The vibriocidal activity of Inaba and Ogawa antisera, from which cross-reacting agglutinin had been absorbed, was specific for Vibrio cholerae strains of the homologous serotype. No vibriocidal action against strains of the heterologous type was detected.

The sera appeared to be equally effective in killing organisms of different biotypes (classical, intermediate, and EITor), provided that these were of the homologous serotype (Inaba or Ogawa). However, they had been raised against strains of the classical biotype only; and sera resulting from immunization with other biotypes had not been prepared.

The implications of these findings in immunity to cholera are discussed.

Chickenpox is caused by varicella-zoster-virus (VZV) and is highly contagious. Immigration detention settings are a high-risk environment for primary VZV transmission, with large, rapidly-changing populations in close quarters, and higher susceptibility among non-UK-born individuals. During outbreaks, operational challenges occur in detention settings because of high-turnover and the potential need to implement population movement restriction for prolonged periods. Between December 2017 and February 2018, four cases of chickenpox were notified amongst 799 detainees in an immigration removal centre (IRC). Microbiological investigations included case confirmation by vesicular fluid polymerase chain reaction, and VZV serology for susceptibility testing. Control measures involved movement restrictions, isolation of cases, quarantining and cohorting of non-immune contacts and extending VZV immunity testing to the wider detainee population to support outbreak management. Immunity was tested for 301/532 (57%) detainees, of whom 24 (8%) were non-immune. The level of non-immunity was lower than expected based on the existing literature on VZV seroprevalence in detained populations in England. Serology results identified non-immune contacts who could be cohorted and, due to the lack of isolation capacity, allowed the placement of cases with immune detainees. The widespread immunity testing of all detainees was proving challenging to sustain because it required significant resources and was having a severe impact on operational capacity and the ability to maintain core business activities at the IRC. Therefore, mathematical modelling was used to assess the impact of scaling back mass immunity testing. Modelling demonstrated that interrupting testing posed a risk of one additional case compared to continuing with testing. As such, the decision was made to stop testing, and the outbreak was successfully controlled without excessive strain on resources. Operational challenges generated learning for future outbreaks, with implications for a local and national policy on IRC staff occupational health requirements, and proposed reception screening of detainees for VZV immunity.

In 1917 and 1918 Tunnicliff announced that she was able to obtain cocci from the blood of cases of measles in the pre-eruptive and eruptive stages of the disease. It was claimed that anaerobic methods were necessary for their isolation, but after the initial growth appeared these organisms could be sub-cultured aerobically. Later, this worker (Tunnicliff, 1919) found a similar organism to be the predominating species in cultures obtained from the sputum of acutely ill cases. Caronia (1923) reported that he was able to isolate with great regularity a small diplococcus from the blood of measles cases by using the Tarozzi-Noguchi medium.

Using isolates from reported cases of Escherichia coli O157 from Alberta, Canada in 2002, we applied randomization tests to determine if cases associated with an outbreak or statistical space–time cluster had more similar pulsed-field gel electrophoresis patterns, based on Dice coefficients, than expected by chance alone. Within each outbreak and space–time cluster, we assessed the mean, median, 25th percentile, 75th percentile, standard deviation, coefficient of variation, and interquartile range of the Dice coefficients of each pairwise comparison among the isolates. To assess the statistical significance of measures of location (e.g. mean) and variation (e.g. standard deviation) we created randomization distributions using all isolates or only isolates from sporadic cases. We determined that randomization tests are an appropriate tool for evaluating the similarity among isolates from cases that have been linked epidemiologically or statistically. We found little difference between using all cases or only sporadic cases when creating our randomization distributions.

Hand, foot, and mouth disease (HFMD) is a common childhood infectious disease. The incidence of HFMD has a pronounced seasonal tendency and is closely related to meteorological factors such as temperature, rainfall, and wind speed. In this paper, we propose a combined SARIMA-XGBoost model to improve the prediction accuracy of HFMD in 15 regions of Xinjiang, China. The SARIMA model is used for seasonal trends, and the XGBoost algorithm is applied for the nonlinear effects of meteorological factors. The geographical and temporal weighted regression model is designed to analyze the influence of meteorological factors from temporal and spatial perspectives. The analysis results show that the HFMD exhibits seasonal characteristics, peaking from May to August each year, and the HFMD incidence has significant spatial heterogeneity. The meteorological factors affecting the spread of HFMD vary among regions. Temperature and daylight significantly impact the transmission of the disease in most areas. Based on the verification experiment of forecasting, the proposed SARIMA-XGBoost model is superior to other models in accuracy, especially in regions with a high incidence of HFMD.

Without protective immunity, recurrent sexually transmitted infections (STI) could occur. In this study, we retrospectively collected STI diagnosis records from public STI clinics attended by an average of 6,000 male patients annually in Hong Kong in 2009–2019. We estimated the prevalence of three bacterial STI (syphilis, chlamydia and gonorrhoea) coinfection from 2009 to 2019, and examined the factors associated with coinfection in 2014/15 and repeat infection in 2009–2019. We observed an increasing coinfection prevalence in male attendees with bacterial STI over the years, which reached the highest level of 15% in 2019. Among 3,698 male patients in 2014–2015, chlamydia/gonorrhoea coinfection was the commonest among all coinfections (77%). Factors such as young age (29 or below), HIV-positive status, and a history of concurrent genital warts/herpes were positively associated with coinfection in 2014/15 in multivariable logistic regression. Of all male patients with STI coinfection in 2014/15, those of age 30–49 and who self-reported as men who have sex with men (MSM) were more likely to have been repeatedly infected in 2009–2019. The results support the implementation of regular multi-STI testing as an STI control strategy for selected communities like MSM and people living with HIV.

The actiology, epidemiology and clinical presentation of 137 bacteriologically confirmed cases of superficial mycobacterial lymphadenitis identified at the Liverpool Public Health Laboratory between 1969 and 1984 were reviewed. Despite a fall in pulmonary and total extrapulmonary isolates, the annual recovery of mycobacteria from lymph nodes remained relatively constant. Mycobacterium tuberculosis was the cause of infection in 121 patients (88·3%), M. bovis in 6 and the remaining 10 isolates were atypical mycobacteria. In European patients (68·6%) the highest incidence was in the elderly, whereas in non-Europeans (31·4%) the disease almost exclusively occurred in the third and fourth decades. The proportion of isolates from non-Europeans reflected the size of the immigrant population and increased during the period of study.

Kansas City, Missouri, became one of the major United States hotspots for COVID-19 due to an increase in the rate of positive COVID-19 test results. Despite the large numbers of positive cases in Kansas City, MO, the spatial-temporal analysis of data has been less investigated. However, it is critical to detect emerging clusters of COVID-19 and enforce control and preventive policies within those clusters. We conducted a prospective Poisson spatial-temporal analysis of Kansas City, MO data to detect significant space-time clusters of COVID-19 positive cases at the zip code level in Kansas City, MO. The analysis focused on daily infected cases in four equal periods of 3 months. We detected temporal patterns of emerging and re-emerging space-time clusters between March 2020 and February 2021. Three statistically significant clusters emerged in the first period, mainly concentrated in downtown. It increased to seven clusters in the second period, spreading across a broader region in downtown and north of Kansas City. In the third period, nine clusters covered large areas of north and downtown Kansas City, MO. Ten clusters were present in the last period, further extending the infection along the State Line Road. The statistical results were communicated with local health officials and provided the necessary guidance for decision-making and allocating resources (e.g., vaccines and testing sites). As more data become available, statistical clustering can be used as a COVID-19 surveillance tool to measure the effects of vaccination.

Measles resurged in Vietnam between 2018 and 2020, especially in the Southern region. The proportion of children with measles infection showed quite some variation at the provincial level. We applied a spatio-temporal endemic–epidemic modelling framework for age-stratified infectious disease counts using measles surveillance data collected in Southern Vietnam between 1 January 2018 and 30 June 2020. We found that disease transmission within age groups was greatest in young children aged 0–4 years whereas a relatively high between-group transmission was observed in older age groups (5–14 years, 15–24 years and 25+ years groups). At the provincial level, spatial transmission followed an age-dependent distance decay with measles spread mainly depending on local and neighbouring transmission. Our study helped to clarify the measles transmission dynamics in a more detailed fashion with respect to age strata, time and space. Findings from this study may help determine proper strategies in measles outbreak control including promotion of age-targeted intervention programmes in specific areas.

A measles outbreak occurred in a school in a small town in the South East of Ireland in September–November 2013. Most (and all early) cases had one dose of the measles-mumps- rubella (MMR) vaccination. All suspected cases were followed up, in order to advise on sampling and provide public health advice to them and their contacts. MMR vaccination control measures were instituted in the town. These included early second MMR in primary schools and childcare facilities, bringing forward the planned school MMR catch-up programme, early first MMR dose for children aged 6–12 months and targeted advice to unvaccinated children. There were 20 cases (17 confirmed) of measles associated with the outbreak. Fifteen cases occurred in the index school, with four in pre-school-age children (<4 years) who had clear epidemiological links with children at the school. This was a well-circumscribed outbreak occurring, unusually, in a well-vaccinated population. The outbreak came late to the attention of Department of Public Health staff but prompt action, once notified, and institution of control measures resulted in quick termination of the outbreak and prevention of cases in a neighbouring city.

Nasal swabs were taken from 369 four-year-old children in two South Wales towns and cultured for Streptococcus pneumoniae. The organism was isolated in 34% of the specimens, similar rates being found in boys and girls in the two towns. The children were swabbed again a year later, when the prevalence of nasal pneumococci had fallen to 25%. There was no association between the presence of the organism on the two occasions. Types 6 and 23 were most often isolated. After excluding children who had received an antibiotic, the proportion carrying a pneumococcus was higher in those who had recently had a respiratory infection than in the rest, although the difference was not quite statistically significant. There was a significant negative association between the presence of Staphylococcus aureus and Strep. pneumoniae.

Respiratory infections among infants constitute a major burden to health care systems in developed nations, yet the course and risk factors leading to these conditions are poorly understood. We examine the longitudinal patterns of respiratory infection hospitalisation (RIH) and how these patterns are influenced by neonatal pulmonary morbidities. We included all live births (n = 429 058) occurring in the Australian state of Queensland between January 2009 and December 2015. Data were structured so that each participant had a record (present/absent) of RIH for each month from birth to 12 months. Initially, latent class growth analysis was used to identify the trajectories of RIH adjusted for spatial–temporal factors; using the identified trajectories of RIH as outcomes, we built a multinomial logistic regression model to identify neonatal predictors of RIH trajectories. Our results indicated that a four-class solution was the best fit to the data, comprising a ‘no-risk’ trajectory, a ‘low-risk’ trajectory, an ‘early-risk’ trajectory and a ‘chronic-risk’ trajectory. Compared with the no-risk trajectory, membership in the other trajectories was predicted by a range of neonatal pulmonary morbidities, with transient tachypnoea of newborn showing a specific relationship with the early-risk group and sleep apnoea showing a specific and strong risk with the chronic-risk group. Our findings suggest the possibility of identifying neonates at risk of recurrent RIH and implementing effective intervention strategies prior to neonatal discharge.

1. An electrophoretically homogeneous antigen preparation extracted from a strain (LII) of Pseudomonas aeruginosa by trichloracetic acid inhibits four phages active against this strain, and two phages (5 and 14) to which it is resistant but which attack a mutant strain LIII–3 bi.

2. An extract prepared in the same way from strain LIII–3 bi has no antigenic or inhibitory properties. Lysis of LIII–3 bi organisms by chloroform, however, yields a potent inhibitor active against several phages.

3. TCA extracts from immunologically distinct Ps. strains AII, BII and GII also inhibit phages 5 and 14 to which these strains are resistant.

4. The effect of a third phage (13) on Ps. LIII–3 bi is activated by the extract from strain LII which normally inhibits phages 5 and 14. Prolonged contact with very dilute solutions of the extract also causes activation of phage 5. Activation of phage 14 has not been observed.

5. The above findings are discussed in relation to current theories of phage action and phage inhibition.

Chlorine at the rate of 5 and 10 parts per million of available chlorine in the form of Milton significantly increased the reduction time of milk samples.

Observed increases varied from −0·50 to + 1·25 hr.

At this level of chlorination the increase in R.t. is not correlated with the initial plate count and also occurs at all levels of R.t.

Although cattle movement and commingling play an important role in the inter-herd transmission of pathogens, little is known about the effect of commingling of heifers at raising operations. The objective of this study was to compare the resistance of E. coli and prevalence of Salmonella from pooled faecal pats of heifers raised off-farm at multi-source raisers (MULTI) that raised heifers from at least two farms compared with on-farm raisers (HOME), with heifers from only that farm. MULTI faecal pat samples were collected from pens with animals that had arrived at the farm within the previous 2 months (AP) and from animals that would be departing the heifer raiser in 2–3 months (DP). Corresponding age sampling was conducted at HOME raisers. Odds of ampicillin resistance were 3·0 times greater in E. coli collected from MULTI compared to HOME raisers. E. coli from AP pens had significantly (P < 0·05) higher odds of resistance to ampicillin, neomycin, streptomycin, and tetracycline compared to DP pens. Salmonella recovery was not significantly different between heifer-raising systems (P = 0·3). Heifer-raising system did not have a major overall impact on selection of resistant E. coli, which was strongly affected by the age of the animals sampled.

Strongyloides stercoralis is a neglected parasite that can cause death in immunocompromised individuals. There were no data on the epidemiology of S. stercoralis infection in San Marino Republic until two patients (one of whom died) were diagnosed with severe strongyloidiasis (hyperinfection) between September 2016 and March 2017. A serology test for Strongyloides spp. was introduced in routine practice in the laboratory of the State Hospital to test patients considered to be at risk for strongyloidiasis. Between August 2017 and August 2018, of 42 patients tested with serology, two (4.8%) were positive. An additional case was found by gastric biopsy. Two of the positive cases were presumably autochthonous infections (elderly people with no significant travel history), while the other was a probable imported case (young man born in Nigeria and settled in Europe since 2003). Epidemiology of strongyloidiasis in San Marino might be similar to Northern Italy, where a relevant proportion of cases was diagnosed in immigrants (mainly from sub-Saharan Africa) and in elderly Italians with eosinophilia. Screening for strongyloidiasis might be worthwhile in inhabitants of San Marino in the same categories of individuals, particularly those at risk of immune suppression.

1. Non-avid tetanus antitoxin appears to have a higher titre in relation to an avid standard if titrations are made against test toxins with a high toxoid content. The least avid serum tested appeared to be 2·87 times as potent when titrations were made against a toxin grown for 35 days than when a 2-day growth was used. Using the same test doses avid sera did not show this discrepancy.

2. A mixture of short-growth toxin and formol toxoid reacted similarly to the long-growth toxin.

3. Some non-avid tetanus antitoxic sera showed evidence of difference in goodness of fit with two test toxins; one serum was 2·49 times the titre of another when tested against one toxin and only 1·37 times when tested against another toxin.

4. Diphtheria toxoid has less affinity than toxin for antitoxin; this difference is greater with formol toxoids of poor immunizing efficiency; the difference is further accentuated if non-avid anti-toxin is used.

5. The Danysz effect may be very small if non-avid antitoxin is used.

6. In the presence of excess antitoxin, toxin or formol toxoid can combine with 3, 4 or more times its equivalent as judged by in vivo titrations for free antitoxin.

7. The serum ratio, i.e. in vivo titre/in vitro titre of high or low ratio antitoxin in multiple combinations is nearer unity than that of the original antitoxin.

Epidemic surveillance is an effective means to determine the characteristics of acute diarrhoea and the benefits of disease control and prevention. The epidemiological, clinical, and aetiological data of adult (aged ⩾15 years) acute diarrhoea in a general hospital in Shanghai were collected and analysed. Out of 2430 acute diarrhoea patients, 162 subjects were sampled (sample ratio 15:1). The sampled subjects had an average age (±s.d.) of 44 ± 18 years; 142 (87·7%) had a history that indicated ingestion of contaminated food; and 40 (24·7%), 54 (33·3%), and 73 (45·1%) patients had diarrhoea that was attributed to viral, bacterial, and unknown aetiological origins respectively. Viral diarrhoea is mainly prevalent during the winter and spring months, while bacterial and diarrhoea of unknown aetiology occur mainly in the summer months. The average age of the unknown aetiology group (48 ± 19 years) was significantly older than that of the viral diarrhoea group (39 ± 16 years). The number of patients with vomiting in the viral group (30·6%) was significantly higher than that in the bacterial (17·1%) and unknown aetiology (8·2%) groups. Viral and bacterial infections are the main cause of acute diarrhoea in Shanghai. However, further effective technological means are needed to improve the surveillance, control, and prevention of acute diarrhoea.

Enquiries have frequently been received at the National Institute for Research in Dairying concerning the efficiency of the Fermentation-Reductase Test as a method for the grading of milk, and the suggestion has been made that this test, which is now in use in some European countries, might with advantage be substituted for the standard methods of counting bacteria and demonstrating the presence or absence of B. coli, which at present form the basis for the grading of milk in England. A study of this question was therefore undertaken, and since similar enquiries are still being received, it is thought advisable to publish a résumé of the results that have already been obtained.