Yellow fever (YF), an acute infectious disease, is endemic in the north and central-west of Brazil. This disease can be prevented by the use of a vaccine. In Brazil, four fatal adverse events have been associated with the YF vaccine used in the country (17DD vaccine). We briefly describe the last two fatalities, and estimate the risk of 17DD-associated fatal adverse events under different epidemiological scenarios. Controversies regarding the appropriate denominator that enters the estimation of risk serve as a motivation for each proposed scenario. The statistical procedures used show optimum behaviour when assessing the risk of rare events. Risk estimates vary from 0·043 (95% CI 0·017–0·110) to 2·131 (95% CI 0·109–12·071) fatalities per million doses administered. The robust estimates of the risk of fatal adverse events we present constitute an important element in future risk–benefit analysis and point to the need for good quality vaccine coverage and adverse-events surveillance data to assess the risk of vaccination. Although vaccination of YF endemic regions is necessary to maintain low disease prevalence, preventive administration of YF vaccine to the entire population should be cautiously analysed.

A comprehensive examination of gender and age-specific influenza and pneumonia hospitalization seasonality is currently lacking. Using population-based data for Ontario, Canada between April 1988 and March 2002 (n=339803 hospitalizations), findings from this study revealed clear seasonality [Fisher's Kappa (FK) test=68·64, P<0·001; Bartlett's Kolmogorov–Smirnov (BKS) test=0·68, P<0·001] with consistent summer troughs and winter peaks for both sexes and all ages combined. The very young (both sexes 0–4 years) demonstrated the strongest seasonality (Rautoreg2=0·97) and females aged 10–19 years, the weakest (Rautoreg2=0·59). Gender differences were most pronounced in the oldest age groups (80+ years) where females had an average annualized peak rate of 250/100000 compared to 400/100000 for males. These findings can contribute to more population-specific prevention strategies and effective resource and service allocation based on seasonal and specific population demands.

An epidemic of diarrhoea in Jawhar, a tribal area of Thane district, Maharashtra, India was investigated. Within a period of approximately 2 months 490 cases of acute diarrhoea were reported among children under 5 years of age, with a case fatality rate of 0·40%. Twenty-seven out of 39 (69·23%) rectal swabs/faecal specimens obtained from hospitalized paediatric patients up to 2 years of age from Jawhar were positive by ELISA for rotavirus. Of these, seven were in the age group of [les ]6 months. Seven ELISA-positive faecal specimens were positive for serotype G3 by RT–PCR. Out of 15 serum samples collected from these patients, 12 showed the presence of rotavirus-specific IgM. Rotavirus appears to be the aetiological agent of this widespread outbreak in Jawhar, Thane district, Maharashtra state, India.

Generally, group A rotaviruses are the most common cause of paediatric diarrhoea. However, group B rotavirus, adult diarrhoea rotavirus (ADRV), was found to be involved in epidemics of severe gastroenteritis in several areas of China during 1982–1983 and had resulted in more than one million cases among adults as well as older children. Human group B rotavirus has been rarely reported outside China, but has been detected first from five adults with diarrhoea in Kolkata, India during 1997–1998 (strain CAL-1). During epidemiological studies at the National Institute of Virology (NIV) on hospitalized diarrhoea patients at Pune, India, faecal specimens from patients of >5 years age, which were negative for group A rotavirus by ELISA were tested by polyacrylamide gel electrophoresis (PAGE). We detected rotavirus RNA migration patterns similar to that of group B rotavirus in three faecal specimens from adults, two from the specimens collected in 1993 and one in 1998 from sporadic diarrhoea cases. RT–PCR was carried out using primers derived from gene 8 which codes for the NS2 protein, followed by nested PCR, which confirmed the presence of group B rotavirus in all three specimens. The sequences of the PCR products of NIV specimens were compared with that of CAL-1, ADRV and IDIR (infectious diarrhoea of infant rat) belonging to group B rotaviruses. The sequence analysis of the PCR products showed the highest identity with CAL-1, which was reported from Kolkata, India during 1997–1998. The finding suggests that human group B rotaviruses have been circulating in Pune, India, since 1993. This emerging virus may lead to more severe disease among adults in India. There is a need for surveillance of group B rotavirus infections, especially in adult diarrhoea cases and seroepidemiological studies on group B rotavirus are required among humans and animals of Western Maharashtra, India.

Scrapie is endemic in the sheep flocks of many countries, but good epidemiological information on this disease is scarce. Data on the initial stages of an epidemic are even more rare. We describe the ongoing epidemic of scrapie in Cyprus that has been tracked since it began in the mid-1980s. The early stages of the spread of scrapie from farm to farm, between 1985 and 2000, is analysed with a simple mathematical model. The flock-to-flock basic reproductive number (R0) for the spread of scrapie was estimated at between 1·4 and 1·8. The impact of interventions on the control of the epidemic are discussed from an epidemiological and economic point of view. Early identification of scrapie cases on farms can have a large impact on the number of farms affected. The long period before detection of disease in a flock means that policies based on whole-flock slaughter can be inefficient in preventing spread. Under a range of scenarios, a concentration of resources on early detection and quarantine may be more effective in terms of both the costs and control of the epidemic.

A total of 211 episodes of bloodstream yeast infections in 207 patients, hospitalized in 28 Belgian hospitals participating in a National Surveillance Program, were evaluated. A total of 81% of the patients were more than 50 years of age. Candida albicans was the cause of infections in 55% of patients, 22% were due to C. glabrata and 13% to C. parapsilosis. The most common predisposing factors were antibacterial therapy (42%), residence in an intensive care unit (32·9%) and presence of an intravascular catheter (29·7%). Most patients had more than one predisposing factor. Fluconazole alone or in association with another antifungal agent was the treatment of choice for 89·7% of the cases. In vitro susceptibility testing of the isolates revealed that 99% were susceptible to amphotericin B, 95% to 5-fluorocytosine, 82% to fluconazole and 69% to itraconazole. Resistance to azoles was more common among C. glabrata isolates in the elderly. We conclude that the frequency of C. albicans infection is decreasing in Belgium and this is associated with the emergence of other species, most notably, C. glabrata.

Among the known human rotavirus serotypes, types G1–G4 are ubiquitous and account for >80% of global human rotavirus strains. Since 1994 an increase in reports of G9 serotype isolates has been observed in both developed and developing countries. In the winter season of 1999–2000 we detected the appearance of G9 rotavirus in Palermo, Italy, accounting for 19% of all rotaviruses circulating in our geographical area. Some of these Italian G9 isolates have been submitted to partial sequencing of their VP7 gene. All of them showed complete nucleotide identity suggesting a clonal origin. The Italian VP7 sequences were found to be very closely related to that of other G9 strains recently isolated in Europe, America, Africa and Asia. Our results confirm that G9 strains circulating worldwide since 1994 are closely related genetically in their VP7 genes.

An individual-based stochastic simulation model was constructed to study the epidemiology of Haemophilus influenzae type b (Hib) transmission, immunity and invasive disease. Embedded in a demographic model, the transmission model of Hib carriage employs the most important social mixing patterns with three types of contact sites (family, day-care group, and school class). The model includes immunity against invasive Hib disease, initiated and boosted by Hib carriage and cross-reactive bacterial encounters. The model reproduces the observed age patterns in Hib carriage and disease in Finland before large-scale use of the Hib conjugate vaccines. The model was used to investigate characteristics of Hib transmission. The analysis emphasizes transmission between children and adults in families while pointing out the importance of pre-school and school-aged children in maintaining Hib circulation. Carriage in these age groups is thus identified as being essential to target for sustained effects of interventions by vaccination.

We used a structured population model to study factors determining the magnitude of indirect protection in Haemophilus influenzae type b (Hib) vaccination. On a simulation platform mimicking the population of Finland, a Hib transmission and immunity model, including cross-reactive bacterial encounters, was formulated. Utilizing different vaccination coverages and vaccine types we could study how fast the incidence of Hib disease declined due to direct and indirect vaccination effects. With the Finnish vaccination schedule we could reproduce the observed disappearance of Hib cases. Our results show that an indirect effect was already significant with a relatively low vaccine coverage, even with a vaccine only partly reducing carriage acquisition. This suggests that the vaccination schedule and vaccine to be used should be chosen to result, in addition to immunological memory, in high antibody concentrations, sufficient to reduce carriage, the latter being the main factor behind successful elimination of transmission and disease.

We aimed to determine the seroprevalence of poliovirus antibody in Korea by using the cell culture neutralization method recommended by the WHO. A total of 500 sera collected from children at eight primary schools in Kyunggi province were used for this study. We found that 82·2% of children were positive for all three types of poliovirus and antibody-positive rates for types I, II and III were 94·4, 96·6 and 86·8% respectively, indicating that seropositive rates for types I and II were considerably higher than for type III (P<0·0001). This result implies that the type III component of the oral polio vaccine should be evaluated further. Although a greater number of children, including young infants, need to be tested for seroprevalence, this study still provides us with valuable information on the effectiveness of vaccination against polioviruses in Korea.

Street-vendors in Mexico City provide ready-to-eat food to a high proportion of the inhabitants. Nevertheless, their microbiological status, general hygienic and trading practices are not well known. During spring and summer 2000, five tianguis (open markets) were visited and 48 vendors in 48 stalls interviewed. A total of 103 taco dressings were sampled for E. coli and Salmonella spp.: 44 (43%) contained E. coli and 5 (5%) Salmonella (2 S. Enteritidis phage type 8, 1 S. Agona, 2 S. B group). Both E. coli and salmonellas were isolated from three samples. Of Salmonella-positive stalls 80% (4/5) had three or more food-vendors and 80% of vendors were males, compared with 37·3% (16/43) and 46·4% (20/43) in the Salmonella-negative stalls respectively. Food-vendors kept water in buckets (reusing it all day), lacked toilet facilities, and prepared taco dressings the day before which remained at the tianguis without protection for 7·8 h on average. Consumption of street-vended food by local and tourist populations poses a health risk.

A conjunctivitis outbreak affecting more than 200 individuals occurred on a university campus in Evanston, Illinois, USA, in spring 2002. An investigation was conducted jointly by the Evanston Department of Health and the Illinois Department of Public Health. A combination of e-mail and traditional telephone-based surveys demonstrated that wearing contact lenses was a risk factor for any conjunctivitis and bilateral conjunctivitis, whereas using glasses was protective. Laboratory and epidemiological evidence suggested that the outbreak was caused by a viral pathogen that eluded characterization despite extensive culture and PCR-based laboratory testing. Enhanced laboratory surveillance could help clinicians and public-health officials to identify relevant secular changes in the spectrum of causes of conjunctivitis. During institutional outbreaks, e-mail surveys can help public-health officials to efficiently access information not easily collected by traditional case-control studies, and can provide an effective conduit for providing prevention recommendation, such as the need for improved hand and contact-lens hygiene during outbreaks.

A recent resurgence in serious infections due to Haemophilus influenzae type b (Hib) has been observed in the United Kingdom. More information on Hib transmission in the population is required in order to better understand the mechanism of this increase. The Public Health Laboratory Service (subsumed into the Health Protection Agency since April 2004) conducted four cross-sectional studies of asymptomatic oropharyngeal Hib carriage in children attending day-care nurseries in England and Wales in 1992, 1994, 1997 and 2002. These demonstrated a marked reduction in the prevalence of Hib colonization over time since vaccine introduction (3·98% in 1992; 0·70% in 1994; 0% in 1997; 0% in 2002), which did not explain the increase in invasive disease reports from 1999 onwards. We believe that a reduction in antibody levels over the first 5 years of life in immunized children in recent years has fuelled the rise in reported cases in the absence of an obvious increase in transmission.

In order to identify Helicobacter in gallstones of Iranian patients with biliary disease, gallstone and bile samples from 33 patients were subjected to rapid urease test, culture and Multiplex PCR using primers based on 16s rRNA and isocitrate dehydrogenase genes for the identification of Helicobacter genus and H. pylori respectively. This PCR was also done on bile samples from 40 autopsied gallbladders with normal pathology (control group). In 18·1% of stone and 12·1% of bile samples, H. pylori DNA was detected using PCR. Rapid urease and culture tests were negative for all samples. The PCR was negative in the control group. In conclusion, H. pylori DNA was detected in stone samples of Iranian patients with gallstones but we are not sure of their viability. To clarify the clinical role of Helicobacter in gallbladder diseases, studies using accurate tests on larger patient and control groups are needed to ascertain whether this microorganism is an innocent bystander or active participant in gallstone formation.

In November 1973 Newcastle disease suddenly appeared in Northern Ireland, where the viscerotropic disease had not been seen in 3½ years and the two Irelands had been regarded as largely disease free for 30 years. It was successfully controlled with only 36 confirmed affected layer flocks, plus 10 more slaughtered as ‘dangerous contacts’. Contemporary investigations failed to reveal the source of the Irish epidemic. Using archival virus samples from most of the affected flocks, RT–PCR was conducted with primers selected for all six NDV genes. Phylogenetic analyses of three genes, HN, M and F, confirmed vaccine as the cause of one of the outbreaks. The other six samples were identical and closely related to previous outbreaks in the United States and western Europe initiated by infected imported Latin American parrots. The probable cause of the epidemic followed from the importation from The Netherlands of bulk feed grains contaminated with infected pigeon faeces.

Giardiasis surveillance data as well as drinking water, socioeconomic and land-use data were used in spatial regression models to investigate determinants of the geographic distribution of endemic giardiasis in southern Ontario. Higher giardiasis rates were observed in areas using surface water [rate ratio (RR) 2·36, 95% CI 1·38–4·05] and in rural areas (RR 1·79, 95% CI 1·32–2·37). Lower rates were observed in areas using filtered water (RR 0·55, 95% CI 0·42–0·94) and in those with high median income (RR 0·62, 95% CI 0·42–0·92). Chlorination of drinking water, cattle density and intensity of manure application on farmland were not significant determinants. The study shows that waterborne transmission plays an important role in giardiasis distribution in southern Ontario and that well-collected routine surveillance data could be useful for investigation of disease determinants and identification of high-risk communities. This information is useful in guiding decisions on control strategies.

The objective of this study was to assess the serological association between previous Chlamydia trachomatis infection and subfertility in a general population sample. A nested case (n=493)-control (n=986) study in a population-based birth cohort consisting of 12058 live births from the year 1966 was conducted. The analysis was restricted to those 6007 cohort members who replied to a postal inquiry and participated in a health examination including blood samples at the age of 31 years. The presence of C. trachomatis-specific serum IgG antibodies was screened by a synthetic peptide-based enzyme-linked immunosorbent assay. All the positive sera were further tested by the microimmunofluorescence method using immunotype pools and individual immunotypes of C. trachomatis as antigens. An association was found between the detection of immunotype-specific C. trachomatis antibodies and subfertility both in men and women. The results of the present study confirm the serological association between past C. trachomatis infections and subfertility in male or female partners of the couple in the population-based sample.