Primary infection with varicella-zoster virus in pregnancy poses a risk of severe infection and embryopathies. Upon exposure, seronegative women are candidates for varicella-zoster immunoglobulin (VZIG). The aim of this paper was to describe risk factors for VZIG treatment including sources of varicella exposure and to study how many women developed clinical infection and received postpartum vaccination. We identified all pregnant women who received VZIG from December 2005 to March 2015. Additional information was obtained from Danish registers and a follow-up questionnaire. A total of 104 women were included and 88 completed the questionnaire. Significantly more women had ‘other country of origin’ than Denmark. They were more often second para (57%) and had most commonly been exposed to varicella by their own child (58%). Five women developed clinical varicella infection, and only 26·5% were vaccinated after delivery. The study concludes that few women developed infection after VZIG and none developed pneumonia. General practitioners should be particularly aware of obtaining varicella anamnesis in parous women from non-temperate countries in order to perform selective vaccination prior to pregnancy. In case of varicella exposure during pregnancy in a seronegative woman, postpartum vaccination is crucial.

System dynamics approach offers great potential for addressing how intervention policies can affect the spread of emerging infectious diseases in complex and highly networked systems. Here, we develop a model that explains the severe acute respiratory syndrome coronavirus (SARS-CoV) epidemic that occurred in Hong Kong in 2003. The dynamic model developed with system dynamics methodology included 23 variables (five states, four flows, eight auxiliary variables, six parameters), five differential equations and 12 algebraic equations. The parameters were optimized following an iterative process of simulation to fit the real data from the epidemics. Univariate and multivariate sensitivity analyses were performed to determine the reliability of the model. In addition, we discuss how further testing using this model can inform community interventions to reduce the risk in current and future outbreaks, such as the recently Middle East respiratory syndrome coronavirus (MERS-CoV) epidemic.

Approximately one-quarter of annual global cervical cancer deaths occur in India, possibly due to cultural norms promoting vaccine hesitancy. We sought to determine whether people of Indian ancestry (POIA) in the USA exhibit disproportionately lower human papilloma virus (HPV) vaccination rates than the rest of the US population. We utilised the 2018 National Health Interview Survey to compare HPV vaccine initiation and completion rates between POIA and the general US population and determined factors correlating with HPV vaccine uptake among POIA. Compared to other racial groups, POIA had a significantly lower rate of HPV vaccination (8.18% vs. 12.16%, 14.70%, 16.07% and 12.41%, in White, Black, Other Asian and those of other/mixed ancestry, respectively, P = 0.003), but no statistically significant difference in vaccine series completion among those who received at least one injection (3.17% vs. 4.27%, 3.51%, 4.31% and 5.04%, P = 0.465). Among POIA, younger individuals (vs. older), single individuals (vs. married), those with high English proficiency (vs. low English proficiency), those with health insurance and those born in the USA (vs. those born outside the USA) were more likely to obtain HPV vaccination (P = 0.018, P = 0.006, P = 0.029, P = 0.020 and P = 0.019, respectively). Public health measures promoting HPV vaccination among POIA immigrants may substantially improve vaccination rates among this population.

There are few applications of virology to clinical medicine that have received more attention than the laboratory diagnosis of rubella. Many laboratories attempt it and most readers of this journal will be familiar with the techniques that have been used. It would therefore be superfluous to review the ‘state of the artm’ had there not recently been an innovation that is likely to alter laboratory practice in this field.

Incomplete antibodies demonstrable by the Coombs antiglobulin technique were found in almost all guinea-pigs inoculated subcutaneously with Brucella abortus. They were detected between the 20th and 30th day after infection and reached a peak between the 50th and 70th day, at which time their titre was 4—8 times that of the ordinary agglutinins.

Paper electrophoresis of sera from infected guinea-pigs showed a great increase in y-globulin as infection developed. Smaller increases in α1- and β-globulin were observed.

This study investigated the identification and antimicrobial susceptibility testing of Salmonella isolates in Northern Ireland during 2001–2003. All six participating hospital laboratories used similar methods. Identification and antimicrobial resistance of human enteric (n=897) Salmonella isolates were analysed by retrospective collation of laboratory records. Resistance of human Salmonella isolates to nalidixic acid was 16% but resistance to ciprofloxacin or cefotaxime was rare (<1%). Minor inter-laboratory variations in sensitivity testing practices make it difficult to compare antimicrobial sensitivity results reliably and also to monitor for epidemic clones such as S. Typhimurium DT104 with the ACSSuT resistance pattern. The outcome of this study was the adoption of a standardized regional approach to the isolation of salmonella antimicrobial resistance. This should improve epidemiological monitoring of epidemic clones and assure optimum treatment options are available. In cases of treatment failure, MICs to third-generation cephalosporins and ciprofloxacin should be determined.

A large outbreak of Legionnaires’ disease occurred at a California state prison in August 2015. We conducted environmental and epidemiological investigations to identify the most likely source of exposure and characterise morbidity. Sixty-four inmates had probable Legionnaires’ disease; 14 had laboratory-confirmed legionellosis. Thirteen (17%) inmates were hospitalised; there were no deaths. Ill inmates were more likely to be ⩾65 years old (P < 0.01), have the chronic obstructive pulmonary disease (P < 0.01), diabetes mellitus (P = 0.02), hepatitis C infection (P < 0.01), or end-stage liver disease (P < 0.01). The case-patients were in ten housing units throughout the prison grounds. All either resided in or were near the central clinical building (for appointments or yard time) during their incubation periods. Legionella pneumophila serogroup 1 was cultured from three cooling towers on top of the central medical clinic (range, 880–1200 cfu/ml). An inadequate water management program, dense biofilm within the cooling towers, and high ambient temperatures preceding the outbreak created an ideal environment for Legionella sp. proliferation. All state prisons were directed to develop local operating procedures for maintaining their cooling towers and the state health department added a review of the maintenance plans to their environmental inspection protocol.

In Australia, varicella vaccine was universally funded in late 2005 as a single dose at 18 months. A school-based catch-up programme for children aged 10–13 years without a history of infection or vaccination was funded until 2015, when those eligible for universal infant vaccination would have reached the age of high school entry. This study projects the impact of discontinuing catch-up vaccination on varicella and zoster incidence and morbidity using a transmission dynamic model, in comparison with alternative policy options, including two-dose strategies. At current vaccine coverage (83% at 2 years and 90% at 5 years), ceasing the adolescent catch-up programme in 2015 was projected to increase varicella-associated morbidity between 2035 and 2050 by 39%. Although two-dose infant programmes had the lowest estimated varicella morbidity, the incremental benefit from the second dose fell by 70% if first dose coverage increased from 83% to 95% by age 24 months. Overall zoster morbidity was predicted to rise after vaccination, but differences between strategies were small. Our results suggest that feasibility of one-dose coverage approaching 95% is an important consideration in estimating incremental benefit from a second dose of varicella vaccine.

The designation, Newington, is proposed for those cultures of S. anatum having the antigenic formula III XV: eh: 1, 4, 6. A new type, New Brunswick, is described which is represented by the formula III XV: lv: 1, 7 +. Attention is called to the inadequacy of the symbols currently employed in the representation of the non-specific antigens to express correctly the non-specific phases of the Nyborg and New Brunswick types.

1. One hundred and eighty-seven freshly isolated strains of Haemophilus pertussis, together with ten laboratory strains and eleven strains of H. parapertussis were submitted to tests of their morphological, biochemical and antigenic properties in relation to their virulence to mice.

2. The naturally occurring H. pertussis strains form a single antigenic type differing from that of the attenuated laboratory strains.

3. H. parapertussis forms, as previously claimed, a distinctive type with characteristic properties closely related to H. pertussis.

Our thanks are due to Col. H. J. Bensted, Prof. J. W. McLeod and Drs A. Beck, D. G. Evans, G. Eldering, J. Marks, M. T. Parker, M. Pittman and H. Proom for supplying strains used in this investigation.

Some months ago a bat flew into my house at Grahamstown and was captured. Unfortunately the animal was fatally injured. It was placed in a tobacco-box and on opening the box next day a lively insect like a common bed-bug (Acanthia lectularia) and emiting a similar odour was found in the fur behind the bat's neck. The bug was sent to Mr C. W. Mally, M. Sc., Entomologist to the Eastern Province, for identification and he kindly determined the species as being Acanthia pipistrelli Jenyns, adding that the specimen agreed very well with the description given by Jenyns. Mr Mally wrote, “In the absence of the Northern specimens of this species I cannot express an opinion as to varietal characters. This specimen is of especial importance because there is apparently no record of its occurrence in these parts, nor has the species of bat in connection with which it was first discovered been found at the Cape”. Through the kind intermediation of Mr Mally the bat was forwarded to Professor Duerdin of the Rhodes University, who determined the species to be Vespertilio capensis, “The Cape Serotine Bat”. Prof. Duerdin states it is “apparently one of the commonest of South African bats, but we do not seem to have many”.

Hospital isolates of Enterobacter cloacae were analysed by polyacrylamide gel electrophoresis for enzyme polymorphism and the results were compared with established serotyping, phage typing and biotyping techniques. Initially, the diversity of electromorphs of 13 enzymes was determined on a representative set of 62 distinct strains. Two broad clusters of strains were found in the species, and analysis by serotype suggested a limited diversity within the most frequent o serotvpes. A subset of three enzymes, lactate dehydrogenase, 6-phosphogluconate dehydrogenase, glutamate dehydrogenase and an unidentified marker, were selected and used to type groups of hospital isolates. There was good general agreement between the two systems, although the enzyme method failed to distinguish between some strains with the same serotype. This method provided useful epidemiological information and, in the absence of established typing systems, it is a practical approach to subdividing the species.

Throughout history, acute gastrointestinal illness (AGI) has been a significant cause of morbidity and mortality among US service members. We estimated the magnitude, distribution, risk factors and care seeking behaviour of AGI among the active duty US Army service members using a web-based survey. The survey asked about sociodemographic characteristics, dining and food procurement history and any experience of diarrhoea in the past 30 days. If respondents reported diarrhoea, additional questions about concurrent symptoms, duration of illness, medical care seeking and stool sample submission were asked. Univariable and multivariable logistic regression were used to identify the factors associated with AGI and factors associated with seeking care and submitting a stool sample. The 30-day prevalence of AGI was 18.5% (95% CI 16.66–20.25), the incidence rate was 2.24 AGI episodes per person-year (95% CI 2.04–2.49). Risk factors included a region of residence, eating at the dining facility and eating at other on-post establishments. Individuals with AGI missed 2.7–3.7 days of work, which costs approximately $ 847 451 629 in paid wages. Results indicate there are more than 1 million cases of AGI per year among US Army Soldiers, which can have a major impact on readiness. We found that care-seeking behaviours for AGI are different among US Army Service Members than the general population. Army Service Members with AGI report seeking care and having a stool sample submitted less often, especially for severe (bloody) diarrhoea. Factors associated with seeking care included rank, experiencing respiratory symptoms (sore throat, cough), experiencing vomiting and missing work for their illness. Factors associated with submitting a stool sample including experiencing more than five loose stools in 24 h and not experiencing respiratory symptoms. US Army laboratory-based surveillance under-estimates service members with both bloody and non-bloody diarrhoea. To our knowledge, this is the first study to estimate the magnitude, distribution, risk factors and care-seeking behaviour of AGI among Army members. We determined Army service members care-seeking behaviours, AGI risk factors and stool sample submission rates are different than the general population, so when estimating burden of AGI caused by specific foodborne pathogens using methods like Scallan et al. (2011), unique multipliers must be used for this subset of the population. The study legitimises not only the importance of AGI in the active duty Army population but also highlights opportunities for public health leaders to engage in simple strategies to better capture AGI impact so more modern intervention strategies can be implemented to reduce burden and indirectly improve operational readiness across the Enterprise.

Human skin scales which have been shed naturally bear a flora of micro-organisms which is unknown until tested. To replace these scales in a study of the micro-environment of both the human body and of models a method has been devised of making synthetic scales which behave both physically and aerodynamically in a similar way to the natural material. The synthetic materials carry no natural flora and it is possible to include in them test markers of several kinds to assist in identification after dispersion.

Fusiformis is a multicellular organism having the cytological characters of the Eubacteria, and normally reproducing by fission.

A few cells of all the strains examined pass through the L cycle; usually the initiation of this process follows the patterns described in Proteus and the Morax-Axenfeld bacillus. It has not so far been possible to grow these L-forms of Fusiformis in culture without immediate reversion to the bacillary form.

The stable forms described by other workers appear to be produced by a process analogous to the sexual conjugation seen in the Actinomyces.

The evidence suggests that passage through the L cycle is a normal function of Fusiformis in its natural habitat.

1. The investigation is based on 2666 Moloney tests performed before the injection of prophylactics and 595 tests carried out after the injection of toxoids in prophylactic doses. Methods of reading the test reactions are described.

2. Certain individuals develop sensitivity to toxoid at a very early stage of their existence—even during the first 18 months of life. In the herd the periods of most rapid development of sensitivity to toxoid are between the first and second years, between the fourth and seventh years, and just before the age of fourteen years.

3. For practical purposes the important reactions are those which are designated ++ and +++. Up to the age of 5 years the combined percentages of children who showed these ++ and +++ Moloney reactions did not exceed 3 per cent, at any age. At 7 years the incidence was 9·6 per cent. and thereafter there was a rapid increase until the maximum (43·3 per cent.) was reached at 14 years. Not every individual who shows such ++ or +++ results will develop unpleasant reactions on the injection of toxoids in prophylactic doses. But an investigation into the age and Moloney state of 2041 persons who received prophylactics demonstrated quite definitely that children who showed general and local reactions after inoculation were nearly always over 5 years of age, and most of them (79 per cent.) showed ++ or +++ results with the Moloney test. Hence the test should be used whenever it is intended to inoculate children of school age with prophylactic doses of toxoid or its alum preparations.

4. The assumption that strong positive Moloney reactors are usually immune is unjustified. Of 74 individuals who showed a +++ Moloney reaction 20·3 per cent., and of 173 individuals who showed a ++ Moloney reaction 32·4 per cent, were definitely non-immune as judged by the Schick test. The coefficient of association (Q5) between the two conditions was 0·632.

5. The relationship between positive pseudo-Schick reactions and positive Moloney reactions is examined statistically, and it is shown that the association is not sufficiently high to warrant the substitution of one test for the other. Confirmation of this conclusion was obtained from an examination of the pseudo-Schick and Moloney states of all individuals who showed any degree of local or general reaction after the injection of prophylactic doses of toxoids or other prophylactics.

6. The degree of association between the antitoxic content of the blood serum and the positive Moloney state was investigated in 108 cases. The coefficient (Q5) was found to be in the region of 0·5.

7. The delayed Moloney reaction (+D) is further described and its significance is discussed. The frequency of +D reactions is 1·69±0·17 per cent.

8. In general, a definite Moloney-positive state appears to be permanent. The injection of toxoid in prophylactic doses does not tend to render the injected individual sensitive to toxoid. Exceptions to this rule may be due to the acceleration of a normal process.

9. The incidence of positive Moloney reactions is practically identical in males and in females.

10. The association between the number of children in a family and the number of those who will give positive Moloney reactions is very slight. The effect of an urban environment appears to be more important than the actual family environment in determining the development of sensitivity to toxoid.

11. The relationship between protein skin tests and the Moloney reaction is discussed. Toxoid sensitivity is probably an allergic condition which is due to previous contact with the products of the C. diphtheriae. There is little evidence that age is in itself a factor in the development of sensitivity.

Cytotoxic enterotoxin (Act) is a key virulence factor in the pathogenesis of infections caused by Aeromonas spp. The cytotoxic enterotoxin gene (act) was detected in 32 out of 69 environmental isolates of Aeromonas spp. by hybridization with the act gene probe. To evaluate the pathogenic potential of the act gene probe-positive isolates, 32 act gene probe-positive and 31 randomly selected act gene probe-negative isolates were tested for enterotoxicity in a suckling mice assay (SMA), for haemolytic activity on sheep blood agar plates, for the presence of CAMP-like factors, and for cytotoxicity in a Vero cell line. The act gene probe-positive isolates significantly differed from the toxin gene probe-negative ones with respect to enterotoxicity in the SMA (P=0·009) and haemolytic activity (P=0·005). The CAMP–haemolysin phenotype was significantly associated with the rabbit ileal loop assay (P=0·08), Vero cell assay (P=0·064), and haemolysin production under the microaerophilic conditions (P=0·056) of the act gene probe-positive isolates of Aeromonas spp. These data indicated the role of Act in the pathogenesis of Aeromonas infections and that the enterotoxic potential of Aeromonas spp. could be assessed by simply performing a CAMP–haemolysin assay.

Influenza epidemics are monitored using influenza-like illness (ILI) data reported by health-care professionals. Timely detection of the onset of epidemics is often performed by applying a statistical method on weekly ILI incidence estimates with a large range of methods used worldwide. However, performance evaluation and comparison of these algorithms is hindered by: (1) the absence of a gold standard regarding influenza epidemic periods and (2) the absence of consensual evaluation criteria. As of now, performance evaluations metrics are based only on sensitivity, specificity and timeliness of detection, since definitions are not clear for time-repeated measurements such as weekly epidemic detection. We aimed to evaluate several epidemic detection methods by comparing their alerts to a gold standard determined by international expert consensus. We introduced new performance metrics that meet important objective of influenza surveillance in temperate countries: to detect accurately the start of the single epidemic period each year. Evaluations are presented using ILI incidence in France between 1995 and 2011. We found that the two performance metrics defined allowed discrimination between epidemic detection methods. In the context of performance detection evaluation, other metrics used commonly than the standard could better achieve the needs of real-time influenza surveillance.

This study was undertaken to determine the distribution of phage types of Staphylococcus aureus isolates from hospital outbreaks or sporadic cases received in our laboratory during the past 14 years. The records for 15803 isolates from 55 Spanish hospitals have been analysed.

In relation to sporadic isolates we have been able to detect the predominance of phage group I and non-typable staphylococcal strains. Since 1989, we have observed a considerable increase in hospital infection caused by methicillin-resistant S. aureus strains which we could differentiate in to two groups; one belonging to phage group III (6/47/54/75/77/84/85) and other groups of non-typable strains which could be classified as phage group I-III after heat treatment (29/77/84) and with similar patterns by reverse typing (6/47/53/54/75/83A/84/85/W57/1030/18042).

During 1990 and 1991, these strains have extended widely to at least six different autonomous regions creating an epidemic situation in Spain.

Influenza causes significant morbidity and mortality in children. This study's objectives were to describe influenza A(H1N1)pdm09 during the pandemic, to compare it with circulating influenza in 2010/2011, and to identify risk factors for severe influenza defined as requiring admission to a paediatric intensive care unit (PICU). Children hospitalized with influenza during the pandemic were older, and more likely to have received antiviral therapy than children hospitalized during the 2010/2011 season. In 2010/2011, only one child admitted to a PICU with underlying medical conditions had been vaccinated. The risk of severe illness in the pandemic was higher in females and those with underlying conditions. In 2010/2011, infection with influenza A(H1N1)pdm09 compared to other influenza viruses was a significant risk factor for severe disease. An incremental relationship was found between the number of underlying conditions and PICU admission. These findings highlight the importance of improving low vaccination uptake and increasing the use of antivirals in vulnerable children.