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.

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.

Statistical models are commonly employed in the estimation of influenza-associated excess mortality that, due to various reasons, is often underestimated by laboratory-confirmed influenza deaths reported by healthcare facilities. However, methodology for timely and reliable estimation of that impact remains limited because of the delay in mortality data reporting. We explored real-time estimation of influenza-associated excess mortality by types/subtypes in each year between 2012 and 2018 in Hong Kong using linear regression models fitted to historical mortality and influenza surveillance data. We could predict that during the winter of 2017/2018, there were ~634 (95% confidence interval (CI): (190, 1033)) influenza-associated excess all-cause deaths in Hong Kong in population ⩾18 years, compared to 259 reported laboratory-confirmed deaths. We estimated that influenza was associated with substantial excess deaths in older adults, suggesting the implementation of control measures, such as administration of antivirals and vaccination, in that age group. The approach that we developed appears to provide robust real-time estimates of the impact of influenza circulation and complement surveillance data on laboratory-confirmed deaths. These results improve our understanding of the impact of influenza epidemics and provide a practical approach for a timely estimation of the mortality burden of influenza circulation during an ongoing epidemic.

HIV-positive children are still born in Europe despite low mother-to-child transmission (MTCT) rates. We aimed to clarify the remaining barriers to the prevention of MTCT. By combining the national registers, we identified all women living with HIV delivering at least one child during 1983–2013. Of the 212 women delivering after HIV diagnosis, 46% were diagnosed during the pregnancy. In multivariate analysis, age >30 years (P = 0.001), sexual transmission (P = 0.012), living outside of the metropolitan area (P = 0.001) and Eastern European origin (P = 0.043) were risk factors for missed diagnosis before pregnancy. The proportion of immigrants increased from 18% before 1999 to 75% during 2011–2013 (P < 0.001). They were diagnosed during the pregnancy equally to natives and achieved similar, good treatment results. No MTCT occurred when the mother was diagnosed before the delivery. In addition, 12 women had delivered in 2 years prior their HIV diagnosis, most before implementation of the national screening of pregnant women. Three of these children were infected, the last one in 2000. Our data demonstrate that complete elimination of MTCT is feasible in a high-income, low-prevalence country. This requires ongoing universal screening in early pregnancy and easy access to antiretroviral therapy to all HIV-positive people.

Sampling of sera from 202 Sudanese and 124 Swedish children 1–14 years of age was conducted at the end of the 1980s presenting an opportunity to compare the seroprevalence of anti-Neisseria meningitidis (MC) serogroup A antibodies in an area immediately before outbreak of an epidemic (Sudan 1988) with a low endemic area (Sweden). An ELISA antibody assay was developed for detection of antibodies against capsular polysaccharide of MC serogroup A and Haemophilus influenzae type b (Hib). Serum antibody against MC serogroup A was found significantly more frequently in Sudanese than in Swedish children. This indicates that factors other than herd immunity, as measured by serum antibodies against MC serogroup A polysaccharide, are important for avoidance of an MC serogroup A epidemic. The seroprevalence of Hib antibodies was, in contrast, significantly higher in Swedish than in Sudanese children, especially for 5–9-year-old children. A possible explanation may be the different systems of day-care of children in the two countries.

We report seven cases of probable endotoxin poisoning linked to contaminated compounded glutathione. Five of the cases were using the infusions for treatment of Lyme disease highlighting the risks of using compounded sterile preparations for unapproved indications, especially if the quality of source products cannot be assured.

Among 622 cultures of Salmonella montevideo, 27 biotypes belonging to two biogroups were recognized. One biogroup (10di) was predominant in all animals in Scotland but only in sheep in England and Wales. The other (biogroup 2d) was responsible for almost all human, cattle and poultry infection in England and Wales, but only 24% of human infection in Scotland.

The DNAs of Shigella sonnei or Shigella dysenteriae type 1 strains isolated in outbrealis of shigellosis or in sporadic cases were analysed by restriction fragment length polymorphism (RFLP). Southern blots of the DNAs of 36 S. sonnei isolates digested by 8 restriction enzymes were hybridized with an Escherichia coli rRNA probe. The S. sonnei strains were unexpectedly diverse in their RFLP. Antibiotypes of the same isolates showed clusters of strains corresponding to the various outbreaks. On the other hand, RFLP analysis suggested concomitant multiple sources of infection rather than a common source and thereby introduced a new insight in the epidemiology of shigellosis. RFLP was also used to trace S. dysenteriae type 1 transmission in a recent cluster of clinical cases. Although antibiotic resistance patterns indicated the presence of more than one strain, RFLP analysis showed that the six isolates were identical clones and suggested the loss of an R episome after one person-to-person passage.

The geographical distribution of the different species of rat flea is one of the most important factors governing the spread of plague.

Xenopsylla cheopis is the most effective transmitter of both epidemic and epizootic bubonic plague in all parts of the world.

The relative immunity of certain parts of India and Ceylon from plague is to be primarily attributed to the prevalence of an inefficient plague-carrying flea on the rats of these localities, viz. Xenopsylla astia.

Climatic conditions play only a secondary part in limiting the spread of the disease in these relatively plague-free localities.

Plague infection can be maintained in such localities by the importation of cheopis-infested merchandise.

Climate does not exert an equal effect upon the transmitting power of different species of flea.

Numerous attempts to transmit plague from rat to rat by means of X. astia at room temperature during the plague season in Colombo have all failed. X. astia, however, can carry plague from rat to rat under climatic conditions favourable to plague transmission. Continuous transmission of plague from rat to rat has been obtained with X. cheopis in Colombo under exceptionally unfavourable climatic conditions.

Both plague and X. cheopis have a very irregular distribution within limits of Colombo City. The coefficient of correlation between two periods of human plague incidence and percentage of cheopis to total rat fleas of all species in 14 districts of the city is ·95, probable error ± ·02 for both periods.

There is a close relation between premises infested with X. cheopis and premises where plague-infected rats are found.

A three-fold relationship exists between the amount of imported grain, the prevalence of cheopis on rats, and the incidence of plague in the localities where grain is stored in Colombo.

The measures so far devised for combating plague among Oriental populations, tolerant of all forms of animal life, have not proved conspicuously successful.

Due recognition of the importance of the flea species factor should lead to marked improvement in plague preventive measures in many parts of the world.

A rat flea survey of all the principal plague areas, especially the ports, becomes urgently necessary.

The exports from localities where X. cheopis is found to be prevalent upon the rats should be considered actively dangerous when the locality is plague infected, and potentially dangerous even if it is plague free, since the continual importation of cheopis into a locality where this flea is not indigenous may eventually result in the extension of plague infection to a new area.

I agree with Glen Liston and Norman White, that the export of produce, especially grain, from plague-infected ports should be controlled by international agreement.

The limitation of imported cheopis and plague to definite zones in such localities as Colombo greatly facilitates the task of plague prevention, since all available resources can be concentrated simultaneously, or successively, on the infected areas.

In such instances it is possible to mark out the potentially plague-infected zones by the simple and accurate method of surveying the rat fleas.

Ten years have now elapsed since I tentatively put forward the suggestion that the spread of epizootic plague in the East Indies might be governed by the flea species factor. At first I adopted a cautious attitude towards my own hypothesis. I believe that the evidence now available warrants its acceptance by epidemiologists without further hesitation.

If so, the discovery is but further testimony to the essential unity of science in its bearings on the welfare of the human race, for it is the natural outcome of the purely zoological researches of Rothschild and Jordan on the systemics of the Siphonaptera.

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 surveillance enables systematic collection of data on spatially and demographically heterogeneous epidemics. Different data collection mechanisms record different aspects of the underlying epidemic with varying bias and noise. We aimed to characterize key differences in weekly incidence data from three influenza surveillance systems in Melbourne, Australia, from 2009 to 2012: laboratory-confirmed influenza notified to the Victorian Department of Health, influenza-like illness (ILI) reported through the Victorian General Practice Sentinel Surveillance scheme, and ILI cases presenting to the Melbourne Medical Deputising Service. Using nonlinear regression, we found that after adjusting for the effects of geographical region and age group, characteristics of the epidemic curve (including season length, timing of peak incidence and constant baseline activity) varied across the systems. We conclude that unmeasured factors endogenous to each surveillance system cause differences in the disease patterns recorded. Future research, particularly data synthesis studies, could benefit from accounting for these differences.

Of 1171 isolates of Escherichia coli isolated from urine samples at the Public Health Laboratory, Toronto, Ontario, Canada, between May 1990 and December 1991, 120 (10·3%) were resistant to trimethoprim (TMP), cotrimoxazole (TMP/SMX), sulfamethoxazole (SMX) and other antimicrobial agents; 110 of the 120 isolates (91·7%) were resistant to four or more agents. The majority of resistant isolates (91·7%) exhibited high-level resistance (MIC > 1000 mg/L) to TMP. The MIC of TMP/SMX for all 120 isolates was > 2·0/38·0 mg/L and for SMX > 1024 mg/L. High-level resistances were also present among the β-lactam antimicrobials with MICs ranging from 16- > 256 mg/L. Forty-three of 120 TMP-resistant (35·8%) isolates conjugally transferred TMP-resistance to E. coli K-12. Co-transfer of several other resistances was observed. SMX cotransferred from 86% of the 43 donors and β-lactams together with SMX cotransferred from 70%. Nalidixic acid resistance was present among 22 (18·3%) of the 120 resistant isolates, however, nalidixic acid resistance was not transferred to E. coli K-12.

The effectiveness of screening travellers during times of international disease outbreak is contentious, especially as the reduction in the risk of disease importation can be very small. Border screening typically consists of travellers being thermally scanned for signs of fever and/or completing a survey declaring any possible symptoms prior to admission to their destination country; while more thorough testing typically exists, these would generally prove more disruptive to deploy. In this paper, we describe a simple Monte Carlo based model that incorporates the epidemiology of coronavirus disease-2019 (COVID-19) to investigate the potential decrease in risk of disease importation that might be achieved by requiring travellers to undergo screening upon arrival during the current pandemic. This is a purely theoretical study to investigate the maximum impact that might be attained by deploying a test or testing programme simply at the point of entry, through which we may assess such action in the real world as a method of decreasing the risk of importation. We, therefore, assume ideal conditions such as 100% compliance among travellers and the use of a ‘perfect’ test. In addition to COVID-19, we also apply the presented model to simulated outbreaks of influenza, severe acute respiratory syndrome (SARS) and Ebola for comparison. Our model only considers screening implemented at airports, being the predominant method of international travel. Primary results showed that in the best-case scenario, screening at the point of entry may detect a maximum of 8.8% of travellers infected with COVID-19, compared to 34.8.%, 9.7% and 3.0% for travellers infected with influenza, SARS and Ebola respectively. While results appear to indicate that screening is more effective at preventing disease ingress when the disease in question has a shorter average incubation period, our results suggest that screening at the point of entry alone does not represent a sufficient method to adequately protect a nation from the importation of COVID-19 cases.

Shenzhen is one of the largest migratory metropolitan cities in China. A standardized influenza surveillance system has been operating in Shenzhen for several years. The objectives of the present study were to describe the epidemiology of influenza in Shenzhen and to assess the impact of pandemic H1N1 on influenza activity. An average rate of 71 cases of influenza-like illness (ILI)/1000 consultations was reported, which was greater than the rate in the preceding 3 years. Laboratory surveillance showed that the annual proportion of specimens positive for influenza was 25·4% in 2009, representing a significant increase over the proportions of 5·4%, 11·6% and 12·2% in 2006, 2007 and 2008, respectively. A total of 414 ILI outbreaks were reported in 2009, which was a marked increase compared to the previous 3 years. Influenza activity reached a record high in Shenzhen in 2009. Seasonal A/H3N2 was the dominant strain during the summer and was gradually replaced by pandemic H1N1. A semi-annual cycle for influenza circulation began to appear due to the emergence of pandemic H1N1.

The timely identification of the high-risk groups for nosocomial infections (NIs) plays a vital role in its prevention and control. Therefore, it is crucial to investigate whether the ABO blood group is a risk factor for NI. In this study, patients with NI and non-infectionwere matched by the propensity score matching method and a logistic regression model was used to analyse the matched datasets. The study found that patients with the B&AB blood group were susceptible to Escherichia coli (OR = 1.783, p = 0.039); the A blood group were susceptible to Staphylococcus aureus (OR = 2.539, p = 0.019) and Pseudomonas aeruginosa (OR = 5.724, p = 0.003); the A&AB blood group were susceptible to Pseudomonas aeruginosa (OR = 4.061, p = 0.008); the AB blood group were vulnerable to urinary tract infection (OR = 13.672, p = 0.019); the B blood group were susceptible to skin and soft tissue infection (OR = 2.418, p = 0.016); and the B&AB blood group were vulnerable to deep incision infection (OR = 4.243, p = 0.043). Summarily, the patient’s blood group is vital for identifying high-risk groups for NIs and developing targeted prevention and control measures for NIs.

After the 2003 SARS epidemic, China started constructing a primary-level emergency response system and focused on strengthening and implementation of policies, resource allocation. After 17 years of restructuring, China's primary-level response capabilities towards public health emergencies have greatly improved. During the coronavirus disease 2019 epidemic, primary-level administrative and medical personnel, social organisations, volunteers, etc. have played a significant role in providing professional services utilising the primary-level emergency response system of 17 years. However, China's organisations did not learn their lesson from the SARS epidemic, and certain problems are exposed in the system. By analysing the experience and shortcomings of China's disease prevention and control system at the primary level, we can focus on the development of disease control systems for major epidemics in the future.

1. There were 90 patients at the Eastern Hospital, who, during the years 1897, 1898, 1899, 1904, 1905 and 1906, were injected with horseserum for a second attack or relapse of diphtheria, who had been treated with horse-serum at the first attack.

2. Of these 9 had an “immediate reaction,” 22 an “accelerated reaction,” and 8 had both, 39 in all, or 43·4 per cent.

3. The “immediate reaction” showed itself a few minutes to six hours after the first injection for the second attack.

4. The shortest interval between the first injection at the primary attack and the occurrence of an “immediate reaction” after a reinjection for a second attack was 35 days; the longest was 363 days.

5. The ”accelerated reaction” showed itself 19 hours to five days after the first injection for the second attack.

6. The shortest interval between the first injection at the primary attack and the occurrence of an “accelerated reaction” after a reinjection for a second attack was 25 days; the longest was 1511 days. In each of these cases the reaction occurred the day after the reinjection.

7. In seven of the cases of “immediate reaction” the symptoms were severe. In all save one of those of “accelerated reaction” they were mild or moderate.

8. In 24 of the cases there was a normal serum-reaction after the reinjection for the second attack; but even this occurred in most cases slightly earlier than is usual after injection at a primary attack.

9. So far as the figures go they show:

(a) that when a patient has had a serum-reaction at the primary attack, he is more likely to have an abnormal reaction after injection at the second attack;

(b) that the greater the volume of serum given in the primary attack, the more likely is an abnormal reaction to occur after serum at the second attack;

(c) and that consequently an abnormal reaction is most likely to occur after serum at a second attack when the patient has had a large volume of serum followed by a reaction at the first attack.

There are, however, indications that the volume of serum given at the primary attack may have different effects as regards the determination of an “immediate” or an “accelerated reaction,” according to its amount.

Discrete, Feulgen-positive granules, attached to the periphery of bacterial spores, were described by Pietschmann & Rippel (1931), who considered them to be residual cytoplasmic structures; by Stille (1937), who was apparently in doubt as to their nature; and by others, including Robinow (1945), who at first described them as the natural appearance of the spore nucleus. Delaporte (1950) figured the spore nucleus as a less discrete, crescentic body lying against one side of the spore, and in a later study Robinow (1951) accepted this view, and presented evidence to prove that the appearance of the discrete body was an artefact, caused by the hydrolysis with HC1 which was employed in staining. Robinow, in this later study, employed nitric acid instead of hydrochloric acid, and claimed that it gave a truer picture. Both Delaporte and Robinow observed a central, stainable body, which they considered to be cytoplasmic.