This study assessed risk factors for respiratory syncytial virus (RSV) hospitalization and disease severity in Wellington, New Zealand. During the southern hemisphere winter months of 2003–2005, 230 infants aged <24 months hospitalized with bronchiolitis were recruited. RSV was identified in 141 (61%) infants. Comparison with data from all live hospital births from the same region (2003–2005) revealed three independent risk factors for RSV hospitalization: birth between February and July [adjusted risk ratio (aRR) 1·62, 95% confidence interval (CI) 1·15–2·29], gestation <37 weeks (aRR 2·29, 95% CI 1·48–3·56) and Māori ethnicity (aRR 3·64, 95% CI 2·27–5·85) or Pacific ethnicity (aRR 3·60, 95% CI 2·14–6·06). The high risk for Māori and Pacific infants was only partially accounted for by other known risk factors. This work highlights the importance of RSV disease in indigenous and minority populations, and identifies the need for further research to develop public health measures that can reduce health disparities.

In patients with community-acquired pneumonia (CAP) prediction rules based on individual predicted mortalities are frequently used to support decision-making for in-patient vs. outpatient management. We studied the accuracy and the need for recalibration of three risk prediction scores in a tertiary-care University hospital emergency-department setting in Switzerland. We pooled data from patients with CAP enrolled in two randomized controlled trials. We compared expected mortality from the original pneumonia severity index (PSI), CURB65 and CRB65 scores against observed mortality (calibration) and recalibrated the scores by fitting the intercept α and the calibration slope β from our calibration model. Each of the original models underestimated the observed 30-day mortality of 11%, in 371 patients admitted to the emergency department with CAP (8·4%, 5·5% and 5·0% for the PSI, CURB65 and CRB65 scores, respectively). In particular, we observed a relevant mortality within the low risk classes of the original models (2·6%, 5·3%, and 3·7% for PSI classes I–III, CURB65 classes 0–1, and CRB65 class 0, respectively). Recalibration of the original risk models corrected the miscalibration. After recalibration, however, only PSI class I was sensitive enough to identify patients with a low risk (i.e. <1%) for mortality suitable for outpatient management. In our tertiary-care setting with mostly referred in-patients, CAP risk scores substantially underestimated observed mortalities misclassifying patients with relevant risks of death suitable for outpatient management. Prior to the implementation of CAP risk scores in the clinical setting, the need for recalibration and the accuracy of low-risk re-classification should be studied in order to adhere with discharge guidelines and guarantee patients' safety.

We aimed to explore Campylobacter genotype-specific risk factors in Australia. Isolates collected prospectively from cases recruited into a case-control study were genotyped using flaA restriction fragment-length polymorphism typing (flaA genotyping). Exposure information for cases and controls was collected by telephone interview. Risk factors were examined for major flaA genotypes using logistic and multinomial regression. Five flaA genotypes accounted for 325 of 590 (55%) cases – flaA-6b (n=129), flaA-6 (n=70), flaA-10 (n=48), flaA-2 (n=43), flaA-131 (n=35). In Australia, infections due to flaA-10 and flaA-2 were found to be significantly associated with eating non-poultry meat (beef and ham, respectively) in both case-control and inter-genotype comparisons. All major genotypes apart from flaA-10 were associated with chicken consumption in the case-control comparisons. Based on several clinical criteria, infections due to flaA-2 were more severe than those due to other genotypes. Thus genotype analysis may reveal genotype-specific niches and differences in virulence and transmission routes.

We conducted a case-control study examining risk factors for ciprofloxacin resistance in Campylobacter infections that were reported in 2004 and 2005 in two health regions in southern Alberta. The study questionnaire included questions about recent travel and antibiotic use, food consumption frequency, use of household and personal hygiene products with antibacterial agents, contact with animals, and potential misuse of antibiotics. Of the 210 patients who participated, 31·0% had ciprofloxacin-resistant Campylobacter infections. Foreign travel was the strongest predictor of resistance. Surprisingly, possession of antibiotics for future use was identified as a risk factor for resistance. We also examined the potential for participation bias and resistance misclassification to affect the resulting multivariable models. Participation bias appears to have had a substantial effect on the model results, but the estimated misclassification effect due to the use of different ciprofloxacin susceptibility testing methods was only slight.

We conducted a seroprevalence survey in Belgium, Finland, England & Wales, Italy and Poland on 13 449 serum samples broadly representative in terms of geography and age. Samples were tested for the presence of immunoglobulin G antibody using an enzyme immunoassay. The age-specific risk of infection was estimated using parametric and non-parametric statistical modelling. The age-specific risk in all five countries was highest in children aged 7–9 years and lower in adults. The average proportion of women of child-bearing age susceptible to parvovirus B19 infection and the risk of a pregnant women acquiring B19 infection during pregnancy was estimated to be 26% and 0·61% in Belgium, 38% and 0·69% in England & Wales, 43·5% and 1·24% in Finland, 39·9% and 0·92% in Italy and 36·8% and 1·58% in Poland, respectively. Our study indicates substantial epidemiological differences in Europe regarding parvovirus B19 infection.

The objective of this study was to model the age–time-dependent incidence of hepatitis B while estimating the impact of vaccination. While stochastic models/time-series have been used before to model hepatitis B cases in the absence of knowledge on the number of susceptibles, this paper proposed using a method that fits into the generalized additive model framework. Generalized additive models with penalized regression splines are used to exploit the underlying continuity of both age and time in a flexible non-parametric way. Based on a unique case notification dataset, we have shown that the implemented immunization programme in Bulgaria resulted in a significant decrease in incidence for infants in their first year of life with 82% (79–84%). Moreover, we have shown that conditional on an assumed baseline susceptibility percentage, a smooth force-of-infection profile can be obtained from which two local maxima were observed at ages 9 and 24 years.

The first epidemic of sporotrichosis in humans as a result of zoonotic transmission was identified in Rio de Janeiro, Brazil, in 1998. A cross-sectional study was conducted applying questionnaires to patients seen in 2002 at Evandro Chagas Clinical Research Institute, Fiocruz, with a confirmed diagnosis of sporotrichsosis. A total of 73 dwellings were studied, where 255 individuals, including 94 patients and 161 healthy household contacts, lived with 133 cats with sporotrichosis. Most dwellings were houses with 83% having complete basic sanitation. Among patients, there was a predominance of women with a median age of 41 years who were engaged in domestic activities. These women contracted the disease twice more often than men. The prevalence of sporotrichosis was four times higher among patients caring for animals, irrespective of gender. In the current epidemic of sporotrichosis, taking care of sick cats was the main factor associated with transmission of the disease to humans.

Neisseria meningitidis is an important cause of childhood meningitis and septicaemia. Between 1999 and 2005, 133 invasive meningococcal disease (IMD) cases occurred in Jerusalem, 112 (84·2%) of them in children aged 0–14 years. The annual incidence rate in Jerusalem was higher than the national average (2·45±0·6 vs. 1·13±0·16/100 000 population, P=0·002). Most of the children (82·1%) were from low socio-economic Arab and Jewish ultra-orthodox communities; mortality was higher among Arab than Jewish children (1·3 vs. 0·22/100 000 person-years, P=0·004). A cluster of 10 children with severe meningococcal sepsis (three fatalities) emerged in the winter of 2003–2004. Compared to the other 102 cases in 1999–2005 both meningococcaemia (100% vs. 51%, P=0·003) and mortality (30% vs. 6·9%, P=0·014) rates were higher. Serogroup B comprised 77·6% of the bacterial isolates. Pulsed-field gel electrophoresis showed considerable variability among cluster isolates, but significant resemblance in Arab cases throughout 1999–2005. The increased susceptibility of specific sub-populations to IMD necessitates further evaluation.

Rotavirus is the most common cause of gastroenteritis in children aged <5 years old, two new vaccines have recently been developed which can prevent associated morbidity and mortality. While apparently safe and efficacious, it is also important to establish whether rotavirus immunization is cost effective. A decision analytical model which employs data from a review of published evidence is used to determine the cost effectiveness of a rotavirus vaccine. The results suggest that some of the health sector costs, and all of the societal costs, of rotavirus gastroenteritis in children can be avoided by an immunization programme. The additional cost to the health sector may be considered worthwhile if there is a sufficient improvement in the quality-of-life of children and parents affected by gastroenteritis; this study did not find any evidence of research which has measured the utility gains from vaccination.

This study aimed to: (1) investigate whether non-ruminant wildlife interfacing with dairy sheep and goats of four Greek flocks endemically infected with Mycobacterium avium subspecies paratuberculosis (MAP) harboured MAP and (2) genetically compare the strains isolated from the wildlife to those isolated from the small ruminants of these flocks. We cultured and screened, by polymerase chain reaction (PCR), pooled-tissue samples from 327 wild animals of 11 species for the MAP-specific IS900 insertion sequence. We also cultured faecal samples from 100 sheep or goats from each of the four flocks. MAP was detected in samples from 11 sheep, 12 goats, two mice, two rats, a hare and a fox. Only one rat had histopathological findings. Genetic typing categorized 21 isolates as cattle-type strains and two, from a house mouse and a goat respectively, as sheep-type strains; this is the first report of a rodent harbouring a sheep-type strain. The MAP types that were most frequently isolated amongst the sheep and goats of each flock were also the ones isolated from sympatric rodents; those isolated from the fox and hare also belonged to the predominant ruminant strains.

Réunion Island (Indian Ocean) has been suffering from its first known Chikungunya virus (CHIKV) epidemic since February 2005. To achieve a better understanding of the disease, a questionnaire was drawn up for hospital staff members and their household. CHIKV infected about one-third of the studied population, the proportion increasing with age and being higher in women. Presence of a garden was associated with CHIKV infection. The geographical distribution of cases was concordant with insect vector Aedes albopictus distribution. The main clinical signs were arthralgia and fever. The disease evolved towards full recovery in 34·4% of cases, a relapse in 55·6%, or a chronic form in 10%. Paracetamol was used as a painkiller in 95% of cases, sometimes associated with non-steroidal anti-inflammatory drugs, corticoids, or traditional herbal medicine. The survey provided valuable information on the factors that favour transmission, the clinical signs, the importance of relapses and the therapies used.

During the period from 2001 to 2004, a total of 72 isolates of Salmonella enterica serovars: Anatum (n=40), Enteritidis (n=18), Corvallis (n=8), and Typhimurium (n=6), of various origins (mainly food and diarrhoeagenic stool samples), were collected and further characterized by antibiotic resistance, plasmid analysis, and pulsed-field gel electrophoresis (PFGE). Forty-five isolates presented multidrug resistance to antibiotics. Among which one S. enterica serovar Anatum isolate was resistant to 11 antibiotics, and one S. enterica serovar Typhimurium DT104 isolate was resistant to eight antibiotics. Plasmid profiling identified eight plasmid profiles (with 1–5 plasmids) among the isolates, of which one plasmid profile (P01) was predominant. XbaI PFGE analysis revealed the presence of a predominant clone of the four studied Salmonella serovars circulating in Tunisia throughout the years 2001–2004.

In Finland, most cases of shigellosis are related to travel abroad. Antimicrobial drug resistance of 1814 Shigella strains isolated from Finnish patients during 1990–2005 was studied using discs of 12 antimicrobial agents. Since 2000, the E-test has been performed to determine ciprofloxacin minimum inhibitory concentrations of nalidixic acid-resistant isolates. The proportion of multi-resistant strains (resistant to ⩾4 antimicrobials) was highest among isolates from China and India, but is increasing significantly in other parts of Asia. Resistance to nalidixic acid has become common among the strains from the Far East, and the first isolates also resistant to ciprofloxacin were detected during 2004–2005. All the ciprofloxacin-resistant isolates belonged to the S. flexneri 2a serotype. All the nalidixic acid-resistant S. flexneri strains had reduced susceptibility to ciprofloxacin, whereas 23% of the nalidixic acid-resistant S. sonnei strains were still completely susceptible to ciprofloxacin.

Epidemiological data from bank voles, Myodes glareolus, naturally infected by the hantavirus Puumala (PUUV) were collected by a capture–mark–recapture protocol from 2000 to 2002 in the French department of Ardennes. Four monitored trapping sites were established in two forests located in two cantons (Flize and Monthermé). We captured 912 bank voles corresponding to 557 different individuals during 8820 trapping nights for an overall trapping success of 10·34%. The average PUUV seroprevalence was 22·4%. Characteristics of the system reported in North European countries are confirmed in France. PUUV seroprevalence and abundance of rodents appeared weakly linked. Adult voles were more frequently antibody-positive, but no difference between sexes was established. Anti-PUUV seropositive voles were captured and high seroprevalence was observed from both forests, without human infection reported in Flize canton during the study. One site among the four exhibited peculiar infection dynamics, where vole weight and infection risk were negatively correlated.

Isolates from 3903 cases of invasive pneumococcal disease (IPD) were referred to the national reference laboratory over the 8 years, 1998–2005, as part of the laboratory-based surveillance of this disease in New Zealand. All isolates were serotyped and their antimicrobial susceptibility was tested. The incidence of IPD was highest in young children, with an average annual incidence of 100·8/100 000 in infants aged <2 years. There were changes in the prevalence of several of the serotypes during the 8-year period. Overall the seven serotypes included in the 7-valent pneumococcal conjugate vaccine, 4, 6B, 9V, 14, 18C, 19F and 23F, were the most common serotypes and accounted for 80·9% of the disease in infants aged <2 years. There was no overall change in penicillin resistance or non-susceptibility during the 8 years, and rates were 7·1% and 17·1%, respectively, in 2005. In contrast, cefotaxime and erythromycin resistance increased to reach 3·1% and 12·2%, respectively, by 2005.

This study compares the seasonality of rotavirus diarrhoeal hospital admissions and its relationship to climatic factors across three Australian cities. Weekly admission of rotavirus diarrhoea (1993–2003) in children aged <5 years and weekly average temperature and relative humidity for each city were modelled using a log-linear model with a cubic trend and season. Interactions were included to test for differences in the effect of temperature and humidity between seasons and between cities. Admissions of rotavirus diarrhoea peaked in winter and spring and were lowest in summer. Higher temperature and humidity in the previous week were associated with a decrease in rotavirus diarrhoeal admissions in three cities. The effects of both temperature and humidity on rotavirus admissions in Brisbane differed across seasons. Strategies to combat outbreaks of rotavirus diarrhoea should take climatic factors and seasonal effects into consideration to plan for the excess seasonal hospital admissions.

Hospital-level predictors of high rates of ‘Clostridium difficile-associated disease’ (CDAD) were evaluated in over 2300 hospitals across California, Arizona, and Minnesota. American Hospital Association data were used to determine hospital characteristics associated with high rates of CDAD. Significant correlations were found between hospital rates of CDAD, common infections and other identified pathogens. Hospitals in urban areas had higher average rates of CDAD; yet, irrespective of geographic location, hospital rates of CDAD were associated with other infections. In addition, hospitals with ‘high CDAD’ rates had slower turnover of beds and were more likely to offer transplant services. These results reveal large differences in rates of CDAD across regions. Hospitals with high rates of CDAD have high rates of other common infections, suggesting a need for broad infection control policies.

The purpose of this study was to document the dynamics of HIV-1 subtypes in Scotland over a 6-year period. Viral RNA from all-new diagnoses was amplified by nested PCR and sequenced in the gag and/or env regions. Subtype was assigned by phylogenetic analysis, and aligned with demographic data including likely route and geographical origin of infection. We present data on 80% of all new diagnoses in Scotland between April 2000 and April 2006. Within the background of an expanding epidemic, subtype B predominates in men who have sex with men and intravenous drug users but there is a small but consistent number of UK-acquired infections in these risk groups caused by non-B subtypes. In heterosexuals, non-B subtypes acquired abroad, especially Africa, are still the largest group but again UK-acquired numbers are rising. The social and clinical significance of the spread of non-B subtypes in different ethnic and risk groups remains to be established.

The objective of the study was to identify the extent and cause of an outbreak of epidemic keratoconjunctivitis (EKC). The study design was active case finding and a case-control study of clinic patients who developed symptoms of EKC between 31 December 2005 and 31 March 2006. The main outcome measures were clinical procedures carried out and clinicians seen during clinic visit. Significantly more cases than controls had tonometry with instillation of anaesthetic drops (OR 16·5, 95% CI 3·9–145·1, P<0·01), optical coherence tomography (OR 4·7, 95% CI 1·2–21·9, P=0·01), or instillation of dilating drops by an orthoptist (OR 2·3, 95% CI 1·1–4·7, P=0·01). Significantly more cases than controls were seen by one orthoptist (OR 21·8, 95% CI 8·2–60·0, P<0·01). Transmission of EKC within the clinic was probably due to contamination of either or both the anaesthetic drops and the tonometer head in the room used by an orthoptist. A comprehensive suite of strategies is required to prevent healthcare-associated EKC.

In 2003 and 2004 two measles outbreaks occurred in Jewish ultra-orthodox communities in Jerusalem. The index case of the first outbreak (March 2003) was a 2-year-old unvaccinated child from Switzerland. Within 5 months, 107 cases (mean age 8·3±7·5 years) emerged in three crowded neighbourhoods. The first cases of the second outbreak (June 2004) were in three girls aged 4–5 years in one kindergarten in another community. By November 2004, 117 cases (mean age 7·3±6·5 years) occurred. The virus genotypes were D8 and D4 respectively. Altogether, 96 households accounted for the two outbreaks, with two or more patients per family in 79% of cases. Most cases (91·5%) were unvaccinated. Immunization coverage was lower in outbreak than in non-outbreak neighbourhoods (88·3% vs. 90·3%, P=0·001). Controlling the outbreaks necessitated a culture-sensitive approach, and targeted efforts increased MMR vaccine coverage (first dose) to 95·2%. Despite high national immunization coverage (94–95%), special attention to specific sub-populations is essential.