To know the types of meningococcal strains in Spain, we serotyped and subtyped 743 Neisseria meningitidis isolates recovered between 1990 and 1992 from patients. A great number of serogroup B, serogroup C and non-groupable meningoccoci reacted with the serotyping reagents while many serogroup C and non-groupable isolates did not react with the serosubtyping reagents (78·2% and 54·8 % respectively); only 8·9 % of serogroup B meningococci were non-subtypeable (NST). Distribution of serotypes was similar in serogroup C and in non-groupable strains. Isolates showed great variability in antigenic phenotypes (71 in serogroup B, 20 in serogroup C and 25 in non-groupable meningococci). The most frequent antigenic combinations were 4:P1. 15 (39·8%) in serogroup B, 2b:NST (55·8%) in serogroup C and 2b:NST (35·6%) in non-groupable meningococci.

Staphylococcus aureus strains of type 95 in Denmark have increased to a frequency of 20% of the total S. aureus population. A clonal origin and possible subdivision of these strains have been discussed. In the present investigation 35 epidemiologically unrelated S. aureus strains of type 95 as well as reference strains of other types have been analysed by other typing techniques including lectintyping, multilocus enzyme electrophoresis and pulsed-field gel electrophoresis of genomic restriction fragments. No subdivision could be achieved based on any of these methods and a clonal origin seems therefore possible.

Terminal complement component deficiency predisposes to meningococcal infection and is inherited in an autosomal co-dominant manner. An Irish family is described, in which 2 of 3 brothers had recurrent meningococcal infection. A novel screening assay was used to investigate for terminal complement deficiency and the 2 affected brothers were found to be completely deficient in the seventh component of complement (C7). Enzyme-linked immunosorbent assay for C7 revealed lower than normal levels in the remaining brother and parents. C7 M/N protein polymorphism allotyping, used to investigate the segregation of the C7 deficiency genes, showed that the apparently complement sufficient brother was heterozygous C7 deficient and a carrier of one of the deficiency genes. Complement screening should be carried out in any individual suffering recurrent meningococcal infection or infection with an uncommon meningococcal serogroup. Identification of complement deficient patients allows the implementation of strategies to prevent recurrent infection.

Clonal dissemination of two different MRSA strains, both clumping factor negative, has been observed in Germany for more than a year. Both strains possess the mec-A determinant and each exhibits a characteristic genomic DNA fragment pattern. One strain has spread in the north, the other in the south-west of Germany.

Intensive care units are mainly affected by MRSA-infections and probably play a special role in further intra- and inter-hospital spread.

An outbreak of food intoxication involving over 265 cases in western United States occurred in October 1991. Staphylococcus intermedius was implicated as the aetiologic agent. Representative outbreak isolates (five clinical and ten from foods) produced type A enterotoxin. DNA fragments generated by four restriction endonucleases and analysed by pulsed-field gel electrophoresis (PFGE) provided definitive evidence that all isolates from nine different counties in California and Nevada were derived from a single strain. The PFGE pattern of these outbreak isolates was distinct from those of a heterogeneous collection of seven S. intermedius strains of veterinary origin and five unrelated S. aureus laboratory strains. The data show a significant PFGE pattern heterogeneity not only among members of different Staphylococcus species but also within members of the same species and even the same enterotoxin type. The results indicate that PFGE is a valuable strain-specific discriminator for the epidemiological characterization of S. intermedius. To our knowledge, this represents the first documented foodborne outbreak caused by S. intermedius. These findings suggest that the presence of S. intermedius and other species such as S. hyicus in food should be reason for concern.

A cohort of 4515 surgical patients in ten selected intervention groups was followed. Three hundred and seventeen developed postoperative wound infections, and 291 of these cases were matched 1:1 to controls by operation, sex and age. In comparison to the controls the cases stayed longer in hospital after the intervention and had more contact after discharge with the social security system.

Using data from a national sentinel reference database of the incidence of postoperative wound infections, and using national activity data, we established an empirical cost model based on the estimated marginal costs of hospital resources and social sick pay. It showed that the hospital resources spent on the ten groups, which represent half of the postoperative wound infections in Denmark, amounted to approximately 0·5% of the annual national hospital budget. This stratified model creates a better basis for selecting groups of operations which need priority in terms of preventive measures.

Human infections with pathogenic strains of Yersinia enterocolitica have been linked to contact with dogs excreting these microorganisms. This study examines the carriage and transmission of Y. enterocolitica biotype 4, serotype 03 in dogs. Fourteen 6-month-old cross-bred dogs were separated into 5 groups, 2 containing 4 dogs (I and II) and the others 2 dogs (III-V). Each of the 4 dogs in Group I and 2 of the dogs in Group II were inoculated orally with the test strain. Bacteriological examination of faecal samples showed that dogs can be readily infected and can carry the organism for up to 23 days. The two in-contact dogs in Group II started to shed the test organism after 5 days. Subsequent transfer of these dogs to Group III and those in Group III to Group IV showed that Y. enterocoliticabiotype 4, serotype 03 can be readily transmitted between dogs. At no time did any of the dogs show clinical signs of infection. Group V served as a negative control for the trial. These findings suggest that dogs can carry Y. enterocoliticabiotype 4, serotype 03 asymptomatically and hence might act as a potential source of infection for people.

Although there has been a considerable amount of research conducted into Bacillus anthracis, the causative agent of anthrax, the data are widely disseminated in the scientific literature and are therefore not always easy to assimilate. In view of continuing concern about potential anthrax contamination in environmental materials and sites, this review brings together the currently available information relating to the health hazards from B. anthracis. The relevance of the available information for risk assessment purposes is assessed.

In late 1992, three cases of smear-positive tuberculosis were diagnosed among secondary school students in Lodi, Italy. The three attended different schools but travelled on the same bus. Schoolmates, other bus riders, family members, and friends underwent tine testing and X-rays. Of the 3188 students tested, 277 (8·7 %) were reactors. Independent risk factors for tine reactivity among students included living in the same town (odds ratio [OR] = 4·8; 95% confidence intervals [CI] = 3·8–6·0); having classroom contact (OR = 4·4; 95% CI = 3·4–5·7); or riding the same bus (OR = 5·4; 95% CI = 4·3–6·7) as a smear-positive case. Twenty-four cases of pulmonary tuberculosis were identified. The index case was a student whose father had had cavitary tuberculosis. Despite being tine test positive in 1989, he was not given prophylaxis and was lost to follow-up. This large outbreak emphasizes the need for identification and prompt chemoprophylaxis of reactors, especially in vulnerable adolescent populations.

An investigation into two cases of post-operative Bacillus cereus meningitis revealed that hospital linen laundered by a batch continuous washing machine was heavily contaminated by B. cereus spores. The washing machine, detergents, other chemical additives and the water supply were eliminated as the source of contamination.

It was found that the linen introduced into the washing machine had a high B. cereus spore content and that this was still present after the wash process. The spores were not killed by either the heat disinfection stage of the wash or the addition of chemical disinfectants and were not removed by the dilution in the process.

The multiplication of B. cereus was thought to have occurred on used, damp linen stored in plastic bags, particularly when ambient temperatures were high. An increase in the water flow through the washing machine was the only measure associated with a decrease in B. cereus on laundered linen.

Giardia lamblia is a common and increasing cause of gastrointestinal illness in the UK. We report a case-control study that examined risk factors for giardiasis. Patients with giardiasis were identified from reports to the Consultants in Communicable Disease in1 Avon and Somerset, and age-sex matched controls were obtained from their general practitioners' lists. Details of travel history, water consumption and recreational water use were collected by postal questionnaire. Over the period July 1992 to May 1993, 74 cases and 108 matched controls were obtained. The data were analysed using conditional logistic regression. Swimming appeared to be an independent risk factor for giardiasis (odds ratio 2·4, 95% CI 1·0 to 6·1, P = 0·050). Travel (P = 0·001), particularly to developing countries, and type of travel (P = 0·004) - that is, camping, caravanning or staying in holiday chalets - were also observed to be significant risk factors. Other recreational water use and drinking potentially contaminated water were found to be not statistically significant after adjustment for other factors.

Enzyme immunoassays (EIA) were used to measure serum antibodies to Cryptosporidium in four immunocompetent adults with recent proven cryptosporidial infection, 379 healthy children and 73 adult volunteers in Melbourne, Australia, and 205 children in Papua New Guinea (PNG) (47 healthy children; 158 with pneumonia). Antibodies peaked 3–6 weeks after infection and fell to baseline within a few months. A high level (5000 EIA units/ml) or a significant change between paired sera, of IgG or IgM, were taken as evidence of recent infection and found in 24% of PNG children and in 8% of children and 5% of adults in Melbourne. Among PNG children with pneumonia who had high cryptosporidial antibody levels, those with measles (6/8) were significantly more likely (P = 0·002) to have diarrhoea than the remainder (4/28). Symptomatic cryptosporidiosis may be associated with transient immune suppression due to viral infection. This study indicates that serological surveys can contribute to an understanding of the epidemiology of cryptosporidosis.

Between 1966 and 1991, melioidosis, a disease caused by Pseudomonas pseudomallei that is mostly confined to tropical regions, occurred in farm animals and a farmer in temperate south-west Western Australia. Using an Escherichia coli probe containing a ribosomal RNA operon, P. pseudomallei DNA from isolates from 8 animals, a soil sample and the human case showed an identical ribotype on Southern blotting. The ribotype was different from the 3 commonest ribotypes seen in tropical Australia. This molecular typing supports the theory of clonal introduction of P. pseudomallei into a non-endemic region, with environmental contamination, local dissemination and persistence over 25 years. As melioidosis is often fatal in humans, such persistence in a temperate region is cause for concern.

To assess unfiltered drinking water as a source of cryptosporidium infection in patients with the acquired immunodeficiency syndrome (AIDS) the prevalence of cryptosporidiosis among persons with AIDS in Los Angeles County was assessed by water service area. One water distributor, serving approximately 60% of the county's residents (area B), has consistently employed filtration. The other company, which serves the remainder of the county (area A), did not institute nitration until mid-December 1986. This difference provided a ‘natural experiment ’ in which to assess the effect of municipal water filtration on the level of cryptosporidiosis among persons with AIDS. The prevalence of cryptosporidiosis among AIDS patients was compared for the two water service areas for the time period (1983–6) preceding the implementation of filtration in area A. From 1983 to 1986 the age-standardized prevalence of cryptosporidiosis among AIDS patients was 32% lower in area A (4·2%), which received unfiltered water, than in area B (6·2%). Following addition of filtration in area A, the prevalence of cryptosporidiosis among AIDS patients decreased by 20%; however, a decline, of 47%, was also observed in area B. The similar baseline levels of cryptosporidiosis and the corresponding post-filtration decline in both areas suggest that filtration had no effect on levels of cryptosporidiosis among persons with AIDS. Thus it does not appear that municipal drinking water is an important risk factor for cryptosporidiosis in AIDS patients residing in Los Angeles County.

In 1993 New York and Texas each reported a human rabies case traced to a rare variant of rabies virus found in an uncommon species of bat. This study examined the epidemiology of bat rabies in New York State. Demographic, species, and animal-contact information for bats submitted for rabies testing from 1988–92 was analysed.

The prevalence of rabies in 6810 bats was 4·6%. Nearly 90% of the 308 rabid bats identified to species were the common big brown bat (Eptesicus fuscus), which comprised 62% of all submissions. Only 25 submissions were silver-haired bats (Lasionycterus noctivagans), the species associated with the two 1993 human cases of rabies, and only two of these bats were positive. Rabies was most prevalent in female bats, in bats submitted because of human or animal contact, and in animals tested during September and October.

These results highlight the unusual circumstances surrounding the recent human rabies cases in the United States. A species of bat rarely encountered by humans, and contributing little to the total rabies cases in bats, has been implicated in the majority of the indigenously acquired human rabies cases in the United States. The factors contributing to the transmission of this rare rabies variant remain unclear.

Influenza B virus reinfection in Japanese children was studied epidemi-ologically during 1979–91 and virologically during 1985–91. During this investigation, there were four epidemics caused by influenza B viruses, each of which accompanied antigenic drift. Between the epidemics in 1987/88 and 1989/90, the viruses changed drastically, both genetically and antigenically. The minimum rate of reinfection with influenza B virus during the whole period was 3–25% depending on the influenza seasons. The antigens of primary and reinfection strains of influenza B virus isolated from 18 children during 1985–90, which covered three epidemic periods, were studied by haemagglutination inhibition tests. The results showed that the viruses isolated in the 1984/85 and 1987/88 influenza seasons, which belonged to the same lineage, were antigenically close, and reinfection occurred with these viruses. The results of amino-acid analysis of the HA1 polypeptide of these viruses corresponded with those of antigenic analysis. There were no specific amino-acid changes shared by the primary infection and reinfection influenza B viruses; the patients were infected with the viruses epidemic at that time.

Multilocus enzyme electrophoresis was used to divide 124 Australian isolates of Streptococcus suis type 2 into 17 electrophoretic types (ETs). Isolates in ET 1 were the most frequent cause of disease amongst Western Australian pigs, but isolates of ET 8 were more commonly associated with disease in other Australian states. Multiple isolates from 10 of 19 farms all belonged to the same ET, whilst isolates from the other farms belonged to between 2 and 4 different ETs. Some isolates could be differentiated further by DNA restriction endonuclease analysis, whilst others with the same restriction pattern were located in different, but closely-related ETs. Fourteen isolates were tested for their virulence in mice. Most caused disease if given in high numbers, but isolates in ET 1 were virulent at lower dose rates. This virulent clone also was distinguished by the fact that 80% of isolates produced extracellular factor (EF).

Sera from an age-stratified sample of 7196 individuals, submitted for diagnostic purposes to four public health laboratories in England in 1986/7, were tested for hepatitis A antibody. The serological profiles, which showed marked regional differences, were consistent with declining incidence in the past. The decline in the incidence of hepatitis A has resulted in an increase in susceptibility in adults. This has three main consequences: an increase in the average age of infection may be leading to an increase in morbidity; normal immunoglobulin may become less protective against hepatitis A; the risk of transmission through blood products contaminated by viraemic blood donors may rise.

Current average annual incidence in 5–14-year olds was estimated to vary between regions from 0·5–1·9%. This supports the view that, in the absence of a vaccination programme, hepatitis A will remain endemic unless there are further improvements in living conditions and standards of hygiene. A vaccine giving long-lasting protection could eliminate hepatitis A transmission with modest coverage at a young age. Targeting childhood vaccination on economically deprived areas or using vaccine to control outbreaks might be more effective policies.

A common source outbreak of small round structure virus (SRSV) gastroenteritis affected 81 patients and 114 staff in four hospitals served by one central hospital kitchen. Eating salad items was found to be significantly associated with illness. In a cohort study of a staff buffet function eating turkey salad sandwiches was associated with illness (relative risk = 2·4; 95% CI = 1·4–4·1; P = 0·003), and a case control study of patients in one hospital showed an odds ratio of 6·6 (95% CI = 1·0–71·6; P = 0·04) for eating tuna salad and becoming ill. One of two food handlers who prepared the salads became ill the day following food preparation; she also had a young child at home who had been ill with a gastrointestinal illness during the previous two days. Contamination of food by mechanical transmission of the virus from the child via clothes and hands of the mother, or pre-symptomatic faecal excretion in the mother are possible explanations of contamination of food.

To determine whether or not occupational exposure to sewage is associated with a higher seroprevalence of hepatitis A virus (HAV) infection, 600 sewage workers in Singapore were tested for total (IgG and IgM) antibody to HAV by enzyme immunoassay. Using logistic regression with stepwise procedure, the adjusted seroprevalence of sewage workers was 2·2 times higher than that of another non-occupationally exposed population group. Seroprevalence was significantly correlated with age and educational levels, the association being independent of the occupational association. The epidemiological data in the study show that sewage workers have an increased occupational risk of acquiring HAV infection and should be protected by active immunization.