The use of 1 per cent, milk agar gives a significant increase in colony numbers for both raw milk and pasteurised milk at all levels of count. There is a marked increase with pasteurised milk on the 1/100 and 1/1000 plates. Milk agar also gives better colony growth, tending to more rapid and accurate counting. With raw milk there is no correlation between the increase and the count on standard agar.

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.

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.

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.

A Point of great importance in medico-legal practice is the differentiation of human from other bloods. In dealing with fresh stains no difficulty has been found in distinguishing mammalian from avian and reptilian bloods. The more difficult operation of differentiating between mammalian bloods, for example between human and pig's blood, had up till the introduction of the biological, or preferably precipitin, test, except with the freshest material, baffied the ingenuity of the expert in legal medicine. In 1901 Nuttall (1. VI. '01) was amongst the first to draw attention to the possible value of this test for blood and serum in forensic practice.

Genital human papillomavirus (HPV) infections are caused by a broad diversity of genotypes. As available vaccines target a subgroup of these genotypes, monitoring transmission dynamics of nonvaccine genotypes is essential. After reviewing the epidemiological literature on study designs aiming to monitor those dynamics, we evaluated their abilities to detect HPV-prevalence changes following vaccine introduction. We developed an agent-based model to simulate HPV transmission in a heterosexual population under various scenarios of vaccine coverage and genotypic interaction, and reproduced two study designs: post-vs.-prevaccine and vaccinated-vs.-unvaccinated comparisons. We calculated the total sample size required to detect statistically significant prevalence differences at the 5% significance level and 80% power. Although a decrease in vaccine-genotype prevalence was detectable as early as 1 year after vaccine introduction, simulations indicated that the indirect impact on nonvaccine-genotype prevalence (a decrease under synergistic interaction or an increase under competitive interaction) would only be measurable after >10 years whatever the vaccine coverage. Sample sizes required for nonvaccine genotypes were >5 times greater than for vaccine genotypes and tended to be smaller in the post-vs.-prevaccine than in the vaccinated-vs.-unvaccinated design. These results highlight that previously published epidemiological studies were not powerful enough to efficiently detect changes in nonvaccine-genotype prevalence.

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.

One of the difficulties in the way of recommending pasteurisation as a general measure for the protection of the milk supply is the fact that as a technical process it is not completely satisfactory, or perhaps better stated, that there are many loopholes for faulty practice. The problems of pasteurisation are not solved merely by enunciating that scientific investigations under laboratory conditions show that certain time-temperature factors are capable and requisite to kill all pathogenic bacteria in milk and that in the process the damage to the milk is neither material nor detrimental. The application of these time-temperature factors under working conditions involves consideration of a number of practical problems. If we are to adopt pasteurisation as a regular part of Public Health practice it is essential to consider these problems and to make the procedure as technically perfect and satisfactory as possible. Any trade objections have to be considered and weighed and, if they are of substance, removed, if that can be done without harm to essential requirements. This is important, since demands which cut across trade needs are likely to be evaded or at least carried out in a lukewarm fashion.

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.

Interactive water fountains are established sources of gastrointestinal infections yet most health codes fail to regulate their design and operation. This report describes multi-agency, concurrent interactive fountain-associated cryptosporidiosis and salmonellosis outbreak investigations and highlights the need for the adoption of appropriate regulations for interactive fountains.

(1) Dysentery strains from various sources have been examined with respect to their power of reducing nitrates to nitrites and of further destroying nitrites. All the strains with one exception (B. Neisser Ac.) reduced nitrates to nitrites. None of the strains which fail to ferment mannite (Shiga type) destroyed nitrites. Those dysentery strains which form acid from mannite differ amongst themselves in regard to their action on sugars and also in their effect on nitrites. Of the eight mannite-fermenting strains examined, two (B. dysenteriae Jürgens and B. Neisser Nc.) failed to destroy nitrites.

(2) B. dysenteriae Jürgens, although closely related to B. dysenteriae Flexner, differs from it both in its action on litmus-whey and in failing to destroy nitrite. It must therefore be considered a different strain. B. dysenteriae Jürgens is remarkable as being the only one of the strains examined which forms indol and at the same time fails to destory nitrites. It is consequently the only one which gives the cholera-red reaction.

(3) The addition of glucose (i.e. of a carbohydrate from which acid can be formed) enables Shiga strains to destroy nitrite.

(4) In the presence of an abundant supply of oxygen all the strains fail to destroy nitrites and nitrates.

(5) In glucose-containing media the inhibitory effect of oxygen is less marked.

(6) Under anaerobic conditions Shiga strains and B. dysenteriae Jiirgens still fail to destroy nitrites.

1. The outbreak of typhoid fever in the Ecclefechan Special Water District affected 55 per 1000 of the inhabitants (primary cases only).

2. The evidence available indicated the public water supply as the vehicle of infection.

3. A typhoid carrier was found employed in the water-collecting area.

4. Examination of the water pipes after excavation showed that surface pollution might gain access to the pipes conveying spring water to the collecting tank.

5. Secondary cases were few in number, and so far there is no evidence that foci of infection remain as sequelae of the outbreak.

Scabies is a contagious skin infection commonly occurring in institutions such as care homes. However, a large proportion of vulnerable people in England receive domiciliary care in the community and their experience of scabies has not been described. We undertook a pragmatic cross-sectional survey of Health Protection Teams (HPTs) in England to determine the burden of scabies related to domiciliary care. Fifteen cases or outbreaks were notified to HPTs between January 2013 and December 2017. Although a relatively uncommon event for individual HPTs, they were complex to manage and required the co-ordination of multiple stakeholders. Diagnosis was often delayed and required several clinical consultations. A lack of guidance led to difficulties establishing stakeholder roles and responsibilities and sources of funding for treatment. The stigmatisation of scabies sometimes affected the quality of care provided to patients, such as use of excessive personal protective equipment. Our study demonstrates that scabies is an issue of public health importance for domiciliary care service providers and users, and research is required to better understand the impacts of the disease and to develop evidence-based guidance. More generally, there is a need for simpler treatment regimens and methods of diagnosing scabies.

The death of Professor von Pettenkofer, which was briefly alluded to in the last issue of the Journal of Hygiene, has removed one who was everywhere acknowledged as a great leader among the workers in our science, and as the pioneer who has been mainly instrumental in bringing about the recognition of Hygiene, particularly on its experimental side, as a separate subject of investigation and university instruction.

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.

Specimens for the detection of avian influenza virus (AIV) were collected from 1937 waterfowl on the Wexford Sloblands, a major wetland reserve in southeast Ireland, between January 2003 and September 2007. During the same period, 1404 waterfowl were sampled at other locations in Ireland. Specimens were tested either by virus isolation or real-time reverse transcriptase polymerase chain reaction (rtRT–PCR). A total of 32 isolates of AIV, comprising nine subtypes, was obtained from specimens from the Sloblands compared with just one isolate from elsewhere in Ireland. Samples from nine other waterfowl, five of which were from the Sloblands, tested positive for AIV by rtRT–PCR. Ecological factors are likely to have contributed to the higher detection rate of AIV at the Sloblands compared with the rest of Ireland. It was concluded that targeted surveillance at such sites is a cost-effective means of monitoring the circulation of new AIVs in waterfowl, whereas widespread opportunistic sampling is unproductive and wasteful of resources.

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.

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.

The objectives of this study were to identify human papillomavirus (HPV) genotypes in a group of Bosnian-Herzegovinian women with abnormal cytology and to assess their potential coverage by vaccines. HPVs were identified by multiplex real-time PCR test (HPV High Risk Typing Real-TM; Sacace Biotechnologies, Italy) of 105 women with an abnormal cervical Pap smear and positive high-risk (HR) HPV DNA screening test. The most common genotypes in the study were HPV-16 (32·6%, 48/147), HPV-31 (14·3%, 21/147), HPV-51 (9·5%, 14/147) and HPV-18 (7·5%, 11/147). The overall frequency of HR HPV-16 and/or HPV-18, covered by currently available vaccines [Gardasil® (Merck & Co., USA) and Cervarix®; (GlaxoSmithKline, UK)] was lower than the overall frequency of other HPVs detected in the study (40·1%, 59/174, P = 0·017). Group prevalence of HR HPVs targeted by a nine-valent vaccine in development (code-named V503) was higher than total frequency of other HPVs detected (68·0%, 100/147, P < 0·001). Development of cervical cytological abnormalities was independent of the presence of multiple infections (χ2 = 0·598, P = 0·741). Compared to other HPVs, dependence of cervical diagnosis and HPV-16, -18 (P = 0·008) and HPV-16, -18, -31 (P = 0·008) infections were observed. Vaccines targeting HR HPV-16, -18 and -31 might be an important tool in the prevention of cervical disease in Bosnia and Herzegovina.