The surveillance of vero cytotoxin-producing Escherichia coli O157 in Wales, 1990 to 1998.

Population-based surveillance for Vero cytotoxin-producing Escherichia coli (VTEC) O157 has been carried out in Wales since 1990. The annual incidence has remained stable during the 9-year period (mean: 1.6 cases per 100,000 population); the rate is highest in children younger than 5 years of age. Blood in the stool is reported in fewer than half the cases, indicating the importance of screening all fecal specimens for VTEC O157

Ability of enteroaggregative Escherichia coli strains to adhere in vitro to human intestinal mucosa

A collection of 44 enteroaggregative Escherichia coli (EAggEC) strains isolated from infants with diarrhea in India and the United Kingdom were examined for their ability to adhere in vitro to human intestinal mucosa and by electron microscopy for production of putative adherence factors. None of the strains adhered to human duodenal mucosa, and six strains tested did not adhere to ileal mucosa; all 44 strains, however, adhered to human colonic mucosa in localized aggregates. Electron microscopy of infected colonic mucosa indicated fimbrially mediated adhesion of the EAggEC strains. Four morphologically distinct kinds of fimbriae, including a new morphological type of E. coli fimbriae consisting of bundles of fine filaments, were identified among the EAggEC strains; this new type of fimbria was observed in 43 of the 44 EAggEC strains. Forty-three of the 44 EAggEC strains were positive with a DNA probe developed to identify EAggEC, and most of the strains belonged to serotypes unrelated to the other major classes of diarrheic E. coli. These results suggest that EAggEC may be a large-bowel pathogen and colonize the colon by a fimbrially mediated adhesion mechanism

Fish as Reservoirs and Vectors of Vibrio cholerae

Vibrio cholerae, the etiologic agent of cholera, is autochthonous to various aquatic environments, but despite intensive efforts its ecology remains an enigma. Recently, it was suggested that copepods and chironomids, both considered as natural reservoirs of V. cholerae, are dispersed by migratory waterbirds, thus possibly distributing the bacteria between water bodies within and between continents. Although fish have been implicated in the scientific literature with cholera cases, as far as we know, no study actually surveyed the presence of the bacteria in the fish. Here we show for the first time that fish of various species and habitats contain V. cholerae in their digestive tract. Fish (n = 110) were randomly sampled from freshwater and marine habitats in Israel. Ten different fish species sampled from freshwater habitats (lake, rivers and fish ponds), and one marine species, were found to carry V. cholerae. The fish intestine of Sarotherodon galilaeus harboured ca. 5×103 V. cholerae cfu per 1 gr intestine content—high rates compared with known V. cholerae cfu numbers in the bacteria's natural reservoirs. Our results, combined with evidence from the literature, suggest that fish are reservoirs of V. cholerae. As fish carrying the bacteria swim from one location to another (some fish species move from rivers to lakes or sea and vice versa), they serve as vectors on a small scale. Nevertheless, fish are consumed by waterbirds, which disseminate the bacteria on a global scale. Moreover, V. cholerae isolates had the ability to degrade chitin, indicating a commensal relationship between V. cholerae and fish. Better understanding of V. cholerae ecology can help reduce the times that human beings come into contact with this pathogen and thus minimize the health risk this poses

Agricultural, socioeconomic and environmental variables as risks for human verotoxigenic Escherichia coli (VTEC) infection in Finland

<p>Abstract</p> <p>Background</p> <p>Verotoxigenic <it>E. coli </it>(VTEC) is the cause of severe gastrointestinal infection especially among infants. Between 10 and 20 cases are reported annually to the National Infectious Disease Register (NIDR) in Finland. The aim of this study was to identify explanatory variables for VTEC infections reported to the NIDR in Finland between 1997 and 2006. We applied a hurdle model, applicable for a dataset with an excess of zeros.</p> <p>Methods</p> <p>We enrolled 131 domestically acquired primary cases of VTEC between 1997 and 2006 from routine surveillance data. The isolated strains were characterized by virulence type, serogroup, phage type and pulsed-field gel electrophoresis. By applying a two-part Bayesian hurdle model to infectious disease surveillance data, we were able to create a model in which the covariates were associated with the probability for occurrence of the cases in the logistic regression part and the magnitude of covariate changes in the Poisson regression part if cases do occur. The model also included spatial correlations between neighbouring municipalities.</p> <p>Results</p> <p>The average annual incidence rate was 4.8 cases per million inhabitants based on the cases as reported to the NIDR. Of the 131 cases, 74 VTEC O157 and 58 non-O157 strains were isolated (one person had dual infections). The number of bulls per human population and the proportion of the population with a higher education were associated with an increased occurrence and incidence of human VTEC infections in 70 (17%) of 416 of Finnish municipalities. In addition, the proportion of fresh water per area, the proportion of cultivated land per area and the proportion of low income households with children were associated with increased incidence of VTEC infections.</p> <p>Conclusions</p> <p>With hurdle models we were able to distinguish between risk factors for the occurrence of the disease and the incidence of the disease for data characterised by an excess of zeros. The density of bulls and the proportion of the population with higher education were significant both for occurrence and incidence, while the proportion of fresh water, cultivated land, and the proportion of low income households with children were significant for the incidence of the disease.</p

A comparison of attendance for drug misuse to Dublin accident and emergency departments 1985-1993.

The figures available from the NDTRS in 1991-1992 indicate that the level of opiate misuse has increased after previous years of stabilisation. This study attempts to make a comparison between attenders at Accident & Emergency departments in 1993 and those who attended in 1985. The study also seeks to determine if the increase in opiate users seen in the drug treatment system is reflected in the numbers attending A & E departments. A questionnaire was administered by a trained A & E staff member to patients who presented in a four week period from 1 April 1993 to 28 April 1993 to the eight A & E department in the greater Dublin area. Individuals attending were judged by the attending doctor to have, in the past 6 months; experimented with drugs, abused drugs or be drug dependent. Information obtained included: socio-demographic details and the names of various misused drugs. The results for misused drugs were analysed using the Chi-squared Test. 68 drug misusers attending eight A & E departments were identified in the four week period. Physical problems associated with drug misuse were the most common cause for attendance, followed by drug over dose and deliberate self-harm. Drug use was intentional in 66.7% of the females and 50% of the males. Although the numbers attending were similar, the recent survey show the total number of drugs misused (260) compared with previous reports (140) is much higher. 38 subjects admitted to injecting a variety of drugs in this survey, compared to 43 subjects in 1983. Patients in 1993 have reported that they are using more drugs per person than in 1983. There is an increased misuse of prescribed drugs, and Benzodiazepines have become the major drug of misuse among males and females. Use of these minor tranquillisers can lead to behavioural dis-inhibition and memory impairment. There has also been an increase in the misuse of prescribed opiates such as methadone and morphine sulphate. The most noticeable trend emerging from this study is the rise in poly substance misuse and the increasing misuse of prescribed medication such as Benzodiazepines and methadone

Fiscal Transition in Countries of the Former Soviet Union

This paper reviews the uneven record of fiscal performance in the states of the former Soviet Union since independence. Deficits have come down rapidly, an important contribution to stabilization. Given, however, the unexpectedly severe revenue decline and limited financing, the stabilization was reached by sharp cuts in expenditure. The cuts were abrupt and not focused on transition goals, and the instruments used vitiated normal budgetary processes. Hence, benchmarks of fiscal success other than stabilization are elusive. Government intervention and subsidies remain important, social spending is inefficient, and there is little evidence in the budget of restructuring.