This study aimed to evaluate the performance of Cobas human papillomavirus (HPV) test in cervical cancer screening. A total of 3442 women aged ⩾20 years used Cobas HPV and hybrid capture 2 (HC2) tests were included in this study. Women with any positive result were examined by liquid-based cytology (LBC) test. Then subjects with abnormal LBC or positive Cobas HPV16/18 were further checked by colposcopy to observe the visible lesions to perform the pathological examination. Of these 3442 women, 328 cases were Cobas HPV positive, and the positive rate was 9.53% (95% confidence interval (CI) 8.50–10.53). The positive rate of HPV16, HPV18, and other 12 types of high-risk HPV were 1.54% (95% CI 1.12–1.95), 0.55% (95% CI 0.30–0.80), and 7.44% (95% CI 6.56–8.32), respectively. The coincidence rate of Cobas HPV test and HC2 test was 90% (95% CI 89.00–91.00; Kappa = 0.526) in the primary screening. Age had a non-linear relationship with Cobas HPV positive rate (χ2 = 4.240, P = 0.040) and HPV16/18 typing positive rate (χ2 = 6.610, P = 0.010). Compared with the LBC test, the Cobas HPV test had higher sensitivity when detecting patients with high cervical intraepithelial neoplasia (CIN2+ and CIN3+).

New Zealand has a long-running campylobacter infection (campylobacteriosis) epidemic with contaminated fresh chicken meat as the major source. This is both the highest impact zoonosis and the largest food safety problem in the country. Adding to this burden is the recent rapid emergence of antibiotic resistance in these campylobacter infections acquired from locally-produced chicken. Campylobacteriosis rates halved in 2008, as compared with the previous 5 years, following the introduction of regulatory limits on allowable contamination levels in fresh chicken meat, with large health and economic benefits resulting. In the following decade, disease rates do not appear to have declined further. The cumulative impact would equate to an estimated 539 000 cases, 5480 hospitalisations, 284 deaths and economic costs of approximately US$380 million during the last 10 years (2009–2018). Additional regulatory interventions, that build on previously successful regulations in this country, are urgently needed to control the source of this epidemic.

The problem which we shall discuss in this communication is of great importance, is perhaps the most important of all epidemiological problems, and we are far indeed from supposing that we have solved it. We think, however, that the work we have done is certainly useful in enabling us, and others, to state the problem correctly, and possibly useful in suggesting a first approximation to its solution.

Hand, foot, and mouth disease (HFMD), usually a self-limiting illness for young children, could cause a significant burden for parents because it can take up to 1–2 weeks for a sick child to recover. We conducted a two-wave longitudinal study over one summer peak season (May–July 2014) of HFMD to examine parents’ HFMD-related risk perceptions and protective responses. In total, 618 parents with at least one child aged ⩽12 years, recruited using randomly-dialled household telephone calls completed the baseline survey interview, 452 of whom subsequently completed the follow-up survey. Around two-thirds of participants perceived the chance of their child being infected by HFMD was ‘zero/very small/small’ but the likelihood of being hospitalized once infected was ‘somewhat likely/likely/very likely’. At follow-up, 82% reported washing child's hands frequently (Hygiene), 16% would keep their child away from school if HFMD cases were identified in school (Distancing) and 23% were ‘very likely/certainly’ to take the child for HFMD vaccination if available (Vaccination). Anticipated regret was consistently the strongest predictor for Hygiene (OR 3.34), and intention of Distancing (OR 2.58) and Vaccination (OR 3.16). Interventions focusing on anticipated regret may be effective to promote protective behaviour against HFMD among parents for their children.

In 2016, imported Zika virus (ZIKV) infections and the presence of a potentially competent mosquito vector (Aedes albopictus) implied that ZIKV transmission in New York City (NYC) was possible. The NYC Department of Health and Mental Hygiene developed contingency plans for a urosurvey to rule out ongoing local transmission as quickly as possible if a locally acquired case of confirmed ZIKV infection was suspected. We identified tools to (1) rapidly estimate the population living in any given 150-m radius (i.e. within the typical flight distance of an Aedes mosquito) and (2) calculate the sample size needed to test and rule out the further local transmission. As we expected near-zero ZIKV prevalence, methods relying on the normal approximation to the binomial distribution were inappropriate. Instead, we assumed a hypergeometric distribution, 10 missed cases at maximum, a urine assay sensitivity of 92.6% and 100% specificity. Three suspected example risk areas were evaluated with estimated population sizes of 479–4,453, corresponding to a minimum of 133–1244 urine samples. This planning exercise improved our capacity for ruling out local transmission of an emerging infection in a dense, urban environment where all residents in a suspected risk area cannot be feasibly sampled.

A survey embracing all cattle vaccinated in Kenya with lapinized rinderpest virus between 1 January 1954 and 30 June 1956 revealed an over-all incidence rate of adverse reactions of 0·09 %. The real incidence rate approached 3 per 1000 cattle because only susceptible cattle were at risk. Four types of reactions were recognized. The most serious, because of the attendant high case mortality rate, was aggravation of latent protozoal infections. The commonest reactions were rinderpest-like without serious sequelae except in pregnant cows, many of which aborted. Transient spermatolysis was observed in six vaccinated bulls and anaphylaxis was recorded rarely.

The incidence of rinderpest-like reactions was primarily influenced by the innate resistance of the cattle. The viral strains recovered from reacting cattle were genotypically unchanged.

I am grateful to Mr J. W. Macaulay, B.Sc., F.R.C.V.S., D.V.S.M., Chief Veterinary Research Officer, Kabete, Kenya, for his encouragement, advice and counsel. This paper is published by permission of the Director of Veterinary Services, Kenya.

This study aimed to assess the prevalence of anti-hepatitis E virus (HEV) immunoglobulin (Ig) M and elevated serum alanine aminotransferase (ALT) levels among employees in catering and public place industries. Blood samples were collected between January and December 2020 from 26,790 employees working in the Qinhuai district of Nanjing, China. Anti-HEV IgM in the serum samples was tested by the capture ELISA method and ALT was tested by the IFCC method. Samples positive for anti-HEV IgM or with ALT levels over 200 U/L were subjected to PCR screening of HEV RNA. The overall seroprevalence of anti-HEV IgM was 0.41%, and the seroprevalence was slightly higher in males (0.47%) than in females (0.37%); however, the difference was not substantial (p = 0.177). Seroprevalence of anti-HEV IgM increased with age, reaching its peak level after 48 years of age. The prevalence of elevated ALT levels was 4.24%, and males exhibited a higher prevalence than females (6.78% vs 2.65%, p < 0.001). Prevalence of elevated ALT levels differed in age groups and the 26–36-year-old group had the highest rate of elevated ALT levels. Employees with elevated ALT levels had a higher prevalence of positive anti-HEV IgM than those with normal ALT (0.57% vs 0.31%, p < 0.001). Positive HEV RNA was detected in one anti-HEV IgM-negative employee with ALT higher than 200 U/L. In our study, all the HEV RNA-positive and IgM-positive individuals are asymptomatic, and a combination of ALT tests, serological methods, and molecular methods is recommended to screen asymptomatic HEV carriers and reduce the risk of transmission.

A microbial survey of Sri Lankan desiccated coconut has been made on material purchased in supermarkets in Sheffield or on material obtained directly from the processing company. The total viable count (TVC) was reduced by spoilage and pasteurization from 104/g to 103/g. Most samples contained low levels of coagulase-positive Stephylococcus aureus suggesting that this commodity had been handled during production. One focus of contamination with Aspergillus flavus was found for each 8·34 g of desiccated coconut (mean contamination). The number of bacteria and moulds in spoiled coconut was significantly lower than that in coconut obtained from the processor or purchased from retail outlets. It is suggested that the accumulation of free fatty acids, aliphatic methyl ketones and secondary alcohols produced during fungal spoilage has had a bactericidal and fungicidal effect. The use of microbial specifications for foods is questioned in situations where there is evidence of microbial spoilage having taken place.

In July 2021, Public Health Wales received two notifications of salmonella gastroenteritis. Both cases has attended the same barbecue to celebrate Eid al–Adha, two days earlier. Additional cases attending the same barbecue were found and an outbreak investigation was initiated. The barbecue was attended by a North African community’s social network. On same day, smaller lunches were held in three homes in the social network. Many people attended both a lunch and the barbecue. Cases were defined as someone with an epidemiological link to the barbecue and/or lunches with diarrhoea and/or vomiting with date of onset following these events. We undertook a cohort study of 36 people attending the barbecue and/or lunch, and a nested case-control study using Firth logistic regression. A communication campaign, sensitive towards different cultural practices, was developed in collaboration with the affected community. Consumption of a traditional raw liver dish, ‘marrara’, at the barbecue was the likely vehicle for infection (Firth logistic regression, aOR: 49.99, 95%CI 1.71–1461.54, p = 0.02). Meat and offal came from two local butchers (same supplier) and samples yielded identical whole genome sequences as cases. Future outbreak investigations should be relevant to the community affected by considering dishes beyond those found in routine questionnaires.

In the Medical Research Council's Special Reports, Nos. 91 and 92, and in the Journal of Hygiene, vol. XIV. No. 1, July, 1925, W. G. Savage and P. Bruce White stress the desirability of restricting the term “B. paratyphosus B” to the organism of paratyphoid fever and nothing else, and of designating the organism that most commonly causes food-poisoning outbreaks as B. aertrycke, and not as B. paratyphosus B (type aertrycke). In view of the fact that the features of a paratyphoid fever outbreak due to infected ice-cream, and of an aertrycke enteritis due to infected pork as occurring in Aberdeen in 1925 emphasise the distinction between paratyphoid fever and aertrycke enteritis, it has seemed well to record these two outbreaks in some detail for the purpose of contrasting them the one with the other and with the milkborne Gaertner enteritis which is recorded in the preceding paper.

Though milk has often been considered the medium by means of which outbreaks of diphtheria have been propagated, the diphtheria bacillus has only on rare occasions been isolated from the milk in a virulent form.

The introduction of pneumococcal conjugate vaccines (PCV) into the childhood vaccination programme has reduced invasive pneumococcal disease (IPD). Although anticipated from data elsewhere, surveillance in Ireland has confirmed reductions in IPD amongst those ⩾65 years of age due to a decline of PCV serotypes in this age group. Currently, direct protection against IPD in the elderly is focused on immunisation with the 23-valent pneumococcal polysaccharide vaccine (PPV23). However, immunity may not be as effective as with PCV and, furthermore, PPV23 uptake is poor in Ireland. Hence, consideration should be given to providing a PCV to this age group.

This work is concerned with the cleaning and disinfection by heat of stainless-steel and polypropylene bedpans, which had been soiled with either a biological contaminant, human serum albumin (HSA) labelled with technetium-99m 99m(Tc), or a bacteriological contaminant, streptococcus faecalis mixed with Tc-labelled HSA. Results of cleaning and disinfection achieved with a Test Machine and those achieved by procedures adopted in eight different wards of a general hospital are reported. Bedpan washers installed in wards were found to be less efficient than the Test Machine, at least partly because of inadequate maintenance. Stainless-steel and polypropylene bedpans gave essentially the same results.

The analysis of an epidemic of influenza in the New Zealand division of the Royal Navy confirms the following hypotheses which were suggested by previous studies of the same and other diseases.

(1) The type of influenza in different places, especially if they are more or less isolated areas, such as islands or ships, tends to assume special characters as regards infectivity, virulence, and clinical type1. In this respect the influenza virus, or viruses, are only following a well-known biological “law,” namely, that isolation tends to encourage the evolution of new varieties and species. A classical example of this “law” is found in Darwin's reference to the fact that each island of the Galapagos Archipelago has its own special flora and fauna—similar to but yet different from that of the other islands.

(2) One wave of influenza, even if of a different type, will confer considerable immunity to a subsequent wave not only on the victims attacked, but also on those who apparently escaped infection during the first wave.

(3) The brunt of the morbidity of influenza (and other infections) is borne by recruits and junior ratings, not because they are, on the whole, younger, but because they have had less time than the senior men to adapt themselves, by means of auto-vaccination, to the bacterial environment of crowded ships or barracks.

The effect of bacterial adaptation to environment is often overlooked. Hence other factors, such as physical fitness, are often given more credit than they deserve as preservers of the public health.

(4) Senior ratings mixed with recruits suffer a higher morbidity from infectious disease than they do under similar circumstances in the absence of recruits. This statement, if true, should have a most important practical bearing on military medical administration. The phenomenon is probably due to increased velocities of infection (due to the higher infectibility of the recruits) breaking down the herd immunity of the senior men.

(5) In this epidemic New Zealanders suffered more from influenza than the British sailors not, as usually supposed, because of the mere fact of being born in New Zealand, but because all the recruits and the bulk of the junior ratings were New Zealanders.

In recent years widespread circulation of salmonella and shigella strains resistantto multiple antibiotics has become an international problem. Accordingly the bacterial sensitivity to a range of antibiotics has been assessed in vitro and recorded for the period 1979–83 for patients from the Al Qassimi Hospital. A total of 229 enteric pathogens from 148 children and 59 adult patients were isolated and studied. Most of the enterobacteria were sensitive to colistin, gentamicin, trimethoprim and chloramphenicol (Salmonella typhi approached 100% sensitivity). High rates of sensitivity were also found to ampicillin in S. typhi (96%) and other salmonella serotypes (85%), whilst only 57% of Shigella species and 14% of Escherichia coli were sensitive to this antibiotic. Low rates of sensitivity to sulphamethoxazole, streptomycin and tetracycline were found in shigella and E. coli (ranging from 7 to 14%). Approximately 50% of S. typhi and other salmonella serotypes were sensitive to sulphamethoxazole and streptomycin and 80% to tetracycline. Resistance to three or more antibiotics was very common in shigella and enteropathogenic strains of E. coli (74–85%), less common in non-typhoid salmonella (29%) and exceptional in S. typhi strains. In general, shigella and E. coli isolates showed a high rate of resistance to several antibiotics, whilst S. typhi and other salmonella serotypes retained their original sensitivity to most of the antibiotics used in clinical practice.

Green & Mellanby (1928, 1930) were the first to direct attention to a specific relationship between vitamin A deficiency and infection. They studied the occurrence of spontaneous infections in vitamin A-deficient rats and concluded that animals fed on a diet deficient in vitamin A, but complete in all other respects, develop multiple infective lesions and die. Since then vitamin A has become known as the ‘anti-infective’ vitamin.

To investigate the current epidemiology of melioidosis in Yangon, Myanmar, between June 2017 and May 2019 we conducted enhanced surveillance for melioidosis in four tertiary hospitals in Yangon, where the disease was first discovered in 1911. Oxidase-positive Gram-negative rods were obtained from the microbiology laboratories and further analysed at the Department of Medical Research. Analysis included culture on Ashdown agar, the three disc sensitivity test (gentamicin, colistin and co-amoxiclav), latex agglutination, API 20 NE, antibiotic susceptibility testing, and a subset underwent molecular confirmation with a Burkholderia pseudomallei specific assay. Twenty one of 364 isolates (5.7%) were confirmed as B. pseudomallei and were mostly susceptible to the antibiotics used in standard therapy for melioidosis. Ten patients were from Yangon Region, nine were from Ayeyarwaddy region, and one each was from Kayin and Rakhine States. A history of soil contact was given by seven patients, five had diabetes mellitus and one had renal insufficiency. The patients presented with septicaemia (12 cases), pneumonia (three cases), urinary tract infection (two cases) and wound infection (four cases). Eighteen patients survived to hospital discharge. This study highlights the likelihood that melioidosis may be far more common, but underdiagnosed, in more rural parts of Myanmar as in other countries in SE Asia.

In this study, we used plasmid profile analysis, XbaI macrorestriction with pulsed-field gel electrophoresis (PFGE), and PCR of the ipaH gene, to study the molecular characteristics of 183 Shigella spp. isolated during May 2000 to April 2003 from rectal swabs of patients with watery and/or bloody diarrhoea in a new industrialized area of Thailand. Among the 183 isolates, 167 were S. sonnei and 16 were S. flexneri. For plasmid profile analysis, the 183 isolates revealed 16 different plasmid patterns, designated patterns A to P. The sizes of the plasmid bands were: 6, 5·5, 5, 4·5, 4, 3·25, 2·75, 2·5, 2, 1·75, 1·5 and/or 1·25 kb. The frequency of each plasmid band was 4·5 kb (165 isolates), 3·25 kb (161 isolates), 5·5 kb (129 isolates), 1·75 kb (121 isolates), 1·5 kb (35 isolates), 5 kb (21 isolates), 2 kb (16 isolates), 2·75 kb (12 isolates), 1·25 kb (9 isolates), and 6 kb (8 isolates). PFGE analysis revealed 45 different XbaI macrorestricted DNA banding patterns which could be grouped into 11 groups. All the isolates gave PCR amplicons of the ipaH gene. Plasmid profile analysis and PFGE are powerful tools for differentiation of the Shigella spp. This study provides important data on the molecular characteristics of Shigella isolates in Thailand, which could be useful as an epidemiological baseline for identifying relationships with strains that may emerge in the future.

(a) A field investigation into an outbreak of poliomyelitis in Auckland in the summer of 1947–8 is described.

(b) The object of the investigation was to study the background of the epidemic in the general population, to discover how it had commenced, and how much minor illness related to poliomyelitis had occurred (i) amongst household contacts, (ii) in other persons residing in the same neighbourhood, and (iii) in those parts of the urban area least affected by the epidemic.

(c) Conclusions reached have been detailed in the preceding section. A relationship was established between minor (‘suspect’) illnesses and positive cases; the ratio of ‘suspect’ to positive cases at different age levels has been calculated, and an estimate is given of the extent to which the population as a whole was affected. Reasons are adduced for believing that, during an epidemic, mode of life and personal habits may be of more importance in determining the fate of the individual than previously acquired immunity.

(d) It is suggested that indoor dust-borne infection, at school and in the home, may be important, and that the results of recent research into threadworm infestation may throw light on this factor.

Middle East respiratory syndrome coronavirus (MERS-CoV) causes a potentially fatal respiratory disease. Although it is most common in the Arabian Peninsula, it has been exported to 17 countries outside the Middle East, mostly through air travel. The Risk Assessment Guidelines for Infectious Diseases transmitted on Aircraft (RAGIDA) advise authorities on measures to take when an infected individual travelled by air. The aim of this systematic review was to gather all available information on documented MERS-CoV cases that had travelled by air, to update RAGIDA. The databases used were PubMed, Embase, Scopus and Global Index Medicus; Google was searched for grey literature and hand searching was performed on the EU Early Warning and Response System and the WHO Disease Outbreak News. Forty-seven records were identified, describing 21 cases of MERS that had travelled on 31 flights. Contact tracing was performed for 17 cases. Most countries traced passengers sitting in the same row and the two rows in front and behind the case. Only one country decided to trace all passengers and crew. No cases of in-flight transmission were observed; thus, considering the resources it requires, a conservative approach may be appropriate when contact tracing passengers and crew where a case of MERS has travelled by air.