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.

People who use drugs (PWUD) are a key population for hepatitis B virus (HBV) vaccination and screening. We aimed to estimate the seroprevalence of HBs antigen (HBsAg) and self-reported HBV vaccination history in French PWUD attending harm reduction centres using data from the ANRS-Coquelicot multicentre survey conducted in 2011–2013 in 1718 PWUD. Self-fingerprick blood samples were collected on dried blood spots to detect the presence of HBsAg. HBsAg seroprevalence was estimated at 1·4% [95% confidence interval (CI) 0·8–2·5]. It varied between PWUD born in high (7·6%, 95% CI 2·7–19·1), moderate (2·2%, 95% CI 0·8–5·7) and low (0·7%, 95% CI 0·3–1·5) endemic zones. Factors independently associated with HBsAg carriage were being born in a moderate or high endemic zone or reporting precarious housing. Self-reported HBV vaccination history varied from 47·4% in high endemic zones, to 59·3% and 62·6% for moderate and low endemic zones, respectively. Our results suggest that drug use plays a small and substantial role, respectively, in HBsAg carriage in PWUD born in high/moderate and low endemic zones.

1. The circumstances attending an outbreak of haemolytic streptococcal infection in a training centre, followed by acute rheumatism, are described.

2. The incidence of streptococcal infections in trained men and apprentices was 64 and 474 per 1000 respectively.

3. Of streptococcal infections 78·0% occurred in members of two younger classes of apprentices.

4. The eight cases of acute rheumatism were all in apprentices, seven cases being in the same two classes. All but one case had had tonsillitis or scarlatina during the epidemic.

5. The smallest percentage of post-epidemic Dick-positive reactors was found in the youngest class which had suffered most in the outbreak.

Urinary tract infection (UTI) is common in children aged <5 years with diarrhoea, but little is known about risk factors, aetiology and outcome of such children. We aimed to evaluate these knowledge gaps of UTI in children aged <5 years with diarrhoea. We enrolled all children aged <5 years with diarrhoea admitted to Dhaka Hospital of the International Centre for Diarrhoeal Disease Research, Bangladesh, between May 2011 and April 2013, who had history of fever (⩾38 °C) and obtained a urine sample for culture. Diarrhoea with UTI (confirmed by culture) constituted cases (n = 26) and those without UTI constituted controls (n = 78). Threefold controls were randomly selected. The case-fatality rate was comparable in cases and controls (4% vs. 1%, P = 0·439). Escherichia coli (69%) and Klebsiella (15%) were the most commonly isolated pathogens. Persistent diarrhoea, pneumonia and prior antibiotics use were identified as risk factors for UTI in logistic regression analysis (P < 0·05 for all). Thus, children with diarrhoea presenting with persistent diarrhoea, pneumonia, and prior antibiotic use should be investigated for UTI for their prompt management that may reduce morbidity.

The transmission of tuberculosis (TB) in bars is difficult to study. The objective was to describe a large TB outbreak in a company's bar and other leisure settings. A descriptive study of a TB outbreak was carried out. Contacts were studied in the index case's workplace bar (five circles of contacts) and other recreational areas (social network of three bars in the index case's neighbourhood). Chest X-rays were recommended to contacts with positive tuberculin skin tests (TST) (⩾5 mm). The risk of latent tuberculosis infection (LTBI) was determined using an adjusted odds ratio. The dose–response relationship was determined using the chi-square test for linear trend. We studied 316 contacts at the index case's workplace and detected five new cases of TB. The prevalence of LTBI was 57·9% (183/316) and was higher in the first circle, 96·0% (24/25), and lower in the fifth, 46·5% (20/43) (P < 0·0001). Among 58 contacts in the three neighbourhood bars, two TB cases were detected and the LTBI prevalence was 51·7% (30/58). Two children of one secondary TB company patient became ill. Bars may be transmission locations for TB and, as they are popular venues for social events, should be considered as potential areas of exposure.

Vaccinating monkeys against yellow fever (YF) has been a common practice in the beginning of the 17D vaccine development. Although it may seem strange at first sight, vaccinating monkeys as a public health strategy is, we think, feasible and theoretically could eliminate the infection among non-human primates, interrupting the virus circulation (or significantly reducing it) and therefore reducing the risk of spilling over to the human population. We propose a series of studies that could demonstrate (or not) the efficacy and feasibility of vaccinating non-human primates YF reservoirs living in green areas of urban centres to cut off or curb the virus circulation that recurrently spill over to the human population. Therefore, vaccinating monkeys in relatively small green areas of the urban centres is perhaps the ultimate solution for the Brazilian recurrent YF epizootics.

In a residential home for children, 367 cases of streptococcal illness were observed in a period of 30 months. The children lived in groups of about twelve in separate cottages. There were 194 occasions on which a streptococcus was thought to have been newly introduced into and produced illness in a cottage; on 132 of these 194 occasions there were no secondary cases of illness. The remaining 62 cottage introductions were followed by one or more secondary cases.

In 27% of the 194 introductions, the primary case of illness seemed to have been infected from a healthy person in the cottage. In all, 30% of introductions of a new streptococcus into a cottage could be attributed to recognized contacts with one or more known infected children.

The most important factor determining spread within the cottage seemed to be the carrier state of the primary case, spread following more often when the primary case had streptococci in the nose either on admission to hospital, or in convalescence.

There was no evidence that spread within cottage bedrooms was of great importance.

In about 35% of the incidents with spread, the initial spread to secondary cases seemed to be from the incubation-stage carriage of the introducer; in 42% it was from his or her convalescent carriage.

The carrier rate in the healthy cottage-contacts was generally higher in cottages experiencing clinical spread of infection than in those that had single-case introductions. There was a strong correlation between the carrier rate in the first week after an introduction and the final bacteriological attack rate, and a weaker correlation with the final clinical attack rate.

Continued spread of infection in a cottage was commonly due to the arrival of new children and was almost always associated with the presence of nasal carriers of streptococci.

The 194 cottage introductions could be grouped into sixty-three overlapping Village epidemics, each apparently derving from a new importation of the particular type into the Village, although the evidence for this was often merely the absence of known infections within the previous few months. Only 13% of the introductions resulted in more than 10 cases, and some 80% had 5 or fewer. Introductions were more frequent in the cottages receiving children new to the homes than in those for the more permanent residents.

The principal factor found as determining the spread from the first cottage to others was the attack rate in the first cottage. Introductions in cottages for school-age children, and especially those in which a child attending the school in the Village grounds was the first to be attacked, also seemed to lead to spread more often than others.

The interval between successive Village introductions of one type did not appear to affect the extent of spread at the second; but the number of cases occurring in the first of two introductions had a notable effect: in no case did two successive introductions both result in a large number of cases of illness.

SARS-CoV-2 has severely affected capacity in the National Health Service (NHS), and waiting lists are markedly increasing due to downtime of up to 50 min between patient consultations/procedures, to reduce the risk of infection. Ventilation accelerates this air cleaning, but retroactively installing built-in mechanical ventilation is often cost-prohibitive. We investigated the effect of using portable air cleaners (PAC), a low-energy and low-cost alternative, to reduce the concentration of aerosols in typical patient consultation/procedure environments. The experimental setup consisted of an aerosol generator, which mimicked the subject affected by SARS-CoV-19, and an aerosol detector, representing a subject who could potentially contract SARS-CoV-19. Experiments of aerosol dispersion and clearing were undertaken in situ in a variety of rooms with two different types of PAC in various combinations and positions. Correct use of PAC can reduce the clearance half-life of aerosols by 82% compared to the same indoor-environment without any ventilation, and at a broadly equivalent rate to built-in mechanical ventilation. In addition, the highest level of aerosol concentration measured when using PAC remains at least 46% lower than that when no mitigation is used, even if the PAC's operation is impeded due to placement under a table. The use of PAC leads to significant reductions in the level of aerosol concentration, associated with transmission of droplet-based airborne diseases. This could enable NHS departments to reduce the downtime between consultations/procedures

We update our previous insights into COVID-19 vaccine acceptance and hesitancy in Finland. Vaccine acceptance increased from 64% (November/December 2020) to 74% (April 2021). However, there was a group of participants that were preferring to wait to get vaccinated ranging from 6% of over-64-years-olds to 29% of under-30-years-olds. The previously identified enablers convenience (below-50-years-olds), worry about severe disease and protection for oneself (above-50-years-olds) were no longer significantly associated with increased vaccine acceptance. Understanding barriers and enablers behind vaccine acceptance is decisive in ensuring a successful implementation of COVID-19 vaccination programs, which will be key to ending the pandemic.

Dengue, one of the most important mosquito-borne diseases, is a major international public health concern. This study aimed to assess potential dengue infection risk from Aedes aegypti in Kaohsiung and the implications for vector control. Here we investigated the impact of dengue transmission on human infection risk using a well-established dengue–mosquito–human transmission dynamics model. A basic reproduction number (R 0)-based probabilistic risk model was also developed to estimate dengue infection risk. Our findings confirm that the effect of biting rate plays a crucial role in shaping R 0 estimates. We demonstrated that there was 50% risk probability for increased dengue incidence rates exceeding 0·5–0·8 wk−1 for temperatures ranging from 26°C to 32°C. We further demonstrated that the weekly increased dengue incidence rate can be decreased to zero if vector control efficiencies reach 30–80% at temperatures of 19–32°C. We conclude that our analysis on dengue infection risk and control implications in Kaohsiung provide crucial information for policy-making on disease control.

A total of 556 individuals in Agbalenyi Community of Oji-River local government area of Enugu State, Nigeria were studied using questionnaires, focus group discussions and key informant interviews to determine the socio-cultural factors affecting the transmission of onchocerciasis. The result revealed a low level of knowledge about the cause, prevention and complications of onchocerciasis. Respondents have developed a cultural system around the disease due to long exposure. The majority are aware of the disease which they recognize once their body starts itching or musculoskeletal pain develops but only 64·4, 34·0, 1·4 and 3·6%, respectively attributed chronic itching, nodules, bad vision and leopard skin to blackfly bite. Other perceived causes mentioned include ageing, the type of food eaten, farm work and ‘bad blood’. Only 0·8% knew diagnosis could be made through skin snips. Neither Oji-River nor any of the river systems were associated with any of the complications of onchocerciasis. Significant differences in most socio-demographic characteristics were associated with differences in the level of knowledge about the disease.

Utilising routine surveillance data, this study presents a method for generating a baseline comparison that can be used in future foodborne outbreak investigations following a case–case methodology. Salmonella and Campylobacter cases (2012–2015) from Maricopa County, AZ were compared to determine differences in risk factors, symptoms and demographics. For foods and other risk factors, adjusted odds ratios were developed using Campylobacter as the reference. Comparisons were also made for three major Salmonella subtypes, Typhimurium, Enteritidis and Poona as compared with Campylobacter. Salmonella cases were younger, while Campylobacter cases were more Hispanic and female. Campylobacter cases reported consuming peppers, sprouts, poultry, queso fresco, eggs and raw nuts more and reported contact with animal products, birds, visiting a farm or dairy, owning a pet, a sick pet, swimming in a river, lake or pond, or handling multiple raw meats more. Salmonella cases reported visiting a petting zoo and contact with a reptile more. There were significant variations by Salmonella subtype in both foods and exposures. We recommend departments conduct this analysis to generate a baseline comparison and a running average of relevant odds ratios allowing staff to focus on trace-back of contaminated food items earlier in the outbreak investigation process.

Four thousand and one hospital staff were screened for hepatitis B virus (HBV) markers in a vaccination programme in Hong Kong. The seropositivity rate for HBsAg, anti-HBs and anti-HBc were significantly higher in the 3160 existing hospital staff than in 841 new recruits. Of the subjects negative for HBV markers, 605 were randomized to receive three doses of either 10 or 20 μg of the Merck Institute vaccine (HB-VAX). Compared with the 20 μg dose, vaccination with the 10 μg dose results in equal immunogenicity and efficacy at the completion of the three injections but induced a slower response rate and lower anti-HBs titres with the first two doses. The commonest side-effect of local soreness was less with the 10 μg dose. We conclude that (1) hospital staff working in high endemic areas should be vaccinated on recruitment and (2) the 10 μg dose of HB-VAX can replace the recommended 20 μg dose for adults, being cheaper and as efficacious.

As there appears to be a considerable amount of uncertainty (as evidenced by recent writings on this subject) regarding the biological relationships and the etiological significance of the so-called “atypical B. dysenteriae,” this short communication is intended as a brief résumé of conclusions arrived at in the course of an extended investigation of dysentery bacilli in Egypt during 1916 and 1917. It is to be noted that the results recorded here were obtained from the examination of cases of dysentery observed in the earliest stages and frequently followed into convalescence. Such experience has shown that conclusions derived solely from an investigation of the later stages of the disease, e.g. convalescents examined after arrival from over-seas in the United Kingdom, throw little light on the problem of the bacterial etiology of the disease as a whole. In a paper by Thomson and Mackie (1917) on the clinical and laboratory study of dysentery in Egypt a number of atypical dysentery strains were described, but at the time this communication was submitted for publication my observations were not sufficiently complete to make any general statements regarding organisms of this type and no attempt was made to classify them.

The KwaZulu Natal and Eastern Cape provinces of South Africa have experienced a serious dog rabies epidemic over the past three decades. Towards a better understanding of this epidemic, we have previously analysed nucleotide sequences of 142 rabies virus specimens that were obtained from these regions during 2003–2004 and provided a molecular description of the geographical distribution of rabies viral variants in the affected provinces. Here, as an extension, we studied five human cases that occurred during 2002–2003 and demonstrated the use of the sequence database in tracking unknown human rabies case histories. We were able to identify the geographical origin of viruses responsible for each human infection and in one case obtained evidence that suggested a non-bite transmission of rabies virus from an infected dog to a child. We argue for the value of this information in surveillance and epidemiological study and in the follow-up and management of potential exposures.

The spread of Staphylococcus aureus was studied in three general surgical wards of identical design which consisted of a number of separate rooms, and the results were compared with those in the same unit previously studied, in subdivided wards elsewhere and in large open wards.

The nasal carrier rate of Staph. aureus by patients rose during their stay in the ward, but its peak rate was comparable with minimum rates reported in other subdivided wards and was lower than in open wards.

Staphylococcal sepsis rates were lower than in most open wards and were also much lower than those found previously in the same unit when overcrowding was common and each sex had its own ward.

A simple method of breeding large numbers of rabbit fleas in a rabbit house with minimal disruption to the general routine is described.

The distribution of neutralizing antibody to Yaba virus and 1211 agent in the sera of three Asian and one African monkey species was examined.

Cynomolgus (Macaca irus), bonnet (M. radiata) and rhesus (M. mulatta) monkeys possessed antibody to Yaba virus at incidences of 19·9, 8·4 and 0%, respectively. In African green monkeys (Cercopithecus aethiops) the incidence was as high as 76·4%.

As for 1211 agent, no Asian monkeys had neutralizing antibody and 5·5% of African green monkey sera neutralized the virus.

Cases of gastroenteritis were examined to identify if dietary intake prior to an episode and food-handling and storage practices in the home were risk factors for illness. Cases and controls completed a dietary questionnaire after an event or when well, and questionnaires concerning food-handling, storage and general food-hygiene practices. Comparing cases to themselves when well, subjects were more likely to have eaten cold sliced salami, fried rice and foods cooked elsewhere, and to have had a baby in nappies in the house (OR 1·52–6·24, P[les ]0·01). Cases compared to non-cases were more likely to have bought frozen poultry, have eaten foods cooked elsewhere and to have had a baby in nappies in the house (OR 1·44–2·05, P[les ]0·01). Although food-handling and storage practices are considered important, we were unable to detect an association in this study.

The finding that there had been multiple isolations of Palyam serogroup orbiviruses from aborted cattle fetuses in neighbouring Zimbabwe, suggested that there was a need to investigate the possible occurrence of the viruses in South Africa. Unidentified viruses isolated in South Africa, which had been in storage, were examined. Four viruses which had been isolated from Culicoides midges collected at various sites in the years from 1969 to 1977, were identified as three strains of Gweru virus and one of the Nyabira virus (Palyam group serotypes originally described from Zimbabwe) A fifth virus, isolated in 1967 from the blood of a cow with mild fever, was found to be a distinct new member of the Vellore antigenic complex of the Palyam serogroup and was named Apies River virus. Sera from 476 cattle, 150 sheep, 24 goats and 78 humans from 10 farms were tested for neutralizing antibodies to the above three serotypes of virus plus Abadina and Marondera serotypes. Only 1 of 100 cattle sera from two farms in the southern coastal area had antibody, but elsewhere there was a high prevalence of antibody with 254 (53%) of all cattle exhibiting activity for one or more of the five serotypes of virus tested. Only 6 (4%) sheep, 3 (12–5%) goats and 11 (14%) humans had antibody.