (2·5%) ass-mules, 4 of 100 (4%) cattle, 43 of 114 (37·7%) dogs, 35 of 259 (13·5%) horses, 18 of 88 (20·4%) humans and 1 of 100 (1%) sheep, tested positive for WNV-neutralizing antibodies. The results indicate that a wide range of mammals are exposed to a West Nile-related virus and this could contribute to the long-term survival of this virus in the absence of overt disease.

Routine surveillance systems capture only a fraction of infectious intestinal disease (IID) that is actually occurring in the community. Different methodologies utilized among various international studies in the field were reviewed in order to devise an appropriate survey to obtain current estimates of prevalence of IID in Malta. An age-stratified retrospective cross-sectional telephone study was selected for the study due to its feasibility in terms of limited resources necessary (funds, time and human). The disadvantages of this type of study include the inherent biases such as selection bias (sampling, ascertainment and participation bias) and information bias (recall and observer bias). A pilot study was carried out using a random age-stratified sample of 100 persons over a 3-month period. A total of 5·0% (95% CI ±4·27) of the population was estimated to have suffered from IID during that period. This estimate was used in order to assist in sample size calculations for a large-scale community study. It also served to test the survey instrument and methodology and to identify operational problems.