In August 2015, Public Health England detected an outbreak of Shiga toxin-producing Escherichia coli (STEC) serotype O157:H7 caused by contaminated salad leaves in a mixed leaf prepacked salad product from a national retailer. The implicated leaves were cultivated at five different farms and the zoonotic source of the outbreak strain was not determined. In March 2016, additional isolates from new cases were identified that shared a recent common ancestor with the outbreak strain. A case–case study involving the cases identified in 2016 revealed that ovine exposures were associated with illness (n = 16; AOR 8·24; 95% CI 1·55–39·74). By mapping the recent movement of sheep and lambs across the United Kingdom, epidemiological links were established between the cases reporting ovine exposures. Given the close phylogenetic relationship between the outbreak strain and the isolates from cases with ovine exposures, it is plausible that ovine faeces may have contaminated the salad leaves via untreated irrigation water or run-off from fields nearby. Timely and targeted veterinary and environmental sampling should be considered during foodborne outbreaks of STEC, particularly where ready to eat vegetables and salads are implicated.

The oncogenic potential of human papillomaviruses (HPV) is well known in the context of cervical carcinoma; however, their role in the development of oesophageal squamous cell carcinoma (OSCC) is less clear. We aimed to determine the extent of the association between HPV infection and OSCC. A comprehensive literature search found 132 studies addressing HPV and OSCC in human cases, and a meta-analysis was performed using a random-effects model. There was evidence of an increased risk of OSCC in patients with HPV infection [odds ratio (OR) 2·69, 95% confidence interval (CI) 2·05–3·54]. The prevalence of HPV in OSCC was found to be 24·8%. There was an increased risk associated with HPV-16 infection (OR 2·35, 95% CI 1·73–3·19). Subgroup analyses showed geographical variance, with Asia (OR 2·94, 95% CI 2·16–4·00), and particularly China (OR 2·85, 95% CI 2·05–3·96) being high-risk areas. Our results confirm an increase in HPV infection in OSCC cases.

In Norway, no published data on seroprevalence of hepatitis E virus (HEV) in humans and swine exists. Serum samples from blood donors, veterinarians, swine farm workers and swine were analysed by ELISA to estimate the seroprevalence of HEV in Norway and to investigate the association between direct contact with swine and HEV seroprevalence in humans. The seroprevalence of HEV IgG antibodies was 30% (24/79) in farm workers, 13% (21/163) in veterinarians, 14% (162/1200) in blood donors and 90% (137/153) in swine. Our results show a high seroprevalence of HEV in humans and swine in Norway. HEV seroprevalence in farm workers and blood donors increased with age, and veterinarians working with swine were twice as likely to be HEV seropositive compared to other veterinarians. High HEV seroprevalence in farm workers and veterinarians working with swine support previous reports suggesting swine as a reservoir for HEV infections in humans in Europe.

Resident and transient Escherichia coli strains from the colonic microflora of 13 Swedish schoolgirls were analysed for carriage of genes encoding a range of adhesins (P, type 1 and S fimbriae, Dr haemagglutinin and three varieties of the P fimbrial papG adhesin) and other virulence traits (K1 and K5 capsule, haemolysin and aerobactin) using multiplex PCR. Forty-four percent of the resident clones carried genes for P fimbriae, K1 or K5 capsule, and aerobactin, compared with only 3% of transient clones (P<0·0001). The P-fimbriated clones most often had the class II variety of the P-fimbrial adhesin gene papG and this adhesin was significantly associated with persistence of a strain. S fimbriae and type 1 fimbriae were equally common in resident and transient strains. The results indicate that not only P fimbriae, but also, certain capsules and the ability to produce the siderophore aerobactin might contribute to persistence of E. coli in the large intestine.

This study determined the occurrence of legionellae in private houses for which there were no available data on aquatic environments other than the water supply system. From June 2013 to November 2014, we collected 138 water and 90 swab samples from aquatic environments in 19 houses. Legionella DNA was detected via a loop-mediated isothermal amplification assay in 66 (47·8%) water and 17 (18·9%) swab samples. High Legionella DNA detection rates were observed in water samples from washing machines and aquariums. Legionella spp. was isolated from 9 (6·5%) water and 3 (3·3%) swab samples. Legionella pneumophila SG 1 was detected from the outlet water of a bathtub spout and a bath sponge. Use of amoebic co-culture effectively increased legionellae and Legionella DNA detection rates from all sample types. A logistic regression analysis revealed that the heterotrophic plate count was significantly related to Legionella contamination. Our findings indicate that there is a risk of legionellosis from exposure to Legionella spp. in a variety of aquatic environments in residential houses. Control measures for legionellae in houses should include frequent cleaning and disinfecting to reduce heterotrophic bacteria in water and, where possible, preventing aerosolization from aquatic environments.

Direct detection assays for Mycoplasma pneumoniae were established by PCR amplification of short sequences within the foot protein/adhesin (P1) gene and the 16S ribosomal RNA gene.

Specificity and sensitivity was excellent, no hybridization was observed with M. genitalium and other human Mycoplasma species. In nose and throat washings from subjects with respiratory infection a pattern of high counts (c.f.u./ml) of M. pneumoniae (deduced from the amount of amplified PCR product), and a positive antigen capture assay, was found in 83% of subjects with serological evidence of current infection with M. pneumoniae.

A small proportion of subjects with serological patterns suggesting infection in the more distant past had positive PCR assays. This was considered to represent either persistence of the organism from a previous infection or perhaps transient carriage during a reinfection, without substantial change in antibody response.

PCR-based assay of M. pneumoniae offers a powerful, rapid, and sensitive substitute for culture of the mycoplasma. Antigen capture, while less sensitive than PCR, offers the advantage that it is more often positive with samples from current infection and requires less stringent laboratory organization to contain false positive results. We conclude however that the laboratory diagnosis of a chosen clinical episode should not rest on the PCR or Ag-EIA assays alone, but must also include antibody assays to confirm whether infection is current or represents persistence from past exposure.

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

A cross-sectional study was conducted in Mapastepec, a rural community of the southern state of Chiapas, Mexico. The overall prevalence of leptospirosis infection in 1169 subjects was 37·7% [95% confidence intervals (95% CI) 34·9–40·5]. The main risk factors related to leptospirosis infection were flooding, mainly if subjects had a skin cut or abrasion [odds ratio (OR) 4·2; 95% CI 3·1–5·7], having domestic animals, either dogs and/or cats (OR 1·3; 95% CI 0·96–1·8) or cattle and/or pigs (OR 1·9; 95% CI 1·3–2·7), contact with animal excreta with no protection and with a skin cut or abrasion (OR 2·3; 95% CI 1·1–4·6). Those subjects with a dengue infection in the previous year had also an excess risk (OR 1·4; 95% CI 0·9–2·0). Mapastepec is a previously unknown area with high endemicity. Specific preventive measures should be adopted to prevent any contact with infected animals, and animal immunization should also be implemented. There is need of an epidemiological surveillance system to allow proper diagnosis.

Three unrelated severe infections with Streptococcus zooepidemicus occurred in England in 1985. The first patient developed septic arthritis, which has not been recorded before with this organism. The second died with septicaemia, pneumonia and post-streptococcal glomerulonephritis, the only record so far of nephritis following sporadic S. zooepidemicus infection and of nephritis and systemic sepsis in the same patient. The third patient experienced septicaemia during pregnancy but recovered without complications. A likely animal source of infection was found in only one case.

We evaluated the risk factors for childhood pneumonia with particular reference to indoor air-pollution associated with solid fuel use for cooking (e.g. coal, wood, dung), using a case-control study in a children's hospital in Calcutta. Cases were 127 children aged 2–35 months of either sex admitted with pneumonia and controls were 135 children attending their immunization clinic. Solid fuel use (odds ratio = 3.97, CI = 2.00–7.88), history of asthma in the child (OR = 5.49, CI = 2.37–12.74), poor economic status indicator (OR = 4.95, CI = 2.38 to 10.28), keeping large animals (OR = 6.03, CI = 1.13–32.27) were associated with high risk of pneumonia after adjusting for confounding (logistic regression analysis). Nearly 80% of people in India use such smoke producing fuel and the population attributable risk would be very high. This finding has important health policy implications. Furthermore, history of asthma is a useful prognostic indicator for early action for prevention of severe pneumonia.

The physiological reactions of two subjects were investigated in air at a temperature of 70–100° F., and of 40–96 per cent. relative humidity. The experiments lasted 3 hours, and one of the subjects performed mechanical work (step climbing) at the rate of 14,000 kg. m. per hour.

The pulse rate was about 10 beats greater in dry air than in moist air of the same wet-bulb temperature. The winter observations agreed well with the effective temperature scale, but did not agree with the wet bulb, the dry-bulb or the kata-thermometer scales.

Acclimatisation effects showed themselves in experiments made at a dry-bulb temperature of 87° F. or more, but only very slightly in those made at 81° or less. Acclimatisation was fairly well marked in the summer, the pulse rate being 5 to 10 beats less than in the winter, and no longer agreeing with the effective temperature scale.

The body temperature corresponded with the pulse rate, for it was 0·3–0·6° F. higher in dry air than in moist air of the same wet-bulb temperature, and was 0·15° lower in summer than in winter. The winter observations agreed well with the effective temperature scale.

The skin temperature of the face was found to depend on the dry-bulb temperature of the air, but that of the trunk showed no agreement with any of the scales. In moist air it was 1° F. lower than that of the face, and in dry air, 6° lower, owing to the cooling effect of increased sweating.

The gross mechanical efficiency fell off slightly at temperatures above 70 or 75° F. It was affected by the dry-bulb temperature of the air as well as the wet bulb, but not to the extent indicated by the effective temperature scale.

The weight of moisture lost by sweating corresponded well with the effective temperature scale. It increased gradually in consecutive experiments made in dry air, and diminished in those made in moist air.

The degree of fatigue experienced in dry air was considerably greater than in moist air of the same wet-bulb temperature, and it corresponded with the effective temperature scale.

Acknowledgments. We wish, to express our indebtedness to the authorities at the London School of Hygiene and Tropical Medicine, and especially to Dr G. P. Crowden, for the facilities offered to us in our work.

In mice and in monkeys, ‘selective’ elimination of Enterobacteriaceae species from the digestive tract of animals with a sensitive flora was accomplished by oral treatment with nalidixic acid (1 mg./g. body weight in mice and 0·4 mg./g. body weight in monkeys). During treatment, the concentration of enterococci (and also of Candida albicans in the monkey) remained unaltered. This indicates that the fraction of the anaerobic microflora which is responsible for the colonization resistance of the digestive tract is not affected by the treatment. An important consequence seems to be, that elimination of yeast and fungi with fungistatic drugs can be started at the same time as elimination of Enterobacteriaceae is attempted.

In our previous studies on the spread of bacterial infection among mice, the resistance of the host has not been especially investigated; although the importance of this factor has been repeatedly referred to in discussing the experimental results obtained.

Twelve herds of dairy cows were examined by rectal swabbing for the presence of Campylobacter jejuni. Ten herds were positive with the incidence of colonized animals ranging from 10 to 72% of those tested. With the exception of the two negative herds where mains water only was consumed, all animals drank from rivers or streams when grazing. There was no relationship between total and coliform counts and the presence of C.jejuni in raw milk. However, milk from one farm that consistently gave positive results had significantly higher Escherichia coli counts than other samples.

In an outbreak of small round structured virus (SRSV) gastroenteritis at an international AIDS conference 67 people were ill with diarrhoea or vomiting, one requiring admission to hospital. Epidemiological investigations demonstrated that the vehicle of infection was food prepared by a foodhandler who was recovering from a mild gastrointestinal illness. The food most strongly associated with illness, coronation chicken, was prepared by the food handler on the second day after symptoms ceased.

The investigation confirms the view that foodhandlers may contaminate food with SRSV after cessation of symptoms and should remain off work until at least 48 h after recovery.

Avian rotaviruses were isolated from feral pigeon faeces treated with trypsin using roller tube cultures of mammalian cells. Two pigeon strains, designated as strains PO-8 and PO-13, produced a marked cytopathic effect (CPE), small intracytoplasmic inclusion bodies and high titres of infectious particles in infected MA-104 and MDBK cell lines without cell adaptation and roller drum apparatus. The pigeon rotaviruses shared a common group specific antigen with the Lincoln strain of bovine rotavirus by indirect immunofluorescence, but differed from both the Lincoln strain and the Wa strain of human rotavirus in neutralization tests.

The RNA segment profile of this virus on polyacrylamide gel electrophoresis differed from that of group A mammalian rotaviruses. The results of a serological survey suggested that antibody to pigeon rotaviruses was widespread in avian species in Japan.

Cryptosporidium is an important cause of diarrhoeal disease worldwide and, as several recent waterborne outbreaks have shown, poses a significant threat to public health in Ireland. We identified the Cryptosporidium spp. in 199 positive human stool samples by PCR–RFLP of the 18S rRNA and COWP gene loci. Subspecies were identified in 104 samples by sequence analysis of the 60 kDa glycoprotein (gp60) gene fragment. Overall C. parvum was identified in 80%, and C. hominis in 20% of cases. No other Cryptosporidium spp. were detected. C. parvum was by far the most common species in the rural, more sparsely populated west of Ireland and exhibited a pronounced spring peak coincident with a peak in the national cryptosporidiosis incidence rate. Our data indicated a trend towards higher proportions of C. hominis in older age groups. Ninety-nine per cent of all subtyped C. parvum isolates belonged to allele family IIa, of which allele IIaA18G3R1 was by far the most common (63%). According to a recent study by Thompson and colleagues [Parasitology Research (2007), 100, 619–624] this allele is also the most common in Irish cattle. Subtyping of the C. hominis isolates indicated that they belonged to a geographically widely distributed allele (IbA10G2) known to have caused several water- and foodborne outbreaks around the world. The predominance of C. parvum, its geographic and seasonal distribution and the IIaA18G3R1 subtype underlines the importance of zoonotic Cryptosporidium transmission in Ireland.

The weekly number of dengue cases in Peru, South America, stratified by province for the period 1994–2006 were analysed in conjunction with associated demographic, geographic and climatological data. Estimates of the reproduction number, moderately correlated with population size (Spearman ρ=0·28, P=0·03), had a median of 1·76 (IQR 0·83–4·46). The distributions of dengue attack rates and epidemic durations follow power-law (Pareto) distributions (coefficient of determination >85%, P<0·004). Spatial heterogeneity of attack rates was highest in coastal areas followed by mountain and jungle areas. Our findings suggest a hierarchy of transmission events during the large 2000–2001 epidemic from large to small population areas when serotypes DEN-3 and DEN-4 were first identified (Spearman ρ=−0·43, P=0·03). The need for spatial and temporal dengue epidemic data with a high degree of resolution not only increases our understanding of the dynamics of dengue but will also generate new hypotheses and provide a platform for testing innovative control policies.

By building reconstruction models for a case of gastroenteritis in the general population moving through different steps of the surveillance pyramid we estimated that millions of illnesses occur annually in the European population, leading to thousands of hospitalizations. We used data on the healthcare system in seven European Union member states in relation to pathogen characteristics that influence healthcare seeking. Data on healthcare usage were obtained by harmonized cross-sectional surveys. The degree of under-diagnosis and underreporting varied by pathogen and country. Overall, underreporting and under-diagnosis were estimated to be lowest for Germany and Sweden, followed by Denmark, The Netherlands, UK, Italy and Poland. Across all countries, the incidence rate was highest for Campylobacter spp. and Salmonella spp. Incidence estimates resulting from the pyramid reconstruction approach are adjusted for biases due to different surveillance systems and are therefore a better basis for international comparisons than reported data.

Results are presented from a number of epidemiological studies using enzyme immunoassays (EIA) based on the purified anthrax toxin antigens, protective antigen, lethal factor and oedema factor. Studies on sera from a group of 62 human anthrax patients in Turkey and from cattle in Britain following two unrelated outbreaks of anthrax show that EIA using protective antigen can be a useful diagnostic aid and will detect subclinical infections in appropriate circumstances. A serological survey on wildlife in the Etosha National Park, Namibia, where anthrax is endemic, showed that naturally acquired anthrax-specific antibodies are rare in herbivores but common in carnivores; in carnivores, titres appear to reflect the prevalence of anthrax in their ranges. Problems, as yet unresolved, were encountered in studies on sera from pigs following an outbreak of anthrax on a farm in Wales.

Clinical details, including treatment, of the human and one of the bovine outbreaks are summarized and discussed in relation to the serological findings.