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Large incidents and natural disasters are on the increase globally. They can have a major impact lasting many years or decades; and can affect large groups of people including those that are more susceptible to adverse consequences. Following a major incident, it may be considered necessary to establish a register of those people affected by the incident to provide appropriate advice on relevant immediate and longer-term public health interventions that may be required, provide reassurance to the public that their care is paramount, to reassure the worried well to avoid them inappropriately overwhelming local services, and to facilitate epidemiological investigations. Arrangements for the prompt follow-up of populations after large incidents or disasters have been agreed in England and a protocol for establishing a register of individuals potentially affected by a large incident has been developed. It is important for countries to have a protocol for implementing a health register if the circumstances require one to be in place, and are supported by Public Health Authorities. Health registers facilitate the initial descriptive epidemiology of exposure and provide the opportunity of carrying out long term analytical studies on the affected population. Such epidemiological studies provide a greater understanding of the impact that a large incident can have on health, which in turn helps in the planning of health care provision. Registers can also assist more directly in providing access to individuals in need of physical and mental health interventions. The challenge that still remains is to formally pilot the register in the field and refine it based on that experience. [ABSTRACT FROM AUTHOR]

Six students at the University of Southampton developed meningococcal disease in October 1997, five of them with confirmed serogroup C infections, and three died. The outbreak had major organisational and financial implications for the agencies involved. Detailed planning and good working relationships with the management of higher educational institutions can prove invaluable in such situations. This paper summarises the management of the outbreak in Southampton and presents recommendations based on our experience.

We surveyed consultants in communicable disease control (CCDCs) for their views on the current and potential value of Statutory Incident Reports--Salmonella in Animals, Birds and their Products received from the Ministry of Agriculture Fisheries and Food (MAFF), in the surveillance, prevention, and control of Salmonella typhimurium infections in humans. CCDCs from 103 (83%) of 124 district health authorities responded. Most CCDCs in rural areas used the reports either to cross reference information about animal and human isolates or to discuss with environmental health officers. Many believed that the reports' relevance to human infection could be improved if they were sent more quickly. Some CCDCs suggested that it would be useful to cross reference laboratory reports of animal and human infection at regional level and to have personal contact with local veterinary officers of MAFF. Close cooperation between public health doctors and MAFF and a coordinated approach is needed to prevent and control associations between animal and human zoonotic infections.

The objective of the study was to determine the prevalence of mastitis among primiparous heifers at calving and at drying off in 11 Waikato dairy herds during the 1993-94 dairy production season. Duplicate quarter milk samples were collected aseptically from 458 heifers within 5 days after calving for bacteriological analysis. Mastitis was diagnosed in at least one quarter in 35.6% of these heifers. Coagulase-negative staphylococci were isolated from 21.8% of the heifers. The prevalence of coagulase-negative staphylococci varied between herds from 4.3% to 44.8%. Environmental streptococci caused mastitis in 12.2% of heifers, ranging from 5.6% to 24.1% between herds. Streptococcus uberus was the pathogen identified most frequently at calving and accounted for more than 90% of the streptococcal isolates. Staphylococcus aureus and coliforms were isolated from less than 1% of samples. Clinical mastitis was observed in 8.1% of heifers at calving; environmental streptococci were isolated from 67.6% of these clinical clinical cases. Only 2.8% of heifers developed clinical mastitis during lactation and environmental streptococci were isolated from 38.5% of these cases. The prevalence of mastitis among 428 of the heifers at drying off was 64.7%; a 1.8 fold increase during lactation. Corynebactetium bovis was isolated from 43% of heifers at drying off even though it was not isolated from any heifers at calving. During the season, the prevalence of Staphylococcus aureus mastitis increased to 2.8% while mastitis caused by environmental streptococci declined to 2.8%. The prevalence of environmental mastitis pathogens decreased during lactation while contagious pathogens increased in each of the 11 herds. Ineffective post-milking teat sanitation probably contributed to the increase in mastitis caused by contagious pathogens. Specific factors were not determined that affected the variation in prevalence between herds.

Reports of human infection with Salmonella typhimurium definitive type (DT) 104 have generated considerable interest. We undertook a descriptive study of infections with S. typhimurium DT 104 infection in humans and farm animals in Herefordshire between 1991 and 1993. Laboratory reports of human salmonellosis, sent to the consultant in communicable disease control, were compared with cases identified using Statutory Incident Reports of salmonella in animals, birds and their products, received from the Ministry of Agriculture, Fisheries and Food. Six separate associations of infection between farming families and their livestock were identified. Nine out of 23 human cases, including three family outbreaks, were associated with animal infection. This study suggests that occupationally acquired infection in farmers and their families may be contributing to the national increase in cases, and shows the value of drawing together data from human and animal sources for the surveillance, investigation, and control of human infection with S. typhimurium DT104.

Among the 81 cultures of Salmonella typhimurium of phage type 141 examined, 72 had been isolated from Sheffield incidents in 1984-5 and 9 were Scottish isolates from 1986-7. All of these cultures from diverse sources belonged to primary biotype 31; 79 were of full biotype 31beg and 2 anaerogenic cultures were of full biotype 31begj. This is the first known occasion on which an epidemic strain of S. typhimurium of phage type/biotype 141/31beg has been implicated in outbreaks of human or animal infection in the UK. Because previous epidemic strains of S. typhimurium of phage type 141 in the UK belonged to biotypes 1f and 9f which are phylogenetically unrelated to biotype 31beg, the likely origin of this most recent epidemic S. typhimurium strain of phage type/biotype 141/31beg is discussed.