Community-based prevention strategies for seasonal and pandemic influenza are essential to minimize their potential threat to public health. Our aim was to evaluate the efficacy of hand hygiene interventions in reducing influenza transmission in the community and to investigate the possible modifying effects of latitude, temperature and humidity on hand hygiene efficacy. We identified 979 articles in the initial search and 10 randomized controlled trials met our inclusion criteria. The combination of hand hygiene with facemasks was found to have statistically significant efficacy against laboratory-confirmed influenza while hand hygiene alone did not. Our meta-regression model did not identify statistically significant effects of latitude, temperature or humidity on the efficacy of hand hygiene. Our findings highlight the potential importance of interventions that protect against multiple modes of influenza transmission, and the modest efficacy of hand hygiene suggests that additional measures besides hand hygiene may also be important to control influenza.

Experiments to determine the role of particle size in the infectivity of anthrax spores are described. Clouds of homogeneous particles were produced. The mortality-dosage curves for guinea-pigs and monkeys are given for clouds of various particle sizes. Data are given on the effect of time in the concentration-time relationship. The results are compared with those recorded by other workers on the relationship of particle size to respiratory retention.

Infectivity was highest with single-spore clouds, falling off as particle size increased. Reasons are given for attributing this effect to difference in site of deposition of different-sized particles.

Krönig and Paul (1897) were the first to study the process of disinfection by making quantitative observations at intervals during its progress. Their figures showed that disinfection proceeded in an orderly manner and that the rate diminished as the number of survivors became less. Ikéda (1897) attempted to express their results by an empirical formula.

Features are described of a new staining method for the detection of Cryptosporidium oocysts in faeces. Smears, fixed in acid-methanol, are stained with heated safranin and counterstained with methylene blue. Oocysts stain a vivid orange-pink and are easily recognized. The method is rapid and simple with little source of error. The method is more sensitive than currently recommended Ziehl-Neelson methods; of 26 cases of cryptosporidiosis diagnosed by the new method only 19 were detected by acid-fast and only 11 by acid-alcohol-fast methods. Oocysts can be stained by safranin-methylene blue after concentration by various methods, in paraffin-embedded material, and after storage for months at various temperatures.

To determine the prevalence and routes of transmission of hepatitis C virus (HCV) infection in Hafizabad, Pakistan, we collected sera in 1993 from a geographically based random sample of residents, and in 1994 identified 15 HCV-infected individuals (cases) and 67 age and sex matched uninfected individuals (controls). Initially we approached 504 households, and collected serum from a randomly selected household member in 309 (64%). Twenty persons (6·5%) had anti-HCV antibody; 31% percent had hepatitis B core antibodies, and 4·3% had hepatitis B surface antigen. In the case-control study, persons who received more therapeutic injections (categorized as averaging 1, 2–4, 5–9 or >10 injections per year in the previous 10 years) were more likely to be infected with HCV (odds ratio 0, 1·5, 2·5 and 6·9 respectively, P=0·008) compared to persons averaging 0 injections per year. Efforts to limit therapeutic injections to only those that are medically indicated and that use sterile equipment are essential in order to prevent transmission of HCV.

A microneutralization test for serotyping of FMD viruses is described. It is based on earlier observations by Booth, Rweyemamu & Pay (1978) that dose-response relationships in quantal microneutralizations often deviated from linearity. The typing test described therefore utilizes undiluted virus preparations. In about 90% of samples a positive typing was obtained in contrast with about 50% for the complement fixation test. The test was also found to be susceptible to minimal quantities of heterotypic viral contamination.

For strain differentiation the microneutralization test was carried out as a checkerboard test. When compared with the complement fixation test it was found to be more specific. The necessity to utilize virus-neutralization test systems for comparing (FMD) virus strains particularly for the purpose of vaccine selection is emphasized. The two dimensional microneutralization test has been applied to a study of comparing FMDV vaccine strains for Europe, South America, the Middle East and East Africa.

A novel water quality intervention that consists of point-of-use water disinfection, safe storage and community education was field tested in Bolivia. A total of 127 households in two periurban communities were randomized into intervention and control groups, surveyed and the intervention was distributed. Monthly water quality testing and weekly diarrhoea surveillance were conducted. Over a 5-month period, intervention households had 44% fewer diarrhoea episodes than control households (P=0·002). Infants <1 year old (P=0·05) and children 5–14 years old (P=0·01) in intervention households had significantly less diarrhoea than control children. Campylobacter was less commonly isolated from intervention than control patients (P=0·02). Stored water in intervention households was less contaminated with Escherichia coli than stored water in control households (P<0·0001). Intervention households exhibited less E. coli contamination of stored water and less diarrhoea than control households. This promising new strategy may have broad applicability for waterborne disease prevention.

Analysis of cloacal samples collected from 12321 wild ducks in Alberta, Canada, from 1976 to 1990 showed influenza A infections to be seasonal, with prevalences increasing as the population became increasingly more dense. Viruses with 3 haemagglutinin (H3, H4, and H6) and 3 neuraminidase subtypes (N2, N6, and N8) were found consistently to infect both adult and juvenile ducks each year, indicating that wild ducks may be a reservoir for these viruses. In contrast, viruses with 7 haemagglutinin (H2, H5, H7, H8, H9, H11, and H12) and 3 neuraminidase subtypes (N1, N3, and N4) were not found for prolonged periods during the study; when they were found, they primarily infected juveniles at moderate levels. Whilst wild ducks appear to perpetuate some influenza A viruses, they apparently do not act as a reservoir for all such viruses.

During systemic treatment of mice with ampicillin or streptomycin, oral contaminations with exogenous bacterial species resulted in an abnormal colonization pattern. The contaminants persisted much longer and in much higher concentrations in the caecum of systemically treated mice than in control animals. Spread of the contaminant into the mesenteric lymph nodes and the spleen was found much more often in the antibiotic treated group. This, however, was only seen when the contaminant was ‘resistant’ to the antibiotic injected. The experiments suggest that the ‘CR-inducing species’ of the microflora live in close contact with the mucosa and therefore could be identical with the anaerobic tapered rods described by Savage & Dubos (1968).

The aim of this study was to quantify the association between alcohol consumption and incidence of pneumonia and to examine possible pathways. This was done by a systematic review and meta-analyses on the dose–response relationship between alcohol consumption or alcohol-use disorders and the incidence of community-acquired pneumonia (CAP). The relative risk (RR) of CAP increased monotonically with increasing alcohol consumption. Individuals consuming 24, 60, and 120 g of pure alcohol daily demonstrated RRs for incident CAP of 1·12 (95% CI 1·02–1·23), 1·33 (95% CI 1·06–1·67) and 1·76 (95% CI 1·13–2·77), respectively, relative to non-drinkers. Clinically defined alcohol-use disorders were associated with an eightfold increased risk of CAP (RR 8·22, 95% CI 4·85–13·95). In conclusion, alcohol was found to be a risk factor for pneumonia with a clear statistical association, and a monotonic dose–response relationship.

We present a systematic review providing estimates of the overall and regional burden of infectious complications following prostate biopsy. A directly standardized prevalence estimate was used because it reflects the burden of disease more explicitly. Complications included sepsis, hospitalization, bacteraemia, bacteriuria, and acute urinary retention after biopsy. There were 165 articles, comprising 162 577 patients, included in the final analysis. Our findings demonstrate that transrectal biopsy was associated with a higher burden of hospitalization (1·1% vs. 0·9%) and sepsis (0·8% vs. 0·1%) compared to transperineal biopsy, while acute urinary retention was more prevalent after transperineal than transrectal biopsy (4·2% vs. 0·9%). The differences were statistically non-significant because of large heterogeneity across countries. We also demonstrate and discuss regional variations in complication rates, with Asian studies reporting higher rates of sepsis and hospitalization.

The purpose of this study was to assess and describe the current spectrum of emerging zoonoses between 2000 and 2006 in European countries. A computerized search of the Medline database from January 1966 to August 2006 for all zoonotic agents in European countries was performed using specific criteria for emergence. Fifteen pathogens were identified as emerging in Europe from 2000 to August 2006: Rickettsiae spp., Anaplasma phagocytophilum, Borrelia burgdorferi, Bartonella spp., Francisella tularensis, Crimean Congo Haemorrhagic Fever Virus, Hantavirus, Toscana virus, Tick-borne encephalitis virus group, West Nile virus, Sindbis virus, Highly Pathogenic Avian influenza, variant Creutzfeldt–Jakob disease, Trichinella spp., and Echinococus multilocularis. Main risk factors included climatic variations, certain human activities as well as movements of animals, people or goods. Multi-disciplinary preventive strategies addressing these pathogens are of public health importance. Uniform harmonized case definitions should be introduced throughout Europe as true prevalence and incidence estimates are otherwise impossible.

This study was performed to better understand and more precisely quantify the amount and burden of illness caused by acute diarrhoea in the United States today. A telephone-based population survey was conducted between 1 July, 1996, and 31 June, 1997, in sites of the Foodborne Diseases Active Surveillance Network (FoodNet). The overall prevalence of acute diarrhoea in the 4 weeks before interview was 11%, giving a rate of 1.4 episodes of diarrhoea per person per year. The rate of diarrhoeal illness defined as a diarrhoeal episode lasting longer than 1 day or which resulted in significant impairment of daily activities was 0.7 per person per year. It can be concluded that acute diarrhoea is common and represents a significant burden of illness in the United States. Our data on self-reported diarrhoea, when generalized to the entire nation, suggests 375 million episodes of acute diarrhoea each year in the United States. Many of these episodes are mild. However, our data also indicate that there are approximately 200 million episodes of diarrhoeal illness each year in the United States.

Sixty-three Staphylococcus aureus isolates recovered from bovine sources in the USA and the Republic of Ireland were characterized by multilocus enzyme electrophoresis (MLEE), ribotyping, and random amplified polymorphic DNA polymerase chain reaction (RAPD–PCR) typing at two separate laboratories. The S. aureus isolates were assigned by MLEE to 10 electrophoretic types (ETs) (Index of Discrimination, D=0·779). In contrast, the same isolates were assigned to 13 ribotypes (D=0·888), and to 12 RAPD types (D=0·898). A common clone, ET3, of worldwide distribution, was represented by six distinct combinations of ribotypes and RAPD types. S. aureus clones recovered from cows in Ireland were also associated with mastitis in dairy cows in the USA. These findings are consistent with the hypothesis that only a few specialized clones of S. aureus are responsible for the majority of cases of bovine mastitis, and that these clones have a broad geographic distribution.

Sera from 1029 individuals, 864 from Edinburgh and 165 from Oxford, have been examined for the presence of antibodies to Herpesvirus hominis. The results of the smaller Oxford survey did not reveal a higher incidence of antibody where direct comparison was possible with those from Edinburgh.

The incidence of both complement-fixing and neutralizing antibodies in the sera from 710 people in Edinburgh with ages varying from 1 month to 92 years was compared with the more complete of the earlier surveys, and in particular with that of Holzel et al. (1953) in Manchester, England. This comparison revealed a lower incidence of antibody in people under 25 in Edinburgh in 1965.

Results obtained with sera from medical students in Oxford and Edinburgh and from nurses in Edinburgh were in agreement with those of previous surveys. The low incidence of antibody in these young people emphasized the possible occupational risk of infection from patients and that primary herpetic infection might be encountered more frequently than before in teenagers and young adults.

Our understanding of the Coronavirus disease 2019 (COVID-19) continues to evolve and there are many unknowns about its epidemiology. This study aims to synthesise case fatality rate (CFR) among confirmed COVID-19 patients, incubation period and time from onset of COVID-19 symptoms to first medical visit, intensive care unit (ICU) admission, recovery, and death. We searched MEDLINE, Embase, Google Scholar, and bibliographies of relevant articles from 01 December 2019 to 11 March 2020 without any language restrictions. Quantitative studies that recruited people with confirmed COVID-19 diagnosis were included. Two independent reviewers extracted the data. Out of 1675 non-duplicate studies, 43 were included in the meta-analysis. The pooled mean incubation period was 5.68 (99% confidence interval [CI]: 4.78, 6.59) days. The pooled mean number of days from the onset of COVID-19 symptoms to first clinical visit was 4.92 (95% CI: 3.95, 5.90), ICU admission was 9.84 (95% CI: 8.78, 10.90), recovery was 18.55 (95% CI: 13.69, 23.41), and death was 15.93 (95% CI: 13.07, 18.79). Pooled CFR among confirmed COVID-19 patients was 0.02 (95% CI: 0.02, 0.03). We found that the incubation period and lag between the onset of symptoms and first clinical visit for COVID-19 are longer than other respiratory viral infections including Middle East respiratory syndrome and severe acute respiratory syndrome; however, the current policy of 14 days of mandatory quarantine for everyone potentially exposed to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) might be too conservative. Longer quarantine periods might be more justified for extreme cases.

The persistence of Escherichia coli O157[ratio ]H7 in cattle and the farm environment was investigated on eight Ontario dairy farms positive for E. coli O157[ratio ]H7 in a longitudinal study commenced one year previously. Faecal samples from cows, calves, humans, cats, rodents, wild birds, a composite fly sample and numerous composite and individual environmental samples were cultured and tested for verotoxin-producing E. coli (VTEC). VTEC isolates were serotyped and E. coli O157[ratio ]H7 isolates were phage typed. E. coli O157[ratio ]H7 phage type 34 was isolated from one calf on each of two farms. The same phage type had been isolated on one of these farms 12 months earlier. Most E. coli O157[ratio ]H7-positive animals and farms became culture-negative within 2 and 3 months, respectively. E. coli O157[ratio ]H7 was not isolated from any environmental samples, although evidence of VTEC was found in composite samples from calf feeders (19·1%), calf barn surfaces (18%), cow feeders (14·9%), flies (12·5%), cow barn surfaces (11·3%), and individual milk filters (12·5%). VTEC belonging to 21 non-O157 serotypes were isolated from 24 cows (8·2%), 21 calves (18·3%), 2 cow feeder samples (3·0%), and 1 calf feeder sample (4·8%). Shedding of E. coli O157[ratio ]H7 by infected dairy cattle appears to be transient and persistence of E. coli O157[ratio ]H7 was not demonstrated from the farm environment sites tested.

The standard tests for infectivity of influenza viruses in eggs or mice have two major shortcomings. First, the host systems are known to be inhomogeneous, i.e. the response does not depend solely on the dose; and second, this variation from host to host cannot be assessed independently, since a single test only can be made on any one egg or mouse. Thus, the two probabilities—the presence of an infective unit in the inoculum and the success of a particular virus-host interaction—are confounded, so that we estimate not the number of infective units but an unknown function of this number. Valid comparisons of infectivity can still be made as long as one is satisfied with a relative answer, and does not wish to inquire into the nature of host-resistance.

Results of serotyping on 291 astrovirus-positive stools collected between 1976 and 1992 showed that about two-thirds (64.9%) were serotype 1. Infections were more frequent in the fourth quarter of the year and there was a suggestion that during the past 5 years serotype 1 has occurred with greater frequency in alternate years. Evidence is provided for the existence of two new serotypes, 6 and 7.

Livestock-associated MRSA has been found in various animals, livestock farmers and retail meat. This study aimed to determine the prevalence and determinants of nasal MRSA carriage in pig slaughterhouse workers. Three large pig slaughterhouses in The Netherlands were studied in 2008 using human and environmental samples. The overall prevalence of nasal MRSA carriage in employees of pig slaughterhouses was 5·6% (14/249) (95% CI 3·4–9·2) and working with live pigs was the single most important factor for being MRSA positive (OR 38·2, P<0·0001). At the start of the day MRSA was only found in environmental samples from the lairages (10/12), whereas at the end of the day MRSA was found in the lairages (11/12), the dirty (5/12) and clean (3/12) areas and green offal (1/3). The MRSA status of the environmental samples correlated well with the MRSA status of humans working in these sections (r=0·75). In conclusion, a high prevalence of nasal MRSA carriage was found in pig-slaughterhouse workers, and working with live pigs is the most important risk factor. Exact transmission routes from animals to humans remain to be elucidated in order to enable application of targeted preventive measures.