1. The annual number of notified cases of erysipelas is approximately 17,000, and assuming complete notification of the disease the general case fatality is approximately 6 per cent.

2. The death-rate, deaths in terms of the population, varies according to age, being highest at the beginning and end of life and at a minimum between the age of 5 and 10 years. The mortality of males is identical with that of females up to age 25, but is afterwards in excess.

3. The disease has in recent years a well-marked seasonal incidence—a winter and spring excess with a summer defect. In this respect it resembles scarlet and puerperal fevers and, although its seasonal incidence has changed in the course of time, the alteration has not been nearly so pronounced as that for scarlet fever.

4. The incidence is highly correlated with overcrowded conditions, the correlation coefficient being in some periods as high as + 0·83 in the divisions of London and + 0·70 in the sanitary districts of Glasgow.

5. The morbidity from erysipelas is fairly well correlated in time with that from scarlet fever and erysipelas, but in London, in the urban and in the rural districts of England and Wales, the spacial correlation is very small. On the other hand, in Glasgow the spacial correlation between the incidence of erysipelas and that of scarlet fever is highly negative, −0·718 ±0·109, whereas between erysipelas and puerperal fever the association is positive, + 0·689±0·109 during the period 1903–8, but these values were much reduced when the partial coefficients were calculated.

Adolescent men who have sex with men (AMSM) and transgender women (ATGW) enrolled as part of the PrEP1519 study between April 2019 and February 2021 in Salvador were tested for Neisseria gonorrhoeae (NG) and Chlamydia trachomatis (CT) infections.We performed real-time polymerase chain reaction using oropharyngeal, anal, and urethral swabs; assessed factors associated with NG and CT infections using multivariable Poisson regression analysis with robust variance; and estimated the prevalence ratios (PRs) and 95% confidence intervals (95% CIs). In total, 246 participants were included in the analyses (median age: 18.8; IQR: 18.2–19.4 years). The overall oropharyngeal, anal, and urethral prevalence rates of NG were 17.9%, 9.4%, 7.6%, and 1.9%, respectively. For CT, the overall, oropharyngeal, anal, and urethral prevalence rates were 5.9%, 1.2%, 2.4%, and 1.9%, respectively. A low level of education, clinical suspicion of STI (and coinfection with Mycoplasma hominis were associated with NG infection. The prevalence of NG and CT, especially extragenital infections, was high in AMSM and ATGW. These findings highlight the need for testing samples from multiple anatomical sites among adolescents at a higher risk of STI acquisition, implementation of school-based strategies, provision of sexual health education, and reduction in barriers to care.

The outbreak of poliomyelitis in Finland in 1984 was caused by a wild strain of poliovirus 3 with uncommon molecular and antigenic properties. We prepared a synthetic oligonucleotide probe complementary to nucleotides 494–510 in the 5′-noncoding part of the genome of a representative strain of the outbreak. This short nucleotide stretch was found to be relatively well conserved within the outbreak and uncommon among 82 independent poliovirus isolates. It may thus be a useful marker for screening isolates to identify those requiring more detailed genetic comparison. The sequences of the corresponding region of the genome are known for 32 separate poliovirus strains and 3 coxsackie B virus strains and show 6 fully conserved nucleotides that could assume a constant hairpin-loop position in a hypothetical secondary structure of the RNA. This could explain the persistence of a particular 17 nucleotide sequence for 40 years in nature in this highly variable region of the poliovirus genome.

Tick-borne diseases (TBDs) can sometimes cause severe symptoms and lead to hospitalisation, but they often go unnoticed in the Emergency Department (ED). The aim of this study was twofold: (i) to describe the profile of patients hospitalised by TBDs; and (ii) to evaluate the data collected in the medical records from the ED in order to analyse their potential clinical consequences. A total of 84 cases that included all TBD diagnoses registered in the ED records were identified and analysed. These corresponded to all the hospitalisations by TBDs in the last 10 years (2009–2019) in two tertiary hospitals in Granada, Spain. Statistical analyses were made using RStudio. Coinciding with the absence of patient's report of exposure to ticks, 64.3% of TBDs were not suspected in the ED. Intensive care unit admission was required in 8.3% of cases, and the mortality rate was 2.4%. Non-suspected cases showed longer hospital stay (P < 0.001), treatment duration (P = 0.02) and delay in the initiation of antibiotic treatment (P < 0.001). Our findings indicate that symptoms associated with TBDs are highly non-specific. In the absence of explicit information related to potential tick exposure, TBDs are not initially suspected. As a consequence, elective treatment administration is delayed and hospitalisation time is prolonged. In conclusion, our results highlight the importance of addressing potential exposure to ticks during the ED contact with patients presenting with febrile syndrome.

Noroviruses (NoVs) are major causal agents of acute gastroenteritis in humans. NoV GII.4 is the predominant genotype globally. However, uncommon and minor types of NoVs are consistently detected and some have been shown to dominate over GII.4. Therefore, the prevalence of dominant and uncommon NoVs makes the identification of these viruses important for the prediction and prevention of pandemics. In this study, the full-genome sequence of a NoV (strain JW) detected in Korea was extensively characterized. The full-length genome was 7510 nucleotides long, and phylogenetic analysis based on the whole-genome sequences, including open reading frame (ORF)1, ORF2, and ORF3, indicated that it belonged to the GII.21 genotype. Strain JW showed maximum identity with strain YO284; however, comparison of the amino acid sequence of ORF2, which functions as an antigen, showed substitutions in several amino acids. GII.21 is not a prevalent epidemiological agent of acute gastroenteritis in humans, but it is consistently found in gastroenteritis patients from several countries. The present study provides the first full-genome sequence analysis of NoV GII.21 isolated from a patient in Korea. Our findings provide not only valuable genome information but also data for epidemiology studies, epidemic prevention, and vaccine development strategies.

The fermentation of mannitol by coagulase-positive staphylococci has been studied. It was found difficult to obtain reproducible results by methods which could be conveniently used in a routine department.

A method of grading based on the fermentation of mannitol has been examined. Organisms of the supposedly most dangerous grade (Grade A) were isolated slightly more frequently from lesions than from carriers, but from all sources a high proportion of strains belonged to this grade.

It was not possible to correlate the grades to which staphylococci were assigned with their production of diffusible antigens.

In this hospital it seems that the proportion of strains assigned to Grade A has become very much higher than it was 15 years ago.

We thank Prof. R. Knox, Mr J. B. Blaikley, Dr W. H. H. Merivale, and Dr R. H. Gorrill for the help and advice they have given us in the course of this investigation and numerous members of the nursing staff of Guy's Hospital for their co-operation in checking records and answering questions.

The variously coloured patches appearing on the surface of chilled beef are caused by fungi. Amongst these, Cladosporium herbarum, producing black spots, is the only fungus that has become specially adapted for flourishing on such an unusual substratum, and may in consequence be expected to continue and even increase in quantity on its new matrix, unless stringent measures are adopted. This fungus is not pathogenic, and the only effect caused by its presence is the unsightly appearance of the meat and consequent deterioration in value. If extensive, the meat may be rendered unsaleable.

The beef is infected with the “black spot” fungus before, it is shipped, and to arrest the continuance of this infection special measures should be taken, with the object of exterminating the fungus, which in its specialised form can only occur in the vicinity of the establishment where meat is prepared for shipment.

Data on the prevalence of extrapulmonary tuberculosis (EPTB) patients are limited in many African countries including Malawi. We conducted a retrospective review of all histology reports for cancer suspected patients at Mzuzu Central Hospital (MZCH) between 2013 and 2018 to determine the proportion of EPTB cases among cancer suspected patients and characterised them epidemiologically. All reports with inconclusive findings were excluded. In total, 2214 reports were included in the review, 47 of which reported EPTB, representing 2.1% (95% CI 1.6−2.8). The incidence of EPTB was significantly associated with sex, age and HIV status. Men were more than twice (OR 2.1; 95% CI 1.2–3.9) as likely to have EPTB as women while those with HIV were more than six times (OR 6.4; 95% CI 1.7–24.8) as likely to have EPTB compared to those who were HIV-negative. EPTB demonstrated an inverse relationship with age. The highest proportion of EPTB was found from neck lymph nodes (10.3% (5.4–17.2)). A reasonable number of EPTB cases are diagnosed late or missed in Malawi's hospitals. There is a need for concerted efforts to increase EPTB awareness and likely come up with a policy to consider EPTB as a differential diagnosis in cancer suspected patients.

It is well known that when milk is allowed to sour, the rise in acidity is not directly proportional to the increase in the number of acid-forming bacteria. There is a distinct phase in the process during which numerical increase of these organisms takes place, accompanied only by slight acid production, after which the acidity rises very rapidly to a maximum.

This study assessed the efficacy of ThinPrep cytologic test and human papillomavirus (HPV) co-test in cervical cancer screening during pregnancy. A cohort of 8,712 pregnant women from Ren Ji Hospital participated in the study. Among them, 601 (6.90%) tested positive for high-risk HPV (HR-HPV) and 38 (0.44%) exhibited abnormal cytology results (ASCUS+). Following positive HR-HPV findings, 423 patients underwent colposcopy, and 114 individuals suspected of having high-grade squamous intraepithelial lesion and cervical cancer (HSIL+) underwent cervical biopsy. Histological examination revealed 60 cases of normal pathology (52.63%), 35 cases of low‐grade squamous intraepithelial lesion (30.70%), 17 cases of HSIL (14.91%), and 2 cases of cervical cancer (1.75%). The incidence of HSIL+ in HPV 16/18 group was significantly higher than that in non-HPV16/18 group (10.53% vs. 6.14%, P < 0.05). Subsequent evaluation of the clinical performance of cytology alone, primary HPV screening, and co-testing for HSIL+ detection revealed that the HSIL+ detection rate was lowest with cytology alone. These findings suggest that HPV testing, either alone or combined with cytology, presents an efficient screening strategy for pregnant women, underscoring the potential for improved sensitivity in cervical cancer screening during pregnancy. The significantly higher incidence of HSIL+ in the HPV16/18 group emphasizes the importance of genotype-specific considerations.

Routine blood examination is an easy way to examine infectious diseases. This study is aimed to develop a model to diagnose serious bacterial infections (SBI) in ICU neonates based on routine blood parameters. This was a cross-sectional study, and data were extracted from the Medical Information Mart for Intensive Care III (MIMIC-III). SBI was defined as suffering from one of the following: pyelonephritis, bacteraemia, bacterial meningitis, sepsis, pneumonia, cellulitis, and osteomyelitis. Variables with statistical significance in the univariate logistic regression analysis and log systemic immune–inflammatory index (SII) were used to develop the model. The area under the curve (AUC) was calculated to assess the performance of the model. A total of 1,880 participants were finally included for analysis. Weight, haemoglobin, mean corpuscular volume, white blood cell, monocyte, premature delivery, and log SII were selected to develop the model. The developed model showed a good performance to diagnose SBI for ICU neonates, with an AUC of 0.812 (95% confidence interval (CI): 0.737–0.888). A nomogram was developed to make this model visualise. In conclusion, our model based on routine blood parameters performed well in the diagnosis of neonatal SBI, which may be helpful for clinicians to improve treatment recommendations.

A foodborne outbreak related to milk cartons served in school lunches occurred in June 2021, which involved more than 1,800 cases from 25 schools. The major symptoms were abdominal pain, diarrhoea, vomiting, and fever. Although major foodborne toxins and pathogens were not detected, a specific Escherichia coli strain, serotype OUT (OgGp9):H18, was predominantly isolated from milk samples related to the outbreak and most patients tested. The strains from milk and patient stool samples were identified as the same clone by core genome multilocus sequence typing and single-nucleotide polymorphism analysis. The strain was detected in milk samples served for two days related to the foodborne outbreak at a rate of 69.6% and levels of less than ten most probable number/100 mL but not on days unrelated to the outbreak. The acid tolerance of the strain for survival in the stomach was similar to that of enterohaemorrhagic E. coli O157:H7, and the same inserts in the chu gene cluster in the acid fitness island were genetically revealed. The pathogenicity of the strain was not clear; however, it was indicated that the causative pathogen was atypical diarrhoeagenic E. coli OUT (OgGp9):H18.

In 1898 I published1 a brief account of certain amœbulæ and flagellulæ found by me during the previous year in mosquitoes near and in Ootacamund, India. Similar parasites were frequently observed by me subsequently in various species of Culicina, especially in C. fatigans Wiedemann, and once in an Anophelina. Since then what appear to be the same, or at least closely allied, organisms have been described as occurring in Anophelina by Chatterjee, Stephens and Christophers, and L´ger, the last of whom named them Chrithidia fasciculata. Their habitat appears to be principally the intestinal cavity of the larva, pupa and imago. Many of them (as still well shown in an unstained preparation of my own made in Calcutta in 1899) have a considerable resemblance to trypanosomes—a resemblance which appears to be further suggested by the stained preparations of Léger, Christophers, and Stephens.

In early October 2014, 7 months after the 2014–2015 Ebola epidemic in West Africa began, a cluster of reported deaths in Koinadugu, a remote district of Sierra Leone, was the first evidence of Ebola virus disease (Ebola) in the district. Prior to this event, geographic isolation was thought to have prevented the introduction of Ebola to this area. We describe our initial investigation of this cluster of deaths and subsequent public health actions after Ebola was confirmed, and present challenges to our investigation and methods of overcoming them. We present a transmission tree and results of whole genome sequencing of selected isolates to identify the source of infection in Koinadugu and demonstrate transmission between its villages. Koinadugu's experience highlights the danger of assuming that remote location and geographic isolation can prevent the spread of Ebola, but also demonstrates how deployment of rapid field response teams can help limit spread once Ebola is detected.

Repeated serosurveys are an important tool for understanding trends in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and vaccination. During 1 September 2020–20 March 2021, the NYC Health Department conducted a population-based SARS-CoV-2 antibody prevalence survey of 2096 NYC adults who either provided a blood specimen or self-reported the results of a previous antibody test. The serosurvey, the second in a series of surveys conducted by the NYC Health Department, aimed to estimate SARS-CoV-2 antibody prevalence across the city and for different groups at higher risk for adverse health outcomes. Weighted citywide prevalence was 23.5% overall (95% confidence interval (CI) 20.1–27.4) and increased from 19.2% (95% CI 14.7–24.6) before coronavirus disease 2019 vaccines were available to 31.3% (95% CI 24.5–39.0) during the early phases of vaccine roll-out. We found no differences in antibody prevalence by age, race/ethnicity, borough, education, marital status, sex, health insurance coverage, self-reported general health or neighbourhood poverty. These results show an overall increase in population-level seropositivity in NYC following the introduction of SARS-CoV-2 vaccines and highlight the importance of repeated serosurveys in understanding the pandemic's progression.

We aimed to assess whether the characteristics of influenza-like illness (ILI) cases in the general population were similar during the seasonal and pandemic A(H1N1)pdm09 influenza periods. We conducted a study using a general population database, which included demographic (sex, age) and clinical (underlying medical conditions, influenza vaccination status) information on more than 80 000 subjects. We assessed the most important predictors of ILI during each season by using multiple logistic regression. We descriptively compared whether they were similar during different seasons. The model, including all demographic and clinical characteristics, showed that age ⩾60 years decreased the odds for ILI by 52% and 81% during the seasonal and A(H1N1)pdm09 pandemic periods, respectively. Being vaccinated decreased the odds of ILI for seasonal influenza by 32%, while suffering from the comorbidities other than lung or cardiovascular diseases doubled the odds of ILI during the A(H1N1)pdm09 pandemic.

Despite well-recognized heterogeneity in malaria transmission, key parameters such as the force of infection (FOI) are generally estimated ignoring the intrinsic variability in individual infection risks. Given the potential impact of heterogeneity on the estimation of the FOI, we estimate this quantity accounting for both observed and unobserved heterogeneity. We used cohort data of children aged 0·5–10 years evaluated for the presence of malaria parasites at three sites in Uganda. Assuming a Susceptible–Infected–Susceptible model, we show how the FOI relates to the point prevalence, enabling the estimation of the FOI by modelling the prevalence using a generalized linear mixed model. We derive bounds for varying parasite clearance distributions. The resulting FOI varies significantly with age and is estimated to be highest among children aged 5–10 years in areas of high and medium malaria transmission and highest in children aged below 1 year in a low transmission setting. Heterogeneity is greater between than within households and it increases with decreasing risk of malaria infection. This suggests that next to the individual's age, heterogeneity in malaria FOI may be attributed to household conditions. When estimating the FOI, accounting for both observed and unobserved heterogeneity in malaria acquisition is important for refining malaria spread models.

A method is presented with which the mechanical cleaning effect of flushing disinfectors can be estimated independently of the thermal disinfecting effect of the hot flushing water. This makes it possible to specify the demands to be placed on the disinfecting effect of flushing with water of 85°C or more.

Bacillus stearothermophilus spores suspended in faeces were used as indicators because of their non-sensitivity to the hot-water temperature. Their elimination by flushing could thus be attributed to the mechanical effect of the water and not to the disinfecting effect of the temperature. A simple bacteriological technique was used, and the elimination factor (EF) was calculated as the ratio of the number of micro-organisms in the contamination before and after flushing. By using flushing water below 50°C for 130 s the EF on a bedpan was about 104–106. The effect of flushing with water of the same temperature for only half that time was somewhat weaker and when the temperature was raised to 85 °C after half the flushing time the effect was somewhat stronger.

It can be presumed that the conventional disinfecting phase with hot (85 °C) water for about 45 s in the commonly used flushing units could be substantially shortened and the costs of their use thereby reduced.

1. In our hands the assay of a plague vaccine, in terms of its power to protect mice against what was hoped to be a standard challenge, was found to be impracticable.

2. Assay by mouse protection tests in terms of a Standard vaccine was found to be possible, but it proved to be a very time-consuming procedure and demanded the use of an almost prohibitively large number of mice for a sufficient number of replicate tests which are required to offset the variability in the method. Theoretically a single test might be adequate if the numbers of immunized mice were very large, but there are obvious limitations to the numbers of mice that can be included in a single test of this nature.

3. The Ouchterlony plate technique proved to be useful in indicating the antigens present in a particular vaccine, but not on a strictly quantitative basis.

4. The vaccine prepared from the virulent human strain of P. pestis was found to protect mice more efficiently than those prepared from avirulent strains and when the protective potency was expressed in terms of content of antigen and high molecular weight substances the vaccine prepared from the virulent culture was found to be even more potent than the Standard acetone-dried vaccine.

5. The use of formalin as a preservative results in some loss of potency of a vaccine but, provided the strain of P. pestis used for the preparation of the vaccine is highly virulent, this need not be serious and is offset by a number of advantages.

The co-ordinates of the dwellings where cases of variola minor (alastrim) occurred during a small epidemic were used in a worked example of contour mapping of disease spread. The contoured variable was the date of onset, relative to an arbitrary base date, of the case introducing the disease into each of twenty-two households. Three contour maps prepared with slightly different computer programmes or dates exhibited similar concentric loops whose centres were close to the first infected household. The average rate of spread of the disease was estimated by regression of the number of days to onset of the first case in the household on the average distance from an arbitrary origin to the relevant contour line. The calculated average rate of spread was 1.22 metres per day. An additional map was contoured using the cumulative number of cases as the contoured variable, relative to the onset of the example epidemic.