Eleven cases of aseptic meningitis occurred in a Cambridgeshire village between 17 October and 11 November 1955. The syndrome consisted of severe headache, backache, vomiting, fever and neck stiffness together with lymphocytes and frequently some granulocytes in the cerebrospinal fluid. Principally, it affected persons aged between 10 and 30 years. Out of a total population twenty-three at risk, seventeen were infected and eight became ill. A further three contacts who were living in Cambridge became ill.

Identical strains of virus were isolated from the faeces of two patients by inoculation of trypsin-dispersed human amnion cells and from the faeces of another two patients by inoculation of monkey kidney cultures. Bourn virus, which belonged to the ECHO group, Type 9, multiplied readily and produced cytopathogenic effects in human amnion and monkey kidney cultures, but it was not cytopathogenic in HeLa cell cultures. These investigations strongly suggest that Bourn virus caused the epidemic.

We wish to thank Dr M. G. P. Stoker for his advice and criticism and Mrs B. M. Cook for technical assistance.

We are indebted to Dr J. O'H. Tobin and Dr F. K. Sanders for advice on certain technical procedures.

It is a pleasure to acknowledge the assistance given by many colleagues and friends, including Dr D. I. Annear, Miss D. K. Bell, Mrs D. Ditchburn, Dr R. M. Fry, Dr D. Gairdner, Dr J. E. Power, Dr D. Simpson, Dr P. Tyzer and Dr P. J. Wormald.

This survey assessed the maintenance of evaporative cooling towers in Glasgow, following two Legionnaires' disease outbreaks. Information was obtained from 76 of 81 premises and a maintenance score was calculated for each of 174 towers. The quality of maintenance was extremely varied (range of maintenance scores, 8–30 mean, 22 (S. D., 5.0); median, 23; maximum possible, 33) and some towers were neglected. Breaches of maintenance principles were mainly structural and organizational, e.g. inadequate drift control, rather than failure to use chemicals. Low maintenance scores were associated with no log book, no guidelines, no change in procedures in last 5 years, solitary cooling towers, and towers on industrial premises. Despite intense publicity the standard of cooling tower maintenance in Glasgow remained a concern. Information campaigns directed at those responsible for cooling–tower maintenance are neccessary.

In previous reports (Topley and Ayrton, 1924 a, b and c) we have recorded the results obtained by feeding mice on cultures of B. aertrycke, and studying the subsequent excretion of that organism in the faeces. The present report deals with the application of the same technique to the study of an experimental epidemic of mouse-typhoid.

In September 2016, an imported case of measles in Edinburgh in a university student resulted in a further 17 confirmed cases during October and November 2016. All cases were genotype D8 and were associated with a virus strain most commonly seen in South East Asia. Twelve of the 18 cases were staff or students at a university in Edinburgh and 17 cases had incomplete or unknown measles mumps rubella (MMR) vaccination status. The public health response included mass follow-up of all identified contacts, widespread communications throughout universities in Edinburgh and prompt vaccination clinics at affected campuses. Imported cases of measles pose a significant risk to university student cohorts who may be undervaccinated, include a large number of international students and have a highly mobile population. Public health departments should work closely with universities to promote MMR uptake and put in place mass vaccination plans to prevent rapidly spreading measles outbreaks in higher educational settings in future.

Surveillance of dengue fever is mainly based on specific laboratory tests. However non-specific systems, such as clinical surveillance, are also required. In French Guiana, we have tested a non-specific laboratory surveillance system where different biological examinations performed for other reasons than the diagnosis of dengue fever were analysed as methods for dengue fever surveillance. The number of negative malaria diagnoses in Cayenne and Kourou was found to be the best indicator of dengue fever infections in these towns. This surveillance system appears to be very simple and reliable, and a test which could serve as an indicator that is likely to be found everywhere.

Faecal samples of 2660 domestic animals from 116 farms and 956 samples of food were examined for the presence of Shiga toxin-producing Escherichia coli (STEC). STEC was recovered from 126 (15·3%) cattle, 135 (11·3%) pigs, 135 (66·8%) sheep, 31 (73·8%) goats, 4 (1%) chicken, and 15 (1·6%) food samples. Of all STEC isolates, 21·5, 25·8 and 15% produced enterohaemolysin, α-haemolysin, and aerobactin respectively, 1·6% displayed localized adherence (LA) to HEp-2 cells, 27·6% were sorbitol negative, and 30% were resistant to antibiotics. Only 14 (3·1%) of the STEC isolates belonged to human infection-associated serogroups (O26, O55, O111, O128 and O157), designated as enterohaemorrhagic E. coli (EHEC). This study revealed that STEC are prevalent in domestic animals, and to a lesser extent in food of animal origin in Serbia, but the absence of a EHEC phenotypic profile (characteristic serogroup, LA, enterohaemolysin production) in most animal STEC strains may explain the low incidence of human STEC infection in this part of the world.

The morphology of faecal microflora of nine healthy human volunteers was studied by digital image analysis of microscopic slides. Weekly specimens were collected during an 8-week period. Seven morphometrical parameters were derived: the means and medians of components 1, 2 and 3, and morphometrical entropy. Statistically significant differences among subjects were found for means of components 1 and 2, medians of components 1, 2 and 3, and entropy. The stability in normal circumstances provides an excellent basis for the detection of pathological change in gut flora balance.

Transmission of bovine herpesvirus 1 (BHV1) within and between herds was studied on the island of Ameland, The Netherlands. There were 50 herds with 3300 head of cattle on the island. Herds were divided into three groups: (1) only containing seronegative cattle, (2) containing seronegative cattle and vaccinated seropositive cattle, and (3) containing only vaccinated cattle. All 23 herds in groups 1 and 2 were monitored. Three major outbreaks of BHV1 infections were observed due to the introduction of infectious cattle. Another major outbreak was most likely induced by reactivation of latent BHV1 in seropositive cattle. The basic reproduction ratio within these herds was estimated at least 4. Only one of these outbreaks led to three secondary outbreaks in susceptible herds in which all cattle were seronegative. These outbreaks were most likely due to respectively, direct animal contact, human transmission, and aerogenic transmission. The basic reproduction ratio between herds in this study was estimated to be 0·6.

Identification of priority populations such as men who have sex with men (MSM) is important in surveillance systems to monitor trends of sexually transmitted infections (STIs). We explored using routinely collected non-behavioural data as a means to establish MSM status in surveillance by assessing anorectal swab as a marker of male-to-male sexual exposure. We used chlamydia testing data from a sexual health clinic, 2007–2012. Men reporting any male sexual partner(s) in the previous 12 months were considered MSM. The dataset was split into development and validation samples to develop a univariate predictive model and assess the model fit. The dataset included 30 358 individual men and 48 554 episodes of STI testing; 45% were among reported MSM and an anorectal swab was performed in 40% of testing episodes. Anorectal swabbing had good diagnostic performance as a marker for MSM status (sensitivity = 87%, specificity = 99%, positive predictive value = 98·6%, negative predictive value = 90·3%). The model showed good fit against the internal validation sample (area under the curve = 0·93). Anorectal swabs are a valid marker of MSM behaviour in surveillance data from sexual health clinics, and they are likely to be particularly useful for monitoring STI trends among MSM with higher risk behaviour.

Using the polymerase chain reaction (PCR) test for diagnosis of canine leishmaniasis has greater sensitivity and specificity than culture and visualization of the parasite. This study compares PCR for the diagnosis of the genus and species of Leishmania with serological techniques used for the control of canine visceral leishmaniasis (CVL) in Brazil, considering two regions. We analysed peripheral blood samples collected from 195 dogs in the Campinas (SP) and Teresina (PI) regions. ELISA was performed as a serological method and PCR was performed using specific primers for the genus Leishmania spp. and the species Leishmania chagasi. In Campinas, a greater sensitivity of PCR (88·24%) (P = 0·0455) compared to Teresina (14·71%) (P < 0·0001) was observed, and an agreement was observed for Cohen's kappa index (0·9096). Both PCR and ELISA showed discordance for sensitivity (Campinas 100%, Teresina 21·74%), specificity (Campinas 30·77%, Teresina 100%), positive predictive value (Campinas 68·97%, Teresina 100%), negative predictive value (Campinas 100%, Teresina 37·94%) and Cohen's kappa index (0·1238). This study confirms the importance of PCR in analysis of the canine reservoir, and as an effective method for the detection of active and recent infection.

To find out the salmonella carrier rate, 1980 samples comprising faeces, mesenteric lymph nodes, liver and spleen were collected from 812 sheep and 683 goats slaughtered for food. In all 72 salmonella strains from 51 animals (25 sheep and 26 goats) were isolated. These represented 22 salmonella serotypes. The public health significance of these findings is discussed.

In a retrospective epidemiological study, 293 meningococcal disease patients hospitalized during 1985–2002, were examined for fatality and risk factors related to death. The overall case fatality rate (CFR) was 8·2%, but increased from 4% during 1985–1993 to 17% during 1994–2002. The latter 9-year period was characterized by more serogroup C infections and more patients with thrombocytopenia on admission to hospital. All patients categorized as meningitis on admission survived. Of the 24 patients who died, 21 had meningococcal skin rash on admission, 23 had an onset to admission time of ⩽24 h, and 16 had severe septicaemia with hypotension and/or ecchymoses without meningitis on admission. By multivariate analyses, a short onset to admission time, >50 petechiae, thrombocytopenia and severe septicaemia on admission were associated with fatality. More lives could be saved through earlier admission to hospital. This can be achieved through more information to the public about the early signs of meningococcal septicaemia, with the recommendation to look for skin rash in patients with acute fever during the first day and night.

The 2016–17 European outbreak of H5N8 HPAIV (Clade 2.3.4.4b) affected a wider range of avian species than the previous H5N8 outbreak (2014–15), including an incursion of H5N8 HPAIV into gamebirds in England. Natural infection of captive-reared pheasants (Phasianus colchicus) led to variable disease presentation; clinical signs included ruffled feathers, reluctance to move, bright green faeces, and/or sudden mortality. Several birds exhibited neurological signs (nystagmus, torticollis, ataxia). Birds exhibiting even mild clinical signs maintained substantial levels of virus replication and shedding, with preferential shedding via the oropharyngeal route. Gross pathology was consistent with HPAIV, in gallinaceous species but diphtheroid plaques in oropharyngeal mucosa associated with necrotising stomatitis were novel but consistent findings. However, minimal or modest microscopic pathological lesions were detected despite the systemic dissemination of the virus. Serology results indicated differences in the timeframe of exposure for each case (n = 3). This supported epidemiological conclusions confirming that the movement of birds between sites and other standard husbandry practices with limited hygiene involved in pheasant rearing (including several fomite pathways) contributed to virus spread between premises.

The Phene Plate system for typing Salmonella serotypes (PhP-S) is a simple automated typing method based on biochemical fingerprinting. It gives a quantitative value of the metabolism of various substrates by measuring the speed and intensity of each reaction. The ‘biochemical fingerprint’ of each isolate is used to calculate similarities among the tested strains with a personal computer program. We used this system to examine a collection of 86 strains of Salmonella enteritidis isolated from human sporadic cases in Germany between 1980 and 1992. Twenty-three biochemical phenotypes (BPTs) consisting of 9 common (C) and 14 single (S) BPTs were identified. BPTs C2 and C4 containing 20 and 36 strains respectively accounted for 65% of the isolates. Strains of BPT C2 were found over a wide period of time whereas strains of BPT C4 were isolated during the period between 1988 and 1992. With phage typing, 11 discrete phage types (PTs) and 18 strains designated as non-specific type (NST) were identified. PTs 4 and 8 with 39 and 17 strains respectively were the dominant PTs. Strains of PT 8 were isolated over a wide period of time whereas all (except one) strains of PT 4 were isolated between 1988 and 1992. Combination of biochemical fingerprinting and phage typing divided the strains into 25 phenotypes (BPT:PTs). Whilst phenotype C2:8 was found over a number of different years, phenotype C4:4 was isolated only between 1988 and 1992. These findings indicate the presence of one persistent and one recently emerged phenotype among S. enteritidis strains in Germany. Although both methods identified the presence of both major and less common types, biochemical fingerprinting with the PhP-S system also provided information about relationships between the strains.

Mycobacterium tuberculosis is the cause of tuberculosis (TB), a granulomatous illness that mostly affects the lungs. Pakistan is one of the eight nations that accounts for two-thirds of all new cases of developing TB. TB has long been an endemic disease in Pakistan. According to the World Health Organization (WHO) estimates, the nation has over 500 000 incident TB infections per year, with a rising number of drug-resistant cases. Recently, the coexistence of COVID-19 and TB in Pakistan has provided doctors with a problem. Fever or chills, cough, shortness of breath or difficulty breathing are all signs of COVID-19. After SARS-CoV-2 infection, cough might persist for weeks or months and it is frequently accompanied by persistent tiredness, cognitive impairment, dyspnoea or pain – a group of long-term consequences known as post-COVID syndrome or protracted COVID. Coughing with mucus or blood, and coughing that continues over 2 months are indications of TB. The same clinical presentation features make it difficult for healthcare personnel to effectively evaluate the illness and prevent the spread of these fatal diseases. Pakistan lacks the necessary healthcare resources to tackle two contagious diseases at the same time. To counteract the sudden increase in TB cases, appropriate management and effective policies must be implemented. Thus, in order to prevent the spread of these infectious diseases, it is critical to recognise and address the problems that the healthcare sector faces, as well as to create an atmosphere in which the healthcare sector can function at its full potential.

Major surgery carried out in low- and middle-income countries is associated with a high risk of surgical site infections (SSI), but knowledge is limited regarding contributory factors to such infections. This study explores factors related to patients developing an SSI in a teaching hospital in Ghana. A prospective cohort study of patients undergoing abdominal surgical procedures was conducted at Korle Bu Teaching Hospital. Patient characteristics, procedures and environmental characteristics were recorded. A 30-day daily surveillance was used to diagnose SSI, and Poisson regression analysis was used to test for association of SSI and risk factors; survival was determined by proportional hazard regression methods. We included 358 patients of which 58 (16.2%; 95% CI 12.7–20.4%) developed an SSI. The median number of door openings during an operation was 79, with 81% being unnecessary. Door openings greater than 100 during an operation (P = 0.028) significantly increased a patient's risk of developing an SSI. Such patients tended to have an elevated mortality risk (hazard ratio 2.67; 95% CI 0.75–9.45, P = 0.128). We conclude that changing behaviour and practices in operating rooms is a key strategy to reduce SSI risk.

Over a period of about 10 months samples were taken at frequent intervals from various stages of treatment at two sewage works; one of these was a small rural works treating only domestic sewage, and the other treated the sewage of an industrial town. These samples were submitted to bacteriological and to chemical examination.

The total plate counts, the counts of coli-aerogenes bacteria, and the counts of Streptococcus faecalis in settled sewage were higher in the warmer than in the colder months of the year.

Though the average total numbers of bacteria in the sewage containing trade wastes were appreciably higher than that of the domestic sewage the counts of faecal organisms were somewhat lower.

Treatment at the works considerably reduced not only the polluting strength of the sewage but also the numbers of bacteria. At the works receiving sewage from an industrial town an average of about 80% of bacteria in settled sewage were removed by treatment in the bio-aeration plant, percolating filters, and humus tanks, and a further 8–10% were removed by subsequent treatment in pressure sand or anthracite filters. At the small rural works, where the rate of treatment was much lower, rather more than 90% of the bacteria were, on the average, removed by treatment in percolating filters and humus tanks, and a further 6% by subsequent passage through shallow gravity sand filters.

The final effluents discharged from the works still contained large numbers of bacteria. Their effect on the bacterial content of the streams to which they are discharged may be gauged from the fact that, in the effluent from the small rural sewage works, which was of consistently good quality when judged by chemical criteria, there were on the average about 160,000 cells of faecal Bacterium coli and about 20,000 faecal streptococci per 100 ml. Numbers in the effluent from the works in the industrial town were even higher. Sand filters of the type investigated here could therefore not be relied upon to produce an effluent of good bacterial quality.

The 44°C. test in MacConkey broth, prescribed by the Ministry of Health (1939) for examination of water, was found, when applied to samples of sewage or sewage effluent, to be almost specific for Bacterium coli, type I. Growth with formation of acid in sodium azide broth incubated at 45° C. was found to be an almost specific test for Streptococcus faecalis.

Helicobacter pylori culture on gastric biopsy was performed on 4964 subjects aged <18 years from 1988 to 2007 at a central laboratory in Brussels. The total number of biopsies increased markedly from 941 in 1988–1993 to 1608 in 2004–2007. Biopsies were repeated at least once for 922 subjects (603 initially negative and 319 initially positive for H. pylori). Persistence rate of H. pylori at 1 year after initial positive biopsy was greater in the 1998–2007 cohort than in the 1988–1997 cohort (72·7% vs. 45·8%, P = 0·002), suggesting a tailored selection of candidates for biopsy with non-invasive tests (13C urea breath test). Of 68 subjects initially positive and re-examined subsequently after a documented cure, re-infection/relapse rate was 48·6% within 5 years post-elimination of H. pylori. Acquisition rate over 10 years follow-up in the initially negative cohort (603 patients) was 38·7% (re-infection/relapse vs. acquisition: P < 0·001). Multivariate analysis showed a fourfold greater risk of H. pylori acquisition in children of non-European origin vs. European origin (P < 0·001). Clarithromycin and metronidazole susceptibility were determined in 226 and 223 paired positive cultures in cases of re-infection/relapse or persistence. An initial non-susceptibility profile was highly predictive of a subsequent non-susceptibility profile, and the non-susceptible proportion increased markedly from 13·3% to 21·2% for clarithromycin (P < 0·001) and from 27·3% to 35·0% for metronidazole (P = 0·014), with no difference regarding European or non-European origin.

Human respiratory tract chlamydial infections have been studied in Cambridge-shire for many years, but until recently we have been unable to distinguish between infection with Chlamydia psittaci Or Chlamydia pneumoniae (TWAR). In this study, we have employed the micro-immunofluorescence (micro-IF) test for this purpose and to look for the relative incidence of C. psittaci and C. pneumoniae infections in Cambridgeshire. Among 50 patients with community-acquired respiratory tract symptoms whose serum samples had Chlamydia complement fixation test titres ≥ 64, 25 had evidence of recent C. psittaci or C. pneumoniae infection. Nineteen (76%) of the 25 patients had evidence of recent C. psittaci infection and of these 16 (84%) had recently had contact with birds. Six patients (24%) had evidence of recent C. pneumoniae infection, and of these, only two (33% had recently had contact with birds). While C. psittaci was grown from several of the birds associated with human C. psittaci infection, it was not cultured from any of the birds in contact with the two human C. pnemoniae cases.

We developed a new phage-typing method and evaluated its application in combination with XbaI macrorestriction analysis by pulsed-field gel electrophoresis (PFGE) as a useful tool for the long-term epidemiology of Salmonella enterica serovar Infantis. In this study, we investigated 1008 S. Infantis isolates recovered from humans, various animal species and food products from 1973 to 2009. The typing scheme is based on 17 typing phages, defining 61 different patterns within the strain collection. The experiments showed that phage typing is a reliable method for differentiation of outbreaks and sporadic clinical cases as well as for elucidation of chains of transmission. The combined analysis of phage typing and PFGE revealed the existence of epidemic clones with a high stability over time like PT29/XB27 which was identified in nosocomial salmonellosis, community outbreaks as well as in broiler chickens from 2002 to 2009.