The prevalence of three waterborne zoonotic pathogens (Campylobacter sp., Giardia sp. and Cryptosporidium parvum) in rectal faecal samples from a random sample of adult beef cattle was determined. Management factors that may be associated with shedding of these organisms were examined. For Campylobacter sp. prevalence was 5·0%, and the number of females on the farm was positively associated with the proportion that tested positive. For Giardia sp. prevalence was 6·5%, and none of the management factors examined was significantly associated with the proportion in a herd testing positive. C. parvum was identified in 1·1% of samples. The length of calving season and whether any procedures were performed on the calves in the first 2 days of life were positively associated with the proportion that tested positive. We conclude that this sample of adult beef cattle represent a relatively limited threat to water supplies and subsequent disease transmission to humans from these pathogens.

Demographic and clinical risk factors are important in guiding vaccination policy for pneumococcal pneumonia. We present data on these variables from a population-based surveillance network covering adult bacteraemic pneumococcal pneumonia (BPP) in the Delaware Valley region from 2002 to 2004. Surveillance data were used with U.S. Census data and a community health survey to calculate stratified incidence rates. Missing data were handled using multiple imputation. Overall rates of adult BPP were 10·6 cases/100 000 person-years. Elevated rates were seen in the elderly (>65 years), Native Americans, African Americans, the less-educated (less than high-school education), the poor, smokers, and individuals with histories of asthma, cancer, or diabetes. Multivariable modelling suggested that income was more robustly associated with risk than African American race. Of methodological interest, this association was not apparent if census block-group median income was used as a proxy for self-reported income. Further research on socioeconomic risk factors for BPP is needed.

The Coronavirus Disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a public health emergency of international concern. The current study aims to explore whether the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) are associated with the development of death in patients with COVID-19. A total of 131 patients diagnosed with COVID-19 from 13 February 2020 to 14 March 2020 in a hospital in Wuhan designated for treating COVID-19 were enrolled in the current study. These 131 patients had a median age of 64 years old (interquartile range: 56–71 years old). Furthermore, among these patients, 111 (91.8%) patients were discharged and 12 (9.2%) patients died in the hospital. The pooled analysis revealed that the NLR at admission was significantly elevated for non-survivors, when compared to survivors (P < 0.001). The NLR of 3.338 was associated with all-cause mortality, with a sensitivity of 100.0% and a specificity of 84.0% (area under the curve (AUC): 0.963, 95% confidence interval (CI) 0.911–1.000; P < 0.001). In view of the small number of deaths (n = 12) in the current study, NLR of 2.306 might have potential value for helping clinicians to identify patients with severe COVID-19, with a sensitivity of 100.0% and a specificity of 56.7% (AUC: 0.729, 95% CI 0.563–0.892; P = 0.063). The NLR was significantly associated with the development of death in patients with COVID-19. Hence, NLR is a useful biomarker to predict the all-cause mortality of COVID-19.

Spatiotemporal analysis is an important tool to monitor changes of tuberculosis (TB) epidemiology, identify high-risk regions and guide resource allocation. However, there are limited data on the contributing factors of TB incidence. This study aimed to investigate the spatiotemporal pattern of TB incidence and its associated factors in mainland China during 2005–2013. Global Moran's I test, Getis-Ord Gi index and heat maps were used to examine the spatial clustering and seasonal patterns. Generalized Linear Mixed Model was applied to identify factors associated with TB incidence. TB incidence presented high geographical variations with two main hot spots, while a generally consistent seasonal pattern was observed with a peak in late winter. Furthermore, we found province-level TB incidence increased with the proportion of the elderly but decreased with Gross Demographic Product per capita and the male:female ratio. Meteorological factors also influenced TB incidence. TB showed obvious spatial clustering in mainland China and both the demographic and socio-economic factors and meteorological measures were associated with TB incidence. These results provide the related information to identify the high-risk districts and the evidence for the government to develop corresponding control measures.

A bacteriological study of burned patients and of the staff and environment in a burns unit was made with the purpose of discovering the principal reservoirs and routes of transfer of Ps. pyocyanea.

Infected burns appeared to be the most important reservoirs. About 3 % of the stools of normal subjects and of patients with intestinal symptoms carried the organism, which was also isolated from the nose, throat, nasopharynx, skin and ear of a small proportion of patients and staff in the burns wards.

The hands of nurses in the wards were often contaminated with Ps. pyocyanea, and presented a likely vector in the transfer of the organism by contact—e.g. from the bandages of infected patients, and from furniture and other objects near to their beds.

It was shown by slide agglutination that a new type of Ps. pyocyanea admitted to one of the wards spread freely in that ward but hardly at all to the other ward. Since patients from both wards used the same dressing station and operating theatres, it seemed from this finding that a large proportion of the cross-infection occurred in the wards.

Polymyxin dusting powder was shown in a controlled trial to protect exposed burns against contamination by Ps. pyocyanea.

These results are discussed in relation to the mechanism of transfer of the organism and the methods of preventing cross-infection. The need to use several methods concurrently is emphasized, since none of those which have been investigated contributes more than a partial effect. Cubicle wards are advocated, since much cross-infection is shown to occur in open wards.

We are much indebted to Dr G. T. Cook for kindly letting us use results obtained by him at the Oxford Public Health Laboratory. We also wish to thank Prof. J. F. D. Shrewsbury of Birmingham University and our colleagues at the Birmingham Accident Hospital for their valuable co-operation, and Dr A. C. Cunliffe of King's College Hospital for information on the typing of Proteus from patients in our wards.

Although veterinary authorities aim to limit persistence of classical swine fever (CSF) in wild boar (Sus scrofa), to avoid potential transmission to pigs, factors influencing CSF transmission and persistence are not clearly understood. Here we analyse incidence and persistence in a CSF epidemic that occurred in the French Vosges Forest. Higher incidence was found in large forests compared to smaller isolated ones, being highest near the starting point of the epidemic, but poorly related to the local density. We hypothesize that the spatial and social structure of wild boar populations may be responsible for this variability of incidence over space. Persistence was highest near the starting point of the epidemic and where initial density was highest. We hypothesize that persistence was favoured by the abundance of young wild boar, itself encouraged by CSF. Our results allow us to propose management measures aimed at limiting CSF persistence.

Microaerophilic organisms were monitored in sewage effluent undergoing two secondary treatments: air and oxygen-activated sludge. The mean numbers of Arcobacter cryaerophilus and thermophilic campylobacters detected in incoming sewage were 5639/100 ml and 1720/100 ml respectively.

Secondary treatment in air tanks reduced the population of A. cryaerophilus by 97.1% and of thermophilic campylobacters by 99.08%, whereas treatment in oxygen tanks reduced the bacteria 97.8% and 99.63% respectively, showing that oxygen-activated sludge treatment was more effective. Subsequent tertiary treatment with 2 p.p.m. chlorine dioxide evidenced the removal of A. cryaerophilus to 99.9% and eliminated thermophilic campylobacters.

Campylobacter jejuni and C. coli constituted 54.1% and 45.9% of 74 thermophilic campylobacter strains isolated. In air-activated sludge effluent C. jejuni was found more often, thus appearing more sensitive to oxygen.

The most probable number assay used for detection of campylobacters, blood medium for enrichment and blood-free medium for plating, also appeared to be fit for A. cryaerophilus, the high density of which in urban sewage may be due to inflows from slaughterhouses.

A micro-organism, previously known as the J agent, was grown on solid medium: its various characteristics suggested that it was a mycoplasma and it was provisionally named Mycoplasma suipneumoniae.

In the growth-inhibition and metabolic-inhibition tests, M. suipneumoniae was indistinguishable from M. hyopneumoniae (Maré & Switzer, 1965).

By the growth-inhibition test, M. suipneumoniae seemed unrelated to all of a wide range (42 strains) of other mycoplasmas examined. These results suggest that, if the similarity between M. suipneumoniae and M. hyopneumoniae is substantiated in further work, these latter two strains are probably a new species.

M. suipneumoniae was also identified by the metabolic-inhibition test, by precipitation in agar gel, and by immune-fluorescence. Using the last two methods, M. suipneumoniae was distinguished from a second porcine mycoplasma (strain 603).

The most important property of M. suipneumoniae is its ability to induce enzootic pneumonia experimentally in pigs.

We aimed to describe the incidence of new episodes of molluscum contagiosum, scabies and lichen planus presenting to general practitioners in England and Wales. We examined data collected in a sentinel practice network (the Weekly Returns Service of the Royal College of General Practitioners) in which about half a million persons were observed each year over the period 1994–2003. The incidence of molluscum contagiosum in males was 243/100000 person-years and in females 231; of scabies, males 351, females 437; of lichen planus, males 32, females 37. Incidence varied by year and age. Ninety per cent of molluscum contagiosum episodes were reported in children aged 0–14 years, where incidence in 2000 (midpoint of a 6-year period of stable incidence) was 1265/100000 (95% CI 1240–1290). Scabies affected all ages and annual incidence ranged between 233 (95% CI 220–246) in 2003 and 470 (95% CI 452–488) in 2000. Lichen planus occurred chiefly in persons aged over 45 years: incidence (all ages) ranged between 27 (95% CI 23–31) in 2003 and 43 (95% CI 37–49) in 1998. The relative risk of female to male incidence (all ages) of molluscum contagiosum was 0·95 (95% CI 0·91–0·99); of scabies 1·25 (95% CI 1·21–1·28); and of lichen planus 1·19 (95% CI 1·08–1·13).

Groups of student volunteers were immunized with one of five different inactivated influenza virus vaccines. The concentration of virus in the various vaccines differed by both the international unitage test and by the concentration of haemagglutinin, as measured by the single radial diffusion test; the results of the two methods of standardization showed no correlation. The serum HI response to immunization was variable; volunteers given A/England/72 showed a 16·6-fold increase in homologous serum antibody titre whilst volunteers given A/Hong Kong/68 vaccine showed a 4·2-fold increase. The variable response of volunteers to immunization could not be explained by the varied concentration of virus in the vaccines, as measured by either test, the titres of serum HI antibody present before immunization, or a combination of these two factors.

The ability to infect volunteers with WRL 105 virus 4 weeks after immunization with heterologous, inactivated virus vaccine was directly related to the degree of cross-reactivity between the haemagglutinins of this vaccine virus and WRL 105 virus. Thus, the greatest number of infections by the challenge virus were seen in volunteers given A/Hong Kong/68 vaccine, less were observed in volunteers given A/England/72 vaccine, and least were found in groups given A/Port Chalmers/73 or A/Scotland/74 vaccine. However, compared with the incidence of infection in volunteers given B/Hong Kong/73 vaccine, all the heterologous influenza A vaccine gave some immunity to challenge infection.

Seasonal autoregressive integrated moving average (SARIMA) has been used to model nationwide tuberculosis (TB) incidence in other countries. This study aimed to characterise monthly TB notification rate in China. Monthly TB notification rate from 2005 to 2017 was used. Time-series analysis was based on a SARIMA model and a hybrid model of SARIMA-generalised regression neural network (GRNN) model. A decreasing trend (3.17% per years, P < 0.01) and seasonal variation of TB notification rate were found from 2005 to 2016 in China, with a predominant peak in spring. A SARIMA model of ARIMA (0,1,1) (0,1,1)12 was identified. The mean error rate of the single SARIMA model and the SARIMA–GRNN combination model was 6.07% and 2.56%, and the determination coefficient was 0.73 and 0.94, respectively. The better performance of the SARIMA–GRNN combination model was further confirmed with the forecasting dataset (2017). TB is a seasonal disease in China, with a predominant peak in spring, and the trend of TB decreased by 3.17% per year. The SARIMA–GRNN model was more effective than the widely used SARIMA model at predicting TB incidence.

Antibiotic resistance data, made available from laboratory records during eight cholera outbreaks between 1990 and 2004 showed Vibrio cholerae serogroup O1 to have a low level of resistance (2–3%) to tetracycline during 1990–1991. Resistance increased for tetracycline (95%), chloramphenicol (78%), doxycycline (70%) and trimethoprim–sulphamethoxazole (97%) in subsequent outbreaks. A significant drop in resistance to tetracycline and chloramphenicol followed the adoption of a national policy to replace tetracycline with erythromycin for treating cholera. Sixty-nine strains from cholera outbreaks in Zambia between 1996 and 2004, were examined for antibiotic resistance and basic molecular traits. A 140 MDa conjugative, multidrug-resistant plasmid was found to encode tetracycline resistance in strains from 1996/1997 whereas strains from 2003/2004 were resistant to furazolidone, but susceptible to tetracycline, and lacked this plasmid. PCR revealed 25 of 27 strains from 1996/1997 harboured the intl1 class 1 integron but lacked SXT, a conjugative transposon element. Similar screening of 42 strains from 2003/2004 revealed all carried SXT but not the intl1 class 1 integron. All 69 strains, except two, one lacking ctxA and the other rstR and thus presumably truncated in the CTX prophage region, were positive for important epidemic markers namely rfbO1, ctxA, rstR2, and tcpA of El Tor biotype. Effective cholera management is dependent on updated reports on culture and sensitivity to inform the choice of antibiotic. Since the emergence of antibiotic resistance may significantly influence strategies for controlling cholera, continuous monitoring of epidemic strains is crucial.

Investigations were performed by the Laboratory of Enteric Pathogens on Vero cytotoxin-producing Escherichia coli (VTEC) in England and Wales from 1992–4. Bacterial isolates, faeces and sera obtained from patients with diarrhoea, bloody diarrhoea and haemolytic uraemic syndrome were examined. Using serotyping, Vero cytotoxin gene probing and serodiagnostic tests for E. coli O157, evidence of infection was detected in 543, 434 and 491 individuals in 1992, 1993 and 1994 respectively; VTEC of serogroup O157 were isolated from 470, 385 and 411 cases. The O157 VTEC strains belonged to at least 19 different phage types (PT) although 84% belonged to PT2, PT49, PT8, PT1 or PT4. Antibodies to E. coli O157 lipopolysaccharide were detected in 13% of the cases. The average annual rate of infection with O157 VTEC was 0·83/100000 and 12% of the 1458 individuals with evidence of infection with VTEC or E. coli O157 developed haemolytic uraemic syndrome. There were at least 18 general outbreaks and many family outbreaks.

In patients with community-acquired pneumonia (CAP) prediction rules based on individual predicted mortalities are frequently used to support decision-making for in-patient vs. outpatient management. We studied the accuracy and the need for recalibration of three risk prediction scores in a tertiary-care University hospital emergency-department setting in Switzerland. We pooled data from patients with CAP enrolled in two randomized controlled trials. We compared expected mortality from the original pneumonia severity index (PSI), CURB65 and CRB65 scores against observed mortality (calibration) and recalibrated the scores by fitting the intercept α and the calibration slope β from our calibration model. Each of the original models underestimated the observed 30-day mortality of 11%, in 371 patients admitted to the emergency department with CAP (8·4%, 5·5% and 5·0% for the PSI, CURB65 and CRB65 scores, respectively). In particular, we observed a relevant mortality within the low risk classes of the original models (2·6%, 5·3%, and 3·7% for PSI classes I–III, CURB65 classes 0–1, and CRB65 class 0, respectively). Recalibration of the original risk models corrected the miscalibration. After recalibration, however, only PSI class I was sensitive enough to identify patients with a low risk (i.e. <1%) for mortality suitable for outpatient management. In our tertiary-care setting with mostly referred in-patients, CAP risk scores substantially underestimated observed mortalities misclassifying patients with relevant risks of death suitable for outpatient management. Prior to the implementation of CAP risk scores in the clinical setting, the need for recalibration and the accuracy of low-risk re-classification should be studied in order to adhere with discharge guidelines and guarantee patients' safety.

This study describes the results of the health programme implemented in the Valencian Community (Spain) to achieve an early diagnosis of Chagas disease in pregnant Latin American women and their newborns. During 2009 and 2010, 1975 women living in the health districts of three university hospitals were enrolled via midwives or at the time of delivery. Diagnosis of disease was performed using two serological tests with different antigens. Congenital infection was diagnosed by parasitological, molecular or serological methods from blood samples obtained at birth or in subsequent controls. The overall seroprevalence of Chagas infection in pregnant women from 16 different endemic countries was 11·4%. Infection was higher in those from countries in the Gran Chaco Region (Bolivia, 34·1%; Paraguay, 7·4%; Argentina, 5·3%). Eight newborn infants from Bolivian mothers had congenital Chagas which represents a vertical transmission rate of 3·7%. In conclusion, this work supports the benefits of offering an early diagnosis to pregnant women and newborns during routine prenatal healthcare.

An outbreak of Salmonella dublin infection occurred in England and Wales in October to December 1989. Forty-two people were affected, mainly adults, and most lived in south-east England. Microbiological and epidemiological investigations implicated an imported Irish soft unpasteurized cows' milk cheese as the vehicle of infection. A case-control study showed a statistically significant association between infection and consumption of the suspect cheese (p = 0·001). Salmonella dublin was subsequently isolated from cheeses obtained from the manufacturer's premises. Initial control measures included the withdrawal of the cheese from retail sale and a Food Hazard Warning to Environmental Health Departments, as well as a press release, from the Department of Health. Subsequently, a decision was taken by the manufacturer to pasteurize milk used in the production of cheese for the UK market and importation of the cheese resumed in June 1990.

The efficient control of the spread of yellow fever is a matter of such vast practical importance, both from the hygienic and commercial point of view—not only for the countries where this disease prevails as an epidemic, but also for those in which, after importation, it may assume epidemic proportions—that it has seemed appropriate to bring together in this paper a summary of the work thus far accomplished by the United States Army Commission 1 on the Island of Cuba, during the years 1900 and 1901, in order that English and Colonial readers who have not, perhaps, had access to the original contributions published in different American journals, may be able to form an intelligent opinion concerning the permanent value of this work. It will also afford opportunity for recording the more recent confirmatory observations made by others concerning the mode of transmission of yellow fever discovered by the Commission, and for calling attention to the results already obtained by the U.S. Army Medical Department in the suppression of this disease, especially in the city of Havana, through the enforcement of sanitary measures based on these later researches.

An enzyme immunoassay (EIA) for astrovirus type 1 together with immune electronmicroscopy (IBM) was used to type a collection of 162 astroviruses obtained from 1981–93 from children with diarrhoea. The EIA was found to be specific for astrovirus type 1. Astrovirus types 2–4 were typed by IEM.

Astrovirus type 1 was the prevalent serotype 107/125 (86%), followed by type 3 (8%), type 4 (6%) and type 2 (1 %). Six samples containing astrovirus could not be typed or detected by EIA because they were coated with coproantibodies; 11 others were not identified. Virus particles could no longer be detected in 15/162 (9%) samples following storage for ≥ 2 years.

Selected samples containing astrovirus types 1–4 were passaged in CaCO2 cells and their identity confirmed by one or both assays. One sample was shown to have remained viable for 10 years when stored as an aqueous suspension at −20 °C.

Two patients with severe combined immune deficiency disease (SCID) were shown to be excreting astrovirus type 1 for 32 and 102 days respectively. One child was simultaneously shedding rotavirus and the other child was excreting adenovirus.

Two cyclones for sampling dilute aerosols in the field are described. Their advantages are their robustness and reliability, the high degree of concentration achieved, and the ease with which they will provide a long uninterrupted sequence of samples.

Methods of correcting estimates of cloud concentration for transfer lag in the cyclone are derived.

The cyclones were constructed by J. Nott. We are indebted to G. J. Harper and E. J. Morris for allowing us to make use of their observations, and to Dr J. S. Paterson (Superintendent, Allington Farm) for providing the realistic aerosol at our convenience.

In August 1998, an outbreak of campylobacteriosis occurred in one municipality in northern Finland. A 10% random sample of residents (population 15000) was selected through the National Population Registry for a survey conducted by using postal questionnaires. Cases were defined as residents of the municipality with onset of acute gastroenteritis from 1 to 20 August 1998. Of 1167 respondents (response rate 78%), 218 (18·7%) met the case definition. Drinking non-chlorinated municipal tap water was strongly associated with illness (OR 34·4). The estimated total number of ill persons was 2700. Campylobacter jejuni was isolated from stool samples of 45 (61%) out of 74 patients tested. All five isolates tested had indistinguishable PFGE patterns. Water samples were negative for campylobacter and coliforms. Epidemiological and environmental evidence suggested mains repair as the source of contamination. Non-chlorinated ground-water systems may be susceptible to contamination and can cause large outbreaks.