Highly pathogenic avian influenza (HPAI) subtype H5N1 remains a public health threat as long as it circulates in wild and domestic birds. Information on the transmissibility of H5N1 HPAI from wild birds is needed for evidence-based public health advice. We investigated if transmission of H5N1 HPAI had taken place in people that had unprotected contact with infected wild mute swans during an incident at the Abbotsbury Swannery in Dorset, England. Thirteen people who had been exposed to infected swans were contacted and actively followed up for symptoms. Serology was taken after 30 days. We did not find evidence of transmission of H5N1 HPAI to humans during the incident. The incident provided a rare opportunity to study the transmissibility of the virus from wild birds to humans.

This systematic review and meta-analysis aims to estimate the prevalence of coronavirus disease 2019 (COVID-19) vaccine hesitancy in Turkey, which can aid future health policies and strategies. A comprehensive search was conducted on various databases using keywords related to COVID-19 vaccine hesitancy in Turkey. Quality assessment was performed using Joanna Briggs Institute (JBI) checklist for prevalence studies. Data extraction was conducted. The random effect model (DerSimonian and Laird method) was used in pooled prevalence data analysis (95% confidence interval [CI]). A total of 1,072 articles were identified. After removing duplicates and excluding articles, 61 articles remained for bias assessment. Among these, 19 articles with low risk of bias were included in the review and meta-analysis. Total population included in the analysis was 15,164, vaccine hesitancy was 30.5% (95% Cl: 24.3–36.8%). Prevalence of the vaccine hesitancy was found to be 39.8% (95% Cl: 31.4–48.2%) in studies conducted before the initiation of vaccination, while in studies conducted after the commencement of vaccination, hesitancy was 20.4% (95% Cl: 12.9–28%). We suggest conducting high-quality studies in different populations to understand the level of vaccine hesitancy, as many of the previous studies have mainly focused on healthcare workers and students, and rest were community-based studies, which have generally shown high bias. Also, we suggest that early vaccination can reduce vaccine hesitancy.

Leptospirosis is a zoonotic disease that the pathogen can be transmitted to humans through the excretions of infected animals. In the Republic of Korea, the Livestock Manure Control Act was enforced in September 2007 to improve underground water hygiene. The objective of this study was to evaluate the impact of Livestock Manure Control Policy on the incidence and the trend of human leptospirosis. An interrupted time series analysis using the monthly incidence of leptospirosis was conducted based on data derived from the Korean National Surveillance System between January 1999 and January 2015. We used a Spearman correlation method to compare the level of leptospirosis incidence decrease between the metropolitan cities and rural provinces. The annual incidence of leptospirosis in South Korea decreased by 33% after policy enforcement of the policy. A significant change in the slope of human leptospirosis cases was observed after the policy enforcement (β = −0·09, P < 0·001). Moreover, we detected a clear association between the size of the rice paddy fields and the decrease in leptospirosis incidence in provinces (r = 0·817, P = 0·01). This study shows that the Livestock Manure Control Policy had significantly reduced human leptospirosis incidence in the Republic of Korea, in particular, in rural regions.

Scrapie is a fatal neurological disease of sheep which is endemic in the United Kingdom. It is one of the family of transmissible spongiform encephalopathies (TSEs) that includes BSE. In this paper, we developed a micro-simulation model for scrapie in the UK sheep population, incorporating the genetic and structural diversity of the population and infectious contact between flocks through trading. The simulation was fitted to epidemiological data from a range of sources. We found a detection/reporting probability of 16% (95% CI 12–17) for animals dying of scrapie. Prevalence of infected animals in the population was about 0·15%. Infected individuals were found in 9% of flocks overall, rising to 60% in Shetland and 75% in Swaledale flocks. Mean values of R0 for flocks varied with breed from 2·43 (Shetland) to 0·21 (Suffolk). We also examined the possible long-term persistence of scrapie in the UK flock in the absence of any intervention.

Societal and technological changes render traditional study designs less feasible for investigation of outbreaks. We compared results obtained from case-case and case-control designs during the investigation of a Salmonella Enteritidis PT14b (SE14b) outbreak in Britain to provide support for validation of this approach. Exposures of cases were compared to concurrent non-Enteritidis Salmonella cases and population controls recruited through systematic digit phone dialling. Infection with SE14b was associated with eating in oriental restaurants [odds ratio (OR) 35·8, 95% confidence interval (CI) 4·4–290·9] and consuming eggs away from home (OR 13·8, 95% CI 1·5–124·5) in the case-case study and was confirmed through a concurrent case-control study with similar effect estimates and microbiological findings of SE14b in eggs from a specific chicken flock on a Spanish farm. We found that the case-case design was feasible, quick and inexpensive, potentially minimized recall bias and made use of already interviewed cases with subtyping results. This approach has potential for use in future investigations.

Streptococcus pneumoniae (Spn) is a leading cause of community-acquired pneumonia (CAP), yet existing diagnostic tools remain inadequate. We aimed to evaluate laboratory and radiological methods for detecting pneumococcal aetiology in CAP patients and to estimate Spn prevalence in this group. All-aged patients hospitalized with clinically defined CAP in northern Togo were enrolled during 2010–2013. Latent class analysis pooled results of semi-automated blood culture (SABC), whole blood lytA real-time polymerase chain reaction (rt-PCR), serum C-reactive protein (CRP), and chest radiography (CXR) and categorized patients as likely pneumococcal or non-pneumococcal CAP. We enrolled 1684 patients; 1501 had results for all tests. CXR, SABC, lytA rt-PCR and CRP >71·2 mg/l had sensitivities of 94% [95% confidence interval (CI) 87–100], 13% (95% CI 10–16), 17% (95% CI 14–21) and 78% (95% CI 75–80), and specificities of 88% (95% CI 84–93), 100% (95% CI 99–100), 97% (95% CI 96–99) and 77% (95% CI 75–79), respectively. Pneumococcal attributable proportion was 34% (95% CI 32–37), increasing with age and in men. We estimated that Spn caused one third of CAP. Whole blood lytA rt-PCR was more sensitive than SABC; both had low sensitivity and high specificity. Conversely CXR was highly sensitive and reasonably specific; it could be a useful tool for epidemiological studies aiming to define Spn pneumonia incidence across all ages.

Data regarding humoral immunity against HPV infection are scarce. Most analyses focus on the identification of viruses on mucous membranes and primarily refer to women of reproductive age. The aim of this work was to estimate the seroprevalence of antibodies against HPV serotypes 6, 11, 16 and 18 among unvaccinated boys living in Mexico City. A cross-sectional study of 257 male students from 48 public primary schools in Mexico City, whose ages fluctuated between 9 and 14 years, was carried out. Immunological status was assessed by applying the competitive Luminex Immunoassay of HPV (cLIA). Among the study population, we initially found that 38.52% (n = 99) of the children tested positive against one or more of the HPV 6, 11, 16 and/or 18 serotypes. The most commonly found serotype was isolated HPV 18 or in combination with other serotypes (22% and 31%, respectively), followed by HPV 6 with frequencies of 4.7% and 11%, respectively; however, lower frequencies were estimated for HPV 16 (2%; 6%) and isolated HPV 11, 4%. If a second set of cut-off points for seropositivity is applied, the overall prevalence for any serotype is reduced to 15.2%. As it appears that a significant sector of the study population has had basal contact with an HPV serotype, we recommend considering the possibility of vaccination against HPV at earlier ages.

It is well known that fresh sewage always contains large numbers of the common colon bacillus. It is also true that when a water source is polluted with any considerable quantity of fresh sewage it is usually possible to demonstrate the presence of the colon bacillus in such water. Upon these familiar facts have been based various methods and conclusions of greater or less value to public hygiene.

This paper uses a robust method of spatial epidemiological analysis to assess the spatial growth rate of multiple lineages of SARS-CoV-2 in the local authority areas of England, September 2020–December 2021. Using the genomic surveillance records of the COVID-19 Genomics UK (COG-UK) Consortium, the analysis identifies a substantial (7.6-fold) difference in the average rate of spatial growth of 37 sample lineages, from the slowest (Delta AY.4.3) to the fastest (Omicron BA.1). Spatial growth of the Omicron (B.1.1.529 and BA) variant was found to be 2.81× faster than the Delta (B.1.617.2 and AY) variant and 3.76× faster than the Alpha (B.1.1.7 and Q) variant. In addition to AY.4.2 (a designated variant under investigation, VUI-21OCT-01), three Delta sublineages (AY.43, AY.98 and AY.120) were found to display a statistically faster rate of spatial growth than the parent lineage and would seem to merit further investigation. We suggest that the monitoring of spatial growth rates is a potentially valuable adjunct to outbreak response procedures for emerging SARS-CoV-2 variants in a defined population.

The recognition of small-flaking, granular or “O” agglutination and the conditions under which it occurs have lately assumed importance in the diagnosis and prognosis of enteric infections.

To quantify the risk of human immunodeficiency virus (HIV) infection in children with tuberculosis (TB) a hospital-based, 1-year prospective, case-control study was performed in Addis Ababa, Ethiopia. Children with TB were compared to a control group of children admitted for elective surgery. The control group was also compared to a recent census of the background population. The crude odds ratio for HIV infection was 8·6 (95% CI 2·2–73). After adjustment for possible confounders in a multivariate regression model, the odds ratio for HIV infection in children with TB was found to be 12·7 (95% CI 2·9–55). Of several independent determinants of TB assessed in the study, this association was the strongest. Until HIV transmission has reached its peak, an increasing burden of dual infection among Ethiopian children is to be expected.

An investigation of the blood of 28 patients suffering from plague has been made, involving the examination of 74 specimens. The B. pestis was not found in the blood of five patients whose illness ended in recovery; nor was it found in seven of the fatal cases. The salient facts ascertained from an analysis of the remaining 16 fatal septicaemic cases may be recapitulated thus:

(1) Microscopical examination of the blood cannot be regarded as a trustworthy criterion of the degree septicaemia.

(2) A severe septicaemia may be present at a comparatively early stage of the disease and for a considerable number of hours before death.

(3) The septicaemia may be of an irregular or fluctuating type.

Group A Streptococcus (GAS) are globally distributed bacterial pathogens. We examined the emm genotypes, which are important indicators of virulence, of 349 clinical GAS isolates collected using two surveillance systems, i.e. Invasive Bacterial Infection Surveillance (IBIS) from 2010 to 2011 (234 isolates) and routine surveillance of clinically isolated bacteria from various hospitals during 1996–2011 (115 isolates) in Thailand. The major emm genotypes in IBIS samples were emm44 (12·0%), emm104 (6·8%), emm22 (5·6%), and emm81 (5·6%), whereas only one isolate (0·4%) had the emm1 genotype, which is significantly more common in invasive cases in the Western world. In samples collected during routine surveillance, emm238 (10·4%), emm44 (8·7%), and emm165 (7·0%) were dominant. The major superantigen gene profiles were similar between the groups, and 30·1% of isolates did not possess the phage-encoded superantigens (speA, speC, speH, speI, speK, speL, speM, ssa). Although most isolates exhibited limited gene profiles, emm44 isolates had highly variable gene profiles (15 patterns). We conclude that emm44 is the predominant GAS genotype in Thailand, and isolates varied in superantigen gene profiles.

Two strains of rubella virus multiplied in organ cultures of human embryonic trachea, nasal epithelium, pharynx, larynx, skin and brain derived from foetuses aged 15–28 weeks. Growth curve experiments conducted on cultures of nasal epithelium and trachea showed that virus appeared in the culture fluid 72 hr. after inoculation and thereafter rose to titres varying from 10 to 103·7TCD50/ml. These titres persisted for periods up to 34 days after inoculation. Intracelmlar and organ culture fluid virus titres were shown to be similar in specimens tested in both the early and late stages of the growth curve. No degenerative changes or loss of ciliary activity was observed in these cultures.

We are grateful to Dr H. E. M. Kay and his staff (Royal Marsden Hospital), for the supply of human embryos; Dr D. A. J. Tyrrell (M.R.C. Common Cold Research Unit, Salisbury) for his encouragement, and Miss G. E. Fairbairn (St Thomas’s Hospital) for the histological preparations.

This research was supported by a grant from the Medical Research Council.

1. In all species of animals tested—rabbit, guinea-pig, chicken and horse—normal agglutinins for B. agglutinabilis U2 are far more abundant than those for B. proteus X 19.

2. Human serum reacts in the same manner. Wassermann negative sera have been employed as normal sera. Their reaction in Weltmann's globulin test was also negative.

3. Wassermann positive sera from cases of syphilis and sera from lepers give distinctly higher agglutination reactions with U2 than normal human sera. On X 19, however, those sera do not exercise any increased agglutinating action.

4. Similar though somewhat stronger reactions with U2 are obtained with typhus sera. However, this reaction is far from being uniformly positive in typhus, while this is the case with the X 19 reaction.

5. The discordance between these results and those published by Wilson and by Fletcher, Lesslar and Lewthwaite is due to the failure by these workers to employ controls of suitable type.

6. In syphilis and leprous sera high titres of agglutination with U2 coincide with globulin-increase as indicated by the Weltmann reaction.

7. The summation effect of the non-specific agglutination by gelatine and the action of specific immune agglutinins, described by Weil, is again demonstrated.

8. The combined action of an abundance of preformed normal agglutinins and of augmented serum colloids is suggested as one of the factors involved in increased heterologous agglutination (polyagglutination).

9. B. agglutinabilis U2 is a typical representative of “polyagglutinable” organisms; B. proteus X 19, however, is not liable to the action of “polyagglutinating” sera.

1. A male guinea-pig which has received a single injection of a mixture of diphtheria toxin-antitoxin causing severe constitutional disturbance, may beget offspring of slightly lower resistance than normal to diphtheria toxin

2. This effect is generally restricted to young born within twelve months after the injection of the father, being rarely noticed in the young of later litters.

3. An increased susceptibility to diphtheria toxin is likewise observed in the offspring of male or female guinea-pigs which have received a large dose of horse serum. The greater susceptibility to diphtheria toxin of the young of male guinea-pigs which have been treated with toxin-antitoxin may therefore be non-specific in character.

4. The injection of diphtheria toxin-antitoxin mixtures into guinea-pigs whether male or female reduces their rate of breeding and lowers the vitality of their young.

5. These effects are most pronounced when the toxin-antitoxin mixture produces severe constitutional disturbance or contains excess of horse serum

It is necessary to assess surveillance systems for infectious animal diseases to ensure they meet their objectives and provide high-quality health information. Each system is generally dedicated to one disease and often comprises various components. In many animal industries, several surveillance systems are implemented separately even if they are based on similar components. This lack of synergy may prevent optimal surveillance. The purpose of this study was to assess several surveillance systems within the same industry using the semi-quantitative OASIS method and to compare the results of the assessments in order to propose improvements, including future synergies. We have focused on the surveillance of three major equine diseases in France. We have identified the mutual and specific strengths and weaknesses of each surveillance system. Furthermore, the comparative assessment has highlighted many possible synergies that could improve the effectiveness and efficiency of surveillance as a whole, including the implementation of new joint tools or the pooling of existing teams, tools or skills. Our approach is an original application of the OASIS method, which requires minimal financial resources and is not very time-consuming. Such a comparative evaluation could conceivably be applied to other surveillance systems, other industries and other countries. This approach would be especially relevant to enhance the efficiency of surveillance activities when resources are limited.

Following the capture of Jerusalem and in the early months of 1918 Capt. C. M. Craig, R.A.M.C., obtained a culture of a proteus-like bacillus from the civil Jewish bacteriologist of that city. He was informed that this organism was being extensively used by German and Austrian bacteriologists on the Eastern front for the diagnosis of Typhus Fever. After making some preliminary observations on its agglutination by the sera of typhus patients he forwarded the culture on to this laboratory for further investigation, the preliminary account of which was published by Craig and Fairley (21 Sept., 1918, Lancet, pp. 385–6).

The ultimate problem underlying many applications of the precipitin test, whether it be the determination of biological relationships, the identification of blood stains and other animal traces, or the detection of adulteration in food, is the recognition of the homologous protein (antigen) and its separation from closely allied heterologous proteins. Recognising that the antiserum is the main source of the precipitate in a precipitin reaction and having regard to the exact quantitative relations of antiserum, antigen and precipitate we have been able to arrange methods for the differentiation of proteins of closely related species and, we believe, to render more accurate the diagnosis of the source of individual proteins. To take a crucial instance, by means of an antiserum prepared with hen egg-white we have been able clearly to distinguish solutions of hen egg-white from all other avian egg-whites tested, including those of the duck, quail, partridge, pheasant and ostrich. So far as we know, Nuttall and Graham Smith alone have previously been successful in differentiating homologous and heterologous avian egg-albumens, and their methods appear to be more cumbersome than ours. Incidentally we have found that our results are not only consistent inter se but consistent also with the interpretation of the precipitin reaction which our previous observations had led us to adopt.