One thousand, nine hundred and seventy-seven pharmaceutical products used in the home were examined for microbial contamination. Viable micro-organisms were recovered from 14.0% of samples. Medicines used in the home are apparently not exposed to the same opportunities for contamination as those used in hospital.

Since 2015, the incidence of invasive meningococcal disease (IMD) caused by serogroup W (MenW) has increased in Sweden, due to the introduction of the 2013 strain belonging to clonal complex 11. The aim of this study was to describe the clinical presentation of MenW infections, in particular the 2013 strain, including genetic associations. Medical records of confirmed MenW IMD cases in Sweden during the years 1995–2019 (n = 113) were retrospectively reviewed and the clinical data analysed according to strain. Of all MenW patients, bacteraemia without the focus of infection was seen in 44%, bacteraemic pneumonia in 26%, meningitis in 13% and epiglottitis in 8%, gastrointestinal symptoms in 48% and 4% presented with petechiae. Phylogenetic analysis was used for possible links between genetic relationship and clinical picture. The 2013 strain infections, particularly in one cluster, were associated with more severe disease compared with other MenW infections. The patients with 2013 strain infections (n = 68) were older (52 years vs. 25 years for other strains), presented more often with diarrhoea as an atypical presentation (P = 0.045) and were more frequently admitted for intensive care (P = 0.032). There is a risk that the atypical clinical presentation of MenW infections, with predominantly gastrointestinal or respiratory symptoms rather than neck stiffness or petechiae, may lead to delay in life-saving treatment.

We compared serotype distributions of Streptococcus pneumoniae isolates from patients aged <5 and ⩾5 years with invasive pneumococcal disease in New South Wales, Australia, and antibiotic susceptibilities of isolates from the <5 years age group only, before (2002–2004) and after (2005–2009) introduction of the 7-valent pneumococcal conjugate vaccine (PCV7). Overall, there were significant decreases in the mean annual number of referred isolates (770 vs. 515) and the proportion belonging to PCV7 serotypes (74% vs. 38%), but non-PCV7 serotypes, particularly 19A, increased (5% vs. 18%). All changes were more marked in the <5 years age group. Susceptibility testing of isolates from the <5 years age group showed variation in resistance between serotypes, but significant overall increases in penicillin non-susceptibility (23% vs. 31%), ceftriaxone resistance (2% vs. 12%) and multidrug resistance (4% vs. 7%) rates; erythromycin resistance fell (32% vs. 25%). Continued surveillance is needed to monitor changes following the introduction of 13-valent PCV in 2012.

A strain of Mycoplasma californicum successfully infected an experimentally inoculated ovine mammary gland causing a severe mastitis. The condition lasted for about 25 days, and resulted in atrophy and loss of milk production in the gland. Four experimentally infected ewes, treated over a 3-day period with various regimes of the antibiotics oxytetracycline or tylosin during the acute stage of infection, successfully eliminated the infection. Two others similarly treated with combined intramammary and intramuscular tiamulin or with intramammary Bay Vp2674, did not eliminate the infection; but another ewe treated with intramuscular as well as intramammary Bay Vp2674, did resolve the infection. The two ewes that were unsuccessfully treated with antibiotics at the acute stage did respond to tylosin or oxytetracycline at a later stage of infection. Measurement of antibiotic concentrations demonstrated that the persistence of inhibitory levels in the milk varied between the antibiotics and were influenced by the extent of parenteral treatment.

Methicillin-resistant Staphylococcus aureus (MRSA) is a major public health concern associated with residence in a long-term care facility (LTCF). The aim of this prospective study was to characterize MRSA isolated from residents over a 1-year period and their physical environment over a 2-year period. MRSA was recovered from 17/64 residents (R) of a LTCF and from 42 environmental (E) sites. All isolates carried the mecA gene and lacked the mecC and Panton–Valentine leukocidin (PVL) genes. Thirteen spa types were identified with t032 being the most frequent (41% of total; n = 8R, 16E), followed by t727 (22% of total; n = 13E), and t8783 (10% of total; n = 6E). Five spa types were each represented by single isolates. Thirty-nine isolates were of spa types associated with the multilocus sequence type ST22 (t032, 41%; spa-CC22, 68%) and reflect the predominance of ST22 in Irish hospitals. The uncommon spa types t727, t8783, t1372, t3130, t10038 were present in the environment but not detected in residents and are infrequently observed in Ireland.

The relative efficiencies of three commercially available dehydrated Rappaport–Vassiliadis media have been compared with a similar medium prepared from individual constituents in our own laboratory. An inoculation ratio of 1 : 100 was found to be optimal for each of the media tested. Laboratory produced RV-medium was significantly better than the three commercial preparations after 24 h incubation. However, when the duration of incubation was extended to 48 h, there was no significant difference in the number of salmonella isolates obtained when using our own RV medium and that produced by Oxoid Ltd and Difco Ltd (P > 0·05). All of these three media were, however, significantly more effective than the medium produced by Lab.M.(P <0·01).

A survey of unopened ice cream, ice cream in use, and ice-cream-scoop water (n=91) was conducted to determine the effect of scoop water hygiene on the microbiological quality of ice cream. An aerobic plate count around 106 c.f.u. ml−1 was the modal value for scoop waters. Unopened ice creams generally had counts around 103–104 c.f.u. ml−1 and this increased by one order of magnitude when in use. Many scoop waters had low coliform counts, but almost half contained >100 c.f.u. ml−1. E. coli was isolated in 18% of ice creams in use, and in 10% of unopened ice creams. S. aureus was not detected in any sample. Statistical analysis showed strong associations between indicator organisms and increased counts in ice cream in use. EC guidelines for indicator organisms in ice cream were exceeded by up to 56% of samples.

An epidemiologic investigation was conducted to characterize and evaluate the possibility of a viral aetiology of an outbreak of acute vertigo in Hot Springs Country, Wyoming, during autumn 1992. Case-finding identified Hot Springs County residents who sought medical attention for new onset vertigo during 1 August, 1992–31 January 1993. Thirty-five case-patients and 61 matched controls were interviewed and serum specimens were obtained during January 1993. Case-patients were more likely than controls to report symptoms (e.g. fatigue, sore throat, fever, diarrhoea) of antecedent acute illness. Case-patients did not have a significantly greater prevalence or mean titre of IgG antibodies to respiratory syncytial virus, parainfluenza viruses, Epstein–Barr virus, and cytomegalovirus than controls. Serologic evidence of recent enterovirus infection (IgM antibodies) was found for 74% of case-patients compared with 54% of controls (P < 0·05), suggesting a possible association between vertigo and enterovirus infection. Future studies are needed to define the role of enteroviruses in inner-ear diseases.

We combined smartphone mobility data with census track-based reports of positive case counts to study a coronavirus disease 2019 (COVID-19) outbreak at the University of Wisconsin–Madison campus, where nearly 3000 students had become infected by the end of September 2020. We identified a cluster of twenty bars located at the epicentre of the outbreak, in close proximity to campus residence halls. Smartphones originating from the two hardest-hit residence halls (Sellery-Witte), where about one in five students were infected, were 2.95 times more likely to visit the 20-bar cluster than smartphones originating in two more distant, less affected residence halls (Ogg-Smith). By contrast, smartphones from Sellery-Witte were only 1.55 times more likely than those from Ogg-Smith to visit a group of 68 restaurants in the same area [rate ratio 1.91, 95% confidence interval (CI) 1.29–2.85, P < 0.001]. We also determined the per-capita rates of visitation to the 20-bar cluster and to the 68-restaurant comparison group by smartphones originating in each of 21 census tracts in the university area. In a multivariate instrumental variables regression, the visitation rate to the bar cluster was a significant determinant of the per-capita incidence of positive severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) tests in each census tract (elasticity 0.88, 95% CI 0.08–1.68, P = 0.032), while the restaurant visitation rate showed no such relationship. The potential super-spreader effects of clusters or networks of places, rather than individual sites, require further attention.

The stability of IS6110 restriction fragment length polymorphism (RFLP) pattern was determined in 31 isolates from patients with multidrug-resistant tuberculosis (MDR-TB). These patients were in actual chains of transmission and they referred to the National Institute of Tuberculosis and Lung Diseases, Tehran, Iran. Susceptibility testing against first- and second-line drugs were performed by the proportional method on Lowenstein–Jensen culture media. Thereafter, DNA fingerprinting by IS6110 with direct repeat (DR) region as a probe was performed by standard protocols. The rate of IS6110 changes was 16%, although, no variation was found in the DR region, in a time-span of 1–63 months. The strains with unstable IS6110 patterns were resistant to all drugs tested, and the majority of them (60%) were collected from HIV-positive patients. The results demonstrated that for a reliable interpretation of strain typing, it is better to use an additional marker along with IS6110 RFLP.

From 72 cases of pyrexial illness, occurring in British Guiana, an organism has been isolated which has the cultural and serological reactions of B. para-typhosus C (Hirschfeld). It seems probable that enteric fever, due to infection with this organism, is now endemic in the Colony, and is an important cause of sickness and death.

1. One hundred and seventeen rats have been examined, and thirty-two or 27·3% were found to harbour virulent Leptospira.

2. The correlation of carrier conditions with the presence of immune bodies in the serum showed:

(a) Leptospira-positive, sero-reaction negative, four or 3·4%.

(b) Leptospira-positive, sero-reaction positive, twenty-eight or 23·8%.

(c) Leptospira-negative, sero-reaction positive, twenty-one or 17·9%.

(d) Leptospira negative, sero-reaction negative, sixty-four or 54·7%.

3. The titres of the immune bodies in their sera have been determined. A positive reaction in the lower dilutions of the serum does not necessarily indicate that the rat is a carrier of virulent Leptospira.

4. There is evidence to show that there is a greater incidence of carriers amongst fully grown animals than in the young rodents.

5. Rodents which have been killed prior to examination in the laboratory are unsuitable for the determination of the presence of Leptospira.

Colonization factors (CFs) mediate attachment of enterotoxigenic Escherichia coli (ETEC) to the intestinal mucosa and induce protective immunity against ETEC diarrhoea. We designed CF-specific polymerase chain reaction (PCR) primers, and developed a simple PCR-based genotypic CF identification method. ETEC strains (n=17) isolated from patients with diarrhoea in Thailand were examined for genotypical identification of CFs of ETEC strains. Coli surface antigen 6 (CS6) was the most common CF (29%), followed by CS13 (12%), colonization factor antigen I (CFA/I), CS2 and CS3, and CS17/CS19 (6% each), while 41% of the strains were negative. This simple PCR method for the detection of CF genes is useful for surveillance of ETEC infections in diagnostic laboratories.

The radioimmunoassay for brucellosis previously reported from this laboratory was a sensitive and useful method for detecting antibody against Brucella abortus in bovine serum. Changes in the procedure have improved sensitivity, have apparently increased interassay precision, and have made the assay easier to perform.

Enteric fever in British Guiana, according to official reports, would not appear to be excessively common: the number of notifications for the whole Colony during the years 1930 and 1931 was 244 and 250 respectively on a population of 310,000.

The few observers who have studied this disease in the Colony have all insisted on its sporadic character. Rowland (1910) has clearly illustrated this peculiarity with a series of spot maps showing the distribution of enteric in Georgetown from 1909 to 1913.

Poliomyelitis continued to be a rare disease in England and Wales in the period 1969–75. Only 31 paralytic and 44 cases of possible non-paralytic poliomyelitis were recorded during the 7 years.

Of the 31 paralytic cases approximately one third were vaccine-associated; 3 were patients who had recently received oral poliovaccine and 7 had been in contact with a vaccinated person. Five of these 7 patients were parents of recently vaccinated children. The rate of vaccine-associated poliomyelitis was estimated in recipients to be 0·2 and in contacts 0·4 per million doses of vaccine given.

Marker test results were reported on 555 strains of poliomyelitis virus isolated during 1969–75, using the reproductive capacity temperature test. Forty-eight (8·6%) resembled wild virus in this property, 15 strains being type 1, 8 type 2 and 25 type 3. Most of these isolations of apparently wild virus were from excreters with no symptoms of poliomyelitis, although 3 of the 15 type 1 strains were from patients with paralytic poliomyelitis and 3 from possible cases of non-paralytic poliomyelitis. None of the 8 apparently wild type 2 viruses was from a case of paralytic illness and only 1 of the 39 type 3 strains.

Eleven of the 31 paralytic cases were in patients in whom the infection was likely to have been acquired abroad.

The behaviour of certain infected individuals within socially structured populations can have a disproportionately large effect on the spatio-temporal distribution of infection. Endemic infection with Mycobacterium bovis in European badgers (Meles meles) in Great Britain and Ireland is an important source of bovine tuberculosis in cattle. Here we quantify the risk of infection in badger cubs in a high-density wild badger population, in relation to the infection status of resident adults. Over a 24-year period, we observed variation in the risk of cub infection, with those born into groups with resident infectious breeding females being over four times as likely to be detected excreting M. bovis than cubs from groups where there was no evidence of infection in adults. We discuss how our findings relate to the persistence of infection at both social group and population level, and the potential implications for disease control strategies.

An outbreak of tuberculosis caused by Mycobacterium avium type 2 is described which resulted in the total condemnation of 26 carcasses and partial condemnation of tissues and organs of a further 200 animals. Circumstantial evidence is presented that hens running in the farmyard were the source of the infection.

Examinations of the carcasses and organs of the diseased pigs suggested that the accepted pathogenesis of the disease is incorrect and a new hypothesis is presented. The problems for the meat inspector in differentiating tuberculosis from ‘milk-spot liver’ are discussed and recommendations made.

The findings of the study are discussed in the light of ‘The Meat Inspection Regulations 1963’ and it is recommended that where tuberculosis is suspected there is no longer any necessity to split the carcasses. The public health implications of this study are discussed.

1. “Normal” agglutinins for B. typhosus and B. paratyphosus B appear to be conclusively of the O type.

2. Such agglutinins appear to be of consistently low titre and are absent in many sera.

3. Normal agglutinins for B. paratyphosus A have not been encountered.

4. O agglutinins are readily produced by inoculation of a T.A.B. vaccine, and may rise to as high titres as those encountered during an enteric infection.

5. It is impossible to fix any limit for residual O agglutinins in inoculated persons.

6. The value of examining for O agglutinins in enteric cases is confirmed.

7. Some fallacies of a purely qualitative method are pointed out, and a plea is made for the inclusion of the principles of qualitative receptor analysis in a quantitative Widal.

The novel coronavirus, severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2), is the causative agent of the 2020 worldwide coronavirus pandemic. Antibody testing is useful for diagnosing historic infections of a disease in a population. These tests are also a helpful epidemiological tool for predicting how the virus spreads in a community, relating antibody levels to immunity and for assessing herd immunity. In the present study, SARS-CoV-2 viral proteins were recombinantly produced and used to analyse serum from individuals previously exposed, or not, to SARS-CoV-2. The nucleocapsid (Npro) and spike subunit 2 (S2Frag) proteins were identified as highly immunogenic, although responses to the former were generally greater. These two proteins were used to develop two quantitative enzyme-linked immunosorbent assays (ELISAs) that when used in combination resulted in a highly reliable diagnostic test. Npro and S2Frag-ELISAs could detect at least 10% more true positive coronavirus disease-2019 (COVID-19) cases than the commercially available ARCHITECT test (Abbott). Moreover, our quantitative ELISAs also show that specific antibodies to SARS-CoV-2 proteins tend to wane rapidly even in patients who had developed severe disease. As antibody tests complement COVID-19 diagnosis and determine population-level surveillance during this pandemic, the alternative diagnostic we present in this study could play a role in controlling the spread of the virus.