1. INFECTION PATTERNS IN THE WORLD

Selected articles

Viral and Host Factors in Human Respiratory Syncytial Virus Pathogenesis.
Collins PL, Graham BS. Journal of Virology. 2008;2040–55.
Human respiratory syncytial virus (RSV) was first isolated in 1956 from a laboratory chimpanzee with upper respiratory tract disease. RSV was quickly determined to be of human origin and was shown to be the leading worldwide viral agent of serious paediatric respiratory tract disease. In a 13-year prospective study of infants and children in the United States, RSV was detected in 43%, 25%, 11%, and 10% of paediatric hospitalisations for bronchiolitis, pneumonia, bronchitis, and croup, respectively. RSV is also a significant cause of morbidity and mortality in the elderly, with an impact approaching that of nonpandemic influenza virus. Although RSV has a single serotype, reinfection can occur throughout life. Strains circulate quickly around the earth. Neither a vaccine nor an effective antiviral therapy is available; however, infants at high risk for serious disease can receive passive immunoprophylaxis by a monthly injection of a commercial RSV-neutralising monoclonal antibody, palivizumab (Synagis), which provides a 55% reduction in RSV-associated hospitalisation.

Human Listeria monocytogenes infections in Europe - an opportunity for improved European surveillance.
Denny J, McLauchlin J, Euro Surveill. 2008;13(13).
The 2006 Community Summary Report from the European Food Safety Authority (EFSA) and the European Centre for Disease Prevention and Control (ECDC) was published recently with the latest trends and figures on the occurrence of zoonotic infections and agents, antimicrobial resistance and foodborne outbreaks in the then 25 European Union (EU) Member States and five non-EU countries. This article seeks to expand further upon reports of human listeriosis (Listeria monocytogenes infections) and changes in the epidemiology of this disease, and to provide information about important developments as they relate to an opportunity for the establishment of a formalised listeriosis surveillance network in Europe.
 
Increasing Incidence of Listeriosis in France and Other European Countries.
Goulet V, Hedberg C, Monnier A, de Valk H. Emerging Infectious Diseases. 2008;14(5).
From 1999 through 2005, the incidence of listeriosis in France declined from 4.5 to 3.5 cases/million persons. In 2006, it increased to 4.7 cases/million persons. Extensive epidemiologic investigations of clusters in France have ruled out the occurrence of large foodborne disease outbreaks. In addition, no increase has occurred in pregnancy associated cases or among persons <60 years of age who have no underlying disease. Increases have occurred mainly in people ≥60 years of age and appear to be most pronounced for people ≥70 years of age. In 8 other European countries, the incidence of listeriosis has increased, or remained relatively high, since 2000. As in France, these increases cannot be attributed to foodborne outbreaks, and no increase has been observed in pregnancy-associated cases. European countries appear to be experiencing an increased incidence of listeriosis among people ≥60 years of age. The cause of this selective increased incidence is unknown.

Increasing Hospitalizations and General Practice Prescriptions for Community-onset Staphylococcal Disease, England.
Hayward A, Knott F, Petersen I,  Livermore DM, Duckworth G, Islam A, et al. Emerging Infectious Diseases. 2008;14(5).
We used Hospital Episode Statistics to describe trends in hospital admissions for community-onset staphylococcal disease and national general practice data to describe trends in community prescribing for staphylococcal disease. Hospital admission rates for staphylococcal septicemia, staphylococcal pneumonia, staphylococcal scalded-skin syndrome, and impetigo increased >5-fold. Admission rates increased 3-fold for abscesses and cellulitis and 1.5-fold for bone and joint infections. In primary care settings during 1991–2006, floxacillin prescriptions increased 1.8-fold and fusidic acid prescriptions 2.5-fold. The increases were not matched by increases in admission rates for control conditions. We identified a previously undescribed but major increase in pathogenic community-onset staphylococcal disease over the past 15 years. These trends are of concern given the international emergence of invasive community-onset staphylococcal infections.

Increased Health Risk Associated with Lack of In-home Running Water.
Hennessey et al 2008. American Journal of Public Health′s Web site, http://www.ajph.org/.
Study Shows Rural Alaska Natives without In-Home Running Water Suffer More Disease.

Little progress made in controlling US foodborne illness.
Nelson R. The Lancet infectious disease. 2008;8(6).
The CDC Foodborne Diseases Active Surveillance Network (FoodNet) reported a total of 17,883 laboratory-confirmed cases of infection in the 10 FoodNet surveillance areas during 2007. Although significant declines in the incidence of certain foodborne pathogens have occurred since 1996, these declines all occurred before 2004. Incidence of Campylobacter, Salmonella, Shigella, and E. coli O157 infections remains highest among children aged <5 years.

Severe atopic dermatitis is associated with a high burden of environmental staphylococcus aureus.
Leung AD., Schiltz AM., Hall CF., Liu AH. Clinical & Experimental Allergy. 2008;38(5):789-93.
About 90% of patients with atopic dermatitis (AD) are colonized with Staphylococcus aureus. S. aureus worsens AD by secreting superantigens and structural molecules within the cell wall that induce skin inflammation. Participants with mild (n=18), moderate (n=14), severe (n=15), and no AD (n=15), collected dust from their bed and bedroom floor, and from their home vacuum cleaner bag. DNA was extracted from dust samples, and the S. aureus-specific femB gene was quantified using quantitative real-time PCR. 0.0684). The conclusion was that in the home and especially the bedroom, higher levels of S. aureus may contribute to disease severity and persistence in AD patients.

Norovirus Outbreak in an Elementary School — District of Columbia, February 2007.
Davies-Cole J, Lyss S, Blair J. Morbidity and Mortality Weekly Report. 2008;56: 51 & 52.
On February 8, 2007, the District of Columbia Department of Health (DCDOH) was notified of an outbreak of acute gastroenteritis in an elementary school. The school nurse reported that 27 students and two staff members had become ill during February 4–8 with nausea, vomiting, and diarrhea; because symptoms lasted <48 hours, a viral aetiology was suspected. DCDOH recommended two preinvestigation interventions, which were implemented the same evening (February 8): 1, more thorough hand washing and 2,  bleach cleaning of all shared environmental surfaces with a diluted (1:50 concentration) household bleach solution. This report summarises the subsequent investigation of the outbreak, which suggested that noncleaned computer equipment (i.e., keyboards and mice) and person-to-person contact resulted in illness. To decrease disease transmission during gastroenteritis outbreaks, public health officials should emphasise good hand washing practices, exclusion of ill persons, and thorough environmental disinfection, including fomites that are shared but not commonly cleaned.

Extended-spectrum β-lactamase (ESBL)-producing enterobacteria: factors associated with infection in the community setting, Auckland, New Zealand.
Moor CT, Roberts SA, Simmons G, Briggs S, Morris AJ, Smith J, et al. Journal of Hospital Infection. 2008;68:355-62.
We aimed to document the epidemiology of extended-spectrum β-lactamase (ESBL)-producing enterobacteria and to identify factors associated with infection using a case control study design. ESBL-producing enterobacteria were isolated from 107 infected patients, for which demographic and clinical data were available for 98 cases (92%). Escherichia coli was the predominant organism (82%), with urine as the commonest source (97%). Compared with a control group infected with ESBL-negative enterobacteria, factors significantly associated with infection on univariate analysis were: living in a residential care home (RCH); recent admission to hospital ‘M’; recent antibiotic use; older age (>75 years); presence of a urinary catheter; and a history of comorbid chronic obstructive pulmonary disease (COPD), cardiovascular disease, neurological disease or recurrent urinary tract infection. On multivariate analysis, residence in RCH and COPD remained significant associations. Pulsed-field gel electrophoresis typing of the ESBL-producing E. coli identified a common strain. We concluded that residence in RCH and a history of COPD are significant associations with ESBL-producing enterobacterial infection.

Food-borne viruses in Europe network report: the norovirus GII.4 2006b (for US named Minerva-like, for Japan Kobe034-like, for UK V6) variant now dominant in early seasonal surveillance.
Siebenga J, Kroneman A, Vennema H, Duizer E,  Koopmans M, on behalf of the Food-borne Viruses in Europe network. Euro Surveill 2008;13(2).
Institutes charged with the surveillance of norovirus (NoV) outbreaks in Ireland, Germany, the Netherlands and Sweden reported high NoV activity to the European Food-borne Viruses in Europe network (FBVE) in late 2007. In these countries, the number of reported NoV outbreaks exceeded that of October and November of the previous record seasons, 2004 and 2006. A similar situation has been reported in the United Kingdom (UK). In recent years, most norovirus outbreaks have been caused by GII.4 strains. These viruses evolve rapidly by genetic mutation coupled with selective pressure. The rapid evolution of GII.4 noroviruses resulting in the successive emergence of new variants has been observed since 2002. In the norovirus outbreak season of 2006–7, two variants emerged that co-circulated. Early observations for the 2007–8 season suggest that one of these variants now dominates. The currently circulating strains have mutations that set them apart from the older strains, leading to one amino acid change in the capsid sequence. Although the strains that currently circulate are not new variants, based on the global character of norovirus and previous experience with high numbers of reported outbreaks, high norovirus activity is predicted in other countries.

MRSA: Deadly Super Bug or Just Another Staph?
Talan DA, MD. Annals of Emergency Medicine. 2008;51(3).
This review of MRSA concludes that Community-associated MRSA is not a deadly super bug. Although community-associated MRSA appears to be more efficient at causing infection in healthy individuals than methicillin-susceptible S aureus, particularly among groups with frequent skin-to-skin contact, most infections are uncomplicated skin and soft tissue infections. Patients with community-associated MRSA infections have a good prognosis and many antibiotic treatment options  Continued surveillance for invasive community-associated MRSA will help determine whether the low rate of more serious community-associated MRSA infections is increasing.

Proposed definitions of community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA).
Millar B.C., Loughrey A., Elborn J.S., Moore J.E. Journal of Hospital Infection 2007;67:109-13.
A new type of methicillin-resistant Staphylococcus aureus (MRSA) is emerging as a significant pathogen in otherwise healthy individuals in the community. This MRSA is distinct from healthcare-associated (HA)-MRSA, in terms of epidemiology, microbiology and clinical manifestations. At present there is a lack of consensus as to the terminology used to describe community-associated (CA)-MRSA. This confusion is further compounded with the recent emergence of nosocomial transmission of CA-MRSA within hospitals. The aim of this article is to highlight the differences between HA-MRSA and CA-MRSA and to propose standard definitions of the various subgroups of CA-MRSA.

Norovirus activity – United States 2006-2007.
Morbidity Mortality Weekly Report 2007;56(33):842-6.
In late 2006, CDC began receiving requests for information about a perceived increase in the number of outbreaks of acute gastroenteritis (AGE), especially those involving person-to-person transmission in long-term care facilities. No national surveillance system exists for AGE outbreaks, including those caused by norovirus, unless food-borne transmission is suspected. CDC solicited information from the health departments of 24 states who reported a total of 1,316 AGE outbreaks, onset during October-December 2006; a median of 50% occurred in long-term care facilities, and a median of 26% had laboratory confirmation of norovirus by RT-PCR. Of these 24 states, 22 (92%) reported an increase in the number of outbreaks compared with the same period in 2005.

Transmission of influenza A in human beings.
Brankston G., Gitterman L., Hirji Z., Lemieux C., Gardam M. The Lancet Infectious Diseases 2007;7:257-65.
Infection control precautions to prevent airborne, droplet, and contact transmission are quite different and will need to be decided on and planned before a pandemic occurs. Despite vast clinical experience, there continues to be much debate about how influenza is transmitted. This paper describes a systematic review of the literature to better inform infection control planning efforts. The review suggests that existing data are limited to identify specific modes of transmission. However, it was concluded that transmission occurs at close range rather than over long distances, suggesting that airborne transmission, as traditionally defined, is unlikely to be of significance. Further research is required to better define how the virus may transmit via the airborne route.

SurvNet electronic surveillance system for infectious disease outbreaks, Germany.
Krause G., Altmann D., Faensen D., et al. Emerging Infectious Diseases 2007 Oct.
In 2001, the Robert Koch Institute (RKI) implemented a new electronic surveillance system
(SurvNet) for infectious disease outbreaks in Germany. SurvNet has captured 30,578 outbreak reports in 2001-2005. The most common settings among the 10,008 entries for 9,946 outbreaks in 2004 and 2005 were households (5,262; 53%), nursing homes (1,218; 12%), and hospitals (1,248; 12%).

Invasive methicillin-resistant Staphylococcus aureus infections in the United States.
Klevens R.M., Morriso M:A:, Nadle J., et al. JAMA2007;298(15):1763-71.
Data was taken from population-based surveillance for invasive MRSA in 9 sites across the US during 2004 and 2005. Reports of MRSA were classified as either healthcare-associated (either hospital-onset or community-onset) or community-associated (patients without established health care risk factors for MRSA). There were 8987 observed cases of invasive MRSA reported. Most infections were healthcare-associated: 5250 (58.4%) were community-onset infections, 2389 (26.6%) were hospital-onset infections; 1234 (13.7%) were community-associated infections, and 114 (1.3%) could not be classified. In 2005, the standardized incidence rate of invasive MRSA was 31.8 per 100 000 (interval estimate, 24.4-35.2). Incidence rates were highest among persons 65 years and older, blacks and males. There were 1598 in-hospital deaths among patients with MRSA infection.

The true burden and risk of cholera: implications for prevention and control.
Zuckerman J.N., Rombo L., Fisch A. The Lancet Infectious Diseases 2007;7:521-30.
Cholera is a substantial health burden on the developing world. The exact scale of the problem is uncertain because of limitations in existing surveillance systems, differences in reporting procedures, and failure to report cholera to WHO; official figures are likely to greatly underestimate the true prevalence of the disease. We have identified, through extensive literature searches, additional outbreaks of cholera to those reported to WHO, many of which originated from the Indian subcontinent and southeast Asia.

Skin and soft tissue infections caused by methicillin-resistant Staphylococcus aureus USA300 clone.
Johnson J.K., Khoie T., Shurland S., Kreisel K., Stine O.C., Roghmann M.C. Emerging Infectious Diseases 2007;13:1195-200.
MRSA infections and skin and soft tissue infections (SSTIs) were studies in outpatients receiving care at the Baltimore Veterans Care Service during 2001-2005. MRSA infections increased from 0.2 to 5.9 per 1,000 visits (>80% of MRSA infections were caused by USA300). SSTI visits increased from 20 to 61 per 1,000 visits(p<0.01). These increases in community-associated MRSA infections and SSTIs suggest that USA300 is becoming more virulent and has a greater propensity to cause SSTIs.

Highly Pathogenic Avian Influenza A/H5N1 – update and overview of 2006
Eurosurveillance 2006, Volume 11.
This is an update of the current situation on Avian influenza. Since 2003, 258 human H5N1 infections have been reported to WHO. Critically, human to human transmission, as indicated by cluster size, is still extremely inefficient. The report states that a nimals are still the source of human infections. H5N1 avian viruses remain poorly adapted to humans. With a high enough viral challenge and perhaps some genetic host susceptibility the viruses can infect humans, in which case they are then often lethally pathogenic, although they are still unable to transmit efficiently between humans.

Flu update - Hygiene and other personal protective measures for reducing transmission of influenza in the home and community.
Nicoll A., Eurosurveillance 2006, Volume 11.
This paper outlines published advice (interim recommendations) on personal protective measures for reducing transmission of flu drawn up by the European Centre for Disease Prevention and Control (ECDC). The advice is intended to apply both to human seasonal flu and in the event of pandemic influenza. The ECDC recommendations are based on the currently available evidence on the transmission characteristics of influenza and the evidence of effectiveness of measures as summarised in a number of reviews and are compatible with recommendations already put forward by WHO.

Disrupted spatial memory is a consequence of picornavirus infection.
Buenz E.J. et al. Neurobiology of Disease doi:10.1016/j.nbd.2006.07.003.
An animal model study suggests that over the lifetime of an individual, picornavirus-related infections could have a permanent effect on memory late in life. Picornaviruses infect more than one billion people worldwide each year. In the study, mice were infected with Theilers murine encephalomyelitis virus. Mice that contracted the virus had difficulty learning to navigate a maze designed to test various components of spatial memory, the degree of memory impairment, ranging from no discernable damage to complete devastation and correlated to the number of dead brain cells in the hippocampus region of the brain. Clinical studies indicate that picornavirus infections in humans may be associated with inflammation of the brain and damage to the hippocampus, the part of the brain responsible for forming, storing and processing memory.

Legionnaires' disease: when an 'outbreak' is not an outbreak.
Pereira A.J., Broadbent J., Mahgoub H., Morgan O., Bracebridge S., Reacher M., Ibbotson S., Lee J.V., Harrison T.G., Nair P. Eurosurveillance 2006 vol 11, issue 11.
During August 2006, there was an increase in non-travel related legionella cases throughout England and in the Netherlands , possibly associated with the fluctuating weather conditions in July. In August and September, eight cases were reported to a local health authority in eastern England . No common source for this cluster could be established. Legionella was isolated from the home of two patients (2 showerheads in one home and a hot tub in the other) but unfortunately clinical isolates were not available for further genetic typing. The incident control team concluded that multiple sources (both domestic and environmental) may have caused the cluster.

Non-pharmaceutical interventions for pandemic influenza, international measures.
World Health Organization Writing Group. Emerging Infectious Diseases 2006; 12:81-7.
This is the first part of a two part report which summarises the scientific data, historic experience, and contemporary observations that make up the limited evidence base for these interventions as applied to influenza. Part 1 summarizes the relevant transmission characteristics of influenza and the basis for interventions to prevent spread from one country to another. Non-pharmaceutical interventions outside of healthcare settings focus on measures to 1) limit international spread (e.g., travel screening and restrictions); 2) reduce spread within national and local populations (e.g., isolation and treatment of ill persons; monitoring and possible quarantine of exposed persons; and social distancing measures, such as cancellation of mass gatherings and closure of schools); 3) reduce an individual person's risk for infection (e.g., hand hygiene); and 4) communicate risk to the public. Part 1 discusses the first category.

Non-pharmaceutical public health interventions for pandemic influenza, national and community measures.
World Health Organization Writing Group. Emerging Infectious Diseases 2006;12:88-94.
This is the second part of a two part report which summarises the scientific data, historic experience, and contemporary observations that make up the limited evidence base for these interventions as applied to influenza. Part 2 summarises the basis for measures within countries at the national and community levels. Non-pharmaceutical interventions outside of healthcare settings focus on measures to 1) limit international spread (e.g., travel screening and restrictions); 2) reduce spread within national and local populations (e.g., isolation and treatment of ill persons; monitoring and possible quarantine of exposed persons; and social distancing measures, such as cancellation of mass gatherings and closure of schools); 3) reduce an individual person’s risk for infection (e.g., hand hygiene); and 4) communicate risk to the public. Categories 2 and 3 are addressed in Part 2.

Emergence and resurgence of Methicillin-resistant Staphylococcus aureus as a public-health threat.
Grundmann H., Aires-de-Sousa M., Boyce J., Tiemersma E. Published online June 21, 2006 DOI:10.1016/S0140-6736(06)68853-3 1.
This paper reviews the scientific literature related to the emergence and resurgence of MRSA.

Hedgehog zoonoses. Riley P.Y., Chomel B.B., Emerging Infectious Diseases 2005; 11: 1-5.
Exotic pets, including hedgehogs, have become popular in recent years among pet owners, especially in North America. Such animals can carry and introduce zoonotic agents, a fact well illustrated by the recent outbreak of monkeypox in pet prairie dogs. This paper reviews known and potential zoonotic diseases that could be carried and transmitted by pet hedgehogs or by wild-caught hedgehogs that have been rescued.

A one-year intensified study of outbreaks of gastroenteritis in The Netherlands. van Duynhooven Y.T.H.P., de Jager C.M., Kortbeek L.M., Vennema H., Koopmans M.P.G., van Leusden F., van der Poel W.H.M., van den Broek M.G.L. Epidemiology and Infection 2005;133:9-21.
This paper describes a study of 281 gastroenteritis outbreaks mainly from nursing homes and homes for the elderly (57%) (restaurants (11%), hospitals (9%) and day care centres (7%)).Direct person-to-person spread was the pre-transmission route in all settings (78%) except for the rest of the outbreaks where food was suspected in almost 90% of cases. The most common pathogen was norovirus (54%) followed by Salmonella spp (4%), rotavirus group A (2%) and Campylobacter spp (1%).

The seasonality of human campylobacter infections and Campylobacter isolates from fresh retail chicken in Wales. Meldrum R.J., Griffiths J.K., Smith R.M.M., Evans M.R. Epidemiology and Infection 2005;133:49-52.
Seasonal peaks in human Campylobacter infections and poultry isolates have been observed in several European countries but remain unexplained. This study compared data on human infections and isolation rates from fresh retail chicken portions purchased in Wales between January and December 2002. Overall, 71% of chicken samples were positive for Campylobacter, with rates in excess of 90% in week 24. Human isolates (2631) peaked between weeks 22 and 25 and chicken isolates (364) between weeks 24 and 26. The authors postulate that the seasonal rise in human infections is not caused by a rise in poultry isolation rates, but that both are more likely to be associated with a common, but as yet unidentified environmental source.

Focussing on improved water and sanitation for health. Bartram J., Lewis K., Lenton R., Wright A. Lancet 2005;365:810-2.
This paper argues the case for greater emphasis on initiatives to improve water and sanitation.

Bed, bath and beyond: pitfalls in prompt eradication of methicillin-resistant Staphylococcus aureus carrier status in healthcare workers. Kniehl E., Becker A., Forster D.H. Journal of Hospital Infection 2005;59:180-7.
MRSA was found in nasal swabs of 87 healthcare workers (HCWs), after contact with MRSA-positive patients. These HCWs were withdrawn from work, treated with topical antimicrobials and advised to disinfect bathrooms and personal hygiene articles, and to wash bed linen and pillows. Seventy-three (84%) HCWs lost their carrier status when tested after 3 days and up to 3 months. Environmental sampling detected contamination in 7/8 home environments of HCWs where eradication failed. When eradication was applied to household contacts and when household surfaces were cleaned and disinfected, the carriage cleared in most cases within a few weeks. When home environments are heavily contaminated, eradication took up to 2 years. The authors conclude that MRSA control measures for HCWs must include cleaning and disinfection of the home.

Prevalence of hospital-acquired infections in a homecare setting. Patte R., Drouvot V., Quenion J.L., Denic L., Briand V., Patris S. Journal of Hospital Infection 2005;59:148-51.
This study evaluated the prevalence of hospital-acquired infections (HAI) in patients undergoing a care procedure with an infection risk and who had been in homecare for >48 h on the day of the survey. Overall, 6.1% of patients had at least one HAI. The most common infection was urinary tract infection, followed by skin infection. E. coli, Staph aureus and Enterococcus species were the most predominant species.

How to prevent transmission of MRSA in the open community? Vandenesch F. Etienne. Journal of Eurosurveillance 2004; 9: 5.
Demographic characteristics of hospital-acquired (HA) MRSA infections differ from those of CA-MRSA, the former occurring mainly in elderly people and the latter occurring in young people. HA-MRSA infections are particularly associated with surgical wounds or intravenous indwelling catheters. CA-MRSA infections are mainly skin and soft tissue infections occurring in patients with no initial skin wounds. The Panton-Valentine leukocidin (PVL) produced by CA-MRSA strains represents, with its necrotic activity, one of the virulence factors possibly associated with cutaneous tissue destruction. These PVL-positive CA-MRSA are easily transmissible not only within families but also on a larger scale in community settings such as prisons, schools and sport teams. Skin-to-skin contact and indirect contact with contaminated towels, sheets, and sport equipment seem to represent the mode of transmission. The exact prevalence of CA-MRSA is still unknown. Isolates collected at hospitals certainly represent the tip of the iceberg. CA-MRSA strains have been detected in France, Switzerland, Germany, Greece, the Nordic countries, Australasia, Netherlands and Latvia. Where cases of skin and soft tissue infections have been observed in a close-living community of patients, therapeutic and infection control measures have proven successful in controlling the outbreak. The main question is how to prevent transmission of these strains in the open community.  

Salmonella enteritidis infections, United States 1985–1999. Patrick, M.E., Adcock, P.M., Gomez, T.M., Altekruse, S.F., Holland, B.H., Tauxe, R.V. and Swerdlow, D.L. Emerg Infect Dis 2004;10:1-7.
This papers examines the trends in S. enteritidis infection in the US from 1985 to 1999 based on surveillance data for sporadic infections and outbreaks reported to the Centers for Disease Control and Prevention (CDC). Overall, rates of sporadic S. enteritidis infection, outbreaks, and deaths have declined. Prevention and control strategies along the entire farm-to-table continuum, and a plan for further reduction of S. enteritidis infections are suggested.

Risk factors for infection with Giardia duodenalis in pre-school children in the city of Salvador, Brazil. Prado, M.S., Strina, A., Barreto, M.L., Olivera-Assis, A.M., Paz, L.M. and Cairncross, S. Epidemiol Infect 2003 Oct;131(2): 899-906.
This study of 694 children (aged 2-45mths) was carried out to identify environmental risk factors for infections with Giardia duodenalis. Variables studied included 3 social and demographic factors, 5 factors relating to the peri-domestic environment, 7 relating to the home and a score for hygiene behaviour based on structured observation. Prevalence of infection with G. duodenalis was nearly 14% (as identified from stool samples). Only 4 significant risk factors were found (i) number of children under 5yrs old in the household, (ii) rubbish not collected from the house, (iii) presence of visible sewage nearby, and (iv) absence of a toilet.

Indoor mold, toxigenic fungi and Stachybotrys chartarum: infectious disease perspective. Kuhn, D.M. and Ghannoum, M.A. Clinical Microbiology Reviews 2003;16:144-172
This review discusses indoor environmental mould exposure, with an emphasis on Stachybotrys and its toxins. It also discusses specific organ toxicity, focusing on illnesses allegedly caused by indoor mould. From their review of the available literature, the authors conclude they did not find any supportive evidence linking the presence of Stachybotrys in the environment with health concerns elaborated in the scientific and lay press.

Human campylobacteriosis in developing countries.  Coker, A.O., Isokpehi, R.D., Thomas, B.N., Amisu, K.O. and Obi, C.L. Emerging Infectious Diseases 2002;8:237-243. 
This paper presents epidemiologic and clinical features of Campylobacter enteritis in developing countries:

• Campylobacter is most common bacteria from <2-yr old children with diarrhoea in developing countries
• Poor hygiene/sanitation and close proximity to animals contribute to acquiring enteric pathogens.
• A study in Egypt showed that infection could be pathogenic regardless of the child’s age, highlighting the need for improving prevention and control strategies.

Verocytotoxin-producing Escherichia Coli (VTEC) 0157 and other VTEC from human infections in England and Wales: 1995-1998. Willshaw, G.A., Cheasty, T., Smith, H.R., O’Brien, S.J. and Adak, G.K. J Med Microbiol 2001;50:135-142.
Outbreaks of VTEC 0157 increased and involved 3 transmission routes: foodborne, person-to-person and animal contact. There was a peak of infections each year from July to September. The incidence of infection was highest in children aged 1-4 years. Although the numbers remain low compared with other GI pathogens such as salmonella, the potential severity of disease results in high patient morbidity.

Enteric and foodborne disease in children: a review of the influence of food and environment-related risk factors. Sockett, P.N. and Rodger, F.G. Paediatrics and Child Health 2001;6:203-209..
This review suggests that risk factors for infection in young children (aged <4yrs) are different that for older children and adults. Contact with animals or family pets and contaminated surfaces are important routes of infections for young children. The evidence presented emphasises the importance of personal and home hygiene practice in limiting children’s exposure to enteric pathogens.

Diarrhoea: a significant worldwide problem. Farthing, M.J.G. International Journal of Antimicrobial Agents 2000;14 (1)65-69.
It has been estimated that there may be as many as 4 billion cases of acute diarrhoea each year worldwide. Diarrhoea continues to be a problem in the developing and developed world. Several groups of individuals are at increased risk, e.g. infants, the elderly. The spectrum of organisms varies depending on the clinical setting.

Food-related illness and death in the United States Mead PS, Slutsker L, Dietz V, McCaig LF, Bresee JS, Shapiro V, Griffin PM and Tauxe RV. 
Emerging Infectious Diseases 1999;5:607-625.
From a compilation and analysis of multiple surveillance systems and information sources, it is estimated that foodborne diseases cause approx. 76 million illnesses, 325,000 hospitalisations and 5000 deaths in the US each year. Unknown agents account for 81% of foodborne illnesses and 64% of deaths. Among those due to known agents, Norwalk-like viruses account for over 67% of all cases, 33% of hospitalisations and 7% of deaths.

Study of infectious intestinal disease in England: rates in the community, presenting to general practice, and reported to national surveillance. Wheeler JG, Sethi D, Cowden JM, Wall PG, Rodrigues LC, Tompkins DS, Hudson MJ and Roderick PJ.
British Medical Journal 1999;318:1046-1050.
This English study investigates the incidence and aetiology of infectious intestinal disease in the community. Results reveal an estimated 9.4 million cases occurring in the community each year, i.e., 1 in 5 people each year, of whom only 1 in 6 (1.5 million cases) presents to a general practitioner.

Foodborne viral infections. Hale A.
British Medical Journal 1999;318:1433-1434.
An editorial highlighting that we need to know more about Norwalk-like viruses, as the epidemiology of foodborne outbreaks in the UK show a predominance of this group (also known as small round structured viruses).

Campylobacter jejuni – An emerging foodborne pathogen. Altekruse SF, Stern NJ, Fields PI and Swerdlow DL
Emerging Infectious Diseases 1999;5(1):28.
Campylobacter jejuni is the most commonly reported bacterial cause of foodborne infection in the US. Mishandling of raw poultry and consumption of undercooked poultry are the major risk factors for human campylobacteriosis.

Emerging and evolving microbial foodborne pathogens. Meng J and Doyle MP.
Bulletin De L’Institute Pasteur 1998;96:151-164.
A review of the epidemiology of important foodborne pathogens such as E. coli 0157, Salmonella typhimurium, Cryptosporidium and Campylobacter jejuni, concluding that changes in food processing, products and practices, and human behaviour will influence the emergence of foodborne pathogens into the next century.

Epidemiology of foodborne diseases: a worldwide review. Todd ECD.
World Health Statistics Quarterly 1997;50:30-50.
This worldwide survey shows that microbiological issues are key in all countries conducting foodborne disease surveillance programmes. Salmonella, S. aureus and the better recognised agents continue to plague most countries, and other emerging pathogens are presenting new challenges to the food industry and national authorities.

Memorandum on the threat posed by infectious diseases. Need for reassessment and a new prevention strategy in Germany. Rudolphe Schulke Foundation. 1996 Weisbaden: pmh-Verlag GmbH.
A working group memorandum assessing all available scientific data on the emergence of infectious diseases world-wide and in Germany.

Epidemic cholera in the new world: translating field epidemiology into new prevention strategies. Tauxe RV and Quick RE.
Emerging Infectious Diseases 1995;1(4).
A discussion document outlining the causes and the possible strategies to prevent further spread of cholera in Latin America.