Among the 81 cultures of Salmonella typhimurium of phage type 141 examined, 72 had been isolated from Sheffield incidents in 1984–5 and 9 were Scottish isolates from 1986–7. All of these cultures from diverse sources belonged to primary biotype 31; 79 were of full biotype 31beg and 2 anaerogenic cultures were of full biotype 31begj. This is the first known occasion on which an epidemic strain of S. typhimurium of phage type/biotype 141/31beg has been implicated in outbreaks of human or animal infection in the UK. Because previous epidemic strains of S. typhimurium of phage type 141 in the UK belonged to biotypes 1f and 9f which are phylogenetically unrelated to biotype 31beg, the likely origin of this most recent epidemic S. typhimurium strain of phage type/biotype 141/31beg is discussed.

To identify the predictive and prognostic factors associated with ampicillin-resistant enterococcal bacteraemia, we retrospectively reviewed demographic, microbiological and clinical data of patients attending the Kyoto University Hospital, Japan, between 2009 and 2015. Logistic regression and Cox regression analyses were performed to determine the predictive and prognostic factors, respectively. In total, 235 episodes of enterococcal bacteraemia were identified. As ampicillin susceptibility was uniform for Enterococcus faecalis isolates and almost all ampicillin-resistant isolates were E. faecium, bacteraemia due to these species was investigated separately. E. faecalis and E. faecium accounted for 41.7% (98/235) and 48.1% (113/235) of the isolates, respectively and 91.2% of all E. faecium were ampicillin resistant. Nosocomial E. faecium bacteraemia acquisition (odds ratio (OR), 13.6; 95% confidence intervals, 3.16–58.3) was associated with ampicillin-resistant isolates. Bacteraemia from an unknown source (hazard ratio (HR), 2.91; 95% CI 1.36–6.21) and an increased Pitt bacteraemia score (PBS) (HR, 1.36; 95% CI 1.21–1.52) were associated with 30-day mortality in E. faecium infections. Likewise, bacteraemia from an unknown source (HR, 4.17; 95% CI 1.25–13.9) and increased PBS (HR, 1.27; 95% CI 1.09–1.48) were associated with 30-day mortality in patients with E. faecalis bacteraemia. The empirical therapeutic administration of glycopeptides is recommended for patients with bacteraemia from an unknown source in whom severe E. faecium bacteraemia is suspected.

In the present study rubella HI antibodies were determined in cases of congenital malformation and bad obstetric history to determine the role of rubella in such cases in India, as it has been reported to be rare in Japan in contrast to Western countries. The incidence of antibodies was statistically significant in cases of congenital eye, c.n.s., visceral and miscellaneous malformations and cases of spontaneous abortion and still-birth compared with controls of matching age groups. This is further supported by the demonstration of IgM antibodies in seven cases of congenital malformations and ten cases of spontaneous abortion. Our findings show that congenital rubella is not rare in India.

A retrospective study of clinical characteristics, outcome and prognostic factors of patients with cryptococcosis was undertaken in intensive care units (ICUs) of a medical centre for the period 2000–2005. Twenty-six patients with Cryptococcus neoformans var. grubii infection were identified (16 males, median age 58 years). The most frequent underlying diseases were liver cirrhosis (38·5%), diabetes mellitus (26·9%) and HIV infection (19·2%). The most frequently identified sites of infection were blood (61·5%), cerebrospinal fluid (38·5%) and airways (34·6%). The mean Acute Physiologic and Chronic Health Evaluation II score at ICU admission was 22·46. The ICU mortality rate in these patients was 73·1% (19/26) and there were a further two mortalities recorded after discharge from ICU, reaching a total mortality rate of 80·8% (21/26). Patients with ICU survival >2 weeks had lower rates of HIV infection (P=0·004), less use of inotropic agents during ICU stay (P<0·001) and lower white blood cell counts (P=0·01). After adjusting for clinical variables in the multivariate Cox regression model, diabetes and cryptococcal infection after ICU admission were independent predictors of good long-term prognosis (P=0·015) and HIV infectious status was associated with poor outcome (P=0·012).

Studies of several cultures of Salmonella typhi-murium var. binns revealed the fact that all contained specific components characteristic of S. typhi-murium. These cultures lacked the somatic factor V. It is proposed, therefore, to emend the antigenic formula of S. typhi-murium var. binns from IV, V: —: 1, 2, 3, to IV: i: 1, 2, 3. Under the emended variety would also be included the organisms described by Kauffmann as S. typhi-murium var. copenhagen and by Edwards as S. aertrycke var. storrs.

The writer acknowledges with grateful appreciation his indebtedness to Dr Harry Schiitze for his interest and helpful suggestions and to Dr W. M. Scott, Dr F. Kauffmann and Miss Georgia Cooper for forwarding cultures.

The analysis of the serological results of blood specimens submitted during the course of the past 2 years for the Widal reaction has been made.

The sera from cases of typhoid and paratyphoid fever were examined in particular for their agglutinin content for the “H” and “O” antigens of B. typhosus and B. paratyphosus B. The results obtained indicate that it is essential to use the “O” antigen of B. typhosus, but no particular advantage has been derived, from the point of view of early diagnosis, from the use of B. paratyphosus B “O” antigen.

A comparison of the value of suitable living and killed antigens has been made. Either type of antigen appears to be equally effective, but for convenience and stability the suspensions issued by the Standards Laboratory, Oxford, have proved entirely satisfactory.

Cases showing the serological difficulties which arise when a mixed specific and non-specific form of B. paratyphosus B “H” antigen is used are described.

The author is indebted to the Medical Eesearch Council for a personal grant, and to Miss N. A. Davidson for much technical assistance.

Cattle and sheep were housed with infected pigs for 11 days. Small amounts of virus were recovered intermittently from the pharynx, milk and rectal swabs of the cattle, but no evidence of subclinical infection was found. Some indication of virus growth in the sheep was obtained in that large amounts of virus were recovered from the pharyngeal region 4 to 7 days after exposure and six of the eight sheep developed significant titres of neutralizing antibody which were maintained in four animals for at least 6 weeks.

1. A survey of post-operative wound infection was done in 1959–60 on 559 surgical patients admitted to a provincial general hospital.

2. Clinical evidence of post-operative wound sepsis was observed in 71(12·7 %), suppuration in 51(9·1 %) and staphyloccocal wound sepsis in 48 (8·6 %).

3. Seventeen of the patients died in hospital. Although 5 of these had septic wounds, the sepsis did not appear to have been the cause of death.

4. Contrary to some reported findings, the post-operative wound sepsis rate was considerably lower in patients who were staphylococcal nasal carriers on admission to hospital than in non-carriers. Nine out of 153 carriers (5·9 %) developed wound sepsis and 36 out of 385 non-carriers (9·4 %). When allowance is made for 3 highly probable self-infections, the incidence of wound cross-infection was 3 % in carriers and 9 % in non-carriers.

5. The excess of sepsis in non-carriers could not be explained in terms of different age or sex distribution in carrier and non-carrier groups, nor by differences in the types of operation undergone or in degree of exposure to staphylococcal contamination.

6. The excess of sepsis in non-carriers was accounted for by the patients whose wounds had drains rather than by clean-stitched wounds.

7. Those carriers who harboured a staphylococcus of the 80/81 group in the nose on admission to hospital had a higher incidence of wound sepsis than carriers of other phage types or staphylococcus.

8. Three probable instances of wound self-infection occurred, and in the early stages of the survey at least 5 wound infections were probably directly caused by two members of the theatre staff carrying staphylococci of the 80/81 group in the nose and with existing skin sepsis or a recent history.

9. The survey findings and a study of the literature suggested: (a) that the acquisition of a nasal staphylococcus in hospital was probably, as a rule, evidence of exposure to staphylococeal contamination and not a determinant of wound sepsis, unless the patient also became a skin carrier; (b) that a small proportion of patients are self-infected, some are directly infected by theatre personnel, and the wounds of other patients are directly or indirectly contaminated by staphylococci from the ward environment; (c) that wool or cotton fluff contaminated with staphyloccoci may cause wound sepsis by falling into open wounds and as foreign bodies induce a significant reduction in the minimum pus-forming dose of staphylococci; (d) that before ascribing high or low sepsis rates to factors such as the nasal carrier state, the relevant groups should be shown not to differ materially in respect of other factors known to influence the incidence of wound sepsis.

We gratefully acknowledge the help and encouragement of our surgical colleagues Mr H. P. Guerrier, Mr P. J. W. Monks, Mr J. Macpherson and Mr C. C. Jeffery; and of Dr C. P. Warren, consultant pathologist to the Torbay Hospital, Mrs M. Stamp, Matron, Sister E. M. Cottrell, first Infection Control Sister at the Torbay Hospital, and her successor Mr H. Street.

Acknowledgement is also due to the South Western Regional Hospital Board for its encouragement and for a research grant for technical aid, without which the surveys described would not have been possible.

In a semi-closed institution, Greenwich Hospital School:

1. There was no constant relation between the prevalence of cases and carriers of virulent, or avirulent, diphtheria bacilli.

2. Carrier rates showed a seasonal periodicity with a maximum in the autumn and a minimum in the winter school term.

3. High rates for carriers of virulent bacilli were found in the absence of clinical diphtheria and presence of numerous Schick susceptibles.

4. As much as 40 per cent. of a random sample of healthy boys, none of whom contracted diphtheria, were discovered to harbour diphtheria bacilli (M.D.)1 within 1 year, during which the average carrier rate in the sample was 6·8 per cent.

5. The carrier rate for avirulent diphtheria bacilli, among boys recently infected with virulent, was three times the expected rate.

6. The carrier rate for virulent diphtheria bacilli, among boys recently infected with avirulent, was no higher than the expected rate.

7. The frequency of avirulent diphtheria bacilli infections was twice as great among Schick susceptibles as among Schick immunes.

8. Carriers of virulent bacilli (with five exceptions) were always found to have Schick-negative reactions, in spite of their being more frequent among the junior members of the institution.

9. Carriers of avirulent diphtheria bacilli were as common among the senior as the junior Schick-immune members of the school.

10. Carriers of avirulent bacilli were less frequently found in those Schick-susceptible members of the community who were most quickly immunised by artificial diphtheria antigens.

11. The hypothesis that, when a Schick susceptible is infected with virulent diphtheria bacilli, the latter often acquire avirulence, could satisfactorily explain many anomalies in the distribution of latent infection with diphtheria bacilli and Schick immunity.

[Since this article went to press I have received a reprint from A. Garrido-Morales and 0. Costa (“ The Mechanism of Natural Immunity to Diphtheria,” Amer. J. Hyg. (1931), 14, 89), who describe the distribution of diphtheria carrier infection and Schick immunity in a school at San Juan, Porto Rico. In the main their results parallel those obtained at G.H.S. The most important difference between the tropical and G.H.S. observations was found in a sample of children, who were Schick tested and swabbed synchronously, in which the frequency of virulent carrier infections was greater among Schick susceptibles than Schick immunes. (However, only 9 T.C.D. infections were found among 642 children, but 5 of these were discovered among the 194 Schick susceptibles in this group.)—S. F. D.]

The prevalence of antibodies against Entamoeba histolytica was studied in the Mexican population using an immunoenzyme assay in solid phase (ELISA) and semiautomatic equipment. The antigen was a mixture of membrane proteins obtained by Triton X-100 extraction from an axenic culture of Entamoeba histolytica HM1-IMSS. The method was standardized by comparing serum samples from amoebic liver abscess patients with healthy volunteers. From the 60538 samples supplied by the National Seroepidemiology Survey, antibodies were found in 4·49 % (4·32–;4·65% at 95 % confidence limit). More significant titres occurred in the central region of the country. The ratio female to male was 1·25:1. The population living in metropolitan areas had probably been infected at a younger age than those living in the country.

Important differences were found in the seroprevalence obtained by ELISA compared with a study which used indirect haemagglutination (IHA) in the same sample frame.

The degree of immunity due to cross-reactions between antibody to influenza virus A/Hong Kong/1/68 and A/England/42/72 was studied in ferrets. Ferrets were immunized with the viruses by either live infection or by inoculation with inactivated virus vaccines. The vaccines were given with Freund's incomplete adjuvant or were given to ferrets previously infected with influenza virus A/PR/8/34. As a result of these immunizations the animals all produced similar titres of serum HI antibody to the immunizing virus, although the degree of crossreaction with the other virus strain was variable. After immunization the animals were challenged by infection with an A/Eng/42/72-like virus and their degree of immunity was measured. It was found that the greatest immunity was in ferrets previously infected with the homologous A/Eng/42/72 virus. Animals previously infected with A/HK/68 virus also showed a measurable degree of immunity to A/Eng/42/72 infection, and this was greater than that found in animals given inactivated virus vaccines. The immunity produced by the vaccines was approximately equal, regardless of which vaccine or method of immunization was used. Thus, live infection produced a more effective, broader immunity than did the use of inactivated virus vaccines.

We compared rotavirus detection patterns before (2001–2006) and after (2008–2015) rotavirus vaccine introduction. We also compared rotavirus detection patterns in odd (2009, 2011, 2013, 2015) and even (2008, 2010, 2012, 2014) years post-vaccine separately. Results of stool rotavirus antigen testing from inpatient, outpatient and emergency department encounters from July 2000 to July 2015 at two paediatric hospital laboratories in Atlanta, Georgia were reviewed. Post-vaccine, rotavirus detection declined (30.2% vs. 13.7% (overall 54.6% decline, P <0.001)), occurred more frequently outside the rotavirus season (19.8% vs. 3.5%; P < 0.001), and was more common among older children (26 vs. 13 median months of age; P < 0.001). During odd years post-vaccine, rotavirus detection was significantly higher than even years (20.2% vs. 6.4%; P < 0.001). Rotavirus detection declined substantially and developed a biennial pattern in the post-vaccine era. The intensity and temporality of rotavirus detection in odd years post-vaccine resembled that observed pre-vaccine, although considerably reduced in magnitude.

Nasal swabs were taken from 492 babies born consecutively to residents of two South Wales towns soon after their discharge from maternity hospitals. Staphylococcus aureus was isolated from 352 babies (72%) and in 79 (22%) of these it was resistant to at least one antibiotic. By the time these babies were a year old the prevalence of both sensitive and resistant strains had fallen, so that only 12% still carried nasal staphylococci, but 64% of these organisms were then resistant to penicillin. Administration of penicillin to the baby seemed to be a more important factor in selecting resistant organisms than other antibiotics given to the baby, any antibiotic treatment to other members of the household, or discharge from hospital.

This study aims to ascertain the long-term epidemic trends of malaria and evaluates the probability of achieving the eradication goal by 2020 in China. Data on malaria incidence and deaths were extracted from the China Information System for Disease Control and Prevention. The epidemic trends by sex, age and spatial distribution and predictions of malaria were estimated by using Joinpoint and Poisson regressions. From 1950 to 2016, 227 668 374 malaria cases were reported in China, with an annualised average incidence of 337.02 (336.98–337.07, 95% confidence interval (CI)) per 100 000 population. The incidence decreased with an average annual per cent change (AAPC) of −11.4% (−16.6 to −6.0). There were 36 085 malaria deaths, with an annualised average mortality of 0.534 (0.529–0.540) per 1 000 000 population. The mortality decreased with an AAPC of −8.7% (−13.7 to −3.4). The predicted number of malaria cases and deaths for 2020 is 2 562 and 10, respectively, and zero for indigenous cases. The disease burden of malaria dramatically decreased in China. Though, the goal of malaria elimination is realistic by 2020 in China, routine clinical and entomological surveillance should be continually conducted, especially for the cross-border areas and imported malaria cases.

The survival rate of mice actively or passively immunized against intracerebral challenge with Bordetella pertussis, was independent of the size of challenge dose within the range of 20–2000 LD.

This unexpected result appears to be due to the anatomical peculiarities of the infected organ, in which circulating antibody does not pass the normal blood-brain barrier easily. The pertussis infection does not cause sufficient inflammation to induce a pathological increase in the permeability of the barrier until the number of living microbes in the brain reaches 10 to 10. Since this stage in the brain consistently occurs after 4–5 days, independently of the size of the inoculum within the range 20–2000 LD, the outcome of infection in the immunized animal depends solely on the degree of specific immunity.

In the non-immune mouse, the increase in permeability of the barrier persists until death. In the immunized mouse, the elimination of the infection leads to a restoration of the normal barrier at about the 6th day.

Since 2016, the European Region has experienced large-scale measles outbreaks. Several measles outbreaks in England during 2017/18 specifically affected Romanian and Romanian Roma communities. In this qualitative interview study, we looked at the effectiveness of outbreak responses and efforts to promote vaccination uptake amongst these underserved communities in three English cities: Birmingham, Leeds and Liverpool. Semi-structured in-depth interviews were conducted with 33 providers involved in vaccination delivery and outbreak management in these cities. Interviews were analysed thematically and factors that influenced the effectiveness of responses were categorised into five themes: (1) the ability to identify the communities, (2) provider knowledge and understanding of the communities, (3) the co-ordination of response efforts and partnership working, (4) links to communities and approaches to community engagement and (5) resource constraints. We found that effective partnership working and community engagement were key to the prevention and management of vaccine-preventable disease outbreaks in the communities. Effective engagement was found to be compromised by cuts to public health spending and services for underserved communities. To increase uptake in under-vaccinated communities, local knowledge and engagement are vital to build trust and relationships. Local partners must work proactively to identify, understand and build connections with communities.

Pasteurisation at 62.8° C. (145° F.) for 30 minutes leads to a marked reduction in the total bacterial content of milk, varying for different specimens from 94 to 99·8 per cent., when the process is carried out under the most exact conditions. At lower temperatures, e.g. 60° C., the percentage reduction may vary widely—from 51·6 to 97·4 per cent. The percentage reduction has been found to be slightly less when the same specimens of milk are pasteurised in a large scale apparatus than when treated in small quantities under laboratory conditions, the average reduction being 91·2 per cent, in the former case and 98·4 per cent, in the latter. The reasons for this are discussed.

An effectively pasteurised milk should not contain lactose-fermenting bacilli in 1 c.c, and the B. coli content is a valuable index of the efficiency of a pasteurising process.

Milk containing B. tuberculosis, when pasteurised at 62·8° C. for 30 minutes (1) in tubes in a water bath in the laboratory, and (2) on a large scale by a commercial plant, is rendered non-infective to guinea-pigs. By laboratory pasteurisation, even at 60° C. for 30 minutes, milk containing tubercle bacilli is rendered non-infective.

A prospective longitudinal study was conducted on 96 smallholder duck farms in Indonesia over a period of 14 months in 2007 and 2008 to monitor bird- and flock-level incidence rates of H5 highly pathogenic avian influenza (HPAI) infection in duck flocks, and to identify risk factors associated with these flocks becoming H5 seropositive. Flocks that scavenged around neighbouring houses within the village were at increased risk of developing H5 antibodies, as were flocks from which carcases of birds that died during the 2 months between visits were consumed by the family. Duck flock confinement overnight on the farm and sudden deaths of birds between visits were associated with lower risk of the flock developing H5 antibodies. Scavenging around neighbouring houses and non-confinement overnight are likely to be causal risk factors for infection. With this study we have provided insights into farm-level risk factors of HPAI virus introduction into duck flocks. Preventive messages based on these risk factors should be included in HPAI awareness programmes.

In 2016, we reviewed preventive control measures for secondary transmission of Shiga-toxin producing Escherichia coli (STEC) in humans in European Union (EU)/European Free Trade Association (EEA) countries to inform the revision of the respective Norwegian guidelines which at that time did not accommodate for the varying pathogenic potential of STEC. We interviewed public health experts from EU/EEA institutes, using a semi-structured questionnaire. We revised the Norwegian guidelines using a risk-based approach informed by the new scientific evidence on risk factors for HUS and the survey results. All 13 (42%) participating countries tested STEC for Shiga toxin (stx) 1, stx2 and eae (encoding intimin). Five countries differentiated their control measures based on clinical and/or microbiological case characteristics, but only Denmark based their measures on routinely conducted stx subtyping. In all countries, but Norway, clearance was obtained with ⩽3 negative STEC specimens. After this review, Norway revised the STEC guidelines and recommended only follow-up of cases infected with high-virulent STEC (determined by microbiological and clinical information); clearance is obtained with three negative specimens. Implementation of the revised Norwegian guidelines will lead to a decrease of STEC cases needing follow-up and clearance, and will reduce the burden of unnecessary public health measures and the socioeconomic impact on cases. This review of guidelines could assist other countries in adapting their STEC control measures.

Five pigs were treated orally with norfloxacin for 5 consecutive days in two well-separated periods. This was done to determine the lowest dose required to free the pigs of Enterobacteriaceae. In the first period of the study, the animals were treated with 400 mg per day while in the second treatment 800 mg norfloxacin was given. Daily faecal culturing indicated that the faeces became free of Enterobacteriaceae in 3–5 days when treated with 400 mg/day, while all animals were found negative on culturing after 3 days of treatment with 800 mg/day. Investigation of the concentration of norfloxacin in the faeces revealed that a substantial fraction of the dose was either absorbed or inactivated by faecal substances. An in vitro study in faeces confirmed that a substantial part, some 75% of the dose, may have been inactivated by intestinal contents. This finding helps to explain the much lower concentration of 120 mg norfloxacin per kg of faeces in the pig in comparison with the almost tenfold higher concentration reported to develop in man during treatment with an identical dose.