As a part of an intervention project, all detected carriers of penicillin-resistant pneumococci (PRP) (MIC, > or = 0.5 mg/L) in Malmöhus County, southern Sweden, were followed by means of weekly nasopharyngeal cultures. The median duration of carriage in 678 individuals was 19 days (range, 3-267 days). The duration of carriage was longest in children < 1 year old (median, 30 days) and shortest in adults > 18 years old (median, 14 days). Index cases, whose cultures were performed during an acute infection, were carriers for a mean of 10 days longer than asymptomatic contact cases (P < .05). The PRP spontaneously disappeared from the nasopharynx within 4 weeks in 68%, within 8 weeks in 87%, and within 12 weeks in 94% of the individuals. Other significant risk factors for prolonged carriage were the occurrence of > 6 episodes of acute otitis media (AOM) or first episode of AOM before the age of 1 year (P < .01), the carriage of PRP by other family members (P < .05), and the obtainment of a first positive culture during the winter months (P < .05).

Human lymph was collected from patients with leaking lymph vessels after thoracic surgery. Ovine lymph was obtained from the mesenteric, lumbar, popliteal and prescapular lymph ducts by cannulation. The concentration of hyaluronate varied considerably (between 0.2 and 50 mg/l) and the highest concentrations were found in mesenteric lymph. The Mr of the polysaccharide showed a great polydispersity and variation between individuals and in different regions of the lymphatic system. High-Mr hyaluronate (greater than 10(6) was present in lymph both from man and sheep. Hyaluronate was also isolated by affinity chromatography in 70-80% yield from human serum and plasma obtained from healthy individuals and patients with rheumatoid arthritis and primary biliary cirrhosis. The weight (Mw)- and number (Mn)-average relative molecular masses were roughly the same in the three groups [(1.4-2.7) X 10(5) and (2.1-5.7) X 10(4) respectively]. The low Mr of hyaluronate in blood compared with that in lymph is explained by a preferential uptake of the large molecules by the liver endothelial cells.

HIV-1 can be subdivided into at least nine genetic subtypes (A through H and O), but in Europe and the United States there is an almost complete dominance of subtype B. In this study three Swedish HIV-1 transmission chains of subtypes other than subtype B have been biologically and molecularly characterized. The three index cases were African men. The p17 gag and env V3 regions of the HIV-1 genome were directly sequenced from uncultured lymphocytes. Phylogenetic analyses showed that the HIV-1 variants with each transmission group were genetically closely related, supporting the epidemiological information. The individuals in transmission groups I (n = 3) and II (n = 2) carried subtype G and D virus, respectively. Interestingly, all four individuals in transmission group III displayed a recombinant genotype with subtype D p17 gag sequence and subtype A V3 sequence. The biological phenotype of virus isolates (rapid/high, syncytium-inducing; or slow/low, non-syncytium-inducing) correlated with the clinical stage of the infected individual. The study also suggested that the correlation between biological phenotype and V3 genotype that has been established for subtype B HIV-1 variants may be valid also for other subtypes. This study demonstrates that HIV-1 variants of subtypes other than B, including a subtype A/D recombinant, are being transmitted in Europe.

As part of the South Swedish Pneumococcal Intervention Project, aimed at reducing the spread of penicillin-resistant pneumococci with MICs for penicillin G > or =0.5 mg/l (PRP), all patients in Malmöhus county, southern Sweden, with a culture positive for PRP were followed up by means of repeated nasopharyngeal cultures until PRP-negative. If a child carrying PRP attended a day-care centre, nasopharyngeal cultures were obtained from the other children and staff. All children screened for PRP carriage in 30 day-care centres with an identified index case were included in the analysis, and several outcome variables (antibiotic consumption during the preceding 6 months, previous health and social situation) were assessed in relation to the end-point PRP carriage. Of 1036 children, 128 were found to be PRP carriers and 908 were PRP non-carriers. The PRP carriers had higher antibiotic consumption, were younger and were more often of male sex than the non-carriers (P<0.05). Consumption of antibiotics during the preceding 6 months was noted in 53% of carriers and 45% of non-carriers (relative risk 1.20, 95% confidence interval 1.01-1.43). When adjusting for age, gender and day-care centre attendance, recent consumption of cotrimoxazole (trimethoprim/sulfamethoxazole) emerged as an independent risk factor for PRP-carriage (relative risk 3.48, 95% confidence interval 1.10-11.07). The PRP-carriage rate in three day-care centres with high cotrimoxazole consumption was significantly higher (24%) than in the other day-care centres (10%) (P<0.005). The results indicate that measures aimed at reducing consumption of antibiotics in general, and cotrimoxazole in particular, may decrease the incidence of penicillin resistance, but such measures are, by themselves, probably not sufficient to halt the spread.

In an attempt to limit the spread of penicillin-resistant pneumococci (PRP), an intervention project was initiated in the Malmöhus County, southern Sweden in January 1995. The ongoing project combines traditional communicable disease control measures and actions aiming at reducing antibiotics consumption. All patients in the county with a nasopharyngeal culture positive for PRP with MIC of Penicillin G > or =0.5 mg/L are followed with nasopharyngeal cultures until PRP-negative. Nasopharyngeal cultures are obtained from family members and close contacts of the index cases. Preschool children carrying PRP are denied attendance at group day-care. From January 1995 to March 1997, 1,038 PRP-carriers (429 index cases and 609 contact cases) were identified. Children aged 1-6 years dominated (83%). Antibiotics sales decreased during the study period, and epidemiologic data indicate that the intervention may have limited the dissemination of PRP in the county, but further evaluation is needed.

This report concerns a prolonged restaurant-associated outbreak of infection caused by a multidrug-resistant (ASSuT) strain of Salmonella Typhimurium, phage-type U302, which took place during July and August 2003 and affected people from Denmark and neighbouring countries who had attended a specific restaurant. The outbreak comprised 67 laboratory-verified cases and ten probable cases; however, the actual number of patients was estimated to be more than 390. The outbreak strain was isolated from a buffet which was probably contaminated by an assistant chef who was found to excrete the epidemic strain. An attack rate of 7.3% was estimated and long incubation periods were observed, including one extreme instance of 27 days. This outbreak underscores the importance of conscientious personal hygiene, including frequent washing of hands, for professionals handling food.

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