1. Cultures of tubercle bacilli were obtained from 204 cases of lupus.

2. According to their cultural characters the strains could be divided into two main groups, one containing 102 strains with the characters of human tubercle bacilli and the other containing 102 strains with the characters of bovine tubercle bacilli.

3. Virulence tests were carried out on a large number of animals, and in one instance over 100 animals were used for testing strains from a particular case.

4. Of the 102 culturally human strains 41 were highly virulent for the guineapig, and for the monkey when this was tested, producing progressive and rapidly fatal tuberculosis. The remaining 61 strains (59.8%) showed varying degrees of attenuation.

5. Of the 102 culturally bovine strains 34 were highly virulent for all the animals tested, producing in them severe and rapidly fatal general tuberculosis identical with that set up by standard bovine bacilli. The remaining 68 (66.7%) were of lower virulence for the rabbit, and for the calf and goat when these animals were tested, than standard bovine strains, but they all produced in one, two, or three of these species more extensive tuberculosis than human bacilli. For the guineapig, and for the monkey when tested, these strains fell below the virulence of standard bovine strains, except for a few whose virulence was only slightly lowered for the rabbit.

1. Long-established infection of a mouse colony with Eperthyrozoon coccoides was eliminated by regular insecticidal treatments designed to reduce infestation with lice and fleas.

2. Undesirable consequences of E. coccoides infection upon mice used as experimental animals are noted and an easy routine for exclusion of this parasite from mouse colonies is suggested.

A total of 50 duplicate Moore swabs were placed for 2 days, on five different dates, in 9–12 points of the Athens sewage disposal system.

Three methods of enrichment were used for the isolation of salmonellas. In the first method, one half of the duplicate swabs was incubated in Muller–Kauffmann's tetrathionate broth at 43° C. for one day. For the second method, a secondary enrichment was carried out in Rappaport's broth, made from the Muller–Kauffmann's broth and for the third method, the other half of the duplicate swab was cultured in Heart Infusion broth at 43° C. for 16–18 hr. after which a secondary enrichment was made in Rappaport's medium.

By use of these 3 enrichment procedures, 96% of the swabs were found to be positive for salmonellas. A total of 178 strains were isolated (an average of 3·7 strains per positive swab), belonging to 53 different serotypes (an average of 1·1 different serotypes per positive swab).

With the simple enrichment in Muller–Kauffmann's broth, only 72% of the swabs were found positive, and 68 strains of salmonellas belonging to 30 different serotypes were isolated. The secondary enrichment in Rappaport's medium made from the Muller–Kauffmann's broth produced 88% positive samples, and yielded 82 strains belonging to 34 different serotypes. Finally, with the secondary enrichment in Rappaport's broth made from the heart infusion broth, 92% of the swabs were positive and yielded 67 strains of salmonellas belonging to 27 different serotypes.

Although the last procedure yielded the greatest number of positive swabs, the method involving secondary enrichment in Rappaport's broth made from Muller–Kauffmann's broth led to the isolation of the greatest number of strains and different serotypes, while the other two procedures were approximately equal in this respect.

Of the 178 strains isolated, 110 were recovered only by the procedures involving secondary enrichment in Rappaport's broth. The most frequently isolated serotypes were Salmonella senftenberg (33 strains), S.typhimurium including var-copenhagen (18 strains), S.poona (11 strains), S.montevideo (10 strains), etc. The following 23 serotypes were isolated for the first time in Greece: S. adelaide, S. alachua, S. allerton, S. binza, S. bobo, S. butantan, S. gnesta, S. goelzau, S. haelsingborg, S. havana, S. hofit, S. ibadan, S. indiana, S. irumu, S. jodhpur, S. nienstedten, S. panama, S. pomona, S. poona, S. reading, S. schwarzengrund, S. stockholm, S. tournai. Moreover, a new serotype, S. athinai was described.

1. Serological methods for the determination of smallpox immunity are briefly discussed, and it is concluded that they are unlikely to provide a diagnostic method of sufficient accuracy.

2. Experimental work is recorded which shows certain differences in the response of previously vaccinated individuals, revaccinated simultaneously with a standard vaccine lymph and an elementary body suspension (vaccinia) of high potency. The significance of these differences is discussed.

3. The results indicate that although the advantage of the e.b. suspension over vaccine lymph is relatively insignificant, that of two insertions over one is very marked. In revaccination the routine use of one insertion only may result in a certain number of semi-immunes (vaccinoids) being erroneously reported as immunes.

4. It is concluded that if the two insertion technique be practised, persons showing immune reactions (negatives) may be considered, in all probability, as possessing full immunity to vaccinia-variola virus.

Bacteriocin production (P)-typing of 75 M-type 49 group-A streptococci obtained from a variety of epidemiological incidents in different countries gave no evidence of production under the usual aerobic test conditions. However, with anaerobic incubation, 28% of the strains gave a pattern of inhibitory activity against the indicator strains which was indistinguishable from that previously attributed to the bacteriocin, streptococcin A-FF22 (SA-FF22). Isolation and partial purification of the M type 49 bacteriocin (SA-M49) by freeze–thaw elution from anaerobically grown lawn cultures, followed by ammonium sulphate precipitation and Sephadex chromatography, showed the activity to be associated with a heat-stable proteinaceous molecule of molecular weight approximately 8000 – properties similar to those of SA-FF22. SA-FF22 and SA-M49 were found to have identical inhibitory spectra including immunity of the producer strains to the inhibitory activity of both the homologous and heterologous bacteriocin preparations. SA-M49 production occurred in some strains of phage subtypes II, III and provisional VI and. since it was a consistent property for all isolates from single outbreaks of infection, it provides a means of discriminating between strains of each of these three phage subtypes. There was no evidence of any increased incidence of SA-M49 production in M-type 49 strains associated with nephritic sequelae

The process of physical growth in children is manifested by changes in their size, mass and shape. Changes in size are ascertained by measurement, usually, of the standing height of the child, but occasionally of the sitting height, and sometimes, also, of the chest circumference and the width between the hips. Changes in mass are detected by weighing, whilst changes in shape, which are due to unequal rates of growth in height and in mass, are estimated by methods referred to later.

The influence of cytomegalovirus (CMV) infection as a co-factor in HIV-1 disease progression has mainly been studied in haemophiliacs and remains controversial. Based on the files of 1683 HIV-1-infected patients in the Seropositive Cohort (SEROCO) and Haemophiliacs Cohort (HEMOCO) cohorts, we studied the role of CMV infection in progression to CD4+ cell counts of less than 200 μl, AIDS onset and death, in various HIV exposure groups. Adjusted relative risk (aRR) of progression to AIDS and to death was respectively 1·30 (P = 0·05) and 1·58 (P = 0·007). In the sexual exposure group the influence of CMV infection on the risk of progression to AIDS was of borderline significance (aRR = 1·50; P = 0·07) and was more marked on the risk of death (aRR = 2·00; P = 0·03). No such influence of CMV infection was observed in the transfusion and intravenous drug use exposure groups. When we studied the influence of CMV infection according to the stage of HIV disease, the main effect was on progression from AIDS to death, probably because CMV disease is a late event. Sexual CMV transmission and frequent re-exposure to CMV may explain why CMV infection emerged as an important co-factor for HIV progression only in the sexual exposure group.

Pneumonia leads to considerable morbidity and mortality in nursing home residents with dementia. We assessed pneumonia incidence based on data from three different studies: (1) real-time national surveillance of healthcare-associated infections in nursing home residents in 2009–2015; (2) a randomized controlled trial in 2012–2015 to assess effects of a practical guideline in nursing home residents with dementia and pneumonia; and (3) a study in 2007–2010 to assess quality of dying in newly admitted nursing home residents with dementia. In national surveillance data, pneumonia incidence was calculated separately for psychogeriatric and somatic beds, as a proxy for residents with and without dementia. Weekly pneumonia incidence was significantly lower per 1000 psychogeriatric beds (3·9; 95% confidence interval (CI) 3·2–4·6) compared with 1000 somatic beds (5·7; 95% CI 5·1–6·3). Annual incidence per 1000 psychogeriatric beds was similar in national surveillance (range 78·9–117·1) and the trial (range 71·0–94·3), and significantly higher in newly admitted dementia residents (range 267·3–363·2). The incidence was highest during the first months after admission when compared with residents with longer stay. In conclusion, follow-up of pneumonia in newly admitted dementia residents may result in higher incidence, possibly due to higher risk in this population.

1. Glycine, alanine, and several isomers of alanine, DL-glutamic acid and DL-aspartic acid, when added to fresh guinea-pig serum and allowed to stand on the bench for half an hour, will protect the complement of this serum from destruction by heating at 55 and 56° C. for half an hour, but most of the complement activity is destroyed by heating at 57° C. and it is completely destroyed at 58° C. after half an hour.

2. Derivatives of glycine do not have any protective effect.

3. Various substances of high molecular weight, that might be described as ‘protective colloids’ do not have any protective effect.

4. How these amino-acids when added to serum alter the heat-lability of the complement is not understood.

Over 10% of acute rotavirus gastroenteritis (ARGE) requires hospitalization because of complications. The aggravating factors have been widely analysed, but in an isolated way. We aimed to explore the interrelationship between the clinical and epidemiological factors that characterize rotavirus hospitalizations in Spain using information from the Minimum Basic Data Set (MBDS). Using ICD-9-CM codes, we classified acute gastroenteritis (AGE) cases by principal diagnosis fields and then categorized their comorbidities, complications, and epidemiological features by secondary fields. A multivariable, logistic, step-wise regression model was then constructed. We identified 1657 ARGE cases from 17 415 cases of AGE. Rotavirus hospitalizations were associated with place of residence, age, and season (P < 0·0001), as well as with dehydration [odds ratio (OR) 12·44, 95% confidence interval (CI) 1·52–40·38], intravenous rehydration (OR 1·74, 95% CI 1·29–2·35), metabolic acidosis (OR 1·51, 95% CI 1·24–1·83), respiratory tract infections (RTIs) (OR 1·60, 95% CI 1·09–1·98), and concomitant AGE (OR 1·52, 95% CI 1·03–2·25). Dehydration was four times more likely in patients aged <5 years (OR 4·36, 95% CI 1·20–12·96) and was associated with acidosis when ARGE and RTI were present simultaneously (P < 0·0001). Specific co-infecting viruses may play a role in acute respiratory symptoms and aggravation of gastrointestinal manifestations of rotaviruses, thus leading to complications requiring hospitalization.

Bacteriostatic activity was measured in 244 specimens of milk collected during 1977 throughout lactation of up to one year from 78 mothers; the activity varied from very good to fair and only seven were inactive. There was a wider range of activity than was found previously in milk from English mothers. Activity usually fell slowly during lactation but some of the Gambian mothers produced milk of very high activity, like that of colostrum into the second week of lactation, and two mothers did so at six and nine months; other mothers produced good-activity milk throughout lactation. The bacteriostatic activity varied little with the season but slight decreases from that expectcd were found after the high incidence of infant diarrhoea towards the end of the rainy season.

The bacteriostatic activity of most of the milk tested could be prevented by iron salts but that of colostrum and some of the milks with high activity could not. Only these highly active colostra and milks were inhibitory in vitro when the inoculum was increased from 104 to 106 organisms per ml. These and less active milks were able to inhibit the smaller, standard inoculum for longer than 3 h with the addition of bicarbonate and extra iron-binding protein at the concentrations likely to be present in vivo. Both commensal and pathogenic E. coli were inhibited to a similar degree by these milks and there was no evidence of serotype specificity.

The effect of a community intervention programme of antibiotics and meningitis vaccine on pharyngeal carriage of Neisseria meningitidis was investigated. Carriage rates were determined in pupils at both secondary schools (ages 11–18 years) included in the community intervention programme and compared with two schools outside the area matched for socio-economic status. A total of 1869 pupils were studied 6 months after the programmes, and 2457 pupils after 11 months.

Six months after the programme was completed there was a 72% reduction in pharyngeal carriage of Neisseria meningitidis in pupils attending the schools in the intervention area compared with pupils in the control schools. After 11 months this difference persisted in the 11–14 age group but not in the 15–18 age group. No resistance to the antibiotics used in the programme was found.

A community intervention programme of antibiotics and vaccine for the control of meningococcal disease led to a long-term reduction in Neisseria meningitidis carriage in some age groups.

In May 2011, the Center for Disease Control and Prevention of a Chinese county found a rapid increase in the number of hepatitis A case notification; these were traced to an outbreak in an elementary school. Twenty-eight cases aged between 7 and 13 years with onset between 7 May and 8 June were serologically confirmed. Network method was conducted to reconstruct an outbreak network and to quantify the relative importance of those involved in the outbreak. A case-control study was used to study the association between the outbreak and putative risk factors. The network analysis suggested this was a disseminated outbreak originating from a 4-year-old boy with propagated spread. Evidence from the case-control study supported consumption of well water as a potential risk factor; however, this was unable to be established through field investigation. Outbreak networks can be used to identify the possible source of infectious disease outbreak, especially when the environmental investigation information is negative or not available.

This prospective, multicentre study was conducted during 2–30 April 2001 in the internal medicine/infectious diseases services in France and included data from 1858 hepatitis C virus (HCV)-infected patients, half of whom were HIV co-infected. The aims were to outline the type of pre-therapeutic evaluation of HCV infection performed (HCV RNA, genotype, liver biopsy); determine the proportion and characteristics of patients receiving antiviral treatment; and determine if any changes in these parameters had occurred between 1995 and 2001. Patients whom had a complete pre-therapeutic evaluation (39%, 709/1834) and received antiviral treatment (38%, 690/1830) were more likely to have abnormal liver biochemistry, cirrhosis and cryoglobulinaemia (P<0·001). Injecting drug users and HIV-co-infected patients were less likely to have a complete pre-therapeutic evaluation or receive antiviral treatment (P<0·001). A complete pre-therapeutic evaluation was more often performed in 2001 than in 1995 (39% vs. 6%, P<0·001), including qualitative HCV RNA testing (91% vs. 68%, P<0·001), genotyping (59% vs. 7%, P<0·001) and a liver biopsy (60% vs. 29%, P<0·001). The frequency of anti-HCV treatment approximately doubled between 1995 and 2001 (20% vs. 38%, P<0·001). Although adherence to consensus recommendations regarding pre-therapeutic evaluation is not ideal, a substantial improvement has occurred since 1995. Nevertheless, means of increasing the availability of antiviral therapies, particularly for patients with HIV co-infection or injecting drug use, require further study.

The social networks of 49 ethnic Vietnamese injecting drug users (IDUs) and 150 IDUs of other ethnicities recruited in Melbourne, Australia, were examined for ethnic differences in distribution of hepatitis C virus infection risk using social network analysis and molecular epidemiology. Vietnamese IDUs were more highly connected than non-Vietnamese IDUs, and more likely to be members of dense injecting sub-networks. More related infections were detected in IDUs with discordant ethnicities than were captured in the social network data; nonetheless, most dyads and most IDU pairs with related infections had matching ethnicity, confirming that mixing was assortative on that criterion. Mixing was not obviously dissortative by risk; low-risk Vietnamese IDUs injected more frequently than did correspondingly low-risk non-Vietnamese IDUs, but results for other measures were reversed or equivocal. Network measurements suggest that ethnic Vietnamese IDUs are at elevated risk of blood-borne infection, a conclusion supported by their relatively high HIV prevalence.

The fact that the blood of ordinary laboratory animals exerts a very marked bactericidal effect upon the Bacillus typhosus and the Spirillum cholerae asiaticae, while it exerts little or no effect upon the Staphylococcus and Streptococcus pyogenes, has hardly received the attention which it would seem to merit in view of the circumstance that these facts involve the important problem as to whether the blood exerts its bactericidal action upon pathogenic organisms generally, or only upon certain species of such micro-organisms.

Since measles is a highly contagious respiratory infection with significant airborne transmission risk in hospitals, effective prevention measures are crucial. After a mother accompanying her child on a paediatric ward lacking a negative pressure room was diagnosed with measles, exposed persons without evidence of immunity (documentary evidence of receiving two doses of measles-mumps-rubella vaccine) were treated with vaccination or intravenous immunoglobulin (IVIG). The interruption of transmission with these treatments was evaluated. There were 44 children and 101 adults exposed to the index patient. Twenty-five children and 88 adults were considered immune, providing evidence of immunity. Nineteen children and 13 adults were either given vaccination or IVIG for post-exposure prophylaxis (PEP). There were no additional cases of measles after 3 weeks follow-up. We conclude that measles is highly preventable by adequate PEP with vaccination or IVIG in a healthcare setting that lacks the benefit of a negative pressure room.

It is greatly to be desired that the causes of the decline of tuberculosis, which has been so striking a feature in the history of that disease in recent times, should be clearly ascertained; for only through an understanding of their nature and relative importance can our efforts to accelerate that decline hope to succeed.

Yukon Territory (YT) is a remote region in northern Canada with ongoing spread of tuberculosis (TB). To explore the utility of whole genome sequencing (WGS) for TB surveillance and monitoring in a setting with detailed contact tracing and interview data, we used a mixed-methods approach. Our analysis included all culture-confirmed cases in YT (2005–2014) and incorporated data from 24-locus Mycobacterial Interspersed Repetitive Units-Variable Number of Tandem Repeats (MIRU-VNTR) genotyping, WGS and contact tracing. We compared field-based (contact investigation (CI) data + MIRU-VNTR) and genomic-based (WGS + MIRU-VNTR + basic case data) investigations to identify the most likely source of each person's TB and assessed the knowledge, attitudes and practices of programme personnel around genotyping and genomics using online, multiple-choice surveys (n = 4) and an in-person group interview (n = 5). Field- and genomics-based approaches agreed for 26 of 32 (81%) cases on likely location of TB acquisition. There was less agreement in the identification of specific source cases (13/22 or 59% of cases). Single-locus MIRU-VNTR variants and limited genetic diversity complicated the analysis. Qualitative data indicated that participants viewed genomic epidemiology as a useful tool to streamline investigations, particularly in differentiating latent TB reactivation from the recent transmission. Based on this, genomic data could be used to enhance CIs, focus resources, target interventions and aid in TB programme evaluation.

Over a 2-year period, 25 families comprising of 181 individuals of all ages were longitudinally observed for the excretion of Campylobacter species. Faecal samples were taken from all persons with diarrhoea. Specimens were also taken from apparently healthy individuals and from domestic animals living within the confines of the study families at monthly intervals.

The overall diarrhoea attack rate was 19 episodes per 100 person-years with peak incidence in the 1- to 4-year-old age group (76/100 person-years). Eight (11·5%) of the total episodes were campylobacter-associated and the overall rate of campylobacter positive diarrhoeal episodes were 2·2 per 100 person-years. Of the 1002 stool samples from healthy individuals 32 (3·2/100 samples) were positive for campylobacter. The organism was most frequently isolated from children under 1 year of age both during diarrhoeal episodes (11·5 per 100 person-years) and non-diarrhoeal (11·1 per 100 samples). Multiple infections in a family were rare. In 19·4% of the occasions one or more animals were campylobacter positive. However, only in 7·7% of these occasions was a human infection recorded within 1 month after the animal was found to be positive.

The study showed that the epidemiology of campylobacteriosis in this community was distinct compared to that observed in developed countries.