In South Korea, the resurgence of mumps was noted primarily among school-aged children and adolescents since 2000. We analyzed spatial patterns in mumps incidence to give an indication to the geographical risk. We used National Notifiable Disease Surveillance System data from 2001 to 2015, classifying into three periods according to the level of endemicity. A geographic-weighted regression analysis was performed to find demographic predictors of mumps incidence according to district level. We assessed the association between the total population size, population density, percentage of children (age 0–19 years), timely vaccination rate of measles–mumps–rubella vaccines and the higher incidence rate of mumps. During low endemic periods, there were sporadic regional distributions of outbreak in the central and northern part of the country. During intermediate endemic periods, the increase of incidence was noted across the country. During high endemic period, a nationwide high incidence of mumps was noted especially concentrated in southwestern regions. A clear pattern for the mumps cluster shown through global spatial autocorrelation analysis from 2004 to 2015. The ‘non-timely vaccination coverage’ (P = 0·002), and ‘proportion of children population’ (P < 0·001) were the predictors for high mumps incidence in district levels. Our study indicates that the rate of mumps incidence according to geographic regions vary by population proportion and neighboring regions, and timeliness of vaccination, suggesting the importance of community-level surveillance and improving of timely vaccination.

A technique was described for the artificial contamination of the upper surface of intravenous infusion container plugs with viable micro-organisms. This technique was employed to assess the adequacy of decontamination of two designs of plug by the use of antiseptic swabbing. Results indicated that the MRO plug surface was more difficult to sterilize than that of the Tra venol plug. The possibility of contamination of the infusion fluid during insertion of the giving-set needle was examined. Results indicated that there was a risk of contamination through the administration-set port of the MRC plug if swabbing was inadequate.

Inactivated vaccines prepared from influenza virus strains obtained by the recombination of A/PR/8/34 (H1N1) or A/FM/1/47 (H1N1) viruses with A/Victoria/3/75 (H3N2) virus, were tested for their antigenicity in hamsters. The parental origin of the genes of each cloned recombinant virus was determined by polyacrylamide gel electrophoresis, and vaccines prepared from each strain by concentration, purification on sucrose density gradients and inactivation with formalin. All the recombinant strains used in these studies possessed surface haemagglutinin and neuraminidase antigens derived from the A/Victoria/75 parent strain.

On inoculation into hamsters, at equivalent concentrations, these vaccines varied in their ability to induce haemagglutination-inhibiting (HI) antibodies in the serum. This variation was not dependent on concentration and was observed using neutralization and single radial haemolysis, as well as HI. The possible reasons for the findings are discussed.

1. A strain of Boot, coli adapted to growth in high glycine concentrations, which had lost the power of producing ‘gas’ from sugars, was shown to be devoid of formic hydrogenlyase.

2. Formic acid was prominent among the products of fermentation of sugars by this strain.

3. The appearance of formic hydrogenlyase in vitro, in bacteria grown in such a way as not to contain the enzyme, was inhibited by glycine at high concentrations.

One of us (J. G.) is indebted to the Medical Research Council for a grant-in-aid for expenses.

The morphological, cultural, biochemical, serological and pathogenic properties of two bacterial strains of the group designated ‘Br. suis biotype 5’ were examined. Both strains were found to be atypical of the genus Brucella in many of these characteristics. No serological relationship to known brucella strains could be detected. On the basis of the evidence obtained the two strains examined were classified as Moraxella duplex and the status of ‘Br. suis biotype 5’ questioned.

1. The laboratory findings in a series of 215 cases of enteric fever are described and discussed, with special reference to early diagnosis.

2. In the majority of the cases reviewed, the leucocyte count was about the lower level of normal limits, though considerable variation both upwards and downwards occurred.

3. Blood culture was a very satisfactory and early method of diagnosis; the method used is described fully.

4. Certain variations from normal in the behaviour of the organisms were encountered and are described.

5. Bact. faecalis alkaligenes was isolated from blood culture in five cases in which enteric group organisms were also isolated from blood, faeces or urine and in three which were clinically enteric fever. The relation of these observations to the possibility of primary Bact. faecalis alkaligenes septicaemia is noted.

6. Seventeen cases were fatal. The causes of death are described.

Granulysin is a recently discovered cytolytic protein of natural killer (NK) cells and cytotoxic T lymphocytes. Studies of healthy and immunocompromised patients with primary or recurrent varicella-zoster infections demonstrate the importance of virus-specific cellular immunity in controlling viral replication, but also some studies presented granulysin as a molecule that can play a role in chickenpox immunopathogenesis. This study investigated possible correlation between serum granulysin levels and clinical course of chickenpox. A total of 69 patients with chickenpox were included in the study. We measured the levels of granulysin and percentage count for CD4+, CD8+ and NK cells in serum for all patients and healthy controls. For detection and quantification of granulysin in sera, we performed ELISA test and flow cytometry for detection, identification and percentage measurement of T and B lymphocytes. Descriptive methods, analysis of variance and multivariate logistic regression were used for statistical data analysis. We found respective correlation between serum granulysin level and severity of clinical presentation. These findings can be a good input for further studies, since there is no relevant prognostic parameter of chickenpox in everyday clinical practice. Granulysin, as a therapeutic, also deserves to be a point of interests in the future. If we prove its potential to stop dissemination of human herpes viruses, possibilities to use it in some life-threatening forms of viral disease can be very valuable.

Evidence has been obtained that where the adsorbing capacity for Vi agglutinins is known to be present it is also possible to show affinity for Vi bacteriophages. However, from the conduct of paratyphoid C strains containing Vi antigen it appears that the presence of Vi antigen causes only the adsorption of Vi bacteriophages, but that in the production of lysis by these bacteriophages other factors play a part.

Estimation of the true incidence of tuberculosis (TB) is challenging. The approach proposed by Styblo in 1985 is known to be inaccurate in the modern era where there is widespread availability of treatment for TB. This study re-examines the relationship of incidence to prevalence and other disease indicators that can be derived from surveys. We adapt a simple, previously published model that describes the epidemiology of TB in the presence of treatment to investigate a revised ratio-based approach to estimating incidence. We show that, following changes to treatment programmes for TB, the ratio of incidence to prevalence reaches an equilibrium value rapidly; long before other model indicators have stabilized. We also show that this ratio relies on few parameters but is strongly dependent on, and requires knowledge of, the efficacy and timeliness of treatment.

In determining the fermentative powers of this organism both fluid and solid cultures were used. The fluid medium was made up according to the formula employed by Dr M. H. Gordon. It consisted of Lemco ·1 gram, peptone ·1 gram, sodium bicarbonate ·1 gram, 10 per cent. watery solution of litmus 10 c.c., water to 100 c.c. This medium was sterilized by heating under pressure and to it was then added the substance to be investigated in the proportion of 1 per cent. Subsequent sterilisation was effected by heating in the steamer for 10 minutes on three successive days. In the case of laevulose, arabinose, and xylose the flasks were heated over the Bunsen flame, as in the steamer the medium turned red.

1. The Weil-Felix reaction in a series of forty-five cases of tsutsugamushi disease (type Schüffner) is recorded.

2. The agglutination reaction was negative in fifteen cases, the other thirty showing a positive reaction with the “Kingsbury” strain of B. proteus X.

3. The Weil-Felix reaction is not regarded as an adequate method for differentiating tsutsugamushi disease from scrub typhus, since high titres (1 in 1000) occur in a considerable proportion of cases of tsutsugamushi disease.

4. In the present state of our knowledge of the two diseases it is recommended that they should be separated according to the presence or absence of a primary ulcer and bubo.

In the samples of “blown” preserve tins examined by me, organisms of an intestinal type were present, which on reinoculation into sound tins gave rise to a gaseous decomposition.

No toxic symptoms were produced on feeding guinea-pigs with the contents of the “blown” tins.

1. Diphtheria bacilli have been found in a considerable proportion of persons who have come into contact with cases of diphtheria or with other infected persons.

2. Such persons have been shown to be a grave danger to public health, especially when frequenting schools or institutions, and to constitute the usual channel by which the disease is spread.

3. Very satisfactory results have followed on the isolation of convalescents from the disease and of infected “contacts,” where two or more consecutive negative examinations have been required before release.

4. Carefully conducted investigations amongst healthy persons, who have not at a recent date been in contact with diphtheria cases or infected “contacts,” have shown that virulent diphtheria bacilli are very seldom (3 examples amongst 1511 persons) present in the mouths of the normal population. This fact renders the discovery and isolation of infected persons a practicable possibility and offers a fair prospect of discovering and isolating the majority of them in any outbreak.

5. Diphtheria bacilli are usually distinguishable on morphological and cultural grounds, but whenever possible it is desirable that their virulence should be tested.

6. The bacillus of Hofmann is innocuous to man, and is a very common organism in the mouths of the poorer classes. The distribution of this bacillus points to the conclusion that it is carried from mouth to mouth in the same way as the diphtheria bacillus, and therefore its widespread prevalence in schools attended by poorer children is significant, as showing how widely spread and uncontrollable an outbreak of diphtheria may become unless measures are early taken to deal with infected contacts.

Eight strains of Cl. welchii were studied for the heat-resistance of their spores. Spores of Cl. welchii isolated from food-poisoning cases had greater heat-resistance than strains isolated from soil or faeces. D-values and trend values were calculated from the thermal death curves.

There are few studies from developing countries on the epidemiology of Haemophilus influenzae (Hib) infections among infants and children. We set out to determine the prevalence of oropharyngeal Hib colonization among Turkish children younger than two years of age and to identify antimicrobial resistance among the isolates. A cross-sectional study was conducted on 818 healthy children and oropharyngeal secretions were sampled. The carriage rate of Hib was found to be 7·2% and this increased significantly with age. Carriage of Hib among 3- to 6-month-old children (3·5%) was higher than expected and was significantly higher among children who were passive smokers (P=0·04). Logistic regression analysis showed that breastfeeding status was the sole significant factor for colonization (OR 2·2, 95% CI 1·26–3·82). Antimicrobial susceptibility tests on 56 isolates of H. influenzae showed that 51·8% and 21·4% were resistant to trimethoprim–sulphamethoxazole and ampicillin respectively. Other notable resistances were to cefalexin (10·7%) and chloramphenicol (3·6%); no isolates were resistant to ceftriaxone.

1. The effects of morphine, diacetylmorphine (heroin), methylmorphine (codeine), dihydromorphinone (dilaudid), dihydrocodeinone (dicodid) and dihydroxycodeinone (eukadol) upon the rectum are described.

2. Morphine hydrochloride produces an immediate well-marked increase in rectal tone, which returns to normal about ½ hr. later. Waves of increased tone followed by relaxation are seen during the next 3–4 hr., each wave lasting approximately ½ hr. At the 5 or 6 hr. stage the tone is generally subnormal and remains so for many hours afterwards. The amplitude of the rectal movements is slowly increased, reaching a maximum about 3 hr. later, when they are usually very large and much slower than normal. Later the movements decline to a subnormal amplitude. These effects are abolished by the administration of atropine, and subsequent injections of morphine hydrochloride given within a few hours fail to reproduce them.

3. The effects of diacetylmorphine hydrochloride (heroin) are similar to those of morphine hydrochloride, except that it rarely leaves the rectum in a subnormal state of tone at any time during the first 8 hr. following the injection of the drug. In two experiments a slight relaxation beyond the normal limits was observed at the 5 hr. stage, but it was so small as to be negligible.

4. Methylmorphine phosphate (codeine) produces effects upon the tone and movements which resemble those of morphine, but they are always less marked in degree and of shorter duration than those of morphine. With codeine the effects never lasted longer than 30–45 min.; secondary waves of increased tone, such as were seen after the administration of morphine, diacetylmorphine, dicodid or eukadol, were never observed following the use of codeine. The tone level of the rectum was never subnormal at the 5 hr. stage or later. The effects of codeine were always immediately abolished by atropine, after which codeine was ineffective.

5. Diacetylmorphinone hydrochloride (dilaudid) is a very potent drug, producing very marked effects upon the rectum even when very small doses were employed. Small amounts of the drug cause an immediate increase in tone without any change in the character or rate of the movements. Normal tone was re-established 30–45 min. later, when it declines still further to a subnormal level, reaching its lowest level at 70–90 min. Larger doses of dilaudid produced an increase in the amplitude of the movements in addition to increasing the tone. These effects lasted approximately 30 min., when both tone and movements were normal again. The tone level was generally markedly subnormal at the 6–8 hr. stage. The effects of dilaudid were immediately abolished by atropine, after which dilaudid was ineffective.

6. Dihydrocodeinone hydrochloride (dicodid) is a very active drug which produces an increase in the activity of the rectum which is far greater than that produced by morphine, heroin, codeine, or dilaudid. The immediate effect of dicodid is an increase in rectal tone, accompanied by some decrease in the amplitude of the movements. Later the tone decreases far in excess of normal. Secondary waves of increased tone, each one of 15–25 min. duration, were observed to recur during the first 4½ hr. following the administration of the drug. The tone level of the rectum was never subnormal, even at the 8 hr. stage. The effects of dicodid were always inhibited after the administration of atropine, while the subsequent injection of dicodid always produced its usual effects, which were, however, modified and of shorter duration.

7. Dihydroxycodeinone hydrochloride (eukadol) at first increases the tone of the rectum to a marked extent and later the amplitude of the movements. Secondary waves of increased tone, each one of 18–25 min. duration, and separated from the next by an interval of 8–15 min., were observed through the first 2½–3 hr. following the administration of the drug. The effect of eukadol upon the rectal movements is extremely marked. The maximum-increase in their amplitude was generally observed at the 3–3½ hr. stage, when the tone was subnormal. At the 8 hr. stage the tone was always subnormal, while the movements were decreasing in both rate and amplitude. Atropine immediately inhibited the action of eukadol upon the rectum, while the subsequent administration of eukadol always produced a marked increase in tone without much change in the amplitude of movements.

8. Codeine phosphate is undoubtedly the weakest member of this series in so far as the effects produced upon the rectum are concerned, while dihydrocodeinone (dicodid) and dihydroxycodeinone (eukadol) are the most active.

Campylobacter spp. are one of the most common causes of bacterial gastroenteritis in Canada and worldwide. Fluoroquinolones are often used to treat complicated human campylobacteriosis and strains of Campylobacter spp. resistant to these drugs are emerging along the food chain. A scoping review was conducted to summarise how human (fluoro)quinolone-resistant (FQR; quinolones including fluoroquinolones) Campylobacter spp. infections are characterised in the literature by describing how burden of illness (BOI) associated with FQR is measured and reported, describing the variability in reporting of study characteristics, and providing a narrative review of literature that compare BOI measures of FQR Campylobacter spp. infections to those with susceptible infections. The review identified 26 studies that yielded many case reports, a lack of recent literature and a lack of Canadian data. Studies reported 26 different BOI measures and the most common were hospitalisation, diarrhoea, fever and duration of illness. There were mixed results as BOI measures reported in literature were inconsistently defined and there were limited comparisons between resistant and susceptible infections. This presents a challenge when attempting to assess the magnitude of the BOI due to FQR Campylobacter spp., highlighting the need for more research in this area.

The aim of this study was to apply a back-calculation model to Great Britain (GB) classical scrapie surveillance data, and use this model to estimate how many more cases might be expected, and over what time frame these cases might occur. A back-calculation model was applied to scrapie surveillance data between 2005 and 2019 to estimate the annual rate of decline of classical scrapie. This rate was then extrapolated to predict the number of future cases each year going forward. The model shows that there may be yet further cases of classical scrapie in GB. These will most likely occur in the fallen stock scheme, with approximately a 25% probability of at least 1 further scrapie positive, with a very low probability (~0.2%) of having up to three additional scrapie positives. This highlights the difficulty of completely eliminating all further cases, even in the presence of very effective control measures.

The blood culture records during the 6-year period 1984–9 were reviewed to compare the performance of the BACTEC aerobic (6B) and aerobic-hypertonic (8B) media for the recovery of Candida spp. and Torulopsis glabrata from blood. There were 137 positive blood culture sets that contained both a 6B and an 8B bottle. Sixty-eight different yeasts were recovered from 65 patients including 35 Candida albicans, 19 C. tropicalis, 6 C. parapsilosis, 4 C. krusei, 1 C. pseudotropicalis and 3 Torulopsis glabrata. The 8B medium detected 120 of the positive cultures (87·6%) and was the only positive medium in 35 (25·6%) sets, while the 6B medium detected 102 positive cultures (74·4%) and was the only positive medium in 17 (12·4%) sets (P < 0·04). For those sets in which both bottles were positive, radiometric detection occurred first in the 8B bottle in 39 sets and first in the 6B bottle in 11 sets (P < 0·001). The superior performance of the 8B bottle was not related to the administration of amphotericin B. Cultures of stock strains of C. albicans, C. tropicalis, and C. parapsilosis in 6B and 8B media with and without added blood confirmed the finding that 8B was substantially superior to 6B for the detection of candidaemia. It is concluded that an 8B bottle should be included in the blood culture set whenever candidaemia is suspected.

Two hundred and sixty strains of Pseudomonas aeruginosa were isolated from patients of the Asaf Harofe Government Hospital. The strains were typed by phage technique and 64 of them were also typed according to pyocine sensitivity. The two methods proved complementary, and reduced the number of untypable strains. Phage typing was performed with both routine test dilution (RTD) and more concentrated phage suspensions. The most reliable results were obtained at 100 RTD.