Enterotoxigenic Escherichia coli (ETEC) were the most frequently identified enteric pathogens associated with diarrhoea in 0–5 year old Aboriginal children in tropical north-west Australia with an incidence similar to those from other tropical regions. Heat-stable toxin-producing (ST + ) strains were associated with diarrhoea throughout the year but heat-labile toxin-producing (LT + ) strains were more important in the monsoonal summer season. ST + strains were commonest in children with diarrhoea between 6 and 18 months of age while LT + strains were associated with diarrhoea in children aged 18–24 months. Verotoxigenic E. coli (VTEC) which produced VT1, but not VT2, and enteroadherent (EAF + ) E. coli were significant causes of diarrhoea, mainly in children below 18 months but without a seasonal pattern.

Influenza and pertussis are the two most common vaccine-preventable infections notified in Australia. We assessed the role of polymerase chain reaction (PCR) diagnosis in influenza and pertussis cases notified to the Australian National Notifiable Diseases Surveillance System (NNDSS). There were a total of 2 10 786 notified influenza cases (2001–2013) and 2 55 866 notified pertussis cases (1991–2013). After 1 January 2007, the majority of influenza and pertussis notifications were PCR-based (80·5% and 59·6%, respectively). Before 31 December 2006, PCR-based notifications were limited (29·1% and 11·7%, respectively). By 2013, PCR-based notifications had largely replaced all other diagnostic methods, with the exception of serology-based notifications in pertussis cases in adults aged ⩾25 years.

1. The Wilson-Weil-Felix agglutination reaction with cultures of Proteus “X 19” was Positive in dilutions of the serum ranging from 1 in 40 to 1 in 2560 in 22 out of 23 cases of Typhus Fever occurring in Ireland. In one case the reaction was still negative at the time of the patient's death on the 14th day of the disease. As controls, sera from the following gave completely negative results in a 1 in 20 dilution: 50 cases of Influenza, 12 cases of Trench Fever and 15 cases of Syphilis.

2. The agglutinins in Typhus serum for B. proteus “X 19” are completely destroyed by heating at 65° C. for half an hour.

3. Ten sera were tested for presence of immune body by means of the Complement Fixation test. The results were negative.

4. A coliform bacillus isolated from the urine of one case was agglutinated by the sera of twenty cases—the only ones examined—in dilutions varying from 1 in 40 to 1 in 640.

Sixty-two controls gave negative results with a 1 in 40 or higher dilution of their sera.

5. Absorption experiments indicated that the agglutinins for B. proteus “X 19” and this coliform bacillus were distinct.

6. The literature dealing with the heterologous agglutinins met with in the serum of Typhus Fever has been consulted and the various hypotheses that have been put forward to account for their presence have been examined. It is suggested that under the stimulus of infection with the Typhus Fever virus, some bacterium which is a normal inhabitant of the human intestine produces agglutinins for itself and group agglutinins for numerous other micro-organisms especially for Proteus “X 19,” Proteus “X 2,” and various members of the Colon-typhoid group.

In N'Djamena, capital of Chad, measles vaccination coverage of 12–23-month-old children fell from 61% in 1990 to 15% in 1993. A community survey of measles after an outbreak in 1993 showed that among children < 5 years of age, the mean monthly attack rate was 37 per 1000 (95% CI, 32–43) and the mean case fatality rate was 7·4%. Measles incidence was highest (77/1000/month) in children aged 9–11 months and fell among children > 3 years of age. Incidence rates were high (56/1000/month) among 6–8-month-old children, but only 3 deaths occurred in this age group. Measles vaccine efficacy, estimated by comparing attack rates in unvaccinated and vaccinated children, was 71 % (95% CI, 59–80%). Extrapolation of the results to the city population indicated that an estimated 19000 cases and > 1000 measles-associated deaths occurred in 1993. This preventable morbidity and mortality, in a city where coverage was formerly among the highest in Africa, shows the need for sustained global commitment to preventive health care.

Human papillomavirus (HPV) has been identified as etiologic agent of various cancers for both men and women. However, HPV vaccine has not been recommended for men in China by far. To provide more evidences to promote HPV vaccination among males at high-risk of infection, this study investigated genital HPV genotypes among male attendees of sexually transmitted disease (STD) clinic. Male attendees (⩾18 years old) were recruited from STD clinic of Beijing Ditan Hospital. Data on sociodemographic characteristics and self-reported sexual behaviors were collected based on questionnaire. Genital swab specimens were collected for HPV genotypes. Finally, a total of 198 eligible participants were included in the study. Nearly half of them were infected with at least one type of HPV. The prevalence of genital infection among participants with only heterosexual behaviors (50·91%, 56/110) was significantly higher than those with only homosexual behaviors (36·36%, 32/88) (P < 0·001). However, the distribution pattern of the most frequently observed HPV subtypes were found to be similar between these two subgroups. HPV31, HPV18, HPV16 and HPV58 were the most frequently identified high-risk types and HPV11, HPV6, HPV81 and HPV61 were the most frequently observed low-risk types. Our results, although need further verification by larger sample size, suggested that currently available HPV vaccines covered most prevalent HPV types observed in Chinese men. As HPV vaccine has been approved for application in females in China, molecular epidemiological studies and intervention studies among high-risk males should be promoted as well.

African horse sickness virus serotype 9 (AHSV-9) has been known for some time to be circulating amongst equids in West Africa without causing any clinical disease in indigenous horse populations. Whether this is due to local breeds of horses being resistant to disease or whether the AHSV-9 strains circulating are avirulent is currently unknown. This study shows that the majority (96%) of horses and donkeys sampled across The Gambia were seropositive for AHS, despite most being unvaccinated and having no previous history of showing clinical signs of AHS. Most young horses (<3 years) were seropositive with neutralizing antibodies specific to AHSV-9. Eight young equids (<3 years) were positive for AHSV-9 by serotype-specific RT–PCR and live AHSV-9 was isolated from two of these horses. Sequence analysis revealed the presence of an AHSV-9 strain showing 100% identity to Seg-2 of the AHSV-9 reference strain, indicating that the virus circulating in The Gambia was highly likely to have been derived from a live-attenuated AHSV-9 vaccine strain.

Although infection by the pathogenic bacterium Listeria monocytogenes is relatively rare, consequences can be severe, with a high case-fatality rate in vulnerable populations. A quantitative, probabilistic risk assessment tool was developed to compare estimates of the number of invasive listeriosis cases in vulnerable Canadian subpopulations given consumption of contaminated ready-to-eat delicatessen meats and hot dogs, under various user-defined scenarios. The model incorporates variability and uncertainty through Monte Carlo simulation. Processes considered within the model include cross-contamination, growth, risk factor prevalence, subpopulation susceptibilities, and thermal inactivation. Hypothetical contamination events were simulated. Results demonstrated varying risk depending on the consumer risk factors and implicated product (turkey delicatessen meat without growth inhibitors ranked highest for this scenario). The majority (80%) of listeriosis cases were predicted in at-risk subpopulations comprising only 20% of the total Canadian population, with the greatest number of predicted cases in the subpopulation with dialysis and/or liver disease. This tool can be used to simulate conditions and outcomes under different scenarios, such as a contamination event and/or outbreak, to inform public health interventions.

Giardia duodenalis and Cryptosporidium spp. are common intestinal protozoa that can cause diarrhoeal disease. Although cases of infection with Giardia and Cryptosporidium have been reported in Alaska, the seroprevalence and correlates of exposure to these parasites have not been characterised. We conducted a seroprevalence survey among 887 residents of Alaska, including sport hunters, wildlife biologists, subsistence bird hunters and their families and non-exposed persons. We tested serum using a multiplex bead assay to evaluate antibodies to the Giardia duodenalis variant-specific surface protein conserved structural regions and to the Cryptosporidium parvum 17- and 27-kDa antigens. Approximately one third of participants in each group had evidence of exposure to Cryptosporidium. Prevalence of Giardia antibody was highest among subsistence hunters and their families (30%), among whom positivity was associated with lack of community access to in-home running water (adjusted prevalence ratio [aPR] 1.15, 95% confidence interval (CI) 1.02–1.28) or collecting rain, ice, or snow to use as drinking water (aPR 1.09, 95% CI 1.01–1.18). Improving in-home water access for entire communities could decrease the risk of exposure to Giardia.

The complement-fixing antigen activity of canine hepatitis virus is due to particles which are estimated to measure from 70 to 105 mμ and which probably can form larger aggregates. The active particles in the original virus tissue suspension were of sizes similar to those in the purified preparations, their serological properties being identical. The chemical properties of the antigen are those of protein, probably ribonucleoprotein. No evidence has been obtained to explain the association of a high concentration of the antigen with the presence of numerous intranuclear inclusion bodies in the lesions. It is evident, however, from these experiments that the inclusion bodies are not just deposits of the serologically active material. Since the intranuclear inclusion bodies and also the antigen are probably composed of ribonucleoprotein, it is possible that they both represent certain stages in the formation of virus protein by a catalytic reaction from the denatured host proteinogen.

Six hundred and twenty-four Vibrio cholerae O1 strains, 623 serotype Ogawa and one serotype Inaba, isolated in Romania between 1977–95 were tested to detect all changing traits concerning serogroup, serotype, biotype, phage type and resistotype patterns and subsequently, the possible epidemiological relationship among these strains. Biotyping revealed one classical, 580 eltor strains and 43 intermediary variants. When tested with Mukerjee phages, 546 (87%) strains were sensitive and 78 (13%) resistant. One phage type (M4) dominated during 1977–90, two phage types (M4 and M5) exhibited the same high frequencies during 1991, a diversity of types occurred during 1993–4 whereas in 1995, two phage types (M4 and M5) showed similar distributions again. Five patterns of drug susceptibility were successively described during 1977–95. The most prominent changes in Vibrio cholerae O1 strains were noticed during 1993–4: the highest number of non-typable strains and intermediary variants, the widest spectrum of phage types and of multidrug resistance. In 1995, the strains reverted to the previous typable forms but a new drug resistance pattern was noticed.

A sentinel surveillance system for the control of sexually transmitted diseases (STD) among foreigners was developed in Italy in 1991. From January 1991 to June 1995, 4030 foreigners with a new STD episode were reported. More than one-third of them were North-Africans. The most frequent STDs were non-specific urethritis and genital warts among men, and non-specific vaginitis and latent syphilis among women. The overall HIV prevalence was 5%, with large differences in rates in people from different continents. Very high HIV-positivity rates were observed among homosexuals and homosexual IDUs from Central–South America, with 39·1% and 77·8% seropositive individuals respectively.

These data stress the need for increased knowledge of both the spread of and risk factors for STDs among immigrants. Particular attention should be paid to counselling procedures focused on the prevention of risk behaviours for acquiring STDs and HIV infection.

In April 1997, a large city in the northeastern United States changed their drinking water treatment practices. The city, which previously provided only chlorination for their surface water sources added filtration in addition to chlorination. To assess whether Cryptosporidium infections rates declined following filtration, we tested serological responses to 15/17-kDa and 27-kDa Cryptosporidium antigens among 107 community college students 1 month before and 225 students 5 months after filtration. Results suggest that levels of Cryptosporidium infections did not decline following water filtration. However, seasonal changes in other exposures may have confounded the findings. Swimming in a lake, stream or public pool and drinking untreated water from a lake or stream predicted a more intense response to one or both markers. Residence in the city, not drinking city tap water or drinking bottled water, gender, travel or exposure to pets, young pets, diapers or a household child in day care were not found to be predictive of more or less intense serological responses for either the 15/17-kDa and 27-kDa antigen.

Skilled nursing home facilities (SNFs) house a vulnerable population frequently exposed to respiratory pathogens. Our study aims to gain a better understanding of the transmission of nursing home-acquired viral respiratory infections in non-epidemic settings. Symptomatic surveillance was performed in three SNFs for residents exhibiting acute respiratory symptoms. Environmental surveillance of five high-touch areas was performed to assess possible transmission. All resident and environmental samples were screened using a commercial multiplex polymerase chain reaction platform. Bayesian methods were used to evaluate environmental contamination. Among nursing home residents with respiratory symptoms, 19% had a detectable viral pathogen (parainfluenza-3, rhinovirus/enterovirus, RSV, or influenza B). Environmental contamination was found in 20% of total room surface swabs of symptomatic residents. Environmental and resident results were all concordant. Target period prevalence among symptomatic residents ranged from 5.5 to 13.3% depending on target. Bayesian analysis quantifies the probability of environmental shedding due to parainfluenza-3 as 92.4% (95% CI: 86.8–95.8%) and due to rhinovirus/enterovirus as 65.6% (95% CI: 57.9–72.5%). Our findings confirm that non-epidemic viral infections are common among SNF residents exhibiting acute respiratory symptoms and that environmental contamination may facilitate further spread with considerable epidemiological implications. Findings further emphasise the importance of environmental infection control for viral respiratory pathogens in long-term care facilities.

As part of the evaluation of the French plan for the elimination of measles and rubella, we conducted a seroprevalence survey in 2013, aimed at updating seroprevalence data for people 18–32 years old. A secondary objective was to estimate measles incidence in this population during the 2009–2011 outbreak, and thus estimate the exhaustiveness of measles mandatory reporting. We used a cross-sectional survey design, targeting blood donors 18–32 years old, living in France since 2009, who came to give blood in a blood collecting site. We included 4647 people in metropolitan France, 806 people in Réunion Island and 496 in the French Caribbean. A further 3942 individuals were interviewed in the south-east region of metropolitan France to estimate the exhaustiveness of measles mandatory reporting. One of the main findings of this survey is that the proportion of people 18–32 years old susceptible to both measles and rubella infections remained high in France in 2013, 9.2% and 5.4%, respectively, in metropolitan France, even after the promotion campaigns about vaccination catch-up during and following the major measles epidemic in 2009–2011. Applying our results to French census data would suggest that around 1 million people aged 18–32 years old are currently susceptible to measles in France, despite this age group being one of the vaccination targets of the national measles elimination plan. Another important finding is that only an estimated 45% of the true number of cases in this age group was actually notified, despite notification being mandatory.

In summer 2008, we investigated an outbreak of diarrhoeal illness in participants of a mountain-bike event in Wales (UK) which had been affected by heavy rain. We conducted a retrospective cohort study to investigate the cause using an internet-based questionnaire. Fifty-three percent of those contacted responded, and 161 (46·5%) out of the 347 responders, reported gastrointestinal symptoms. Median day of onset was 3 days following the event. Ten riders reported receiving a laboratory-confirmed diagnosis of Campylobacter. Multivariate logistic regression analysis identified the inadvertent ingestion of mud (OR 2·5, 95% CI 1·5–4·2, P<0·001) and eating ‘other’ food during the event (OR 2·1, 95% CI 1·2–3·6, P=0·01) as significant risk factors for illness. We concluded that the outbreak was caused by Campylobacter, spread to the riders by the inadvertent ingestion of mud which had been contaminated with sheep faeces from the rural course. Mountain-bike race organizers should consider microbiological hazards when risk-assessing potential race courses. The internet is an efficient tool for the investigation of outbreaks in computer-literate populations.

A method has been devised whereby the potency of any given carcinogenic agent can be compared with that of a standard agent. This is called the standard carcinogenic potency of the agent (P.). The relative potency of the agent (R.P.), calculated from P., permits one to estimate the effect on the agent of different chemical treatments, dilutions, etc., the percentage increase or decrease in activity of the agent being at once shown. A unit of carcino-genicity (U.C.) has been established, and a concentration of 500 carcinogenic units per cubic centimetre is considered to induce the maximum relative response on animals when the agent is applied twice a week. These standards have been devised as a natural sequence to the accumulation of a vast amount of experimental data the correlation of which necessitated some expedient more rapid and covering a wider field than the graphs formerly utilized.

Any conclusions that are reached in such an enquiry as this can only be put forward very tentatively, for they are based (1) upon limited data which cannot be free entirely from error, and (2) upon the averaging of individual results drawn, it is true, from the same class, but from families varying considerably in economic status. For this reason, without much further investigation, any generalisation would be out of place, and the conclusions summarised below are put forward not as definite results but only as indications of the actual facts.

(1) In view of the fact that minimum wage legislation for agricultural workers is being introduced in answer to the statements that the economic status of these workers is deplorably low, it is important to bring forward any facts relating to the actual condition of the rural families.

(2) For an investigation of these conditions, Essex (rural districts) was chosen as the field of enquiry in 1923, and for purposes of comparison and confirmation of results earlier rural investigations have been utilised.

(3) A study of the experimental work on metabolism suggests that the agricultural labourer would certainly need a gross amount of at least 3300 calories per day, and that this assumption will not be likely to err on the side of excess.

(4) The Essex studies of 1923 give a mean value of 2872 calories per man value per day and only 17 per cent. of the families secure over 3300 calories per man per day.

(5) This result is not at variance with the conclusions reached in earlier investigations in rural areas, and the suggestion accordingly is that underfeeding is, to some extent, present in the rural areas. (Lusk writes “it is evident… that one may reduce the basal requirement of energy by undernutrition, and that this process may largely economise food, but that to accomplish a given amount of work a fixed amount of food-fuel is required, irrespective of the nutritive condition of the organism.”)

(6) This under-feeding occurs although nearly three-quarters of the total income is spent on food (leaving a very small amount for other essentials and practically nothing for non-essentials), and although the diet is substantially increased by the consumption of home produce. Without the latter the diet would be seriously deficient.

(7) In the Essex studies nearly one-third of the money spent on food was devoted to bread and flour.

(8) On the other hand, in comparison with urban studies, the rural diet compares very favourably with that of urban workers possessed of a higher money income.

(9) This advantage to the rural family is gained by (a) a larger percentage expenditure on food; (b) a less varied diet containing a substantially smaller amount of meats and hence less animal protein; a substantially larger amount of breadstuffs and hence more carbohydrates in place of fats1; (c) by the consumption of home produce, which, however, entails, in its turn, a lengthening of the day's work and increased needs for food. Without this home produce the diets would compare very unfavourably with those of the urban workers studied. With it, the Vitamine content, as well as the energy value of the diet, must be substantially increased.

(10) In spite of the diet being low there is little evidence of malnutrition amoung the rural children of Essex, and their physique is better, age for age, than that of urban children, living on a diet equivalent or superior in energy value. Other factors, especially the “racial” factor and the “fresh air and sunlight” factor, however, must exert such an influence that the efficacy of the diets cannot be satisfactorily measured by a comparison of heights and weights.

Puumala virus (PUUV) is the causative agent of nephropathia epidemica, a mild form of haemorrhagic fever with renal syndrome. PUUV is transmitted to humans via aerosolized excreta of the infected bank vole (Clethrionomys glareolus). Current methods for screening of the PUUV prevalence among bank vole populations are laborious, combining sampling in the field and subsequent analyses in the laboratory. In order to facilitate animal testing, a new serological immunochromatographic rapid test was developed. The test uses PUUV nucleocapsid protein as antigen, and it detects anti-PUUV IgG antibodies in rodents. With fresh and undiluted bank-vole blood samples (n=105) the efficacy of the test was 100%, and with frozen and diluted samples (n=78) the efficacy was 91%. The test was also shown to detect related hantavirus infections in Norway lemmings and sibling voles (n=31) with 99% efficacy. The test provides an applicable tool for studying PUUV and related hantavirus infections in arvicoline rodents.

Nasopharyngeal secretions were taken during the acute phase of illness from 66 infants and children admitted to hospital with lower respiratory tract infections. Second secretions were taken, after an interval of 7 days, from 33 of these patients. A significant increase in neutralizing activity to R.S. virus was demonstrated in the nasopharyngeal secretions of patients in response to severe R.S. virus infection. Seventeen out of 25 patients (68%) with R.S. virus infections developed a rise in secretory neutralizing titre, compared with only 1 out of 8 patients (13%) with respiratory infections not involving R.S. virus.

A high titre of secretory neutralizing activity was found more often in the acute phase of illness in patients with R.S. virus infections, especially bronchiolitis, than in patients with respiratory infections not involving R.S. virus. Fifteen out of 34 patients (44%) with R.S. virus bronchiolitis were found to possess a neutralizing titre of 1/4 or more in their first secretions, compared with 4 out of 12 patients (33%) with R.S. virus infections other than bronchiolitis and 3 out of 20 patients (15%) with respiratory infections not involving R.S. virus.

A quantitative analysis of the immunoglobulins present in the secretions indicated that IgA was the only immunoglobulin consistently present at a detectable concentration. The geometric mean values of IgA, IgM and IgG in the secretions examined were found to be 22·3, 4·3 and 5·3 mg./lOO ml. respectively.

The neutralizing activity against R.S. virus, present in the secretions, was shown to be due to specific IgA antibody. This was accomplished by removing the neutralizing activitv in two secretions bv absorotion with anti-IaA serum.

The study's objectives were to investigate the prevalence, incidence, persistence, and associated risk factors of syphilis in female sex workers (FSWs) in Kaiyuan City, Yunnan, China. Three serial cross-sectional surveys were conducted and biological specimens were collected and tested for HIV, sexually transmitted infections, and drug use. The logistic Generalized Estimating Equation regression model was used to identify risk factors for prevalent syphilis. The prevalence of syphilis was 7·5%, 8·4% and 8·8%, respectively, in the three survey periods. Estimated syphilis incidence was 1·07 cases/100 person-years, and the persistence of syphilis per person at 6 months was 90·4%. In multivariate analysis, the factors associated with syphilis were age, lower education level, number of clients in a week, inconsistent condom use with clients, herpes simplex virus type 2 (HSV-2), and Chlamydia trachomatis. Persistent syphilis in this population of FSWs is a serious public health concern.