There are limited data examining whether outcomes of methicillin-resistant Staphylococcus aureus (MRSA) healthcare-associated infections (HAIs) are worse when caused by community-associated (CA) strains compared to HA strains. We reviewed all patients’ charts at our institution from 1999 to 2009 that had MRSA first isolated only after 72 h of hospitalization (n = 724). Of these, 384 patients had a MRSA-HAI according to CDC criteria. Treatment failure was similar in those infected with a phenotypically CA-MRSA strain compared to a phenotypically HA-MRSA strain (23% vs. 15%, P = 0·10) as was 30-day mortality (16% vs. 19%, P = 0·57). Independent risk factors associated with (P < 0·05) treatment failure were higher Charlson Comorbidity Index, higher APACHE II score, and no anti-MRSA treatment. These factors were also associated with 30-day mortality, as were female gender, older age, MRSA bloodstream infection, MRSA pneumonia, and HIV. Our findings suggest that clinical and host factors, not MRSA strain type, predict treatment failure and death in hospitalized patients with MRSA-HAIs.

Surveillance of newly acquired hepatitis C virus (HCV) infection is crucial for understanding the epidemiology of HCV and informing public health practice. However, monitoring such infections via surveillance systems is challenging because they are commonly asymptomatic. A literature review was conducted to identify methodologies used by HCV surveillance systems to identify newly acquired infections; relevant surveillance systems in 15 countries were identified. Surveillance systems used three main strategies to identify newly acquired infections: (1) asking physicians to classify cases; (2) identifying symptomatic cases or cases with elevated alanine aminotransferases; and (3) identifying cases with documented evidence of anti-HCV antibody seroconversion within a specific time-frame. Case-ascertainment methods varied with greater completeness of data in enhanced compared to passive surveillance systems. Automated systems that extract and link testing data from multiple laboratory and clinic databases may provide an opportunity for collecting testing histories for individuals that is less resource intensive than enhanced surveillance.

Severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) led to a significant disease burden and disruptions in health systems. We describe the epidemiology and transmission characteristics of early coronavirus disease 2019 (COVID-19) cases in Bavaria, Germany. Cases were reverse transcription polymerase chain reaction (RT-PCR)-confirmed SARS-CoV-2 infections, reported from 20 January−19 March 2020. The incubation period was estimated using travel history and date of symptom onset. To estimate the serial interval, we identified pairs of index and secondary cases. By 19 March, 3546 cases were reported. A large proportion was exposed abroad (38%), causing further local transmission. Median incubation period of 256 cases with exposure abroad was 3.8 days (95%CI: 3.5–4.2). For 95% of infected individuals, symptom onset occurred within 10.3 days (95%CI: 9.1–11.8) after exposure. The median serial interval, using 53 pairs, was 3.5 days (95%CI: 3.0–4.2; mean: 3.9, s.d.: 2.2). Travellers returning to Germany had an important influence on the spread of SARS-CoV-2 infections in Bavaria in early 2020. Especially in times of low incidence, public health agencies should identify holiday destinations, and areas with ongoing local transmission, to monitor potential importation of SARS-CoV-2 infections. Travellers returning from areas with ongoing community transmission should be advised to quarantine to prevent re-introductions of COVID-19.

Otitis externa is the inflammation of the external auditory canal. The disease is common and shows a seasonal variation with a greater incidence in warmer months. Pseudomonas aeruginosa is a common pathogen in otitis externa and in this retrospective study, we show a corresponding seasonal variation in the proportional incidence of P. aeruginosa isolates from otitis externa in South East England. In total 7770 patients were diagnosed with otitis externa over a period of 9 years from January 2008 to December 2016. P. aeruginosa was isolated from 2802 patients (proportional incidence of 36%). Incidence was higher in the months of August, September and October and in patients between 5 and 15 years of age. We postulate a combination of increased contact with water during warm weather in the holiday season and increased rainfall in the preceding season as a putative mechanism for the seasonal trends.

Human papillomavirus (HPV) types 6 and 11 are the aetiological agent of recurrent respiratory papillomatosis (RRP). The complete genome of an HPV6 isolate with a 170 base pair (bp) duplication identified within the long control region (LCR) from a patient with aggressive recurrent respiratory papillomatosis was determined. The promoter sequence from the HPV LCR including the 170 bp duplication was placed upstream of a heterologous reporter gene and the activity of the reporter gene product determined using transfected cells. In total, mutations were observed at 157 nucleotide positions of the complete genome and included nucleotide substitutions, deletions and insertions, resulting in amino acid changes at 43 residue positions. Reporter gene activity using an HPV-derived LCR region with a 170 bp duplication was significantly higher than that using an HPV-derived LCR region with no duplication within this region. The results suggest that novel HPV variants warrant further investigation for potential biomarkers of aggressive disease.

Escherichia coli O157 is a human pathogen carried asymptomatically by cattle and shed in their faeces. Infection can occur from the consumption of contaminated beef or by direct contact. Large variations of E. coli O157 shedding in cattle exist and vary in the number of cattle positive for E. coli O157 and the amount of bacteria (c.f.u./g faeces) shed by positive animals. To investigate E. coli O157 shedding and super-shedding (>104 c.f.u./g) we used daily sampling over two 8-day periods; in January 2013 (n = 12) and February 2013 (n = 21). Samples were tested by direct faecal culture for enumeration and by immunomagnetic separation to detect lower levels of shedding. We identified three patterns of shedding, similar to previously observed descriptions: intermittent, transient and consistent. The most commonly observed pattern was intermittent shedding and variation in the level of shedding could be large. This extreme variation is demonstrated by a heifer from which E. coli O157 could be not detected one day, was super-shedding E. coli O157 the next and was detected as shedding >100 c.f.u./g the following day. Recto-anal mucosal swab testing did not predict super-shedding in this cohort of heifers. The variable individual patterns of shedding suggest that a common mechanism of infection may not operate within such a herd when considering previously described patterns and the inferred mechanisms. The sporadic and intermittent nature of shedding is a challenge to identifying risk factors and potential intervention strategies.

Consumption of unpasteurised milk in the United States has presented a public health challenge for decades because of the increased risk of pathogen transmission causing illness outbreaks. We analysed Foodborne Disease Outbreak Surveillance System data to characterise unpasteurised milk outbreaks. Using Poisson and negative binomial regression, we compared the number of outbreaks and outbreak-associated illnesses between jurisdictions grouped by legal status of unpasteurised milk sale based on a May 2019 survey of state laws. During 2013–2018, 75 outbreaks with 675 illnesses occurred that were linked to unpasteurised milk; of these, 325 illnesses (48%) were among people aged 0–19 years. Of 74 single-state outbreaks, 58 (78%) occurred in states where the sale of unpasteurised milk was expressly allowed. Compared with jurisdictions where retail sales were prohibited (n = 24), those where sales were expressly allowed (n = 27) were estimated to have 3.2 (95% CI 1.4–7.6) times greater number of outbreaks; of these, jurisdictions where sale was allowed in retail stores (n = 14) had 3.6 (95% CI 1.3–9.6) times greater number of outbreaks compared with those where sale was allowed on-farm only (n = 13). This study supports findings of previously published reports indicating that state laws resulting in increased availability of unpasteurised milk are associated with more outbreak-associated illnesses and outbreaks.

Outbreaks of myxomatosis during the winter or spring have coincided with the establishment of the European rabbit flea in the Mallee region. The severity of these outbreaks has varied from causing complete suppression of the normal spring increase in rabbit numbers to being completely ineffective in a year in which late spring rains allowed rabbit breeding to extend into the early summer.

In 1973 and 1974 effective spring myxomatosis caused heavy mortality in kittens before they emerged from the warrens. The age of the population increased as the result of few young rabbits coming into the population and of the lessened stress on old rabbits in a low summer-autumn population. This effect was reversed in the late-breeding year, 1976, when flea numbers were apparently too low to maintain a spring outbreak and rabbit numbers increased rapidly.

Fourteen influenza A(H3N2) field isolates, mainly obtained during the first weeks of the 1982/83 influenza epidemic in The Netherlands, and nine influenza A(H3N2) reference strains were examined by means of haemagglutination inhibition (HI) tests with 23 potyclonal ferret sera. The resulting HI patterns were subjected to various methods of numerical taxonomy using, among others, taxonomic distance and correlation between strains for resemblance coefficients. Marked differences between distance and correlation coefficients were found in strains which differed in avidity only. The field isolates could be divided into four groups in respect of their taxonomic resemblance to the reference strains. The same grouping was found for five of the field isolates by testing these against 200 human sera.

The following paper investigates the prevalence and characteristics of asymptomatic norovirus infection in the population living around oyster farm sites. Two consecutive surveys were conducted from January 2014 to December 2014 and 4549 stool samples were screened during the same time period. The total asymptomatic infection rate was 4.04% (184/4549). Norovirus infection rate was 5.20% in oyster farming population which was significantly higher compared with non-farming population where the infection rate was 3.65% (χ2 = 5.49, P < 0.05). A total of 184 NoV positive samples were identified by real time-quantitative polymerase chain reaction (RT-qPCR) and semi-nested RT-PCR and 136 sequences were obtained. The sequences were clustered into 14 genotypes. GI strains were clustered into six genotypes, including GI.2, GI.3, GI.5, GI.6, GI.8 and GI.9; while GII strains were clustered into GII.2, GII.3, GII.4, GII.5, GII.6, GII.8 and GII.13. GI.9 and GII.17 were the predominant and most prevalent genotypes, respectively. The GII.17 genotype replaced GII.4 becoming the dominant genotype in the oyster farming area in 2014. To sum up, long-term monitoring of asymptomatic infection is crucial for the detection of new variant strains and for identifying outbreaks during the early stage.

So-called LC strains of Mycoplasma mycoides subsp. mycoides and, where appropriate, SC strains, were examined, together with M. mycoides subsp. capri strains, by growth, fermentation, and antibiotic-sensitivity tests.

Growth curves in BVF-OS medium showed that, from the 6th until at least the 19th day of incubation, strain Mankefår 2833 had a viable count strikingly higher than that of any other LC strain. Its robust growth properties may explain its ability – unusual among LC strains – to produce mycoplasmaemia readily in mice. Strain 143–A66 Conn, also shown by earlier experiments in mice to possess unusual properties, lost viability more rapidly than any other LC strain between the 13th and 19th days of incubation. The viable count of a subsp. capri strain was considerably lower than that of any LC strain for much of the period between days 6 and 19.

In fermentation tests with 27 substrates and sensitivity tests with 11 antibiotics the strains gave results that, in all but the following respects, were uniform. Sorbitol was fermented to varying degrees by all the LC and subsp. capri strains tested but was unaffected by the SC strains. The LC and subsp. capri strains were in general more resistant than the SC strains to streptomycin. The growth of the LC strains, much more than that of the other strains, was greatly stimulated by the presence of fermentable substrate.

During outbreaks of Escherichia coli O157 a minority of patients with suspected infection develop haemolytic uraemic syndrome (HUS). The ability to identify this subgroup at an early stage is beneficial as mortality from HUS is high and may be influenced by intervention. During the 1996 Central Scotland E. coli O157 outbreak, of 886 patients from the community with suspected infection monitored at an outbreak clinic, nine developed HUS. We assessed factors associated with the development of HUS in this group. Children and the elderly were at increased risk of HUS. However, high white cell count was as least as good a predictor of HUS as age. High white cell counts predicted development of HUS with a sensitivity of 89%, specificity of 87%, positive predictive value of 7% and a negative predictive value of over 99%. We have used the results from this study along with other currently available evidence to propose a monitoring protocol for patients from the community with suspected E. coli O157 infection.

Giardiasis, caused by the intestinal protozoan parasite Giardia intestinalis (synonyms: G. lamblia, G. duodenalis), is one of the most frequent parasites to infect the Scottish population. Transmission of the infective cysts in faecal matter is commonly via food and/or water. Giardia is subdivided into assemblages, where clinical and epidemiological differences have been described between assemblages A and B. This snapshot descriptive epidemiological study examines 30 positive cases of Giardia of which 72% (n = 21) were shown to be assemblage A, 14% (n = 4) assemblage B and 10% (n = 3) mixed assemblages (A and B). There was a 2:3 female:male ratio of affected individuals with foreign travel recorded in 22 of these cases. The commonest symptom was diarrhoea which was reported in 80% of cases followed by tiredness. Five cases required hospitalization emphasizing the importance of gaining a greater understanding of how Giardia assemblages influence clinical outcomes to assist in formulating guidelines to manage potential Giardia outbreaks.

We took the opportunity provided by a large outbreak of cryptosporidiosis in the North West of England to investigate the potential impact of recall bias on strength of association and on estimates of outbreak size. We conducted a community-based survey of 4 towns within the outbreak area and 4 control towns. A postal questionnaire was sent to 120 homes, chosen at random from the local telephone directory, in each of the 8 towns. Although not statistically significant, the prevalence of self-reported diarrhoeal disease was marginally higher in the control towns than in the outbreak towns. There was a very strong association between self-reported diarrhoea and drinking water consumption in both control and outbreak areas. The impact of recall bias in outbreak investigations is much greater than previously thought. Identification of the cause of outbreaks should not be based solely on case-control studies conducted after the press has reported the outbreak. Such evidence is likely to be unreliable and give falsely significant associations between water consumption and disease.

1. A series of experiments is described in whichthe efficacy of vaccination with the vole acid-fast bacillus against tuberculosis in cattle has been studied. Various methods of vaccination have been tried and intravenous inoculation has proved to be the most satisfactory.

2. A single intravenous inoculation of 5 mg. of vole bacilli can raise the resistance of cattle to infection with the bovine bacillus to a high degree, this resistance being evidenced by a complete absence of infection or by a marked diminution in the severity of lesions following exposure to artificial or natural infection.

3. The resistance takes time to develop, reaches its maximum between 6 and 18 months after vaccination and then slowly wanes. The resistance induced by a single inoculation is of insufficient duration in many animals to warrant the practice of single vaccination being used in the field except in special circumstances.

4. Revaccination can intensify resistance provided that it is delayed until the end of the fourth week. A long-term experiment is being carried out to determine if revaccination, in addition to intensifying the initial resistance, can also lengthen its duration.

5. The degree of resistance set up in cattle is correlated with the virulence of the vaccinating strain of vole bacillus for its natural host. This fact will necessitate that any strain used for vaccine purposes will have to be maintained at a high level of virulence by repeated passage through its native host.

6. Care is necessary in the selection of a strain of the vole bacillus for vaccine purposes, for we have encountered one strain, G564, which can set up a fatal infection in calves. Nothing has been noted which would contra-indicate the use of strain LV 285.

7. The histopathological changes pathognomic of tuberculous infection which follow the intravenous inoculation of vole bacilli are mainly confined to the lungs and thoracic glands. They reach their maximum about the 28th day and have undergone resolution by the 84th day.

8. The changes which occur in the cells of the reticulo-endothelial system following vaccination have been described. These changes must be taken into consideration in deciding the optimal time and dosage for revaccination and a further study of them is advisable.

Our thanks are due to Prof. T. Dalling for his unfailing interest in our work and for much helpful advice, and also io Dr A. Q. Wells for suppfyihg cultures of vole bacilli and for the loan of his multiple-puncture instrument. We are indebted to Dr V. D. Davies for painstaking examination of the joint lesions and to Dr J. R. M. Innes, who examined many histological sections of vole-inoculated animals and drew up a short report of which we have made much use. Mr V. L. Mastin was associated with us during part of the work and we gratefully acknowledge the help he gave. We also owe a deep debt of gratitude to our technical assistants, particularly Mr W. Nicholson and Mr C. Spurgeon, much of the routine bacteriological work being done by the former whilst the latter prepared the bulk of the histological sections. The local slaughterhouse officials of the Ministry of Food, particuiarfy Mr Bacchus, the slaughterhouse manager, and Mr C. Rose, the foreman slaughterman, have been most co-operative over the arrangements for the slaughter of many animals. Our thanks are also due to the farmers who allowed us to expose experimental animals to natural infection on their farms, and to these and other farmers who have placed their herds at our disposal for the purpose of field trials.

The cost of these investigations was met mainly by grants from the Agricultural Research Council, but partly from the funds of the Institute of Animal Pathology.

Although Giardia, the aetiological agent of giardiasis, is one of the most prevalent intestinal parasitic infections world-wide, for industrialised countries, it is mainly appreciated as an imported disease with the minimal local transmission. However, the current evidence challenges this perception; Giardia has relevance beyond the high prevalence areas. This infection may be asymptomatic or cause gastrointestinal complains and long-term sequelae, including irritable bowel syndrome, chronic fatigue and impaired child growth and cognitive development. Its detection and diagnosis present a challenge to physicians who may not be familiar with this infection. To improve interventions to control this parasitosis, it is necessary to maintain a high index of suspicion and remain vigilant in finding cases at risk for infection. A better understanding of the characteristics of populations importing infections alongside improved methods to reliably classify infections as imported or acquired locally will help to ensure early and accurate diagnosis. The evidence shows that public health problems like giardiasis are global issues that need to be addressed collectively by both high and low prevalence countries.

The efficacy of seven rodenticides for use against Sigmodon hispidus was investigated in the laboratory. The poisons (warfarin, coumatetralyl, difenacoum, brodifacoum, bromadiolone, calciferol and zinc phosphide) were all toxic at the concentrations normally used against Rattus rattus and R. norvegicus and all were palatable.

Trials are now needed to confirm the efficacy of these poisons in the field, but it seems likely that, if used in suitable bait formulations, they would all be useful for the practical control of S. hispidus.

B. dysenteriae (Sonne Type III) may be separated from the dispar group by the fact that it is indol negative and zylose negative. It is usually inagglutinable when freshly isolated but will remove all agglutinins from a Sonne serum. B. dysenteriae (Sonne Type III) is a serological entity and can readily be distinguished from B. dysenteriae Flexner and from the dispar group. Eleven strains of B. dysenteriae (Sonne Type III) have been isolated and examined, along with standard cultures of this group of organisms.

As the literature on Haemophilus ducreyi and clinical chancroid is reviewed, it becomes obvious that many significant findings have been forgotten over the years. As a result, from the time of Ducrey's original description of the organism in 1890 until about 1977, both clinical and laboratory experts in the United Kingdom believed that H. ducreyi infections were rare, generally acquired abroad, and almost impossible to confirm in the routine laboratory! In consequence it was a common view that it was not worth looking for H. ducreyi until all other possible causes of genital ulceration had been excluded. Moreover, the search for such an infection stopped as soon as any other cause for the patient's lesions had been found.

A decision to ignore this ‘rule’ in Sheffield led to our looking for H. ducreyi in specimens from an unselected series of patients with genital ulceration including a number with herpes genitalis infections. The surprise finding of H. ducreyi in circumstances suggesting that it was a secondary invader made us re-examine the whole question of H. ducreyi infections and chancroid and wonder if the same organism can act as a primary pathogen and as a secondary invader. An account of the media and methods we used and of the characteristics of the organism is presented. In an attempt to find out more about the characteristic coherent colonies of H. ducreyi we studied them with the scanning electron microscope. It is clear that the whole subject of H. ducreyi infections has been neglected in the United Kingdom, but we believe that interest has now been aroused and progress will surely follow. Some areas for further investigation are suggested.

Enterovirus A-71 (EV-A71) may be fatal, but the natural history, symptoms, and signs are poorly understood. This study aimed to examine the natural history of fatal EV-A71 infection and to identify the symptoms and signs of early warning of deterioration. This was a clinical observational study of fatal cases of EV-A71 infection treated at five Chinese hospitals between 1 January 2010 and 31 December 2012. We recorded and analysed 91 manifestations of EV-A71 infection in order to identify early prognosis indicators. There were 54 fatal cases. Median age was 21.5 months (Q1−Q3: 12–36). The median duration from onset to death was 78.5 h (range, 6 to 432). The multilayer perceptron analysis showed that ataxia respiratory, ultrahyperpyrexia, excessive tachycardia, refractory shock, absent pharyngeal reflex, irregular respiratory rhythm, hyperventilation, deep coma, pulmonary oedema and/or haemorrhage, excessive hypertension, tachycardia, somnolence, CRT extension, fatigue or sleepiness and age were associated with death. Autopsy findings (n = 2) showed neuronal necrosis, softening, perivascular cuffing, colloid and neuronophagia phenomenon in the brainstem. The fatal cases of enterovirus A71 had neurologic involvement, even at the early stage. Direct virus invasion through the neural pathway and subsequent brainstem damage might explain the rapid progression to death.