Young men were immunized against cholera, typhoid, paratyphoid A, and paratyphoid B. Agglutinating antibodies were measured 3 weeks after completion of the immunization schedule. Two injections separated by a 4-week interval were found to be as efficient as three injections with 1-week intervals.

Intracutaneous immunization with one-fifth of the standard subcutaneous dose was just as efficient as the standard subcutaneous immunization and did not cause greater general or local reaction.

In Greece the public health surveillance for most infectious diseases, including shigellosis, is not well developed. However, four waterborne outbreaks of shigellosis have been recorded in Greece in the last three decades, in different areas of the country, under different environmental and socioeconomic conditions. This study presents the epidemiological characteristics of these four outbreaks in order to examine common points and differences and to investigate their possible association with environmental and socioeconomic conditions. All four outbreaks were caused by Shigella sonnei and related to drinking water. Epidemic curves, distribution of cases by age and gender, hospitalization rates, environmental conditions and laboratory results were compared. The outbreaks seemed to correspond to two different ‘models’ presenting two characteristic types of epidemic waves related to specific environmental conditions. The attack rates for the general population varied from about 9 to 13% and were similar for both sexes. Children were affected mostly. In these outbreaks there was a strong suspicion of contamination of the water distribution system from the sewage network, highlighting the importance of environmental health control measures.

Although elimination of measles virus (MV) by 2010 was a revised target, a new epidemic has been ongoing in Greece and other European countries. The purpose of this study was the molecular and phylogenetic analysis of the Greek MV circulating strain. Twenty-four MV strains isolated from clinical samples during the 2010 outbreak were genotyped and studied in terms of nucleotide variation and phylogeny. All of the detected viruses were of the D4 genotype, which is circulating in Greece in the Roma population of Bulgarian nationality, the Greek Roma population and the Greek non-minority population, as well as in other EU countries. Phylogenetic analysis revealed that these viruses belonged to subgroup 4 of D4 MV strains. It is essential to continue epidemiological surveillance of measles in Greece to monitor the transmission pattern of the virus and the effectiveness of measles immunization, which eventually will lead to its elimination.

Understanding patterns of influenza spread and persistence is crucial for pandemic preparedness. The H1N1pdm09 virus caused the first influenza pandemic of the 21st century which resulted in at least 18500 deaths. Based on laboratory-confirmed primary-care case reports we investigated the role of weather conditions and socio-demographic variables in its initial spread and subsequent presence in France. Our findings suggest that low relative humidity and high population density were determinants in shaping the early spread of the virus at the national level. Those conditions also favoured the persistence of viral presence throughout the first 33 weeks of the pandemic. Additionally this persistence was significantly favoured by low insolation. These results confirm the increasingly recognized role of humidity in influenza dynamics and underlie the concomitant effect of insolation. Therefore climatic factors should be taken into account when designing influenza control and prevention measures.

Dystrophies due to chronic fluorine poisoning in organs regulated by the parathyroid glands, namely the skin and its appendages, the nails, teeth and hair, and also in bones, are here shown to be unusually common in this country. They should be regarded as easily detectable signs of a serious disturbance of the calcium metabolism of the body. Fluorine is a poison of which the action, in many respects, is similar to that of arsenic. It is the task of the authorities responsible for the health of the nation to search for ways and means capable of minimizing its effect.

I wish to express my sincere thanks to the Librarian of the Royal Society of Medicine and his staff for their never-failing courtesy and help.

Influenza A antibodies in serum samples obtained in 1980 from two Indian populations in Central Brazil were compared. The Kren-Akorore, who were first contacted in 1973 and two years later transferred to the Xingu Indian Park (PIX), were compared with Indians from other tribes already living in the PIX before 1975. An analysis was made of the prevalence and distribution of antibodies against the influenza A viruses which have circulated in the civilized world since 1918. Antibodies to the early influenza A viruses were absent in both Indian populations, but A/Hong Kong/1/68 (H3N2) virus apparently circulated in the PIX. No antibody to influenza A/Bangkok/I/79 or to A/Brazil/11/78 (H1N1) was found in any of the sera, whereas antibodies to these viruses were commonly found in urban populations in Brazil. The evidence from influenza antibodies agrees with the information that the Kren-Akorore Indians had been living in complete isolation until 1973, when they were first contacted.

The production of enterotoxin A and B by strains of Staphylococcus aureus isolated from nasal swabs of healthy carriers, from lesions of hospital patients and from foods unconnected with outbreaks of food-poisoning was investigated. Sixty-six strains of S. aureus were obtained from human beings, two produced enterotoxin A, 45 produced enterotoxin B. seven produced enterotoxins A + B. Thirty-six strains were isolated from 111 samples of food, one produced enterotoxin A, 16 produced enterotoxin B. The relative incidence of A, B and A + B enterotoxigenicity was assessed.

Four red cell antigen-antibody systems in the rabbit are described.

Three of these systems, Z, Y and W, appear to be inherited as an allelomorphic series. The fourth is inherited independently.

Some of the serological properties which allow these sera to be recognized are described and attention is drawn to a property of rabbit red cells, manifested by a variation in their susceptibility to agglutination by homologous antisera, which can complicate the separation of a mixture of antibodies in one serum.

Influenza A(H1N1) viruses of the 2009 pandemic (A(H1N1)pdm09) continue to cause outbreaks in the post-pandemic period. During January to May 2015, an upsurge of influenza was recorded that resulted in high fatality in central India. Genetic lineage, mutations in the hemagglutinin (HA) gene and infection by quasi-species are reported to affect disease severity. The objective of this study is to present the molecular and epidemiological trends during the 2015 influenza outbreak in central India. All the referred samples were subjected to qRT–PCR for diagnosis. HA gene sequencing (23 survivors and 24 non-survivors) and cloning were performed and analyzed using Molecular Evolutionary Genomic Analyzer (MEGA 5·05). Of the 3625 tested samples, 1607 (44·3%) were positive for influenza A(H1N1)pdm09, of which 228 (14·2%) individuals succumbed to death. A significant trend was observed in positivity (P = 0·003) and mortality (P < 0·0001) with increasing age. The circulating A(H1N1)pdm09 virus was characterized as belonging to clade-6B. Clinically significant mutations were detected. Patients infected with the quasi-species of the virus had a greater risk of death (P = 0·009). This study proposes a robust molecular and clinical surveillance program for the detection and characterization of the virus, along with prompt treatment protocols to prevent outbreaks.

The West Midlands was the first English region to report sustained community transmission during the ‘containment’ phase of the influenza A(H1N1)pdm09 pandemic in England. To describe the epidemiological experience in the region, West Midlands and national datasets containing laboratory-confirmed A(H1N1)pdm09 virus cases in the region during the ‘containment’ phase were analysed. The region accounts for about 10·5% of England's population, but reported about 42% of all laboratory-confirmed cases. Altogether 3063 cases were reported, with an incidence rate of 56/100 000 population. School-associated cases accounted for 25% of cases. Those aged <20 years, South Asian ethnic groups, and residents of urban and socioeconomically deprived areas were disproportionately affected. Imported cases accounted for 1% of known exposures. Regional R0 central estimates between 1·41 and 1·43 were obtained. The West Midlands experience suggests that interpretation of transmission rates may be affected by complex interactions within and between sub-populations in the region.

While investigating variations in agglutinability, occurring among certain strains of paratyphoid bacilli, it became desirable to obtain cultures derived from single bacterial cells. The technique at first adopted was that devised by Mutch (1919), but the results obtained were not satisfactory. Certain modifications of this method were attempted, but were no more successful.

The main difficulty, and one which appears to us to have been far too little emphasised in all the methods hitherto described, has been encountered in obtaining satisfactory conditions for the microscopical observation of the bacillary suspensions employed. The difficulty of accurately observing hanging-drop preparations, and still more of controlling manipulation of them by microscopical observation, would seem to us to have been insufficiently realised; and the ease with which faulty interpretation of microscopical appearances may introduce fatal errors into work of this kind has not, perhaps, been fully taken into account.

The epidemiology of human rotavirus (HRV) in north-east Scotland was investigated between 1982 and 1984. During this period 708 HRV infections were recorded. The majority (83%) of the infections were in children less than 5 years of age although some were recorded in adults. The peak incidence occurred in the winter months although a high number of HRV infections was reported during the summer of 1983. A total of 840 faecal specimens containing rotavirus were screened for HRV genome RNA by polyacrylamide gel electrophoresis. Seven hundred (83%) specimens gave RNA profiles suitable for establishing the HRV electrophoretype. Twenty-five different electrophoretypes were identified, of which 21 had ‘long’ RNA profiles and four had ‘short’ RNA profiles. There was extensive co-circulation of distinct electrophoretypes although during any one epidemic period the majority of viruses belonged to a relatively small number of types. Comparison of viruses collected from hospitalized and non-hospitalized Patients showed no differences in electrophoretype distribution. HRV was identified in faecal specimens from a wide age group and no correlation was demonstrated between age of patient and electrophoretype of the infecting virus.

To identify hospital-level factors associated with post-cardiac surgical pneumonia for assessing their impact on standardized infection rates (SIRs), we studied 43 691 patients in a cardiac surgery registry (2001–2011) in 16 hospitals. In a logistic regression model for pneumonia following cardiac surgery, associations with hospital characteristics were quantified with adjustment for patient characteristics while allowing for clustering of patients by hospital. Pneumonia rates varied from 0·7% to 12·4% across hospitals. Seventy percent of variability in the pneumonia rate was attributable to differences in hospitals in their long-term rates with the remainder attributable to within-hospital differences in rates over time. After adjusting for patient characteristics, the pneumonia rate was found to be higher in hospitals with more registered nurses (RNs)/100 intensive-care unit (ICU) admissions [adjusted odds ratio (aOR) 1·2, P = 0·006] and more RNs/available ICU beds (aOR 1·4, P < 0·001). Other hospital characteristics had no significant association with pneumonia. SIRs calculated on the basis of patient characteristics alone differed substantially from the same rates calculated on the basis of patient characteristics and the hospital characteristic of RNs/100 ICU admissions. Since SIRs using patient case-mix information are important for comparing rates between hospitals, the additional allowance for hospital characteristics can impact significantly on how hospitals compare.

Both serological and bacteriological investigations revealed a cyclic, seasonal pattern of Yersinia enterocolitica 1B/O8 infections in Poland during the years 2008–2011. A large increase in incidence was observed in the second quarter and a decrease in the third quarter of each year. Such seasonal changes were not seen in the case of infections caused by the other enteropathogenic Yersinia bioserotypes.

One hundred and nine strains of Haemophilus influenzae type b were subtyped by sodium dodecyl sulphate polyacrylamide gel electrophoresis of whole-cell polypeptides. Twenty-one strains from England, 44 from Scotland, 8 from Sweden, 6 from the Netherlands and 30 from the USA were examined. Some of these strains had been subtyped by outer membrane protein analysis; most of the strains had been isolated from cases of invasive disease.

Comparison of polypeptide profiles using the Dice coefficient of similarity showed that the majority of European strains were closely related and formed a single large group. Four smaller groups were identified; three of these included American and European strains, indicating a world-wide distribution of subtypes. However, the common European and American subtypes fell into different groups, indicating the existence of marked geographical variations in subtype frequency.

A cylinder filled with medium is described, with which prints are made of floors or other surfaces. After a print has been made a slice is cut off the medium, put in a Petri dish and incubated. With one filled cylinder about twenty prints can be made. The method can be used for quantitative bacteriological testing of floors, and the effect of treatment with disinfectants can also be checked in a simple way. Preference was given to disinfection with Halamid.

Using the dengue surveillance program, we prospectively collected data on all the suspected and confirmed cases of dengue in Barbados from 2006 to 2015. Data were analysed for demographic, seasonal and temporal dynamics of this disease in this country. The overall mean annual incidence rate of suspected and confirmed dengue over the study period was 0.49% (range 0.15%–0.99%) and 0.16% (range 0.05%−0.48%), respectively. There was a significant correlation between the mean monthly number of confirmed cases, the mean monthly rainfall and the mean monthly relative humidity percentage. Dengue in this population is predominantly an infection affecting children and young adults. The median age of the patients with both, suspected and confirmed dengue was 25 years and the highest proportion of cases was seen in the age group 0–15 years. The annual incidence rates of both the suspected and the confirmed cases showed an upward trend during the study period and this upward trend was more pronounced among children.

This paper draws on the mortality records of the French, US and UK Royal navies to reconstruct the spatiotemporal evolution of the 1918–1919 influenza pandemic in global Allied naval forces. For a total of 7658 deaths attributed to respiratory diseases (French and US navies) and all diseases (UK Royal Navy) at 514 locations worldwide, techniques of spatial point pattern analysis were used to generate weekly maps of global mortality intensity in 1918. The map sequence for the main period of pandemic mortality, mid-August to mid-November 1918, revealed a near-simultaneous development of mutiple foci of high disease intensity in three distant locations (Europe, North America, West Africa). Given the relatively slow speed of naval ships in convoy at this time (<12 knots), our findings suggest that the pandemic influenza virus was circulating on three continents at the observed onset of the main mortality wave.

This paper is the result of an attempt to determine if, in the different social classes obtained by a grading of a large section of the male working population of England and Wales for the triennial period 1910–12, as described by the Registrar-General in the Supplement to his 75th Annual Report, there was shown any special susceptibility to cancer in particular parts of the body. From a comparison of the standardised mortality-rates from cancer in 16 different sites in (1) men of three social grades, namely, the upper and middle classes, skilled workmen and unskilled workmen, (2) two sub-groups of the upper and middle classes and (3) men of two social classes, a higher and a lower intermediate to classes 1 and 3 and 3 and 5 respectively, it seems reasonable to draw the following conclusions:

1. The mortality-rates from cancer in the majority of the parts of the body considered, including amongst others the tongue, oesophagus and stomach, which altogether account for 92 per cent, of the total deaths, are definitely higher in the men of lowest social status; the incidence decreases, though not always regularly, with ascent in the social scale.

2. The mortality from cancer in other parts of the body, namely, the bowel, the prostate and probably the pancreas, is definitely highest, however, in men of the best social status.

3. Though the relatively high cancer mortality-rates in these sites in the best social class may probably be attributed in some measure, which it is difficult or impossible to assess, to improved facilities for, and methods of diagnosis in this class, as compared with those in the lowest classes, this cannot be the whole explanation as the differences are considerable and as no increased mortality from cancer is evident in any of the sites except the pancreas with such an ascent in the social scale as takes place in passing from social group 1 b, to social group 1 a, where the influence of more skilful diagnosis might also be expected to reveal itself. If we may accept the mortality from hepatic cancer in the different social classes as an approximate index of the general accuracy of diagnosis of malignant disease therein, then varying accuracy of diagnosis can have little influence in producing the divergencies in mortality from cancer in these special sites that are found in the social groups under review.

4. The excessive mortality from cancer of the bowel amongst males of the best social class cannot reasonably be ascribed to their habits of life such as high-feeding and easy-living or to their alleged greater liability to autointoxication. If this were so, cancer of the stomach and cancer of the rectum might also be expected to show a higher incidence in the same social class; the mortality-rates from cancer in these sites, however, are not higher in this class than in the lower social classes.

Only a small proportion of animals tested were found to be excreting Fusobacterium necrophorum biovar A, the causative organism of necrobacillosis, in the faeces (3 of 69 wallabies, 1 of 66 deer, 2 of 81 cattle). The two positive cattle belonged to a single group of calves on a farm with a history of necrobacillosis and the litter underfoot also readily yielded biovar A organisms. All attempts to demonstrate biovar A in litter on other farms and in soil from an area populated by wallabies and deer failed. Ruminal contents from young beef cattle proved a fertile source of F. necrophorum biovar A, 15 of 18 animals giving a positive result. It is suggested that disturbance of the gastrointestinal microflora leads to intestinal multiplication and faecal excretion of the organism, which may then give rise to necrobacillosis of the body surface.