The minimum inhibitory concentration (MIC) of five antibiotics and the presence of resistance genes was determined in 163 Haemophilus influenzae isolates collected over 13 years (1987–2000) in four two-yearly sampling periods from patients with respiratory tract infections. The prevalence of β-lactamase-negative ampicillin-susceptible strains was approximately 80% over the sampling period although fewer strains (65·9%) were recovered in the period 1995–1997. TEM-1 type β-lactamase-producing strains were less frequent starting at 15·6% and declining to 2·2% in the final sampling period. Low-β-lactamase-negative ampicillin-resistant (BLNAR) strains were uncommon in 1987–1989 (2·2%), peaked to 19·5% in 1995–1997, but fell back to 11·1% by 2000. Fully BLNAR strains were not detected until the last sampling period (6·7%). The MICs of ampicillin, levofloxacin, cefditoren and ceftriaxone remained stable but there was an eight-fold increase in the MIC of cefdinir over the sampling period. Pulsed-field gel electrophoresis of DNA digests showed that three representative BLNAR strains were genetically distinct and 11 DNA profiles were identified among 17 low-BLNAR strains. These data suggest that the number of genetically altered BLNAR and low-BLNAR strains are increasing in Japan.

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.

Giardia spp. is a common gastrointestinal (GI) parasite of multiple host species, including dogs and humans, with the potential for zoonotic transmission. The risk of GI parasitism in dogs (including Giardia spp.) may increase with park use in urban areas. This study aimed to (1) determine whether park attendance is a risk factor for Giardia spp. infection in dogs and (2) characterize the behavioural and demographic risk factors for Giardia spp. infection in park-attending and non-park-attending dogs. From August to September 2012, a total of 1293 dog owners completed a survey and 860 corresponding dog faecal samples were collected. Dog faeces were screened for Giardia spp. using a direct immunofluorescence assay and associations assessed among behaviours, demographics, and Giardia spp. infection. Main results included off-leash and swimming frequencies within parks as significantly positively associated with Giardia spp. infection in dogs. Dog-owner age was negatively associated with off-leash and swimming frequencies in parks. The results suggest some recreational behaviours in parks and certain demographics are risk factors for parasitism in pet dogs.

With ordinary care and cleanliness it is possible to obtain milk which, when freshly drawn, contains less than 1500 organisms per cubic centimetre.

Freshly drawn milk should not contain gas-forming organisms in at least 50 c.c.

Gas-forming organisms are present in milk owing to contamination with faecal material. Of these organisms the B. oxytocus perniciosus, the B. neapolitanus and the B. coli communis occur in greatest number in fresh milk, while the B. cloacae and B. lactis aerogenes appear at a later stage.

Out of 107 non-chromogenic lactose fermenters isolated from milk only one bacillus gave the reactions of the B. acidi lactici (Hüppe); while the B. Grünthal, B. pneumoniae (Friedländer), and the B. coscoroba have not been met with once.

Finally, I desire to enter a plea for the substitution of certain fermentation reactions in the place of some of the tests now usually employed, in the routine examination of water and food-stuffs, to identify these organisms. At present bacteriologists make use of some, or all, of the following tests:

1. Morphology.

2. Motility.

3. Staining by Gram's method.

4. Character of the growth on nutrient gelatin.

5. Liquefaction of gelatin.

6. Action on milk.

7. Foemation of indol.

8. Fermentation of glucose.

9. Fermentation of lactose.

10. Fermentation of cane sugar.

11. Action on neutral-red.

All the organisms mentioned in Tables I and II produced clotting in milk, fermented glucose, gave the neutral-red reaction, had much the same morphology, and the growths on agar and gelatin did not afford any assistance towards differentaniting between them.

I would therefore suggest that instead of five of the tests, Nos. 4, 6, 7, 8, and 11, we should substitute the following:

Fermentation of dulcit,

Fermentation of adonit,

Fermentation of inulin,

Vodes and Proskauer's reaction, as by so doing we should get a finer differentiation without increase in work and we should not be classing as B. coli organisms which may have little in common with, and have a distribution entirely different from that of the B. coli communis.

This study investigated the characteristics of transmission routes of COVID-19 cluster infections (⩾10 linked cases within a short period) in Gangwon Province between 22 February 2020 and 31 May 2021. Transmission routes were divided into five major categories and 35 sub-categories according to the relationship between the infector and the infectee and the location of transmission. A total of 61 clusters occurred during the study period, including 1741 confirmed cases (55.7% of all confirmed cases (n = 3125)). The the five major routes of transmission were as follows: ‘using (staying in) the same facility (50.7%), ‘cohabiting family members’ (23.3%), ‘social gatherings with acquaintances’ (10.8%), ‘other transmission routes’ (7.0%), and ‘social gatherings with non-cohabiting family members/relatives’ (5.5%). For transmission caused by using (staying in) the same facility, the highest number of confirmed cases was associated with churches, followed by medical institutions (inpatient), sports facilities, military bases, offices, nightlife businesses, schools, restaurants, day-care centres and kindergarten, and service businesses. Our analysis highlights specific locations with frequent transmission of infections, and transmission routes that should be targeted in situations where adherence to disease control rules is difficult.

Tuberculosis is a major public health issue in Yemen, a country located at the southwestern tip of the Arabian Peninsula, while the situation of tuberculosis had been further exacerbated since the war started in 2015. The objective of this study is to investigate the incidence of tuberculosis in Yemen before the outbreak of COVID-19, from 2006 to 2018. During the 13-year period, 92 482 patients were enrolled in the TB programme records from the 22 governorates. Almost equal number of cases were diagnosed between males and females (a male to female ratio, 1.03:1). A notable rising incidence was observed in all age groups starting from 2011. The sharpest increase occurred in children under age 15, rising by 8.0-fold from 0.5 in the period 2006–2010 to 4.1 in the period 2011–2018. Paediatric TB accounted for 9.6% of all reported cases. In terms of the patient residence, incidence has more than doubled in Sana'a city, Sana'a Gov., Hajjah and Saadah. Concomitant diseases with tuberculosis included diabetes mellitus (14.0%), brucellosis (6.1%), hepatitis (6.0%), rheumatoid arthritis (4.3%), renal disorders (2.5%) and HIV infection (2.5%). Development of interventions to reduce tuberculosis incidence in children and concomitant communicable diseases is urgently needed.

Pyocine typing was used for the characterization of 134 Pseudomonas aeruginosa strains isolated from bovine mastitis. The scheme of Gillies & Govan (1966) was adopted with some modifications, and the procedure gave 89·6% typability. Pyocine type 1 strains were most commonly encountered and were followed in frequency by types 10 and 3. The introduction of two additional indicator strains allowed for division of these types into subtypes.

In spite of some limitations, discussed in the paper, the pyocine typing scheme proved to be useful in ‘marking’ P. aeruginosa strains and in following their association with bovine mastitis in various herds.

Methicillin-resistant Staphylococcus aureus (MRSA) bacteraemia cause significant morbidity and mortality in hospitalized patients. Using a nested case-control design, 204 MRSA bacteraemia cases were compared to 301 unmatched methicillin-susceptible Staphylococcus aureus (MSSA) bacteraemia controls and were matched 1:2 with non-infected controls. The independent risk factors for MRSA bacteraemia compared to MSSA bacteraemia were older age (P = 0·048), major organ transplant during current hospital stay (P = 0·016) and quinolone use (P = 0·016). Cases were more likely than non-infected controls to have renal failure (P = 0·003), cirrhosis (P = 0·013), and a central venous catheter (P = 0·003) after controlling for other risk factors. This large case-control study made it possible to assess risk factors for MRSA bacteraemia using two sets of controls and showed that risk factors differed greatly depending on the control group chosen. These results confirm the need for careful selection of appropriate control groups and the need to carefully adjust for underlying severity of illness.

After experimental inoculation of Cytoecetes ondiri, the agent of bovine petechial fever (BPF), multiplication occurred in impala, bushbuck, Thomson's gazelles and wildebeest, as shown by infectivity studies and clinical findings. Similar attempts to infect one eland failed.

As a sequel to this, blood and spleen samples were collected from four species of wild ruminants in an area where BPF was endemic. Isolations of C. ondiri were made from three of five bushbuck, but not from any other species.

Although patients with end-stage renal disease (ESRD) are known to be at high risk for developing bloodstream infections (BSI), the risk associated with lesser degrees of renal dysfunction is not well defined. We sought to determine the risk for acquiring and dying from community-onset BSIs among patients with renal dysfunction. A retrospective, population-based cohort study was conducted among adult residents without ESRD in the western interior of British Columbia. Estimated glomerular filtration rates (eGFR) were determined for cases and incidence rate ratios (IRR) were calculated using prevalence estimates. Overall, 1553 episodes of community-onset BSI were included of which 39%, 32%, 17%, 9%, 2% and 1% had preceding eGFRs of ≥90, 60–89, 45–59, 30–44, 15–29 and <15 ml/min/m2, respectively. As compared to those with eGFR ≥60 ml/min/m2, patients with eGFR 30–59 ml/min/m2 (IRR 4.4; 95% confidence interval (CI) 3.9–4.9) and eGFR <30 ml/min/m2 (IRR 7.0; 95% CI 5.0–9.5) were at significantly increased risk for the development of community-onset BSI. An eGFR <30 ml/min/m2 was an independent risk factor for death (odds ratio 2.3; 95% CI 1.01–5.15). Patients with renal dysfunction are at increased risk for developing and dying from community-onset BSI that is related to the degree of dysfunction.

Multidrug-resistant isolates of Acinetobacter baumannii from New York City generally belong to one of three ribotypes. To assess the accuracy of ribotyping, the relatedness of representative isolates was further assessed by rep-PCR, pulsed-field gel electrophoresis (PFGE), and DNA sequencing of five genes potentially associated with antimicrobial resistance (ampC, ompA, adeB, adeR, and abeM). The isolates fell into several major groups. The first group shared the same ribotype and had common mutations affecting OmpA, AdeR, and AbeM, but consisted of two subtypes with distinctive rep-PCR and PFGE patterns and ampC mutations. The second and third groups shared common alterations in OmpA, AdeR, and AbeM, but had distinct ribotype, rep-PCR, and PFGE patterns. The resistant isolates were unrelated to the β-lactam susceptible isolates. Many of the resistant strains shared OmpA and AdeB patterns observed in several European clonal groups. Further development of a multilocus sequencing typing scheme will help determine if multidrug-resistant isolates from diverse geographic areas are indeed ancestrally related.

During commercial processing of broiler chickens, injection of polyphosphate (Puron 604 or 6040) resulted in microorganisms being added to the deep breast muscle. The level of contamination was related to the microbiological condition of the injection solution.

Injection of polyphosphate had no effect on the shelf-life of fresh chilled carcasses held at 1° or 10°C but changes were observed in the growth rate of microorganisms in the deep muscle and in the composition of the muscle microflora following storage.

Cross-contamination of carcasses and the transfer of organisms from the skin to the deep muscle during injection was demonstrated with a marker strain of Clostridium perfringens. However, both processes were influenced by the number of marker organisms applied initially to the skin.

The above findings are discussed in relation to the possible behaviour of any food poisoning bacteria present.

Pneumonia causes significant morbidity and mortality in Aboriginal populations in Australia's Northern Territory (NT). Kava, consumed in Arnhem Land since 1982, may be a risk factor for infectious disease including pneumonia. A case–control study (n=115 cases; n=415 controls) was conducted in 7001 Aboriginal people (4217 over 15 years). Odds ratios (OR) were calculated by conditional logistic regression with substance use and social factors as confounders. Pneumonia was not associated with kava use. Crude OR=1·26 (0·74–2·14, P=0·386), increased after controlling for confounders (OR=1·98, 0·63–6·23, P=0·237) but was not significant. Adjusted OR for pneumonia cases involving kava and alcohol users was 1·19 (0·39–3·62, P=0·756). In communities with longer kava-using histories, adjusted OR was 2·19 (0·67–7·14, P=0·187). There was no kava dose–response relationship. Crude ORs for associations between pneumonia and cannabis use (OR=2·27, 1·18–4·37, P=0·014) and alcohol use (OR=1·95, 1·07–3·53, P=0·026) were statistically significant and approached significance for petrol sniffing (OR=1·98, 0·99–3·95, P=0·056).

Inadequate notification is a recognized problem of measles surveillance systems in many countries, and it should be monitored using multiple data sources. We compared data from three different surveillance sources in 2007: (1) the sentinel surveillance system mandated by the Act on Prevention of Infectious Diseases and Medical Care for Patients Suffering Infectious Diseases, (2) the mandatory notification system run by the Aichi prefectural government, and (3) health insurance claims (HICs) submitted to corporate health insurance societies. For each dataset, we examined the number of measles cases by month, within multiple age groups, and in two categories of diagnostic test groups. We found that the sentinel surveillance system underestimated the number of adult measles cases. We also found that HIC data, rather than mandatory notification data, were more likely to come from individuals who had undergone laboratory tests to confirm their measles diagnosis. Thus, HIC data may provide a supplementary and readily available measles surveillance data source.

We examined the association between socioeconomic status and the level of serum antibodies to selected faeco-orally transmitted pathogens among Israeli adolescents. Random samples of eighty volunteers aged 12–15 years from high (HSL), medium (MSL) and low (LSL) standard of living towns were included in the study. Serum samples were examined by radioimmunoassay for HAV and by in-house-developed ELISA systems for IgA and IgG antibody levels against Shigella sonnei, S. flexneri, E. coli O157[ratio ]H7 lipopolysacchride and Cryptosporidium parvum antigens. Seropositivity to HAV was highest (98·8%) in the LSL towns and lowest (25%) in the HSL towns, showing a statistically significant linear trend. Antibody levels to the other enteropathogens had gender variation, with higher titres in females. Significantly lower titres in the HSL towns were found for: IgA anti-S. sonnei in females (P<0·001); IgG anti-S. sonnei in females (P=0·024) and males (P=0·033); IgG anti-S. flexneri in females (P=0·016). Inverse linear association with socioeconomic status was found for IgA anti-C. parvum in females (P<0·001); IgA anti-E. coli O157[ratio ]H7 in females (P<0·001) and males (P=0·024). A statistically significant association between HAV seropositivity and higher titres of IgA anti-S. sonnei and E. coli O157[ratio ]H7 was shown. In conclusion, exposure to enteropathogens transmitted via the faecal–oral route in communities of lower socioeconomic status is reflected in a higher prevalence of lifelong lasting antibodies to HAV, and higher levels of antibodies to bacterial and protozoan enteropathogens. Among females, the levels of specific serum antibodies are higher and more strongly associated with low socioeconomic status.

When the blood serum of one animal is injected into an animal of a different species the injected animal in many instances appears to take no hurt. If however after a certain interval the experiment is repeated, it has been noted that the injected animal may speedily show evidence of physical disturbance. Its breathing becomes rapid: its heart-beat grows feeble: its limbs move spasmodically and general convulsions may ensue. These phenomena have been taken to indicate that the injected animal has been supersensitized—or rendered abnormally sensitive—to the serum employed. They may attain such gravity that the animal dies. It has been suggested that the same untoward issue is possible in the case of man, and that the death of patients under treatment for diphtheria is to be apprehended in certain circumstances as the result of repeated injections of antidiphtherial serum, for the reason that the serum in question is derived not from the human subject but from the horse. A suggestion which assails the prestige of the antitoxin treatment of diphtheria cannot be viewed with indifference: it must either be sustained or rejected.

Only 2 out of 71 German patients infected with rotavirus (3%) and 8 out of 147 German control patients (5%) showed serum antibody to the new serotype 8 rotavirus. Such antibody was detected in the sera of 232 of 870 Ecuadorian children (27%). Twelve Ecuadorian sera showed neutralizing activity only against serotype 8 and not to the other serotypes (1–4) tested, indicating that human serotype 8 rotavirus circulates in South America.

We aimed to quantify the proportion of people receiving care for HIV-infection that are 50 years or older (older HIV patients) in Latin America and the Caribbean between 2000 and 2015 and to estimate the contribution to the growth of this population of people enrolled before (<50yo) and after 50 years old (yo) (⩾50yo). We used a series of repeated, cross-sectional measurements over time in the Caribbean, Central and South American network (CCASAnet) cohort. We estimated the percentage of patients retained in care each year that were older HIV patients. For every calendar year, we divided patients into two groups: those who enrolled before age 50 and after age 50. We used logistic regression models to estimate the change in the proportion of older HIV patients between 2000 and 2015. The percentage of CCASAnet HIV patients over 50 years had a threefold increase (8% to 24%) between 2000 and 2015. Most of the growth of this population can be explained by the increasing proportion of people that enrolled before 50 years and aged in care. These changes will impact needs of care for people living with HIV, due to multiple comorbidities and high risk of disability associated with aging.

Formalin-inactivated polio vaccine has been used in the Netherlands since 1957. Within 3 years all children born in 1945 and later were offered vaccine. In the first years poliovaccine from different manufacturers were used. In 1961 a vaccine produced in the Netherlands by the ‘Rijks Instituut voor de Volksgezondheid’ (National Institute of Public Health) became available and in 1962 the poliomyelitis components were incorporated in a quadruple vaccine, which contains 15 Lf diphtheria, 5 Lf tetanus toxoid and 16 × 109Bordetella pertussis organisms in addition to the three polio components. As an adjuvant this quadruple vaccine contains 1·5 mg. aluminium phosphate per 1 ml. dose. For infants the schedule became three doses at ages 3, 4 and 5 months respectively, followed by a booster dose at the end of the first year. The over-all acceptance rate can be estimated at almost 90% of those eligible, but there were pockets in the population with lower rates.

Since 1924 poliomyelitis has been a notifiable disease. During and after the last World War major epidemics occurred.

The poliomyelitis morbidity rates in the 8 post-vaccination years 1958–65 were compared with those from two preceding 4-year periods 1950–3 and 1954–7. In the 1–4-year-old children, who presented the most vulnerable age group, paralytic poliomyelitis was reduced by about 97 % and in the other age groups this percentage was slightly less. The over-all reduction was 96 %. Comparison of the morbidity rates of non-vaccinated persons in 1958–65 with the rates from 1950–3 and 1954–7 gave an impression of the extent of the herd immunity. These rates were reduced 70–80 % in the children under 15 years and 90–95 % in those over this age. The individual protection given to the vaccinated was calculated from the morbidity rates in non-vaccinated, incompletely and fully vaccinated persons in the 1958–65 period. The reduction of morbidity was 90–95% for children of 1–14 years who got three doses or more and about 85 % for those who had only 1 or 2 doses. Fully vaccinated children, who are profiting from both individual protection and herd immunity, showed a reduction of 97–99 %.

From the data presented it is concluded that vaccination with inactivated poliomyelitis vaccine can provide very effective protection for the individual and the community provided that a vaccine of good quality is used and the rate of acceptance is 75 % or better.

Helicobacter pylori is a cause of stomach cancer and peptic ulcer. For prevention, improving the eradication rate of H. pylori is crucial. However, the association between eradication and lifestyle of infected patients, including alcohol consumption, remains unclear. We explored associations between failed primary eradication therapy and drinking status by sex. This study involved 356 patients who visited a pharmacy with prescriptions for primary H. pylori eradication therapy. We assessed drinking habits using a questionnaire. Data on patients with failed primary eradication were provided by the nearby local clinic. We performed logistic regression analysis to examine the effect of drinking habit and frequency of drinking on failed primary eradication by sex. The odds ratio of primary eradication failure in female patients with a drinking habit was 3.75 (P = 0.001), but that in male patients was not significant. The odds ratio tended to increase in relation to drinking frequency in women. Frequent consumption of alcohol is not only likely to affect eradication, but also has a large impact on the bodies of women, who are more susceptible than men to the effects of alcohol. Thus, women should take greater care in alcohol consumption.