We conducted a 31-month retrospective review of all laboratory-confirmed Streptococcus suis infections admitted to public hospitals in Hong Kong. Strain identification, serotyping and antibiotic susceptibility tests were conducted on S. suis isolates. Twenty-one sporadic cases were identified, comprising 18 (86%) males and 3 (14%) females. About half were patients aged ⩾65 years. More cases occurred during summer. Occupational exposure was documented in five (24%) cases. The estimated annual incidence was 0·09/100 000 in the general population and 32/100 000 in people with occupational exposure to pigs and raw pork. The primary clinical manifestations were meningitis (48%), septicaemia (38%) and endocarditis (14%). The case-fatality rate was 5%. All available isolates from 15 patients were serotype 2, sensitive to penicillin, ampicillin, ceftriaxone, but resistant to tetracycline. Injury prevention and proper handling of pigs or raw pork should be advocated to both at-risk occupational groups and the general population.

During the 2003 rainy season, a follow-up survey in sentinel chickens was undertaken to assess the seasonal transmission of West Nile virus (WNV) in a sahelian ecosystem: the Ferlo (Senegal). The estimated incidence rate in chickens was 14% (95% CI 7–29), with a very low level of transmission between July and September, and a transmission peak occurring between September and October. Comparing these results with the estimate obtained from a previous transversal serological study performed on horses the same year in the same area, the relevance of sentinel chickens in estimating the WNV transmission rate is highlighted. Conventionally adult mosquito populations disappear during the dry season but WN disease was shown to be endemic in the study area. The mechanisms of virus maintenance are discussed.

To determine prevalence, serotype diversity and antimicrobial resistance of Salmonella in healthy pigs, faecal samples from 6771 pigs on 73 farms collected during 1998–1999 and 2004–2005 were examined. Salmonella isolates were serotyped and tested for susceptibility to 22 antimicrobials: benzylpenicillin, ampicillin, amoxicillin, cefazolin, cephaloridine, gentamicin, kanamycin, streptomycin, fradiomycin, colistin, tetracycline, chlortetracycline, oxytetracycline, chloramphenicol, thiamphenicol, sulfadimethoxine, sulfamethoxazole, sulfamethoxypyridazine, trimethoprim, sulfamethoxazole/trimethoprim, norfloxacin and ofloxacin. Farm-level and pig-level Salmonella prevalences were 35·5% and 2·2% in 1998–1999, and 35·7% and 3·3% in 2004–2005. Prevalence by growth stage was 2·4% for sows, 3·3% for weaned pigs, 2·7% for fattening pigs and 3·8% for finishing pigs. The predominant serotypes identified were Agona (28·4%), Typhimurium (17·9%) and Infantis (16·4%) in 1998–1999, and Typhimurium (32·5%), Anatum (24·6%) and Infantis (13·5%) in 2004–2005. Compared with the 1998–1999 isolates, the 2004–2005 isolates showed significantly higher rates of resistance to all the antimicrobials except tetracyclines (P<0·01 to P<0·05) and resistance to ⩾2 antimicrobials [19·4% (13/67) vs. 39·7% (50/126), P<0·01]. This study provides national estimates of Salmonella prevalence in healthy pigs of different growth stages in Japan.

Surveillance activities for ovine scrapie have expanded in the 21st century, following concerns about the potential for a hidden epidemic of bovine spongiform encephalopathy in European sheep populations. Large-scale surveys have been used to estimate the prevalence of scrapie infection. In this study we analyse data from the surveys in Great Britain between 2002 and 2004. When we estimate genotype-specific prevalences for each of the two screening tests used a difference is observed. One test underestimates the number of positive cases in genotypes classically considered to be at a low relative risk of developing clinical disease (ARR- and AHQ-containing genotypes). By comparison, the other test underestimates the number of positive cases in genotypes classically considered to be at an increased relative risk of developing clinical disease (VRQ-containing genotypes). These findings have implications for surveillance, disease control, and diagnostic test evaluation.

The purpose of this study was to compare the occurrence of tuberculosis (TB) and the outcome of treatment between TB patients living in urban and rural areas. Cases of TB reported from 2001 to 2003 in England and Wales were assigned to a rural or urban area classification. The outcome of interest, non-completion of treatment, was investigated to determine the odds ratio for urban vs. rural residence. The effects of age, sex, ethnicity, place of birth, time since arrival in the United Kingdom, disease site, isoniazid resistance and previous diagnosis were adjusted for by multivariable logistic regression. Crude odds ratios showed a significantly higher level of treatment non-completion in rural areas. These results became non-significant (OR 1·02, 95% CI 0·83–1·26, P=0·82) after adjusting for the confounding effects of ethnic group and age. In England and Wales residence in a rural location is not an independent determinant of TB treatment outcome failure.

We describe a method of working on publicly available data to estimate disease prevalence in small geographic areas using Helicobacter pylori as a model infection. Using data from the Third National Health and Nutrition Examination Survey, risk parameters for H. pylori infection were obtained by logistic regression and validated by predicting 737·5 infections in an independent cohort with 736 observed infections. The prevalence of H. pylori infection in the San Francisco Bay Area was estimated with the probabilities obtained from a predictive logistic model, using risk parameters with individual-level 1990 U.S. Census data as input. Predicted H. pylori prevalence was also compared to gastric cancer incidence obtained from the Northern California Cancer Center and showed a positive correlation with gastric cancer incidence (P<0·001, R2=0·87), and no statistically significant association with other malignancies. By exclusively using publicly available data, these methods may be applied to selected conditions with strong demographic predictors.

We determined the epidemiological features of three zoonoses in hospitalized patients in southern Croatia. Patients were diagnosed by serological testing. Clinical and epidemiological data were also collected. Between 1982 and 2002, Mediterranean spotted fever (MSF) was diagnosed in 126 (incidence rate 1·27/100 000 per year), murine typhus (MT), in 57 (incidence rate 0·57/100 000 per year), and Q fever in 170 (incidence rate 1·7/100 000 per year) patients. MSF and Q fever were characterized by a marked seasonality. Incidences of Q fever and of MSF were higher for males than for females (P<0·0001 and P=0·0024, respectively). The most frequent of the three zoonoses in children was MSF. Q fever and MT cases were mostly seen in the 21–50 years age group. We found no statistically significant differences between season- and gender-specific incidence rates of MT. Whereas infections due to rickettsiae decreased, the incidence of Q fever increased over the last 12 years of the study.

Viral infections are associated with pulmonary exacerbations in children with cystic fibrosis (CF), but few studies have addressed the frequency in adults. This paper investigates the frequency and impact of viral infections in adults with CF receiving intravenous antibiotics. Pre- and post-treatment spirometry, inflammatory markers and antibody titres against influenza A, influenza B, adenovirus, respiratory syncytial virus, Mycoplasma pneumoniae, Chlamydia psittaci, and Coxiella burnetti were analysed over a 10-year period. Non-bacterial infections were identified in 5·1% of 3156 courses of treatment. The annual incidence of admissions per patient associated with viral infection was 4·9%. The presence of viral infection in association with a pulmonary exacerbation did not adversely affect lung function or inflammatory markers in the short term. Adults with CF have a lower incidence of respiratory viral infections associated with pulmonary exacerbations requiring intravenous antibiotics compared to children and infants with CF.

Spatial–temporal patterns of measles incidence reflect the spatial distribution of human hosts. The heterogeneous spatial distribution of communities has been shown to introduce spatially dependent temporal lags in the timing of measles incidence. Incidence patterns reflect internal dynamics within a community and coupling of communities through the movement of infectious individuals. The central role of human movement in coupling dynamics in separate communities suggests that physical geographic barriers to movement should reduce spatial–temporal correlation. We examine measles dynamics in Maryland and Pennsylvania during the period of 1917–1938. The central feature of interest is the Chesapeake Bay, which separates Maryland into two distinct regions. We find that correlation of measles incidences in communities separated by the bay is reduced compared to communities not separated by the bay, suggesting the bay acted as a barrier to human movement during this time sufficient to decouple measles dynamics in Maryland counties.

Prospective surveillance was conducted in three remote Aboriginal communities with high rates of rheumatic heart disease in order to investigate the epidemiology of group A β-haemolytic streptococci (GAS). At each household visit, participants were asked about sore throat. Swabs were taken from all throats and any skin sores. GAS isolates were emm sequence and pattern-typed using standard laboratory methods. There were 531 household visits; 43 different emm types and subtypes (emmST) were recovered. Four epidemiological patterns were observed. Multiple emmST were present in the population at any one time and household acquisition rates were high. Household acquisition was most commonly via 5- to 9-year-olds. Following acquisition, there was a 1 in 5 chance of secondary detection in the household. Throat detection of emmST was brief, usually <2 months. The epidemiology of GAS in these remote Aboriginal communities is a highly dynamic process characterized by emmST diversity and turnover.

Eluted dried blood spot specimens from newborn screening, collected in 2004 in North Thames and anonymously linked to birth registration data, were tested for maternally acquired rubella IgG antibody as a proxy for maternal antibody concentration using an enzyme-linked immunosorbent assay. Finite mixture regression models were fitted to the antibody concentrations from 1964 specimens. The Bayesian Information Criterion (BIC) was used as a model selection criterion to avoid over-fitting the number of mixture model components. This allowed investigation of the independent effect of maternal age and maternal country of birth on rubella antibody concentration without dichotomizing the outcome variable using cut-off values set a priori. Mixture models are a highly useful method of analysis in seroprevalence studies of vaccine-preventable infections in which preset cut-off values may overestimate the size of the seronegative population.

Roe deer Capreolus capreolus are among the most important feeding hosts for the sheep tick Ixodes ricinus, thus contributing to the occurrence of tick-borne diseases in Europe. Tick-borne encephalitis (TBE), which is transmitted by co-feeding of larvae and nymphs on rodents, requires precise climatic conditions to occur. We used roe deer as sentinels for potential circulation of TBE virus in Northern Italy, by examining the association between tick infestation, occurrence of TBE human cases, geographical and climatic parameters. Tick infestation on roe deer, and particularly frequency of co-feeding, was clearly associated with the geographic location and the autumnal cooling rate. Consistently, TBE occurrence in humans was geographically related to co-feeding tick abundance. The surveillance of tick infestation on roe deer, combined with remotely sensed climatic data, could therefore be used as an inexpensive early risk assessment tool of favourable conditions for TBE emergence and persistence in humans.

Rift Valley fever virus (RVFV) is an arbovirus associated with periodic outbreaks, mostly on the African continent, of febrile disease accompanied by abortion in livestock, and a severe, fatal haemorrhagic syndrome in humans. However, the maintenance of the virus during the inter-epidemic period (IEP) when there is low or no disease activity detected in livestock or humans has not been determined. This study report prevalence of RVFV-neutralizing antibodies in sera (n=896) collected from 16 Kenyan wildlife species including at least 35% that were born during the 1999–2006 IEP. Specimens from seven species had detectable neutralizing antibodies against RVFV, including African buffalo, black rhino, lesser kudu, impala, African elephant, kongoni, and waterbuck. High RVFV antibody prevalence (>15%) was observed in black rhinos and ruminants (kudu, impala, buffalo, and waterbuck) with the highest titres (up to 1:1280) observed mostly in buffalo, including animals born during the IEP. All lions, giraffes, plains zebras, and warthogs tested were either negative or less than two animals in each species had low (⩽1:16) titres of RVFV antibodies. Of 249 sera collected from five wildlife species during the 2006–2007 outbreak, 16 out of 19 (84%) of the ruminant (gerenuk, waterbuck, and eland) specimens had RVFV-neutralizing titres ⩾1:80. These data provide evidence that wild ruminants are infected by RVFV but further studies are required to determine whether these animals play a role in the virus maintenance between outbreaks and virus amplification prior to a noticeable outbreak.

In the investigation we report the occurrence and spread of multiresistant Salmonella Typhimurium phage type (DT) 104 in 174 known Danish animal herds infected between 1996 and 2003. We applied PFGE, plasmid analysis and spatio-temporal analysis for a description of the development and spread of infection among herds. The results showed that in Denmark DT104 are mainly spread by trade of animals; however, horizontal spread of DT104 is also important and the risk of an animal herd becoming infected increased with the proximity in time and space to a DT104-infected herd. Based on these results, it is recommended that specific actions are taken to limit the risk of horizontal spread of DT104 from newly infected herds.

The social networks of 49 ethnic Vietnamese injecting drug users (IDUs) and 150 IDUs of other ethnicities recruited in Melbourne, Australia, were examined for ethnic differences in distribution of hepatitis C virus infection risk using social network analysis and molecular epidemiology. Vietnamese IDUs were more highly connected than non-Vietnamese IDUs, and more likely to be members of dense injecting sub-networks. More related infections were detected in IDUs with discordant ethnicities than were captured in the social network data; nonetheless, most dyads and most IDU pairs with related infections had matching ethnicity, confirming that mixing was assortative on that criterion. Mixing was not obviously dissortative by risk; low-risk Vietnamese IDUs injected more frequently than did correspondingly low-risk non-Vietnamese IDUs, but results for other measures were reversed or equivocal. Network measurements suggest that ethnic Vietnamese IDUs are at elevated risk of blood-borne infection, a conclusion supported by their relatively high HIV prevalence.

We developed a mathematical model of the transmission dynamics of salmonella to describe an outbreak of S. Cerro infection that occurred in a Pennsylvania dairy herd. The data were collected as part of a cooperative research project between the Regional Dairy Quality Management Alliance and the Agricultural Research Service. After the initial detection of a high prevalence of S. Cerro infection in the herd, a frequent and intensive sampling was conducted and the outbreak was followed for 1 year. The data showed a persistent presence of S. Cerro with a high prevalence of infection in the herd. The dynamics of host and pathogen were modelled using a set of nonlinear differential equations. A more realistically distributed (gamma-distributed) infectious period using multiple stages of infection was considered. The basic reproduction number was calculated and relevance to the intervention strategies is discussed.

Acute parvovirus B19 infection is a risk for pregnant women. After vertical transmission the infected fetus may develop hydrops fetalis. Since B19 infection occurs mainly during childhood, children represent a main source for virus transmission. In order to determine whether certain groups in the German population show increased risks for B19 infection we analysed the seroprevalence using 6583 sera collected from adults in former Eastern and Western Germany during the German National Health Survey and 649 sera from healthy Thuringian children and adolescents. In adults the overall seroprevalence was 72·1%, rising from 20·4% in children (1–3 years) and 66·9% in adolescents (18–19 years) to 79·1% in the elderly (65–69 years). Significant differences were observed between females (73·3%) and males (70·9%) and between inhabitants of small (74·8%) and big cities (69·0%) but not between people of the former Eastern (72·8%) and Western states (72·0%) of Germany. For women during childbearing age (18–49 years) highest values were observed in those living together with two or more children (81·6%) and in women with occupational contact with children aged <6 years (88·9%). In contrast seroprevalence was significantly lower in age-matched female singles (64·8%) and in women with occupational contact with children aged >6 years and adolescents (63·8%).

The aim of this study was to assess the change of seasonal pattern of Japanese encephalitis (JE) cases in the post-vaccination period and to elucidate whether the lagged climate variables (precipitation and temperature) were associated with occurrence of JE after adjustment for seasonal pattern, time trend, geographic areas, pig density, vaccination coverage rate for humans, and time dependence of time-series numbers of JE cases. A total of 287 confirmed JE cases between 1991 and 2005 were collected, together with monthly data on socio-ecological archival data including climate, pig density and vaccination. A time-series generalized autoregressive Poisson regression model was used to achieve the objectives. The rate of JE increased from 1998 onwards. The seasonal pattern on occurrence of JE cases clustered between May and August during the period from 1991 to 2005 in Taiwan. In each geographic area, monitoring temperature and precipitation, two possible proxy variables for mosquito density, in conjunction with seasonal factors and pig density is of assistance in forecasting JE epidemics.

Humoral and cell-mediated immunity (CMI) against B. pertussis was assessed in a sample of adolescent, adult and senior subjects distributed in five different geographical areas in Italy. Most (99·1%) subjects had IgG anti-pertussis toxin (PT) antibodies exceeding the minimum detection level [⩾2 ELISA units (EU)/ml]. There were no significant differences between the genders; 6·2% samples recorded titres ⩾100 EU/ml. CMI was positive [stimulation index (SI) ⩾5] against PT in 39·0% of all samples. This study suggests that B. pertussis continues to circulate in age groups that have been previously considered to be uninvolved in the circulation of this pathogen and that adolescent and adult pertussis boosters may be of value in these populations. Nevertheless, over the last 10 years, large increases in vaccination coverage rates have contributed to reduce the spread of the aetiological agent, especially in the immunized population.

Finding lice can be difficult in head louse infestation. We compared a new louse detection comb with visual inspection. All children in two rural Turkish schools were screened by the two methods. Those with lice were offered treatment and the results monitored by detection combing. Children with nits only were re-screened to identify latent infestations. Using visual inspection we found 214/461 children (46%) with nits but only 30 (6·5%) with live lice. In contrast detection combing found 96 (21%) with live lice, of whom 20 had no nits. Detection combing was 3·84 times more effective than visual inspection for finding live lice. Only 10/138 (7·2%) children with nits and no lice were found to have active infestation by day 16. We found that the detection comb is significantly (P<0·001) more effective than visual screening for diagnosis; that nits are not a good indicator of active infestation; and that treatment with 1% permethrin was 89·6% effective.