Strong notifiable disease surveillance systems are essential for disease control. We sought to determine if a brief informational session between clinic and health department employees followed by reminder faxes and a newsletter would improve reporting rates and timeliness in a notifiable disease surveillance system. Ambulatory clinics were randomized to an intervention group which received the informational session, a faxed reporting reminder and newsletter, or to a control group. Among intervention and control clinics, there were improvements in the number of cases reported and the timeliness of reporting. However, there were no statistically significant changes in either group. Despite improved communication between the health department and clinics, this intervention did not significantly improve the level or the timeliness of reporting. Other types of interventions should be considered to improve reporting such as simplifying the reporting process.

The disease burden and the age group of children most affected by Haemophilus influenzae remain controversial particularly in many countries of South Asia. Nasopharyngeal carriage of H. influenzae can indicate the transmission dynamics in these settings. In a prospective population-based study, nasopharyngeal swabs from 1000 children aged <2 years, belonging to various socioeconomic groups from rural and urban areas of northern India were taken. The prevalence of H. influenzae carriage was found to be 11·2%. Among these isolates, 69% belonged to type b and the rest were non-typable. The age group most affected was 18–21 months. The carriage rate was influenced by age and socioeconomic factors namely type of housing, overcrowding, and season. Hib carriage is quite common in northern India and it is associated with age, type of housing, overcrowding, and season. Since carriage gets established early, Hib vaccination should target children in early infancy.

Scrapie is a fatal neurological disease of sheep which is endemic in the United Kingdom. It is one of the family of transmissible spongiform encephalopathies (TSEs) that includes BSE. In this paper, we developed a micro-simulation model for scrapie in the UK sheep population, incorporating the genetic and structural diversity of the population and infectious contact between flocks through trading. The simulation was fitted to epidemiological data from a range of sources. We found a detection/reporting probability of 16% (95% CI 12–17) for animals dying of scrapie. Prevalence of infected animals in the population was about 0·15%. Infected individuals were found in 9% of flocks overall, rising to 60% in Shetland and 75% in Swaledale flocks. Mean values of R0 for flocks varied with breed from 2·43 (Shetland) to 0·21 (Suffolk). We also examined the possible long-term persistence of scrapie in the UK flock in the absence of any intervention.

The incidence and causes of infectious intestinal disease (IID) in children aged <5 years presenting to general practitioners (GPs) were estimated. During a 12-month period, soiled nappies were collected from children presenting with symptoms suggestive of IID in a network of 65 GPs located across England. Molecular methods were used to detect a range of enteric pathogens including viruses, bacteria and parasites. Genotyping was performed on rotavirus and norovirus isolates. A total of 583 nappies were collected from 554 children; a pathogen was detected in 361 (62%) specimens. In the 43 practices 1584 new episodes of IID were recorded in a population averaging 19774; the specimen capture rate was 28%. IID incidence peaked during March and April. Norovirus (24·5%), rotavirus (19·0%) and sapovirus (12·7%) were most commonly detected, and mixed infections were detected in 11·7% of cases. Strain characterization revealed G1P[8] (65·8%), G4P[4] (8·1%) and G9P[8] (8·1%) as the most common rotavirus genotypes, similar to the UK national distribution. GII-3 (42·9%) and GII-4 (39·7%) were the most common norovirus genotypes; this was significantly different (P<0·005) to the national distribution.

Of 303 children hospitalized with acute non-bloody, non-mucoid diarrhoea, 69 (22·8%) had polymicrobial infection, including 52 (17·2%) multiple viral infection and 17 (5·6%) viral and bacterial co-infection. Rotavirus had the most important role in both categories; thus the control of rotavirus infection is crucial for maintaining children's health in Taiwan.

Vibrio parahaemolyticus and Norovirus have been recognized as the cause of sporadic cases or outbreaks of diarrhoeal illness in association with the ingestion of raw or improperly cooked seafood. This report describes a foodborne outbreak of gastroenteritis caused by both Norovirus and Vibrio parahaemolyticus following the consumption of raw seafood in a restaurant in Terrassa (Catalonia, Spain) in September 2005. Measures are needed to reduce contamination of raw seafood. Consumers can reduce the risk of foodborne illness by avoiding consumption of raw or undercooked food.

Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) infections are increasingly recognized in persons without established risk factors. Population-based prevalence studies of CA-MRSA colonization in persons without risk factors are relatively limited. Subjects aged 2–65 years were enrolled from a student recreation centre, public office building, and out-patient clinics. Persons or close contacts with a history of hospitalization, nursing-home residence, surgery, emergency-department visit, or healthcare employment during the previous year and persons with chronic debilitating illness, indwelling catheter, or surgical device were excluded. Swabs of anterior nares were obtained. Demographic and clinical information was collected. During January–June 2005, three (1·2%) of 259 subjects were colonized with MRSA. All three subjects were adults enrolled at the recreation centre. Healthy persons living in households without recent exposure to healthcare environments were at low risk for MRSA colonization. Studies from other geographic locations are needed to elucidate differences in prevalence of CA-MRSA.

Specimens for the detection of avian influenza virus (AIV) were collected from 1937 waterfowl on the Wexford Sloblands, a major wetland reserve in southeast Ireland, between January 2003 and September 2007. During the same period, 1404 waterfowl were sampled at other locations in Ireland. Specimens were tested either by virus isolation or real-time reverse transcriptase polymerase chain reaction (rtRT–PCR). A total of 32 isolates of AIV, comprising nine subtypes, was obtained from specimens from the Sloblands compared with just one isolate from elsewhere in Ireland. Samples from nine other waterfowl, five of which were from the Sloblands, tested positive for AIV by rtRT–PCR. Ecological factors are likely to have contributed to the higher detection rate of AIV at the Sloblands compared with the rest of Ireland. It was concluded that targeted surveillance at such sites is a cost-effective means of monitoring the circulation of new AIVs in waterfowl, whereas widespread opportunistic sampling is unproductive and wasteful of resources.

Scrapie is a fatal transmissible spongiform encephalopathy (TSE) of sheep, endemic in the UK for centuries. Interest in the disease has been heightened over the last decade by the possibility of the related BSE being transmissible to and between sheep and a range of control interventions has been proposed and implemented. In this paper, we examined the effect of these policies and their components on observed case rate, susceptible allele frequency and R0 within the framework of a large simulation model of the British sheep population and its breeding and trading structure. We compared interventions with the natural fade-out of scrapie in the population through loss of susceptible genotypes in the absence of control. We compare the results of interventions with the natural course of the scrapie epidemic. Our model suggested that scrapie will persist in the national flock for 300–400 years with the impact on gene frequencies confined largely to high case-rate breeds, such as Shetland and Swaledale. We found the National Scrapie Plan (NSP) to be the most effective in terms of the removal of both susceptible genotypes and scrapie from the population. Complete eradication of scrapie can be achieved within 32 years (95% CI 23–43 years). The Compulsory Scrapie Flock Scheme (CSFS) is as effective as the NSP in reducing the observed case rate but has a limited impact on the frequencies of susceptible genotypes in the population overall. In combination with the NSP, eradication of scrapie is achieved >10 years faster. Of the components of the CSFS, the breeding and culling aspects are each almost as effective as the full policy, with trading restrictions contributing little. We have speculated on the impact of control measures on the possibility BSE infection within the national flock by examining their effect on flock R0 for BSE across different breeds.

To evaluate associations between indicators of livestock farming intensity (manure surplus and livestock density) and acute gastroenteritis hospitalization (AGH) rate, we conducted an ecological study on 306 selected agricultural municipalities of Quebec. We estimated the AGH rate for the period 2000–2004 from the Quebec hospital database. Multivariate Poisson regression was used to estimate the strength of association between the farming indicators and AGH with adjustment for confounders. The modifying effect of age and water source was also evaluated. Association between manure and AGH was observed in children, especially those aged 0–4 years for selected zoonotic infections [adjusted hospitalization rate ratio (aHRR) 1·93, 95% CI 1·21–3·09]. The risk ratio was higher for subjects using ground-water source. An increasing HRR trend with each additional level of poultry density was observed in children aged 0–4 years, especially for Salmonella infections. We conclude that livestock farming intensity may be linked to bacterial acute gastroenteritis in children.

This study evaluated whether antibiotic cycling programmes using broad-spectrum agents including carbapenems were associated with increased rates of colonization or infection by Stenotrophomonas maltophilia. Retrospective analyses of colonization or infection by S. maltophilia from 1992 to 2002 were conducted using University of Virginia Hospital clinical microbiology records of patients with any culture positive for S. maltophilia and hospital epidemiology records of nosocomial S. maltophilia infections. Incidence rates were calculated and compared for cycling and non-cycling periods. No significant differences were found in incidence rates of S. maltophilia isolates between cycling and non-cycling periods, but there was a significant secular increase in the hospital-wide rate of infections caused by S. maltophilia (P=0·01728). Antibiotic cycling protocols were not associated with a significantly increased rate of colonization of S. maltophilia as determined by the frequency of patients having at least one positive routine clinical culture in this hospital.

The effects of temperature on reported cases of a number of foodborne illnesses in England and Wales were investigated. We also explored whether the impact of temperature had changed over time. Food poisoning, campylobacteriosis, salmonellosis, Salmonella Typhimurium infections and Salmonella Enteritidis infections were positively associated (P<0·01) with temperature in the current and previous week. Only food poisoning, salmonellosis and S. Typhimurium infections were associated with temperature 2–5 weeks previously (P<0·01). There were significant reductions also in the impact of temperature on foodborne illnesses over time. This applies to temperature in the current and previous week for all illness types (P<0·01) except S. Enteritidis infection (P=0·079). Temperature 2–5 weeks previously diminished in importance for food poisoning and S. Typhimurium infection (P<0·001). The results are consistent with reduced pathogen concentrations in food and improved food hygiene over time. These adaptations to temperature imply that current estimates of how climate change may alter foodborne illness burden are overly pessimistic.

Although spatio-temporal patterns of influenza spread often suggest that environmental factors play a role, their effect on the geographical variation in the timing of annual epidemics has not been assessed. We examined the effect of solar radiation, dew point, temperature and geographical position on the city-specific timing of epidemics in the USA. Using paediatric in-patient data from hospitals in 35 cities for each influenza season in the study period 2000–2005, we determined ‘epidemic timing’ by identifying the week of peak influenza activity. For each city we calculated averages of daily climate measurements for 1 October to 31 December. Bayesian hierarchical models were used to assess the strength of association between each variable and epidemic timing. Of the climate variables only solar radiation was significantly related to epidemic timing (95% CI −0·027 to −0·0032). Future studies may elucidate biological mechanisms intrinsically linked to solar radiation that contribute to epidemic timing in temperate regions.

A large mumps outbreak occurred among students at a Kansas university in 2006. To reduce transmission, students with mumps were asked to isolate themselves. We describe isolation measures and student compliance with these measures. Questionnaires were administered to students suspected of having mumps. Of the 132 students instructed to stay isolated, 75% stayed isolated for the number of days recommended and were considered compliant. Case-students told to stay isolated for 1–4 days were more likely to be compliant [86% vs. 66%; adjusted odds ratio (aOR) 3·6, 95% CI 1·4–9·0] than those told to stay isolated for 5–9 days. Those who rated avoiding contact with others during isolation as very important were also more likely to be compliant (83% vs. 60%; aOR 3·6, 95% CI 1·5–8·4) than those who rated the importance lower. In a college setting, it may be difficult to achieve high compliance with guidelines recommending that persons stay isolated for much longer than 4 days.

Neisseria meningitidis capsular switching has been reported in several countries. In order to establish the genetic relationship within group B and C strains expressing subtypes 2a or 2b, and to evaluate whether C to B capsular switching occurred in Portugal, 64 meningococci (56 serogroup C and 8 serogroup B) isolated from invasive meningococcal disease were typed using molecular methods. The studied phenotypes, 2b:P1.5,2 and 2a:P1.5-1,10-8, were the most frequent among serogroup C, but were uncommon among serogroup B strains. The multi-locus sequence typing (MLST) allelic profile and the pulsed-field gel electrophoresis (PFGE) fingerprints showed that seven serogroup B strains were genotypically identical to C strains, suggesting that capsular switching occurred. Active laboratory surveillance to find evidence of capsule switching is a now priority as MenC was introduced in the Portuguese vaccination schedule in January 2006.

The Belgian data for foodborne norovirus (NoV) outbreaks became available for the first time with the introduction of an extraction and detection protocol for NoV in the National Reference Laboratory for foodborne outbreaks in September 2006. In 2007, 10 NoV foodborne outbreaks were reported affecting 392 persons in Belgium. NoV became the most detected agent in foodborne outbreaks followed by Salmonella (eight foodborne outbreaks). The major implicated foods were sandwiches (4/10), where food handlers reported a history of gastroenteritis in two outbreaks. A food handler was implicated in the limited number of Belgian NoV outbreaks which is in accord with internationally recorded data. Forty foodborne and waterborne outbreak events due to NoV, epidemiological and/or laboratory confirmed, from 2000 to 2007 revealed that in 42·5% of the cases the food handler was responsible for the outbreak, followed by water (27·5%), bivalve shellfish (17·5%) and raspberries (10·0%).

We aimed to develop a prediction rule for urinary tract infections (UTIs) in patients with type 2 diabetes mellitus (DM2). A 12-month prospective cohort study was conducted in patients with DM2 aged ⩾45 years to predict the occurrence of recurrent UTIs in women and lower UTIs in men. Predictors for recurrent UTI in women (n=81, 2%) and lower UTIs in men (n=93, 3%) were age, number of general practitioner (GP) visits, urinary incontinence, cerebrovascular disease or dementia. In women, renal disease was an additional predictor. The optimum corrected area under the receiver-operating curve (AUC) was 0·79 (95% CI 0·74–0·83) for women and 0·75 (95% CI 0·70–0·80) for men. Using a cut-off score of 4, women with a lower risk assignment had a probability of 0·3% for the outcome. For a cut-off score of 6, women with a higher risk assignment had a probability of 5·8%. For men these figures were 0·8 and 7·1 for a cut-off score of 2 and 4, respectively. Simple variables can be used for the risk stratification of patients.

The feasibility of using risk markers to screen broiler chicken flocks and anticipate their risk of condemnation at meat inspection was examined in 404 randomly selected flocks in 15 French slaughterhouses in 2005. Condemnation rate and information about rearing conditions, health history, catching and loading, transport and slaughtering were collected. The Poisson regression model of the condemnation rate consisted of six simple and biologically relevant predictors: production type, frequency of farmer's visits during the starting period, health disorders during rearing, on-farm mortality, mortality during transport, and slaughter-line speed. Although accurate prediction of the condemnation rate for a given flock was not feasible, flocks with low or high risk of condemnation could be distinguished. These findings could be useful at various stages of chicken production, to monitor and improve farm husbandry practices, minimize the impact of transport conditions, and optimize meat inspection procedures.

Extensive surveillance for classical scrapie has been carried out in Great Britain since 1993, the results of which can be used for monitoring the effect of control measures introduced since 2001. A back-calculation approach was used to estimate the prevalence of sheep infected with classical scrapie, which integrates data on reported clinical cases (1993–2007) and the results of fallen stock and abattoir surveys (2002–2007). The prevalence of classical scrapie in GB was fairly constant until 2003, although the estimates depended on assumptions made about the performance of diagnostic tests used in the surveys. If infected animals could be detected in the final quarter of the incubation period, the estimated prevalence was 0·6–0·7%, while if they could be detected in the final half of the incubation period, it was 0·3–0·4%. Between 2003 and 2007 the prevalence declined by around 40%, and the magnitude of the reduction was independent of assumptions made about the diagnostic tests.

Respiratory syncytial virus (RSV) has been demonstrated to cause substantial disease in elderly and immunocompromised subjects. The relationship of serum antibody to RSV infection and the risk of infection in elderly subjects is controversial, thus we evaluated the presence of neutralizing antibodies to RSV in healthy people of different age groups and the correlation with viral protection. Baseline blood samples from 197 subjects aged 20–80 years were analysed for the presence of anti-RSV antibodies either by indirect immunofluorescence and microneutralization test. The percentage of people who had neutralizing antibodies to RSV was significantly higher (P=0·001) in the youngest group (92·51%) compared to the frail group (36·21%). The RSV antibody level tends to wane in some older people; this factor could determine proneness to RSV re-infections in the elderly who are at a greater risk of developing severe respiratory disease.