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.

This is the first large-scale study to investigate the seroprevalence of varicella zoster (VZV) in the general population of England and Wales. The study focused on those aged 1–20 years, that age group in whom most infections occur. Prevalence rose rapidly with age, with 53% of children showing evidence of prior infection by the age of 5 years and most young adults having experienced infection. In addition to using a fixed cut-off recommended by the manufacturer, a mixture modelling technique was also used to define the proportion of the population seropositive in each age group. This was shown to be a more accurate approach to categorizing data from an epidemiological perspective.

Foodborne outbreaks of cryptosporidiosis are uncommon. In Denmark human cases are generally infrequently diagnosed. In 2005 an outbreak of diarrhoea affected company employees near Copenhagen. In all 99 employees were reported ill; 13 were positive for Cryptosporidium hominis infection. Two analytical epidemiological studies were performed; an initial case-control study followed by a cohort study using an electronic questionnaire. Disease was associated with eating from the canteen salad bar on one, possibly two, specific weekdays [relative risk 4·1, 95% confidence interval (CI) 2·1–8·3]. Three separate salad bar ingredients were found to be likely sources: peeled whole carrots served in a bowl of water, grated carrots, and red peppers (in multivariate analysis, whole carrots: OR 2·1, 95% CI 1·1–4·0; grated carrots: OR 2·1, 95% CI 1·2–3·9; peppers: OR 3·3, 95% CI 1·7–6·6). We speculate that a person excreting the parasite may have contaminated the salad buffet.

The prevalence of antibody to the viruses of bovine virus diarrhoea (BVD), bovine herpes virus type1 (BHV1), rift valley fever (RVF), bovine ephemeral fever (BEF) and bluetongue (BT) and to Leptospira sp. was determined in wildlife populations in Zimbabwe. Evidence of infection with BVD virus was found in 14 of the 16 species examined but was greatest in eland Taurotragus oryx, nyala Tragelaphus angasi and bushbuck Tragelaphus scriptus. Persistent infection with BVD virus was found in 1 of 303 antibody-free eland but not in the smaller sample of 102 antibody-free buffalo Syncerus caffer. Antibody to BHV1 was widespread, being found in 10 of 16 species with the highest prevalence being in buffalo and eland. Antibody to RVF was most prevalent in black rhino Diceros bicornis and white rhino Ceratotherium simum, buffalo and waterbuck Kobus ellipsiprymnus. Both BEF and BT were widespread in all the species examined. Evidence of infection with Leptospira sp. was found in 7 species. Infections were due to up to 3 of 8 different serovars.

We examined the spatial distribution pattern and meteorological drivers of dengue fever (DF) in Guangdong Province, China. Annual incidence of DF was calculated for each county between 2005 and 2011 and the geographical distribution pattern of DF was examined using Moran's I statistic and excess risk maps. A time-stratified case-crossover study was used to investigate the short-term relationship between DF and meteorological factors and the Southern Oscillation Index (SOI). High-epidemic DF areas were restricted to the Pearl River Delta region and the Han River Delta region, Moran's I of DF distribution was significant from 2005 to 2006 and from 2009 to 2011. Daily vapour pressure, mean and minimum temperatures were associated with increased DF risk. Maximum temperature and SOI were negatively associated with DF transmission. The risk of DF was non-randomly distributed in the counties in Guangdong Province. Meteorological factors could be important predictors of DF transmission.

A micro-epidemic of hantavirus infections occurred in Lower Bavaria, South-East Germany, starting in April 2004. While only three cases were registered from 2001 to 2003, a dramatically increased number of clinically apparent human hantavirus infections (n=38) was observed in 2004, plus seven additional cases by June 2005. To determine the reservoir responsible for the infections, a total of 43 rodents were trapped in Lower Bavaria. Serological and genetic investigations revealed that Puumala virus (PUUV) is dominant in the local population of bank voles. Partial PUUV S segment nucleotide sequences originating from bank voles at four different trapping sites in Lower Bavaria showed a low divergence (up to 3·1%). This is contrasted by a nucleotide sequence divergence of 14–16% to PUUV strains detected in Belgium, France, Slovakia or North-Western Germany. PUUV sequences from bank voles in Lower Bavaria represent a new PUUV subtype which seems to be responsible for the observed increase of human hantavirus infections in 2004–2005.

From July 1985 to March 1987, the occurrence of motile Aeromonas sp. in stool, food and environmental specimens was investigated to assess their pathogenic significance and to determine sources and routes of infection. A total of 9366 stool specimens were examined; Aeromonas was isolated from 11.1% of diarrhoeal stools and 2.2% of normal stools (P 0.001). Aeromonas counts in food specimens, which included minced beef, pork and chicken, seafood and various vegetables and their products, were unexpectedly high suggesting that infection might be food–borne rather than water–borne. About 70% of the isolates from meat products were A. hydrophila and A. sobria, while A. Caviae was the most common in sea–fish, vegetables and their products. Most A. hydrophila and A. sobria strains produced haemolysin, but haemagglutinin was found more frequently in A. Sobria.

During 1986 and 1987, faecal samples from patients with haemorrhagie colitis (HC) or haemolytic-uraemic syndrome (HUS) were examined for evidence of infection by verotoxin-producing Escherichia coli (VTEC). During the 2-year period VTEC infections were found in 31 (78%) of 40 patients initially presenting with HC, and in 5 (63%) of 8 patients initially presenting with HUS, VTEC were found in only 2 (0·9%) of 229 age and sex matched control patients with acute non-bloody diarrhoea. All but one VTEC belonged to E. coli serogroup O 157. During 1987 this serogroup was isolated from 2 (1%) of 207 samples of faeces taken from cattle arriving at a Sheffield abattoir, indicating a possible source of these infections for man. We are unaware of previous reports of isolation of this organism from cattle in England.

A community-based seroepidemiological survey of Addis Ababa, Ethiopia was conducted in 1994 to inform on the transmission dynamics and control of hepatitis B virus (HBV) infection. Venous blood from 4736 individuals under 50 years of age from 1262 households, selected using stratified cluster-sampling, was screened for HBV markers using commercial ELISAs. HBsAg prevalence was 7% (95% CI 6–8), higher in males (9%; 7–10) than females (5%; 4–6). HBeAg prevalence in HBsAg positives was 23% (18–29), and less than 1% of women of childbearing age were HBeAg positive. Overall HBV seroprevalence (any marker), rose steadily with age to over 70% in 40–49 year olds, indicating significant childhood and adult transmission. Estimated instantaneous incidence was 3–4/100 susceptibles/year, higher in males than females in 0–4 year olds, and peaking in early childhood and young adults. The age at which 50% had evidence of infection was around 20 years, and the herd immunity threshold is approximated at 63–77%. Addis Ababa is of intermediate-high HBV endemicity, with negligible perinatal transmission. Our main findings are the identification of a significant difference between males and females in the age-acquisition of HBV infection, and marked differences between age groups in HBV incidence rates. These results should target future research studies of underlying risk factors. Furthermore, we generate a crude estimate of the level of coverage of HBV vaccine that would be required to eliminate the virus from the study population.

Foxes harbouring E. multilocularis represent an important source for human infection with this parasite which causes alveolar echinococcosis. To minimize the risk of human infection, a control study was conducted to reduce the prevalence of E. multilocularis-infection in foxes in an focal endemic area of 5000 km2. Foxes were given access to baits containing 50 mg praziquantel. Twenty baits per km2 were distributed by airplane during 14 campaigns. The effects of control measures were monitored by parasitological examination of 9387 foxes shot before and during the control trial. A distinct reduction of the prevalence of E. multilocularis was observed for both, the initially endemic area and the low-endemic periphery. The effect was more pronounced in adult than in juvenile foxes. Under control conditions, the risk area decreased in size. However, an eradication of the parasite was not reached with the chosen strategy.

When examined under similar conditions in the laboratory, the two strains of myxoma virus used to initiate the Australian and European epizootics, and three somewhat attenuated strains recovered in the field in Australia and France, were found to produce lesions containing approximately the same amount of virus, and were transmitted by mosquitoes with approximately equal efficiency. The laboratory variant neuromyxoma multiplied poorly in the skin and was very rarely transmitted by mosquitoes.

The survival potential of different virus strains in the field is correlated with the length of time during which rabbits infected with different strains present to biting mosquitoes lesions containing high concentrations of virus. Sickness of the infected rabbit, and extensive viruliferous skin lesions, will increase its suitability as a source of virus for mosquitoes. These considerations explain the dominance of slightly attenuated strains of myxoma virus in the field in Australia.

Species of mosquitoes, when tested under standard conditions in the laboratory, differ in their efficiency as vectors of myxomatosis. These differences may be related to differences in the method of feeding, and to structural differences in the mouthparts.

Engorgement on an immune rabbit after probing through myxomatous skin lesions had no greater effect on the subsequent ability of mosquitoes to transmit myxomatosis than a similar blood feed on a normal rabbit.

Nine serial mosquito-bite passages of the standard laboratory strain of virus, each involving one week in the rabbit and two weeks in the mosquito, had no effect on its pathogenic behaviour.

Nine different arboviruses are known to be transmitted by, or associated with, mosquitoes in Europe, and several (West Nile, Sindbis and Tahyna viruses) are reported to cause outbreaks of human disease. Although there have been no reported human cases in Great Britain (GB), there have been no published in-depth serological surveys for evidence of human infection. This paper investigates the ecological and entomological factors that could influence or restrict transmission of these viruses in GB, suggesting that in addition to West Nile virus, Sindbis and Tahyna viruses could exist in enzootic cycles, and that certain ecological factors could facilitate transmission to humans. However, the level of transmission is likely to be lower than in endemic foci elsewhere in Europe due to key ecological differences related to spatial and temporal dynamics of putative mosquito vectors and presence of key reservoir hosts. Knowledge of the potential GB-specific disease ecology can aid assessments of risk from mosquito-borne arboviruses.

Campylobacter is the most common bacterial cause of gastroenteritis in England and Wales, with 45 000 cases reported annually. Campylobacter incidence is highly seasonal; the consistent peak in late spring suggests a role for meteorological factors in the epidemiology of this organism. We investigated the relationship between ambient temperature and Campylobacter enteritis using time-series analysis to study short-term associations between temperature and number of Campylobacter reports adjusted for longer-term trend and seasonal patterns. We found a linear relationship between mean weekly temperature and reported Campylobacter enteritis, with a 1°C rise corresponding to a 5% increase in the number of reports up to a threshold of 14°C. There was no relationship outside this temperature range. Our findings provide evidence that ambient temperature influences Campylobacter incidence, and suggest that its effect is likely to be indirect, acting through other intermediate pathways.

Estimates of the number of hospitalizations attributable to specific pathogens are required to predict the potential impact of vaccination. All hospital admissions for lower respiratory tract infection (LRI) in children <5 years in England in 1995–8 were reviewed. Most admissions (76.8%) were not associated with specific organisms. Seasonality in pathogens that cause bronchiolitis and pneumonia was used to predict the proportion of cases with unspecified aetiology attributable to different organisms using multiple linear regression. Of 12298 admissions for LRI, 17.5% were due to RSV infection. An estimated 74.8% (95% CI, 72.0–77.7%) of ‘unspecified bronchiolitis’ admissions and 16.3% (95% CI, 13.7–18.8%) of ‘unspecified pneumonia’ admissions were RSV related. The total mean annual incidence of hospital admissions attributable to RSV is 28.3/1000 children <1 year of age, and 1.3/1000 children 1–4 years old. The greater burden of RSV infection than indicated through discharge data is revealed through applying simple statistical methods.

We confirm the finding of Behnke, et al. (1935) that air at 8·6 atm. pressure has a somewhat intoxicating effect on human beings, and that this effect is due to nitrogen. The nitrogen effect reaches its maximum after about 3 min. There was no reduction of manual dexterity in the test used by us, but a considerable effect on performance of arithmetic, and on most practical activities. At 10 atm. these effects were somewhat enhanced, and manual dexterity was lowered in some cases. When helium or hydrogen was substituted for nitrogen there was no intoxication.

3–4% of carbon dioxide at atmospheric pressure caused no deterioration in manual or arithmetical skill, and in the two subjects tested, 6% of carbon dioxide caused no deterioration.

When air containing about 0·4% of carbon dioxide, and therefore with a partial pressure of about 4%, was breathed at 10 atm., there was a marked deterioration in manual dexterity, and a good deal of confusion. When breathing carbon dioxide at partial pressures of 6·6–9·7% at 10. atm., eight subjects lost consciousness in 1–5 min., but some could tolerate partial pressures of over 8% for 5 min. or more. With half an hour's exposure to a partial pressure of 6–7% of carbon dioxide, one subject lost consciousness after 7 min. at 10 atm. pressure, and another nearly did so.

We consider that the percentage of carbon dioxide in air at 10 atm. pressure should be kept below 0·3%. Exposure to high partial pressures of carbon dioxide at 10 atm. does not increase the liability to ‘bends’ or other symptoms due to rapid decompression.

Immersion in water below 40° F. did not enhance the effects of high-pressure air, or of carbon dioxide at atmospheric pressure, but somewhat enhanced those of high pressure and carbon dioxide together.

In certain breathing apparatus the resistance became so great at 10 atm. as to be intolerable.

Few subjects experienced serious trouble during compression, or during or after decompression. But one developed a unilateral pneumothorax.

Isolated reports of brucellosis among family members have been documented. The aim of this study is to determine if active serological screening of the households' members of acute brucellosis cases will detect additional unrecognized cases. From May 2000 to October 2001, patients with acute brucellosis were enrolled and their household members were serologically screened for brucellosis using the Standard Agglutination Test (SAT). Fifty-five index cases with acute brucellosis and 404 household members were enrolled. The majority of index cases (48%) were young adults, and 79% were illiterate. Ownership of animals and ingestion of unpasteurized raw milk were reported by 45 and 75% of the index cases respectively. Of the 55 families screened, 23 (42%) had two family members or more with serological evidence of brucellosis and 32 (58%) had only the index case. Households of [ges ]5 members and a history of raw-milk ingestion by family members were risk factors associated with the seropositives (P<0·05). Of the 404 household members screened, 53 (13%) were seropositive; of these 39 (74%) were symptomatic, and 9 (35%) had brucella bacteraemia. Symptomatic seropositives tended to have bacteraemia and higher brucella antibody titres compared to asymptomatic seropositives (P[les ]0·05). Screening family members of an index case of acute brucellosis will detect additional cases.

We conducted a study to determine the incidence of haemolytic uraemic syndrome (HUS) in children in France and to assess the role of Shiga-toxin-producing Escherichia coli (STEC) infection in the aetiology of HUS. In collaboration with the Société de Néphrologie Pédiatrique we undertook a retrospective review of all cases of HUS hospitalized from January 1993 to March 1995 and a 1-year prospective study (April 1995–March 1996) of epidemiological and microbiological features of cases of HUS. The polymerase chain reaction (PCR) procedure was used to detect stx, eae, e-hlyA genes directly from case stool samples. Serum samples from cases were examined for antibodies to lipopolysaccharide (LPS) of 26 major STEC serogroups. Two hundred and eighty-six cases were reported. The average incidence per year was 0·7/105 children < 15 years and 1·8/105 children < 5 years. During the prospective study, 122/130 cases were examined for evidence of STEC infection using PCR and/or serological assays and 105 (86%) had evidence of STEC infection. Serum antibodies to E. coli O157 LPS were detected in 79 (67%) cases tested. In conclusion, this study showed that STEC infection is an important cause of HUS in children in France, with a high proportion related to the O157 serogroup.

The epidemiological, clinical and virological features of 1220 children with acute bronchiolitis admitted to the Prince of Wales Hospital, Hong Kong, from 1985 to 1988 are reported. They accounted for 6·6% of total paediatric admissions and provided a case incidence of bronchiolitis requiring admission to hospital of approximately 21 per 1000 children 0–24 months of age.

The clinical course and outcome was in general benign. The average hospital stay was 5 days and there were no deaths. Ten per cent of patients were repeatedly admitted to hospital with recurrent wheezing after discharge. Two infants developed bronchiolitis obliterans.

Respiratory syncytial virus (RSV) was shown by direct immunofluorescence, virus culture and serology to be the commonest cause of acute bronchiolitis in Hong Kong. Other aetiological agents included parainfluenza and influenza viruses, adenoviruses, and Mycoplasma pneumoniae.

In contrast to western countries, a seasonal variation of bronchiolitis was found with a peak incidence in the summer months. The significance of these observations is discussed.

A simple method for preparing radial haemolysis gels for rubella antibody screening is described. In use it gave clear zones of haemolysis when a standard serum was tested at dilutions down to 5·6 i.u./ml rubella antibody. In five lab oratories 8404 sera were screened by the method and the results were read by comparing zones of haemolysis with that of a standard serum diluted to contain 15 i.u./ml antibody. A zone ⋝ 15 i.u./ml, indicating immunity, was given by 7433 (88·4%) of the sera. No zone indicating susceptibility was seen with 748 (8·9%) sera. Small zones, < 15 i.u./ml standard, were given by 189 (2·2%) sera, and in only 34 cases (0·4%) did non-specific haemolysis interfere with the test readings. Further testing of the radial haemolysis negative and low positive sera by the haemagglutination inhibition test gave rise to some discrepant results which are discussed.