Syphilis is a chronic, multi-stage infectious disease that is usually transmitted sexually by contact with an active lesion of a partner or congenitally from an infected pregnant woman to her fetus. Although syphilis is still endemic in many developing countries, it has re-emerged in several developed countries. The resurgence of syphilis is a major concern to global public health, particularly since the lesions of early syphilis increase the risk of acquisition and transmission of infection with human immunodeficiency virus (HIV). Because there is no vaccine to prevent syphilis, control is mainly dependent on the identification and treatment of infected individuals and their contacts with penicillin G, the first-line drug for all stages of syphilis. The emergence of clinically significant azithromycin resistance in Treponema pallidum subsp. pallidum, the syphilis agent, has resulted in treatment failures, thus precluding the routine use of this second-line drug. Information is presented here on the diagnosis and recommended antibiotic treatment of syphilis and the challenge of macrolide-resistant T. pallidum.

Invasive pneumococcal disease (IPD) is of concern in Japan, where the heptavalent pneumococcal conjugate vaccine (PCV7) is unavailable. We determined serotypes, genotypes indicating β-lactam resistance, and antibiotic susceptibilities of 496 isolates from normally sterile sites in patients (193 children, 303 adults) from 186 institutions between August 2006 and July 2007. Disease presentations included sepsis (46·2%), pneumonia (31·5%), and meningitis (17·5%). Mortality was 1·4% in children and 22·1% in adults, many of whom had underlying diseases. In children, serotype 6B (22·5%) was followed by 19F (14·1%), and 14 (13·1%); potential coverages of PCV7 and PCV13 were 75·4% and 93·7%, respectively. In adults, serotype 12F (14·3%) was followed by 3 (11·3%), and 6B (10·3%); 23-valent polysaccharide vaccine (PPV23) coverage was 85·4%. Most serotype 12F strains were gPISP, with pbp2b gene alteration; carbapenem had an excellent MIC90. PCV7 is recommended for children and PPV23 for adults to increase prevention against IPD.

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.

1. Bacteriological surveys of more than forty popular bathing beaches around the coasts of England and Wales have been made during the past 5 years. The great majority of the beaches studied were subject to contamination with sewage.

2. A rough grading of the beaches studied gave a similar ranking order whether the results of the presumptive coliform test or faecal coli counts were used as the basis of grading.

3. Grading of beaches was valid only when surveys were carefully planned to ensure representative sampling from the areas on the beaches concerned where bathing actually took place.

4. The coliform test as used in the bacteriological examination of drinking waters was the main test procedure used but had certain limitations. Promising results with plate counts on relatively non-inhibitory media were obtained.

5. Various salmonella serotypes, notably Salm. paratyphi B, were isolated in small numbers from a high proportion of sea-water samples. The proportion of positive results for salmonella isolation increased from 13·3% in samples with less than 1000 coliform organisms per 100 ml. to 40·1% in samples with over 10,000 coliforms per 100 ml. Comparison of the numbers of salmonellae isolated with what is known of the minimum infective doses of these organisms suggested that very large volumes of sea water would require to be ingested for infection to occur.

6. Poliovirus was not isolated from a small series of sea-water samples examined. Because of the very large dilution factor, special concentration procedures would probably be required to isolate this virus from sea water.

7. Four cases of paratyphoid fever probably due to bathing were recorded. Surveys of the two associated beaches had given median presumptive coliform counts of more than 10,000 per 100 ml., and both showed gross macroscopic pollution with sewage.

8. A statistically controlled study of the bathing histories of 150 poliomyelitis cases in children living permanently by the seaside gave no evidence that bathing had played any part in causing the disease.

Analyses of outbreaks of African horse sickness showed that movement of infected Culicoides midges on the wind was most likely responsible for the spread of the disease over the sea from Morocco to Spain in 1966, from Turkey to Cyprus in 1960, and from Senegal to the Cape Verde Islands in 1943. The pattern of spread of the epidemic in the Middle East in 1960 could have been laid down by the infected midges carried on spells of south-east winds, and analyses of outbreaks in Algeria in 1965 and India in 1960 also suggested windborne spread of the disease. Each spread occurred when the presence of virus, host and vector coincided either with a spell of winds unusual for a particular time of year (Spain, Cyprus, Cape Verde Islands and Algeria) or with a series of disturbances usual at that time of the year (Middle East and India). Inferred flight endurance of the midge varied up to at least 20 h and flight range from 40 to 700 km. Flight occurred when temperatures were likely to have been in the range of 15–25 °C if it was at night or 20 to about 40 °C if it was by day.

It is suggested that likely movements of midges on the wind can be estimated from synoptic weather charts, and should be taken into account when planning control of the disease in the face of an outbreak. Such control includes a ban on movement of horses, vaccination and spraying of insecticide.

The risk of spread to countries outside the endemic areas should be assessed by reference to possible wind dispersal of infected midges.

Multiple introductions of methicillin-resistant Staphylococcus aureus (MRSA) strains occurred to a new hospital in Hong Kong. Two years of clinical microbiological surveillance of the resulting outbreaks was combined with laboratory investigation by phage and antibiogram typing, and plasmid profiling. The outbreaks on the special care baby (SCBU) and burns (BU) units were studied in detail, and colonization of staff and contamination of the environment were investigated. MRSA were spread by the hands of staff on the SCBU, where long-term colonization of dermatitis was important, but were probably transmitted on the BU by a combination of the airborne, transient hand-borne and environmental routes. Simple control measures to restrict hand-borne spread on the SCBU were highly effective, but control was not successful on the BU.

A novel enzyme-linked immunosorbent assay (ELISA) and a confirmatory Western blot (WB) to detect human antibodies against Francisella tularensis were evaluated. The ELISA was based on partially purified lipopolysaccharide (LPS), the WB on whole antigen of F. tularensis. Positive WB showed a typical LPS ladder. Sensitivity and specificity of the ELISA, as assessed in 104 positive sera and 1149 ‘normal’ sera from healthy young adults, were 99·0% and 97·1% respectively. Sensitivity of the WB was close to 100%, whereas specificity was 99·6%. Antibodies against the LPS of F. tularensis were detected in four of the ‘normal’ sera in both ELISA and WB. The assays were further evaluated using sera of individuals from Norway, Sweden and Kosovo suspected to be infected in tularemia outbreaks. Results revealed that the combination of ELISA and WB is suitable for laboratory confirmation of tularemia as well as for large-scale epidemiological studies.

Annually for 4 years groups of young Australian wild rabbits have been captured during non-epizootic periods from areas in which myxomatosis has occurred during the previous summer. The intensity of the preceding epizootic was measured by testing a sample of survivors for antibody. The captured young rabbits were raised in the laboratory until they were about 4 months old and then inoculated intradermally with small doses of the slightly attenuated myxoma virus strain Aust/Corowa/12–52/2 (KM 13), all samples of virus being derived from the same batch which has been stored at -70°C.

The results show there is a significant negative correlation between the mortality rate and the degree of exposure to myxomatosis of the forbears of the tested animals. Passive and active immunization have been excluded and this result is ascribed to increased genetic resistance.

We are greatly indebted to Mr. F. N. Ratcliffe, Officer in Charge of the Wildlife Survey Section of the Commonwealth Scientific and Industrial Organization, and to his officers, especially Messrs W. E. Poole, K. E. Myers, G. Douglas, B. V. Fennessy, H. Frith and K. Keith for their invaluable assistance in collecting rabbits and serum samples.

We have had valuable discussions with Dr W. R. Sobey, Dr P. J. Claringbold and Dr G. S. Watson on genetical and statistical aspects of the problems under study.

We systematically reviewed the current understanding of human population immunity against SARS-CoV in different groups, settings and geography. Our meta-analysis, which included all identified studies except those on wild animal handlers, yielded an overall seroprevalence of 0·10% [95% confidence interval (CI) 0·02–0·18]. Health-care workers and others who had close contact with SARS patients had a slightly higher degree of seroconversion (0·23%, 95% CI 0·02–0·45) compared to healthy blood donors, others from the general community or non-SARS patients recruited from the health-care setting (0·16%, 95% CI 0–0·37). When analysed by the two broad classes of testing procedures, it is clear that serial confirmatory test protocols resulted in a much lower estimate (0·050%, 95% CI 0–0·15) than single test protocols (0·20%, 95% CI 0·06–0·34). Potential epidemiological and laboratory pitfalls are also discussed as they may give rise to false or inconsistent results in measuring the seroprevalence of IgG antibodies to SARS-CoV.

In 1934 a committee on the eradication of bed-bugs appointed by the Minister of Health issued its report (Report on the Bed-bug, 1934) in which recommendations for research into the biology of Cimex lectularius L. were made. The committee was struck by the lack of precise information on certain aspects of the bionomics and habits of the insect and suggested work along the following lines:

The effect of food supply and starvation at different seasons and at different stages of development.

The periods of survival of bed-bugs and their eggs under different conditions.

The extent to which bed-bugs can subsist on the blood of birds, bats, mice, etc., when deprived of human blood.

The position and types of harbourages most favoured by bed-bugs under different conditions.

The distance which bed-bugs will travel, the factors (warmth, smell, etc.) which attract them, and whether they habitually return to the same harbourage.

Giardia intestinalis is the leading parasitic aetiology of human enteric infections in the United States, with an estimated 1·2 million cases occurring annually. To better understand transmission, we analysed data on all giardiasis outbreaks reported to the Centers for Disease Control and Prevention for 1971–2011. The 242 outbreaks, affecting ~41 000 persons, resulted from waterborne (74·8%), foodborne (15·7%), person-to-person (2·5%), and animal contact (1·2%) transmission. Most (74·6%) waterborne outbreaks were associated with drinking water, followed by recreational water (18·2%). Problems with water treatment, untreated groundwater, and distribution systems were identified most often during drinking water-associated outbreak investigations; problems with water treatment declined after the 1980s. Most recreational water-associated outbreaks were linked to treated swimming venues, with pools and wading pools implicated most often. Produce was implicated most often in foodborne outbreaks. Additionally, foods were most commonly prepared in a restaurant and contaminated by a food handler. Lessons learned from examining patterns in outbreaks over time can help prevent future disease. Groundwater and distribution system vulnerabilities, inadequate pool disinfection, fruit and vegetable contamination, and poor food handler hygiene are promising targets for giardiasis prevention measures.

The indirect immunofluorescent technique has been used to study the specific immunoglobulin responses in twelve adult cases of acute uncomplicated rubella. IgG, IgA and IgM antibodies increased virtually simultaneously. IgG antibody persisted throughout the period of study but showed a slight tendency to fall in titre after 7 months. IgM antibody was detected in nine cases. In these patients it was present in high titre 5–15 days after the rash but was not detected after 20 days. IgA antibody was detected in all cases. It was present in high titre 5–20 days after the rash but was no longer detectable after 29 days except in one patient who had a very low titre at 78 days. The presence of specific IgA and IgM indicates recent rubella in uncomplicated cases, and if the immunofluorescent method is used both types of antibody should be sought.

This study assesses the contribution of different sources of human campylobacteriosis in Denmark using two different source-attribution approaches. In total, 794 non-human isolates and 406 isolates from human cases (domestic, travel related, and cases with unknown travel history) were collected. Isolates were characterized by multilocus sequence typing, flaA typing and susceptibility to antibiotics. Both models used indicate that the major burden of human campylobacteriosis in Denmark originates from the domestic broiler chicken reservoir. The second most important reservoir was found to be cattle. The Asymmetric Island model attributed 52% [95% credibility interval (CrI) 37–67] to Danish chicken, 17% (95% CrI 3–33) to imported chicken, and 17% (95% CrI 7–28) to cattle. Similarly, the Campylobacter source-attribution model apportioned 38% (95% CrI 28–47) to Danish chicken, 14% (95% CrI 10–18) to imported chicken, and 16% (95% CrI 7–25) to cattle. The addition of flaA type as an extra discriminatory typing parameter did not change the attribution of cases markedly.

Serological surveillance of measles immunity has been carried out in England since 1986/7. Results from sera collected in 1989–91 revealed that the proportion of school age children who were susceptible to measles was increasing, following the introduction of the measles, mumps and rubella vaccination programme in October 1988. Mathematical models are used to interpret these data and determine whether this increasing susceptibility is sufficient to allow a resurgence of disease from the low levels achieved by 1993. The models summarize serological profiles by a single parameter, the reproduction number R, which quantifies the level of herd immunity in the population. Results showed that there was cause for concern over the levels of susceptibility to measles, with an epidemic of over 100000 cases likely in 1995/6. These predictions are consistent with trends in the incidence and age distribution of measles and have enabled the planning of a major vaccination campaign.

Clinical descriptions of Epstein–Barr virus (EBV) positive infectious mononucleosis (IM) are rare and their results are inconsistent. Over a 4-year period, we prospectively studied 590 young adults with clinically suspected IM, all of whom were tested for the presence of EBV IgM antibodies. We investigated the demographical, clinical and laboratory features of subjects with positive EBV IgM serology and heterophile antibodies. Contrary to previous studies, we found a seasonal disease pattern with a peak incidence during summer months, and a lower-than-expected prevalence of lymphadenopathy (88·9%), leucocytosis (46·2%), atypical lymphocytosis (89·2%) and elevated liver enzymes (57·9%). The prevalence of hyperbilirubinemia was relatively high (14·9%). The classic triad of fever, sore throat and lymph-adenopathy had relatively low sensitivity (68·2%) and specificity (41·9%) for EBV infection. Our study provides a complete and updated description of the clinical and laboratory presentation of laboratory confirmed IM, which is important for both clinicians and epidemiologists.

In simple epidemiological models that describe the interaction between hosts with their parasites, the infection process is commonly assumed to be governed by the law of mass action, i.e. it is assumed that the infection rate depends linearly on the densities of the host and the parasite. The mass-action assumption, however, can be problematic if certain aspects of the host–parasite interaction are very pronounced, such as spatial compartmentalization, host immunity which may protect from infection with low doses, or host heterogeneity with regard to susceptibility to infection. As deviations from a mass-action infection rate have consequences for the dynamics of the host–parasite system, it is important to test for the appropriateness of the mass-action assumption in a given host–parasite system. In this paper, we examine the relationship between the infection rate and the parasite inoculum for the water flee Daphnia magna and its bacterial parasite Pasteuria ramosa. We measured the fraction of infected hosts after exposure to 14 different doses of the parasite. We find that the observed relationship between the fraction of infected hosts and the parasite dose is largely consistent with an infection process governed by the mass-action principle. However, we have evidence for a subtle but significant deviation from a simple mass-action infection model, which can be explained either by some antagonistic effects of the parasite spores during the infection process, or by heterogeneity in the hosts' susceptibility with regard to infection.

Our objective was to determine the association between temperature, humidity, rainfall and dengue activity in Singapore, after taking into account lag periods as well as long-term climate variability such as the El Niño Southern Oscillation Index (SOI). We used a Poisson model which allowed for autocorrelation and overdispersion in the data. We found weekly mean temperature and mean relative humidity as well as SOI to be significantly and independently associated with dengue notifications. There was an interaction effect by periods of dengue outbreaks, but periods where El Niño was present did not moderate the relationship between humidity and temperature with dengue notifications. Our results help to understand the temporal trends of dengue in Singapore, and further reinforce the findings that meteorological factors are important in the epidemiology of dengue.

This study measured the prevalence and the risk factors associated with HCV antibody-positive prisoners. A total of 630 prisoners completed a questionnaire about risk behaviours associated with HCV transmission and were tested for HCV antibody from a blood test. Of these 362 (57·5%) prisoners were HCV antibody positive. A total of 436 (68·8%) prisoners reported ever injecting drugs and 332 reported injecting drugs in prison. HCV-positive prisoners were more likely to have injected drugs (OR 29·9) and to have injected drugs in prison during their current incarceration (OR 3·0). Tattooing was an independent risk factor for being HCV positive (OR 2·7). This is the first study conducted on prisoners that has identified having a tattoo in prison as a risk factor for HCV. Injecting drugs whilst in prison during this incarceration was also a risk factor for HCV. Our results show prisoners who injected drugs outside of prison continue to inject in prison but in a less safe manner.

Two Enteritidis PT4 isolates which differed in inherent tolerance to heat, acid, H2O2 and the ability to survive on surfaces were used to infect mice, day-old chicks or laying hens. The acid-, heat-, H2O2- and surface-tolerant isolate was more virulent in mice and more invasive in laying hens, particularly in reproductive tissue. However, no significant differences were observed in behaviour in chicks. Both PT4 isolates were able to infect chicks housed in the same room as infected birds, although the heat-tolerant isolate survived significantly better than the heat-sensitive one in aerosols.

From 1 January 1992 to 31 December 2000, 27 milkborne general outbreaks of infectious intestinal disease (IID) were reported to the Public Health Laboratory Service (PHLS) Communicable Disease Surveillance Centre (CDSC). These outbreaks represented a fraction (2%) of all outbreaks of foodborne origin (N=1774) reported to CDSC, but were characterized by significant morbidity. Unpasteurized milk (52%) was the most commonly reported vehicle of infection in milkborne outbreaks, with milk sold as pasteurized accounting for the majority of the rest (37%). Salmonellas (37%), Vero cytotoxin-producing Escherichia coli (VTEC) O157 (33%) and campylobacters (26%) were the most commonly detected pathogens, and most outbreaks were linked to farms (67%). This report highlights the importance of VTEC O157 as a milkborne pathogen and the continued role of unpasteurized milk in human disease.