Leptospirosis is the most widespread zoonosis in the world. Humans become infected through contact with the urine of carrier animals, directly or via contaminated environments. This review reports available data on animal leptospirosis in ten tropical islands: Barbados, Martinique, Guadeloupe, Grenada, Trinidad, New Caledonia, Hawaii, French Polynesia, La Réunion and Mayotte. Leptospirosis is endemic in these insular wild and domestic fauna. Each island presents a specific panel of circulating serovars, closely linked with animal and environmental biodiversity, making it epidemiologically different from the mainland. Rats, mongooses and mice are proven major renal carriers of leptospires in these areas but dogs also constitute a significant potential reservoir. In some islands seroprevalence of leptospirosis in animals evolves with time, inducing changes in the epidemiology of the human disease. Consequently more investigations on animal leptospirosis in these ecosystems and use of molecular tools are essential for prevention and control of the human disease.

Most viruses are maintained by complex processes of evolution that enable them to survive but also complicate efforts to achieve their control. In this paper, we study patterns of evolution in foot-and-mouth disease (FMD) serotype C virus isolates from Kenya, one of the few places in the world where serotype C has been endemic and is suspected to remain. The nucleotide sequences encoding the capsid protein VP1 from eight isolates collected between 1967 and 2004 were analysed for patterns of sequence divergence and evolution. Very low nucleotide diversity (π=0·0025) and remarkably little change (only five segregating sites and three amino-acid changes) were observed in these isolates collected over a period of almost 40 years. We interpret these results as being suggestive of re-introductions of the vaccine strain into the field. The implications of these results for the maintenance of serotype C FMD virus and the use of vaccination as a control measure in Kenya are discussed.

This study aimed to identify risk factors for intestinal colonization with multidrug-resistant (MDR) E. coli in dogs on admission to a veterinary teaching hospital. Exposures to potential risk factors, including prior treatments, hospitalizations and interventions during the 42 days prior to admission were assessed for 82 case admissions and 82 time-matched controls in a retrospective prevalence-based case-control study of 20 months duration. On multivariable analyses, risk of MDR E. coli colonization on admission was increased with prior hospitalization for 4–7 days and >7 days relative to shorter periods, and in dogs that had prior diagnostic imaging techniques. Univariable analyses indicated that risk was increased following prior treatment with several antimicrobial agents. However, on multivariable analysis, administration of fluoroquinolones was associated with increased risk but risk did not appear to increase following administration of other antimicrobials. These results can inform management of canine patients and infection control procedures to mitigate the risk of clinical disease due to MDR bacteria in hospitalized dogs.

Reducing the burden of Salmonella in broiler flocks presents a challenge for public health. Worldwide, grow-out broilers are routinely vaccinated to prevent or lessen clinical manifestation of other infections. In this exploratory analysis we tested if details of a routine vaccination programme delivered to conventional grow-out broilers were associated with the burden of Salmonella in the flock as it progressed through its production cycle. None of the flocks studied were vaccinated against Salmonella or received a competitive exclusion product. The flocks were reared on conventional grow-out farms in southeastern USA, and sampled in a prospective field observational study. We observed significant associations between the content and design of a grow-out vaccination programme targeting other infections and the probability of detecting Salmonella in the broiler flock at different time points throughout the production cycle. To the best of the authors' knowledge, this is the first field report of such associations.

The association between coronaviruses and bats is a worldwide phenomenon and bats belonging to genus Rhinolophus are the reservoir host for several coronaviruses, including a large number of viruses closely related genetically to severe acute respiratory syndrome-coronavirus (SARS-CoV). We carried out a survey in colonies of Italian bats (Rhinolophus ferrumequinum) for the presence of coronaviruses. Two of 52 R. ferrumequinum captured from different Italian areas tested positive by reverse transcription–PCR for a fragment of RNA-dependent RNA polymerase (RdRp) gene of viruses related to Coronavirus. Phylogenetic analysis revealed close correlations between one of the positive samples and SARS-related CoV belonging to the genus Betacoronavirus.

We report a major outbreak of rabies in dogs and other domestic animals that occurred in eastern Bhutan between May 2005 and November 2007. The outbreak peaked in February 2006 and subsided by the end of April 2006 with sporadic cases reported until November 2007. Rabies affected 18 of the 40 sub-districts in the three eastern districts of Bhutan. There were reportedly one human and 256 domestic animal fatalities. The outbreak affected cattle (n=141, 55%), dogs (n=106, 41%), horses (n=7, 3%) and cats (n=2, 1%). Rabies was primarily diagnosed by clinical signs but 36 cases were confirmed by fluorescent antibody test of brain samples. High densities and movements of free-roaming dogs might have been responsible for the rapid spread and persistence of the infection for a longer period than expected in dogs in eastern Bhutan.

Newborns often present with skin conditions ranging from transient benign to severe. An occasional cause of neonatal exanthemic rash is infection due to Gram-positive bacteria, but Gram-negative infection is uncommon. We describe an outbreak of sepsis in 10 neonates over a 2-week period, caused by Klebsiella pneumoniae in a level III neonatal intensive care unit (NICU). Seven babies developed an exanthematous maculopapular rash. Molecular analysis by pulsed-field gel electrophoresis showed that all the babies with rash were infected by a single strain of K. pneumoniae which was distinct from the strain recovered from babies without rash.

This population-based cohort study aimed to investigate the incidence and relative hazard of renal and perinephric abscess (RA) in the diabetic population in Taiwan. More than a half million diabetic patients and sex- and age-matched controls were identified from the 1997 Taiwan National Health Insurance data and were linked to in-patient claims from 1997 to 2007. Person-year approach with Poisson assumption was used to estimate the incidence density (ID) of RA. The hazard ratios (HRs) of hospitalization due to RA in relation to diabetes were analysed using a Cox proportional hazard model. The ID for the diabetic and control subjects was 4·6 and 1·1/10 000 person-years, respectively, in 11 years of follow-up, representing an adjusted HR of 3·81 (95% confidence interval 3·44–4·23). This study confirmed the association of diabetes with RA, and argued that more aggressive urological care should be administered to diabetic patients.

This study determined the carriage rate and serotype distribution of group B Streptococcus (GBS) in women of child-bearing age in the southern region of Ireland. A total of 2000 vaginal swabs collected in two periods in 2004 and 2006 were examined and revealed a GBS carriage rate of 16·1%. Serotyping of isolates showed that serotypes Ia, II, III, IV, and V were the most prevalent. A high prevalence of serotype IV was found, increasing from 7·6% to 15·2% between 2004 and 2006. Random amplified polymorphic DNA analysis demonstrated considerable genetic heterogeneity in the serotype IV isolates. This serotype should be considered for inclusion in potential vaccines for use in Ireland.

The rate of case investigation for measles-like illness (MLI) is an important indicator for the quality of measles surveillance in countries targeting measles elimination. However, a benchmark rate is still being discussed. We assessed different rates of investigation in 11 territories of the Russian Federation with low reported measles incidence during the previous 4–7 years. Each territory maintained their existing surveillance activities and also undertook additional surveillance activities for MLI over a 3-year period. The annual routine rate of investigation varied from 0·06 to 1·8/100 000 population; the overall rate of investigation, including enhanced surveillance, varied from 1·4 to 7·2/100 000. Forty-nine (30·8%) of 159 measles cases detected were identified through enhanced surveillance. Based on the results of this study, the Russian Federation concluded that a rate of routine investigation of 2/100 000 provided the best balance between available resources and sensitivity for detection of measles cases.

The documented vaccine coverage rate of measles-mumps-rubella (MMR) vaccination is almost 99% in Korea, but measles cases are constantly being reported. This study evaluated the vaccine coverage, timeliness, and barriers to immunization of measles vaccination in preschool children in Korea. We assessed 452 children aged 15–23 months and 300 children aged 4–6 years in September 2007. Questionnaires were administered in order to estimate measles vaccination rate, its timeliness and barriers to vaccine uptake. Being unaware of the necessity for vaccination and its schedule, child being sick during the recommended vaccination period, and recommended vaccination period not being over were significant preventive factors to timely vaccination (P<0·05). Children with working mothers, single parents, those not being cared for by their parents, and those younger among siblings were at a higher risk of not being vaccinated on time. In order to increase timely vaccination, accurate information should be delivered and a systematic approach should be targeted to high-risk groups.

Measles is regarded as a disease that can be eliminated by vaccination; however, disease epidemics still occur in Wuhan, China. This study explored the effect of measles control programmes on the periodic structure of disease epidemics in Wuhan. The monthly reported measles incidence from 1953 to 2008 was divided into pre-vaccine range (1953–1965) and post-vaccine range (1966–2008). For the incidence in each range, spectral analysis was conducted and power spectral density (PSD) was obtained. In PSD for the pre-vaccine range, the most dominant spectral line was observed at a 2·0-year period, as in the case of Japan. It was confirmed that spectral lines of periodic modes longer than a 1-year cycle of the incidence rates behave in response to the introduction of measles control programmes. The investigation of periodic structures of measles epidemics will contribute to effective measles control programmes in Wuhan.

Measles vaccine efficacy is higher at 12 months than 9 months because of maternal immunity, but delaying vaccination exposes the children most vulnerable to measles mortality to infection. We explored how this trade-off changes as a function of regionally varying epidemiological drivers, e.g. demography, transmission seasonality, and vaccination coverage. High birth rates and low coverage both favour early vaccination, and initiating vaccination at 9–11 months, then switching to 12–14 months can reduce case numbers. Overall however, increasing the age-window of vaccination decreases case numbers relative to vaccinating within a narrow age-window (e.g. 9–11 months). The width of the age-window that minimizes mortality varies as a function of birth rate, vaccination coverage and patterns of access to care. Our results suggest that locally age-targeted strategies, at both national and sub-national scales, tuned to local variation in birth rate, seasonality, and access to care may substantially decrease case numbers and fatalities for routine vaccination.

Noroviruses are an important aetiological agent of acute gastroenteritis. They are responsible for large outbreaks of disease in the community, hospitals and long-term-care facilities. The clinical manifestations of norovirus outbreaks in psychiatric units are rarely described. The disease burden and impact highlight the importance of timely notification and investigation of these outbreaks. We analysed the characteristics of four norovirus outbreaks which occurred during a 3-year period in an in-patient psychiatric care unit. A total of 184 patients were affected which included 172 hospitalized patients, seven healthcare workers (HCWs) and five psychiatric nursing-home residents. The mean incidence rate of norovirus gastroenteritis (NVG) in hospitalized patients during these outbreaks was 12·7%. These outbreaks were characterized by higher incidence in middle-aged male patients, predominant sickness of diarrhoea, short duration of illness, peaks in late winter and early spring, and higher susceptibility in acute psychiatric patients. HCWs had longer duration of illness than psychiatric patients. More than 10% of affected patients experienced ⩾2 infections. Infection control measures were instituted and a comprehensive, responsive standard operating procedure for NVG and outbreak management was developed. After implementation of these measures, no further outbreaks of NVG occurred during the study period.

To identify the epidemiological and genetic characteristics of norovirus (NoV) outbreaks and estimate the impact of NoV infections in an older population, we analysed epidemiological and laboratory data collected using standardized methods from long-term care facilities (LTCFs) during 2003–2006. Faecal specimens were tested for NoV by real-time reverse transcriptase–polymerase chain reaction. NoV strains were genotyped by sequencing. Of the 234 acute gastroenteritis (AGE) outbreaks reported, 163 (70%) were caused by NoV. The annual attack rate of outbreak-associated NoV infection in LTCF residents was 4%, with a case-hospitalization rate of 3·1% and a case-fatality rate of 0·5%. GII.4 strains accounted for 84% of NoV outbreaks. Median duration of illness was longer for GII.4 infections than non-GII.4 infections (33 vs. 24 h, P<0·001). Emerging GII.4 strains (Hunter/2004, Minerva/2006b, Terneuzen/2006a) gradually replaced the previously dominant strain (Farmington Hills/2002) during 2004–2006. NoV GII.4 strains are now associated with the majority of AGE outbreaks in LTCFs and prolonged illness in Oregon.

We examined the association between water exposures and acute diarrhoeal illness (ADI) in children under non-outbreak conditions in a major US metropolitan area. We used a nested case-control study of children seen in an urban/suburban emergency department. Cases were those seen for a complaint of diarrhoea, while controls were age-matched children with a non-gastrointestinal complaint. Parents of subjects completed a validated water-use survey. Stratum-specific adjusted odds ratios (aOR) were calculated for the three main water effects: water source [surface vs. ground (well)], drinking-water type (tap vs. bottled), and use of water filters. Of 2472 subjects, 45% drank mostly or only bottled water. Well-water use was associated with increased odds of ADI compared to surface water [aOR 1·38, 95% confidence interval (CI) 1·01–1·87]. Use of bottled water did not affect the odds of ADI in well-water users, but increased the odds of ADI for surface-water users (aOR 1·27, 95% CI 1·02–1·57). We conclude that well-water use and bottled-water use are associated with increased odds of ADI in children.

We report the results of the New Zealand Acute Gastrointestinal Illness (AGI) Community Study, a representative cross-sectional community telephone survey of 3655 participants conducted over a 12-month period. Respondents were asked questions about vomiting and diarrhoea in the previous 4 weeks. At least one episode of diarrhoea and/or vomiting was reported by 8·6% of respondents, an incidence of 1·11 episodes/person per year. Prevalence was highest in children aged <5 years and lowest in those aged >64 years. The mean duration of illness was 2·5 days and most common symptoms were diarrhoea (82·5%), stomach cramps (75·7%), nausea (56·9%) and vomiting (49·0%). Extrapolation of the adjusted estimates indicates there are about 4·66 million episodes of AGI per year in New Zealand, nearly 1 million visits to the general medical practitioner, in excess of 300 000 courses of antibiotics being dispensed and more than 4·5 million days of paid work lost due to AGI. This represents a significant burden of disease.

A multistate outbreak of Escherichia coli O157:H7 infections occurred in the USA in November–December 2006 in patrons of restaurant chain A. We identified 77 cases with chain A exposure in four states – Delaware, New Jersey, New York, and Pennsylvania. Fifty-one (66%) patients were hospitalized, and seven (9%) developed haemolytic uraemic syndrome; none died. In a matched analysis controlling for age in 31 cases and 55 controls, illness was associated with consumption of shredded iceberg lettuce [matched odds ratio (mOR) 8·0, 95% confidence interval (CI) 1·1–348·1] and shredded cheddar cheese (mOR 6·2, CI 1·7–33·7). Lettuce, an uncooked ingredient, was more commonly consumed (97% of patients) than cheddar cheese (84%) and a single source supplied all affected restaurants. A single source of cheese could not explain the regional distribution of outbreak cases. The outbreak highlights challenges in conducting rapid multistate investigations and the importance of incorporating epidemiological study results with other investigative findings.

In December 2006, an outbreak of gastroenteritis occurred involving 372 guests and 72 employees at a hotel after a guest vomited in corridors on the third (F3) and 25th (F25) floors. Norovirus with identical genotype was confirmed by real-time reverse transcription–polymerase chain reaction in faecal samples from guest cases and employees. Spread of the outbreak on F25 was compared with that on F3. The attack rate in the guests who visited F25 alone (15·0%, 106/708 guests) was significantly higher than in those who visited F3 alone (3·5%, 163/4710 guests) (relative risk 4·3, 95% confidence interval 3·4–5·5, P<0·001). The outbreak on F3 ended within 2 days, while that on F25 extended over 7 days. The environmental ratios of F3 to F25 were 7·4 for volume, 6·9 for floor area and 7·6 for ventilation rate. This outbreak suggests that environmental differences can affect the propagation and persistence of a norovirus outbreak following environmental contamination.