Transmission of hepatitis C (HCV) in Pakistan is a continuing public health problem; 15 years ago it was linked to the practice of reusing therapeutic instruments in healthcare settings. We sought to examine current risk factors for HCV transmission in a hospital population in Karachi, Pakistan. We enrolled 300 laboratory-confirmed HCV-positive participants and 300 laboratory-confirmed HCV-negative participants from clinics at Indus Hospital. Independent and significant risk factors for both men and women were: receiving ⩾12 injections in the past year, blood transfusions, having had dental work performed, and delivery in hospital or transfusion for women. Interestingly, being of Mohajir origin or born in Sindh province were protective. Encouragingly, a strong protective effect was observed for those that reported bringing their own needle for injections (59%). The widespread reuse of therapeutic needles in healthcare settings in Karachi remains a major driver of the HCV epidemic.

Strain characteristics of 51 Shigella sonnei isolates obtained from children seeking medical care (MC) and 48 isolates recovered during a prospective diarrhoea birth cohort (BC) study were compared. Biochemical characterization and antibiotic susceptibility testing determined that all S. sonnei isolates were biotype g and multidrug-resistant. Plasmid profiling identified 15 closely related patterns and XbaI pulsed-field gel electrophoresis confirmed the high degree of genetic similarity between isolates. All S. sonnei isolates harboured ipaH and class II integrase genes and 84·3 and 80% of the MC and BC isolates, respectively carried the sen gene. Neither the class I integrase nor the set gene was detected. Our results indicate that S. sonnei isolates associated with severe diarrhoea were indistinguishable from those associated with mild diarrhoea. Additional genetic tests with greater discrimination might offer an opportunity to determine genetic differences within the globally disseminating biotype g clone.

In this study, we characterized 272 Shiga toxin-producing Escherichia coli (STEC) isolates from humans, food, and cattle in Belgium [O157 (n = 205), O26 (n = 31), O103 (n = 15), O111 (n = 10), O145 (n = 11)] for their virulence profile, whole genome variations and relationships on different genetic levels. Isolates of O157 displayed a wide variation of stx genotypes, heterogeneously distributed among pulsogroups (80% similarity), but with a concordance at the pulsosubgroup level (90% similarity). Of all serogroups evaluated, the presence of eae was conserved, whereas genes encoded on the large plasmid (ehx, espP, katP) occurred in variable combinations in O26, O103, and O145. The odds of having haemolytic uraemic syndrome was less for all genotypes stx2a, stx2c, stx1/stx2c, and stx1 compared to genotype stx2a/stx2c; and for patients aged >5 years compared to patients aged ⩽5 years. Based on the genetic typing and by using epidemiological data, we could confirm outbreak isolates and suggest epidemiological relationships between some sporadic cases. Undistinguishable pulsotypes or clones with minor genotypic variations were found in humans, food, and cattle in different years, which demonstrated the important role of cattle as a reservoir of STEC O157, and the circulation and persistence of pathogenic clones.

A total of 105 033 eggs were collected across Japan from June 2010 to January 2011 and tested for Salmonella Enteritidis to provide data for the risk profiling of S. Enteritidis in eggs by the Food Safety Commission of Japan. S. Enteritidis isolates were recovered from three samples (20 eggs/sample) and these samples were different in regard to sampling period, grading and packaging centre and farm. The prevalence of S. Enteritidis in commercial eggs in Japan is estimated at ∼0·003% which was a tenfold decrease in prevalence compared to similar surveillance in the mid 1990s. The decrease in the contamination in commercial eggs is considered a contributory factor in the decrease of foodborne diseases associated with S. Enteritidis in this period.

Associations between monthly counts of all laboratory-confirmed cases of salmonellosis in Arkhangelsk, northern Russia, from 1992 to 2008 and climatic variables with lags 0–2 were studied by three different models. We observed a linear association between the number of cases of salmonellosis and mean monthly temperature with a lag of 1 month across the whole range of temperatures. An increase of 1 °C was associated with a 2·04% [95% confidence interval (CI) 0·25–3·84], 1·84% (95% CI 0·06–3·63) and 2·32% (95% CI 0·38–4·27) increase in different models. Only one of the three models suggested an increase in the number of cases, by 0·24% (95% CI 0·02–0·46) with an increase in precipitation by 1 mm in the same month. Higher temperatures were associated with higher monthly counts of salmonellosis while the association with precipitation was less certain. The results may have implications for the future patterns of enteric infections in northern areas related to climate change.

Human brucellosis occurs when humans ingest or contact Brucella spp. from shedding animals or contaminated environments and food. In Georgia animal and human brucellosis is endemic, but the epidemiology has not been fully characterized. A case-control study was conducted in 2010 to identify risk factors for human brucellosis. Using multivariable logistic regression, the following risk factors were identified: animal-related work [odds ratio (OR) 77·8, 90% confidence interval (CI) 4·7–1278], non-animal-related work (OR 12·7, 90% CI 1·1–149), being unemployed or a pensioner (OR 13·1, 90% CI 1·7, 101), sheep ownership (OR 19·3, 90% CI 5·1–72·6), making dairy products (OR 12·4, 90% CI 1·4–113), living in eastern Georgia (Kakheti) (OR 278·1, 90% CI 9·5–8100), and being aged >44 years (OR 9·3, 90% CI 1·02–84·4). Education of at-risk groups about risk factors and control of disease in sheep may reduce the human disease risk. This is the first study of its kind in Georgia since the collapse of the Soviet Union.

No U.S. general population-based study has characterized the epidemiology and risk factors, including skin and soft tissue infection (SSTI), for healthcare-associated (HA) and community-associated (CA) methicillin-resistant Staphylococcus aureus (MRSA). We estimated the incidence of HA- and CA-MRSA and SSTI over a 9-year period using electronic health record data from the Geisinger Clinic in Pennsylvania. MRSA cases were frequency-matched to SSTI cases and controls in a nested case-control analysis. Logistic regression was used to assess risk factors, while accounting for antibiotic administration. We identified 1713 incident CA- and 1506 HA-MRSA cases and 78 216 SSTI cases. On average, from 2005 to 2009, the annual incidence of CA-MRSA increased by 34%, HA-MRSA by 7%, and SSTI by 4%. Age, season, community socioeconomic deprivation, obesity, smoking, previous SSTI, and antibiotic administration were identified as independent risk factors for CA-MRSA.

Due to the current epidemiological situation of pertussis, several countries have implemented vaccination strategies that include a booster dose for adolescents. Since there is still no evidence showing that the adolescent booster has a positive effect on the most vulnerable group represented by infants, it is difficult to universalize the recommendation to include such reinforcement. In this work we present an age-structured compartmental deterministic model that considers the outstanding epidemiological features of the disease in order to assess the impact of the booster dose at age 11 years (Tdap booster) to infants. To this end, we performed different parameterizations of the model that represent distinct possible epidemiological scenarios. The results obtained show that the inclusion of a single Tdap dose at age 11 years significantly reduces the incidence of the disease within this age group, but has a very low impact on the risk group (0–1 year). An effort to improve the coverage of the first dose would have a much greater impact on infants. These results hold in the 18 scenarios considered, which demonstrates the robustness of these conclusions.

The Belgian data (2003–2010) for the European Antimicrobial Resistance Surveillance Network (EARS-Net) showed a significant decreasing trend in the proportion of penicillin non-susceptible Streptococcus pneumoniae (9·4% to <1%) from blood and CSF isolates. We found that 75% of this decrease was explained by a change in Clinical and Laboratory Standards Institute (CLSI) breakpoints as the trend disappeared if only the new breakpoints were applied. Applying only European Committee on Antimicrobial Susceptibility Testing (EUCAST) breakpoints also resulted in a relatively stable proportion of penicillin non-susceptibility (average 5%), but this proportion was 7–13 times higher than with the new CLSI breakpoints. When the new CLSI breakpoints alone are used, fewer than 1% of bacteraemia isolates were penicillin non-susceptible during the entire period, but the proportion of non-susceptible meningitis isolates rose from 6·3% in 2003 to 15·9% between 2003 and 2010. Changing breakpoints should lead to retrospective analysis of historical data to minimize wrongly interpreting resistance trends.

A dairy herd (77 cows) from Rio de Janeiro, Brazil, with a history of tuberculosis infection was tested by a comparative cervical test (CCT). Seventeen cows were reactive and seven were inconclusive (swelling ⩾2·0 mm and ⩽3·9 mm, respectively). All of these 24 cows were slaughtered and necropsied; samples from lungs and lymph nodes were collected for multiplex polymerase chain reaction (PCR) and culturing. Infection was confirmed in 23/24 (95·8%) of the slaughtered animals (five by culturing, four by PCR, and 14 by both tests). All cows with inconclusive results at CCT were confirmed as infected. Although slaughter of inconclusive reactor cows is not mandatory in many countries, our study provided evidence to support the slaughter of these cows, at least during an outbreak.

This study was conducted to determine the seroprevalence of anti-Neospora caninum antibodies and to investigate the risk factors related to seroprevalence in dogs from urban and rural areas with distinct economic activities (milk and coffee production) in Minas Gerais state, Brazil. For this purpose, blood samples from 703 dogs were collected and questionnaires addressing epidemiological aspects were completed by dog-owners. The sera were analysed for anti-N. caninum antibodies by indirect fluorescent antibody tests (IFAT ⩾ 1:50). Association between epidemiological aspects and seropositivity in dogs was evaluated with multivariate logistic regression models. A total of 80 (11·4%) dogs tested positive for N. caninum. In the multivariate logistic regression models, dogs aged >4 years, dogs used as guard dogs, dogs that spontaneously hunt, and history of bovine abortion were found to be greater risk factors for canine N. caninum infection. When we considered only dogs from rural areas, an association with seroprevalence was seen for milk farms, dogs not fed with commercial food, dogs that hunt, and dogs used as guard dogs.

As a major foodborne pathogen, Campylobacter is frequently isolated from food sources of animal origin. In contrast, human Campylobacter illness is relatively rare, but has a considerable health burden due to acute enteric illness as well as severe sequelae. To study silent transmission, serum antibodies can be used as biomarkers to estimate seroconversion rates, as a proxy for infection pressure. This novel approach to serology shows that infections are much more common than disease, possibly because most infections remain asymptomatic. This study used antibody titres measured in serum samples collected from healthy subjects selected randomly in the general population from several countries in the European Union (EU). Estimates of seroconversion rates to Campylobacter were calculated for seven countries: Romania, Poland, Italy, France, Finland, Denmark and The Netherlands. Results indicate high infection pressures in all these countries, slightly increasing in Eastern EU countries. Of these countries, the differences in rates of notified illnesses are much greater, with low numbers in France and Poland, possibly indicating lower probability of detection due to differences in the notification systems, but in the latter case it cannot be excluded that more frequent exposure confers better protection due to acquired immunity.

A cohort study on a barbecue-associated Salmonella outbreak was conducted to describe the burden of disease and to identify the outbreak vehicle. Dose–response relationships were tested with Fisher's exact and Wilcoxon rank sum tests (alpha = 0·05). S. Enteritidis isolates were cultured and phage-typed. Information was available for 11 out of 14 individuals attending the barbecue; all were healthy young adults (median age 27 years). The attack rate was 100%. Three cases were hospitalized and two developed acute pancreatitis. The exposure common to all cases was a vegetable pasta salad that had been stored unrefrigerated for 23 h. Consuming higher doses was associated with longer median symptom duration (7 days vs. 4 days, P = 0·11). S. Enteritidis was found in the stools of nine barbecue guests. Phage type 8/7 was identified in the stools of the salad preparer and one barbecue guest. This outbreak shows that S. Enteritidis can cause serious infection in young healthy individuals without well-known risk factors.

Noroviruses are an important cause of acute gastroenteritis in humans. We incorporated new insights gained over the past decade in an updated estimate of the disease burden of (foodborne) norovirus illness in The Netherlands in 2009. The disease outcomes – non-consulting cases, visiting a general practitioner, hospitalization and mortality – and the foodborne proportion were derived from cohort studies, surveillance data and literature. Age-specific incidence estimates were applied to the population age distribution in The Netherlands in 2009. The general population incidence was 3800/100 000 (95% CI 2670–5460), including 0·4 fatal cases/100 000, resulting in 1622/100 000 (95% CI 966–2650) disability-adjusted life-years in a population of 16·5 million. The updated burden of norovirus is over twofold higher than previously estimated, due in particular to the new insights in case-fatality ratios. Results suggest that the burden of norovirus institutional outbreaks is relatively small compared to the burden of community-acquired norovirus infections.

Introduced brushtail possums (Trichosurus vulpecula) are wildlife maintenance hosts for Mycobacterium bovis in New Zealand, often living sympatrically with other potential hosts, including wild red deer (Cervus elaphus scoticus). Population control of possums has been predicted to eradicate tuberculosis (TB) from New Zealand wildlife; however, there is concern that long-lived M. bovis-infected deer could represent a ‘spillback’ risk for TB re-establishment (particularly when possum populations recover after cessation of intensive control). We constructed a time-, age- and sex-structured, deer/TB population generic model and simulated the outcomes of deer control on this potential spillback risk. Maintaining intensive possum control on a 5-year cycle, the predicted spillback risk period after TB eradication from possums is ∼7 years, while the probability of TB re-establishing in possums over that period is ∼6%. Additional targeted control of deer would reduce the risk period and probability of spillback; however, even with high population reductions (up to 80%) only modest decreases in risk and risk period would be achieved. We conclude that possum control alone remains the best strategy for achieving TB eradication from New Zealand habitats in which possums and wild deer are the main M. bovis hosts.

The overall incidence and serotype distribution of non-typhoid Salmonella (NTS) may vary between different geographical localities. To investigate possible regional differences and the effect of demographic factors, we studied 15 865 episodes of laboratory-confirmed NTS infection in Israel. Using Poisson models we found significant variation in the average annual incidence rate of NTS in 15 administrative sub-districts, which was inversely associated with the percent of rural residency (incidence rate ratio 0·75, 95% confidence interval 0·65–0·86, P < 0·001). Variation was also found in the relative incidence of the most prominent serotypes (Enteritidis, Virchow, Typhimurium, Hadar, Infantis), which was affected by rural residency, the percent of non-Jewish population in the sub-district, and the percent of population aged ⩾55 years in the sub-district. Rural residency had a major effect on the epidemiology of salmonellosis in Israel. Future research is required to understand whether decreased incidence in rural areas is an under-detection bias or reflects true differences in NTS illnesses.

To determine the burden and distribution of acute gastrointestinal illness (AGI) in the population, a cross-sectional, monthly face-to-face survey of 10 959 residents was conducted in Jiangsu province between July 2010 and June 2011. The adjusted monthly prevalence was 4·7% with 0·63 AGI episodes/person per year. The prevalence was the highest in children aged <5 years and lowest in persons aged ⩾65 years. A bimodal seasonal distribution was observed with peaks in summer and winter. Regional difference of AGI prevalence was substantial [lowest 0·5% in Taicang, highest 15·1% in Xinqu (Wuxi prefecture)]. Healthcare was sought by 38·4% of the ill respondents. The use of antibiotics was reported by 65·2% of the ill respondents and 38·9% took antidiarrhoeals. In the multivariable model, gender, education, season, sentinel site and travel were significant risk factors of being a case of AGI. These results highlight the substantial burden of AGI and the risk factors associated with AGI in Jiangsu province, China.

Escherichia coli, a prominent waterborne pathogen, causes a variety of gastrointestinal and extraintestinal infections that depend on virulence determinants. To monitor natural aquatic systems for virulence-associated genes of E. coli, multiplex PCR was used in a survey covering 46 major natural water bodies in Bangladesh. DNA was extracted directly from water samples as well as from pre-enriched and enriched cultures during three successive seasons and assessed for E. coli virulotype distribution. From the five virulotypes, genes from the enterotoxigenic (ETEC), enteropathogenic (EPEC), and enterohaemorrhagic (EHEC) virulotypes were detected consistently, but genes from the enteroinvasive (EIEC) and enteroaggregative (EAEC) virulotypes were traced only occasionally. ETEC was the most prevalent virulotype, followed by EPEC. However, EIEC and EAEC virulotypes could not be detected in winter or the rainy season, respectively. Specific regional distribution patterns of different E. coli virulotypes and their temporal fluctuations were identified. These observations may assist with assessing seasonal risk and identifying vulnerable areas of the country prone to E. coli-associated outbreaks.

Dogs can be infected by a wide range of Bartonella spp., but limited studies have been conducted in tropical urban and rural dog populations. We aimed to determine Bartonella antibody prevalence in 455 domestic dogs from four tropical countries and detect Bartonella DNA in a subset of these dogs. Bartonella antibodies were detected in 38 (8·3%) dogs, including 26 (10·1%) from Colombia, nine (7·6%) from Brazil, three (5·1%) from Sri Lanka and none from Vietnam. DNA extraction was performed for 26 (63%) of the 41 seropositive and 10 seronegative dogs. Four seropositive dogs were PCR positive, including two Colombian dogs, infected with B. rochalimae and B. vinsonii subsp. berkhoffii, and two Sri Lankan dogs harbouring sequences identical to strain HMD described in dogs from Italy and Greece. This is the first detection of Bartonella infection in dogs from Colombia and Sri Lanka and identification of Bartonella strain HMD from Asia.