Calls to a UK national telephone health helpline (NHS Direct) have been used for syndromic surveillance, aiming to provide early warning of rises in community morbidity. We investigated whether self-sampling by NHS Direct callers could provide viable samples for influenza culture. We recruited 294 NHS Direct callers and sent them self-sampling kits. Callers were asked to take a swab from each nostril and post them to the laboratory. Forty-two per cent of the samples were returned, 16·2% were positive on PCR for influenza (16 influenza A(H3N2), three influenza A (H1N1), four influenza B) and eight for RSV (5·6%). The mean time between the NHS Direct call and laboratory analysis was 7·4 days. These samples provided amongst the earliest influenza reports of the season, detected multiple influenza strains, and augmented a national syndromic surveillance system. Self-sampling is a feasible method of enhancing community-based surveillance programmes for detection of influenza.

To predict the spread of a pandemic strain of influenza virus in Italy and the impact of control measures, we developed a susceptible–exposed, but not yet infectious–infectious–recovered, and no longer susceptible (SEIR) deterministic model with a stochastic simulation component. We modelled the impact of control measures such as vaccination, antiviral prophylaxis and social distancing measures. In the absence of control measures, the epidemic peak would be reached about 4 months after the importation of the first cases in Italy, and the epidemic would last about 7 months. When combined, the control measures would reduce the cumulative attack rate to about 4·2%, at best, although this would require an extremely high number of treated individuals. In accordance with international findings, our results highlight the need to respond to a pandemic with a combination of control measures.

Understanding the epidemiology of current health threats to deployed U.S. troops is important for medical assessment and planning. As part of a 2004 study among U.S. military personnel deployed to Al Asad Air Base, in the western Anbar Province of Iraq, over 500 subjects were enrolled, provided a blood specimen, and completed a questionnaire regarding history of febrile illness during this deployment (average ∼4 months in country). This mid-deployment serum was compared to pre-deployment samples (collected ∼3 months prior to deployment) and evaluated for seroconversion to a select panel of regional arboviral pathogens. At least one episode of febrile illness was reported in 84/504 (17%) of the troops surveyed. Seroconversion was documented in nine (2%) of deployed forces tested, with no association to febrile illness. Self-reported febrile illness was uncommon although often debilitating, and the risk of illness due to arbovirus infections was relatively low.

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.

The control programme for Salmonella infection in Danish swine has reduced the number of human cases attributable to pork consumption and the focus is now on cost-effectiveness. We applied time-series and longitudinal analyses to data collected between January 1995 and May 2005 to identify if there were predictable periods of risk that could inform sampling strategy; to investigate the potential for forecasting for early aberration detection; and to explore temporal redundancy within the sampling strategy. There was no evidence of seasonality hence no justification to change to targeted sampling at high-risk periods. The forecast of seropositivity made using an ARIMA (0, 1, 2) model had a root-mean-squared percentage error criterion of 8·4% indicating that accurate forecasts are possible. The lorelogram identified temporal redundancy at up to 10 weeks suggesting little value in sampling more frequently than this on the ‘average’ farm. These findings have practical applications for both farm-level sampling strategy and national-level aberration detection which potentially could result in a more cost-effective surveillance strategy.

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.

A large outbreak of enterohaemorrhagic Escherichia coli (EHEC) infections occurred in southern Sweden during autumn 2002. A matched case-control study was performed and indicated an association between consumption of fermented sausage and EHEC infection (odds ratio 5·4, P<0·002). Pulsed-field gel electrophoresis analysis identified a strain of E. coli O157:H7 in clinical faecal isolates, which was identical to a strain isolated from sausage samples obtained from households of infected individuals. A combination of microbiological and epidemiological results established a link between sausage consumption and the outbreak in 30 out of a total of 39 investigated cases. Contaminated beef was suspected to be the source of infection. Delayed start of fermentation, lack of heat-treatment and a short curing period in cold temperature were identified as the main factors enabling EHEC survival. EHEC can survive throughout the entire production process of fermented sausage if curing conditions are inadequate.

An outbreak of psittacosis related to a bird park occurred in Matsue City, Shimane Prefecture, Japan, during winter 2001. Seventeen cases of psittacosis (12 visitors, three staff, and two student interns) were confirmed. A cohort study was conducted among the park staff and students to determine the risk factors for the development of acute serologically confirmed psittacosis (SCP) infection. Being ‘bird staff’ had an increased risk of SCP infection (RR 3·96, 95% CI 1·48–10·58). Entering the staff building, where ill birds were maintained without proper isolation, was also associated with an increased risk of SCP infection (RR 3·61, 95% CI 1·03–12·6). Isolation of ill birds and quarantine measures were found to be insufficient. Dehumidifiers and a high-pressure water spray under a closed ventilation environment may have raised the concentration of Chlamydophila psittaci in the hothouses. Bird park staff and visitors should be educated about psittacosis.

Choline-binding proteins (CBP) have been associated with the pathogenesis of Streptococcus pneumoniae. We screened, using PCR, for the presence of genes (cbpA, D, E, G) encoding these proteins in 34 isolates of pneumococci of known serotypes and penicillin susceptibility from invasive and non-invasive disease. All isolates harboured cbpD and cbpE whereas cbpA and cbpG were found in 47% and 59% respectively; the latter were more frequent in vaccine-associated types and together accounted for 77% of these isolates. No association was observed with penicillin susceptibility but 85% of non-invasive isolates were positive for these genes.

Lyssaviruses cause acute, progressive encephalitis in mammals. Current rabies vaccines offer protection against the lyssaviruses, with the notable exceptions of Mokola virus (MOKV), Lagos bat virus (LBV) and West Caucasian bat virus (WCBV). Here we describe the cross-protective and cross-reactive immune responses induced by experimental recombinant vaccinia viruses encoding the glycoprotein genes of rabies virus (RABV), MOKV and WCBV, either singly or in dual combinations. Constructs expressing a single glycoprotein gene protected mice against lethal intracranial challenge with homologous virus. Similarly, recombinants expressing glycoprotein genes from two different lyssaviruses offered mice protection against both homologous viruses. VNAb induced by vaccines that included a MOKV glycoprotein gene cross-neutralized LBV, but not WCBV. We concluded that a single recombinant poxvirus-vectored vaccine including MOKV and RABV glycoprotein genes, should be a major addition to available rabies biologics and should offer broad protection against all of the lyssaviruses, except WCBV.

We report a retrospective analysis of 1933 Brucella strains isolated from humans and animals in Latin American countries between 1968 and 1991 and in Argentina between 1994 and 2006. During the first period 50% of strains were from humans, mainly from Argentina, Mexico and Peru but, while B. suis was the main cause of infection in Argentina, B. melitensis was responsible for most infections in the other countries. In Argentina in the later years, B. melitensis and B. suis were observed more frequently than in the first period while isolation of B. abortus decreased. Of 145 B. melitensis human isolates, eight gave susceptibility patterns to dyes and penicillin and two were B. melitensis biovar 3, which has never been reported in animals. Forty-six percent of B. suis isolated were resistant to dyes which is an atypical feature in this species.

In France, salmonellosis is the main cause of foodborne bacterial infection with serotypes Enteritis (SE) and Typhimurium (ST) accounting for 70% of all cases. French authorities implemented a national control programme targeting SE and ST in poultry and eggs from October 1998 onwards. A 33% decrease in salmonellosis has been observed since implementation. We designed an evaluation of the impact of this control programme on SE and ST human infections in France. Using monthly Salmonella human isolate reports to the National Reference Centre we defined two intervention series (SE and ST) and one control series comprising serotypes not know to be associated with poultry or eggs. The series, from 1992 to 2003, were analysed using autoregressive moving average models (ARMA). To test the hypothesis of a reduction of SE and ST human cases >0 after the programme started and to estimate its size, we introduced an intervention model to the ARMA modelling. In contrast to the control series, we found an annual reduction of 555 (95% CI 148–964) SE and of 492 (95% CI 0–1092) ST human infections, representing respectively a 21% and 18% decrease. For SE, the decrease occurred sharply after implementation while for ST, it followed a progressive decrease that started early in 1998. Our study, suggests a true relation between the Salmonella control programme and the subsequent decrease observed for the two targeted serotypes. For ST, however, the decrease prior to the intervention may also reflect control measures implemented earlier by the cattle and milk industry.

Safe drinking water and hygiene are essential to reducing Kenya's diarrhoeal disease burden. A school-based safe water and hygiene intervention in Kenya was evaluated to assess its impact on students' knowledge and parents' adoption of safe water and hygiene practices. We surveyed 390 students from nine schools and their parents at baseline and conducted a final evaluation of 363 students and their parents. From baseline to final evaluation, improvement was seen in students' knowledge of correct water treatment procedure (21–65%, P<0·01) and knowing when to wash their hands. At final evaluation, 14% of parents reported currently treating their water, compared with 6% at baseline (P<0·01). From 2004 to 2005, school absenteeism in the September–November term decreased in nine project schools by 35% and increased in nine neighbouring comparison schools by 5%. This novel programme shows promise for reducing school absenteeism and promoting water and hygiene interventions in the home.

Invasive pneumococcal disease (IPD) notifications are used to monitor IPD vaccination programmes. We conducted sequential deterministic data-linkage between IPD notifications and hospitalization data in Victoria, Australia, in order to determine whether all diagnosed cases were being reported. The proportion of each relevant hospital admission ICD-10-AM code that could be linked to notified cases was calculated. Total and age-specific annual rates were calculated and compared for notified and non-notified cases. Total incidence was estimated using data-linkage results and application of a two-source capture–recapture method. The first 2 years of IPD surveillance in Victoria missed at least one-sixth of laboratory-confirmed IPD cases. Estimated annual IPD rate increased from 9·0 to 10·7/100 000 and rose even higher, to 11·5/100 000, with age-specific rates possibly reaching 90·0/100 000 children aged <2 years, when using capture–recapture. Strategies to improve notification and coding of hospitalized cases of IPD are required.

Sporadic salmonellosis has been reported in mature lactating dairy cattle in the southwestern United States and is an intriguing problem in that Salmonella can be cultured from faecal samples of these cattle throughout the year. However, it is pathogenic only during late summer/early autumn and in certain years. We sampled apparently healthy (n=10) and diarrhoeic (n=10) cattle during an outbreak on a 2000 head dairy in 2003. The following year, monthly faecal (from the same 30 head), total mixed ration, water, and pen soil samples were collected for Salmonella culture. No serogroup, serotype, genetic, or antimicrobial susceptibility differences were observed in comparison of isolates from healthy and sick cattle. During year 2 of the study, Salmonella was routinely cultured (although highly variable from month to month) from the cattle and the environment, although no outbreak of salmonellosis was observed.

A ‘virtual hierarchy’ model is described for studying the spread of pathogens between herds of livestock. This novel approach to simulating disease has animals, herds, and geographic regions in a national livestock industry arranged as a hierarchy of objects in computer memory. Superimposed on all objects is an infection–recovery cycle, a control programme, and surveillance based on test results and animal movement. The model was applied to predicting progress in the control of Salmonella Dublin in the Danish dairy cattle industry over a 10-year period. More frequent testing of bulk tank milk for antibodies to S. Dublin was less effective than improved herd biosecurity. Restricting cattle movement between regions provided a strong benefit to those regions initially with a low prevalence of infection. Enhanced control within infected herds was of intermediate benefit. A combination of strategies was highly effective although cost and feasibility of this option needs further exploration.

An outbreak of Legionnaire's disease was detected in Pamplona, Spain, on 1 June 2006. Patients with pneumonia were tested to detect Legionella pneumophila antigen in urine (Binax Now; Binax Inc., Scarborough, ME, USA), and all 146 confirmed cases were interviewed. The outbreak was related to district 2 (22 012 inhabitants), where 45% of the cases lived and 50% had visited; 5% lived in neighbouring districts. The highest incidence was found in the resident population of district 2 (3/1000 inhabitants), section 2 (14/1000). All 31 cooling towers of district 2 were analysed. L. pneumophila antigen (Binax Now) was detected in four towers, which were closed on 2 June. Only the strain isolated in a tower situated in section 2 of district 2 matched all five clinical isolates, as assessed by mAb and two genotyping methods, AFLP and PFGE. Eight days after closing the towers, new cases ceased appearing. Early detection and rapid coordinated medical and environmental actions permitted immediate control of the outbreak and probably contributed to the null case fatality.

We propose a rather simple model, which fits well the weekly human influenza incidence data from England and Wales. A standard way to analyse seasonally varying time-series is to decompose them into different components. The residuals obtained after eliminating these components often do not reveal time dependency and are normally distributed. We suggest that conclusions should not be drawn only on the basis of residuals and that one should consider the analysis of squared residuals. We show that squared residuals can reveal the presence of the remaining seasonal variation, which is not exhibited by the analysis of residuals, and that the modelling of such seasonal variations undoubtedly improves model fit.

The mathematical function for the horizontal transmission of a pathogen is a driving force of epidemiological models. This paper aims at studying the influence of different transmission functions on a simulated pathogen spread. These functions were chosen in the literature and their biological relevance is discussed. A theoretical SIR (Susceptible–Infectious–Recovered) model was used to study the effect of the function used on simulated results. With a constant total population size, different equilibrium values for the number of infectious (NI) were reached, depending on the transmission function used. With an increasing population size, the transmission functions could be assimilated to either density-dependent (DD), where an equilibrium was obtained, or frequency-dependent (FD), with an exponential increase in NI. An analytical study corroborated the simulated results. As a conclusion, the choice between the different transmission functions, particularly between DD and FD, must be carefully considered for a varying population size.

Denmark has in the past 10 years experienced a decrease in the number of notified cases of meningococcal disease. In 1994 the completeness of the Notification System for Meningococcal Disease (NSMD) was estimated as 96% (95% CI 93–98). To answer the question whether the observed decrease reflects a real decrease in the incidence; we estimated the completeness of the notification system in 2002. We estimated the completeness of registration by a capture–recapture analysis. As the first data source, we used the national NSMD, which is an integrated surveillance system between the Department of Epidemiology and the Neisseria Reference Laboratory. The second independent source was the National Patient Registry (NPR). In 2002, the completeness of the NSMD was estimated as 96% (95% CI 95–98) and for the NPR as 84% (95% CI 82–85). The ‘real’ incidence rate was 1·9/100 000 population, which compared to 4·4/100 000 population in 1994. We concluded that the observed decrease in incidence rate is real. The NSMD in Denmark functions well and captures almost all cases of meningococcal disease. The complete registration which includes a unique personal identification number serves as an outstanding source for nationwide registry linkage studies.