This study was conducted to estimate the varicella morbidity and mortality rates per age group among the non-immune population in France. Morbidity and mortality data for the years 1990–9 were derived from nationwide databases and surveillance systems. An incidence/prevalence model was designed to quantify the non-immune population per age group. The incidence of varicella in the non-immune population peaks during childhood and again in the 25–35 years age group. For children aged 1–4 years, adults aged 25–34 years and those older than 65 years, the hospitalization rates are respectively 235, 1438 and 8154 per 100 000 cases, and the death rates are respectively 7, 104 and 5345 per million cases. Case fatality or case hospitalization rates were not evenly distributed among adults and increased dramatically with age.

We investigated the distribution of serotypes and patterns of drug resistance of 206 strains of salmonella isolated in southern Italy in the years 1998–2000 from raw food of animal origin, faeces of food animals and animal feed. To improve knowledge of mobile genetic elements carrying the resistance genes, some molecular features were also investigated within isolates resistant to three or more antibiotics. A high proportion of isolates, 52.2% and 37.7%, respectively, belonging to both Typhimurium and other serotypes of animal origin, proved to be multidrug resistant. The DT104 complex specific multidrug pattern of resistance was quite infrequent among isolates other than Typhimurium, but resistances to nalidixic acid and kanamycin were more frequent within these last ones (36.9% vs. 11.4% and 56.5% vs. 2.2%, respectively). Class I integrons were detected in isolates of Typhimurium and seven different serotypes. The relevance of food animal environment as a drug resistance reservoir and animal food as a potential resistance gene vehicle between the farm and human ecological niches is confirmed by our findings.

DNA sequencing of the vanC-2 gene was partially carried out on 10 isolates of Enterococcus casseliflavus obtained from 8 samples of imported chickens in Japan between July 1999 and June 2001 to evaluate the variation in the gene. Forty nucleotide substitutions in 36 codons were identified within 345 base pairs when compared with the vanC-2 sequence of the reference strain E. casseliflavus ATCC25788. Identical nucleotide substitutions were commonly found in the isolates recovered from chickens imported from both Brazil and China. Pulsed-field gel electrophoresis (PFGE) patterns of NotI-digested chromosomal DNA of these strains were distinguished by two, or more than six, band differences. These observations suggest that sequencing of the vanC-2 gene may be helpful for epidemiological investigation in combination with the PFGE analyses of the isolates, although particular genotypes are unlikely to be restricted to each of the countries that exported chickens.

Escherichia coli O157[ratio ]H7 infection of cows and calves in a naturally-infected beef cattle herd in Alberta, Canada, was investigated over 2 years, encompassing two calf production cycles. In both years of the study, E. coli O157[ratio ]H7 was isolated from the faeces of cows shortly after but not before parturition in late winter: 6/38 (16%) in 1996 and 13/50 (26%) in 1997. At <1 week post-partum, 13/52 (25%) calves born in 1997 were shedding the organism. Faecal shedding of E. coli O157[ratio ]H7 by cows and calves continued over the 7 weeks that they were in the calving pens, with the organism being isolated from the faeces of 2–18% of cows and 23–26% of calves during this period. Five weeks after they were moved onto a native grass pasture, all the calves and all but one cow in 1997 had ceased shedding the organism. When the calves were weaned in the fall, E. coli O157[ratio ]H7 was isolated from the faeces of 0–1.5% of the calves 1 week prior to weaning and from 6–14% of the calves within 2 weeks after weaning. Parturition, calving pens and weaning appear to be important factors in maintaining E. coli O157[ratio ]H7 infections in this beef cattle herd. Isolates from cows and calves during the immediate post-partum period were mostly of the same pulsed-field gel electrophoresis (PFGE) type of E. coli O157[ratio ]H7. Similarly, at weaning a common PFGE type of E. coli O157[ratio ]H7, which differed slightly from the post-partum PFGE type, was isolated from the calves. These typing data suggest a common source of infection for the animals as well as demonstrate clonal turnover of resident populations of this pathogen.

Varicella infections cause substantial morbidity and mortality in adolescents and adults. The primary infection, chickenpox, results in lifelong immunity to chickenpox. A seroprevalence study carried on adolescents 15–18 years of age attending schools in Lebanon showed 96·6% immunity to varicella. The positive predictive value for immunity to chickenpox based on history alone was 97·4%, whereas the negative predictive value was 4·5%. Coming from a bigger family was a statistically significant predictor of immunity to chickenpox. In a developing country like Lebanon the merits and limitations of implementing universal varicella vaccination is discussed in relation to seroprevalence and socioeconomic factors.

Epidemiol. Infect.127 (2001), 555–60

Escherichia coliO157: H7 infection of calves: infectious dose and direct contact transmission

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The occurrence of Shiga toxin-producing Escherichia coli (STEC) was studied on four cattle farms. STEC were detected in 29–82% of the cattle. STEC with additional EHEC markers were detected on all farms. The occurrence of the complete virulence marker pattern (stx1 and/or stx2, eae, EHEChlyA, katP, espP) was correlated with the presence of known STEC serotypes. STEC O26[ratio ]H11 and O165[ratio ]H25 with the complete pattern of virulence markers were the most prevalent. STEC O157 (H7/H-) STEC O103[ratio ]H2 and STEC O145[ratio ]H- were found sporadically. Five clonal subgroups of the STEC O26[ratio ]H11 isolates were identified by pulsed-field gel electrophoresis. STEC O26[ratio ]H11 were present in three groups of cattle. This serotype was detected in a single group over the entire fattening period. Most STEC O26[ratio ]H11 with the complete pattern of potential virulence markers were found in clinically healthy cattle. These animals may represent a risk factor for farmers and consumers.

Lepto Dri Dot is a new card agglutination test developed by the Dutch Royal Tropical Institute for the rapid diagnosis of leptospirosis. We evaluated the test in field conditions in The Andaman Islands. Patients suspected of leptospirosis who attended three primary health centres were included in the study. The test results were compared with blood culture or microscopic agglutination tests on paired serum samples; 74 of 124 patients were diagnosed as having leptospirosis based on these criteria. Lepto Dri Dot had a sensitivity of 67.6% (50/74) and a specificity of 66.0% (33/50) during week 1. During weeks 2–4 the values increased to 85.5% (47/55) and 80% (40/50) respectively. An IgM ELISA was also performed on the serum samples for comparison and this was marginally less sensitive, but more specific, during the first week of illness. The positivity rates for the Dri Dot test during days 2–3, 4–5 and 6–7 were 53.1% (17/32), 75.0% (18/24) and 83.3% (15/18), respectively. The corresponding values for ELISA were 28.1% (9/32), 54% (13/24) and 77.8% (14/18). Both Dri Dot and ELISA showed good agreement with the standard diagnostic criteria after the first week of illness (κ = 0.65 and 0.74, respectively). The overall concordance of the two tests was 89.5% (κ = 0.79). The test does not require special storage or sophisticated equipment and can be performed by relatively low skilled personnel.

In industrialized countries migrants remain a high-risk group for tuberculosis (TB). Multiple linear regression analysis was used to determine the ability of indicators of TB incidence in the country of birth to predict the incidence of TB among migrants in Australia during 1997. World Health Organization total case notifications, new smear-positive case notifications and the estimated incidence of TB by country of birth explained 55, 69 and 87% of the variance in TB incidence in Australia, respectively. Gross national income of the country of birth and unemployment level in Australia were also significant predictors of TB in migrant groups. Indicators of the incidence of TB in the country of birth are the most important group-level predictors of the rate of TB among migrants in Australia.

In order to determine the prevalence of campylobacter positive broiler flocks in Finland, every flock from all three major slaughterhouses was studied during the period from 1 May to 30 September 1999. Caecal samples were taken in the slaughterhouses from five birds per flock. A total of 1132 broiler flocks were tested and 33 (2.9%) of those were campylobacter positive. Thirty-one isolates were C. jejuni and two isolates were C. coli. Isolates were serotyped for heat-stable antigens (Penner) and genotyped with pulsed-field gel electrophoresis (PFGE). The most common serotypes were serotypes 6, 7, 12 and 4-complex. Together with SmaI and KpnI patterns there were 18 different PFGE genotypes. Simultaneous monitoring of chicken flocks and typing of the isolates produced data which can be used to study the epidemiology of campylobacters in chicken as well as their role in human infections.

One hundred and seven bovine isolates of penicillin and tetracycline resistant Staphylococcus aureus, recovered from 25 different dairy herds in various parts of Norway, were characterized using antimicrobial susceptibility testing, multilocus enzyme electrophoresis, ribotyping, plasmid analysis and serotyping of capsular polysaccharide. Forty-one isolates from one particular herd, 37 isolates from 5 herds that used a common pasture and milking parlour in summer and 21 isolates from 12 herds in 8 different counties belonged to the same strain. The remaining 8 isolates, which originated from herds in 5 different counties, were assigned to 6 different strains. Seven out of these 8 isolates had the same plasmid restriction profile. In conclusion, penicillin and tetracycline resistant S. aureus occurring in dairy herds in Norway mainly seems to represent one particular strain that has achieved widespread distribution or belong to one of several different strains carrying identical plasmids.

A total of 556 individuals in Agbalenyi Community of Oji-River local government area of Enugu State, Nigeria were studied using questionnaires, focus group discussions and key informant interviews to determine the socio-cultural factors affecting the transmission of onchocerciasis. The result revealed a low level of knowledge about the cause, prevention and complications of onchocerciasis. Respondents have developed a cultural system around the disease due to long exposure. The majority are aware of the disease which they recognize once their body starts itching or musculoskeletal pain develops but only 64·4, 34·0, 1·4 and 3·6%, respectively attributed chronic itching, nodules, bad vision and leopard skin to blackfly bite. Other perceived causes mentioned include ageing, the type of food eaten, farm work and ‘bad blood’. Only 0·8% knew diagnosis could be made through skin snips. Neither Oji-River nor any of the river systems were associated with any of the complications of onchocerciasis. Significant differences in most socio-demographic characteristics were associated with differences in the level of knowledge about the disease.

Between 1995 and 2000, a prospective survey was undertaken to investigate the levels of contamination of raw retail chickens (n=1127) with salmonella and campylobacter. The levels of contamination over the 6-year period were 11% (95% CI±6·5%) for salmonella, and 57% (95% CI±9·5%) for campylobacter. S. Bredeney (20%) and S. Enteritidis (18%) were the dominant serovars. Although salmonella contamination was higher than in an earlier survey we conducted (7%), since 1998 it has declined to 6%. Many S. Enteritidis isolates (43%) were associated with one large integrated poultry organization that appears to have successfully managed the contamination, and the serovar has not been isolated since 1998. Contamination ranged from 0 to 44% between different producers. There was no significant difference between producers contributing large and small numbers of samples, although some small producers had much poorer contamination rates than others. S. Bareilly, S. Bredeney, S. Enteritidis and S. Virchow showed associations with particular producers. Campylobacter contamination remains high. Contamination ranged from 47 to 81% between different producers. This study did not show a temporal association between contamination of chickens and human campylobacter infections, indicating that many cases of human campylobacteriosis, particularly during seasonal peaks, do not originate from chickens. Control measures that have reduced salmonella contamination have been largely ineffective against campylobacter and new interventions are needed. Most raw chickens are contaminated with these pathogens, and communicating the importance of minimizing this risk to caterers and the public is vital in reducing human infections.

Ten transmission trials with Actinobacillus pleuropneumoniae were carried out. The observed transmission was highly variable, which was surprising since the design of the trials was very similar. We investigated whether the variable transmission could be explained by variation in infectivity of A. pleuropneumoniae infected pigs. We looked for measurable characteristics, which could be indicative for infectious pigs or for the level of infectivity. The characteristic that appeared to be most indicative for a pig being infectious was an A. pleuropneumoniae positive tonsil at necropsy. The characteristic that was correlated to the level of infectivity was the number of A. pleuropneumoniae colonies isolated from the nasal swab, i.e. the probability for an infectious pig to infect a susceptible pig was tenfold higher on days where at least ten colonies were isolated. In this study it is shown that it is possible to measure the bacterial transmission of A. pleuropneumoniae under controlled circumstances if variation in infectivity is taken into account.

Demographic and epidemiological field data were used in a deterministic model to describe dog rabies transmission in Machakos District, Kenya and to predict the impact of potential vaccination strategies for its control. The basic reproduction number (R0) was estimated to be 2.44 (1.52–3.36, 95% confidence limits). There were three key model predictions. The first was that a threshold dog density (KT) of 4.5 dogs km−2 (3.8–5.2 dogs km−2, 95% confidence limits) was required to maintain transmission. The second was that the estimated annual vaccination rate of 24% failed to decrease incidence and actually increased the stability of transmission and may be counter-productive. Thirdly, to control rabies, it was predicted that 59% (34%–70%, 95% confidence limits) of dogs should be vaccinated at any one time. This requires approximately 70% coverage for annual but only 60% coverage for semi-annual vaccination campaigns. Community-level vaccination trials are needed to test these predictions.

Phylogenetic analyses of bartonella have suggested divergence between bartonellae that infect mammals native to the Old and New Worlds. We characterized bartonella isolated from Eastern grey squirrels (Sciurus carolinensis) in the United States and from grey and red squirrels (Sciurus vulgaris) in the United Kingdom by nucleotide sequence comparison (gltA and groEL). Isolates from grey squirrels in the United States and the United Kingdom were identical, and most similar to Bartonella vinsonii, a species associated with New World rodents. A single and novel bartonella genotype was obtained from all 12 red squirrel isolates. Although grey squirrels were first introduced into the United Kingdom over 125 years ago, they continue to be infected solely by the bartonella associated with grey squirrels native to the United States. These results illustrate that exotic species may be accompanied by the introduction and maintenance, over many generations, of their microparasites.

The street-vended food industry provides employment and cheap ready-to-eat meals to a large proportion of the population in developing countries like Mexico, yet little is known about its role in the transmission of food borne diseases (FBD). Because of its wide consumption, street-vended chili sauces in Mexico are potential vehicles of FBD. An observational study was performed in Mexico City collecting 43 street-vended chili sauces. These sauces were prepared under poor hygienic conditions of handling and selling. Consumers add 4–8 ml of chili sauce per taco, ingest 2–5 tacos per meal and on average, 50 consumers frequent a stall per day. Seventeen (40%) samples were faecally contaminated and 2(5%) sauces harboured sufficient enterotoxigenic Escherichia coli to cause disease. We estimate that the consumption of only one of these chili sauces could result in ETEC disease in at least 21000 consumers per year, making them important potential vehicles of FBD.

The spread of rabbit haemorrhagic disease (RHD) virus from quarantine on Wardang Island to mainland Australia in 1995 suggested that insects could be potential vectors. Field observations and laboratory experiments were conducted to address aspects of this hypothesis. Firstly, the variation in insect populations on the island during the field trials was examined. There was approximately a 1000-fold increase in the number of bushflies, Musca vetustissima, shortly before the spread of the virus. Secondly, M. vetustissima were tested in the laboratory as potential vectors of RHD virus, and it was demonstrated that disease could be transmitted between rabbits by flies. Finally, 13 of 16 insect samples, collected from Wardang Island and from several sites on the mainland following the spread of virus off the island, were positive for the presence of RHD virus by a specific polymerase chain reaction (PCR). Only one sample contained sufficient infectious virus to kill a susceptible rabbit. These data, combined with previously published information on fly biology, suggested that flies, particularly bushflies, may be involved in the transmission of RHD virus. Other possible routes of spread were not assessed in this study.

A number of pathogens cause chronic infection in survivors of acute disease and this is believed to be a common means of persistence, including for highly virulent agents. We present a model in which transmission from chronically infected hosts causes chronic infection in naive individuals, without causing acute disease – indeed ‘protecting’ against it. Thus the pathogen obtains the benefit of virulence (high transmission rate), but mitigates against the cost (high host mortality). Recent findings suggest that rabbit haemorrhagic disease virus (RHDV), a highly contagious and virulent pathogen, may also utilize this alternative, ‘avirulent’, mode of transmission. The model may resolve the paradox of how RHDV can be highly prevalent in some populations, in the absence of mortality. Differences in host demography determine whether avirulent transmission prevents large-scale mortality (as in most UK populations) or not. Other pathogens may exhibit similar behaviour and the implications for emerging diseases in general are discussed.