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The linkage of case notifications with the morbidity database was frequently based on multiple records of hospital admission.
Thus, manual linkage of case and contacts was necessary; this task was time-consuming, onerous, and had the potential to introduce errors because of multiple data sources and common use of a small number of given and family names within a restricted geographic region.
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Molecular typing of Mycobacterium tuberculosis has permitted linkage of cases and demonstration of patterns of inter- or intrapatient strain diversity correlating with reinfection and reactivation.
The probabilistic linkage of case-level records in iPHIS and PHOL had a 77.3% (551/713) success rate and provided additional case information that enhanced our ability to describe the epidemiology of serogroup B disease in the province.
Assuming that the no further linkage of cases was possible, the private laboratory reports contributed to a maximum of 44 cases (equivalent to nine cases/year) in addition to the MRU-confirmed cases over the 5-year period (30 HESonly, 10 unlinked, 4 HES+/MRU-).
Of the 1428 linkages of case notifications with the morbidity database, 337 were linked with 1 morbidity record, 260 were linked with 2 morbidity records, 192 were linked with 3 morbidity records, 121 were linked with four morbidity records and 518 were linked with 5 or more morbidity records.
Linkage of these cases suggests a vulnerability of certain communities, especially young adults, and that survival of virus leakages in such a community created a second epidemic wave in Japan between summer and autumn.
Bats were the focus of this study based on the recent discovery of the related filovirus, Ebola virus, in fruit bats in Gabon and Republic of Congo [4] (RC), and epidemiologic linkage of MHF cases to a gold mine containing sizeable numbers of bats during a large MHF outbreak in Durba, Democratic Republic of Congo (DRC) in 2000 [5], [6].
Linkage of reviewed cases admitted in the last three years of the study time period was hindered due to technical difficulties with the linkage process for those years.
Anonymised data were obtained from the Office for National Statistics, after linkage of incident cases in the National Cancer Registry with information on deaths from the NHS Central Register Officee for National Statistics, 2003a).
Further evidence for a bat reservoir include the linkage of a MHF case in 1987 to Kitum cave at Mt. Elgon, Kenya [7], and transient viremias in asymptomatic bats experimentally infected with Ebola virus [8].
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