It is believed that the emergence of new variants and the increase in outbreaks on cruise ships in 2006 may be the forewarning of a very active norovirus season in Europe during the winter of 2006/2007.

A survey of nine countries across Europe by the Foodborne Viruses in Europe network (FBVE) reported in Eurosurveillance ( http://www.eurosurveillance.org/ew/2006/061214.asp#1/ ) indicated an increase in norovirus activity (outbreaks and/or case reports) in October and/or November 2006 compared with the same period in 2004 and 2005 (see Table). In two countries ( France and Spain ), no increase in activity was found. Unusually high activity already in summer 2006 was reported by the Hungarian authorities (thought to be due to a drinking water related outbreak) as well as The Netherlands, Denmark , Ireland , Finland and Norway . The highest increases were reported in Norway , Hungary and in England and Wales ; for England and Wales the number of outbreaks reported was 768, compared with 374 outbreaks in the previous period of peak activity in 2004.

Table - Reports of norovirus cases and outbreaks across Europe , as provided by an e-mail survey. Numbers of reports in the e-mail survey were partly estimates.

2 - Data from Valencia and Catalonia
3 - Outbreaks reported from virus reference laboratory only. Laboratory data are from England and Wales , these data will include outbreaks and sporadic cases.

The data suggests that most outbreaks were due to genotype G.II 4, which has been the predominant genotype in recent years. New variants of genotype GII.4 2006 appeared during the 2005/2006 season, and became predominant in summer 2006. In the spring of 2006, this variant was found to be circulating widely, causing at least 45 outbreaks on cruise ships sailing across Europe . The prediction that 2006/2007 may be a very active norovirus season is based on observations in 1996, 2002 and 2004, when the appearance of new variants within genotype GII.4 coincided with high levels of outbreak reporting worldwide. The different country reports indicate that the norovirus season has already started in most areas.

Indications are that noroviruses are now the single most significant cause of infectious intestinal disease in the developed world, both outbreak-related and endemic. Although airborne transmission is possibly the most significant cause of the rapid person-to-person infection which occurs during an outbreak, the data suggests that good hygiene to prevent transmission via hands and via hand and food contact surfaces, also plays a key role in reducing the risks of spread, particularly for sporadic and family-related cases in the community.

Norovirus-related gastroenteritis has reached a record high level, according to the Japanese National Institute of Infectious Diseases. Some 3,000 medical institutions across Japan reported they treated 65,638 infected patients between 27 November and 3 December 2006, a record high average of 21.8 per institution, compared with 19.8 logged in the preceding week, also a record since the survey began in 1981. Experts warn that gastroenteritis normally peaks from late December and fear the worst of the outbreak may be yet to come. Since late October, gastroenteritis cases have been double those of regular years. Gastroenteritis symptoms normally disappear after a couple of days, but it has led to fatalities among the elderly in Osaka and Nara prefectures. Previously, the virus has typically been transmitted by eating raw oysters and clams, but this season's epidemic comes mostly from human-to-human infections. Experts suggest the current trend can best be explained by a possible outbreak of a new virus variant. It is currently categorised into genogroup I (GI), containing 15 genotypes, and genogroup II (GII), containing 18 genotypes. GII.4 viruses are now sweeping across the globe, including Japan . It is not clear whether the outbreak in Japan is linked to outbreaks in Europe . For more data go to ProMED-mail post:
http://www.oloep.org/news.asp?id=650 ,
Japan Today: http://www.japantoday.com/jp/news/393947 and the following sites:
http://idsc.nih.go.jp/iasr/26/310/tpc310.html and www.oloep.org/news.asp?id=650

The National Resource for Infection Control (NRIC ) web initiative was launched in May 2006 and is an ongoing project developed by UK infection professionals, aimed at being a single access point to the existing evidence base and resources for infection prevention and control. It is freely available to all healthcare professionals, other public health specialists and to anyone with an interest in this important area of infection prevention and control ( http://www.nric.org.uk ). This project is funded by the Department of Health ( England ) and endorsed by the National electronic Library of Infection (NeLI), which brings together the best available online evidence-based, resources on the investigation, treatment, prevention and control of infectious diseases. It includes scientific reviews, reports, guidelines and other resources, which can be used to develop and promote evidence-based hygiene practice. The information ranges from the control of foodborne diseases in the community to the management and prevention of healthcare-associated infections in healthcare settings. NeLI acts as an “umbrella” website for NRIC and other infection training and resources ( http://www.neli.org.uk ).

NRIC features infection prevention and control policy and guidance documents and evidence-based information. The data are organised by settings, clinical practice tasks, modes of transmission and diseases or organisms. The level of evidence for each resource, and its regional coverage is indicated. Resources are quality appraised. For each resource, the level of evidence and its regional coverage are indicated. Resources are quality appraised, and many resources have a full review by infection professionals .

The development of NRIC has progressed well, and feedback on content and ease of use of the resource, from infection control professionals has been positive Further development of the site is planned with the inclusion of the UK four country policy perspectives and the addition of international evidence where UK research is not available.

Although the site contains primarily UK-based policy, guidance and research, the concept will be of interest in this era of global challenges in infection prevention which dictate a need for international collaboration. The value of this project is demonstrated by the fact that the NRIC website already receives over 8,100 hits per month. The number of unique visitors per month is about 1,000 from UK health professionals and an additional 800 visitors from other countries, most particularly from the USA (around 400) and also other European and Asian countries.

In the past 10 years, both in North America and across Europe , changes in policy for the delivery of healthcare together with social and demographic changes have meant that the number of people at home needing special care, either because they are a source of infection, or at increased risk of infection has significantly increased. Since the trend towards “care in the community” is likely to continue, better education for these people and their carers is needed to ensure homecare is not accompanied by an increase in infectious disease risks, otherwise cost savings are likely to be overridden by additional costs of re-hospitalisation. This new resource, the Home Hygiene Toolkit is an educational, interactive resource for carers (including community nurses and health visitors as well as professional carers) to use in consultations with patients who need advice on hygiene practices in the home setting. A unique feature of the toolkit is that it uses as its starting point, the range of risk situations where carers may be called upon for advice on reducing the risk of infection, allowing the user to tailor their advice to specific situations. It comprises a comprehensive guide for carers providing the information needed to understand and to deal with individual risk situations, together with a patient demonstration flipchart designed to help carers discuss the problem with the patient and/or their family. The toolkit contains practical hygiene advice based on the “targeted hygiene” approach pioneered by IFH. All the evidence now suggests that giving hygiene advice to families when they most need it makes sense. If families are motivated to adopt good habits when they know the risks are high, there's a good chance they can be encouraged to make them part of their daily routine. Not only should this help reduce the incidence of infectious disease overall, but it can make families more self-reliant and able to cope by adapting their knowledge appropriately when new problems arise. This new resource has been developed by Domestos in collaboration with independent hygiene experts and can be obtained by contacting Linsday Breeson at Cohn & Wolfe, 30 Orange Street, London WC2H 7LZ (Tel 0207 331 2327) or by emailing: Domestos@cohnwolfe.com .

In our previous newsheet (July 2006) we featured an article on the work of Waterkyn and Cairncross from the London School of Hygiene and Tropical Medicine who, through studies with rural communities in Zimbabwe, have demonstrated the impact of hygiene promotion through community health clubs (CHCs) as an effective means of achieving hygiene behaviour change, creating demand for sanitation, and taking it to scale. Their work is a response to growing awareness that, unless strategies are found to galvanise rural communities and create a demand for sanitation, the MDG of halving the 2.4 billion people without sanitation by the year 2015 is not achievable. Their work is described in more detail in a summary paper in the IFH home hygiene library.

Africa AHEAD Association has registered in South Africa to provide assistance to other organisations or government ministries to develop a health promotion campaign using the CHC approach. A train ing module is now available to enable the application of this approach in other communities. Although the approach was initially applied to rural areas it is being used even more effectively in high density urban settings such as in informal settlements in South Africa and refugee (IDP) camps in Uganda . It provides guidelines for planners looking for a practical methodology for conducting a health promotion project through community hygiene clubs at district level. The manual gives guidance on how to set up and run health clubs, and on the development of training materials and training of health workers. The manual entitled “District Health Promotion using the consensus approach” can be downloaded from www.africaahead.com or by contacting Juliet Waterkyn at juliet@africaahead.com

This issue of the British Food Journal edited by Professor Chris Griffith and Dr. Elizabeth Redmond describes studies on consumer food safety education, many of which were funded by the UK Food Standards Agency in order to inform food hygiene education initiatives in the UK. As far as school education is concerned, a national study of teachers’ views indicated that food hygiene is taught in a number of subject areas, within UK primary schools with hand washing and personal hygiene being the principal topics. Teachers use a combination of methods to teach food hygiene and reinforce food safety messages, but lack of suitable space and curriculum time and the need for new resources to support teaching food hygiene were identified as key problems. A study of food hygiene knowledge and self-reported behaviours of UK school children (4-14 years) identified areas of weakness in pupils’ hygiene knowledge and understanding, and highlighted barriers to the adoption of desirable behaviours. The study suggested ways in which food hygiene education could be made more engaging for pupils. In another study consumer food safety education provided by UK local authorities was assessed. The study provided evidence of a large quantity of unique and diverse intervention materials across the UK, and suggests the need for the sharing of information materials and areas of innovation between local authorities. Provision of generic, managed and co-ordinated general and targeted food safety education resources in the UK could not only reduce time and financial costs within local authorities, but also increase consumer confidence in the information provided, and alleviate the risk for potential confusion of information from differing sources.

In recent decades, the prevalence of allergic diseases in childhood has increased considerably, especially in western industrialised countries. This 2006 thesis by Dr. Schram-Bijkerk describes the results of the PARSIFAL project (Prevention of Allergy - risk factors for sensitisation in children related to farming and anthroposophic lifestyle) which focused on two groups of children with relatively low prevalence of atopic diseases and sensitisation: farm children and children of families with an anthroposophic lifestyle. Contact with farm animals has been associated with reduced risk of atopic disease, which might be due to exposure to microbial compounds. The anthroposophic way of life involves certain characteristics, such as restrictive use of antibiotics, antipyretics and vaccinations, as well as certain dietary habits, which also might be negatively associated with atopic disease. The main objectives of the study were (1) to investigate whether differences in atopic disease prevalence between farm children or children from anthroposophic families and respective references, as observed previously, could be confirmed in a large population of children from five European countries and (2) to explore factors which might explain the lower prevalence of atopic diseases in these children. From the results, it was concluded that microbial agent levels in house dust may partly account for the protective effect of living on a farm to atopy and/or wheeze. The protective effect of an anthroposophic lifestyle could not be explained by microbial agent levels, and the relatively low prevalence of atopic diseases in these groups could not be attributed to lower pet or mite allergen levels. It was also concluded that higher pet allergen levels, as observed in the homes of the children, could be related to the lower prevalence of atopic diseases, but this seems unlikely in view of conflicting literature on this topic. The thesis is published by the University of Utrecht, Netherlands ISBN-90-393-4126-5.

A new study by Flohr et al supports the hypothesis that the lack of exposure to gut parasites is a key cause of the immune dysregulation which enhances susceptibility to atopic diseases such as eczema, asthma and hay fever. Gut parasites, such as hookworm, evolved together with their human hosts for millions of years. Over time, these parasites have developed ways of surviving in the human gut by “turning down” the immune response directed against them, prolonging survival inside the host and, at the same time, reducing the allergic tissue reactions that characterise asthma and other allergic conditions. Flohr et al examined the links between worm infestation and allergic diseases in 1,600 Vietnamese children aged 6-18, and found that those with the highest level of hookworm infestation were least likely to have an allergic response to house dust mites. These findings add further weight to the “hygiene hypothesis” which proposes a link between “infection” and reduced sensitivity to atopic disease. More recently, Flohr et al have conducted an intervention study in the same population, during which they regularly de-wormed schoolchildren, to see whether this increased prevalence of allergic diseases. The results of this study will be published early next year. The 2006 study is published in Journal of Allergy and Clinical Immunology 2006;118:1305-11.

An analysis, presented in the 2006 Disease Control Priorities Project (DCPP) publication disease Control Priorities in Developing Countries” (2nd edn) has shown that, for the “high burden” diseases such as HIV/AIDS, Malaria, diarrhoeal disease and TB, hygiene promotion is the most cost-effective intervention in terms of DALYs averted (up to $3.35 per DALY averted due to diarrhoeal disease compared with, for example, up to approx $1,000 per DALY averted by anti-retroviral treatment of HIV/AIDS). The DCCP is an ongoing project to assess disease control priorities and produce evidence-based analysis and resource materials to inform health policy makers in developing countries. The DCCP is a joint enterprise of a number of organisations including the World Bank and WHO, and is funded by the Gates Foundation. DCCP highlights cost-effective interventions based on the analysis of health systems, the costs of disease burden, treatment and prevention for a comprehensive range of diseases and conditions including tobacco, alcohol, psychiatric disorders, and injury, as well as communicable diseases. The information on cost effectiveness of hygiene promotion comes is contained in Chapter 41, which has been prepared by Cairncross and Valdmanis. In this chapter they evaluate the available evidence on the health impact and cost effectiveness, in terms of $ per DALY averted, of water, sanitation and hygiene promotion. The publication can be downloaded from: www.dcp2.org/pubs/DCP

As a follow-up to the launch of the first Global Patient Safety challenge “Clean Care is Safer Care” in October 2005, the WHO World Alliance for Patient Safety organised a meeting in Geneva in November 2006 to review progress. A total of 22 countries representing 55% of the world’s population have now signed up to the Global Patient Safety Challenge. At the November meeting, seven countries and regions - Bangladesh, Hong Kong SAR, Gulf Cooperation Council (GCC) States, Ireland, Italy, Scotland, Spain - reported on their first year of achievements and 13 more countries - Australia, Belgium, Bhutan, Bulgaria, Costa Rica, Germany, Kenya, Finland, Luxembourg, Singapore, Sudan, Uganda and the USA - pledged their commitment to the initiative. The aim of the alliance is to implement action to reduce the spread of infection in healthcare settings and share learning internationally. The theme of the current Patient Safety Challenge for 2005-2006 is “Clean Care is Safer Care” with a particular emphasis on hand hygiene. The current emphasis on hand hygiene includes testing implementation of the WHO Guidelines on Hand Hygiene in Health Care (Advanced Draft) in specific districts worldwide. More details can be found at: http://www.who.int/gpsc/en/

A training workshop in values-based home hygiene and sanitation was organised in Yaounde–Cameroon on 18 November 2006 by BetterWorld Cameroon (BWC) to train community health workers on the most appropriate approaches to introducing remedial measures to the critical issues of water, sanitation and hygiene (WASH) within urban and rural poor communities. The workshop came up with a strategic implementation and monitoring system related to the attainment of the MDGs in Cameroon. It assessed the feasibility of community health clubs (CHCs) as a model for participatory training as well as monitoring and evaluation of WASH in Cameroon. The session was attended by high-level experts drawn from the Ministerial Departments of Health, Environment and Nature Protection, Energy and Water Resources, Housing and Agriculture. BWC was registered as a charity in Cameroon in 1996 in order to link local initiatives with sustainable development.

© UNICEF/HQ94-1315/Pirozzi - A garbage-strewn beach in Cameron. The West and Central Africa region has the world’s lowest water and sanitation coverage and its highest under-five mortality rate

Since its creation, it has organised several training workshops to enlighten youth and women about WASH malpractices which hinder socio-economic progress. The recent workshop presented an excellent opportunity for the development of a communication strategy for sustainable management of the WASH Cameroon Action Pan which promotes Cameroon’s strong community development culture based on African solidarity. A network of young graduates was formed to use the BWC Learning Resource Centre to provide access to up-to-date materials and information on WASH best practices and to take practical action with the launch of a CHC in the near future. BWC has evaluated the IFH resource “Home Hygiene - prevention of infection at home: developing country situations - a training resource on hygiene for teachers, community nurses, community workers and other health professionals” and adopted it as a teaching resource for a series of upcoming WASH workshops planned for local community groups. Joshua Konkankoh. Project director BWC betterworld2000@yahoo.co.uk.

BWC Students speak out on poor Hygiene & Sanitation conditions and call for concerted public action in Planning, Implementing, Monitoring & Evaluating WASH with the Active Involvement of Youth & the Community.

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.

his 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. http://www.eurosurveillance.org/ew/2006/061130.asp.

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.

Identity and numbers of bacteria present on tabletops and in dishcloths used to wipe down tabletops in public restaurants and bars. Yepiz-Gomez M.S., Bright R.K., Gerba P.C. Food Protection Trends, 2006; 26, 24-30.

Survey of Salmonella contamination of non-UK produced shell eggs on retail sale in the north west of England and London . Commun Dis Rep CDR Wkly 2006; 16(46): news.

Since 2002, the emergence of egg-associated S. Enteritidis phage types other than PT4 causing human infection has taken place in the United Kingdom, with the greatest increases occurring in S. Enteritidis PT1 and PT14b [4,5]. A survey of Salmonella contamination of non-UK eggs on retail sale over a period of 16 months, between March 2005 and July 2006, showed that 157 (9.0%) samples were contaminated with Salmonella on the shell of the egg. This equates to an estimated prevalence of 3.3%; equivalent to 1 in every 30 ‘boxes' of 6 eggs. Of these 157 samples, S. Enteritidis were detected in 136. The eggs sampled were produced in eight European countries, with most (66.3%) originating from Spain . Of the 157 Salmonella shell-positive samples, 10 were also contents-positive.

How long do nosocomial pathogens persist on inanimate surfaces? A systematic review. Kramer A., Schwebke I. , Kampf G. BMC Infectious Diseases 2006, 6:130 doi:10.1186/1471-2334-6-130. http://www.biomedcentral.com/1471-2334/6/130.

A systematic review of the literature shows that common nosocomial pathogens can survive on surfaces for months and thereby be a continuous source of infection transmission. Gram+ve bacteria, such as Enterococcus spp. Staph. aureus (including MRSA), or Strep. pyogenes , survive for months on dry surfaces. Gram -ve species, such as Acinetobacter spp, E. coli , Klebsiella spp., P.aeruginosa or Shigella spp. can also survive for months. A few others, such as H. influenzae , or Vibrio cholerae , however, persist only for days. Mycobacteria, including Mycobacterium tuberculosis , and spore-forming bacteria, including Cl. difficile , can survive for several months whilst Candida albicans can survive up to 4 months. Viruses from the respiratory tract, such as corona , coxsackie , influenza , SARS or rhino virus, can persist on surfaces for a few days whilst viruses from the GI tract, such as astro virus, HAV , polio- or rota virus, persist for approximately 2 months. Blood-borne viruses, such as HBV or HIV, can persist for more than 1 week, and Herpes viruses persist from only a few hours up to 7 days.

Systematic risk assessment methods for the infection control professional. Larson E., Aiello A.E. Am J Infect Control 2006; 34:323-6.

Handwashing and risk of respiratory infections: a quantitative systematic review. Rabie T., Curtis V.. Tropical Medicine and International Health, 2006; 11 258-267

An evaluation of 8 eligible studies (from a primary list of 410 articles) showed that handwashing lowered risks of respiratory infection, with risk reductions ranging from 6% to 44% [pooled value 24% (95% CI 6–40%)]. Pooling the results of only the seven homogenous studies gave a relative risk of 1.19 (95% CI 1.12%–1.26%), implying that hand cleansing can cut the risk of respiratory infection by 16% (95% CI 11–21%). However, studies were of poor quality, none related to developing countries, and only one to severe disease.

Effectiveness of handwashing in preventing SARS: a review. Chun-Hai Fung I. , Cairncross S . Tropical Medicine and International Health, 2006; 11 1749-1758 .

This review examines data literature on the effectiveness of handwashing as an intervention against SARS transmission. Nine of 10 studies showed that handwashing was protective against SARS when comparing infected cases and non-infected controls, but only in 3 studies was this result statistically significant. There is reason to believe that this is because most of the studies were too small. The authors conclude that the evidence for the effectiveness of handwashing as a measure against SARS transmission in health care and community settings is suggestive, but not conclusive.

Review of Aerosol Transmission of Influenza A Virus. Tellier R. Emerging Infectious Disease s 2006 ; 12, 1657-1662 .

Salmonella Enteritidis in Broiler Chickens, United States, 2000–2005. Altekruse S.F., Bauer N., Chanlongbutra A., DeSagun R., Naugle A. Emerging Infectious Diseases 2006 ; 12, 1848-1852 .

Gastroenteritis and Transmission of Helicobacter pylori. Infection in Households. Perry S., de la Luz Sanchez M., Yang S., Haggerty T.D., Hurst P., Perez-Perez G. and Parsonnet J. Emerging Infectious Diseases 2006, 12, 1701-1208 .

Inoculum Size Influences Bacterial Cross Contamination between Surfaces. Montville R., Schaffner D.W. Applied and Environmental Microbiology, Dec. 2003, p. 7188–7193 Vol. 69, No. 12.

A study of transfer between surfaces showed that the effect of inoculum size on transfer rate was highly statistically significant for all transfer rate data, except for data on contamination via transfer from chicken to hand through a glove barrier. Where inoculum size was greater, transfer rates were lower, and where inoculum size was less, transfer rates were higher. The negative linear trend has serious implications for research seeking to determine bacterial cross contamination rates, since transfer efficiencies that were previously shown to be associated with certain activities may actually be the result of differing initial inoculum levels.

Bacterial transfer and cross-contamination potential associated with paper-towel dispensing. Harrison W.A., Griffith C.J., Ayers T. and Michaels B. American Journal of Infection Control 2003; 31: 387-391 .

The Efficacy of Disinfectants against Staphylococcus aureus ITU Isolates including Methicillin-Resistant S. aureus. Williams G.J.,Denyer S.P., Hosein I.K., Jenkins D.E., Maillard J.-Y. J Hospital Infection, 2006, 64, supplement 1, P6.06.

Susceptibility of Germinating Clostridium difficile Spores to 70% Ethanol. Wheeldon L.J., Worthington T., Hilton A.C. , Lambert P.A., Elliott T.S.J. Journal of Hospital Infection 2006, 64, supplement 1, P9.01.

Efficacy of solar disinfection of Escherichia coli , Shigella flexneri , Salmonella Typhimurium and Vibrio cholerae . Berney M., Weilenmann H.-U., Simonetti A. and Egli T. Journal of Applied Microbiology 2006, 101 828-836.

Resistance to sunlight at 37°C based on F 99 values was in the following order: Salmonella Typhimurium > Escherichia coli > Shigella flexneri > Vibrio cholerae . The applicability of the reciprocity law indicates that fluence rate plays a secondary role in SODIS efficacy. Stating inactivation efficacy with T 90 or F 90 values without showing original data is inadequate for SODIS studies.

The use of microbiocides in infection control: a critical look at safety, testing and applications. Sattar S.A. Journal of Applied Microbiology 2006 ; 101 743-753 .

Preventing Healthcare Associated Infections: The Role of Chlorine Products in Risk Reduction. Soule B.M. A publication of the water quality and health council to the chlorine chemistry Council.

Possible hazards of hypochlorite disinfection for feeding equipment for premature infants. Price E., Awadel-Kariem F.M. , Hateley P. , Harvey J. , Gilks J., Kempley S. Journal of Hospital Infection 2006; 64:90-92.

Food hygiene knowledge and self-reported behaviours of UK school children (4-14 years). Eves A., Bielby G., Egan B., Lumbers M., Raats M., Adams M. British Food Journal 2006 ; 108 706 - 720 .

Food hygiene education in UK primary schools: a nation-wide survey of teachers' views. Bielby G., Egan B., Eves A., Lumbers M., Raats M., Adams M. British Food Journal 2006 ; 108 721 – 731 .

Assessment of consumer food safety education provided by local authorities in the UK . Redmond E.C., Griffith C.J. British Food Journal 2006 ; 108 732 – 752 .

A considerable quantity of food safety advice is provided to UK consumers. The materials etc are unique and diverse, and suggests a need for sharing of materials and areas of innovation between local authorities. Provision of generic, managed and co-ordinated food safety education resources in the UK may not only decrease time and financial costs, but also increase consumer confidence in the accuracy of information provided and alleviate potential confusion of information from differing sources.

A pilot study to evaluate the effectiveness of a social marketing-based consumer food safety initiative using observation. Redmond E.C., Griffith C.J. British Food Journal 2006; 108 : 753 – 770.

The extension programme and food safety education in the USA . Singleton J., Hillers V. British Food Journal 2006; 108: 771 – 774 .

Observation of food safety practices using notational analysis. , Clayton D ., Griffith C.J. British Food Journal (2004), 106(3 ): 211-227.

Microbiological and observational analysis of cross contamination risks during domestic food preparation. Redmond E.G., Griffith C. J., Slader J. and Humphrey T. (2004). British Food Journal. 106: 581-597.

An observational approach in conjunction with isolation techniques for campylobacter and salmonella facilitated evaluation of the risk of cross contamination during food preparation. Identification of suspected exposure routes linked naturally contaminated raw foods with important food-handling malpractices, contaminated contact surfaces and ready-to-eat foods. In a model domestic kitchen, 29% of food preparation sessions resulted in positive campylobacter isolations from prepared salads, cleaning materials and food-contact surfaces. Typing showed that campylobacter strains isolated from prepared chicken salads were the same as strains isolated from the raw chicken pieces, indicating transfer during food preparation.

An Investigation of the Factors Underlying Consumers' Implementation of Specific Food Safety Practices. Clayton D ., Griffith C.J. and Price P. British Food Journal. 2003; 105 : 434-453.