Enteric illness outbreaks are complex events, therefore, outbreak investigators use many different hypothesis generation methods depending on the situation. This scoping review was conducted to describe methods used to generate a hypothesis during enteric illness outbreak investigations. The search included five databases and grey literature for articles published between 1 January 2000 and 2 May 2015. Relevance screening and article characterisation were conducted by two independent reviewers using pretested forms. There were 903 outbreaks that described hypothesis generation methods and 33 papers which focused on the evaluation of hypothesis generation methods. Common hypothesis generation methods described are analytic studies (64.8%), descriptive epidemiology (33.7%), food or environmental sampling (32.8%) and facility inspections (27.9%). The least common methods included the use of a single interviewer (0.4%) and investigation of outliers (0.4%). Most studies reported using two or more methods to generate hypotheses (81.2%), with 29.2% of studies reporting using four or more. The use of multiple different hypothesis generation methods both within and between outbreaks highlights the complexity of enteric illness outbreak investigations. Future research should examine the effectiveness of each method and the contexts for which each is most effective in efficiently leading to source identification.

A group specific agar-gel immunodiffusion test was used to demonstrate that there is a frequent and widespread distribution of bluetongue virus throughout the Sultanate of Oman. The Culicoides midges C. imicola and C. schultzei, both capable of transmitting bluetongue group viruses, were recorded throughout the year. Although these studies did not establish that bluetongue is enzootic in Oman, type-specific neutralizing antibody results supported previous evidence for the existence of a Saudi Arabian bluetongue ecosystem. Variations in antibody evidence of virus activity within a restricted locality suggested a hot-spot theory concerning the perpetuation of the virus.

1. In vitro experiments carried out by a modified Rideal-Walker technique showed the superiority of CTAB over chlorine and chloroxylenol disinfectants against Str. agalactiae.

2. The disinfectant action of 1 % CTAB persisted on the surface of dry hands and cows' teats for a period of at least 3 hr. Subsequent moistening of the hands with milk reduced the efficiency of this disinfectant.

3. For the prevention of dissemination of Str. agalactiae by means of milkers' hands and at the same time to reduce the incidence of infection on the surface of teats, a lanette wax-oil base containing 1 % CTAB was tested. It was found that the inclusion in the cream base of CTAB did not reduce its bactericidal efficiency.

Plasmid profile analysis by agarose gel electrophoresis was performed on 42 drug resistant strains of Shigella boydii serotypes 1–5, 8, 10, 12–14, collected between 1974 and 1985 from endemic cases of shigellosis in Ethiopia, and their Escherichia coli K12 transconjugants. Resistance factors (R factors) were further characterized by incompatibility testing.

Patterns of small plasmids, less than 15 kb, were similar within each of the individual S. boydii serotypes. Plasmids of about 3·3–3·7 kb were found in all strains of serotypes 2 and 4. Plasmids of about 4·3–4·6 kb were found in about 86% of strains. Serotypes 1, 2 and 3 were characterized by plasmids of about 5·6–5·7 kb. The 6·4·6–7 kb plasmid was found consistently in serotypes 1, 2, 3, 5, 8, 12 and 13 which were resistant to SSu or had an SSu resistance component in their phenotypes. Large plasmids (155–186 kb) were found in most S. boydii strains.

Conjugative drug resistance plasmids, most often coding for three or less drugs, were found in about 26% of drug resistant strains. R-factors, coding for AT resistance (in types 2 and 8), and ASSuT resistance (in type 4), were compatible with all reference plasmids tested. Plasmids belonging to incompatibility groups X and N were found in serotypes 5 and 10, respectively.

A village epidemic of brucellosis, due to Brucella melitensis, contracted from infected sheep and goats owned by the vifiagers is described. Of the 309 inhabitants eighty-four became infected and seventy-nine were clinically ill with brucellosis. The investigation covered 232 of the total population and nearly all those not examined belonged to the age group, 0–5 years, not directly exposed to infection by contact with diseased animals.

The population of the village was made up of forty-six families, only nine of which escaped infection. In the affected families, the incidence varied from one to seven in each case. The size of the family varied from three to eleven but there was no correlation between the size of the family and the number contracting brucellosis, neither did sex play any part in the incidence. All age groups were susceptible but the morbidity increased with age and this was correlated with increased risk of exposure to infection of the older age groups.

There was considerable variation in the severity of the clinical illness but there were no fatiities and all patients responded to antibiotic therapy.

Brucella melitensis was isolated from twenty-eight of the thirty-six patients subjected to blood culture and specific agglutinins at an acceptable level were demonstrated in all but three of those with a clinical illness.

The number of persons without evidence of clinical brucellosis who possessed significant brucella agglutinins was very small and the assumption that in an endemic area the number of infected persons is much greater than the number clinically ill was not borne out in the outbreak described here.

Persistence of specific agglutinins up to 2 years after recovery from the clinical illness is recorded.

We wish to pay tribute to the late Professor J. Gurevitch for his constant interest and helpful advice.

Thanks are due to Prof. M. Ruiz Castaneda for providing us with the Castaneda bottles for blood culture work, to Dr E. Neeman of the Government Brucella Reference Laboratory for supplying the Standard Brucella Antigen and for examining the strains of Brucella isolated, and to Colonel H. J. Bensted for his interest and help in preparing the paper. Finally, we are indebted to Mrs Aliza Abut Kayner, social worker in the village health centre, for her valuable help in gathering statistical data.

1. In Hong Kong, where scarlet fever is extremely rare, the Dick reactions of a random sample of 921 Chinese were ascertained. Positive reactions were obtained in 19·1 per cent. The distribution of positive reactors in different age groups is recorded; it bears a general similarity to those recorded by various observers in Europe and the U.S.A.

2. A haemolytic streptococcal carrier rate of 6·6 per cent, was determined by nasopharyngeal swabbing of 1600 Hong Kong Chinese. The frequency of haemolytic streptococci was higher during the cooler months of the year and among the younger age groups.

3. Erythrogenic toxin production and fibrinolytic activity were demonstrated in a number of the strains of streptococci isolated from apparently normal throats.

4. The significance of these findings is discussed.

A short time ago I (1911) described a method for the quantitative estimation of indole. It may be of interest to reproduce the curves obtained by the use of this method, in the study of several strains of Bacterium coli, as curves representing indole-production have seldom been published.

The aim of this study was to determine the burden, management and outcomes of rotavirus infection in young children presenting to a tertiary paediatric hospital in Sydney, Australia. All laboratory-confirmed cases of rotavirus in children aged <5 years were identified and medical records reviewed. In 2004, 80 children aged <5 years presented to the hospital with rotavirus gastroenteritis confirmed by stool testing. Infants aged <24 months comprised 75% of cases, with more males than females affected. Most children (86%) acquired rotavirus infection in the community, with a mean length of hospital admission of 2·3 days. There were eight cases of nosocomial infection at a rate of 3/10 000 admissions. The rates of intravenous fluid management (46%) and antibiotic use (28%) were high, reflecting the severity of disease presenting in a hospital setting. These data will help inform the assessment of the recently introduced rotavirus vaccination programme in Australia.

1. The virtual sterilization time (v.s.t.) has been used as a measure of the rate of disinfection of Bact. coli cultures by phenol under carefully standardized conditions. The relationship of this time to temperature at each of five phenol concentrations has been examined from a fresh point of view, since it has previously been shown (Jordan & Jacobs, 1946) that none of the commonly accepted temperature coefficients was satisfactorily constant.

2. The relationship is such that a minimum or threshold temperature exists for each concentration. A corresponding ‘maximum’ temperature has been fixed, defined as the temperature at which the v.s.t. is 10 min. The value of (v.s.t. – 10) thus varies from infinity to zero between these temperature limits.

3. Sigmoid curves are obtained when log (v.s.t. –10) is plotted against temperature for given phenol concentrations. These may be regarded as asymptotic to ordinates at the minimum and maximum temperatures.

4. The Pearl-Verhulst logistic equation gives a curve of the required sigmoid type, and this formula has been shown to fit the curves of log (v.s.t. – 10) against temperature very satisfactorily over the range of concentrations studied.

5. One of the constants of this formula partakes of the nature of a temperature coefficient, and it has, therefore, been possible to derive a truly constant temperature coefficient for each phenol concentration.

6. The values of this new temperature coefficient do not vary greatly with phenol concentration within the range studied, but it is not yet possible to establish whether it is essentially constant for all phenol concentrations with which it is possible to work.

Our data suggest that there are four different thermolabile antigens in S. dysenteriae (Shiga) appearing in different combinations in the five variants described. These antigens are:

1. The agglutination-inhibiting factor ‘I’, found in variants 1 and 3, which is a typical surface antigen.

2. A precipitinogen, ‘N’, probably identical with the neurotoxin, found in variants 1, 2 and 5.

3. A labile precipitinogen, ‘A’, in the extracts of variants 1 and 2, occurring in the deeper layers of the bacterial cell.

4. An additional precipitinogen, ‘B’, found in extracts of variants 1, 2, 3 and 4. It differs from the other labile antigens as its combining- and immunizing-powers are not destroyed by heating at 100° C. for 2 hr.

The well known cryoprotective additives glucose, sucrose, glycerol, dimethyl sulphoxide, polyvinylpyrrolidone, dextran and ammonium acetate have been found to prevent inactivation of T4Bo phage frozen in sodium bromide solutions. Their protective effects in this experimental system could not be accounted for by a colligative mechanism. It is proposed that they may act by modifying the structure of the unfrozen aqueous phase rather than by direct interaction with the phage.

The presence of parasites on the farm can be a cause of losses in animal production, and often a threat to public health. A cross-sectional study was carried out in rural areas of the western highlands of Cameroon to determine the prevalence and husbandry-related risk factors associated with Cordylobia anthropophaga infestations in domestic cavies. The overall prevalence of myiasis in animals was 2·80% [95% confidence interval (CI) 1·50–5·10]; myiasis was found in 2% and 4·30% animals in Menoua and Bamboutos divisions, respectively. Eleven farms (8·95%) in total were infested with C. anthropophaga, with 6·41% and 13·34% of farms in the Menoua and Bamboutos divisions, respectively. The relative risk of infestation within each factor showed that the risk of myiasis in animals kept in kitchen compartments without litter was 6·16 times higher (95% CI 1·71–22·29, P = 0·04) than in animals kept in kitchens and house floors. Despite the low prevalence, the burden of cordylobiasis needs to be assessed. It is assumed that the risk of humans acquiring the disease is higher in farmers keeping cavies in kitchen compartments without litter. Farmers need to be educated on control measures to reduce the risk of infestation, which include both sanitation and medical (larvae extraction) measures.

An estimate for the source of coagulase-negative staphylococci in blood cultures is presented and its use illustrated in two populations. The method estimates the probability that a positive blood culture is positive due to contamination and the probability of it being positive due to bacteraemia. The effect of changes in efficiency of the blood culture technique on these estimates is demonstrated. One of the illustrative populations consists of 537 sample pairs from 273 patients, taken after open-heart surgery in 1978–80. The other consists of 500 consecutive sample pairs taken in one of two hospitals in 1983–4.

An investigation to test the efficiency of chemical closets in treating excreta from typhoid carriers is described. The use of these closets kept a stream, which had in the past frequently contained Salmonella typhi, typhoid free for 24 months. Selenite broth as made in this laboratory, containing a final concentration of 0·8% sodium hydrogen selenite when inoculated with the water sample, was significantly better than commercial selenite brilliant green enrichment broth for the recovery of S. typhi.

Effective use of data linkage is becoming an increasingly important focus in the new healthcare system in England. We linked data from the results of a multiplex PCR assay for respiratory viruses for a population of 230 inpatients at a UK teaching hospital with their patient administrative system records in order to compare the mortality and length of stay of patients who tested positive for influenza A(H1N1)pdm09 with those positive for another influenza A virus. The results indicated a reduced risk of death among influenza A(H1N1)pdm09 patients compared to other influenza A strains, with an adjusted risk ratio of 0·25 (95% confidence interval 0·08–0·75, P = 0·01), while no significant differences were found between the lengths of stay in the hospital for these two groups. Further development of such methods to link hospital data in a routine fashion could provide a rapid means of gaining epidemiological insights into emerging infectious diseases.

The kernel of modelling transmission dynamics of infectious diseases lies in constructing the force of infection (FOI). Traditionally, it was based on mass-action law. In this paper, we show, based on survey data of Escherichia coli O157 infection on Scottish cattle farms, that the actual form of FOI deviates greatly from mass-action law. Further, control effectiveness deviates qualitatively: the epidemic of mass-action FOI can be controlled with a control effort larger than the so-called herd immunity, while the epidemic inferred from the survey data of E. coli O157 infection was shown to be difficult to control. This indicates that, at least for E. coli O157 infection on cattle farms, it is risky to rely on models of transmission dynamics that were based on mass-action law to design the optimal intervention programme for infectious diseases. This suggests the importance of collecting epidemic data and model selection from data-driven models to infer the most likely model of transmission dynamics.

The supernatant fluids of batch and continuous cultures of Brucella strains contained up to 100 mg/i of soluble RNA which could be recovered by precipitation with lysozyme. This RNA fraction had many of the properties of ribosomal RNA and was single-stranded, sensitive to ribonuclease, with an approximate sedimentation constant of 5S, a molecular weight of about 35000 daltons and an adenine; guanine; cytosine; uracil content of 17·5 26·5 33; 23 mol% respectively. RNA fractions from lysozyme precipitates evoked high titres of Brucella agglutinins on injection into rabbits and induced acute inflammatory responses in guinea-pig skin. Highly purified RNA fractions prepared by phenol extraction of lysozyme precipitates did not evoke antibodies to Brucella abortus.

1. During the summer months 1928–9 an epizootic occurred in De Aar and neighbouring districts among small veld rodents, mainly affecting Namaqua gerbilles (Desmodillus auricularis).

2. Many of the animals dying showed a haemorrhagic septicaemia, the causative organism of which appeared to be a Pasteurella rather smaller in size than Pasteurella (Bacillus) pestis.

3. In a considerable proportion of the animals found dead there was no obvious septicaemia.

4. A description is given of the Pasteurella, which is believed to be a hitherto undescribed species, and for which the name Pasteurella desmodilli is suggested.

5. This organism was found to be highly pathogenic for rabbits, less so for guinea-pigs and mice, and non-pathogenic for rats and fowls.

6. It was found by Rhodes to be highly pathogenic for Lobengula gerbilles (Tatera lobengulae) from Cape Town, but for animals of this species from Johannesburg it proved to be much less virulent, and even when it killed them there was frequently no septicaemia.

7. The above observation seems to indicate the presence of a considerable degree of immunity among the Johannesburg lobengulas, as compared with those from Cape Town.

8. It is suggested that a similar condition of partial immunity among the Namaqua gerbilles (for which there is other evidence adduced) might account for the finding of many of them dead without obvious septicaemia.

9. The existence of this disease introduces a complication in the diagnosis of plague among veld rodents.

Any description of the outbreaks of venereal disease is of necessity bound up with the migration of races, or parts of races, with wars and the consequent dislocation of the social system resulting from them. There are many inferences available from current writers showing how this contagious disease was spread and there is a good deal of reason to believe that some, at least, of the numerous cases of “leprosy” for which provision was made on frequent trade routes in past times were really cases of venereal disease.

THe experiments recorded here were initiated following upon the occurrence in this country of foot-and-mouth disease in a cow, which a short time previously had been injected for the purpose of inducing oestrus with a pituitary extract imported from the Continent. Mr D. A. E. Cabot, M.R.C.V.S., Chief Veterinary Officer of the Ministry of Agriculture, made reference to this interesting case in a discussion on foot-and-mouth disease at the First Imperial Veterinary Conference held in London (1938). Confirmation of the nature of the infection was obtained by the inoculation of test animals under experimental conditions with suitable material collected from the injected animal. Further investigations were made. Three ampoules containing pituitary extract were obtained from the distributors in London of the imported commercial preparation under discussion. These ampoules belonged to the same batch as the ampoule with the extract from which the cow had been inoculated. Messrs A. Eccles, M.R.C. V.S. and A. M. Graham, M.R.C.V.S., at the Experimental Station of the Foot-and-Mouth Disease Research Committee at Pirbright, tested this material for virus infectivity by the inoculation of cattle and guinea-pigs. They reported that all three samples of pituitary extract were contaminated with the virus of footand-mouth disease. In addition they produced evidence that the immunological type of the virus recovered from the extract in the ampoules was the same as that of the virus recovered from the cow, viz. Vallée and Carré 0. This and additional information left no doubt that the outbreak of the disease had been produced by the inoculation of the pituitary extract, and further that this extract had been prepared from the pituitary glands of cattle, which were very probably in the early stages of infection with foot-and-mouth disease at the time of slaughter.