In a survey of five villages in the Eastern Highlands of Papua New Guinea, Serpulina pilosicoli was isolated from rectal swabs from 113 of 496 individuals (22·8%). Colonization rates ranged from 22·6–30·1% in four of the villages but was only 8·6% in the other village. In comparison colonization was demonstrated in only 5 of 54 indigenous people (9·3%) and none of 76 non-indigenous people living in an urban environment in the same region. Colonization did not relate to reported occurrence of diarrhoea, age, sex, or length of time resident in a village. A second set of 94 faecal specimens was collected from 1 village 6 weeks after the first set. S. pilosicoli was isolated from 27 of 29 individuals (93·1%) who were positive on the first sampling and from 7 of 65 individuals (10·8%) who previously were negative. In this case, isolates were significantly more common in watery stools than in normal stools. The annual incidence of infection in the village was calculated as 93·6%, with an average duration of infection of 117 days. S. pilosicoli could not be isolated from any village pig (n=126) despite its confirmed presence in 17 of 50 commercial pigs (34·0%) sampled at a local piggery. Four of 76 village dogs (5·3%) and 1 of 2 village ducks were colonized with S. pilosicoli, suggesting the possibility of cross transmission between humans and animals.

It has been suggested that warm and humid weather is related to a high incidence of Legionnaires' disease (LD), but no data on this association existed in The Netherlands. The objective of this study was to investigate the short-term effects of the weather on LD in The Netherlands. National LD surveillance and meteorological data were obtained. We analysed the data using Poisson regression, adjusting for long-term trends, and using principal components analysis. The highest weekly incidence of LD occurred when the mean weekly temperature was +17·5°C. Mean weekly relative humidity, temperature and precipitation intensity were associated with LD incidence in the multivariable model. Warm, humid and showery summer weather was found to be associated with higher incidence of LD in The Netherlands. These results may be used to predict an increase in the number of cases of LD in The Netherlands during the summer.

We conducted a study to evaluate risk factors for developing typhoid fever in a setting where the disease is endemic in Karachi, Pakistan. We enrolled 100 cases with blood culture-confirmed Salmonella typhi between July and October 1994 and 200 age-matched neighbourhood controls. Cases had a median age of 5·8 years. In a conditional logistic regression model, eating ice cream (Odds ratio [OR]=2·3; 95% confidence interval [CI] 1·2–4·2, attributable risk [AR]=36%), eating food from a roadside cabin during the summer months (OR=4·6, 95% CI 1·6–13·0; AR=18%), taking antimicrobials in the 2 weeks preceding the onset of symptoms (OR=5·7, 95% CI 2·3–13·9, AR=21%), and drinking water at the work-site (OR=44·0, 95% CI 2·8–680, AR=8%) were all independently associated with typhoid fever. There was no difference in the microbiological water quality of home drinking water between cases and controls. Typhoid fever in Karachi resulted from high-dose exposures from multiple sources with individual susceptibility increased by young age and prior antimicrobial use. Improving commercial food hygiene and decreasing unnecessary antimicrobial use would be expected to decrease the burden of typhoid fever.

The Middle East respiratory syndrome coronavirus (MERS-CoV) is a life-threatening respiratory disease with a high case fatality rate; however, its risk factors remain unclear. We aimed to explore the influence of demographic factors, clinical manifestations and underlying comorbidities on mortality in MERS-CoV patients. Retrospective chart reviews were performed to identify all laboratory-confirmed cases of MERS-COV infection in Saudi Arabia that were reported to the Ministry of Health of Saudi Arabia between 23 April 2014 and 7 June 2016. Statistical analyses were conducted to assess the effect of sex, age, clinical presentation and comorbidities on mortality from MERS-CoV. A total of 281 confirmed MERS-CoV cases were identified: 167 (59.4%) patients were male and 55 (20%) died. Mortality predominantly occurred among Saudi nationals and older patients and was significantly associated with respiratory failure and shortness of breath. Of the 281 confirmed cases, 160 (56.9%) involved comorbidities, wherein diabetes mellitus, hypertension, ischemic heart disease, congestive heart failure, end-stage renal disease and chronic kidney disease were significantly associated with mortality from MERS-CoV and two or three comorbidities significantly affected the fatality rates from MERS-CoV. The findings of this study show that old age and the existence of underlying comorbidities significantly increase mortality from MERS-CoV.

A multi-state outbreak of Salmonella enterica serovar Saintpaul infection occurred in Australia during October 2006. A case-control study conducted in three affected jurisdictions, New South Wales, Victoria and Australian Capital Territory, included 36 cases with the outbreak-specific strain of S. Saintpaul identified by multiple locus variable-number tandem repeat analysis (MLVA) in a faecal specimen and 106 controls. Consumption of cantaloupe (rockmelon) was strongly associated with illness (adjusted OR 23·9 95%, 95% CI 5·1–112·4). S. Saintpaul, with the outbreak MLVA profile, was detected on the skin of two cantaloupes obtained from an implicated retailer. Trace-back investigations did not identify the specific source of the outbreak strain of S. Saintpaul, but multiple Salmonella spp. were detected in environmental samples from farms and packing plants investigated during the trace-back operation. Cantaloupe production and processing practices pose a potential public health threat requiring regulatory and community educational interventions.

Sylvatic small mammals were captured in rural habitats near Uppsala, Sweden, to measure the prevalence of bartonella infections, characterize bacterial isolates and identify their host range, and increase our understanding of host–pathogen ecology. During 7 nights of trapping at 3 localities, 236 small mammals were captured (trap success 30%). Bartonella were isolated from bloods of Apodemus flavicollis (19 of 110 tested), Apodemus sylvaticus (6/25), Clethrionomys glareolus (9/60), Microtus agrestis (1/3), Mus musculus (1/18), and Sorex araneus (3/20). Nucleotide sequencing (a 338 bp fragment of the gltA gene) of 40 isolates yielded 6 unique genotypes. Five of the 6 genotypes were most similar to other known bartonella isolated from Old World small-mammal hosts. The most frequent genotype (83%) was isolated from A. flavicollis and M. musculus and was identical to Bartonella grahamii, a recently demonstrated human pathogen. These two hosts were most frequently captured in and around human structures and work places, thus providing conditions that could potentially lead to frequent human infections.

A total of 19200 children, all contacts or relatives of known leprosy patients, and all free of visible leprosy lesions, were included in a controlled trial of BCG vaccination against leprosy in Uganda between 1960 and 1964. They were followed for an average of 8 years, during which time 261 developed early leprosy lesions. A less comprehensive follow-up was carried out for a further 5 years, when 8 more cases of leprosy were identified.

In the main intake, between 1960 and 1962, 16150 tuberculin-negative or weakly tuberculin-positive (Heaf Grades O-II) children were allocated by an effectively random process to either a BCG-vaccinated or an unvaccinated control group. Both groups were seen and examined in an identical fashion for leprosy at approximately 2-year intervals, and precautions were taken to ensure unbiased assessment of new cases of leprosy. After 8 years, 41 cases of leprosy had been identified in the BCG-vaccinated group, and 201 in the control group, a percentage reduction in the BCG-vaccinated group compared with the control group of 80%. The percentage reduction was similar for those initially tuberculin-negative, and for those initially weakly positive, and did not depend upon the age at vaccination. It was also similar for both sexes, for contacts of lepromatous and contacts of non-lepromatous leprosy, for children having contact with one or more than one patient, and for differing grades of physical contact and genetic relationship with a patient. The protective effect of BCG vaccination continued over the 8-year period, although it may have fallen off slightly at the end.

In a group of 1074 strongly tuberculin-positive (Heaf Grades III-IV) children followed in parallel with the other two groups a total of 16 cases of leprosy were identified. When adjusted for age, this incidence is 58% lower than that in the unvaccinated control children who were initially tuberculin-negative, indicating a protective effect against leprosy of naturally-acquired strong tuberculin sensitivity.

Between 1970 and 1975, one new case of leprosy was identified in a child who had initially been strongly tuberculin-positive and had therefore not been vaccinated, one in a BCG-vaccinated child, and 6 in control children. Although the follow-up in this period was less comprehensive than that in the main part of the trial, the ascertainment of cases was unlikely to have been biased towards either vaccinated or control children. These results indicate a continuing protective effect of BCG up to 12–13 years after vaccination.

In February 1992, an outbreak of cholera occurred among persons who had flown on a commercial airline flight from South America to Los Angeles. This study was conducted to determine the magnitude and the cause of the outbreak. Passengers were interviewed and laboratory specimens were collected to determine the magnitude of the outbreak. A case-control study was performed to determine the vehicle of infection. Seventy-five of the 336 passengers in the United States had cholera; 10 were hospitalized and one died. Cold seafood salad, served between Lima, Peru and Los Angeles, California, was the vehicle of infection (odds ratio, 11·6; 95% confidence interval, 3·3–44·5). This was the largest airline-associated outbreak of cholera ever reported and demonstrates the potential for airline-associated spread of cholera from epidemic areas to other parts of the world. Physicians should obtain a travel history and consider cholera in patients with diarrhoea who have travelled from cholera-affected countries. This outbreak also highlights the risks associated with eating cold foods prepared in cholera-affected countries.

Molecular analyses based on plasmid profile typing and pulsed-field gel electrophoresis have defined a strain of Salmonella enterica serotype Anatum associated with the consumption of a particular brand of formula-dried milk responsible for an outbreak in late 1996/early 1997 involving 15 infants and 2 relatives in the UK, and 2 infants in France. The study has demonstrated the value of laboratory-based surveillance involving identification of the outbreak strain at the molecular level coupled with food microbiology and targeted epidemiological investigations, and has highlighted the importance of rapid communication and subsequent international collaboration through the European Union-funded Salm-Net salmonella surveillance network.

In 1988 there were two outbreaks of infection with Salmonella enteritidis phage type 4 in adjacent local authorities. The first affected 18 of 75 helpers and guests who attended a private function. Investigations revealed that home-made vanilla ice-cream containing uncooked eggs was the vehicle of infection and the causative organism was identified at the premises of the egg producer. The second affected 84 of 422 delegates attending a conference dinner, and 12 of 50 hotel staff at risk. A dessert made with lightly-cooked egg yolk and raw egg white was associated with infection, and the epidemic strain was cultured from the shell of an egg and an environmental sample from the producer's farm. It is of interest that one outbreak involved free-range and one battery-produced eggs, and that in one the vehicle was prepared at home and in the other in commercial premises. In neither incident was any deficiency in standards of egg production or catering practice discovered.

Using a direct isolation method Listeria spp. were detected in 101 (47·4%) of 213 houses investigated. L. monocytogenes was present in 45 houses (21·1%). Listeria spp. occurred at all sampling sites. Dish-cloths (37%) and surface samples round the drain in the bathroom (27·2%) were most frequently contaminated. Highest numbers (c. 104 c.f.u./object) were found in dish-cloths and washing-up brushes. Lower levels (up to 103 c.f.u./object) were obtained from kitchen sinks, refrigerator vegetable compartment samples and tooth brushes. In total, 132 isolations of Listeria spp. were made from 871 samples. L. innocua (53%) and L. monocytogenes (41%) were the predominant species in the positive samples. Other Listeria spp. were found in only 6% of the positive samples.

The growth of Salmonella typhimurium in mice was studied by performing viable counts on pooled viscera and, in the case of fatally infected mice, by determining the relation between size of dose and mean death time. The results suggested that this system conformed to a general model which postulates (a) that the organisms causing the response (death in the present experiments) increase in vivo at a rate which is constant for all doses, and (b) that the response is certain to occur when their number reaches a constant figure. It follows that logarithm of dose (for doses > 1 ED50) should be linearly related to mean latent period (the interval between inoculation and response). A search of the literature showed that this relation was observed in many reported infective systems.

The interpretation of the observations on partially resistant mice (LD50 = 102.5−106 organisms) was not straightforward for the hypothesis of independent action (Meynell & Stocker, 1957) states that only a random fraction of the inoculum usually initiates each response. Multiplication of this fraction is considered to cause a reduction in host resistance so that other organisms surviving in vivo began to increase in numbers and to contribute to the fatal infection. The observations showed that this could well occur as (i) the counts on all mice, whether fatally infected or not, increased exponentially for 2–3 days after inoculation; (ii) the growth curves of fatally infected mice showed exponential increase of the whole inoculum as postulated; and (iii) the length of the death time was found to be determined by the growth of the whole inoculum and not by the predicted random fraction. The viable count per fatally infected mouse at the time of death was approximately constant at 108.75 organisms. There was no evidence that the course of the infection was influenced by organisms which may have been killed in vivo as the requirements of the model were satisfied by the observed behaviour of the viable organisms alone. The rate of increase of organisms in a fatally infected animal was found to be less, the greater the LD50 of the host; which suggested that the degree of host resistance was determined by successive random events occurring after inoculation.

The latent period/log dose curve provides a new test of the hypothesis of independent action, since this predicts that most responses to doses equal to or less than 1 ED50 are each initiated by only one inoculated organism. Hence, the latent period should become approximately constant at such doses. This was found to be so in the present experiments.

The authors are grateful to the Medical Research Council for meeting part of the expenses of this work by a grant to G. G. M. They also wish to acknowledge the help of Dr W. R. Bryan, Dr B. Mandel, Dr D. B. W. Reid and Dr G. T. Stewart who provided unpublished data.

A group of 269 pupils of the Harbour and Transport Training Institute in Rotterdam (group A), aged 13–20 years, and of 109 patients of the Dr Mr Willem van den Bergh Foundation at Noordwijk (group B), aged 11–21 years, were immunized with a whole virus vaccine containing 10, 20, or 40 μg HA of A/USSR/92/77 (H1N1) influenza virus. A booster vaccination was administered 6 weeks later with 20 μg HA of the same virus. Many of the participants had been immunized during the two preceding years with a whole virus vaccine containing A/New Jersey/8/76 (H1N1) (A/NJ/76) virus. The side-effects, mostly of a moderate nature, increased with the dose of virus in the vaccine. In group A side effects were least frequent in the vaccinees who had never received A/NJ/76 vaccine. A single dose of A/USSR/77 vaccine did not produce satisfactory levels of homologous antibodies. After booster immunization with 20 μg HA of A/USSR/77 virus participants showed a higher homologous antibody response in all vaccine-dose groups if they had not been immunized with A/NJ/76 virus in previous years. After primary and especially after booster immunization with A/USSR/77 virus, a very high response against A/NJ/76 virus and adequate levels of A/NJ/76 antibody were found in participants who had been immunized previously with A/NJ/76 virus. Those who had not been immunized with this virus previously showed no or a very low antibody response to A/NJ/76 virus.

An investigation was undertaken to determine the isolation rate and antibiotic resistance of Haemophilus influenzae from the nasopharynx of young children. The 996 subjects studied were up to 6 years of age. H. influenzae was isolated from 304 (30·5%) and strains of capsular type b from 11 (1·1%). Age, sibling status, season, respiratory infection and antibiotic therapy all influenced isolation rates. The overall prevalence of antibiotic resistance in the strains isolated was ampicillin 5·4% (all β-lactamase producers), cefaclor 0·3%, chloramphenicol 1·3%, erythromycin 38·2%, tetracycline 1·3%, trimethoprim 5·4% and sulphamethoxazole 0%. Ampicillin resistance was more common in type b than non-capsulated strains.

Poultry are possible sources of non-typhoidal Salmonella serovars which may cause foodborne human disease. We conducted a cross-sectional study to determine the prevalence of Salmonella serovars in egg-laying hens and broilers at the farm level and their susceptibility to antimicrobials commonly used in the poultry industry in Ghana. Sampling of faeces by a sock method (n = 75), dust (n = 75), feed (n = 10) and drinking water (n = 10) was performed at 75 commercial egg-laying and broiler farms in two regions of Ghana and skin neck (n = 30) at a local slaughterhouse from broilers representing different flocks. Salmonella was detected in 94/200 (47%) samples with an overall flock prevalence of 44·0%. Sixteen different serovars were identified with S. Kentucky (18·1%), S. Nima (12·8%), S. Muenster (10·6%), S. Enteritidis (10·6%) and S. Virchow (9·6 %) the most prevalent types. The predominant phage type of S. Enteritidis was PT1. All strains were susceptible to cefotaxime, ceftazidime and cefoxitin. Fifty-seven (60·6%) strains were resistant to one or more of the remaining nine antimicrobials tested by disk diffusion, of which 23 (40·4%) showed multi-resistance (resistance to ⩾3 classes of antimicrobials). Of the resistant strains (n = 57), the most significant were to nalidixic acid (89·5%), tetracycline (80·7%), ciprofloxacin (64·9%), sulfamethazole (42·1%), trimethoprim (29·8%) and ampicillin (26·3%). All S. Kentucky strains were resistant to more than two antimicrobials and shared common resistance to nalidixic acid or ciprofloxacin and tetracycline, often in combinations with other antimicrobials. PFGE analysis using XbaI of S. Kentucky demonstrated one dominant clone in the country. In conclusion, poultry produced in Ghana has a high prevalence of multi-resistant Salmonella and the common finding of clonal S. Kentucky in the Kumasi area warrants further investigations into the epidemiology of this serovar. There is an urgent need for surveillance and control programmes on Salmonella and use of antimicrobials in the Ghanaian poultry industry to protect the health of consumers.

Those who have studied the literature of Bacillus coli infections of the urinary tract, over a period of many years, must be fully conscious that the methods employed in such investigations have been on very similar lines. Bacilli isolated from the urine have been classified on the result of various cultural reactions of which the fermentation of cane sugar anddulcitol appears to occupy the most important position. Animals have been inoculated with various strains of urinary coli, while similar inoculation experiments have been made on animals before and after a mechanical injury to one or both kidneys had been produced.

An outbreak of Norwalk-like calicivirus (NLV) gastroenteritis occurred in a rehabilitation centre in southern Finland between December 1999 and February 2000. An epidemiological investigation was conducted to determine the source and extent of the outbreak. More than 300 guests and staff members became ill during the outbreak. No food or activity in the centre could be linked epidemiologically to illness. NLV genogroup II was detected by RT–PCR in stool samples of symptomatic guests and employees. All strains reacted similarly with the microplate hybridization probe panel and showed the same nucleotide sequence, indicating that they represented the same NLV strain. Food and water samples were negative for NLV, whereas NLV was detected in three environmental specimens. The strains from patients and environment were identical based on microplate hybridization probes, suggesting that environmental contamination may have been important for the spread of calicivirus and the protracted course of the outbreak.

The impact of improved water, sanitation, and hygiene (WASH) access on mitigating illness is well documented, although impact of school-based WASH on school-aged children has not been rigorously explored. We conducted a cluster-randomized trial in Nyanza Province, Kenya to assess the impact of a school-based WASH intervention on diarrhoeal disease in primary-school pupils. Two study populations were used: schools with a nearby dry season water source and those without. Pupils attending ‘water-available’ schools that received hygiene promotion and water treatment (HP&WT) and sanitation improvements showed no difference in period prevalence or duration of illness compared to pupils attending control schools. Those pupils in schools that received only the HP&WT showed similar results. Pupils in ‘water-scarce’ schools that received a water-supply improvement, HP&WT and sanitation showed a reduction in diarrhoea incidence and days of illness. Our study revealed mixed results on the impact of improvements to school WASH improvements on pupil diarrhoea.

The relationship between knowledge, risk perceptions, health belief towards seasonal influenza and vaccination and the vaccination behaviours of nurses was explored. Qualified nurses attending continuing professional education courses at a large London university between 18 April and 18 October 2010 were surveyed (522/672; response rate 77·7%). Of these, 82·6% worked in hospitals; 37·0% reported receiving seasonal influenza vaccination in the previous season and 44·9% reported never being vaccinated during the last 5 years. All respondents were categorized using two-step cluster analyses into never, occasionally, and continuously vaccinated groups. Nurses vaccinated the season before had higher scores of knowledge and risk perception compared to the unvaccinated (P<0·001). Nurses never vaccinated had the lowest scores of knowledge and risk perception compared to other groups (P<0·001). Nurses' seasonal influenza vaccination behaviours are complex. Knowledge and risk perception predict uptake of vaccination in nurses.

Recurrence of peste des petits ruminants (PPR) was diagnosed in the United Arabian Emirates in several wild ruminants confirmed by morphological, immunohistochemical, serological and molecular findings. Phylogenetic analysis revealed that the virus strain belongs to lineage IV, which is different to some previously isolated PPR strains from the Arabian Peninsula. This study shows that wild ruminants may play an important epidemiological role as virus source for domestic small ruminants.