Surveys carried out between 1990 and 2000 indicated that the incidence of STEC O157-associated gastroenteritis in The Netherlands was 1250 cases/year (median), of which 180 visited a general practitioner, 40 are reported and 0·6 are fatal, mainly in the elderly. There are approximately 20 cases of STEC O157-associated haemolytic–uraemic syndrome (HUS) per year, mainly in children. There are 2·5 HUS patients per year who develop end-stage renal disease (ESRD). There are an estimated 2 HUS-related and 0·5 ESRD-related fatalities per year. The mean disease burden associated with STEC O157 in the Dutch population is 116 (90% confidence interval 85–160) Disability Adjusted Life Years (DALYs) per year. Mortality due to HUS (58 DALYs), and ESRD (21 DALYs) and dialysis due to ESRD (21 DALYs) constitute the main determinants of disease burden. Sensitivity analysis indicates that uncertainty associated with model assumptions did not have a major effect on these estimates.

To clarify the epidemiological relationship between cattle and human infections of Shiga toxin-producing Escherichia coli (STEC), we studied the duration and magnitude of the excretion of STEC O157 and STEC O26 with rectal faeces from naturally infected cattle at a breeding farm in the Tohoku area of Japan, using microbiological methods. The prevalence of STEC O157 was 3·5% (11/324), whereas that of STEC O26 was 7·9% (14/178). Faecal shedding of STEC O157 persisted for <1 week to 10 weeks, whereas STEC O26 persisted from <1 week to <3 weeks. The magnitude of faecal shedding (per 10 g) ranged from 4 to >110000 c.f.u. for STEC O157 and from 3 to 2400 c.f.u. for STEC O26. All isolates of both STEC serotypes contained the stx1 or stx2 genes. Pulsed-field electrophoretic analysis of both STEC serotypes identified predominantly STEC O157 type III and STEC O26 type I in isolates, suggesting that a single STEC strain may be mutated in the intestinal tract of calves. These results indicate that STEC O157 is secreted for longer periods and in higher numbers than STEC O26 from healthy calves with natural infections, suggesting that STEC O157 may have more opportunities than STEC O26 to induce human disease.

Although the great majority of antibiotics are prescribed outside hospitals, little is known about the prevalence and determinants of antibiotic resistance in the group of outpatients. Nasal swabs were taken from 627 consecutive patients aged 40 years or above attending general practitioners in Southern Germany. Staphylococcus aureus was cultured and minimal inhibitory concentrations to various antibiotics were tested. Nasal swabs of 152 patients were positive for S. aureus. Prevalence of resistance was 68·3, 8·3 and 0·7% for penicillin G, erythromycin, and oxacillin respectively. Antibiotic use within the last month was associated with erythromycin resistance [adjusted odds ratio (OR) 7·4; 95% confidence interval (CI) 1·0–53]. Besides a high prevalence of resistance to penicillinase-instable antibiotics we found only one (0·7%) methicillin-resistant S. aureus. Recent antibiotic use was associated with increased resistance to erythromycin.

Serum samples from 446 Italian blood donors between 18 and 65 years of age were analysed for the presence of IgG against parvovirus B19 capsid proteins VP1 and VP2 including conformational and linear epitopes. The overall prevalence of IgG against parvovirus B19 capsid proteins VP1 and VP2 against at least one antigen type was 79·1%. No significant difference was found between men and women. In the 18–27 years age group, 77·0% of the population had experienced infection with the virus, reaching 88·5% in the 48–57 years age group. The overall prevalence of IgG was 78·0% against conformational VP1+VP2 antigens, 74·9% against conformational VP2, 70·9% against linear VP1 and 23·3% against linear VP2 in the analysis of the IgG response against different conformational and linear epitopes of VP1 and VP2. Although IgG against conformational VP1+VP2, conformational VP2 and linear VP1 was present in more than 60% of subjects in all age groups, IgG against VP2 linear antigens was present in only 32% of subjects in the 18–27 years age group and then decreased to 20·5% in the 28–37 years age group. A different trend was noted when IgG positivity against linear and conformational epitopes was analysed separately in men and women. A significant increase was found in seroprevalence of IgG against VP2 conformational antigens with increasing age in males and a significant decrease in seroprevalence of IgG against VP2 linear antigens in women with increasing age.

Although reports of isolation of methicillin-resistant Staphylococcus aureus (MRSA) from patients admitted from the community have increased, few studies have investigated colonization of healthy subjects. This study aimed to determine community levels of MRSA in Hong Kong. Nasal swabs from a cross section of young adults and family units were cultured for MRSA. Antibiotic sensitivities and risk factors for carriage were determined and clonal relationships were investigated by pulsed-field gel electrophoresis (PFGE). Overall carriage was low (1·4%), and associated with health-care exposures (OR 13·56, 95% CI 1·11–165·21). Subjects working in health care yielded multi-resistant MRSA strains, but isolates from non-hospital-exposed subjects were methicillin-resistant only. Strains indistinguishable by PFGE were carried by subjects working together, and some spread to other contacts was observed. MRSA colonization in the community is rare in Hong Kong and is largely associated with working in health care. Community-acquired staphylococcal infections may be treated with agents effective against methicillin-sensitive strains.

The antimicrobial susceptibility of isolates of Salmonella enterica serotypes Typhimurium, Enteritidis, and Infantis isolated from humans, foodstuffs and farm animals in Italy between 1999 and 2001 was examined. All the isolates were susceptible to cefotaxime and ciprofloxacin, but high rates of resistance were observed for several other drugs, especially for S. Typhimurium. The rates of resistance and multiresistance were generally higher among animal and food isolates than in human strains; conversely, no significant difference was observed between animal and food isolates. Among S. Typhimurium, multiresistance was more common in bovine, poultry and rabbit strains than in swine isolates, and was rare in strains from pigeon. Resistance to trimethoprim–sulphamethoxazole was mainly found in isolates of swine and human origin. This study confirms the role of livestock as a reservoir of drug-resistant Salmonella spp. and underlines the need for integrated surveillance systems of antibiotic resistance that consider isolates not only from human disease but also from the animal reservoirs and the food vehicles.

Fifty-four isolates of Salmonella enterica subsp. diarizonae (IIIb) in Norway, Sweden, England, the United States, France and Australia were characterized by pulsed-field gel electrophoresis (PFGE). This study focuses on serovar 61:k:1,5,(7) [S. IIIb 61:k:1,5,(7)] isolated from sheep. Digestion of the bacterial DNA with restriction enzyme XbaI yielded 15 distinct PFGE profiles comprising 12–16 fragments in the range 48·5–630·5 kbp. Four different profiles were identified in Norwegian sheep isolates and a single profile in Swedish isolates. The spatial and temporal distribution of profiles is discussed.

Using a self-paired observational study, the association between therapeutic oxytetracycline use and the prevalence of virulence genes in commensal Escherichia coli (E. coli) from cattle was examined. Faeces were collected from 39 yearling bulls prior to and after treatment with oxytetracycline and from 44 untreated animals. Between samplings all animals received in-feed chlortetracycline for 16 days. Five E. coli were isolated from each sample and tested by a polymerase chain reaction (PCR) capable of detecting all verotoxin (vt) genes. Positive isolates were further tested with a multiplex PCR to detect vt1, vt2, eaeA and hlyA. For vt, 23 animals were positive at both samplings, 26 negative at both samplings, 22 negative animals became positive and 12 positive animals became negative. Sixty-eight per cent of the discordant pairs changed from vt-negative to vt-positive (95% CI 48–80) suggesting pressure toward becoming vt-positive perhaps due to the transfer of genes due to mixing of cattle in the months between samplings or an effect of chlortetracycline.

Drug-resistant tuberculosis can be transmitted (primary) or develop during the course of treatment (secondary). We investigated risk factors for each type of resistance. We compared all patients in England and Wales with isoniazid- and multidrug-resistant tuberculosis in two time-periods (1993–1994 and 1998–2000) with patients with fully sensitive tuberculosis, examining separately patients without and with previous tuberculosis (a proxy for primary and secondary drug-resistant tuberculosis). Patients with previous tuberculosis smear positivity and arrival in the United Kingdom <5 years were strongly associated with multidrug resistance and isoniazid resistance. In patients with no previous tuberculosis HIV infection, residence in London and foreign birth were risk factors for multidrug resistance, and non-white ethnicity, residence in London and HIV infection for isoniazid resistance. Risk factors for each type of resistance differ. Elevated risks associated with London residence, HIV positivity, and ethnicity were mainly seen in those without previous tuberculosis (presumed transmission).

Leptospirosis is endemic in the Andaman Islands, often occurring as outbreaks during the post-monsoon period. Pulmonary involvement is common and associated with high morbidity and mortality. During the investigation of an outbreak in North Andaman in 1996 an isolate was recovered from the blood of a patient with fever, headache, body aches and haemoptysis with respiratory distress as presenting symptoms. The isolate was characterized using the cross-agglutination absorption test (CAAT) and monoclonal antibodies (mAbs). The isolate showed typical morphology and characteristic motility of the genus Leptospira. Growth was inhibited at 13 °C and in the presence of 8-azaguanine. The isolate could not be identified with grouping sera representing 25 serogroups, CAAT and mAbs. A new serovar of a new serogroup is proposed. Genetic characterization using polymerase chain reaction (PCR) followed by sequencing of the PCR product and randomly amplified polymorphic DNA fingerprinting (RAPD) showed that the isolate was genetically similar to L. interrogans sensu stricto.

To identify risk factors for sporadic Salmonella Typhimurium definitive phage-type 104 (DT104) and non-DT104 diarrhoeal illness in Canada, we conducted a matched case-control study between 1999 and 2000. Cases were matched 1[ratio ]1 on age and province of residence. Multivariate analysis suggested that recent antibiotic use [odds ratio (OR) 5·2, 95% confidence interval (CI) 1·8–15·3], living on a livestock farm (OR 4·9, 95% CI 1·9–18·9), and recent travel outside Canada (OR 4·1, 95% CI 1·2–13·8) are independent risk factors for DT104 illness. Similar analyses suggested that recent travel outside North America is a sizable risk factor for non-DT104 illness (OR 66·8, 95% CI 6·7–665·3). No food exposure was a risk factor in either analysis. Educating health-care providers and the public about appropriate antibiotic use and antimicrobial resistance is important. Appropriate administration of antibiotics to livestock, particularly cattle, and hygienic measures such as handwashing after contact with farm animals may reduce risk. Travel represents an important and probably underestimated risk factor for sporadic illness with S. Typhimurium. Improved national surveillance and detailed investigation of travel-related illness are required.

In a previous risk factor study in Jakarta we identified purchasing street food as an independent risk factor for paratyphoid. Eating from restaurants, however, was not associated with disease. To explain these findings we compared 128 street food-vendors with 74 food handlers from restaurants in a cross-sectional study in the same study area. Poor hand-washing hygiene and direct hand contact with foods, male sex and low educational level were independent characteristics of street vendors in a logistic regression analysis. Faecal contamination of drinking water (in 65% of samples), dishwater (in 91%) and ice cubes (in 100%) was frequent. Directly transmittable pathogens including S. typhi (n=1) and non-typhoidal Salmonella spp. (n=6) were isolated in faecal samples in 13 (7%) vendors; the groups did not differ, however, in contamination rates of drinking water and Salmonella isolation rates in stools. Poor hygiene of street vendors compared to restaurant vendors, in combination with faecal carriage of enteric pathogens including S. typhi, may help explain the association found between purchasing street food and foodborne illness, in particular Salmonella infections. Public health interventions to reduce transmission of foodborne illness should focus on general hygienic measures in street food trade, i.e. hand washing with soap, adequate food-handling hygiene, and frequent renewal of dishwater.

Salmonella Typhimurium DT1 is endemic to Finland and has caused human outbreaks since the 1960s. Domestic DT1 isolates (n=235) from 1972 to 1999 from human cases, animals and other sources, as well as foreign DT1 isolates from human cases (n=20) were analysed by molecular methods. Pulsed-field gel electrophoresis (PFGE) yielded 38 XbaI profiles. Of these, XbaI profile 10 was seen in 49% (125/255) of the isolates. Twelve IS200 profiles were obtained; the most common IS200 profile D was seen in 64% (33/52) of the isolates. Two clusters were formed by compilation of the XbaI–, BlnI– and SpeI–PFGE and IS200 profiles and possession of the serovar-specific virulence plasmid. The major cluster contained eight IS200 profiles, including IS200 profile D and XbaI profile 10, and had no virulence plasmid, and can be regarded as typical of the endemic Typhimurium DT1 infection.

The epidemiological features and clinical manifestations of adult cases of brucellosis admitted to the Department of Infectious Diseases, Babol Medical University, Iran from 1997 to 2002 were investigated. Of 469 cases, 267 (56·9%) were males. The mean age of cases was 36·9±15 years. Most (60·8%) were from rural areas. Two thirds of cases (306, 66·3%) presented during spring or summer. Fresh cheese (22·4%), animal husbandry (11·3%), laboratory worker (8·1%) and veterinary profession (1·5%) were the main risk factors. Forty-five families (9·6%) had two cases. Sweating, fever, and arthralgia were the most frequent clinical symptoms. Complications were documented in 105 males (39·5%) and 41 females (20·3%, P=0·0001). Peripheral arthritis was seen in 24 (9%) males and 19 (9·4%) females, with knees and hips being the most common sites of infection. Sacroiliitis and spondylitis were seen in 28 (6%) and 32 (6·8%) cases respectively with spondylitis more common in males (P=0·023). Epididymo-orchitis was seen in 29 (10·9%) males. There were three cases each of endocarditis (0·6%) and neurological complications (0·6%). Most patients with brucellosis did not have any of the known risk factors for brucellosis. Thus consumption of unsafe dairy products could be the main route of infection. The disease manifested with a diversity of clinical manifestations and complications. Complications were more frequent in males than females.

A Salmonella Enteritidis (SE) outbreak in Japan was investigated with an observational study, analytical epidemiology and bacteriological examination (including phage typing). The outbreak occurred among 96 schoolchildren, and was caused by SE phage type 1. The outbreak source was dessert buns served at a school lunch (RR 42·55, 95% CI 5·93–305·11, P<0·001). The buns were probably cross-contaminated from eggs from a factory with a history of SE-contaminated products. The incubation period was longer than usual (3–16 days, median 8 days). A low contaminating dose may account for the long incubation period and low attack rate. Outbreak detection was hampered by the absence of routine Salmonella surveillance in Japan. The investigation was complicated by concurrent illnesses from other SE phage types. It was successful, in part, because adequate food samples were available for microbiological testing.

This article describes the spatial and temporal distribution of verotoxin-producing Escherichia coli among humans (EHEC) and cattle (VTEC) in Sweden, in order to evaluate relationships between the incidence of EHEC in humans, prevalence of VTEC O157 in livestock and agricultural structure by an ecological study. The spatial patterns of the distribution of human infections were described and compared with spatial patterns of occurrence in cattle, using a Geographic Information System (GIS). The findings implicate a concentration of human infection and cattle prevalence in the southwest of Sweden. The use of probability mapping confirmed unusual patterns of infection rates. The comparison of human and cattle infection indicated a spatial and statistical association. The correlation between variables of the agricultural structure and human EHEC incidence was high, indicating a significant statistical association of cattle and farm density with human infection. The explained variation of a multiple linear regression model was 0·56.

High overall vaccination levels sometimes hide pockets of poor coverage. We adopted a meta-population framework to model local aggregation of populations, and used this to investigate the effects of vaccination heterogeneity. A recent survey of antibody levels in a community with low vaccination levels in The Netherlands enabled us to assess the relative importance of local and long-range infective contacts, and thus identify feasible levels of aggregation in the meta-population model. In the aggregated model, we found that heterogeneity in vaccination coverage can lead to a much increased rate of infection among unvaccinated individuals, with a simultaneous drop in the average age at infection.

This study investigated host-related factors that influence intestinal colonization by Shiga-toxigenic E. coli (STEC). A quantitative colonization assay was developed to comparatively measure attachment of STEC to bovine colonic tissues maintained in vitro. No differences were determined in colonization susceptibility between tissues derived from weaning calves and adult cattle, or for tissues from cattle fed grain and forage-based rations. Substrate conditions designed to represent various intra-enteric environments were tested for their effect on STEC/mucosal interaction. Under conditions corresponding to a well-fed ruminant (high volatile fatty acid and lactate concentrations, low pH), significantly less STEC colonized the mucosal surface of colonic biopsies. These results may help explain why fasted, poorly or intermittently fed cattle and pre-ruminant calves excrete STEC to a greater degree. Studies on the ecology of STEC within the ruminant gut help identify mechanisms to reduce their threat to public health.

The present study investigates, at farm level, the effect of the time-span between sampling and the last time a particular antimicrobial growth promoter (AGP) was included in the feed on the probability of selecting an AGP-resistant Enterococcus faecium isolate from a broiler flock. The probability that a randomly selected E. faecium isolate was resistant to avilamycin, erythromycin or virginiamycin was 0·91, 0·92 and 0·84, respectively if the isolate originated from a broiler flock fed either avilamycin- or virginiamycin-supplemented feed. As the time-span between sampling and the last AGP consumption increased, the probability of isolating an E. faecium isolate resistant to a particular AGP decreased (probability <0·2 within 3–5 years after last exposure to AGPs). The decrease in probability over time showed little farm-to-farm variation. The number of times a particular AGP was given to previous flocks reared in the same house had no effect on the probability of isolating a resistant isolate.

An epidemiological and molecular investigation of a cutaneous suppurative infection with Staphylococcus aureus in a dairy farmer, occurring concurrently with an outbreak of clinical mastitis in his herd, was carried out. A common aetiology for the diseases in the farmer and his cows was established by combining clinical evidence with a molecular genomic analysis of the bacterial isolates using pulsed field gel electrophoresis of DNA macro-restriction fragments. This case indicates the possibility of the emergence and circulation of anthropozoonotic clones of S. aureus in dairy herds. It also provides further evidence of the severe impact of infection with highly virulent clones on dairy lactating cattle.