Between July 1987 and June 1989, 1054 urinary isolates of enterobacteria from Kaohsiung, Taiwan were studied for their trimethoprim resistance. Trimethoprim resistance was defined as MIC greater than 4 μg/ml and high-level resistance by MIC greater than 1000 μg/ml. The incidence of trimethoprim resistance increased from 33·6% in 1987 to 42·1% in 1989. Among the resistant strains studied, 90% were resistant to high levels of trimethoprim. An increase in the proportion of resistant strains (33·9–46·3%) exhibiting high-level non-transferable trimethoprim resistance was noted. The distribution of the dihydrofolate reductase (DHFR) genes by colony hybridization in 374 trimethoprim-resistant isolates revealed the presence of type I and type V DHFR genes in most of these isolates (45·4% and 10·4% respectively). Type I was predominant in Escherichia coli whereas type V was frequently seen in Enterobacter spp. None showed homology with the type II and type III DHFR probe DNA. In addition, transposon Tn7 was present in 7·8% of 374 trimethoprim-resistant enterobacteria.

A recent countrywide MRSA spa-type 1081 outbreak in The Netherlands predominantly affected nursing homes, generating questions on how infection spreads within and between nursing homes despite a low national prevalence. Since the transfer of residents between nursing homes is uncommon in The Netherlands, we hypothesized that staff exchange plays an important role in transmission. This exploratory study investigated the extent of former (last 2 years) and current staff exchange within and between nursing homes in The Netherlands. We relied on a questionnaire that was targeted towards nursing-home staff members who had contact with residents. We found that 17·9% and 12·4% of the nursing-home staff formerly (last 2 years) or currently worked in other healthcare institutes besides their job in the nursing home through which they were selected to participate in this study. Moreover, 39·7% of study participants worked on more than one ward. Our study shows that, in The Netherlands, nursing-home staff form a substantial number of links between wards within nursing homes and nursing homes are linked to a large network of healthcare institutes through their staff members potentially providing a pathway for MRSA transmission between nursing homes and throughout the country.

Physiologists have recognized for a long time that stuffiness in a close atmosphere is not due to diminution of oxygen or excess of carbon dioxide in the air breathed, or to any other impurity in the air. Such feelings are now shown to be due to the effect of longer infra-red rays on the skin, and are accompanied by a reflex narrowing of the air-ways of the nose and lungs. These effects are set aside by cool air acting on the skin and in many people also by shorter infra-red rays from bright sources of heat. This is why some people are much more comfortable with a bright source of heat than with a dark or dull red one. When people go out of doors to get a “breather”, or stand before an open window during physical exercises, they are instinctively using the stimulus of cold to widen their air-tubes. In open air treatment, and when sleeping with an open window, the same effect is obtained.

All rooms should be adequately ventilated with cool air to prevent stuffy feelings, and keep the air-ways open. Such ventilation will, at the same time, sweep away infection spread by “carriers”.

Partial obstruction of the air-tubes hinders the passage of blood through the lungs; it is this which causes failure of breathing when the obstruction is considerable.

Bleeding is of value because it relieves to a certain extent the impeded circulation.

Breathing through a narrow tube can be used as a test of fitness. An airway gauge has been designed for making such a test.

Seventy-three children under the age of 18 months presenting with acute gastroenteritis were given an electrolyte mixture with added sucrose or glucose in a randomized double-blind trial. The time taken to recovery in those successfully treated as out-patients was identical. However, of the 34 who received glucose, 11 (32%) required admission compared with 7 (18%) of the 39 who received sucrose. There was a wide range of osmolality of the made-up feeds, indicating inaccuracy in diluting the solutions as prescribed, but this did not in general correlate with need for admission.

Sucrose-electrolyte solution is at least as effective as a glucose-electrolyte solution for the out-patient management of acute gastroenteritis in infancy. The cheapness and easy availability of sucrose commends its use in developed and developing countries.

Acute respiratory infections (ARIs) are the most important infectious cause of death, but there is less information of their burden in the community. This study describes the burden of ARI in a cohort of 50 Iranian families visited weekly over 2 months. Eighty-one out of 113 (72%) children and 29/103 (28%) adults had a total of 124 episodes of ARI. Seventy-five per cent of the episodes occurring in children were primary/co-primary compared to 40% of those in adults (P<0·01). Children were more likely to be the first symptomatic cases and infections were frequently transmitted within the family. Frequencies were lowest among adults, low among infants aged <6 months and highest among children aged <5 years (P<0·01). Winter episodes occurred more frequently in January (P<0·01). The high frequency and apparent transmissibility of ARI in this cohort highlights its enormous burden in the community.

A prospective study of hepatitis that began in 1968 and continues to include more than half the dialysis units in the United Kingdom shows that type B infection has been completely controlled in such units since the last outbreak ended in 1973. Though occasionally a single patient has developed hepatitis B surface antigenaemia in the course of dialysis or after transplantation, the infection has not spread to other patients or staff in the survey units.

A detailed analysis of the results in 1974–75 shows clustering of patients with raised aminotransferase levels in about one-fifth of the units but, unlike past outbreaks of hepatitis B, these clusters are not accompanied by clinical hepatitis among staff. The possibility that some of the clusters are caused by hepatitis viruses other than type A or B is discussed. It is concluded that, when reliable tests for type non-A non-B infections become available, the continued existence of the survey will allow prompt assessment of any viral hepatitis problems that may still exist in UK units.

A total of 308 samples of different types were examined for the presence of salmonellas by means of three different procedures. The first consisted of preenrichment in buffered peptone water followed by enrichment in Rappaport-Vassiliadis medium (P/RV). The second differed only in that 1% Teepol was added to the pre-enrichment medium (PT/RV). In the third, buffered peptone water with 1% Teepol was followed by enrichment in Muller–Kauffmann tetrathionate broth also containing 1% Teepol (PT/MKT). The first of these combinations (P/RV) proved superior to the others both in terms of isolation rates and in the appearance of suspicious colonies.

A conjunctivitis outbreak affecting more than 200 individuals occurred on a university campus in Evanston, Illinois, USA, in spring 2002. An investigation was conducted jointly by the Evanston Department of Health and the Illinois Department of Public Health. A combination of e-mail and traditional telephone-based surveys demonstrated that wearing contact lenses was a risk factor for any conjunctivitis and bilateral conjunctivitis, whereas using glasses was protective. Laboratory and epidemiological evidence suggested that the outbreak was caused by a viral pathogen that eluded characterization despite extensive culture and PCR-based laboratory testing. Enhanced laboratory surveillance could help clinicians and public-health officials to identify relevant secular changes in the spectrum of causes of conjunctivitis. During institutional outbreaks, e-mail surveys can help public-health officials to efficiently access information not easily collected by traditional case-control studies, and can provide an effective conduit for providing prevention recommendation, such as the need for improved hand and contact-lens hygiene during outbreaks.

The number of bacteria on the hands of nurses using 2 % hexachlorophene soap intermittently was compared with the numbers of bacteria on the hands of nurses using ordinary soap. No significant differences were observed.

This study would not have been possible without the whole-hearted co-operation of the Matron, Miss M. Schurr, the Deputy Matron, Miss G. Davies and the Sisters and Nursing Staff of Fulham Hospital.

We are also indebted to Mr T. Ridgewell, Mr T. F. Fletcher and Miss Julia Fisher for technical assistance, and to Messers Bibby and Co. For their generous gift of soap.

1. An epidemic of diarrhoea or gastro-enteritis occurring in Aberdeen in 1919, and causing over 1000 cases and 72 deaths, has been proved to be due to infection of milk with dysentery bacilli of the Flexner type.

2. Similar epidemics of milk-borne diarrhoea have occurred formerly, but bacteriological investigation had failed to determine the nature of the infecting organism. Keference to the epidemiological and clinical features of such former epidemics, however, makes it practically certain that they were essentially of the same description as the Aberdeen epidemic of 1919, and accordingly indicates that they were likewise due to infection of milk with dysentery group bacilli.

3. The Aberdeen epidemic of milk-borne bacillary dysentery had run its course and had caused 72 deaths before serological proof of bacillary dysentery was available. Since the time of the Aberdeen investigation, notable advances have been made in methods for the bacteriological diagnosis of the dysenteries as a result of the fundamental work of F. W. Andrewes, A. D. Gardner, C. J. Martin and others. Nevertheless, modern methods of bacteriological diagnosis are not infallible, and the Aberdeen experience clearly indicates that deaths will be prevented if polyvalent anti-dysenteric serum and saline treatment are used at once in a disease having the clinical symptoms of bacillary dysentery, or in an acute enteritis from which has been isolated organisms with the cultural reactions of the dysentery group bacilli.

The blood picture in rubella is characterised by the presence of numerous plasma and Türk cells and by the absence of toxic changes in the neutrophilic leucocytes.

Plasma cells occur also in scarlatina and in measles but with less regularity and, as a rule, in smaller numbers, but these diseases are always associated with “toxic” changes in the neutrophilic cells.

Such haematological features must be considered in relation with the clinical findings because plasma cells and toxic changes in the neutrophiles may occur in entirely different conditions, e.g. in association with the lympho cytosis following almost any acute infective malady.

The haematological method would probably find its greatest application in those cases in which the characters of the rash are not sufficiently well developed to enable a diagnosis to be made in the usual way.

Acknowledgments. My investigations were carried out at the Institute of Pathology of Charing Cross Hospital Medical School, and I am much indebted to the Director, Dr Piney, for assistance and advice, and to Dr Whittaker of the Metropolitan Asylums Board for access to clinical material. Moreover, financial assistance has been afforded by The Virol Research Scholarship which I hold.

The burden of community-associated Clostridium difficile infection (CA-CDI) has increased. We aimed to describe the epidemiology of CA-CDI to inform future interventions. We used population-based linked surveillance data from 2012 to 2016 to describe socio-demographic factors, ribotype and mortality for all CA (n = 1303) and hospital-associated (HA, n = 1356) CDI. For 483 community-onset (CO) CA-CDI and 287 COHA-CDI cases, a questionnaire on risk factors was completed and we conducted a case–case study using logistic regression models for univariate and multivariable analysis. CA-CDI cases had lower odds of being male (adjusted odds ratio (AOR) 0.71, 95% confidence interval (CI) 0.58–0.87; P < 0.001), and higher odds of living in rural rather than urban settlement (AOR 1.5, 95% CI 1.1–2.1; P = 0.05) compared with HA-CDI cases. The distribution of ribotypes was similar in both groups with RT078 being most prevalent. CDI-specific death was lower in CA-CDI than HA-CDI (7% vs. 11%, P < 0.001). COCA-CDI had lower odds of having had an outpatient appointment in the previous 4 weeks compared with COHA-CDI (AOR 0.61; 95% CI 0.41–0.9, P = 0.01) and lower odds of being in a care home or hospice when compared with their own home, than COHA-CDI (AOR 0.66; 95% CI 0.45–0.98 and AOR 0.35; 95% CI 0.13–0.92, P = 0.02). Exposure to gastric acid suppressants (50% in COCA-CDI and 55% in COHA-CDI) and antimicrobial therapy (18% in COCA-CDI and 20% in COHA-CDI) prior to CDI was similar. Our analysis of community-onset cases suggests that other risk factors for COHA-CDI may be equally important for COCA-CDI. Opportunities to safely reduce antibiotic and gastric acid suppressants use should be investigated in all healthcare settings.

An enzyme-linked immunosorbent assay (ELISA) incorporating the sensitive biotin-streptavidin system was developed to detect IgG antibodies to tetanus toxoid in human serum. Serum samples obtained from 557 normal persons aged 1–65 years from different areas in New Zealand were tested. The proportion of those immune ranged from 60–93% in males, and from 46–86% in females. In the 1–9 years age group 85% were immune. The indirect ELISA is suitable for serological surveys as it is simple to perform, economical and reproducible.

Measles elimination goals have been adopted in a range of countries, sub-regions, and regions since the WHO declared an elimination goal by 2015 or 2020. All countries attempt to achieve and maintain high coverage through routine immunization programmes. This routine strategy, however, does not ensure the elimination goal of measles. Many developed countries, such as the United States, that have succeeded in interrupting measles transmission earlier, are now experiencing outbreaks with an increasing number of cases. Using a stochastic, age-structured model of measles vaccination dynamics, we explore and characterize the transient dynamics of measles susceptibility in the years following the implementation of routine vaccination at the herd immunity threshold. We demonstrate how a population could face risks of potentially large outbreaks even within few years of vaccination. We characterize different risk profiles depending on the incidence pattern in the years prior to vaccination. These results suggest that the classic critical vaccination threshold is necessary to achieve herd immunity, but not sufficient to prevent long periods of transient, super-critical dynamics. Our results suggest the need of future work for more careful monitoring of the impacts of current immunization programmes, and developing models that take into account more complicated vaccination strategies, demographic factors, and population movements.

Variation amongst Achromobacter-like strains was examined by DNA restriction endonuclease digestion and rDNA gene patterns generated using a non-radioactive probe. Chromosomal DNA was extracted from 12 cultures representing Achromobacter groups B, E and F, all from human blood cultures. DNA fingerprinting using EcoRI, HaeIII or HindIII sub-divided the strains in a similar manner to that obtained by their protein patterns. The HaeIII patterns, with their small number of bands, were the easiest to interpret. The EcoRI patterns included a species-specific triplet of bands but minor band patterns allowed further differentiation. The Achromobacter group F strains comprised a separate taxon and were distinct from the group B and E strains by all techniques examined. The study demonstrates that, in addition to total DNA digest analysis, rDNA gene restriction patterns provide a simple but discriminatory electrophoretic method for distinguishing within Achromobacter groups B and E.

Pneumococcal meningitis is a subgroup of invasive pneumococcal disease with a case-fatality rate of up to 30% and long-term sequelae in more than 50% of cases in adults in developed countries. We aimed to determine risk factors for this particular form of pneumococcal disease. We conducted a prospective population-based laboratory study of invasive pneumococcal disease in adults in North-Rhine-Westphalia, Germany from February 2001 to August 2006. All isolates underwent serotyping and susceptibility testing at the National Reference Centre for Streptococci in Aachen, Germany. Data were analysed using multiple linear regression. A total of 1043 isolates from bacteraemia and 131 isolates from meningitis were included into the study. Serotype 23F and being female were independent risk factors for pneumococcal meningitis. Being ⩾60 years and serotype 1 were associated with a reduced odds ratio. Season, penicillin and macrolide resistance were not statistically associated with CNS involvement.

The Middle East respiratory syndrome coronavirus (MERS-CoV) is caused by a novel coronavirus discovered in 2012. Since then, 1806 cases, including 564 deaths, have been reported by the Kingdom of Saudi Arabia (KSA) and affected countries as of 1 June 2016. Previous literature attributed increases in MERS-CoV transmission to camel breeding season as camels are likely the reservoir for the virus. However, this literature review and subsequent analysis indicate a lack of seasonality. A retrospective, epidemiological cluster analysis was conducted to investigate increases in MERS-CoV transmission and reports of household and nosocomial clusters. Cases were verified and associations between cases were substantiated through an extensive literature review and the Armed Forces Health Surveillance Branch's Tiered Source Classification System. A total of 51 clusters were identified, primarily nosocomial (80·4%) and most occurred in KSA (45·1%). Clusters corresponded temporally with the majority of periods of greatest incidence, suggesting a strong correlation between nosocomial transmission and notable increases in cases.

The purpose of this study was to document the dynamics of HIV-1 subtypes in Scotland over a 6-year period. Viral RNA from all-new diagnoses was amplified by nested PCR and sequenced in the gag and/or env regions. Subtype was assigned by phylogenetic analysis, and aligned with demographic data including likely route and geographical origin of infection. We present data on 80% of all new diagnoses in Scotland between April 2000 and April 2006. Within the background of an expanding epidemic, subtype B predominates in men who have sex with men and intravenous drug users but there is a small but consistent number of UK-acquired infections in these risk groups caused by non-B subtypes. In heterosexuals, non-B subtypes acquired abroad, especially Africa, are still the largest group but again UK-acquired numbers are rising. The social and clinical significance of the spread of non-B subtypes in different ethnic and risk groups remains to be established.

The virus of Aujeszky's disease (pseudo-rabies) has been found to have a particle size of 100—150 mμ. Two strains were employed in these experiments, one that of Aujeszky, and the other Shope's “mad-itch” strain. The results with both strains were identical.

Antimicrobial resistance (AMR) in pig populations is a public health concern. There is a lack of information of spatial distributions of AMR genes in pig populations at large scales. The objective of the study was to describe the spatial pattern of AMR genes in faecal samples from pig farms and to test if the AMR genes were spatially randomly distributed with respect to the geographic distribution of the pig farm population at risk. Faecal samples from 687 Danish pig farms were collected in February and March 2015. DNA was extracted and the levels of seven AMR genes (ermB, ermF, sulI, sulII, tet(M), tet(O) and tet(W)) were quantified on a high-throughput real-time PCR array. Spatial differences for the levels of the AMR genes measured as relative quantities were evaluated by spatial cluster analysis and creating of risk maps using kriging analysis and kernel density estimation. Significant spatial clusters were identified for ermB, ermF, sulII and tet(W). The broad spatial trends in AMR resistance evident in the risk maps were in agreement with the results of the cluster analysis. However, they also showed that there were only small scale spatial differences in the gene levels. We conclude that the geographical location of a pig farm is not a major determinant of the presence or high levels of AMR genes assessed in this study.