Clostridium difficile may be an emerging community-associated pathogen but little is known about its sources of exposure. This study evaluated C. difficile contamination in households and colonization of pets. C. difficile was isolated from 44/836 (5·3%) sites in 26/84 (31%) households. Ribotype 027 was the most common (25%) environmental strain. C. difficile was isolated from 14/139 (10%) dogs. Living with an immunocompromised individual was associated with C. difficile colonization in dogs. All toxigenic strains identified in pets have been isolated from humans in Ontario. C. difficile was isolated concurrently from dogs and the environment in four households, but in all cases canine and environmental ribotypes were different. C. difficile was relatively common in households, suggesting that exposure to this pathogen may be a regular event. There was no evidence that dogs are a significant source of household C. difficile contamination.

In summer 2008, we investigated an outbreak of diarrhoeal illness in participants of a mountain-bike event in Wales (UK) which had been affected by heavy rain. We conducted a retrospective cohort study to investigate the cause using an internet-based questionnaire. Fifty-three percent of those contacted responded, and 161 (46·5%) out of the 347 responders, reported gastrointestinal symptoms. Median day of onset was 3 days following the event. Ten riders reported receiving a laboratory-confirmed diagnosis of Campylobacter. Multivariate logistic regression analysis identified the inadvertent ingestion of mud (OR 2·5, 95% CI 1·5–4·2, P<0·001) and eating ‘other’ food during the event (OR 2·1, 95% CI 1·2–3·6, P=0·01) as significant risk factors for illness. We concluded that the outbreak was caused by Campylobacter, spread to the riders by the inadvertent ingestion of mud which had been contaminated with sheep faeces from the rural course. Mountain-bike race organizers should consider microbiological hazards when risk-assessing potential race courses. The internet is an efficient tool for the investigation of outbreaks in computer-literate populations.

The scope of this reflection paper was to review the latest research on the risk of MRSA infection and colonization in animals. Attention focused on occurrence, risk factors for colonization and infection, and human contact hazard for livestock, horses, and companion animals. Whereas the clonal relationship between MRSA strains of CC398 is straightforward in livestock this is less obvious in horses. Small companion animals typically share MRSA strains that seem to exchange with a human reservoir. Management and therapeutic options have been suggested for livestock, horses, companion animals, as well as instructions on safety measures for persons in contact with animals. Conclusions were drawn with emphasis on future research activities, especially to confirm the apparent evolution of the organism and to demonstrate efficiency of control strategies.

A case-control study comprising 1315 Campylobacter jejuni cases, 121 Campylobacter coli cases and 3409 frequency-matched controls was conducted in The Netherlands in 2002–2003. Risk factors for both C. jejuni and C. coli enteritis were consumption of undercooked meat and barbecued meat, ownership of cats and use of proton pump inhibitors. Consumption of chicken was a predominant risk factor for C. jejuni enteritis, but many additional risk factors were identified. Unique risk factors for C. coli infections were consumption of game and tripe, and swimming. Contact with farm animals and persons with gastroenteritis were predominant risk factors for C. jejuni enteritis in young children (0–4 years). Important risk factors for the elderly (⩾60 years) were eating in a restaurant, use of proton pump inhibitors and having a chronic intestinal illness. Consumption of chicken in spring, steak tartare in autumn and winter and barbecued meat in rural areas showed strong associations with C. jejuni infections. This study illustrates that important differences in risk factors exist for different Campylobacter spp. and these may differ dependent on age, season or degree of urbanization.

The incidence of hospitalization for acute gastroenteritis (AGE) is a useful parameter to assess the utility of the new rotavirus vaccines in high-income countries. Children hospitalized for AGE were identified by searching hospital discharge data and the records of the microbiology laboratory of Hospital Donostia. Rotavirus antigen was investigated in 96·1% of the 1114 children aged 1 month to <5 years hospitalized for AGE in the study period. Nearly 40% were rotavirus positive (44·9% of the 798 children aged 1 month to <2 years), with G1[P8] being the predominant genotype. The mean annual incidence rate of hospitalization due to rotavirus AGE was 29·8 and 63·7 cases/10 000 inhabitants in the <5 and <2 years age groups, respectively, in 1996–1999, decreasing to 13·6 and 27·4 cases/10 000 inhabitants in <5 and <2 years age groups, respectively, in 2002–2005 (P<0·001). This decrease coincided with a significant increase in the consumption of oral rehydration solutions.

In recent years the control of low pathogenicity avian influenza (LPAI) viruses of the H5 and H7 subtypes has increasingly become a concern. We evaluated the measures (stamping out, controlled marketing, emergency and preventive vaccination, farm density reduction and restocking in homogenous areas) implemented to control the LPAI epidemics that occurred in Italy between 2000 and 2005, using a combination of spatial and space–time analyses and estimates of the basic reproduction ratio (R0). Clustering of infected farms decreased over the years, indicating the effectiveness of the control strategies implemented. Controlled marketing [relative risk (RR) 0·46, 95% confidence interval (CI) 0·27–0·80], emergency (RR 0·47, 95% CI 0·39–0·57) and preventive vaccination (RR 0·19, 95% CI 0·09–0·41) were the most effective measures, yet R0<1 was only for preventive vaccination. Our results are useful for identifying the most effective measures for reducing the risk of the spread of LPAI and optimizing the allocation of resources.

The apparent family clustering of avian influenza A/H5N1 has led several groups to postulate the existence of a host genetic influence on susceptibility to A/H5N1, yet the role of host factors on the risk of A/H5N1 disease has received remarkably little attention compared to the efforts focused on viral factors. We examined the epidemiological patterns of human A/H5N1 cases, their possible explanations, and the plausibility of a host genetic effect on susceptibility to A/H5N1 infection. The preponderance of familial clustering of cases and the relative lack of non-familial clusters, the occurrence of related cases separated by time and place, and the paucity of cases in some highly exposed groups such as poultry cullers, are consistent with a host genetic effect. Animal models support the biological plausibility of genetic susceptibility to A/H5N1. Although the evidence is circumstantial, host genetic factors are a parsimonious explanation for the unusual epidemiology of human A/H5N1 cases and warrant further investigation.

Human cases of Q fever appear to be common in Northern Ireland compared to the rest of the British Isles. The purpose of this study was to describe the seroepidemiology of Coxiella burnetii infection in cattle in Northern Ireland in terms of seroprevalence and determinants of infection. A total of 5182 animals (from a stratified systematic random sample of 273 herds) were tested with a commercial C. burnetii phase 2 IgG ELISA. A total of 6·2% of animals and 48·4% of herds tested positively. Results from a multilevel logistic regression model indicated that the odds of cattle being infected with Q fever increased with age, Friesian breed, being from large herds and from dairy herds. Large dairy herd animal prevalence was 12·5% compared to 2·1% for small beef herds. Preliminary seroprevalence in sheep (12·3%), goats (9·3%), pigs (0%) rats (9·7%) and mice (3·2%) using indirect immunofluorescence is reported.

The objective of this study was to estimate the sensitivity of three different sampling/testing methodologies for the detection of Salmonella Enteriditis in commercial egg-laying flocks relative to the within-flock prevalence. The following methods were compared on 21 farms: (1) The European Union (EU) baseline survey method (five faecal and two dust samples); (2) an in-house method that involved collecting 10 dust and 10 faecal samples into jars with buffered peptone water, and (3) a method involving single samples of pooled faeces and dust that has been adopted as a monitoring method for the National Control Programme across the EU (the NCP method). Testing of individual bird ovaries/oviduct and caeca was carried out on each flock, and the sensitivity of each sampling method was estimated relative to the within-flock prevalence using Bayesian methods. Results showed that the sensitivity of all the sampling methods increased as the within-flock prevalence increased, and that all were more efficient than individual bird sampling for detection of S. Enteriditis in commercial flocks. The in-house method was the most sensitive of the methods compared, with a 98% power to detect a 0·1% prevalence, and the NCP method the least sensitive, with a 93% power to detect a prevalence of 20%.

The daily progression of the 2006 (January–June) Nigerian avian influenza (AI H5N1) epidemic was assessed in relation to both spatial variables and the generation interval of the invading virus. Proximity to the highway network appeared to promote epidemic dispersal: from the first AI generation interval onwards >20% of all cases were located at <5 km from the nearest major road. Fifty-seven per cent of all cases were located ⩽31 km from three highway intersections. Findings suggest that the spatial features of emerging infections could be key in their control. When the spatial location of a transmission factor is well known, such as that of the highway network, and a substantial percentage of cases (e.g. >20%) are near that factor, early interventions focusing on transmission factors, such as road blocks that prevent poultry trade, may be more efficacious than interventions applied only to the susceptible population.

Giardiasis is a common waterborne gastrointestinal illness. In 2007, a community giardiasis outbreak occurred in New Hampshire, USA. We conducted a cohort study to identify risk factors for giardiasis, and stool and environmental samples were analysed. Consuming tap water was significantly associated with illness (risk ratio 4·7, 95% confidence interval 1·5–14·4). Drinking-water samples were coliform-contaminated and a suspect Giardia cyst was identified in a home water filter. One well was coliform-contaminated, and testing indicated that it was potentially under the influence of surface water. The well was located 12·5 m from a Giardia-contaminated brook, although the genotype differed from clinical specimens. Local water regulations require well placement at least 15 m from surface water. This outbreak, which caused illness in 31 persons, represents the largest community drinking-water-associated giardiasis outbreak in the USA in 10 years. Adherence to well placement regulations might have prevented this outbreak.

The annual incidence in 14 361 campylobacteriosis cases reported in Finland in 2002–2005 varied between 61 and 76/100 000 population. The mean incidence was highest (148/100 000) in the 25–29 years age group and lowest (range 21–24/100 000) in children aged 5–14 years and patients aged ⩾75 years. The number of domestic cases was low in winter and peaked in summer. A total of 622 strains isolated from domestic infections and 785 foreign travel-related strains were serotyped. Serotypes Pen 3 and Pen 37 had the strongest association with travel-related infections (96%, P<0·001), and Pen 6,7, Pen 12 and Pen 27 were significantly associated with domestic infections (>70% domestic within each serotype, P<0·001). Pen 2 and Pen 1,44 were less common in older than in younger patients. Of domestic strains, a higher proportion of Pen 2 strains was isolated in winter (18%) compared to the other serotypes (0–10%).

Dengue activity depends on fluctuations in Aedes populations which in turn are known to be influenced by climate factors including temperature, humidity and rainfall. It has been hypothesized that haze may reduce dengue transmission. Due to its geographical location Singapore suffers almost every year from hazes caused by wildfires from Indonesia. Such hazes have a significant impact on pollution indexes in Singapore. We set out to study the relationship of dengue activity and haze (measured as pollution standard index) in Singapore, using ARIMA models. We ran different univariate models, each encompassing a different lag period for the effects of haze and temperature (from lag 0 to lag 12 weeks). We analysed the data on a natural logarithmic scale to stabilize the variance and improve the estimation. No association between dengue activity and haze was found. Our findings do not lend support to the hypothesis that haze is associated with reduced dengue activity in Singapore.

The aim of this study was to analyse the spatio-temporal dynamics of Toxoplasma gondii infection in long-term monitoring of domestic cats (8–15 years) in three populations living in rural France. Overall seroprevalence was 52·7% (modified agglutination test ⩾1:40). Incidence was 0·26–0·39 seroconversions/cat per year, and the estimated rate of soil contamination by T. gondii oocysts ranged between 31 and 3600 oocysts/m2 per year, depending on the population. Incidence risk in cats was related to mean precipitation, explaining both the spatial and temporal variability in risk: local conditions explained differences between the three study sites and incidence risk increased during rainy years. This study brings rare quantitative information on the level of contamination of the environment by T. gondii oocysts, and suggests that the spatio-temporal distribution of incidence risk in cats may reflect both the influence of rain on prey populations and infectivity of T. gondii oocysts.

This study aimed to estimate the natural history and transmission parameters based on experimental viral shedding and symptom dynamics in order to understand the key epidemiological factors that characterize influenza (sub)type epidemics. A simple statistical algorithm was developed by combining a well-defined mathematical scheme of epidemiological determinants and experimental human influenza infection. Here we showed that (i) the observed viral shedding dynamics mapped successfully the estimated time-profile of infectiousness and (ii) the profile of asymptomatic probability was obtained based on observed temporal variation of symptom scores. Our derived estimates permitted evaluation of relationships between various model-derived and data-based estimations, allowing evaluation of trends proposed previously but not tested fully. As well as providing insights into the dynamics of viral shedding and symptom scores, a more profound understanding of influenza epidemiological parameters and determinants could enhance the viral kinetic studies of influenza during infection in the respiratory tracts of experimentally infected individuals.

Pinworm infection remains prevalent in children in many parts of the world. This study was designed to determine the prevalence of this infection in schoolchildren in Taiwan after the termination of the 15-year population-based control project in 2001. Our results showed that 2·4% of 118 190 children in 385 primary schools were found to have enterobiasis by two-consecutive-day adhesive cellophane perianal swabs. The prevalences were significantly different in the 25 counties/cities surveyed (0·6–6·6%). A significantly higher prevalence was found in boys (2·6%) than in girls (2·2%) and the prevalence decreased by grade from 3·8% in grade 1 to 1·0% in grade 6. In the primary schools, 9·1% had positive rates ⩾10%. In addition, pinworm infection was found to be significantly associated with the socioeconomic status, personal hygiene and sanitary conditions of the children. The results indicate that the overall prevalence of enterobiasis remains at a low level after the control programme was transferred to the local governments.

Traditionally, the routine artificial digestion test is applied to assess the presence of Trichinella larvae in pigs. However, this diagnostic method has a low sensitivity compared to serological tests. The results from artificial digestion tests in Switzerland were evaluated over a time period of 15 years to determine by when freedom from infection based on these data could be confirmed. Freedom was defined as a 95% probability that the prevalence of infection was below 0·0001%. Freedom was demonstrated after 12 years at the latest. A new risk-based surveillance approach was then developed based on serology. Risk-based surveillance was also assessed over 15 years, starting in 2010. It was shown that by using this design, the sample size could be reduced by at least a factor of 4 when compared with the traditional testing regimen, without lowering the level of confidence in the Trichinella-free status of the pig population.

Coagulase-negative staphylococci (CNS) are increasingly recognized to cause clinically significant infections, with S. epidermidis often cited as the third most common cause of nosocomial sepsis. Among CNS, there is a high prevalence of methicillin resistance associated with staphylococcal cassette chromosome (SCCmec) elements. Although identical SCCmec types can exist in S. aureus and CNS, some novel classes of SCCmec may be unique to CNS. Differences in the accuracy of identification of CNS species and use of non-standardized methods for the detection of methicillin resistance have led to confusing data in the literature. In addition to the review of SCCmec in CNS, in this paper we report a 2-year surveillance of methicillin-resistant CNS in a tertiary-care hospital in Guadalajara, Mexico.

Influenza can be a serious, sometimes deadly, disease, especially for people in high-risk groups such as the elderly and patients with underlying, severe disease. In this paper we estimated the influenza-related excess mortality in Norway for 1975–2004, comparing it with dominant virus types and estimates of the reproduction number. Analysis was done using Poisson regression, explaining the weekly all-cause mortality by rates of reported influenza-like illness, together with markers for seasonal and year-to-year variation. The estimated excess mortality was the difference between the observed and predicted mortality, removing the influenza contribution from the prediction. We estimated the overall influenza-related excess mortality as 910 deaths per season, or 2·08% of the overall deaths. Age-grouped analyses indicated that the major part of the excess mortality occurred in the ⩾65 years age group, but that there was also a significant contribution to mortality in the 0–4 years age group. Estimates of the reproduction number R, ranged from about 1 to 1·69.