We describe an Escherichia coli O157[ratio ]H7 outbreak associated with a fresh water lake at a county park. Campers were surveyed for diarrhoeal illness within 10 days of their visit, and a case-control study of day visitors was conducted. A confirmed case was a symptomatic person with a stool culture positive for E. coli O157[ratio ]H7 and a probable case was a person with bloody diarrhoea. Clinical isolates of E. coli O157 were subtyped by pulsed field gel electrophoresis (PFGE). In the camper survey, 12 (38%) of 32 swimmers had a diarrhoeal illness (relative risk [RR]=12·4; 95% confidence interval [RR]=1·7–89·7). For the case-control study, the 12 cases were more likely than controls to have purposefully ingested lake water (odds ratio [OR]=6·9, 95% CI=0·9–55·8). The PFGE patterns of six clinical isolates were indistinguishable. This report further demonstrates that contaminated fresh-water lakes can be the source of community outbreaks of E. coli O157[ratio ]H7.

Thirty-seven out of 48 people on a coach excursion to northern France developed gastrointestinal symptoms within 4 days of the trip. Twenty-six had stool samples positive for Escherichia coli O111, 8 were also positive for Campylobacter species, and 1 was positive for campylobacter alone. Strains of E. coli were positive for the effacing and attaching protein (eaeA) gene, but negative for other E. coli virulence genes, and therefore belonged to the enteropathogenic E. coli (EPEC) group. Twenty-two out of 37 people in a second party which followed the same itinerary 2 weeks later also became ill. One had a stool sample positive for E. coli O111. Analytical epidemiology suggested that the source of infections was a restaurant in northern France at which both parties had eaten.

A total of 89760 human and 22551 non-human isolates of salmonella were serotyped in Canada during the period 1983–92. There were 2180 reported outbreaks associated with 10065 cases during the 10-year period. The most common salmonella serovars isolated from human and non-human sources were S. typhimurium and S. hadar. The third and fourth most common serovars from human sources were S. enteritidis and S. heidelberg, respectively, and from non-human sources they were S. heidelberg and S. infantis. The number of S. typhimurium isolations from human and non-human sources showed a downward trend over the 10-year period. A total of 222 outbreaks of S. typhimurium associated with 1622 cases occurred. The S. hadar isolations from human and non-human sources reached a peak during the years 1987–90 and declined thereafter. The number of human isolates of S. enteritidis increased until 1985 and fluctuated at a level of 8·3–12·8% of all human isolates thereafter. Seventy-three outbreaks of S. enteritidis infection associated with 568 cases occurred. More than 50% of the S. enteritidis infections in humans were caused by phage type (PT) 8. During the review period, infections caused by PT4 were less common and were almost exclusively found in people who had travelled abroad. The annual isolation rates of S. heidelberg from human and non-human sources increased steadily during the period. Bacteriophage typing of serovars from outbreaks showed that contaminated food products of poultry and bovine origin were common sources of human infection. Salmonella typhi was identified as the cause of 43 small outbreaks affecting 116 persons.

The antibiotic susceptibility pattern of Vibrio cholerae O139, Bengal, an emerging intestinal pathogen has been determined by the Kirby Bauer technique and the MIC values of some antibiotics against these strains by agar dilution technique. All the strains were susceptible to tetracycline, norfloxacin, ciprofloxacin and a majority was susceptible to gentamicin (95·7%) and nalidixic acid (82·9%). Only 51% were susceptible to cefotaxime and most strains were resistant to furazolidone (95·7%), ampicillin (87·3%) and co-trimoxazole (91·5%). The study shows the importance of judicious use of antibiotics in cholera cases and the need for monitoring the susceptibility status of these strains particularly because of their ability to cause extra-intestinal infections like septicaemia.

Changes in Helicobacter pylori seroprevalence were studied determining IgG and IgA antibodies of 408 randomly selected adults aged 15–74 years living in Vammala, Finland in 1973 and of 504 similarly selected subjects in 1994. Seroprevalence increased by age at both time points. The age-adjusted seroprevalence rate was clearly lower in 1994 than in 1973 (31 vs. 56%, P=0·001). Paired serum samples of 224 subjects collected in 1973 and 1994 showed that the antibody status remained unaltered in 92%; 4% seroconverted and 4% seroreverted within the 21 years. The decrease in the seroprevalence rate in the population and the persistence of individual antibody status over two decades support a difference in H. pylori infection rates among birth cohorts over time rather than continuous acquisition of new infections with advancing age. Thus the risk of helicobacter infection in Vammala, Finland has been highest in childhood and continuously decreased at least for the last five decades.

A survey of unopened ice cream, ice cream in use, and ice-cream-scoop water (n=91) was conducted to determine the effect of scoop water hygiene on the microbiological quality of ice cream. An aerobic plate count around 106 c.f.u. ml−1 was the modal value for scoop waters. Unopened ice creams generally had counts around 103–104 c.f.u. ml−1 and this increased by one order of magnitude when in use. Many scoop waters had low coliform counts, but almost half contained >100 c.f.u. ml−1. E. coli was isolated in 18% of ice creams in use, and in 10% of unopened ice creams. S. aureus was not detected in any sample. Statistical analysis showed strong associations between indicator organisms and increased counts in ice cream in use. EC guidelines for indicator organisms in ice cream were exceeded by up to 56% of samples.

To clarify the relationship between the epidemics of severe invasive group A streptococcal infections (streptococcal Toxic Shock-Like Syndrome; TSLS) and common group A streptococcal infections in Japan, we examined the T serotypes of S. pyogenes strains (group A streptococci) isolated from clinical specimens of the streptococcal infections (17999 cases) in the period 1990–5, including the severe infections (TSLS) (29 cases) in the period 1992–5. Characteristic points of the analyses were: (1) dominant serotypes of the infections in these periods were T12, T4, T1, T28 and TB3264, which were consistently isolated; (2) isolates of T3 rapidly increased through 1990 to 1994 while T6 decreased in the period 1990–3; (3) when Japanese area was divided into three parts, T3 serotype tended to spread out from the north-eastern to the south-western area; (4) strains of T3 and T1 serotypes were dominant in the TSLS. Dominant-serotype strains of streptococcal infections did not always induce severe infections and dominance of T3 serotype in the TSLS seemed to be correlated with the increase of T3 in streptococcal infections. These results may indicate that certain clones of S. pyogenes are involved in the pathogenesis of the TSLS.

A retrospective study was carried out to determine the recent epidemiology of ectopic pregnancy in England between the biennial years 1988/9 and 1992/3. The number of ectopic pregnancy cases were combined with numbers of conceptions and the rates analysed for trend over time. The incidence of ectopic pregnancy rose significantly (P=0·05) over this period. However, this could be entirely explained by increasing numbers of births in older women and a highly significant positive association was found between risk of ectopic pregnancy and maternal age (P<0·0001). Over the study period the incidence of ectopic pregnancy in women aged 40 years or more was over 14 times that observed in those under 16 years of age. It is suggested that this reflects cumulative risk of acquiring pelvic inflammatory disease. The surveillance of ectopic pregnancy provides a useful indicator of the level of reproductive morbidity in women.

During the spring of 1993 an estimated 403000 residents of the greater Milwaukee, Wisconsin area experienced gastrointestinal illness due to infection with the parasite Cryptosporidium parvum following contamination of the city's water supply. To define the clinical, laboratory and epidemiologic features of outbreak-associated cryptosporidiosis in children, medical and laboratory records for all children submitting stool samples to the microbiology laboratory of the Children's Hospital of Wisconsin between 7 April and 13 May 1993 were reviewed retrospectively. Interviews with parents were also conducted to obtain additional clinical history. Cryptosporidium, as the sole pathogen, was identified in stools from 49 (23%) of the 209 children enrolled in the study. Children with laboratory-confirmed cryptosporidiosis were more likely to live in areas of Milwaukee supplied with contaminated water (RR=1·92, CI=1·19–3·09), to be tested later in their illness (P<0·05), to have submitted more than one stool specimen (P=0·01), to have an underlying disease that altered their immune status (RR=2·78, CI=1·60–4·84), and to be older than 1 year of age (RR=2·02, CI=1·13–3·60). Clinical illness in these patients was more prolonged and associated with weight loss and abdominal cramps compared with Cryptosporidium-negative children. In the context of this massive waterborne outbreak relatively few children had documented infection with Cryptosporidium. If many children who tested negative for the parasite were truly infected, as the epidemiologic data suggest, existing laboratory tests for Cryptosporidium were insensitive, particularly early in the course of illness.

To characterize post-treatment clearance of young forms of Plasmodium falciparum from the blood, three differential equation models, a linear decline, a linear then logarithmic decline, and the Michaelis–Menten (MM) kinetic equation, were fitted to log-transformed serial parasite counts from 30 semi-immune patients with synchronous parasitaemias allocated one of six antimalarial drug regimens. The first two equations were solved analytically. The MM equation was solved numerically using a fifth-order Runge–Kutta method. For each equation, parasite clearance was assumed stochastic and log-transformed parasite counts were assumed to be normally distributed at each time-point. Comparisons between models were by Minimum Akaike Information Criterion Estimate. A constrained MM equation fitted the data at least as well as the other two models in 5 of 6 drug groups and also when pooled data were analysed, providing a single index which could be used in drug efficacy studies in similar situations or as part of more complex models that encompass asynchronous, complicated infections.

Between 1980 and 1994 the virological laboratory of the Institute of Hygiene and Epidemiology was responsible for the typing of enteroviruses, isolated by other, mainly university, hospital laboratories. Altogether 3333 strains of entero non-polio (EnP) were typed. The number and the most common types of EnP virus isolations varied from year to year. Each year two to three predominant types determined the main character of the EnP associated illness seen.

A total of 368 blood specimens were resampled from a serum collection containing 2914 blood samples which were collected by a random sampling in Taiwan in 1991. The plaque reduction neutralization test was applied to evaluate the neutralizing ability to two strains of Japanese encephalitis viruses, i.e. Nakayama (the present vaccine strain) and JE5 (a Taiwan isolate). The result revealed that antibodies against JE virus were present in each stratified age group. Antibody positive rates were both highest in the group older than 70 years although the lowest rates were located in different groups. In addition, the result showed that the immunogenicity potency of the antibody induced by the vaccine strain did not have a good coverage against JE5. The rate of neutralizing antibodies above the level of protective efficacy of the present vaccine was limited as low as 37·93%. Efficacy of the vaccine used at present was apparently not efficient. Consideration of a more promising vaccine may be necessary.

A retrospective study of notified hepatitis B virus (HBV) infection in Edinburgh during 1975–92 identified 525 acute cases. For 343 where a probable transmission route could be determined, 215 were due to shared equipment by injection drug users (IDUs), 29 to homosexual intercourse, 25 to heterosexual or household contact with IDUs, 21 to heterosexual contact with infected non-IDU partners and 53 to various other or multiple routes. Cases were unevenly distributed geographically, particularly those among IDUs. The highest incidence within a post code district was approximately 2·5 times that for all Edinburgh. Annual cases peaked in 1984 then declined to low levels in the early 1990s. This reduction was most marked among IDUs, and may be ascribed both to changed injecting behaviour and decreased susceptibility within this group. The latter factor implies that HBV infections may be an unreliable guide to human immunodeficiency virus (HIV) infection in populations where HBV is highly prevalent.

This paper describes a computer model that mimics the spread of bovine viral diarrhoea virus (BVDV) infection through a closed herd. The model is able to simulate the spread of infection when a persistently infected (PI) animal is introduced into an infection-free herd, and it is used to investigate the role of persistently infected animals, seroconverting animals, loss of PI calves and duration of immunity on the level of infection within the herd. Under typical management conditions one persistently infected animal poses a real threat to a herd, and the prospect of the herd becoming infection free in a 10-year period without intervention is remote. Seroconverting animals are found to be an important source of infection in herds with few immune animals. The increased loss of PI calves is likely to restrict the numbers of PI animals in a herd, and loss of immunity is important since it increases the possibility of a PI calf being born.

In 1996 Japan had a big outbreak of enterohaemorrhagic Escherichia coli (EHEC) O157[ratio ]H7, especially in Osaka prefecture where about 6000 patients (mainly schoolchildren) suffered from diarrhoea, haemorrhagic colitis and haemolytic uraemic syndrome (HUS) due to EHEC infection via school lunch. Our survey of doctors who took care of those patients showed that most patients had received antibiotics, especially fosfomycin which comprised 84% of the prescribed treatment. Since the administration of antibiotics for EHEC infection is under discussion, we analysed the effect of fosfomycin on production/release of verotoxins (VTs). Addition of fosfomycin into EHEC culture in CAYE broth at 2 and 5 h after start of incubation caused marked increase of VT1 release. This observation warns of the possibility of fosfomycin treatment making the disease worse.

Cryptosporidium parvum infections of domestic animals can have a considerable economic impact and as oocysts are voided in the faeces of infected hosts, environmental contamination with agricultural waste has also become a matter of concern. Since only viable oocysts are potentially infectious, the numbers of oocysts excreted during infection can have important implications for both veterinary and public health. During the course of infection in experimentally infected lambs, oocyst viability was assessed by a fluorogenic vital dyes assay and by a maximized in vitro excystation assay. The excreted oocyst populations contained a higher proportion of viable oocysts 5–11 days post infection (d.p.i.) than later in the infection. Oocyst viability declined consistently 11–15 d.p.i. and coincided with periods when peaks in serum and intestinal anti-Cryptosporidium antibodies have been reported to occur. Infected lambs excreted a mean of 4·8 (standard error [S.E.]±0·4)×109 oocysts per g of faeces, of which half were non-viable and therefore of no significance for disease transmission. This study demonstrates that the numbers of viable oocysts excreted by infected lambs is smaller than previously suspected.