Leptospirosis has significantly decreased in Korea since 1988, following the leptospiral vaccination programme initiated in 1988. Whether this wholly explains the decreased incidence is uncertain. As an initial step to answer this question, infection rates of Leptospira interrogans in field rodents, Apodemis agrarius, were examined and compared with previous data.

Two hundred and twenty-two A. agrarius were captured during October–December 1996. Spirochaetes were isolated from 22 (9·9%) and leptospiral DNA was detected in an additional 6 rodents (12·6%). Subsequent microscopic agglutination tests (MAT) classified all these isolates as L. interrogans serogroup Icterohaemorrhagiae serovar lai. The above data did not significantly differ from previous surveys in 1984–7. There was no significant change of L. interrogans infection in field rodents following the introduction of the vaccination programme in Korea. Further studies are needed to determine the role of human vaccination in reducing incidence.

We assessed prevalence of and risk factors for candidaemia following Clostridium difficile infection (CDI) using longitudinal population-based surveillance. Of 13 615 adults with CDI, 113 (0·8%) developed candidaemia in the 120 days following CDI. In a matched case-control analysis, severe CDI and CDI treatment with vancomycin + metronidazole were associated with development of candidaemia following CDI.

Periodic outbreaks of West Nile virus (WNV), Eastern equine encephalitis virus (EEEV) and to a lesser extent, California serogroup viruses (CSGV), have been reported in parts of Canada in the last decade. This study was designed to provide a broad assessment of arboviral activity in Quebec, Canada, by conducting serological surveys for these arboviruses in 196 horses, 1442 dogs and 485 humans. Sera were screened by a competitive enzyme linked immunosorbent assay and positive samples confirmed by plaque reduction neutralisation tests. The percentage of seropositive samples was 83·7%, 16·5%, 7·1% in horses, 18·8%, 0·6%, 0% in humans, 11·7%, 3·1%, 0% in adult dogs and 2·9%, 0·3%, 0% in juvenile dogs for CSGV, WNV and EEEV, respectively. Serological results in horses and dogs appeared to provide a meaningful assessment of risk to public health posed by multiple arboviruses.

Since the introduction of routine measles, mumps and rubella immunization for children in England and Wales in 1988, the incidence of mumps has declined steadily. We describe an outbreak of mumps in 1996 attacking 34 of a cohort of 98 schoolchildren born in 1982 and 1983. This is the largest outbreak in the UK since the introduction of the vaccine into the childhood immunization schedule. Salivary IgM assay was used as a simple, minimally invasive test to confirm the diagnosis. The occurrence of the outbreak demonstrates that British children who were just too old to receive mumps immunization in 1988 continue to be at risk of this disease as a result of diminished natural exposure. Further cases and outbreaks in this cohort are to be expected. Cohorts born before 1982 appear to be at less risk, presumably because of naturally acquired infection before the introduction of immunization.

A method of secondary enrichment is described suitable for the isolation of a wide range of salmonella serotypes from abattoir swabs and polluted river water. The technique does not employ selectively toxic chemicals.

Streptococcus agalactiae is a genetically diverse organism; when typed by pulsed-field gel electrophoresis (PFGE), multiple types appear within a single serotype. We tested whether S. agalactiae PFGE types correspond to a specific serotype within individuals, and different individuals from the same geographic area. A total of 872 S. agalactiae isolates from 152 healthy individuals were classified by PFGE and capsular serotype. Serotype V was the most homogeneous (Simpson's diversity index 0·54); and types III, II and Ib were mostly heterogeneous (Simpson's diversity index ⩾0·90). Within an individual, isolates with the same PFGE patterns had identical capsular types, but across individuals the same PFGE types sometimes occurred in different serotypes. Capsular type alone is insufficient to define epidemiological relatedness. Although PFGE types appear to be a valid surrogate for capsular typing of isolates from the same individual, it is not a valid surrogate for serotype in isolates from different individuals.

The purpose of this study was to identify the clinical outcomes of ambulatory-treated Clostridium difficile infection (CDI) and risk factors associated with community-associated CDI (CA-CDI). Adult patients diagnosed with CDI in the institutional or ambulatory-care setting between 1 April 2005 and 30 April 2011, with no other CDI diagnosis in the previous 180 days, and who purchased an ambulatory, anti-CDI agent within 7 days of CDI diagnosis were included. A total of 1201 patients were included with 914 (76%) and 287 (24%) identified with CA-CDI and nosocomial CDI (N-CDI), respectively. Patients with N-CDI were more likely to have had a recurrent CDI (P = 0·043) and died from any cause (P < 0·001). Patients with CA-CDI were younger, healthier, and had fewer traditional risk factors compared to patients with N-CDI. To prevent CA-CDI, clinicians should be aware that patients at risk for CA-CDI are unique from those at risk for N-CDI.

We investigated the first laboratory-confirmed human case of cowpox virus infection in Russia since 1991. Phylogenetic studies of haemagglutinin, TNF-α receptor-like protein and thymidine kinase regions showed significant differences with known orthopoxviruses, including unique amino-acid substitutions and deletions. The described cowpox virus strain, taking into account differences, is genetically closely related to strains isolated years ago in the same geographical region (European part of Russia and Finland), which suggests circulation of viral strains with common origin in wild rodents without spread over long distances and appearance in other parts of the world.

This study evaluates the utility and cost effectiveness of empirical and prophylactic antibiotic treatment of leptospirosis compared with conventional management. We developed decision trees comparing empirical antibiotic treatment (within 4–7 days of symptom onset) or prophylaxis to conventional antibiotic treatment (initiated ⩾7 days post-onset). Costs were calculated using both US and Barbados pricing. Empirical treatment provided slightly lower probability of survival, while prophylactic treatment resulted in slightly higher survival rates. Antibiotic treatment initiated after 4–7 symptomatic days was ineffective in preventing serious health outcomes, but cost less with the exception of azithromycin (US pricing). Empirical treatment in Barbados cost less than conventional treatment. Prophylaxis reduced rare serious health outcomes and resulted in significant cost savings for the United States and Barbados. Prophylactic therapy for high-risk individuals or prompt diagnosis and early treatment (before 4 days of symptoms) appear to be cost-effective approaches to prevent severe complications of leptospirosis.

Preliminary typing of 1820 strains of Staph. aureus from 51 herds with the human set of phages showed that non-typable strains were common (31·4%). Other phages were investigated and 1404 strains from 328 herds were typed with 42 phages; these included the human phage set, phages from Weybridge and phages isolated in Brisbane. The following 20 phages were selected as suitable for typing bovine strains of Staph. aureus in Australia: 29, 80, 13, 71, 6, 7, 42E, 47, 53, 77, 31B, 42D, 81, 101, 102, 107, 110, 600, 367, 425. Phages 13, 367, 425, 600 were from Brisbane and 101, 102, 107 and 110 were from Weybridge.

Antimicrobial resistance of pneumococci is influenced by serotypes, antimicrobial consumption and vaccine use. Serotyping of 697 out of 1331 pneumococcal isolates, recovered in Portugal from 1994 to 2004, showed that the theoretical rate of heptavalent conjugate vaccine coverage was 91·7% and 63·6% for penicillin and erythromycin non-susceptible strains, respectively, in children up to 1 year old. The use of amoxicillin and erythromycin decreased in the vaccine period 2001–2004 (P=0·04 and P<0·01, respectively) but azithromycin usage increased in the same period (P<0·01). By using linear regression models, we evaluated the role of antimicrobial and vaccine use in the trends of resistance to penicillin and erythromycin among the isolates. The models suggest that the use of macrolides was the main factor associated with an increase of penicillin and erythromycin non-susceptible isolates from adults (P<0·01) and erythromycin non-susceptible isolates among children (P=0·006). These models also suggest that heptavalent vaccine is failing to reduce antimicrobial resistance as expected, possibly due to the increased consumption of azithromycin (P=0·04). The efficient use of new antibiotics may reverse the present trends of antimicrobial resistance.

We reviewed serological and epidemiological data relating to 1000 consecutive patients from whom specimens were submitted for estimation of bartonella antibodies, using MRL Diagnostics Bartonella IFA IgM and IgG kits. Using 289 control sera, we estimated the specificity of the kits as [ges ]99·0%. Evidence of bartonella infection was found in 16·3% of patients examined. Rates varied by patient group: 20% of patients for whom a diagnosis of cat scratch disease (CSD) was considered probable had evidence of infection, as did 10·4% of patients with ‘possible CSD’, 8·1% of patients with possible bacillary angiomatosis, 18·2% of patients with ‘culture negative’ endocarditis and 17·6% of patients with possible bartonellosis with ophthalmic involvement. An IgM response was seen in 6·6% of patients and IgG in 15·1%. Cases were more frequent among males than females (18·5% vs. 13·9%). Analysis by age showed that although rates of infection were highest in the decades 0–9 years (19·4%) and 10–19 years (20·7%), they fell only slightly in the next three decades. MRL bartonella kits appears to provide a useful and specific approach to the diagnosis of these infections.

Pulsed field gel electrophoresis (PFGE) and random amplified polymorphic DNA (RAPD) methods were applied for molecular typing of 130 Mannheimia (Pasteurella) haemolytica serotype A1 isolates obtained from 13 prefectures in Japan. These isolates were divided into 15 ApaI PFGE profiles that formed six distinct clusters (clusters A–F). Fifty-three (40·7%) isolates were classified in cluster B, and 20·0, 13·8, 12·3, 6·9 and 6·1% of isolates were in clusters E, A, F, D and C, respectively. The isolates of cluster B were differentiated into seven subtypes (B1–B7) and subtype B5 contained 63% (34/53) of isolates. RAPD revealed four banding patterns (types I–IV), and among 130 isolates 60·7% (79/130) of isolates were RAPD type I. All of the RAPD type I isolates were grouped into clusters A–C by PFGE. There was no relationship between molecular typing and geographic origin of these isolates. These results indicate that isolates of M. haemolytica A1 strain with various molecular profiles have already spread in Japan and may have caused sporadic infections.

COVID-19 as an emerging disease has spread to 183 countries and territories worldwide as of 20 March 2020. The first COVID-19 case (i.e. the index case) in Iran was observed in the city of Qom on 19 February 2020. One of the cities of Markazi Province is Delijan, which shares a border with Qom. Consequently, COVID-19 has quickly spread in this city because a large population commutes daily between the two cities. This study aimed to report the challenges and considerations of community-based preparedness at the onset of COVID-19 outbreak in a city of Iran in 2020.

Malignant catarrhal fever (MCF) herpesvirus was isolated from the nasal secretions of 4/11 young wildebeest calves. In two cases virus was demonstrated in filtered secretions. The presence of cell-free MCF virus would suggest that the virus can be transferred from wildebeest to wildebeest and into cattle in nasal secretions.

Occasional cases of classical bovine spongiform encephalopathy (BSE) still continue to occur within the European Union (EU) for animals born after reinforced feed bans (BARBs), which should in theory have eliminated all risk of infection. The study aimed to determine (i) whether a common rate of decline of BSE infection was evident across EU member states, i.e. to determine whether control measures have been equally effective in all member states, (ii) whether there was any evidence of spontaneous occurrence of BSE in the data and (iii) the expected date for the last BSE case in UK. It was found that there was no significant difference in the rate of decline of BSE prevalence between member states, with a common rate of decline of 33·9% per annum (95% CI 30·9–37%) in successive annual birth cohorts. Trend analysis indicated an ultimate decline to 0 prevalence, suggesting that spontaneous occurrence does not explain the majority of cases. Projecting forward the trends from the back-calculation model indicated that there was approximately a 50% probability of further cases in the UK, and should the current rate of decline continue, there remains the possibility of further occasional cases up until 2026.

The United States has been fortunate in never having had any extensive epidemics of plague. With the exception of a few cases, not over a dozen, that are directly chargeable to the infection of the indigenous rodents (ground squirrels), the disease has been confined to the two largest and most important cities on the Pacific Coast, San Francisco and Seattle. In each city the disease has yielded promptly to vigorous sanitary measures carried out by the public health arm of the Federal Government. Under the political organization of the Government, direct control of measures for the suppression of a disease is taken by the central sanitary authority only when a request is made by the local authorities, but it has been the experience that local authorities are prompt to make requests for assistance whenever any serious epidemic appears.

A longitudinal study of nasal colonization and hand contamination of food handlers with Staphylococcus aureus commenced in 2002 prior to the outbreak of severe acute respiratory syndrome. In the follow-up in 2003 when hygiene measures were strictly implemented, significant reductions in carriage were observed. To investigate if this change was sustained, nasal and hand carriage rates were compared between the earlier studies and a further sampling in 2011. The initial nasal carriage rate was 35% and hand contamination 41·2%, decreasing to 23·5% and 11·6%, respectively in 2003 (P < 0·001). In 2011, nasal carriage was similar to 2003 (22·9%), while hand contamination dropped further to 3·7% (P < 0·001). Spa-typing revealed 39 types in 2002 and 42 in 2011. This study reveals that the marked reduction in colonization had been sustained. This may be attributed to reduced opportunities for spread due to enhanced hygiene and reinforces its importance for control of disease.

We undertook a retrospective descriptive comparison of the spectrum of pathogens responsible for bacteraemia and diarrhoea in HIV antibody positive and negative patients over 4 years (1988–92), in Nairobi, Kenya. The study population was recruited from primary to tertiary centers of clinical care and consisted of 2858 adults (15 years or older). There were 415 significant blood culture isolates, 192 from 1785 HIV negative patients and 223 from 953 HIV positive patients. There were 233 significant faecal isolates, 22 from 115 HIV negative patients and 211 from 531 HIV positive patients. The most common pathogens detected in blood were Streptococcus pneumoniae and Salmonella typhimurium and in faeces Shigella flexneri, S. typhimurium and Cryptosporidium parvum. The agents causing illness in HIV positive patients in Nairobi are similar to those prevalent in the HIV negative community and the investigation of a febrile illness with or wothout diarrhoea in an HIV positive patient should reflect this.

The co-existence of stroke and HIV has increased in recent years, but the impact of HIV on post-stroke outcomes is poorly understood. We examined the impact of HIV on inpatient mortality, length of acute hospital stay and complications (pneumonia, respiratory failure, sepsis and convulsions), in hospitalized strokes in Thailand. All hospitalized strokes between 1 October 2004 and 31 January 2013 were included. Data were obtained from a National Insurance Database. Characteristics and outcomes for non-HIV and HIV patients were compared and multivariate logistic and linear regression models were constructed to assess the above outcomes. Of 610 688 patients (mean age 63·4 years, 45·4% female), 0·14% (866) had HIV infection. HIV patients were younger, a higher proportion were male and had higher prevalence of anaemia (P < 0·001) compared to non-HIV patients. Traditional cardiovascular risk factors, hypertension and diabetes, were more common in the non-HIV group (P < 0·001). After adjusting for age, sex, stroke type and co-morbidities, HIV infection was significantly associated with higher odds of sepsis [odds ratio (OR) 1·75, 95% confidence interval (CI) 1·29–2·4], and inpatient mortality (OR 2·15, 95% CI 1·8–2·56) compared to patients without HIV infection. The latter did not attenuate after controlling for complications (OR 2·20, 95% CI 1·83–2·64). HIV infection is associated with increased odds of sepsis and inpatient mortality after acute stroke.