Comment

The intestinal microbiota and its interactions with host immunity have been intensely studied in many disease states. This knowledge could ultimately modify clinical management of allogeneic haematopoietic stem cell transplantation, which is accompanied by dramatic immunological and microbiota perturbations.

Faecal microbiota transplantation has proved efficacious for diseases such as recurrent Clostridium difficile infection via restoration of gut microbial ecology and bile acid content. However, despite its adoption by mainstream medicine, misuse of this technology in clinical or domestic settings warrants caution.

The apparent emergence of new and devastating Vibrio diseases in Latin America during significant El Niño events is striking. New microbiological, genomic and bioinformatic tools are providing us with evidence that El Niño may represent a long-distance corridor for waterborne diseases into the Americas from Asia.

Concern over Ebola becoming endemic in West Africa has appeared in the medical and lay media. Routes of transmission, rates of viral evolution, suitability of humans as hosts and rarity of spillover events make this very unlikely. Without evidence that endemic Ebola is likely, ending epidemics should remain the focus.

Widespread antibiotic resistance is a growing public health problem. Can we revive large-scale screening to keep the pipelines flowing or will we depend increasingly on biological and ecological insights?

Advances in culturing hepatitis C virus have given hope for a universal cell culture system amenable to primary isolate replication. However, low replication efficiency needs to be overcome. The development of fully susceptible yet immunocompetent in vivo models would aid research towards a prophylactic vaccine.