Patients with a lower respiratory tract infection (LRTI) might be at risk for long-term impaired health status. We assessed whether LRTI patients without Q fever are equally at risk for developing long-term symptoms compared to LRTI patients with Q fever. The study was a cross-sectional cohort design. Long-term health status information of 50 Q fever-positive and 32 Q fever-negative LRTI patients was obtained. Health status was measured by the Nijmegen Clinical Screening Instrument. The most severely affected subdomains of the Q fever-positive group were ‘general quality of life’ (40%) and ‘fatigue’ (40%). The most severely affected subdomains of the Q fever-negative group were ‘fatigue’ (64%) and ‘subjective pulmonary symptoms’ (35%). Health status did not differ significantly between Q fever-positive LRTI patients and Q fever-negative LRTI patients for all subdomains, except for ‘subjective pulmonary symptoms’ (P = 0·048).

In the summer of 1940 an outbreak of paratyphoid fever occurred in Kettering and in the districts surrounding it. The total number of cases was 222. Most of them were mild, and the period of vague symptoms before a doctor was called in was in some as long as three weeks to a month. A few cases were more severe, and one or two at the beginning showed toxic symptoms which led to a diagnosis of meningitis. There was one death. The centre of the epidemic was in Kettering, but the surrounding districts were also affected. The population of this area in peace time is about 133,000: it has been somewhat increased by the influx of evacuees. The age and sex distributions are shown in Table 1.

The incidence was greater in women and children than in adult males. Fig. 1 shows in graphic form the number of notifications week by week. In a few instances the agglutination test of the patient's serum was the only examination made but in the majority Bact, paratyphosum B was isolated either from the blood, faeces or urine. The methods used in isolating the infecting organisms will be described in a separate paper. Many of the cases which were excreting small numbers of paratyphoid bacilli for only a short period were detected only by the use of selective ‘enrichment.’ media, and the experience gained in the epidemic showed that a negative result based only on the use of a comparatively non-selective medium such as McConkey agar is of little value and may be dangerously misleading. Most of the specimens were examined at Leicester Emergency Public Health Laboratory, but a few, especially at the beginning, were sent to private laboratories.

Compared with a similar survey conducted ten years previously, a survey conducted in 1982, eleven years after the implementation of legislation forbidding the routine use of feeds containing ‘therapeutic’ antibiotics, revealed a decreased incidence of resistance to tetracyclines, furazolidone and sulphonamides in Escherichia coli strains causing generalized infections in chickens in the UK; the decrease was particularly marked in the case of tetracycline resistance, 17·9% of strains in 1982 being resistant to this antibiotic compared with 31·2% in 1972.

Giving furazolidone to groups of chickens inoculated intramuscularly with O2:K1 strains of E. coli of differing degrees of furazolidone sensitivity indicated that great care is required in the performance and interpretation of laboratory tests for sensitivity to this antibiotic. Infections caused by strains that required as little as 1·25 μg/ml of furazolidone to inhibit their multiplication in laboratory tests responded poorly to furazolidone treatment; those that were inhibited by less responded well, better than to treatment with tetrac3rcline, chloramphenicol. ampicillin or trimethoprim.

Sixteen strains of leptospires were isolated from surface water (14 in England and 2 in Italy) and were classified. They were all saprophytic, and nine of them belonged to known serovars: the others were found to represent new serovars within already known serogroups.

Salmonella senftenberg was isolated from 168 patients and staff of a general hospital whereas it was isolated from only seven other sources (four of which were unquestionably associated with the hospital) in the surrounding area during the same period. It was isolated in the hospital in 19 of the 48 months of the period. Two clear-cut episodes were recognized against a background of sporadic isolation. Four-fifths of the patients and staff excreting the organism had no symptoms. Only two are known to have been severely ill, though in some patients very ill for other reasons life may have been shortened a little.

The original source of the organism, whether from the farm or from raw materials such as meat or poultry, was not found.

Three sets of experiments were carried out on undergraduate medical students at Oxford, Cambridge and Liverpool during the years 1941–4 in order to supplement the information obtained previously (Downie et al. 1941) on the comparative antitoxin response of those given active immunization alone (Group A) and those given combined active and passive immunization (Group A+P). A summary of each of the experiments has already been given in the text, so that it is unnecessary here to do more than recapitulate briefly the main results.

1. The first experiment showed that in Group A the antitoxin response was not appreciably greater in students receiving doses of 0·3 and 0·3–0·5 ml. of A.P.T. at 4 weeks’ interval than in those receiving doses of only 0·1 and 0·3 ml. In Group A + P no difference was noticed in the antitoxin content of the serum 6–8 weeks after the second injection of A.P.T., but 10–12 weeks after the second injection there was a difference in favour of the students receiving the larger doses of A.P.T., though it was below the conventional level of statistical significance.

2. The second experiment showed that when the doses of A.P.T. were spaced by 2 instead of by 4 weeks the antitoxin response was much less in both the A and the A + P groups, though the difference was less in the latter group, particularly when the measurements were made 10–12 weeks after the second inoculation of A.P.T.

3. The third experiment showed that a dose of 5000 units of diphtheria antiserum given at the time of the first injection of A.P.T. inhibited antitoxin production to a greater extent than a dose of 400–500 units, though the difference was much less when the measurements were made at 12 weeks after the second inoculation than at 4 weeks.

A compilation of the results obtained during 1940–2 in groups of students receiving active and those receiving active plus passive immunization shows that the antitoxin production in the first group (Group A) was much higher than in the second group (Group A + P) 6–8 weeks after the second injection of A.P.T., but that 10–12 weeks after the second inoculation the difference, though still significant, was considerably less. The final Schick-test results at 10–12 weeks gave a Schick-conversion rate of 98.0% in Group A and of 90.9% in Group A + P.

A review of the results obtained during the years 1939–44 on about 450 students at Oxford, Sheffield and Liverpool leads to the conclusion that the effect of giving diphtheria antiserum at the time of the first injection of A.P.T. is to cause a delay and some degree of inhibition in the antitoxin response of the subject. The larger the amount of antiserum given, the greater is this effect. With a dose of 500 units, though the delay in antitoxin formation is very obvious 4 weeks after the second injection of A.P.T., the final degree of immunity attained, as judged by the antitoxin concentration of the blood serum and by the Schick-conversion rate, is not greatly inferior to that resulting from active immunization alone; and even with a dose of 5000 units, the Schick-conversion rate reaches 81 % 12 weeks after the second injection of A.P.T. It is clear, therefore, that the antiserum, even when given in a dose as large as 5000 units, does not neutralize more than a small part of the antigenic activity of the first dose of A.P.T. Its main effect is apparently to diminish the rate of sensitization of the tissues, so that when a second dose of A.P.T. is given 4 weeks later, the rise in the antitoxin content of the blood serum is considerably delayed. Our experiments suggest that by increasing the size of the first dose of A.P.T., some of this delay may be avoided.

The partial neutralization of the first dose of A.P.T. will result in a decrease in the total antigenic stimulus and a delay in the time at which ït comes into operation. It is suggested that, provided the tissues have not been previously sensitized to diphtheria toxin, the result may be that the two doses will act virtually as a single dose. Such an explanation, however, must remain unproven till further observations have been made (see p. 35).

The practical value of combined active and passive immunization, especially when joined with temporary segregation of healthy carriers, in combating outbreaks of diphtheria in schools and other institutions for children has been clearly shown by Fulton, Taylor, Wells & Wilson (1941). Our present experiments lead us to suggest that, when applying the method in practice, it would be wise to give an initial dose of 0·5 ml. of A.P.T., together with 500 units of diphtheria antiserum injected at a different site, followed 6 weeks later by a second dose of 0.5 ml. A.P.T. It is probable that children treated in this way will develop approximately the same ultimate degree of immunity as those actively immunized with doses of 0·3 and 0·5 ml. of A.P.T. at 4 weeks’ interval.

We should like to express our thanks to Prof. A. D. Gardner and Prof. H. R. Dean for permitting observations to be made on the students in the pathology classes at Oxford and Cambridge; and to the students themselves at Oxford, Cambridge and Liverpool, for their ready co-operation in the inquiry.

Twenty-nine strains of penicillinase-producing Neisseria gonorrhoeae (PPNG) and 30 non-penicillinase-producing strains, all isolated in the Gambia, were characterized in terms of their plasmid content, auxotype and protein-I serovar. Sixty-two per cent of the PPNG strains contained the 3·2 MDa penicillinasecoding plasmid, and 38% had the 4·4 MDa plasmid. All the PPNG strains contained the 2·6 MDa cryptic plasmid but lacked the 24·4 MDa conjugative plasmid. In contrast, 46·7% of the non-PPNG strains harboured only the cryptic plasmid while 16·7% contained both the cryptic and conjugative plasmids. Seventeen per cent of the non-PPNG strains contained the conjugative plasmid only and 20% lacked plasmids.

The PPNG and non-PPNG strains also differed in terms of their protein-I serovar. Eighty-six per cent of the PPNG strains belonged to serogroup 1A, whereas the majority (60%) of non-PPNG strains belonged to serogroup IB. There was no significant difference in the auxotypes of the PPNG and non-PPNG strains, with both groups consisting predominantly of prototrophic and prolinerequiring strains, with a minority of strains requiring arginine. When the 59 strains were each characterized in terms of their combined plasmid profile, auxotype and serovar, 39 different combinations were noted, which indicates the heterogeneous nature of the gonococcal population found in the Gambia.

Enzyme-linked immunoabsorbent assay (ELISA) was used to titrate virus-specific IgG, IgM and IgA levels in nasal secretions, lung lavage fluids and serum samples sequentially obtained from lambs experimentally infected with bovine respiratory syncytial virus (RSV). Virus-specific IgG and IgM responses were measured by the indirect double antibody sandwich ELISA using anti-bovine RSV monoclonal antibody, as capture antibody, and peroxidase-conjugated anti-sheep IgG and anti-sheep IgM. Virus-specific IgA antibodies were measured by antibody capture assay using anti-sheep IgA (α–chain specific) and anti-bovine RSV monoclonal antibodies.

Bovine RSV-specific IgM and IgA antibodies were detected in the serum samples within 6 days post-inoculation (p.i.). Virus-specific IgC antibodies appeared in serum samples 4 days later. In nasal secretions, IgA antibodies appeared 7 days p.i. but IgM antibodies were not detected until 12–16 days p.i. In serum samples, IgM titres were predominant for the first 2 weeks p.i. IgC titres becoming predominant thereafter. In nasal secretions and lung lavage fluids, IgA titres were significantly higher than IgM or IgG titres up to 21 days p.i. (0·01).

A schedule for the routine serotyping of strains of Bordetella pertussis based on agglutinin production in mice to the K-antigens has been worked out. Mice have been found as satisfactory as rabbits but far more economical for the production of the very small volumes of serum which are required. Agglutinin production, used in conjunction with direct agglutination, provides definitive information about serotype.

Experience gained from a previous enquiry on this subject in human tuberculosis led to the belief that much information might be derived from an investigation of the complement fixation reaction in animals experimentally infected with tubercle bacilli. Accurate dosage can be measured and the true path of infection is definitely known. Various enquiries were suggested and investigated by the detailed examination of rabbits and guinea-pigs; the latter class of rodents were used in batches of six to twelve in number, as otherwise the individual differences between animals in the same group of experiments are entirely overlooked. My cultures of the human tubercle bacillus were obtained by inoculating guinea-pigs with the sputum from typical cases of pulmonary tuberculosis at the Brompton Hospital Sanatorium at Frimley. Pure cultures of the bacillus were obtained from the infected guinea-pigs and cultivated on Dorset's egg medium, so that within a period varying from 14 to 21 days an abundant growth was obtained. The culture of the bovine bacillus was supplied to me by Professor Delépine who obtained it directly from the tissues of an infected cow, and subcultures were kept going on Dorset's egg medium. In every experiment without exception the animals were infected with definitely known quantities of the human or bovine bacillus. These were obtained by carefully scraping the growth off the surface of the egg medium and weighing it on sterile platinum foil, while in some cases (for comparison) a portion of the growth was dried in a desiccator before it was weighed. The untreated or dried bacilli were then shaken in a known quantity of sterile saline, so that a perfect emulsion free from clumps was obtained. The bacilli were kept in the dark in brown stoppered bottles and were always employed within a few days of their preparation.

In 2017, Public Health England South East Health Protection Team (HPT) were involved in the management of an outbreak of Mycobacterium bovis (the causative agent of bovine tuberculosis) in a pack of working foxhounds. This paper summarises the actions taken by the team in managing the public health aspects of the outbreak, and lessons learned to improve the management of future potential outbreaks. A literature search was conducted to identify relevant publications on M. bovis. Clinical notes from the Public Health England (PHE) health protection database were reviewed and key points extracted. Animal and public health stakeholders involved in the management of the situation provided further evidence through unstructured interviews and personal communications. The PHE South East team initially provided ‘inform and advise’ letters to human contacts whilst awaiting laboratory confirmation to identify the infectious agent. Once M. bovis had been confirmed in the hounds, an in-depth risk assessment was conducted, and contacts were stratified in to risk pools. Eleven out of 20 exposed persons with the greatest risk of exposure were recommended to attend TB screening and one tested positive, but had no evidence of active TB infection. The number of human contacts working with foxhound packs can be large and varied. HPTs should undertake a comprehensive risk assessment of all potential routes of exposure, involve all other relevant stakeholders from an early stage and undertake regular risk assessments. Current guidance should be revised to account for the unique risks to human health posed by exposure to infected working dogs.

The variables operating in respect of the risk of provoking paralytic poliomyelitis by inoculating children with different prophylactic reagents have been analysed.

It is concluded that the use of combined diphtheria fluid toxoid and pertussis vaccine, administered in early infancy, incurs a minimal risk and is to be recommended because of its immunological effciency, its unquestionable value in helping to maintain a high immunization rate against diphtheria in the child community and for its marked administrative convenience.

A variola minor outbreak in a 36-bed hospital-ward comprised seven cases of overt variola after the first case. Clinical and epidemiological findings were typical, seven of the eight cases of overt variola being confirmed by virus isolation or antibody titrations. In addition, thirteen definite and seven possible instances of subclinical variola were deduced from complement-fixation or haemagglutination-inhibition tests. A discussion is made of the validity of serological criteria of variolous and vaccinial infections.

An individual's risk of infection from an infectious agent can depend on both the individual's own risk and protective factors and those of individuals in the same community. We hypothesize that an individual's exposure to an infectious agent is associated with the risks of infection of those living nearby, whether their risks are modified by pharmaceutical interventions or by other factors, because of the potential for transmission from them. For example, unvaccinated individuals living in a highly vaccinated community can benefit from indirect protection, or living near more children in a typhoid-endemic region (where children are at highest risk) might result in more exposure to typhoid. We tested this hypothesis using data from a cluster-randomized typhoid vaccine trial. We first estimated each individual's relative risk of confirmed typhoid outcome using their vaccination status and age. We defined a new covariate, potential exposure, to be the sum of the relative risks of all who live within 100 m of each person. We found that potential exposure was significantly associated with an individual's typhoid outcome, and adjusting for potential exposure affected estimates of vaccine efficacy. We suggest that it is useful and feasible to adjust for spatially heterogeneous distributions of individual-level risk factors, but further work is required to develop and test such approaches.

We assess the relationship between epidemic size and the scaling of epidemic growth of Ebola epidemics at the level of administrative areas during the 2014–16 Ebola epidemic in West Africa. For this purpose, we quantify growth scaling parameters from the ascending phase of Ebola outbreaks comprising at least 7 weeks of epidemic growth. We then study how these parameters are associated with observed epidemic sizes. For validation purposes, we also analyse two historic Ebola outbreaks. We find a high monotonic association between the scaling of epidemic growth parameter and the observed epidemic size. For example, scaling of growth parameters around 0.3–0.4, 0.4–0.6 and 0.6 are associated with epidemic sizes on the order of 350–460, 460–840 and 840–2500 cases, respectively. These results are not explained by differences in epidemic onset across affected areas. We also find the relationship between the scaling of epidemic growth parameter and the observed epidemic size to be consistent for two past Ebola outbreaks in Congo (1976) and Uganda (2000). Signature features of epidemic growth could become useful to assess the risk of observing a major epidemic outbreak, generate improved diseases forecasts and enhance the predictive power of epidemic models. Our results indicate that the epidemic growth scaling parameter is a useful indicator of epidemic size, which may have significant implications to guide control of Ebola outbreaks and possibly other infectious diseases.

With the use of streptomycin-resistant mutants to facilitate recovery, 5 strains of 4 species of Salmonella were shown to grow rapidly at 22° C. on low salt ham even from an inoculum of 10–20 organisms. S. pullorum did not grow well. All 6 strains of Salmonella survived but did not grow on ‘high salt ham’. We conclude that cooked ham containing approximately 2·8 g. NaCl/100 g. H2O once infected is more likely to give rise to food poisoning than is ham with the higher salt content traditionally used.

Thin-layer chromatography (TLC) was compared with seroagglutination for subtyping of Mycobacterium avium complex (MAC) bacteria. Seventy-five significant MAC isolates from patients with AIDS were typed by both methods and 36 isolates, judged to be clinically non-significant, were examined by TLC only. Overall. 75% of isolates tested were typable by seroagglutination and 91% by TLC; the results correlated between the two except for minor discrepancies.

Serovars 1, 8 and 21 and mixed serovars 1–21 and 1–8–21 were common among isolates from AIDS patients and together represented 83 % of isolates compared with only 36% in the non-significant group (odds ratio 8·4; 95% confidence interval 3·4–23·3). This difference remained significant after exclusion of serovar 41 (M. scrofulaceum), which was the commonest isolate (28%) in the non-significant group but was not isolated from patients with AIDS.

TLC is useful to supplement seroagglutination for subtyping of MAC. Further study is required to determine whether apparent differences between isolates from patients with AIDS and from other sources reflect differences in virulence or in environmental prevalence of MAC subtypes.

1. The effects of morphine and diacetylmorphine upon the stomach of the cat are variable. The greater number of experiments showed a decrease in tone which was accompanied by a decrease in the frequency and amplitude of movements. Some animals showed an increase in stomach tone accompained by three to five slowly moving contractions of great amplitude while no change were recorded in two cats.

2. Codeine sometimes produced a slight increase in the amplitude of stomach movements with a diminished frequency, while at first the general tone is unaltered. Tone is later reduced slightly to a subnormal level. In other cases it causes a very slight increase in tone and amplitude of movements. These effects are short lived and very small when compared with those produced by morphine or heroin.

3. The effects of dihydromorphinone (dilaudid) upon the stomach are far from constant. Most animals show an immediate relaxation of the stomach with a decrease in the amplitude of the movements. In a series of nine experiments, six showed relaxation of the stomach, two contraction, and in one no changes were recorded.

4. The effects of dihydrocodeinone (dicodid) on the stomach resemble those of codeine. They consist of a small gradual increase in tone followed by a relaxation to a subnormal level.

5. Dihydro-oxycodeinone (eukodol) produces effects which resemble those of dihydrocodeinone (dicodid).

6. All these drugs produce constant effects upon the pyloric sphincter. They all produce an increase in the tone of the sphincter accompanied by an increase in the amplitude of the rhythmical movements. Dilaudid is approximately eight times more active than morphine, while diacetylmorphine is about one and a half times more potent than morphine. The effects of these three drugs last several hours.

The effects of codeine, dicodid and eukodol show a great similarity. They are of short duration and very small when compared with morphine, heroin and dilaudid.

Between March and July 2003, 671 cases of severe acute respiratory syndrome (SARS) were diagnosed in Taiwan with a total of 84 fatalities. After the epidemic, a serological survey was conducted involving the asymptomatic household contacts. Household contacts of 13 index patients were enrolled in the study. Contact history and clinical symptoms of the household contacts were recorded by standardized questionnaires. Blood samples of patients and household contacts were collected at least 28 days after symptom onset in the index patients or household exposure in the contacts for SARS-associated coronavirus (SARS-CoV) IgG testing. On the basis of this investigation, 29 persons (25 adults and 4 children) were identified as having had unprotected exposure to the index cases before infection-control practices were implemented. Laboratory evaluation of clinical specimens showed no evidence of transmission of SARS-CoV infection to any contacts. This investigation demonstrated that subclinical transmission among household contacts was low in the described setting.

Currently, limited studies have quantified the risk of methicillin-resistant Staphylococcus aureus (MRSA) skin and soft tissue infections (SSTIs) for MRSA-colonized patients on discharge from hospital. Our retrospective, case-control study identified independent risk factors for the development of MRSA SSTIs among such patients detected by active MRSA nasal screening in an acute care hospital by PCR on admission, and bacteriological cultures on discharge. Cases were MRSA-colonized patients aged ⩾18 years who developed a MRSA SSTI post-discharge and controls were those who did not develop a MRSA SSTI post-discharge. Controls were matched to cases by length of follow-up (±10 days) for up to 18 months. Potential demographic and clinical risk factors for MRSA infection were identified using electronic queries and manual chart abstraction; data were compared by standard statistical tests and variables with P values ⩽0·05 in bivariable analysis were entered into a logistic regression model. Multivariable analysis demonstrated prior hospital admission within 12 months (P = 0·02), prior MRSA infection (P = 0·05), and previous myocardial infarction (P = 0·01) were independently predictive of a MRSA SSTI post-discharge. Identification of MRSA colonization upon admission and recognition of risk factors could help identify a high-risk population that could benefit from MRSA SSTI prevention strategies.