Unlike for many other respiratory infections, the seasonality of pertussis is not well understood. While evidence of seasonal fluctuations in pertussis incidence has been noted in some countries, there have been conflicting findings including in the context of Australia. We investigated this issue by analysing the seasonality of pertussis notifications in Australia using monthly data from January 1991 to December 2016. Data were made available for all states and territories in Australia except for the Australian Capital Territory and were stratified into age groups. Using a time-series decomposition approach, we formulated a generalised additive model where seasonality is expressed using cosinor terms to estimate the amplitude and peak timing of pertussis notifications in Australia. We also compared these characteristics across different jurisdictions and age groups. We found evidence that pertussis notifications exhibit seasonality, with peaks observed during the spring and summer months (November–January) in Australia and across different states and territories. During peak months, notifications are expected to increase by about 15% compared with the yearly average. Peak notifications for children <5 years occurred 1–2 months later than the general population, which provides support to the theory that older household members remain an important source of pertussis infection for younger children. In addition, our results provide a more comprehensive spatial picture of seasonality in Australia, a feature lacking in previous studies. Finally, our findings suggest that seasonal forcing may be useful to consider in future population transmission models of pertussis.

Pulsed-field gel electrophoresis (PFGE) of Cpo I-digested genomic DNA and ribotyping (Bgl I) were applied to 60 Vibrio cholerae strains including 48 V. cholerae O139 from Thailand to compare their value in differentiating strains of the present V. cholerae O139 epidemic. PFGE patters were divided into groups A and B representing five and four subtypes, respectively, while ribotyping showed four different patterns. PFGE group B subtypes were only presented among O139 isolates from Thailand, whereas four O139 strains from Bangladesh and India showed identical PFGE group A subtypes observed in O139 isolates from Thailand. Two nontoxigenic O139 isolates from Thailand showed different and unique PFGE types as did five V. cholerae non-Ol non-O139 isolates containing a gene virulence complex found in V. cholerae O139. These results indicate that PFGE (Cpo I) can resolve recent evolutionary divergence within V. cholerae O139 and offers a useful supplementary tool for following the progressing V. cholerae O139 epidemic.

The impact of three current types of preoperative large bowel preparation on the microbial flora and the colonization resistance (CR) was investigated in 15 volunteers. In the first group a whole gut irrigation was performed without administration of antibiotics (group WGI). In the second group 0·5 g/1 metronidazole and 1 g/1 neomycin was added to the irrigation fluid (group WGI + AB). A whole gut irrigation with prior oral administration of 1 l mannitol 10% was performed in the third group. The antibiotic prophylaxis in this group consisted of two doses of 80 mg gentamiein i.v. and 500 mg metronidazole orally 24 h after lavage (group Mann + AB). One hour after the mechanical cleansing procedure was finished all volunteers were orally contaminated with one dose of an Escherichia coli test strain. The aerobic faccal reduction due to the cleansing procedure was 2–3 logs, while for the anaerobes it was 4–5 logs. The anaerobic flora in group WGI recovered within 24 h, while the aerobes showed a transient ‘overgrowth‘ for the period of 2 days. The overgrowth of aerobes in group WGI + AB was observed for more than a week and the total numbers of aerobes started gradually to decline after the anaerobic flora had reached pretreatment levels at day three or four. Despite the normal numbers of anaerobes present 24 h after treatment, overgrowth of E. coli was seen in the group Mann + AB, probably due to residual mannitol left in the intestinal tract. The test strain of E. coli was excreted for a period of 1 week by the volunteers in the groups WGI and Mann + AB, but it was isolated for more than 10 weeks in the group WGI + AB. It is thought that all three methods of preoperative large bowel preparation decreased the CR of the gastrointestinal tract because of a disturbance of the interaction between aerobic and anaerobic microorganisms and alterations of the colonic wall. The anaerobic microflora. however, appeared to be primarily responsible for the maintenance of the CR. Antimicrobial prophylaxis should consist of a high dose, short term. systemic antibiotic regimen, not only because an adequate serum level of an appropriate drug at the time of operation substantially decreases the incidence of postoperative septic complications but also because a systemic regimen scarcely influences the CR of the gastrointestinal tract. β-Aspartylglycine appeared to be a specific but not very sensitive marker for decreased CR.

Salmonellas were isolated from 278 of 800 (34·7 %) samples of frozen carcass or boneless horsemeat from South America and from 101 of 751 (13·5%) samples of frozen boneless beef. However, the percentage of contamination detected depends to a large degree on the method of examination. Contamination was mostly external, a fact which points to slaughterhouse contamination. Boneless meat was contaminated to a higher degree than carcass meat.

Asymptomatic enteric infections are important where sequelae or protection from subsequent illness is an outcome measure. The use of reverse transcription–polymerase chain reaction (RT–PCR) to identify asymptomatic enteric infections in a birth cohort followed for rotaviral infections in a south Indian urban slum is reported. Of 1191 non-diarrhoeal samples from 371 children collected in May–June 2003, 22 (1·9%) were positive by ELISA. A total of 147 (40·6%) of 362 samples tested by VP6 RT–PCR were positive. In those samples that could be typed, a high diversity of G types including G1, G2, G4, G8, G9 and G10, and a high proportion (34·4%) of mixed infections were detected. Noroviruses were identified in 6/28 (21·4%) samples tested. The identification of infections undetectable by conventional techniques indicates the importance of the use of sensitive diagnostic techniques in research studies. Asymptomatically infected children may also act as a source of infection for other susceptible hosts.

Less than one per cent of serum samples taken from 257 fish farmers in 1981 had agglutinating antibodies to strains of Leptospira interrogans of serogroup Icterohaemorrhagiae at a titre of 30 or greater. Compared with the results from other serological surveys, this agglutinating antibody prevalence suggests that fish farming does not have a high occupational risk for leptospirosis. Between 1961 and 1981 the incidence in fish farmers was about 33 per 100000 person years at risk. During the same period the incidence in the general adult male population was 0·137 per 100000 person years at risk, so that fish farming had a moderately increased risk of Icterohaemorrhagiae serogroup infection (relative risk = 243). No one particular risk factor within fish farming could be reliably identified and therefore recommendations to reduce the risk can only be general.

The cell-surface hydrophobicity of 100 urinary isolates of Staphylococcus saprophyticus, cultured from symptomatic females in the general population, was assessed using a two-phase aqueous: hydrocarbon system. Relatively strong cell-surface hydrophobicity was exhibited by 79 isolates using the criteria employed, while only 2 of the remaining 21 isolates failed to demonstrate any detectable hydrophobicity. Cell-surface hydrophobicity may be a virulence factor of S. saprophyticus. important in adherence of the organism to uroepithelia. Additionally, the data support the concept that cell-surface hydrophobicity may be a useful predictor of clinical significance of coagulase-negative staphylococci isoated from clinical sources.

The associations with weather and bathing water quality on infectious intestinal disease (IID) were investigated using data from two Scottish NHS Board areas. Monthly counts of viral and non-viral gastrointestinal infections were modelled as a smooth function of temperature, relative humidity and average monthly counts of faecal indicator organisms, respectively, adjusting for season and long-term trend effects. Strong seasonal patterns were observed for each group of pathogens. Peak viral gastrointestinal infection was in May while that of non-viral gastrointestinal infections was in July. A statistically significant negative association existed between weather (temperature and humidity) and viral infection. Average levels of non-viral gastrointestinal infections increased as temperature and relative humidity increased. Increasing levels of faecal indicator organisms in bathing waters were also associated with an increase in the average number of viral and non-viral gastrointestinal infections at the ecological level. Future climate change and prolonged precipitation events may result in increasing levels of faecal indicator organisms in bathing waters leading to likely increases in IIDs.

The complement-fixation test, as commonly used in the diagnosis of viral infections, was studied for its possible application to the diagnosis of whooping cough and the detection of antibody following pertussis vaccination. The results were compared with those obtained in parallel immunofluorescence tests. CFTs were performed on sera from 41 patients with whooping cough (Bordetella pertussis isolated), 125 vaccinated persons, and 618 controls; parallel tests by IP were made on sera from 24 cases of whooping cough, 36 vaccinated persons and 37 controls. Results of both tests correlated closely and showed that titres of diagnostic significance were seldom found in control sera. They also showed that, in patients suffering from whooping cough, antibody in a single specimen or a rise in antibody between paired sera was almost always demonstrated. Titres in general were lower in infants less than 6 months of age. IgG antibodies were involved in both tests. Although the number of sera tested was small both tests appear to be reliable as means of demonstrating the presence of antibody formed during the course of infection and after vaccination.

Infectious diarrhoea is common in young Australian Aborigines [1–3] and is one of the main causes for their unsatisfactory health standards with consequent widespread failure to thrive and undernutrition [4–5]. Most published reports relate to patients in hospital or to hospital admission statistics and give little indication of the extent or severity of diarrhoeal disease in children in Aboriginal communities.

The present investigation involved more than 100 Aboriginal children up to 5 years of age living in remote communities in the tropical north of Western Australia who were studied prospectively over a 12–month period.

As an estimate of their virulence, the ability of ovine, bovine, canine, feline and simian ureaplasma strains to cause mastitis in the ovine mammary gland was investigated. Five ovine ureaplasmas produced a clinical mastitis. Broth cultures of seven bovine ureaplasmas were unable to infect the ovine gland, but two of these strains plus one other were able to do so following passage through the bovine udder. One of two canine strains and a feline strain both caused mastitis, but the simian strain persisted at low titre for only 5 days post-inoculation in one of the two ewes tested.

We present the results from a novel surveillance system for detecting excess all-cause mortality by age group in England and Wales developed during the pandemic influenza A(H1N1) 2009 period from April 2009 to March 2010. A Poisson regression model was fitted to age-specific mortality data from 1999 to 2008 and used to predict the expected number of weekly deaths in the absence of extreme health events. The system included adjustment for reporting delays. During the pandemic, excess all-cause mortality was seen in the 5–14 years age group, where mortality was flagged as being in excess for 1 week after the second peak in pandemic influenza activity; and in age groups >45 years during a period of very cold weather. This new system has utility for rapidly estimating excess mortality for other acute public health events such as extreme heat or cold weather.

Crimean-Congo haemorrhagic fever (CCHF) is endemic in the southeast of Iran. This study aimed to predict the incidence of CCHF and its related factors and explore the possibility of developing an empirical forecast system using time-series analysis of 13 years’ data. Data from 2000 to 2012 were obtained from the Health Centre of Zahedan University of Medical Sciences, Climate Organization and the Veterinary Organization in the southeast of Iran. Seasonal autoregressive integrated moving average (SARIMA) and Markov switching models (MSM) were performed to examine the potential related factors of CCHF outbreaks. These models showed that the mean temperature (°C), accumulated rainfall (mm), maximum relative humidity (%) and legal livestock importation from Pakistan (LIP) were significantly correlated with monthly incidence of CCHF in different lags (P < 0·05). The modelling fitness was checked with data from 2013. Model assessments indicated that the MSM had better predictive ability than the SARIMA model [MSM: root mean square error (RMSE) 0·625, Akaike's Information Criterion (AIC) 266·33; SARIMA: RMSE 0·725, AIC 278·8]. This study shows the potential of climate indicators and LIP as predictive factors in modelling the occurrence of CCHF. Our results suggest that MSM provides more information on outbreak detection and can be a better predictive model compared to a SARIMA model for evaluation of the relationship between explanatory variables and the incidence of CCHF.

A prospective study of faecal colonization with P-fimbriated Escherichia coli between 0 and 18 months of ago was conducted in 751 healthy infants. The influence of breast-feeding and treatment with antibiotics on this colonization was studied. Colonization with P-fimbriatcd E. coli increased with age from 10% at 6 days to 30% at 18 months of ago (P < 0·01). Breast-feeding influenced colonization at 6 weeks of age when breast-fed children harboured fewer bacterial species (P < 0·001) and fewer P-fimbriated E. coli (P = 0·06) than bottle-fed infants. Treatment with antibiotics increased the colonization rate with P-fimbriatcd E. coli at the age of 11 months (P < 0·05). However, this was not true for treatment with ampicillin, which increased colonization rate with Gram-negative species other than E. coli (P < 0·05). Fifty per cent (378) of all children were colonized and a quarter (183) had pure cultures of P-fimbriatcd E. coli in at least one faecal sample. The clinical importance of this colonization remains to be shown.

An investigation was conducted to determine the distribution, virulence gene profile and phenotypes of Shiga toxin-producing Escherichia coli (STEC) strains within a dairy farm in Kolkata, India by characterizing the STEC strains isolated from healthy dairy cow and calf stool samples, raw milk and farm floor swabs from July 2001 to March 2002. Primary screening by multiplex-PCR detected stx1 and stx2, the common virulence genes of STEC, in 18·9% of cow faeces, 32·4% of calf stool samples, 21·6% of farm floor swabs and 4·5% of raw milk samples and viable STEC were recovered from 4·5, 9·9, 8·1 and 1·8% of the corresponding PCR-positive samples. Strains harbouring stx1 (63·3%) and hlyA (53·3%) were frequently detected compared to eae (13·3%). Most of the strains harboured similar sets of reported virulence genes common among isolates from diarrhoea patients. Most of the strains also exhibited multidrug resistance, sorbitol fermentation and produced enterohaemolysin. The randomly amplified polymorphic DNA–PCR (RAPD–PCR) profile of the STEC strains isolated from the farm milieu revealed diverse banding patterns and clonal analysis demonstrated that the strains from different sources were not identical but showed some genetic relatedness. The study demonstrates the potential of dairy farm for housing virulent STEC.

There have been no previous longitudinal studies of otitis media conducted in non-Aboriginal Australian children. This paper describes the rate and risk factors for middle ear effusion (MEE) in children attending day care in Darwin, Australia. A prospective cohort study of 252 children under 4 years was conducted in 9 day care centres over 12 fortnights between 24 March and 15 September 1997. Tympanometry was conducted fortnightly and multivariate analysis used to determine risk factors predicting MEE. The outcome of interest was the rate of type B tympanograms per child detected in either ear at fortnightly examinations. After adjusting for clustering by child, MEE was detected on average 4·4 times in 12 fortnights (37% of all examinations conducted). Risk factors associated with presence of effusion were younger age, a family history of ear infection, previous grommets (tympanostomy tubes), ethnicity and the day care centre attended. A history of wheeze appeared protective. These effects were modest (RR 0·57–1·70). Middle ear effusion is very common in children attending day care in Darwin. This has clinical importance, since MEE during early childhood may affect optimal hearing, learning and speech development. There is little scope for modification for many of the risk factors for MEE predicted by this model. Further study of the day care environment is warranted.

A study was made of the growth of three strains of non-cholera vibrio in a range of foodstuffs and of the effect of temperature and pH on their ability to grow.

Growth was tested at 4°, 10°, 22°, 30°, 37° and 43 °C in a range of foods likely to be incorporated into cold hors d'oeuvres, e.g. egg, cream, rice, cold meat, seafood, aspic and mayonnaise. Non-cholera vibrios grew well in all these foods except mayonnaise, the rate of growth increasing with increased temperature of storage.

At acid pH values the organisms died or grew very poorly but growth improved as the pH became more alkaline. None of the three strains showed any resistance to heat, an initial inoculum of > 107 organisms/g was reduced to < 100 organisms/g in 2–3 mm at 55°C.

A significant challenge in the epidemiological investigation of recreational waterborne disease is the establishment of a definite association between exposure to a contaminated water and infection. An increase in specific antibodies as a result of infection is a potent measure of disease exposure and its determination would enhance epidemiological studies of waterborne diseases. We report on the automated detection of HAV antibodies in crevicular fluid and its use in a field study. The method is easy to use, non-invasive, could be applied to volunteers of all ages and is comparable in sensitivity to serological procedures. Application to an epidemiological study of water recreationalists demonstrated that surfers were three times more likely to be immune to hepatitis A virus than either wind-surfers or a control group without recreational water contact.

A prospective cohort study using electronic medical records was undertaken to estimate the relative risk (RR) of irritable bowel syndrome (IBS) following acute gastroenteritis (GE) in primary-care patients in The Netherlands and explore risk factors. Patients aged 18–70 years who consulted for GE symptoms from 1998 to 2009, met inclusion/exclusion criteria and had at least 1 year of follow-up data were included. Patients with non-GE consultations, matched by age, gender, consulting practice and time of visit, served as the reference group. At 1 year, 1·2% of GE patients (N = 2428) had been diagnosed with IBS compared to 0·3% of the reference group (N = 2354). GE patients had increased risk of IBS [RR 4·85, 95% confidence interval (CI) 2·02–11·63]. For GE patients, concomitant cramps and history of psycho-social consultations were significantly associated with increased risk. GE patients had increased risk of IBS up to 5 years post-exposure (RR 5·40, 95% CI 2·60–11·24), suggesting there may be other contributing factors.

Laboratory-based surveillance by OzFoodNet in Australia and FoodNet in the USA indicated that the incidence of Campylobacter infections in 2001 in Australia was about nine times higher than in the USA. We assessed whether this disparity could be explained by differences in the frequency of stool culturing. Using data from population surveys of diarrhoea and symptom profiles for Campylobacter from case-control studies, indices of healthcare behaviour taking into account the severity of Campylobacter infections were calculated. These suggest that culture-confirmed Campylobacter infections underestimate the incidence of community cases by similar ratios in the two countries. The incidence of Campylobacter infections in Australia was about 12 times higher than in the USA after consideration of healthcare system differences.