A case control study of foal diarrhoea in the United Kingdom was carried out over a 3-year period. Clostridium perfringens was significantly associated with foal diarrhoea (Odds Ratio (OR) = 3·0), being isolated from 57% of 421 animals with diarrhoea but from only 27% of 223 healthy foals. Also, C. perfringens was significantly associated with fatal diarrhoea (OR = 4·5). About half of diarrhoea with a fatal outcome was attributable to this organism.

The other pathogens significantly associated with diarrhoea were rotavirus (OR = 5·6), Cryptosporidium spp. (OR = 3·2) and the nematode Strongyloides westeri, which was significant only when present in large numbers (> 2000 eggs/g of faeces: OR = 6·1). Salmonella spp. (OR = 14·2) and Cryptosporidium spp. (OR = 3·0) were the only other pathogens associated with fatal illness.

Overall, C. perfringens, rotavirus, and large numbers of Cryptosporidium spp. or S. westeri were isolated from 80% of foals with diarrhoea. Thermophilic Campylobacter spp., Yersinia enterocolitica, Escherichia coli and other parasites were not associated with diarrhoea. Carriage of C. perfringens, rotavirus and Cryptosporidium spp. was significantly greater in healthy foals in contact with cases of diarrhoea than in foals that were not in contact with diarrhoea (P < 0·05). There were no statistical interactions between any of the pathogens associated with diarrhoea although separate cases from one location often involved more than one pathogen.

Horizontal transmission of Campylobacter jejuni was investigated in campylobactor–free broiler chicks. One hundred and twenty chicks housed individually, were provided with water containing 102−109 c.f.u./ml C. jejuni. Colonization was rapid [47 of 73 (64 %) positive cloacal cultures within 3 days and 65 of 73 (89 %) within 7 days], depenedent on C. jejuni–contaminated water or colonized seeder chicks. Transmission occurred in 2–7 days concurrent with a gradual increase of C. jejuni in litter, water and feed. Environmental samples were culture–negative within 3 days following removal of colonized chicks. Treatment of 1–day–old chicks with adult caecal microbiota did not affect colonization. Treated and control chicks were all C. jejuni–positive within 3 days of seeder challenge.

Expert opinion was elicited to undertake a qualitative risk assessment to estimate the current and future risks to the European Union (EU) from five vector-borne viruses listed by the World Organization for Animal Health. It was predicted that climate change will increase the risk of incursions of African horse sickness virus (AHSV), Crimean-Congo haemorrhagic fever virus (CCHFV) and Rift Valley fever virus (RVFV) into the EU from other parts of the world, with African swine fever virus (ASFV) and West Nile virus (WNV) being less affected. Currently the predicted risks of incursion were lowest for RVFV and highest for ASFV. Risks of incursion were considered for six routes of entry (namely vectors, livestock, meat products, wildlife, pets and people). Climate change was predicted to increase the risk of incursion from entry of vectors for all five viruses to some degree, the strongest effects being predicted for AHSV, CCHFV and WNV. This work will facilitate identification of appropriate risk management options in relation to adaptations to climate change.

Novel Coronavirus (2019-nCoV [SARS-COV-2]) was detected in humans during the last week of December 2019 at Wuhan city in China, and caused 24 554 cases in 27 countries and territories as of 5 February 2020. The objective of this study was to estimate the risk of transmission of 2019-nCoV through human passenger air flight from four major cities of China (Wuhan, Beijing, Shanghai and Guangzhou) to the passengers' destination countries. We extracted the weekly simulated passengers' end destination data for the period of 1–31 January 2020 from FLIRT, an online air travel dataset that uses information from 800 airlines to show the direct flight and passengers' end destination. We estimated a risk index of 2019-nCoV transmission based on the number of travellers to destination countries, weighted by the number of confirmed cases of the departed city reported by the World Health Organization (WHO). We ranked each country based on the risk index in four quantiles (4th quantile being the highest risk and 1st quantile being the lowest risk). During the period, 388 287 passengers were destined for 1297 airports in 168 countries or territories across the world. The risk index of 2019-nCoV among the countries had a very high correlation with the WHO-reported confirmed cases (0.97). According to our risk score classification, of the countries that reported at least one Coronavirus-infected pneumonia (COVID-19) case as of 5 February 2020, 24 countries were in the 4th quantile of the risk index, two in the 3rd quantile, one in the 2nd quantile and none in the 1st quantile. Outside China, countries with a higher risk of 2019-nCoV transmission are Thailand, Cambodia, Malaysia, Canada and the USA, all of which reported at least one case. In pan-Europe, UK, France, Russia, Germany and Italy; in North America, USA and Canada; in Oceania, Australia had high risk, all of them reported at least one case. In Africa and South America, the risk of transmission is very low with Ethiopia, South Africa, Egypt, Mauritius and Brazil showing a similar risk of transmission compared to the risk of any of the countries where at least one case is detected. The risk of transmission on 31 January 2020 was very high in neighbouring Asian countries, followed by Europe (UK, France, Russia and Germany), Oceania (Australia) and North America (USA and Canada). Increased public health response including early case recognition, isolation of identified case, contract tracing and targeted airport screening, public awareness and vigilance of health workers will help mitigate the force of further spread to naïve countries.

The mean time-survivor curves of bacteria immersed in two phenolic disinfectants show the same variation of type as the individual curves, that is, (a) an exponential rate, (b) a lag phase followed by an exponential rate. The significance of all these curves and of others is discussed in the next part of the paper.

Waterborne illness related to the consumption of contaminated or inadequately treated water is a global public health concern. Although the magnitude of drinking water-related illnesses in developed countries is lower than that observed in developing regions of the world, drinking water is still responsible for a proportion of all cases of acute gastrointestinal illness (AGI) in Canada. The estimated burden of endemic AGI in Canada is 20·5 million cases annually – this estimate accounts for under-reporting and under-diagnosis. About 4 million of these cases are domestically acquired and foodborne, yet the proportion of waterborne cases is unknown. There is evidence that individuals served by private systems and small community systems may be more at risk of waterborne illness than those served by municipal drinking water systems in Canada. However, little is known regarding the contribution of these systems to the overall drinking water-related AGI burden in Canada. Private water supplies serve an estimated 12% of the Canadian population, or ~4·1 million people. An estimated 1·4 million (4·1%) people in Canada are served by small groundwater (2·6%) and surface water (1·5%) supplies. The objective of this research is to estimate the number of AGI cases attributable to water consumption from these supplies in Canada using a quantitative microbial risk assessment (QMRA) approach. This provides a framework for others to develop burden of waterborne illness estimates for small water supplies. A multi-pathogen QMRA of Giardia, Cryptosporidium, Campylobacter, E. coli O157 and norovirus, chosen as index waterborne pathogens, for various source water and treatment combinations was performed. It is estimated that 103 230 AGI cases per year are due to the presence of these five pathogens in drinking water from private and small community water systems in Canada. In addition to providing a mechanism to assess the potential burden of AGI attributed to small systems and private well water in Canada, this research supports the use of QMRA as an effective source attribution tool when there is a lack of randomized controlled trial data to evaluate the public health risk of an exposure source. QMRA is also a powerful tool for identifying existing knowledge gaps on the national scale to inform future surveillance and research efforts.

H9N2 is the most widespread avian influenza virus subtype in poultry worldwide. It infects a broad spectrum of host species including birds and mammals. Infections in poultry and humans vary from silent to fatal. Importantly, all AIV, which are fatal in humans (e.g. H5N1, H7N9) acquired their ‘internal’ gene segments from H9N2 viruses. Although H9N2 is endemic in the Middle East (ME) and North Africa since the late 1990s, little is known about its epidemiology and genetics on a regional level. In this review, we summarised the epidemiological situation of H9N2 in poultry and mammals in Iran, Iraq, Kuwait, Qatar, United Arab Emirates, Oman, Bahrain, Yemen, Saudi Arabia, Jordan, Palestine, Israel, Syria, Lebanon, Turkey, Egypt, Sudan, Libya, Tunisia, Algeria and Morocco. The virus has been isolated from humans in Egypt and serosurveys indicated widespread infection particularly among poultry workers and pigs in some countries. Some isolates replicated well in experimentally inoculated dogs, mice, hamsters and ferrets. Insufficient protection of immunised poultry was frequently reported most likely due to concurrent viral or bacterial infections and antigenic drift of the field viruses from outdated vaccine strains. Genetic analysis indicated several distinct phylogroups including a panzootic genotype in the Asian and African parts of the ME, which may be useful for the development of vaccines. The extensive circulation of H9N2 for about 20 years in this region where the H5N1 virus is also endemic in some countries, poses a serious public health threat. Regional surveillance and control strategy are highly recommended.

The number of deaths attributable to influenza is believed to be considerably higher than the number certified by vital statistics registration as due to influenza. Weekly mortality data for Canada from the 1989/1990 to the 1998/1999 influenza seasons were analysed by cause of death, age group, and place of death to estimate the impact of influenza on mortality. A Poisson regression model was found to accurately predict all-cause, as well as cause-specific mortality, as a function of influenza-certified deaths, after controlling for seasonality, and trend. Influenza-attributable deaths were calculated as predicted less baseline-predicted deaths. In summary, throughout the 1990s there were on average just under 4000 deaths attributable to influenza annually (for an influenza-attributable mortality rate of 13/100 000 persons), varying from no detectable excess mortality for the 1990/1991 influenza season, to 6000–8000 influenza-attributable deaths for the more severe influenza seasons of 1997/1998 and 1998/1999. On average, 8% (95% CI 7–10) of influenza-attributable deaths were certified as influenza, although this percentage varied from 4% to 12% from year to year. Only 15% of the influenza-attributable deaths were certified as pneumonia, and for all respiratory causes, 40%. Deaths were distributed over most causes. The weekly pattern of influenza-certified deaths was a good predictor of excess all-cause mortality.

Infection of wild animals by bovine tuberculosis (bTB) is raising concern worldwide. This article reviews the current epidemiological situation, risk of emergence and control options at the wildlife–livestock–human interface in sub-Saharan Africa. In livestock, bTB has been confirmed in the majority of countries from all parts of the continent. Wildlife infection is confirmed in seven countries from southern and eastern Africa, apparently spreading in the southern Africa region. Mycobacterium bovis has been isolated from 17 wild mammal species, although only four are suspected to play a role as maintenance host. Zoonotic risks are a concern, but no direct spillover from wildlife to humans has been documented, and no case of bTB spillback from wildlife to livestock has been confirmed. In this paper we assess the main risk factors of bTB spillover at the wildlife–livestock–human interface and suggest several research themes which could improve the control of the disease in the African context.

The consumption of bi-valve mollusean shellfish has been associated with outbreaks of viral gastroenteritis and hepatitis A. Investigations were undertaken to determine the heat inactivation conditions necessary to render shellfish such as cockles safe for the consumer. Conditions for the laboratory maintenance of live cockles are described. In preliminary experiments either poliovirus (106 TCID50/ml seawater) or hepatitis A virus (HAV) (approx. 104 RFU/ml seawater) was introduced into the shellfish tank. Following 48 h filter feeding, virus was recovered from cockles using an adsorption-elution extraction procedure. Titres of virus recovered ranged from 104 to 105 TCID50/ml of shellfish extract for poliovirus and from 103 to 105 RFU/ml of shellfish extract for HAV. Active ingestion of the virus from the seawater was demonstrated by recovering virus from within cockle guts. To quantify recovered HAV, end-point dilutions and an adaptation of a radioimmunofocus assay (RIFA) were compared. The tests were of similar sensitivity but the RIFA has the advantage of being relatively rapid, shortening the time taken to complete an experiment by as much as 4 weeks.

We examined clinical and epidemiological features of 575 laboratory-confirmed cases of vibrio gastroenteritis in Alabama, Florida, Louisiana, and Texas from 1988 to 1997 (the US Gulf of Mexico Regional Vibrio Surveillance System). Illnesses occurred year round, with peaks in spring and autumn. Illnesses lasted a median of 7 days and included fever in half of patients and bloody stools in 25% of patients with relevant information. Seventy-two percent of patients reported no underlying illnesses. In the week before onset, 236 (53%) of 445 patients for whom data were available ate raw oysters, generally at a restaurant or bar. Educational efforts should address the risk of vibrio gastroenteritis for raw oyster consumers, including healthy individuals. Further studies should examine environmental conditions affecting vibrio counts on seafood and processing technologies to enhance the safety of raw oysters.

Hepatitis C virus (HCV) among injecting drug users (IDUs) is one of the European Union's (EU) major public health problems. This review examines the current state of knowledge regarding HCV among IDUs in EU countries. Studies published between January 1990 and December 2000, were identified through a computerized search (MEDLINE and EMBASE). Ninety-eight studies have reported prevalence for HCV among groups of IDUs in all EU countries except Luxembourg. The prevalence of anti-HCV ranged from 30 to 98%. Incidence rates ranged from 6·2 to 39·3 per 100 person years. This review provides a comprehensive examination of HCV infection among IDUs in the countries of the EU, and quite clearly demonstrates that the quality and epidemiological relevance of the studies published varies widely. Thus, the reported data may not reflect accurately the current or recent past prevalence of HCV among IDUs in the EU. A strategic approach to the surveillance of HCV among IDUs in the EU, utilizing robust and consistent methods, is required urgently.

Foodborne outbreaks of Salmonella enterica serovar Enteritidis phage type 4 (PT4) infection (n=497), reported to the Health Protection Agency Communicable Disease Surveillance Centre between 1992 and 2002, were compared with other pathogens (n=1148) to determine factors (season, setting, food vehicles, food safety faults) associated with this pathogen. Logistic regression was applied to control for potential confounding. Foodborne general outbreaks of S. Enteritidis PT4 infection were more likely to occur in the spring and summer, and were more often linked to schools, private residences and residential institutions. Eggs, egg products and the use of raw shell egg were strongly associated with this pathogen. Most outbreaks were linked to cross-contamination and inadequate heat treatment. This paper describes the decline in the S. Enteritidis PT4 epidemic, providing evidence that control measures introduced, e.g. improved biosecurity and vaccination, have worked. Continued surveillance of human and veterinary salmonellosis is essential to detect future problems.

Salmonella enteritidis PT4 was recovered from fingers following the breaking of intact shell eggs artificially contaminated in the contents with the bacterium. Kitchen utensils used to mix egg dishes were salmonella-positive, sometimes after washing. Following the preparation of batter or the mixing of eggs, S. enteritidis was recovered from work surfaces over 40 cm from the mixing bowl. The bacterium survived well in thin, dry films of either batter or egg and, from an initial level of one cell per cm2, could be recovered from formica work surfaces 24 h after contamination.

VP1 gene sequences of SAT-2 type foot-and-mouth disease (FMD) viruses recovered from impala and African buffalo in the Kruger National Park (KNP) were used to determine intra- and interspecies relationships of viruses circulating in these wildlife populations. On this basis five distinct lineages of SAT-2 virus were identified in routine sampling of oesophageo-pharyngeal epithelium from buffalo between 1988 and 1996. Different lineages were associated with discrete geographic sampling localities. Over the period 1985–95, four unrelated epizootics occurred in impala in defined localities within the KNP. Evidence for natural transmission of FMD between buffalo and impala is presented for the most recent 1995 outbreak, with data linking the 1985 and 1988/9 impala epizootics to viruses associated with specific buffalo herds.

Mycobacterium bovis (M. bovis), the causative agent of bovine tuberculosis, has been identified in nine geographically distinct wildlife populations in North America and Hawaii and is endemic in at least three populations, including members of the Bovidae, Cervidae, and Suidae families. The emergence of M. bovis in North American wildlife poses a serious and growing risk for livestock and human health and for the recreational hunting industry. Experience in many countries, including the USA and Canada, has shown that while M. bovis can be controlled when restricted to livestock species, it is almost impossible to eradicate once it has spread into ecosystems with free-ranging maintenance hosts. Therefore, preventing transmission of M. bovis to wildlife may be the most effective way to mitigate economic and health costs of this bacterial pathogen. Here we review the status of M. bovis infection in wildlife of North America and identify risks for its establishment in uninfected North American wildlife populations where eradication or control would be difficult and costly. We identified four common risk factors associated with establishment of M. bovis in uninfected wildlife populations in North America, (1) commingling of infected cattle with susceptible wildlife, (2) supplemental feeding of wildlife, (3) inadequate surveillance of at-risk wildlife, and (4) unrecognized emergence of alternate wildlife species as successful maintenance hosts. We then propose the use of integrated and adaptive disease management to mitigate these risk factors to prevent establishment of M. bovis in susceptible North American wildlife species.

Respiratory syncytial virus (RSV) is the most common pathogen associated with acute lower respiratory tract infections in young children. RSV is also a major viral pathogen causing severe lung disease in the adult population, particularly among the elderly. We conducted a review of adult RSV studies published from January 1970 to February 2017 to determine the burden of disease among adults worldwide. There were no restrictions on health care setting or definition of RSV infection. A total of 1530 published studies were identified, 95 of which were included in this review. The incidence rates of hospitalised RSV acute respiratory tract infection (ARI) in adults >65 years old ranged from 7.3 to 13.0/105 population in Africa and Asia and from 190 to 254/105 population in the USA. Higher incidence rates (195–1790/105 population) were observed in adults ≥50 years old for outpatient or emergency visits in the USA. Of all ARI patients, RSV accounted for 1–10% in adults and 2–14% in patients with chronic diseases or transplantation. Given the limitations in the existing data, significant efforts should be made to generate evidence on the burden of RSV infections in adults and to estimate the potential impact of future preventive interventions.

Mycobacterium ulcerans, the organism which causes Buruli or Bairnsdale ulcer, has never been isolated in culture from an environmental sample. Most foci of infection are in tropical regions. The authors describe the first 29 cases of M. ulcerans infection from a new focus on an island in temperate southern Australia, 1992–5. Cases were mostly elderly, had predominantly distal limb lesions and were clustered in a small region in the eastern half of the main town on the island. The authors suspected that an irrigation system which lay in the midst of the cluster was a source of infection. Limitation of irrigation was associated with a dramatic reduction in the number of new cases. These findings support the hypothesis that M. ulcerans has an aquatic reservoir and that persons may be infected directly or indirectly by mycobacteria disseminated locally by spray irrigation.

Google's ‘Community Mobility Reports’ (CMR) detail changes in activity and mobility occurring in response to COVID-19. They thus offer the unique opportunity to examine the relationship between mobility and disease incidence. The objective was to examine whether an association between COVID-19-confirmed case numbers and levels of mobility was apparent, and if so then to examine whether such data enhance disease modelling and prediction. CMR data for countries worldwide were cross-correlated with corresponding COVID-19-confirmed case numbers. Models were fitted to explain case numbers of each country's epidemic. Models using numerical date, contemporaneous and distributed lag CMR data were contrasted using Bayesian Information Criteria. Noticeable were negative correlations between CMR data and case incidence for prominent industrialised countries of Western Europe and the North Americas. Continent-wide examination found a negative correlation for all continents with the exception of South America. When modelling, CMR-expanded models proved superior to the model without CMR. The predictions made with the distributed lag model significantly outperformed all other models. The observed relationship between CMR data and case incidence, and its ability to enhance model quality and prediction suggests data related to community mobility could prove of use in future COVID-19 modelling.

Rabbits immunized with whole streptococci of group B, type II, produce two immunologically distinct type-specific antibodies which are essentially equal by weight in protecting mice against infection with homologous type strains.

The capsular antigen with which these antibodies react is a polysaccharide containing galactose, glucose, glucosamine, and a labile component which has not been chemically identified. Extraction of the bacteria with TCA yields this ‘complete’ antigen, whereas extraction with HCl yields a partial antigen without the labile component. This degraded antigen can also be derived from the TCA antigen by treating the latter with hot HCl, and is indistinguishable from that extracted directly from the bacteria with HCl.

One of the antibodies produced, the TCA antibody, is directed against the labile component of the polysaccharide. The other, the HCl antibody, is directed against a β-d-galactoside determinant; and the precipitin reaction with this antibody is not masked in the ‘complete’ TCA antigen by the presence of the labile component.

The group-specific polysaccharide, which is located in the cell-wall, is also extracted with either TCA or HCl but can be eliminated from the preparations by fractional precipitation with ethanol. Although it is known that the type-specific polysaccharide is located in the streptococcal capsule, it is not at present clear in what form this substance occurs in the living streptococcal cell. It may be present partially as the degraded HCl form, or possibly wholly as the intact TCA form. Further immunological and chemical studies of these type-specific polysaccharides are in progress, and will be presented in another communication.