We aimed to study patterns of shigellosis in a large observant Jewish community in Israel and to describe local interventions during outbreaks. Surveillance data from the Ministry of Health were used to calculate incidence rates in 1998–2006, both in the city of Bene Beraq and the Tel Aviv district. Information on isolates was collected from the bacteriological laboratory of a community hospital. Public notices and educational conferences conveyed a message to increase personal hygiene and keep ill children at home. During a 9-year period, a clear biennial pattern of outbreaks was noticed. Annual incidence rates ranged between 18 and 353/100 000 population. Shigellosis outbreaks tended to occur in the winter and were attributed to clonally related Shigella sonnei strains. Outbreaks in Bene Beraq preceded those in the other cities of Tel Aviv district, suggesting propagation of disease. In this population with highly endemic as well as superimposed outbreaks of shigellosis, short-term interventions had no lasting effect on prevention; future studies should focus on community-based programmes to avoid anticipated outbreaks.

Invasive group A streptococcal (GAS) disease is a condition of clinical and public health significance. We conducted epidemiological analyses to determine if the presence of gastrointestinal (GI) complaints (diarrhea and/or vomiting) early in the course of invasive GAS disease is associated with either of two severe outcomes: GAS necrotizing fasciitis, or hospital mortality. Subjects were hospitalized for invasive GAS disease throughout the state of Florida, USA, during a 4-year period. Multiple imputation using the Markov chain Monte Carlo method was used to replace missing values with plausible values. Excluding cases with missing data resulted in a sample size of 138 invasive GAS patients (the complete subject analysis) while the imputed datasets contained 257 records. GI symptomatology within 48 h of hospital admission was not associated with hospital mortality in either the complete subject analysis [adjusted odds ratio (aOR) 0·86, 95% confidence interval (CI) 0·31–2·39] or in the imputed datasets. GI symptoms were significantly associated with GAS necrotizing fasciitis in the complete subject analysis (aOR 4·64, 95% CI 1·18–18·23) and in the imputed datasets but only in patients aged <55 years. The common cause of GI symptoms and necrotizing fasciitis may be streptococcal exotoxins. Clinicians who are treating young individuals presumed to be in the early stages of invasive GAS disease should take note of GI symptoms and remain vigilant for the development of a GAS necrotizing soft-tissue infection.

The aim of this study was to investigate the prevalence and associated risk factors of methicillin-susceptible and methicillin-resistant Staphylocccus aureus (MSSA and MRSA) carriage in care homes, with particular focus on dementia. A point-prevalence survey of 748 residents in 51 care homes in Gloucestershire and Greater Bristol was undertaken. Dementia was assessed by the clock test or abbreviated mini-mental test. Nasal swabs were cultured for S. aureus on selective agar media. Multivariable analysis indicated that dementia was not a significant risk factor for MSSA (16·2%) or MRSA (7·8%); and that residents able to move around the home unassisted were at a lower risk of MRSA (P=0·04). MSSA carriage increased with increasing age (P=0·03) but MRSA carriage decreased with increasing age (P=0·05). Hospitalization in the last 6 months increased the risk of MSSA (P=0·04) and MRSA (P=0·10). We concluded that cross-infection through staff caring for more dependent residents may spread MRSA within care homes and from the recently hospitalized. Control of MSSA and MRSA in care homes requires focused infection control interventions.

To better understand the epidemiology of colonization of vancomycin-resistant enterococci (VRE), we performed an 8-year retrospective study of all hospitalized patients with recurrent VRE colonization after they were documented as being clear of VRE and compared the primary colonization isolates and recolonization isolates by pulsed-field gel electrophoresis and Tn1546 typing. Review of the medical records of all patients showed that of the 15 patients with recurrent colonization, six continued to be hospitalized on the same floor. Five were discharged home and then readmitted. Four were moved to another floor. Patients who remained on the same floor were recolonized with a strain that was indistinguishable from the original colonizing strain. Patients who were moved or were discharged had de novo VRE colonization with strains distinct from the original colonizing strain.

Schistosoma japonicum infection associated with a rectal carcinoid in an asymptomatic 44-year-old female from the Philippines is described. A systematic review of the literature could not identify similar reports, suggesting a rare coincidence. However, epidemiological data on the frequency of both conditions as well as published results of a colorectal screening programme from China indicate that underreporting of this concurrence is likely. Moreover, several studies suggest a causal link between schistosomiasis caused by S. japonicum and more common gastrointestinal malignancies such as colorectal carcinoma. Hence the presented case and the apparent neglect of this observation in the current literature allow speculation on a role of S. japonicum in the pathogenesis of rare gastrointestinal neoplasms such as carcinoid tumours as well. Future reports on similar observations could help to determine the need for systematic investigations and are strongly encouraged.

This study aimed to investigate the occurrence of complications, especially musculoskeletal symptoms, after sporadic Campylobacter jejuni enteritis of domestic origin in Finland. This multi-centre cross-sectional study was conducted during a seasonal peak in 2002. Questionnaires were sent to Campylobacter-positive patients, representing different geographical areas, 2 months after collection of positive stool samples. Medical records were viewed in several cases. Besides antimicrobial susceptibility testing C. jejuni isolates were serotyped. A total of 235 patients (58%) returned the questionnaire and 201 C. jejuni-positive patients were finally included in the study. Musculoskeletal symptoms associated with C. jejuni enteritis were frequent (39%); joint pain was most commonly reported (81%). The incidence of reactive arthritis was 4% and that of Achilles enthesopathy and/or heel pain was 9%. Stomach ache during enteritis was associated with the later development of joint pain. Antimicrobial treatment was common but did not prevent complications.

Incarcerated persons comprise about 0·4% of the Croatian population, of whom 25–30% misuse drugs. We attempted to determine the structure of the prison population, prevalence of HBV, HCV, HIV markers, co-infections with HBV, HCV and HIV and acute HBV, HCV and HIV infection. In total, 25·9% of prisoners were positive for some markers for viral hepatitis (HBV 11·3%, HCV 8·3%, HBV/HCV 6·3%). Prevalence of HBV infection in intravenous drug users (IDUs) was 26·2% (highly promiscuous group 20·4%, individuals with psychiatric diseases and personality disorders 16·0%). HCV infection in IDUs was 52·0% and 4·9% in the highly promiscuous group. HBV/HCV co-infection was registered in 34·9% of prisoners positive for HBV markers (203/582). Acute HBV infection was detected in 0·5%, and HCV in 1·2%. Only 0·15% (5/3348) of prisoners were anti-HIV positive. It appears that individuals with psychiatric diseases and personality disorders could be an additional risk population for these viral infections.

Rotavirus (RV) infections progressively confer natural immunity against subsequent infection. Similarly to natural infection, vaccination with a live attenuated vaccine potentially reduces RV transmission and induces herd protection. A mathematical transmission model was developed to project the impact of a vaccination programme on the incidence of RV infection and disease for five countries in the European Union. With vaccination coverage rates of 70%, 90% and 95% the model predicted that, in addition to the direct effect of vaccination, herd protection induced a reduction in RV-related gastroenteritis (GE) incidence of 25%, 22% and 20%, respectively, for RV-GE of any severity, and of 19%, 15%, and 13%, respectively, for moderate-to-severe RV-GE, 5 years after implementation of a vaccination programme.

Dirofilaria immitis is the causal agent of canine and feline cardiopulmonary dirofilariasis. Moreover, the existence of canine dirofilariasis implies a risk for human populations living in an endemic area in which, the parasite can cause pulmonary dirofilariasis. The Spanish epidemiological situation is not well understood, lacking data from many central and Northern provinces. In our study, epidemiological data on canine and human dirofilariasis for La Rioja (Northern Spain) have been obtained for the first time. The overall prevalence of D. immitis in dogs was 12% (9% of patent and 3% of occult infections), being 11·6% the seroprevalence of human residents in this province. The geographic distribution of both canine and human D. immitis infections in La Rioja is restricted to humid and irrigated areas near the Ebro Valley River, being absent in the rest of the province where hills and mountains predominate.

Aichi virus has been proposed as a novel causative agent of acute gastroenteritis. In addition to several Asian countries, South America and Africa, Aichi virus has also recently been found in Europe. Our objective was to study the causative role of Aichi virus in children with acute gastroenteritis in Finland. We analysed 595 stool specimens from infants in an efficacy trial of rotavirus vaccine and 468 stool specimens from children in a hospital-based epidemiological and aetiological study of acute gastroenteritis. The screening was done by nested reverse transcription–polymerase chain reaction amplifying a 519-bp segment and a 223-bp segment in the 3CD junction region of non-structural proteins. Aichi virus was detected in five stool samples (0·5%), of which four were co-infections with other gastroenteritis viruses. Two Aichi virus genotypes, A and B, were found. Aichi virus appears to be rare in children with acute gastroenteritis in Finland.

Antimicrobial resistance (AMR) in Neisseria gonorrhoeae compromises patient treatment and disease control. Epidemiologically based surveillance of AMR in gonococci is needed to optimize standard treatment regimens. Validation of AMR surveillance data depends on external quality assurance schemes (EQAS). AMR surveillance data quality in India during 2001–2007 was assessed by participants testing panels of reference strains and repeated re-challenge with identical controls, accompanied by educative feedback. Overall, correct results were obtained for 944 (82%) of 1030 tests performed for five ‘core’ antibiotics. Aggregated error rates decreased from 33% (123 tests) in 2001 to 4·4% (180 tests) in 2007 with improvements in individual laboratory performance. Cephalosporin test results produced high error rates without improvement. Reference centre and network laboratory collaboration produced marked improvements in test performance through annual EQAS integrating proficiency testing and participant education. More frequent EQAS cycles would assist this process. These experiences may be applicable in similar settings elsewhere.

Three time-series models (regression, decomposition, and Box–Jenkins autoregressive integrated moving averages) were applied to national surveillance data for campylobacteriosis with the goal of disease forecasting in three US states. Datasets spanned 1998–2007 for Minnesota and Oregon, and 1999–2007 for Georgia. Year 2008 was used to validate model results. Mean absolute percent error, mean square error and coefficient of determination (R2) were the main evaluation fit statistics. Results showed that decomposition best captured the temporal patterns in disease risk. Training dataset R2 values were 72·2%, 76·3% and 89·9% and validation year R2 values were 66·2%, 52·6% and 79·9% respectively for Georgia, Oregon and Minnesota. All three techniques could be utilized to predict monthly risk of infection for Campylobacter sp. However, the decomposition model provided the fastest, most accurate, user-friendly method. Use of this model can assist public health personnel in predicting epidemics and developing disease intervention strategies.

We report the prevalence of rotavirus and calicivirus infections, along with their respective association with diarrhoea in the porcine population of the region of northern Spain. A total of 221 samples were collected at random from different farms in the region and from the main slaughterhouse facility in the city of Zaragoza. Faecal samples were scored as diarrhoeic or normal and grouped into five groups to match general farm management and age criteria: group I (suckling 0–4 weeks), group II (weaning >4–8 weeks), group III (transition >8–16 weeks), group IV (fattening >16–24 weeks) and group V (adults >24 weeks). Group A rotavirus detection and caliciviruses were investigated by reverse transcription–polymerase chain reaction (RT–PCR). Conventional RT–PCR was performed using primers designed to detect rotavirus group A, caliciviruses and/or human noroviruses. A real-time RT–PCR was carried out using TaqMan probes for genogroups GI and GII of noroviruses. Rotaviruses and caliciviruses were detected with an overall prevalence of 16·7% and 12·2%, respectively. Rotavirus detection in faecal samples was associated with both age and faecal consistency, being more frequent in piglets aged <8 weeks with odds ratios (ORs) equal to 4·3 and 4·9, respectively. Calicivirus shedding in faecal samples was homogenously distributed in all ages, showing no significant association with age or faecal consistency (OR 0·87 and 0·99, respectively). A selection of rotavirus-positive stools were genotyped by multiplex nested PCR. G10, P[6], G12 P[8], G9 [p8] and G4 P[23] genotype combinations were found. Three isolates showed a G3 genotype, but their VP4 gene could not be amplified. It should be noted that the G9 genotype was the major G genotype circulating during that period in Spain. None of the porcine samples was positive for norovirus by real-time RT–PCR, despite the ability of this technique to detect at least 18 human norovirus genotypes. Our data indicate that human noroviruses are unlikely to be circulating in the porcine population; however, sapoviruses have been found. Contrary to rotavirus infection, Calicivirus infection is asymptomatic. Specific primers to detect porcine noroviruses are needed.

The risk of classical scrapie in sheep is associated with polymorphisms in the prion protein (PrP) gene. In recent years, large-scale selective breeding programmes for sheep at lower risk of disease have been undertaken across the European Union. We analysed large-scale datasets on scrapie and sheep demography to investigate additional effects of sheep breed on scrapie risk. There was evidence for variation between certain breeds in the scrapie risk of some PrP genotypes, which could be caused by innate breed differences or distinct scrapie strains circulating within them. While the PrP genotypes of cases are generally consistent across breeds, some exceptions provide evidence that scrapie strain may influence affected PrP genotypes to a greater extent than innate breed differences. There was a significant association between the breed-level incidence of scrapie and the frequency of susceptible PrP genotypes in breeds. Our results lend support to selective breeding programmes which aim to reduce the frequency of high-risk PrP genotypes with measures not varying by sheep breed.

Most cases of measles in Australia are associated with travel or acquired from travellers from overseas. This study presents a series of three secondary cases of measles acquired through contact with a case of infectious measles acquired in China. Two of the cases were fully immunized siblings sitting eight rows behind the index case on a 4½-h flight from Singapore. The third case was acquired in the airport where the index case was in transit. The report highlights the travel-associated risk of measles and discusses the heredity of vaccine-induced measles immunity.

The success of childhood vaccination against hepatitis B relies on persistence of immunity into adolescence and adulthood. In 2000, two hexavalent vaccines with a hepatitis B component (Hexavac®, Infanrix hexa®) were introduced in Germany. Hexavac was withdrawn in 2005 amidst concerns about its long-term hepatitis B protection. We compared hepatitis B surface antibody (anti-HBs) levels in children fully vaccinated with Hexavac or Infanrix hexa (n=477) in a secondary data analysis of a large cross-sectional health survey in Germany. On average 2·4 years after vaccination, 25·3% of Hexavac vaccinees had anti-HBs levels <10 mIU/ml (95% CI 19·0–32·8) compared to 4·7% of Infanrix hexa vaccinees (95% CI 2·4–8·9). These findings suggest that short-term hepatitis B immunogenicity in Hexavac vaccinees may also be weaker. Further studies are warranted to assess whether Hexavac vaccinees should be re-vaccinated or receive a booster vaccination before these birth cohorts reach adolescence.

To monitor the changing trend of extended-spectrum β-lactamase (ESBL)-producing bacteria, a 7-year continuous study was launched in 2001 at the largest tertiary hospital in Taiwan. A significant increase over the study period was evident for ESBL-producing isolates of Escherichia coli (4·8–10·0%) and Klebsiella pneumoniae (15·0–23·4%). Molecular investigation conducted in three separate periods revealed the prevalent ESBL types and their genetic relatedness. CTX-M-producing isolates (73·8%) were more prevalent than SHV-type ESBLs (37·0%), the most frequent being CTX-M-14 (34·3%), CTX-M-3 (25·9%), and SHV-12 (25·7%). However, a marked increase of CTX-M-15-producing isolates from 2·1% in 2002 to 29·6% in 2007 was also noted. The increase of ESBL-producing isolates in both species may be mainly due to the horizontal transmission of resistance plasmids, while clonal expansion of some epidemic strains further added to the dispersion of ESBL-producing K. pneumoniae.

Japanese encephalitis (JE) has been found to be endemic in Bali, Indonesia. A case-control study was conducted to identify factors associated with JE infection. All 94 serologically confirmed JE cases (cases) and 163 cases of encephalitis or aseptic meningitis without JE (controls) identified in Bali during 2001–2004 were included in the study. Potential risk factors were surveyed at hospital admission. Univariate analyses revealed the following factors to be associated with JE: older age, referral from sub-district health centre or private hospital, playing outdoors after dinner, use of mosquito repellent or spraying, proximity of the residence to rice fields, and pig ownership by the family or next-door neighbours. Multivariate analysis identified proximity to rice fields (OR 2·93, 95% CI 1·57–5·45), pig ownership (OR 2·24, 95% CI 1·17–4·26), and older age (OR 1·21, 95% CI 1·09–1·33) as being independently associated with the risk of JE. Because rice cultivation and pig rearing are essential to the economy of Bali, JE immunization is the best intervention for prevention of JE in Bali.

In low vaccination coverage regions (LVR) in The Netherlands people often reject participation in the National Immunization Programme for religious reasons. During a rubella epidemic in 2004–2005, 32 pregnant women were notified with rubella, and 11 babies were born with defects related to maternal infection. This study presents a cost-utility analysis of a screening and vaccination programme for rubella focusing on three scenarios: (1) screening non-vaccinated pregnant women in LVR; (2) screening all pregnant women in LVR; (3) screening all non-vaccinated pregnant women in The Netherlands (including pregnant first-generation non-Western immigrant women). Cost-utility was estimated over a 16-year period which included two rubella outbreaks. Observed complications from the 2004–2005 epidemic were used to estimate average cost savings and quality-adjusted life-years (QALY) gained. The programme would be cost-effective (€1100/QALY gained) when assuming an acceptability of vaccination of 20% in women belonging to orthodox protestant risk groups.