The status of rabies as a neglected disease has made its eradication rather challenging in different parts of the world despite the availability of a successful vaccine. Lebanon, in particular, is a country endemic to the disease with several cases of rabies deaths reported over the past 30 years. The risk of rabies, however, has taken a new turn over the past few years in Lebanon with two emerging situations that have made the control of the disease rather challenging: the neighbouring Syrian war and the local garbage crisis. Both of these milestone events might have contributed to an increase in the number of disease vectors as well as individuals at risk, thus nourishing the cycle of disease transmission. In this observational study, the effect of these two events are investigated, with an update on the status of this preventable, yet often neglected, disease in the country. Both events were found to be concomitant with a notable increase in the number of dog bites and thus possible rabies exposure. Current regulations are explored through interviews with veterinarians, and custom recommendations, ranging from policies to control dog populations to awareness campaigns in high-risk individuals, are then proposed to help control the disease.

Acinetobacter is a well-recognized nosocomial pathogen. Previous reports of community-associated Acinetobacter infections have lacked clear case definitions and assessment of healthcare-associated (HCA) risk factors. We identified Acinetobacter bacteraemia cases from blood cultures obtained <3 days after hospitalization in rural Thailand and performed medical record reviews to assess HCA risk factors in the previous year and compare clinical and microbiological characteristics between cases with and without HCA risk factors. Of 72 Acinetobacter cases, 32 (44%) had no HCA risk factors. Compared to HCA infections, non-HCA infections were more often caused by Acinetobacter species other than calcoaceticus–baumannii complex species and by antibiotic-susceptible organisms. Despite similar symptoms, the case-fatality proportion was lower in non-HCA than HCA cases (9% vs. 45%, P < 0·01). Clinicians should be aware of Acinetobacter as a potential cause of community-associated infections in Thailand; prospective studies are needed to improve understanding of associated risk factors and disease burden.

1. The term “paratyphoid group of bacilli” has been confined in the present enquiry to those strains which in their cultural characters and agglutination reactions are indistinguishable from B. suipestifer and B. paratyphosus (B). B. enteritidis Gaertner and B. paratyphosus (A) are excluded.

2. The strains of bacilli belonging to the “paratyphoid” group can be separated into two classes by means of the absorption method, namely one group identical with recognised, standard strains of B. suipestifer and one identical with standard strains of B. paratyphosus (B); and we regard these two bacilli as separate organisms.

3. In our experience, B. suipestifer has been found only in food or in outbreaks of acute illness attributable to food-poisoning, whereas B. paratyphosus (B) has been found in cases of paratyphoid fever or in persistent paratyphoid “carriers.”.

4. We are disposed to put forward the suggestion indicated by these observations, that these two organisms have a different distribution in nature, the normal habitat of B. suipestifer being the alimentary canal of the pig (and other animals) and of food derived from such animals, whereas the normal habitat of B. paratyphosus (B) is the human alimentary tract (including the gall-bladder).

5. The examination of cultures from the faeces and urine of 300 typhoid convalescents was completely negative, neither B. suipestifer nor B. paratyphosus (B) being obtained. These observations confirm those of other writers, and, apart from carrier cases, the occurrence of B. paratyphosus (B) in healthy human beings appears to be unknown in this country.

Our thanks are due to Drs Fisher, Trautmann, Uhlenhuth, Williams, Rommeler, Prigge, Schern, Friedrichs, Savage and Fowler, who have very kindly supplied us with strains of bacilli for investigation.

The main aim of this study was to measure and explain geographic variations in the incidence of Legionnaires' disease in Scotland, particularly to help understand the source of non–outbreak infection.

Between 1978 and 1986 the overall mean annual incidence rate was 7·9 per million (range 3·1–20·2), and for non–outbreak, non-travel cases it was 5·6. There were geographical variations by health board, by city and within cities, e.g. the mean annual incidence rate per million for non–travel, non–outbreak disease was 1·2 in Tayside Health Board, 3·7 in Lanarkshire, 5·6 in Lothian and 14·4 in Greater Glasgow. In Greater Glasgow Health Board non–travel cases lived in and around the city centre and in some postcode sectors there, the mean annual incidence rate exceeded 100. Travel–related cases lived in peripheral areas.

These variations could not be explained by differences in access to and use of diagnostic services, surveillance, or host susceptibility (as reflected by socio–economic status and frequency of other respiratory disease). The explanation probably lay in environmental factors, though differences in agent virulence were not excluded.

The two main conclusions are, that non–outbreak cases were not truly sporadic, and that the spacetime variations in incidence support the hypothesis that cooling towers were an important source of infection for not–nravel, non-outbreak cases. If so such infection is potentially preventable.

An investigation has been made into sporadic Salmonella infections. The most prevalent infecting organisms have been found to be Salmonella types aertrycke and thompson. Infections due to S. dublin, S. suipestifer (both European and American types) have also been encountered. The striking features of the investigation have been the number of individual cases and the lack of definite evidence of the source of infection.

Balamuthia mandrillaris is an emerging cause of encephalitis in humans. The transmission dynamics are poorly understood due to the high fatality rate and the sporadic nature of cases. Seventy-two soil samples were collected from beaches and the banks of lagoons, rivers, ponds, mineral springs and streams from across Jamaica and assayed for the presence of B. mandrillaris. Seventy-nine sites were sampled and the mitochondrial 16S rDNA gene of B. mandrillaris was amplified and sequenced to confirm the presence of the amoeba. One isolate of B. mandrillaris was recovered from soil from mineral spring which hosts an informal therapeutic mud bath business. Although B. mandrillaris is less frequently isolated from soil than other free-living amoebae, rubbing mud containing the organism onto the skin increases the likelihood of exposure and infection. This first report on the isolation of B. mandrillaris in the Caribbean and its presence in soil where human contact is likely warrants further investigation using serological methods to elucidate exposure patterns.

Vaccination programmes are considered a main contributor to the decline of infectious diseases over the 20th century. In recent years, the national vaccination coverage in the Netherlands has been declining, highlighting the need for continuous monitoring and evaluation of vaccination programmes. Our aim was to quantify the impact of long-standing vaccination programmes on notified cases in the Netherlands. We collected and digitised previously unavailable monthly case notifications of diphtheria, poliomyelitis, mumps and rubella in the Netherlands over the period 1919–2015. Poisson regression models accounting for seasonality, multi-year cycles, secular trends and auto-correlation were fit to pre-vaccination periods. Cases averted were calculated as the difference between observed and expected cases based on model projections. In the first 13 years of mass vaccinations, case notifications declined rapidly with 82.4% (95% credible interval (CI): 74.9–87.6) of notified cases of diphtheria averted, 92.9% (95% CI 85.0–97.2) cases of poliomyelitis, and 79.1% (95% CI 67.1–87.4) cases of mumps. Vaccination of 11-year-old girls against rubella averted 49.9% (95% CI 9.3–73.5) of cases, while universal vaccination averted 68.1% (95% CI 19.4–87.3) of cases. These findings show that vaccination programmes have contributed substantially to the reduction of infectious diseases in the Netherlands.

Cryptococcosis is not a commonly diagnosed disease. Records of its occurrence in Britain are virtually non-existent before 1945. when the Mycological Reference Laboratory (MRL) of the Public Health Laboratory Service was first established

The fate of Salmonella enterica serovar Enteritidis (SE) in whole, unbroken eggs was monitored during storage at fixed or changing temperatures after inoculation with 20–47 c.f.u. of SE. Eggs stored at 10°C and 20°C showed little or no bacterial growth over 6 weeks, while egg storage at 30°C increased the percentage of the eggs that contained >106 c.f.u. after 3 weeks. Egg storage at 20°C for 5 days followed by 10°C caused only a few eggs with >106 c.f.u. after 2 weeks, whereas storage at 22–30°C or 27–35°C for 5 days followed by 25°C induced a rapid increase of eggs that contained >106 c.f.u. after 1 or 2 weeks, respectively. Therefore, egg storage at 10°C and 20°C can control SE growth, although the temperature during egg storage and transportation from farm to table should also be taken into consideration.

Cellulitis is a common infection of the skin and soft tissue. Susceptibility to cellulitis is related to microorganism virulence, the host immunity status and environmental factors. This retrospective study from 2001 to 2013 investigated relationships between the monthly incidence rate of cellulitis and meteorological factors using data from the Taiwanese Health Insurance Dataset and the Taiwanese Central Weather Bureau. Meteorological data included temperature, hours of sunshine, relative humidity, total rainfall and total number of rainy days. In otal, 195 841 patients were diagnosed with cellulitis and the incidence rate was strongly correlated with temperature (γS = 0.84, P < 0.001), total sunshine hours (γS = 0.65, P < 0.001) and total rainfall (γS = 0.53, P < 0.001). The incidence rate of cellulitis increased by 3.47/100 000 cases for every 1° elevation in environmental temperature. Our results may assist clinicians in educating the public of the increased risk of cellulitis during warm seasons and possible predisposing environmental factors for infection.

The use of polyclonal antibodies in differentiating between samples of faecal microflora derived from ten healthy volunteers was assessed. The distribution of FITC-labelled antibodies (of the IgA, IgG and IgM isotype) over 144 morphologically distinct subsets of faecal bacteria (‘morphotypes’) was quantified by means of digital morphometry and quantitative immunofluorescence. Furthermore, a new dataprocessing algorithm was developed which makes objective quantitation of the antibody distributions over the faecal morphotypes possible. The results of this study imply that the antibody binding capacity of faecal morphotypes is a unique characteristic of faecal microflora.

The drinking water infrastructure in the United States is ageing; extreme weather events place additional stress on water systems that can lead to interruptions in the delivery of safe drinking water. We investigated the association between household exposures to water service problems and acute gastrointestinal illness (AGI) and acute respiratory illness (ARI) in Alabama communities that experienced a freeze-related community-wide water emergency. Following the water emergency, investigators conducted a household survey. Logistic regression models were used to estimate adjusted prevalence ratios (aPR) and 95% confidence intervals (CI) for self-reported AGI and ARI by water exposures. AGI was higher in households that lost water service for ⩾7 days (aPR 2·4, 95% CI 1·1–5·2) and experienced low water pressure for ⩾7 days (aPR 3·6, 95% CI 1·4–9·0) compared to households that experienced normal service and pressure; prevalence of AGI increased with increasing duration of water service interruptions. Investments in the ageing drinking water infrastructure are needed to prevent future low-pressure events and to maintain uninterrupted access to the fundamental public health protection provided by safe water supplies. Households and communities need to increase their awareness of and preparedness for water emergencies to mitigate adverse health impacts.

Analysis of the Dutch national invasive pneumococcal disease (IPD) surveillance data by sex reveals an increase in the incidence of serotype-1 disease in young female adults in The Netherlands after the introduction of the 7-valent pneumococcal conjugate vaccine (PCV7) in the national immunization schedule. This has led to an overall increase in IPD in women aged 20–45 years, which was not observed in men of the same age. No other differences in serotype shifts possibly induced by the introduction of PCV7 were observed between the sexes in this age group. Serotype 1 is a naturally fluctuating serotype in Europe and it has been associated with disease in young healthy adults before. It remains uncertain whether or not there is an association between the observed increase in serotype-1 disease in young female adults and the implementation of PCV7 in The Netherlands.

Knowledge about the infection transmission routes is significant for developing effective intervention strategies. We searched the PubMed databases and identified 10 studies with 14 possible inflight influenza A(H1N1)pdm09 outbreaks. Considering the different mechanisms of the large-droplet and airborne routes, a meta-analysis of the outbreak data was carried out to study the difference in attack rates for passengers within and beyond two rows of the index case(s). We also explored the relationship between the attack rates and the flight duration and/or total infectivity of the index case(s). The risk ratios for passengers seated within and beyond the two rows of the index cases were 1.7 (95% confidence interval (CI) 0.98–2.84) for syndromic secondary cases and 4.3 (95% CI 1.25–14.54) for laboratory-confirmed secondary cases. Furthermore, with an increase of the product of the flight duration and the total infectivity of the index cases, the overall attack rate increased linearly. The study indicates that influenza A(H1N1)pdm09 may mainly be transmitted via the airborne route during air travel. A standardised approach for the reporting of such inflight outbreak investigations would help to provide more convincing evidence for such inflight transmission events.

Prophylactic vaccines against Epstein–Barr virus (EBV) are under development. EBV-naïve college freshmen are ideal candidates for an efficacy trial, because their incidence of infectious mononucleosis (mono) during freshman year is as high as 20%. To assess perceptions about mono and a mono vaccine, and to learn if EBV immune status could be determined using a gingival swab rather than phlebotomy, we performed a cross-sectional study of 235 healthy students at the beginning of their freshman year. Subjects completed questionnaires and donated oral washes, gingival swabs and venous blood. Overall, 90% of students found the swab easy to use and 80% preferred the swab over venepuncture. Of the 193 students with sufficient samples, 108 (56%) had EBV antibodies in blood vs. 87 (45.1%) in the gingival swab. The sensitivity and specificity of the swab compared with blood for detecting EBV antibodies was 75.9% and 94.1%, respectively, with an accuracy of 89.3%. EBV DNA was detected in the oral wash and swab of 39.2% and 30.4% of blood-antibody-positive individuals, respectively. In conclusion, 44% of our freshmen were EBV-naïve and thus vaccine candidates, the gingival swab was an acceptable alternative to phlebotomy for detecting EBV antibody but needs improved sensitivity, and the perceived value of EBV vaccine was high (72% believed they would benefit).

The changing seasonal patterns of reported measles cases in Iceland during this century are analysed. These changes are related to increased population mobility following the development of external and internal transport links, particularly since 1945. The forging of such links has resulted in a shift in the seasonal distribution of cases from one peculiar to the local social and economic conditions in Iceland to one broadly similar to that in other countries of northern temperate latitudes.

One hundred and twenty-eight shigella strains isolated from newborn and infant human faecal specimens at Kaohsiung Medical College Hospital in Taiwan were serogrouped, serotyped and examined for drug-resistance patterns and for the presence of plasmids. Forty-seven pre cent of the isolates were found to belong to the Shigella sonnei serogroup, 41%to the S.flexneri group,9%to the S.boydii group and 3%to the S.dysenteriae group.The serotype with the greatest number of strains was S.sonnei I. (29 %) followed by S. flexneri 1 (27%). Each strain was tested for resistance to 11 antimicrobial agents. Eighty-eight per cent of the strains were resistant to tetracycline, 87% to chloramphenicol, 84% to streptomycin, 52% to ampicillin, 25% to nalidixic acid, 29% to kanamycin, 11 % to cephalothin, 11% to neomycin, 10% to cotrimoxazole, 1% to amikacin and none to gentamicin. The most prevalent resistance pattern was ApCmSmTc (28%). Clinical isolates demonstrating multiple resistance were found to harbour a large transmissible plasmid of 45–75 MDa while isolates without multiple resistance did not. Two large virulence plasmids of 123 and 110 MDa were found in 12 strains of S. flexneri and 4 strains of S. sonnei phase I. Small plasmids of 4·5, 4·2, 3·5, 2·8, 2·5. 2·0 and 1·5 MDa were also present in all strains. These small plasmids were species specific and can be used as marker plasmids to identify species.

A total of 108 raw water samples was collected from 36 wells at nine shanty settlements around Port Harcourt, Nigeria, over a period of 7 months. Samples were analysed for their bacteriological quality. Selected bacterial strains isolated from the samples were tested for their susceptibility to ten commonly used antibiotics. The organisms isolated include Pseudomonas spp., Klebsieila spp., Staphylococcus spp., Proteus spp., Enterococcus faecalis, Aeromonas spp., Escherichia coli, Chromobacterium spp., Flavobacterium spp., and Serratia spp.

Out of 300 strains tested, 23 (6·9%) were susceptible to all the antibiotics, 277 (92·3%) were resistant to at least one antibiotic and 232 (77·3%) were resistant to two or more antibiotics. The epidemiological significance of these results is discussed.

A cross-sectional study was conducted from April 2013 to September 2013 to determine the seroprevalence and possible risk factors for human Toxplasma gondii infection in East Hararghe Zone, Ethiopia. Serum samples were analysed using direct agglutination test, and immunosorbent agglutination assay for detecting IgG (n = 354) and IgM (n = 167) T. gondii antibodies. The T. gondii IgG and IgM seroprevalences were 65·8% [95% confidence interval (CI) 60·62–70·75] and 8·98% (95% CI 5·11–14·38), respectively. Gender difference in IgG seroprevalence was not significant (P > 0·05), but 69·5% of adults exhibited an IgG seroresponse to T. gondii. Pregnant women showed 76·4% and 9·3% seropositivity to IgG and IgM antibodies, respectively. Multivariable logistic regression analysis identified the risk factors significantly associated with T. gondii seropositivity were district [odds ratio (OR) 2·24, 95% CI 1·25–4·01, P = 0·007], pipe water source (OR 6·70, 95% CI 2·70–16·64, P < 0·001), age, with adults (OR 4·32, 95% CI 1·91–9·75, P < 0·001), and keeping cats in the home (OR 2·01, 95% CI 1·11–3·65, P = 0·021). The high seroprevalence of toxoplasmosis in the human population in the study area and the corresponding level of IgM seropositivity may be indicative of reactivation or recent infection and further studies on the status of congenital toxoplasmosis in the study area merit consideration.