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Legionnaires' disease, a form of pneumonia which can be fatal, is transmitted via the inhalation of water droplets containing Legionella bacteria. These droplets can be dispersed in the atmosphere several kilometers from their source. The most common such sources are contaminated water within cooling towers and other air-conditioning systems but other sources such as ornamental fountains and spa pools have also caused outbreaks of the disease in the past. There is an obvious need to locate and eliminate any such sources as quickly as possible. Here a maximum likelihood model estimating the source of an outbreak from case location data has been developed and implemented. Unlike previous models, the average dose exposure sub-model is formulated using a atmospheric dispersion model. How the uncertainty in inferred parameters can be estimated is discussed. The model is applied to the 2012 Edinburgh Legionnaires' disease outbreak., Competing Interests: The authors have declared that no competing interests exist.

Intensive care units (ICUs) play an important role in the epidemiology of methicillin-resistant Staphyloccocus aureus (MRSA). Although successful interventions are multi-modal, the relative efficacy of single measures remains unknown. We developed a discrete time, individual-based, stochastic mathematical model calibrated on cross-transmission observed through prospective surveillance to explore the transmission dynamics of MRSA in a medical ICU. Most input parameters were derived from locally acquired data. After fitting the model to the 46 observed cross-transmission events and performing sensitivity analysis, several screening and isolation policies were evaluated by simulating the number of cross-transmissions and isolation-days. The number of all cross-transmission events increased from 54 to 72 if only patients with a past history of MRSA colonization are screened and isolated at admission, to 75 if isolation is put in place only after the results of the admission screening become available, to 82 in the absence of admission screening and with a similar reactive isolation policy, and to 95 when no isolation policy is in place. The method used (culture or polymerase chain reaction) for admission screening had no impact on the number of cross-transmissions. Systematic regular screening during ICU stay provides no added-value, but aggressive admission screening and isolation effectively reduce the number of cross-transmissions. Critically, colonized healthcare workers may play an important role in MRSA transmission and their screening should be reinforced.

We analyzed data on all laboratory-confirmed cases of H1N1pdm influenza in the UK to 10th June 2009 to estimate epidemiological characteristics. We estimated a mean incubation period of 2.05 days and serial interval of 2.5 days with infectivity peaking close to onset of symptoms. Transmission was initially sporadic but increased from mid-May in England and from early June in Scotland. We estimated 37% of transmission occurred in schools, 24% in households, 28% through travel abroad and the remainder in the wider community. Children under 16 were more susceptible to infection in the household (adjusted OR 5.80, 95% CI 2.99-11.82). Treatment with oseltamivir plus widespread use of prophylaxis significantly reduced transmission (estimated reduction 16%). Households not receiving oseltamivir within 3 days of symptom onset in the index case had significantly increased secondary attack rates (adjusted OR 3.42, 95% CI 1.51-8.55).

Transmission of dirofilariasis in Europe is dependent upon the presence of sufficient numbers of infected dogs, susceptible mosquitoes, and a suitable climate to permit extrinsic incubation of Dirofilaria in the mosquito intermediate host. Dogs returning to the United Kingdom from overseas have been infected with several vector-borne infections (Babesia, Ehrlichia, Leishmania, and Dirofilaria), and this paper assesses the climatic constraints on the potential rate of extrinsic incubation of Dirofilaria in the United Kingdom. A model using an established algorithm based on accumulated temperature predicts that summer temperatures during 1995-2000 may have been sufficient to permit complete incubation of Dirofilaria in 2 of the years for large parts of southern/central England, and 5 years around London. The occurrence of autochthonous transmission would be dependent upon additional factors related to frequency of returning infected dogs and the distribution and abundance of putative mosquito vectors, and these should be studied further.

The international trade in used tires, coupled with the ability to lay non-desiccating eggs, has enabled Aedes albopictus (Skuse) (Diptera: Culicidae) to travel and establish on new continents, including North, Central, and South America, the Caribbean, Australasia, Africa, and Europe. Concerns have been raised over its potential role in the transmission of arboviruses and Dirofilaria nematodes. Following importation into northerly latitudes, photoperiodically-induced egg diapause enables establishment of Ae. albopictus, and a number of abiotic factors determine the subsequent seasonal activity. The United Kingdom (U.K.) imports over 5 million used tires annually, and this seems the most likely route by which Ae. albopictus would be imported. The anthropophilic and container-breeding nature of Ae. albopictus could cause an urban human biting nuisance and the potential for involvement in (human and veterinary) disease transmission cycles needs to be assessed. This paper addresses the likelihood for importation of Ae. albopictus into the U.K. and assesses, using a Geographic Information Systems (GIS)-based model, the ability for Ae. albopictus to establish, and the likely seasonal activity. It also reviews its possible role as a potential disease vector in the U.K. The model predicts that abiotic risk factors would permit establishment of Ae. albopictus throughout large parts of lowland U.K., with at least four to five months of adult activity (May-September), being more prolonged in the urban centers around London and the southern coastal ports. Pre-emptive surveillance of possible imported Ae. albopictus, through a targeted approach, could prevent the establishment of this exotic mosquito and mitigate any subsequent human and animal health implications for the U.K., either now or in the future.

Pattern formation in many biological systems takes place during growth of the underlying domain. We study a specific example of a reaction-diffusion (Turing) model in which peak splitting, driven by domain growth, generates a sequence of patterns. We have previously shown that the pattern sequences which are presented when the domain growth rate is sufficiently rapid exhibit a mode-doubling phenomenon. Such pattern sequences afford reliable selection of certain final patterns, thus addressing the robustness problem inherent of the Turing mechanism. At slower domain growth rates this regular mode doubling breaks down in the presence of small perturbations to the dynamics. In this paper we examine the breaking down of the mode doubling sequence and consider the implications of this behaviour in increasing the range of reliably selectable final patterns.