In an outbreak of measles in North Wales centred on a secondary school in 1991, 74 cases occurred over a period of 51 days. Before the outbreak started, 27 % pupils did not have a history of measles or immunization and were considered susceptible. Active case rinding and identification and vaccination of susceptible contacts commenced after the fourth generation of cases and further reduced the pool of susceptible schoolchildren from 17%, at the onset of the vaccination campaign, to 8%. A fifth generation of cases did not occur. Delays in diagnosis (mean 2·8 days) and notification (mean 6·1 days) hampered control. There was no evidence of primary vaccine failure (observed vaccine efficacy 97%). Sixty-nine (93%) cases were considered preventable. Reasons for the apparent success of the intervention are discussed.

Viral pneumonia is an important cause of death and morbidity among infants worldwide. Transmission of non-influenza respiratory viruses in households can inform preventative interventions and has not been well-characterised in South Asia. From April 2011 to April 2012, household members of pregnant women enrolled in a randomised trial of influenza vaccine in rural Nepal were surveyed weekly for respiratory illness until 180 days after birth. Nasal swabs were tested by polymerase chain reaction for respiratory viruses in symptomatic individuals. A transmission event was defined as a secondary case of the same virus within 14 days of initial infection within a household. From 555 households, 825 initial viral illness episodes occurred, resulting in 79 transmission events. The overall incidence of transmission was 1.14 events per 100 person-weeks. Risk of transmission incidence was associated with an index case age 1–4 years (incidence rate ratio (IRR) 2.35; 95% confidence interval (CI) 1.40–3.96), coinfection as initial infection (IRR 1.94; 95% CI 1.05–3.61) and no electricity in household (IRR 2.70; 95% CI 1.41–5.00). Preventive interventions targeting preschool-age children in households in resource-limited settings may decrease the risk of transmission to vulnerable household members, such as young infants.

A retrospective cohort study was conducted from 1 January 2006 to 31 December 2009 in Michigan to estimate the prevalence of HIV and hepatitis co-infection and identify associated factors. The prevalence of co-infection was 4·1% [95% confidence interval (CI) 3·8–4·5]. Multivariable logistic regression analysis revealed a significant association between co-infection and being male and: of Black race [odds ratio (OR) 2·0, 95% CI 1·2–3·6] and of Other race (OR 3·5, 95% CI 1·7–7·0) compared to Hispanic race. A significant association was found between co-infection and risk categories of blood products (OR 11·1, 95% CI 6·2–20·2), injecting drug user (IDU) (OR 3·6, 95% CI 2·7–4·8) and men who have sex with men/IDU (OR 3·4, 95% CI 2·4–4·9) in addition to two interactions; one between sex and current HIV status and the other between current HIV status and age at HIV diagnosis. Our results document the changing epidemiology of HIV–hepatitis co-infection which can guide preventive measures and interventions to reduce the prevalence of hepatitis co-infection.

Retreatment of tuberculosis (TB) often fails in China, yet the risk factors associated with the failure remain unclear. To identify risk factors for the treatment failure of retreated pulmonary tuberculosis (PTB) patients, we analyzed the data of 395 retreated PTB patients who received retreatment between July 2009 and July 2011 in China. PTB patients were categorized into ‘success’ and ‘failure’ groups by their treatment outcome. Univariable and multivariable logistic regression were used to evaluate the association between treatment outcome and socio-demographic as well as clinical factors. We also created an optimized risk score model to evaluate the predictive values of these risk factors on treatment failure. Of 395 patients, 99 (25·1%) were diagnosed as retreatment failure. Our results showed that risk factors associated with treatment failure included drug resistance, low education level, low body mass index (<18·5), long duration of previous treatment (>6 months), standard treatment regimen, retreatment type, positive culture result after 2 months of treatment, and the place where the first medicine was taken. An Optimized Framingham risk model was then used to calculate the risk scores of these factors. Place where first medicine was taken (temporary living places) received a score of 6, which was highest among all the factors. The predicted probability of treatment failure increases as risk score increases. Ten out of 359 patients had a risk score >9, which corresponded to an estimated probability of treatment failure >70%. In conclusion, we have identified multiple clinical and socio-demographic factors that are associated with treatment failure of retreated PTB patients. We also created an optimized risk score model that was effective in predicting the retreatment failure. These results provide novel insights for the prognosis and improvement of treatment for retreated PTB patients.

We aimed to develop a prediction rule for urinary tract infections (UTIs) in patients with type 2 diabetes mellitus (DM2). A 12-month prospective cohort study was conducted in patients with DM2 aged ⩾45 years to predict the occurrence of recurrent UTIs in women and lower UTIs in men. Predictors for recurrent UTI in women (n=81, 2%) and lower UTIs in men (n=93, 3%) were age, number of general practitioner (GP) visits, urinary incontinence, cerebrovascular disease or dementia. In women, renal disease was an additional predictor. The optimum corrected area under the receiver-operating curve (AUC) was 0·79 (95% CI 0·74–0·83) for women and 0·75 (95% CI 0·70–0·80) for men. Using a cut-off score of 4, women with a lower risk assignment had a probability of 0·3% for the outcome. For a cut-off score of 6, women with a higher risk assignment had a probability of 5·8%. For men these figures were 0·8 and 7·1 for a cut-off score of 2 and 4, respectively. Simple variables can be used for the risk stratification of patients.

The impression has always prevailed, that malaria is the most common disease in Palestine, and that it is more or less highly prevalent in all of rural Palestine. This impression, based as it is on mass experience, is in general correct; but it lacks the certainty derived from statistical data.

Evidence for the isolation of a virus from this epizootic disease of shearwaters is based upon the reproduction of a similar condition in ducklings and pigeons and upon the development of characteristic histological changes with cytoplasmic eosinophilic inclusions in inoculated chorio-allantoic membranes of chick embryos.It was not possible to reproduce the original disease exactly by inoculation of shearwaters with egg-passage virus from the previous season because the birds did not develop blisters at the site of inoculation of the web. Nevertheless, three out of four birds died and the agent was re-isolated from the spleen of one of them.The ability of the virus to cause blisters on duckling webs was neutralized by shearwater serum taken at the convalescent but not at the acute stage of the disease, and complement fixation was obtained with convalescent shearwater serum.

Previous studies on natural virus infections of birds have been mainly limited to psittacosis and ornithosis, the pox viruses, Newcastle disease virus and some of the neurotropic viruses. However, the failure to infect mice by any route, and the ability of the shearwater virus to pass through filters with an A.P.D. of 48 mμ, seemed to rule out the psittacosis group as a cause of the infection. The ability of the virus to cause vesicles and the intracytoplasmic eosinophilic inclusion bodies suggested a member of the pox group of viruses, but the small size of the agent renders a relation to either the pox group or Newcastle disease virus unlikely. Several of the neurotropic viruses which infect birds, for example, Japanese B virus, are about the size of the shearwater virus, but they do not cause the formation of inclusion bodies and they are all pathogenic for mice. Foot and mouth disease virus is also of small size and produces vesicular lesions, but it is unlikely that the shearwater virus is the same since it was unable to infect a cow or the pad of a guinea-pig, and it grew in eggs more readily than foot and mouth disease virus.

There has obviously been insufficient work on the agent to postulate a new virus, but the properties described do not justify its classification in any of the known virus groups. The name puffinosis which was originally suggested still seems suitable for this disease of Puffinus puffinus puffinus.

Five children with a neuroendocrine tumour (NET) of the appendix associated with a parasitic bowel infection are described, and the possibility of inflammation-triggered carcinogenesis is discussed. Schistosoma haematobium is linked primarily to bladder cancer but it has been reported in association with several other histotypes, including NETs of the gastrointestinal tract. Conversely, Enterobius vermicularis has not yet been claimed to participate in the onset of pre-cancerous conditions or tumours. The rare occurrence of contemporary appendiceal NETs and parasitic infection, raises the intriguing hypothesis of an inflammation-related carcinogenesis, although a cause–effect relationship cannot be established. Larger international series of childhood appendiceal NETs, which also include countries with higher prevalence of parasitic bowel infections, are needed to further clarify this possible cause–effect relationship.

Seventy-three cultures of Clostridium difficile isolated both during, and in the period immediately following, an outbreak of infection in a group of three hospitals, were characterized by one-dimensional sodium dodecyl sulphate–polyacrylamide gel electrophoresis (SDS–PAGE) of whole-cell proteins. Each protein pattern was characterized by the presence of one or two dense bands which were highly reproducible. The protein patterns were used as the basis for a numerical analysis which divided the strains into five phenons (electrophoretic or EP types). The majority, 60 of the 73 cultures, belonged to a single phenon which included strains from both patients and the environment. We conclude that high-resolution SDS–PAGE of proteins provides an effective method for typing C. difficile and therefore for tracing the possible spread of epidemic strains in hospitals and other institutions, thereby allowing a better understanding of the epidemiology of the organism.

This study aimed to investigate the characteristics of uncertainty in illness and the coping styles of patients with severe coronavirus 2019 (COVID-19) and to explore their relationship to provide effective guidance for clinical nursing. A cross-sectional survey was used to investigate 56 severe patients with COVID-19 in a designated hospital in Wuhan. A general information questionnaire, the Mishel Uncertainty in Illness Scale for Adults (MUIS-A) and the Medical Coping Modes Questionnaire (MCMQ) were used to collect the data. A statistical analysis was performed. The total score of the MUIS-A was a 66.29 ± 17.25 which was at a low level, while the total score of the MCMQ was 54.16 ± 6.39. The scores of facing and avoiding were significantly higher than those in the norm. The difference in the yielding dimension of patients with different family economic situations was statistically significant. The total score of MUIS-A correlated negatively with the coping style of facing and avoiding and positively correlated with the coping style of yielding. The coping style of patients was one of the factors influencing uncertainty in illness. Nursing staff need to pay close attention to the psychological state of their patients, understand their coping styles and actively correct negative coping styles to reduce the uncertainty in illness and promote physical as well as mental recovery.

1. A technique for studying the behaviour of Salmonella in milk is described.

2. S. typhi, paratyphi B, dublin, cholerae-suis, typhi-murium, enteritidis and bovis-morbificans all multiplied readily even in absolutely fresh raw milk stored at 15°C., and in commercial grades of raw and of heat-treated milk rapid multiplication also occurred.

3. Strains of S. typhi recently isolated from man showed more rapid multiplication in milk than did stock laboratory cultures.

4. These Salmonella all survived at least 2 months when incorporated in various grades of salted and unsalted butter.

In a recent publication1 I described a gas analysis apparatus suitable for rapid and accurate laboratory work. This apparatus is, however, somewhat cumbrous, and cannot easily be conveyed from place to place, as is very often required in investigations relating to questions of hygiene. It also occupies a good deal of working space in a laboratory, as it cannot be moved from its place without a good deal of trouble. On the other hand the already existing forms of portable gas analysis apparatus for technical work are too inaccurate for many of the requirements of work in hygiene and physiology. I have therefore designed an apparatus with a view to meeting these defects as far as possible2.

The test-negative design (TND) has become a standard approach for vaccine effectiveness (VE) studies. However, previous studies suggested that it may be more vulnerable than other designs to misclassification of disease outcome caused by imperfect diagnostic tests. This could be a particular limitation in VE studies where simple tests (e.g. rapid influenza diagnostic tests) are used for logistical convenience. To address this issue, we derived a mathematical representation of the TND with imperfect tests, then developed a bias correction framework for possible misclassification. TND studies usually include multiple covariates other than vaccine history to adjust for potential confounders; our methods can also address multivariate analyses and be easily coupled with existing estimation tools. We validated the performance of these methods using simulations of common scenarios for vaccine efficacy and were able to obtain unbiased estimates in a variety of parameter settings.

In 1994, 171 (27%) of all positive blood cultures in our hospital were due to Acinetobacter species. Of these, 138 cultures were considered significant, 91 (66%) were community-acquired and 47 (34%) were nosocomial. Most acinetobacter bacteraemia in children [les ]1 year old was community-acquired, while nosocomial infection was more common in children >1 year old (P=0·01). Most children [les ]5 years old were severely malnourished. The incidence of bacteraemia was lowest during the post-monsoon to early winter months. Acinetobacter bacteraemia associated mortality was twice (16%) that of all other patients (7·7%, P < 0·0005) and accounted for 4·5% of all hospital deaths during the study period. Bacteraemia caused by Acinetobacter species is an important cause of morbidity and mortality among our patient population with diarrhoeal disease.

Summarising the results obtained in this series of experiments, it would appear that, in the case of Bact. aertrycke infection spreading among a closed community of mice:

(1) The character and severity of the epidemic are mainly determined by the virulence of the infecting bacterial strain.

(2) Strains of high virulence may give rise to non-fatal persistent infections, maintaining their full virulence over long periods of time within the spleens of the infected mice.

(3) Strains of low virulence may persist for long periods of time within such closed populations, spreading to some extent among the mice at risk, causing occasional deaths, and leading to an appreciable number of latent infections.

(4) It would appear that virulence and power to spread are highly corre lated.

The observations here recorded were made, for the most part, during a journey through Upper Palestine and Lower Syria, in June and July, 1901. The country traversed is indicated upon the accompanying map. Its character is so well known as not to need detailed description, being for the most part very hilly and rocky or level plain.

(1) The antiseptic and bactericidal properties of Flavines and Brilliant Green. Extended investigations have confirmed the original values. It has been shown that the inferior potencies recorded by certain other workers depend on the use of methods unsuited for the observation of antiseptic properties, i.e. they fail to detect inhibition of bacterial activity i.e. bacteriostatic action, which is exhibited to a marked degree by flavine and brilliant green.

(2) For the therapy of a local bacterial infection, as in a wound, such bacteriostatic action is of great value. It is not essential that the chemical agent should by itself actually kill the organisms. Highly successful results can be obtained by a co-operation of the antiseptic and the tissues, so that the pathogenic action of the organisms is restrained. The flavines in virtue of their low toxicity to mammalian tissues and their high bacteriostatic power are therefore specially suited to act as local therapeutic agents. In addition, the fact that they are not neutralised by admixture with serum enables them to be applied clinically by a relatively simple method which does not necessitate frequent renewal.

(3) The “fundamental error” to which the method of testing chlorine antiseptics originally practised by Dakin, is liable, and which Dakin and Dunham have drawn attention to, has been shown not to affect our previous results with Chloramine-T. The difference between our values and the others is due to the fact that we employed 80 per cent. serum in the test.medium, which is much more active in neutralising this antiseptic than is 33 to 50 per cent. serum employed by Dakin and his co-workers.

Experimental latent herpes infection of rabbit dorsal root ganglia (DRG) is reported. The simian herpes virus used was derived from fatal natural infection in owl monkeys and has limited neurotropism in the rabbit. Following intradermal injection of the flank it causes a local lesion followed only by dorsal root ganglionitis; segmental paraesthesia and/or sensory loss going on to clinical recovery. Methods were developed for mapping sensory losses.

Virus could be immediately re-isolated from skin or DRG homogenates in the acute (first week) stage but from 8–550 days by DRG organ culture only. Spontaneous recurrence does not occur but reactivation can be provoked.

The system provides an improved analogue model for the study of the pathogenesis and symptomatic treatment of herpes zoster.

A cold-adapted influenza A virus, CR-37 (H1N1), derived from genetic reassortment between A/Ann Arbor/6/60 (H2N2) cold-adapted variant virus and A/California/10/78 (H1N1) wild-type virus, was tested in Japanese adult volunteers. The CR-37 live virus preparation induced only low-grade clinical reactionsin volunteers for the first 3–4 days after inoculation. Two vaccinees who did not show any antibody changes became febrile (over 38–0 °C). Skin tests using the vaccine preparation and uninfected allantoic fluid were performed, and indicated that one of these two vaccinees was positive for the CR-37 vaccine preparation. A high proportion of the vaccinees whose sera had a haemagglutination-inhibition (HI) antibody titre against thevaccine strain of ≤ 64 before inoculation, seroconverted in both HI and neuraminidase-inhibition (NA1) antibody titrations, and only a few seroconverted in the titration of antibody against type-specific internal antigens. The serological examinations against heterotypic H1N1 variants indicated that the cold-adapted live influenza virus vaccine could induce a broad spectrum of HI antibody reactivity and immunity of long duration.

In all countries which make statistical returns, attention has been directed to the large proportion of children failing to complete one year of life. Even the most highly civilised races lose in this way more than ten per cent, of their potential citizens as will appear from the data contained in the following table (Deutsche Sterbetafeln, 1910).