Enteric viruses introduced from the community are major causes of these illnesses.

In a study of Campylobacter infection in northwestern England, 2003England, -2006, C. jejuni multilocus sequence type (ST)-45 was associated with early summer onset and was the most prevalent C. jejuni type in surface waters. ST-45 is likely more adapted to survival outside a host, making it a key driver of transmission between livestock, environmental, and human settings.H uman campylobacteriosis shows a marked seasonality with a peak during the early summer months in many countries (1). The driving factors for this seasonality are not understood. Studies have shown a coincident seasonality of infection in chicken, livestock, and humans, and the possibility of a common environmental trigger has been suggested (2). In a recent study of the infl uence of climate on seasonality in England and Wales, incidence of campylobacteriosis was correlated with air temperature (with higher temperature indicating more cases at key points of the year) (3). This fi nding may relate to animal husbandry practices, especially animal housing (4).Studies have attempted to identify environmental reservoirs of infection in water sources; Campylobacter organisms have been successfully cultured from surface water (5), and campylobacteriosis has been linked with exposure to untreated water (6). We were interested in identifying the factors driving the early summer increase of cases in the United Kingdom and in investigating the role of environmental reservoirs. Preliminary data identifi ed multilocus sequence type (ST)-45 complex as a strain with possible transmission from environmental sources (7), and we have analyzed this complex in more detail. The StudyThe study population was defi ned as all human cases of laboratory-confi rmed Campylobacter infection with onset from April 2003 through March 2006, reported by residents in 4 local authorities in northwestern England, as previously described (7). All case-patients were asked detailed questions about their illnesses and possible exposures.Water samples were collected at least each fortnight from October 2003 through December 2005 as 2-L grab samples from sampling points on 2 rivers associated with the study area (River Mersey and River Wyre). Water samples were transported to the Food and Environmental Microbiology Laboratory, Royal Preston Hospital. Campylobacter species were isolated by the addition of 10 mL of the water sample to 90 mL of warmed Campylobacter enrichment broth (product CM0983, Oxoid Ltd, Basingstoke, UK) and incubated at 37°C for 24 hours, followed by incubation at 42°C for 24 hours. The enrichment broths were subcultured onto Campylobacter blood-free selective agar (charcoal cefoperazone deoxycholate agar product CM0739, Oxoid Ltd) at 37°C for 48 hours microaerobically, by using a microaerobic gas generating kit (product CN0025, Oxoid, Ltd). Campylobacter colonies were identifi ed by morphologic features and confi rmed by microaerobic and aerobic growth on blood agar. The colonies were then placed in Amies transport and sent to the laboratory Health Protection Age...

MLST can be used to describe and analyze the epidemiology of campylobacteriosis in distinct human populations.

Background: In the past few years, increased diagnoses of syphilis have been reported in cities around Britain and Europe. Enhanced surveillance of cases began in 1999 to identify the epidemiology of this increase in Greater Manchester. Methods: Information was collected on all cases of syphilis newly diagnosed in genitourinary medicine (GUM) clinics in Greater Manchester between January 1999 and November 2002. The data collected included demographic information and information about other sexually transmitted infections, sexual behaviour, perception of risk of infection, and awareness of syphilis transmission. Results: The majority of cases identified were white homosexual men resident in Greater Manchester. Of the 414 cases diagnosed, 74% had either a primary or secondary stage of syphilis infection and 37% of cases were HIV positive. High numbers of individuals practised unprotected oral sex despite good awareness of the risk of infection with syphilis. There is evidence that the way people are meeting sexual contacts is changing, with increasing numbers meeting most of their partners through the internet. Conclusions: These findings have implications for targeting interventions. The provision of rapid diagnostic and treatment services is likely to be key for the control of syphilis and potentially of subsequent increases in HIV in the region. We initiated a system of "enhanced surveillance" in February 2000, collecting epidemiological information to establish the extent of infection in Greater Manchester and illuminate the patterns of transmission. METHODSWe devised a form for the collection of epidemiological data, including demographic data, diagnosis, and risk factors and distributed it to each of the 11 GUM clinics in Greater Manchester. Health workers completed one form for each case of syphilis by means of an interview or from case notes where this was not possible. The case definition used was all cases of laboratory confirmed infectious syphilis diagnosed in Greater Manchester from 1999 onwards. For cases diagnosed in 1999 and early 2000, as much data as possible were collected retrospectively from case notes. Completed forms were returned to the North West Office of the Communicable Disease Surveillance Centre (CDSC NW) for collation, data entry, and data analysis. RESULTSBetween January 1999 and November 2002, there were 414 cases of syphilis reported to the enhanced surveillance database by GUM clinics in Greater Manchester. Of these cases, 93% (377/405) were male and 81% (330/405) were homosexual. Of those for whom data were available, 93% of cases (354/382) were born in the United Kingdom, and 82% (310/380) were residents of Greater Manchester. There was no particular residential clustering of cases. The majority of cases (90%; 342/381) were white. The next most significant defined ethnic groups of cases were "Black Caribbean" and "Indian" (each 2.1%; 8/381).The epidemic curve demonstrates some seasonal variation in reporting of infection, with the New Year and summer periods appearing to be key...

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