A survey on the bacteriological quality of both drinking water and flavoured drinks from coin-operated vending machines is reported. Forty-four per cent of 25 drinking water samples examined contained coliforms and 84% had viable counts of greater than 1000 organisms ml at 30 °C. Thirty-one flavoured drinks were examined; 6% contained coliforms and 39% had total counts greater than 1000 organisms ml. It is suggested that the D.H.S.S. code of practice on coin-operated vending machines is not being followed. It is also suggested that drinking water alone should not be dispensed from such machines.

Antibiotic-resistant Gram-negative bacteraemias (GNB) are increasing in incidence. We aimed to investigate the impact of empirical antibiotic therapy on clinical outcomes by carrying out an observational 6-year cohort study of patients at a teaching hospital with community-onset Escherichia coli bacteraemia (ECB), Klebsiella pneumoniae bacteraemia (KPB) and Pseudomonas aeruginosa bacteraemia (PsAB). Antibiotic therapy was considered concordant if the organism was sensitive in vitro and discordant if resistant. We estimated the association between concordant vs. discordant empirical antibiotic therapy on odds of in-hospital death and ICU admission for KPB and ECB. Of 1380 patients, 1103 (79.9%) had ECB, 189 (13.7%) KPB and 88 (6.4%) PsAB. Discordant therapy was not associated with increased odds of either outcome. For ECB, severe illness and non-urinary source were associated with increased odds of both outcomes (OR of in-hospital death for non-urinary source 3.21, 95% CI 1.73–5.97). For KPB, discordant therapy was associated with in-hospital death on univariable but not multivariable analysis. Illness severity was associated with increased odds of both outcomes. These findings suggest broadening of therapy for low-risk patients with community-onset GNB is not warranted. Future research should focus on the relationship between patient outcomes, clinical factors, infection focus and causative organism and resistance profile.

Foodborne and waterborne gastrointestinal infections and their associated outbreaks are preventable, yet still result in significant morbidity, mortality and revenue loss. Many enteric infections demonstrate seasonality, or annual systematic periodic fluctuations in incidence, associated with climatic and environmental factors. Public health professionals use statistical methods and time series models to describe, compare, explain and predict seasonal patterns. However, descriptions and estimates of seasonal features, such as peak timing, depend on how researchers define seasonality for research purposes and how they apply time series methods. In this review, we outline the advantages and limitations of common methods for estimating seasonal peak timing. We provide recommendations improving reporting requirements for disease surveillance systems. Greater attention to how seasonality is defined, modelled, interpreted and reported is necessary to promote reproducible research and strengthen proactive and targeted public health policies, intervention strategies and preparedness plans to dampen the intensity and impacts of seasonal illnesses.

We followed students in eight elementary schools for rubella antibody from 1993 to 1996 (602 pairs) and 1996–9 (588 pairs) in Gyeonggi Province, Korea. We tested rubella IgG and administered rubella vaccine to the children with the titres <10 IU/ml. The loss rates of rubella IgG during the follow-up periods were 14·3 and 15·8%, respectively. Among vaccinated groups, the loss rate was 18·8%, which was significantly higher than 13·8% of the mixture of natural and vaccine-induced immunity groups. The group that had the lower preceding antibody titre had a higher loss rate of 24·8% compared to 7·2% for the group whose titre was 40 IU/ml or above. In a multivariate analysis, age and gender were not related to antibody loss rate. Under this higher rubella antibody loss rate, in order to prevent congenital rubella syndrome, the immunization for women at childbearing age appears necessary until rubella can be eliminated or controlled.

The prevalence of antibodies to human T-cell lymphotropic virus type I (HTLV-1) was determined in high-risk groups and normal adults in Egypt. Among 647 individuals tested, 6 (0·9%) were confirmed positive by western blot analysis. These included 2 (0·7%) of 279 drug addicts, 1 (3·3%) of 30 patients with sexually transmitted diseases, and 3 (2·2%) of 133 healthy individuals. Antibody was not detected in 47 blood recipients or 158 prostitutes. There was no correlation between sex or geographical location and HTLV-I infection. Fifty-three of the 647 sera (8%) were initially reactive by ELISA, but only 12 sera were repeatedly reactive. Since only 4 of these repeatedly reactive sera were confirmed by the western blot, the frequency of false positives using the DuPont screening ELISA was 1·2% (8/643). Two additional sera, confirmed positive by western blot, had been reactive, but not repeatedly, by ELISA. In comparison to the prevalence of HTLV-I antibody among risk groups in many parts of the world, the prevalence in Egypt was low.

The prevalence of antibodies against Lyme disease spirochaetes in serum samples from 80 forestry workers at high occupational risk of Lyme disease was surveyed by enzyme-linked immunosorbent assay (ELISA) with the OspC-I synthetic peptide. The peptide is part of the outer surface protein C (OspC) amino acid sequence located in the region conserved among Borrelia burgdorferi sensu stricto or sensu lato. Positivity for antibodies against OspC-I was observed in 25 (31·3%) of the forestry workers. Of these positive cases, 12 (15·0%) and 19 (23·8%) were positive for immunoglobulin M (IgM) and IgG antibody, respectively. Among 62 workers who were negative for IgG antibody against B. garinii or B. japonica in our previous study, 9 (14·5%) and 4 (6·5%) were positive for IgM and IgG antibody, respectively, in OspC-I ELISA. These results demonstrate for the first time that Lyme disease in forestry workers can be revealed using OspC-I ELISA. We conclude that forestry workers who show positive results for antibodies against OspC-I have very likely been exposed to Lyme disease spirochaetes, and that those who show positivity for IgM antibody against OspC-I may be in the early stage of Lyme disease.

An investigation in an urban area of south-east Kent of 160 patients who had had either pneumonia or unexplained fever during the period from the end of 1948 to the beginning of 1954 revealed that twenty-three (14%) had probably had Q fever.

A comparison of the epidemiological histories of patients who had had Q fever with those of the remainder showed that the use of a household supply of raw milk was commoner among the former.

Occupational exposure to animals (or animal products), visits to potentially infectious places, or residence near potential sources of infection were not significantly more frequent among the Q-fever cases as compared with the controls.

The isolation of Rickettsia burneti from the bulked milk of some local herds supplying retail dairies in the towns, together with the general epidemiological evidence, suggested that Q fever in the towns was predominantly milk-borne.

1. 1000 urinary and 500 faecal cultures of coliform bacteria were studied by means of the methyl-red, citrate and indol tests and also by their fermentation reactions upon saccharose and dulcite.

2. 8 per cent, of the faecal strains and 52 per cent, of the urinary strains were of the aerogenes type, i.e. methyl-red negative and citrate positive. Indol was produced in 94 per cent, and 43 per cent, of cases respectively.

3. This would suggest additional evidence that the coli group are quickly outnumbered by the aerogenes group once they leave the faeces, and also that the presence of the aerogenes type is not confined even in large numbers to an extra-corporeal habitat.

4. In water bacteriology the constancy or change in the relative proportions of coli and aerogenes strains present is the goal at which to aim. The aerogenes variety cannot of itself be regarded as non-excretal or even non-faecal.

5. From a sanitary standpoint, the classification of coliform bacteria by means of the methyl-red and citrate tests cannot be regarded as entirely free from error so long as (a) the aerogenes strains are found in faeces, in however small numbers, (b) these strains occur as the predominant type in urine, and (c) intermediate strains are found in the faeces, urine, soil and water.

6. The principal value of these tests lies in their comparative specificity in identifying B. coli of immediate faecal origin. The presence of such an organism, interpreted together with the indol test, may be said to suggest dangerous faecal pollution if found prominently in a water sample. The presence of other types identified by the same tests cannot be regarded as having the same significant value in regard to a negative opinion.

7. A plea is made for a further study of coliform bacteria by means of the tests described in relation to the biological behaviour of the bacteria under different environmental conditions.

The study identified the common aetiological agents and prominent clinical features of dysentery cases in children aged <5 years and compared this to non-dysentery diarrhoeal cases from the same population. From January 2010 to December 2011, 2324 children aged <5 years received treatment at Kumudini Hospital, of which 682 (29%) presented with dysentery. Of the dysenteric children, aetiology could not be determined for over half (61%). Shigella spp. accounted for 32% of dysentery cases. Significant associations were found between presence of blood in stool and: child age (24–59 months) [odds ratio (OR) 2·21, 95% confidence interval (CI) 1·49–3·27], no treatment of drinking water at home (OR 2·00, 95% CI 1·09–3·67), vomiting (OR 0·19, 95% CI 0·14–0·25), abdominal pain (OR 4·68, 95% CI 3·24–6·77), straining (OR 16·45, 95% CI 11·92–22·69), wasting (OR 1·66, 95% CI 1·15–2·41), and presence of Shigella in stool (OR 6·25, 95% CI 4·20–9·29) after controlling for confounders. This study makes it clear that appropriate public health strategies are needed to reduce the burden of dysentery in Bangladesh.

Normal bovine milk and whey was mycoplasmacidal for 6 of the 13 strains of bovine T-mycoplasmas examined. The in vitro assay used also demonstrated no killing of the human, canine and simian T-mycoplasma strains after 4 hr. incubation. However, there appeared to be some cow-to-cow variation in possession of this activity, and following E. coli endotoxin stimulation of the mammary gland the activity was considerably reduced.

Whey from three normal cows was fractionated on a Bio-Gel A 1·5 m. column and the mycoplasmacidal activity of the resulting five peaks assayed. Only the second peak, peak B, contained activity and was characterized as the only peak containing bovine IgA. The active component in whey, however, was found to be heat stable at 60° C. for 60 minutes and to pass through a dialysis membrane. This is inconsistent with it being immunoglobulin.

Live attenuated influenza vaccine containing the recombinant of A/Victoria/3/75 with A/PR/8/34 virus was administered to healthy adults in a field trial aimed at evaluating protection provided by immunization. The study was designed to measure the effect of vaccination on absenteeism from respiratory disease during a natural influenza epidemic. A total of 2115 male employees of the public transport service of Rome volunteered to participate in the trial, 1050 and 1065 receiving vaccine and placebo respectively, in a randomized blind fashion. Vaccination procedure was completed by the end of December 1976. A small-sized outbreak of influenza, due to a viral strain antigenically homologous to the vaccine, occurred during the month of February 1977. Analysis of absenteeism data, classified according to medical certificate, indicated that morbidity from respiratory disease was reduced in vaccinees compared with controls during the epidemic month; the rate of increase of morbidity compared with that of the preceding month was then three times lower in vaccinees than in controls and the difference in absenteeism between the two groups greatly exceeded the ordinary fluctuation that was observed during non-epidemic periods.

The influence of multiple plating of fluid cultures on salmonella isolation from animal feeding stuffs was examined. Four platings were made from broth culture after 24 h at 37 °C and four platings from selenite enrichment from 24 h at 43 °C. Selenite enrichment followed broth culture which was used as a pre-enrichment stage. Brilliant green MacConkey agar plates were employed for broth subculture and brilliant green MacConkey and desoxycholate citrate agars for selenite subculture. The eight brilliant green plates subcultured from broth and selenite were examined for salmonellas after incubation for 24 h at 37 °C. The four desoxycholate citrate agars after 24 h at 37 °C were used for motility enrichment. The food sample size was a single 100 g instead of 4 x 25 g cultured in an earlier study. This pooling of samples aimed at technical economy. Quadruple plating played an important part in salmonella isolation from 100 g specimens. The combination of multiple plating with motility enrichment was the most successful technique used.

Listeriosis is a rare but serious foodborne disease caused by Listeria monocytogenes. This matched case–control study (1:1 ratio) aimed to identify the risk factors associated with food consumption and food-handling habits for the occurrence of sporadic listeriosis in Beijing, China. Cases were defined as patients from whom Listeria was isolated, in addition to the presence of symptoms, including fever, bacteraemia, sepsis and other clinical manifestations corresponding to listeriosis, which were reported via the Beijing Foodborne Disease Surveillance System. Basic patient information and possible risk factors associated with food consumption and food-handling habits were collected through face-to-face interviews. One hundred and six cases were enrolled from 1 January 2018 to 31 December 2020, including 52 perinatal cases and 54 non-perinatal cases. In the non-perinatal group, the consumption of Chinese cold dishes increased the risk of infection by 3.43-fold (95% confidence interval 1.27–9.25, χ2 = 5.92, P = 0.02). In the perinatal group, the risk of infection reduced by 95.2% when raw and cooked foods were well-separated (χ2 = 5.11, P = 0.02). These findings provide important scientific evidence for preventing infection by L. monocytogenes and improving the dissemination of advice regarding food safety for vulnerable populations.

1. Human and guinea-pig sperms are susceptible to the most diverse chemicals to almost the same degree.

2. There exists a substance in human semen which protects both human and guinea-pig sperms against certain chemicals, especially sodium oleate, orthovanillin and potassium borotartrate.

3. When perfectly fresh human semen is not available, the spermicidal powers of substances may be tested by using guinea-pig sperms suspended in human semen which has been kept cool.

The hepatitis E virus (HEV) has been described in humans and various animal species in different regions of the world. However, the knowledge on natural HEV infection in non-human primates and the corresponding risk of zoonotic transmission is scarce. To determine whether primates in captivity are affected by HEV infection, we investigated 259 individual sera of clinically healthy non-human primates of 14 species from nine German zoos. Using a commercial double-antigen-sandwich ELISA and a commercial IgG ELISA, 10 animals (3·9%) reacted positive in at least one assay. Three ape species and one Old World monkey species were among the seropositive animals: bonobo (Pan paniscus), gorilla (Gorilla gorilla gorilla), lar gibbon (Hylobates lar) and drill (Mandrillus leucophaeus). Testing for anti-HEV-IgM antibodies by commercial ELISA and for viral RNA by reverse-transcription real-time polymerase chain reaction resulted in negative results for all animals indicating the absence of acute HEV infections. In the past, no clinical signs of hepatitis were recorded for the seropositive animals. The results suggest that non-human primates in zoos can get naturally and subclinically infected with HEV or related hepeviruses. Future studies should evaluate potential sources and transmission routes of these infections and their impact on human health.

The aim of this paper is to describe the prevalence of Mycoplasma genitalium and Trichomonas vaginalis in patients who visited general practitioners in the Netherlands. Additionally, we describe the prevalence of M. genitalium resistance to azithromycin and moxifloxacin. We used data from 7,411 consecutive female patients who were screened for Chlamydia trachomatis, Neisseria gonorrhoeae, M. genitalium, and T. vaginalis and data from 5,732 consecutive male patients screened for C. trachomatis, N. gonorrhoeae, and M. genitalium. The prevalence of M. genitalium and T. vaginalis in female patients was 6.7% (95% CI: 6.2 to 7.4) and 1.9% (95%CI: 1.6 to 2.2%), respectively. M. genitalium prevalence in male patients was 3.7% (3.3 to 4.3). M. genitalium co-occurred with C. trachomatis in 1.4% (0.3 to 0.6%) of female and in 0.7% (0.5 to 0.9) of male patients. Macrolide resistance gene mutations and fluoroquinolone resistance gene mutations were detected in 73.8% and 9.9%, respectively. We concluded that M.genitalium is relatively infrequently found in a large general practitioner population in the Netherlands. It can co-occur with C. trachomatis, and is often resistant to azithromycin. Therefore, when treating sexually transmitted infections, these prevalence and resistance data should be taken into account.

The present paper contains the results of an enquiry into the differentiation of certain organisms of varying source, which present characters more or less closely allied to those of the “mannite” or “Flexner” type of the dysentery bacillus.

Skin scales may be attracted onto the surface of administration set connector needles before insertion into infusion containers. Viable microorganisms associated with skin scales may therefore gain access to the infusion by this route. A technique is described for creating an environment of airborne skin scales. This environment is used to examine the attraction of skin scales onto the surface of administration set connector needles and three other materials. After exposure, skin scales are found adhering to the surface of each material examined. The attraction of skin scales onto administration set connector needles is dependent on the time of exposure to the environment. Results suggest that intravenous infusions can be contaminated by this route when the infusion and administration set is assembled.

1. In the intradermic test virulence of “morphological diphtheria bacilli,” 0·2 c.c. containing 100 million organisms is injected. The control guinea-pig receives 500 units of antitoxin the night prior to the test. The test animal receives 125 units six hours after the injection of the cultures. A known virulent organism is always injected as a control; 12 to 20 cultures can be tested on one guinea-pig.

Of 2368 swabs received, 1388 (59 per cent.) showed morphological C. diphtheriae. Fromthese 1286 pure cultures were isolated (92·7 per cent.). In 234 positive swabs from cases of clinical diphtheria, in a series examined under very favourable conditions, morphological C. diphtheriae were obtained in 231 (98·7 per cent.) and of these 229 (99·1 per cent.) were virulent. In 758 positive cultures from carriers morphological C. diphtheriae were isolated in 715 (94 per cent.); 50 per cent. were virulent C. diphtheriae, 39 per cent. avirulent, 3·6 per cent. of Hofmann group, 0·3 per cent. Xerosis and 6.4 per cent. unclassified diphtheroids.

3. Only one culture of intermediate virulence was found, i.e. uncertain reactions occurred with a dose of 100 million organisms while clear reactions occurred with 1000 million.

4. Out of 626 positive cultures from cases of diphtheria, both virulent and avirulent bacilli were isolated in two instances, once from the throat and once from the nose.

5. A monovalent antitoxin (Park Williams 8) nenutralised all of 819 virulent strains.

6. Amongst 39 cultures obtained from the ear in post-diphtherial conditions, virulent C. diphtheriae were isolated fourteen times.

7. Impure primary (“field”) cultures gave reliable results (94 per cent.) when more than one-third of the organisms seen in the smear made from the overnight culture were morphologically C. diphtheriae. If fewer C. diphtheriae were present in the smear th e primary culture gave uncertain results.