Although immediate notification of a case is crucial for epidemic control, clinicians may delay notification due to uncertainties in diagnosis, reflecting a trade-off between timeliness and the accuracy of surveillance. We assessed this trade-off for four epidemic-prone diseases that require immediate notification of suspected cases: shigellosis, typhoid fever, paratyphoid fever, and cholera in the Korean National Notifiable Disease Surveillance System data for 2001–2007. Timeliness was measured as the time to registration (TR), being the time interval from symptom onset to notification by the clinician to the local public health centre. We introduced a new index, ‘time-accuracy trade-off ratio’ to indicate time saved by clinical vs. laboratory-based notifications. Clinical notifications comprised 34·4% of total notifications, and these showed a shorter median TR than laboratory-based notifications (1–4 days). The trade-off ratio was greatest for shigellosis (3·3 days), and smallest for typhoid fever (0·6 days). A higher trade-off ratio provides stronger evidence for clinical notification without waiting for laboratory confirmation.

This study aimed to describe the diurnal shedding dynamics of Escherichia coli O157 in cattle managed on pasture. The purpose was to identify the value of a single measurement for predicting the shedding status on subsequent days. Over a 14-day period, 24 beef cows with known E. coli O157 shedding status were sampled twice daily or daily (21 sampling points) and E. coli O157 was enumerated from faeces. No association between shedding status of individual animals within a 7-h period was identified (odds ratio 1·5, P = 0·08). Short-interval sampling demonstrated substantial diurnal volatility in shedding of E. coli O157 that is not evident in studies based on long-interval (>7 days) sampling. The findings contribute to and support previous findings on the question why it has been difficult to achieve progress in understanding the epidemiology of E. coli O157 infection in cattle.

The experiments here recorded are not sufficiently numerous to justify any decided opinions as to the value of the tests with these various substances in differentiating certain bacilli which very closely resemble the diphtheria bacillus. They show, however, that most of the diphtheria-like organisms tested produce less acid than the diphtheria bacillus. Hofmann's bacillus and a diphtheria-like bacillus from the normal ear can be easily differentiated, since they from no acid. Any bacillus which acts on mannite or saccharose could also be easily differentiated.

Corynebacterium jeikeium causes septicaemia in neutropenic patients usually after colonizing intravenous lines. This paper reports the results of immunoblotting sera from 14 patients with a C. jeikeium septicaemia. Recovery from the septicaemia was associated with production of both IgM and IgG against antigenic bands of 50, 52 and 110 kDa. Antibody against the 110 kDa band was present in controls but the antibody against the 50 and 52 kDa was specific to those patients who had on-going or previous C. jeikeium infection. A case of C. jeikeium endocarditis is also presented and here recovery was associated with seroconversion to the 50 and 52 kDa bands.

Middle East respiratory syndrome coronavirus (MERS-CoV) remains a notable disease and poses a significant threat to global public health. The Arabian Peninsula is considered a major global epicentre for the disease and the virus has crossed regional and continental boundaries since 2012. In this study, we focused on exploring the temporal dynamics of MERS-CoV in human populations in the Arabian Peninsula between 2012 and 2017, using publicly available data on case counts and combining two analytical methods. Disease progression was assessed by quantifying the time-dependent reproductive number (TD-Rs), while case series temporal pattern was modelled using the AutoRegressive Integrated Moving Average (ARIMA). We accounted for geographical variability between three major affected regions in Saudi Arabia including Eastern Province, Riyadh and Makkah. In Saudi Arabia, the epidemic size was large with TD-Rs >1, indicating significant spread until 2017. In both Makkah and Riyadh regions, the epidemic progression reached its peak in April 2014 (TD-Rs > 7), during the highest incidence period of MERS-CoV cases. In Eastern Province, one unique super-spreading event (TD-R > 10) was identified in May 2013, which comprised of the most notable cases of human-to-human transmission. Best-fitting ARIMA model inferred statistically significant biannual seasonality in Riyadh region, a region characterised by heavy seasonal camel-related activities. However, no statistical evidence of seasonality was identified in Eastern Province and Makkah. Instead, both areas were marked by an endemic pattern of cases with sporadic outbreaks. Our study suggested new insights into the epidemiology of the virus, including inferences about epidemic progression and evidence for seasonality. Despite the inherent limitations of the available data, our conclusions provide further guidance to currently implement risk-based surveillance in high-risk populations and, subsequently, improve related interventions strategies against the epidemic at country and regional levels.

The findings of clinical nutrition surveys of 3351 children aged 8–15 years and of 3326 adults, of both sexes, were analysed statistically to ascertain the relationship existing between nutritional grade (good, fair and poor) and the incidence of a variety of clinical signs (pityriasis, folliculosis, gingivitis, etc.) observed at the time of the medical examination but not taken into account in grading the subjects according to their state of nutrition.

The analysis showed negligible correlations between the clinical signs singly and collectively and the clinician's nutritional grade. Further, when we compared the incidence of each clinical sign and the nutritional state as a combination of all the clinical signs (i.e. the general nutritional factor), there was negligible agreement as shown by the low general factor saturation coefficients, thus suggesting that the presence of these signs is not a dependable expression of the general state of nutrition.

A special clinical survey of 1067 children was carried out to provide data which would throw light on the relationship between the criteria (posture, muscular development, etc.) which the clinician consciously takes into account but does not as a rule record in deciding the nutritional grade, and the nutritional grade itself. The grading criteria in the survey were separately assessed and recorded and so also were the usual clinical signs (pityriasis, gingivitis, etc.).

For the grading criteria there was a high degree of correlation between each one and the nutritional grade and also between each one and the combined pool of all the criteria. The clinical signs showed only negligible correlations with each other, with the nutritional grade or with any of the grading criteria.

It would seem, therefore, that nutritional assessment as at present understood is determined mainly by the value placed on the grading criteria (posture, muscular development, etc.), and to a negligible extent or not at all by the presence or absence of clinical signs (pityriasis, folliculosis, gingivitis, etc.).

An investigation is described which shows the type of skin reaction which may be expected from the intracutaneous injection of 0·1 c.c. normal horse serum in the normal and sensitized human subject. 150 normal individuals and 100 who had received previous serum injection were skin-tested. Of the normal subjects 30% showed a reaction of skin sensitivity, while 88% of the sensitized group gave a sensitive response, the reactions in the latter being more intense and of longer duration than those of the normal group. It is also shown that general skin sensitivity, demonstrated by a sensitive skin reaction in the opposite arm 2 weeks later, can be produced by intracutaneous injection of 0·2 c.c. of normal horse serum.

The value of specific skin tests in the prognosis of serum reaction is considered and a series of tests on 200 diphtheria cases is recorded. Since it has been shown that diphtheria has no appreciable effect in diminishing skin sensitivity (Westwater, 1935) the present series probably gives an accurate estimation of serum skin sensitivity even in the presence of acute diphtheritic infection.

The incidence of serum reaction was found to be only 6% higher in those cases which gave a sensitive skin reaction to horse serum prior to therapeutic serum injection than in those showing a normal response. It is therefore concluded that the demonstration of skin sensitivity is of no value in predicting the subsequent development of general serum reaction, and skin testing with horse serum, although it may demonstrate the presence of specific antibodies in the skin cells, is not an index of general sensitivity, which depends upon individual reactivity and power to produce antibodies following injection of foreign serum.

This study determined farm management factors associated with long-duration bovine tuberculosis (bTB) breakdowns disclosed in the period 23 May 2016 to 21 May 2018; a study area not previously subject to investigation in Northern Ireland. A farm-level epidemiological investigation (n = 2935) was completed when one or more Single Intradermal Comparative Cervical Test (SICCT) reactors or when one or more confirmed (positive histological and/or bacteriological result) lesion at routine slaughter were disclosed. A case-control study design was used to construct an explanatory set of management factors associated with long-duration bTB herd breakdowns; with a case (n = 191) defined as an investigation into a breakdown of 365 days or longer. Purchase of infected animal(s) had the strongest association as the most likely source of infection for long-duration bTB herd breakdowns followed by badgers and then cattle-to-cattle contiguous herd spread. However, 73.5% (95% CI 61.1–85.9%) of the herd type contributing to the purchase of infection source were defined as beef fattening herds. This result demonstrates two subpopulations of prolonged bTB breakdowns, the first being beef fattening herds with main source continuous purchase of infected animals and a second group of primary production herds (dairy, beef cows and mixed) with risk from multiple sources.

A series of simulation experiments was conducted to determine how estimates of the latent and infectious periods, number of neighbours (contacts) and population size impact on the predicted magnitude and distribution of foot-and-mouth disease (FMD) outbreaks in white-tailed deer in southern Texas. Outbreaks were simulated using a previously developed and applied susceptible–latent–infected–recovered geographic automata model. There were substantial differences in the estimated predicted number of deer and locations infected, based on the model parameters used (3779–119 879 deer infected and 227–6526 locations affected). There were also substantial differences in the spatial risk of infection based on the model parameters used. The predicted spread of FMD was found to be most sensitive to the assumed latent period and the assumed number of contacts. How these parameters are estimated is likely to be critical in studies on the impact of FMD spread in situations in which wildlife reservoirs might potentially exist.

1. From the Municipal abattoir, specimens of liver, spleen, lymph node, surface meat, bile and faeces from a sheep and a bovine, were examined fortnightly for 14 months for the presence of possible pathogenic bacteria. The results suggest that slaughtering procedures are satisfactory.

2. Offal, consisting mainly of tripe and intestine, is eaten in large quantities by the Bantu population and is both nutritious and economical. The high incidence of salmonella isolations in the tripe (48%) and intestines (29%), and faecal E. coli and Cl. welchii, show that this commodity is distributed in an inadequately cleansed condition.

3. Faecal E. coli was isolated from 86% of samples of sour milk collected from street pedlars.

4. Dog faeces collected from the township pavements yielded 21% salmonellas, and faeces from fowls sold live by shopkeepers 14%.

5. From the offal specimens, S. typhimurium (23%) and S. london (18%) were the salmonella types most frequently isolated. S. dublin was isolated on only one occasion.

6. Throughout the survey no shigellas were isolated.

7. The significance of the Cl. welchii, coagulase positive Staphylococcus aureus and B. cereus isolations from the various specimens tested is not known.

8. It is emphasized that although there is a definite need for improved treatment of the offal before distribution to the consumer, the resulting increase in cost must not be such as to deprive the population of this important source of protein.

We wish to thank the Director of this Institute, Professor J. H. S. Gear, for permission to publish this paper, Dr P. J. Meara, Director of the City of Johannesburg Abattoir and Livestock Market Department for facilities granted, and Mr C. J. Franklin for collecting all the abattoir specimens. Our thanks are also due to Dr A. Smith, Medical Officer of Health, and Dr I. H. F. Spencer of the Johannesburg City Health Department for help and advice; to Mr A. J. MacG. Bryce for collecting all the specimens from the Soweto township; to Mrs Leonie Jonk for typing the salmonella organisms and Mr R. G. Robinson for investigating the micro-organisms' sensitivity to antibiotics.

All observers agree that Musca domestica comprises over 90 percent. of the flies found in houses; my own observations show 97 percent. M. domestica is most easily distinguished by the venation of its wings, the fourth vein being bent up at an angle, and by the four longitudinal black stripes on the thorax. It is thus easily distinguished from Homolomyia canicularis, another somewhat smaller fly which frequents houses and forms the bulk of the remaining 3—10 per cent.

Seasonal influenza virus epidemics have a major impact on healthcare systems. Data on population susceptibility to emerging influenza virus strains during the interepidemic period can guide planning for resource allocation of an upcoming influenza season. This study sought to assess the population susceptibility to representative emerging influenza virus strains collected during the interepidemic period. The microneutralisation antibody titers (MN titers) of a human serum panel against representative emerging influenza strains collected during the interepidemic period before the 2018/2019 winter influenza season (H1N1-inter and H3N2-inter) were compared with those against influenza strains representative of previous epidemics (H1N1-pre and H3N2-pre). A multifaceted approach, incorporating both genetic and antigenic data, was used in selecting these representative influenza virus strains for the MN assay. A significantly higher proportion of individuals had a ⩾four-fold reduction in MN titers between H1N1-inter and H1N1-pre than that between H3N2-inter and H3N2-pre (28.5% (127/445) vs. 4.9% (22/445), P < 0.001). The geometric mean titer (GMT) of H1N1-inter was significantly lower than that of H1N1-pre (381 (95% CI 339–428) vs. 713 (95% CI 641–792), P < 0.001), while there was no significant difference in the GMT between H3N2-inter and H3N2-pre. Since A(H1N1) predominated the 2018–2019 winter influenza epidemic, our results corroborated the epidemic subtype.

The work on the meningococcus described in this report was begun in 1916 in connection with the measures instituted by Lieut.-Colonel M. H. Gordon, C.M.G., for the preventive control of cerebro-spinal fever in the Army.

Three tubular electrostatic precipitators are described for the assay of bacterial and bacteriophage aerosols. Particles can be sampled directly on agar or on agar-impregnated paper in a wide range of aerosol concentrations, or sampled into a fluid for the assay of airborne micro-organisms. Rapid consecutive sampling is possible with the samplers and a collection efficiency approaching 100% is readily obtained. Their sampling efficiency is compared with that of the slit sampler and the liquid impinger.

Stability of aminoglycoside resistance has been investigated in 20 strains of Staphylococcus aureus resistant to gentamicin (16 strains were also resistant to methicillin). In view of previous reports that incubation at elevated temperatures can hasten the loss of unstable antibiotic resistance, we passaged strains daily in a liquid medium for 24 days at 43 °C. The nine strains which were resistant to neomycin kept their aminoglycoside resistance virtually intact, whereas most of the other 11 strains (sensitive to neomycin) lost almost all their resistance to gentamicin and kanamycin after 5 days. It thus appears that the stability of aminoglycoside resistances in Staph. aureus is closely linked to the resistance of the strains to neomycin. This finding has important possible consequences in terms of the advisability of the clinical usage of preparations containing neomycin or framycetin for topical application and bowel sterilization.

1. A further improvement in the modified McLeod's medium (Gaze, 1933) has resulted from the substitution of saccharose for glucose with the addition of Andrade's indicator.

2. Of the total positive swabs, the saccharose-containing medium detected about 22 per cent which were negative on Loeffler's medium, whereas it failed to detect only 0·36 per cent.

3. On this medium colonies typical of the gravis, intermediate and mitis types are formed and can be easily differentiated with the aid of a hand lens. It is also invaluable for the isolation of pure cultures.

A study of diphtheria in Iran was undertaken during the summer of 1969. Diphtheria was found to be more common among the younger people and to reach its peak 3 months after the start of the school term, during the coldest period of the year. Owing to the liberal use of antibiotics a number of modified clinical cases were observed. Of the strains isolated, 89·7% were gravis, 1·3% intermedius and 9 % mitis. Phage typing of these strains showed that the mitis and intermedius strains could only be typed by adapted phages and the majority of gravis strains were phage type XIV, which is the epidemic type seen in other countries.

As the mass immunization campaign reduces the incidence of diphtheria in Iran, the epidemiological pattern of the disease will change as seen in the U.K. and U.S.A. It is, therefore, suggested that in the future further studies of diphtheria in Iran be undertaken in order to provide us with information about the changing epidemiological pattern of the disease.

Influenza vaccination has been shown to be the most effective preventive strategy to reduce influenza-related morbidity and mortality in high-risk groups. Despite healthcare personnel (HCP) being considered part of such high-risk groups, their vaccination coverage is low in Europe. In January 2012, we distributed an 18-question survey regarding influenza vaccination to HCP at Gregorio Marañon Paediatric Hospital, in Madrid, Spain. After we documented that only ~30% of HCP were vaccinated an educational programme was implemented in October 2012 before the next influenza season. In January 2013, the same survey delivered again to all HCP documented a significant increase in vaccination rates (from 30% to 40%, P = 0·007) mainly among physicians and for patients' protection. In summary we found that a simple and inexpensive educational programme significantly improved the uptake of influenza vaccination in HCP in our centre. Nevertheless, vaccination rates remained low, and broader and updated campaigns are needed to overcome perception barriers.

Changes in seroprevalence of cysticercosis diagnosed in Chandigarh, India between 1998 and 2014 were investigated by extraction and analysis of data from records held at the Postgraduate Institute of Medical Education and Research in Chandigarh. Among the total number of samples for which cysticercosis had been suspected during this period (N = 9650), 1716 (17·8%) were seropositive. Adults were more likely to be seropositive than children, and women were more likely to be seropositive than men. In addition to there being fewer patients with suspicion of cysticercosis over the data analysis period, the proportion of patients seropositive also reduced significantly. Despite these reductions, which are probably associated with improved infrastructure and sanitation within Chandigarh, and despite meat consumption being relatively rare in this area, the extent of cysticercosis in this population remains problematic. Further efforts should be made to reduce transmission of this infection, with particular emphasis on women. Such efforts should follow the One Health concept, and involve medical efforts (including diagnosis and treatment of T. solium tapeworm carriers), veterinary efforts directed towards meat inspection and prevention of infection of pigs, and environmental health and sanitation engineers (to minimize environmental contamination with human waste).

Little is known about the main routes of human cytomegalovirus (HCMV) transmission in young adult populations. This study investigated risk factors for HCMV transmission in young adults attending university over a 3-year period. Blood samples were tested for HCMV specific viral capsid antigen IgG by enzyme immunoassay. Being born in a developing country and having lived in Africa were associated with HCMV seropositivity at study onset. No risk factors were associated with HCMV seroconversion over the 3-year follow-up. In contrast to previous reports, sexual activity was not associated with HCMV seroprevalence or seroconversion.