We propose that postal Change-of-Address (CoA) data can be used to monitor/predict likely second wave caseloads in viral infections around urban epicentres. To illustrate the idea, we focus on the tri-state area consisting of New York City (NYC) and surrounding counties in New York, New Jersey and Connecticut States. NYC was an early epicentre of the coronavirus disease 2019 (Covid-19) pandemic, with a first peak in daily cases in early April 2020, followed by the second peak in May/June 2020. Using CoA data from the US Postal Service (USPS), we show that, despite a quarantine mandate, there was a large net movement of households from NYC to surrounding counties in the period April–June 2020. This net outward migration of households was strongly correlated with both the timing and the number of cases in the second peaks in Covid-19 cases in the surrounding counties. The timing of the second peak was also correlated with the distance of the county from NYC, suggesting that this was a directed flow and not random diffusion. Our analysis shows that CoA data is a useful method in tracking the spread of an infectious pandemic agent from urban epicentres.

Veterinary healthcare workers are in close contact with many different animals and might be at an increased risk of acquiring Clostridioides difficile. In this cross-sectional study, we assessed the prevalence and risk factors of C. difficile carriage in Dutch veterinary healthcare workers. Participants provided a faecal sample and filled out a questionnaire covering potential risk factors for C. difficile carriage. C. difficile culture positive isolates were polymerase chain reaction (PCR) ribotyped and the presence of toxin genes tcdA, tcdB and cdtA/cdtB was determined. Eleven of 482 [2.3%; 95% confidence interval (CI) 1.3–4.0] veterinary healthcare workers were carriers of C. difficile. Three persons carried C. difficile ribotype 078 (0.6%; 95% CI 0.2–1.8). Risk factors for carriage were health/medication and hygiene related, including poor hand hygiene after patient (animal) contact, and did not include occupational contact with certain animal species. In conclusion, the prevalence of C. difficile carriage in veterinary healthcare workers was low and no indications were found that working in veterinary care is a risk for C. difficile carriage.

A modification of Sharpe's microdroplet counting technique is presented which permits viable counting of Bacteroides fragilis. Lysed horse blood was added to 0·1 ml soy digest agar droplets and 2% was found to be the optimal concentration which combined adequate intradroplet colony size with acceptable visibility on the counting screen of the Colworth Droplette machine.

This study aims to locate the knots of cumulative coronavirus disease 2019 (COVID-19) case number during the first-level response to public health emergency in the provinces of China except Hubei. The provinces were grouped into three regions, namely eastern, central and western provinces, and the trends between adjacent knots were compared among the three regions. COVID-19 case number, migration scale index, Baidu index, demographic, economic and public health resource data were collected from 22 Chinese provinces from 19 January 2020 to 12 March 2020. Spline regression was applied to the data of all included, eastern, central and western provinces. The research period was divided into three stages by two knots. The first stage (from 19 January to around 25 January) was similar among three regions. However, in the second stage, growth of COVID-19 case number was flatter and lasted longer in western provinces (from 25 January to 18 February) than in eastern and central provinces (from 26 February to around 11 February). In the third stage, the growth of COVID-19 case number slowed down in all the three regions. Included covariates were different among the three regions. Overall, spline regression with covariates showed the different change patterns in eastern, central and western provinces, which provided a better insight into regional characteristics of COVID-19 pandemic.

An account is given of outbreaks of anthrax among mink, which occurred in Great Britain during 1936–8, and the possible danger to human beings from this source is discussed. Attention is called to the peculiar features of one of the outbreaks and to the probable mode of infection.

Acknowledgements. My best thanks are due to Dr D. Jordan Lloyd for supplying information and references concerning the dressing of pelts, to the Veterinary Department of the Ministry of Agriculture for details of outbreaks of anthrax during 1936–8, and to Dr F. C. Minett for his assistance in compiling this paper.

The purpose of the study was to describe the results of follow up of human contacts of bovine tuberculosis. The bovine tuberculosis cases occurred on farms in North Staffordshire between 1993 and 1997. A total of 162 people were identified as having close contact with cattle diagnosed as having bovine tuberculosis, or who had drunk unpasteurized milk from a herd with bovine tuberculosis. A retrospective review of chest clinic notes was performed. One hundred and thirty-eight people attended for follow up, and Heaf test results, necessity for chest X-ray and further clinical follow-up are described. No case of human Mycobacterium bovis infection was identified. It is suggested that follow-up of human contacts is limited to those with close contact with herds who have bovine tuberculosis and cattle with visible pulmonary lesions or evidence of udder infection. Children on the farms with affected cattle should also be offered BCG in advance of the routine school's programme.

A sensitive antigen suspension is described for use with a simple slide agglutination method which makes possible a serological diagnosis or exclusion of typhoid fever without recourse to a laboratory. The method has been tested on 414 sera sent to our laboratory; it detected all cases with a titre of 1: 80 or more, and most of those with a titre of 1: 40. The method was further tested on 130 clinically observed cases, in which it gave satisfactory results. The S. A. method gave a positive result with 98 out of 100 sera from patients with typhoid fever, whereas the classical Widal reaction gave a positive result with 68 of them only.

The intensity and rapidity of the slide agglutination reaction provide a rough measure of the titre of a serum. A quick and distinct agglutination indicates a titre of 1: 80 or more and is diagnostic of typhoid fever. A slow and indistinct result is obtained when the titre of the serum is about 1: 40. A negative test indicates with great probablity that a diagnosis of typhoid fever may be excluded.

We think the method succeeds because the nature of the suspension employed and the peculiar behaviour of slide agglutinations permit the detection of O agglutinins as well as H agglutinins.

This study describes epidemiological trends for acute rotavirus gastroenteritis (RVGE) in Belgium in children aged ⩽5 years during the period June 2007 to May 2014 after the introduction of routine rotavirus (RV) vaccination. This period encompassed the switch from lyophilized to the liquid formulation of Rotarix™ (GlaxoSmithKline, Belgium) in August 2011. Uptake of RV vaccine remained consistently high throughout the study period with Rotarix the brand most often used. RV was present in 9% (1139/12 511) of hospitalized cases with acute gastroenteritis included in the study. Epidemiological trends for hospital admissions for RVGE remained consistent throughout the study period, with no evidence of any change associated with the switch from lyophilized to liquid formulation of Rotarix. This suggests both formulations perform similarly, with the liquid formulation not inferior regarding ability to reduce hospital admissions for acute RVGE in children aged ⩽5 years. A strong seasonal effect was observed with most RVGE occurring in the winter months but with some variability in intensity, with highest incidence found in those aged 6–24 months. The main observation was the decreased number of hospital admissions for RVGE in Belgium that occurred during winter 2013/2014.

The investigation of plasmid similarity is an important component in the surveillance of antimicrobial resistance and in the detection of epidemic plasmids. The use of restriction endonucleases in the classification of transferable, multiply-resistant plasmids from faecal Enterobacteriaceae isolated at the Children's Emergency Hospital, Khartoum was investigated. Twenty-four transconjugant plasmids, coding for 11 different resistance patterns, each of molecular weight 62 MDa. were studied using four restriction enzymes; Pst I, Eco R I, Hind III and Ara II. Fifteen different digest profiles were obtained. Restriction profiles discriminated between plasmids with differing resistance patterns and demonstrated homology of plasmids with common resistance patterns. Restriction endonuclease digest patterns provide a potentially rapid and reproducible method of plasmid classification, that could contribute towards surveillance systems in tropical countries with a high prevalence of antimicrobial resistance.

The prevalence of human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) is increasing day by day in the region, including Turkey. The study aimed to examine AIDS-related deaths in Turkey between 2009 and 2018 according to the national death registration system records. In this descriptive study, data on AIDS-related deaths were obtained from the Turkish Statistical Institute. The data consist of the cause of death codes, year of death, age and gender. Findings were presented using numbers and percentages. Seven hundred twenty-one AIDS-related deaths were reported in Turkey between 2009 and 2018. AIDS-related deaths in Turkey increased more than twice at the end of 10 years. The male/female death ratio is 4.5. Deaths under the age of 15 were 4.2% in total; however, they were increased to 10.2% in 2018. AIDS-related deaths are decreasing in the world but increasing in Turkey. The data from the Ministry of Health do not match the data of the national death registration system. Establishing a strong and accurate HIV/AIDS reporting system and identifying the causes and risk groups of this increase in AIDS-related deaths are critical.

The chemical changes which occur in the dissolved solids of sewage on discharge into sea-water have been investigated by several workers (see references 1–11). Some observation on the difference of these changes to those occurring in polluted fresh water have been made by Letts and Richards (6,11). In regard to waters whose saline composition is not such as to preclude their admissibility for potable purposes on this account, Liversidge(12) has made a brief communication on the variation in the free and albuminoid ammonia.

An analysis of the medical condition of 223 entrants to the nursing profession is attempted, with particular reference to 161 such nurses examined in accord with the recommendations of the King Edward's Hospital Fund for London (1943). This is followed by a short-term medical follow-up on these nurses by clinical examination, weight records, and ancillary tests. Of the total number of entrants eight (3·6 %) were rejected on medical grounds, and four (2·5 %) of the 161 were rejected on the findings of the initial examination.

An analysis of the sixty-five (29 %) nurses lost to the profession in their first year of service shows that 70 % had attempted an uncongenial vocation. It is suggested that vocation selection tests should be tried in attempting to lessen this costly drain of recruits. This figure of 29 % is no higher than the peacetime figure found by the Lancet Commission (Athlone Report, 1938).

An analysis of the illnesses of the nursing staff at Westminster Hospital during 3 years from 1 July 1943 to 30 June 1946 is presented, nearly 60 % of the illnesses being accounted for by respiratory tract infection and cutaneous sepsis. It has been shown that illness of more than 50 days in duration accounts for only 5 % of attacks of illness, but practically 30 % of the time lost through illness. It is suggested that such illness should be differentiated in analyses, from illnesses of shorter duration. A comparison of illnesses in staff nurses and student nurses follows; the figures suggest a lower morbidity rate in staff nurses, but the number of staff nurses is so small that the author cannot state that this has been demonstrated.

A comparison table between previous illness surveys and the present figures is presented which demonstrates a decreasing number of attacks of illness per nurse over the last 20 years in this country, probably due to better basic conditions of life.

A similar but international comparison applied to respiratory tract infection and cutaneous sepsis demonstrates that the former accounts for about 40 % of all the attacks of illness in this country and internationally. The previous figures for Great Britain, however, are exceptional in showing a much higher incidence of sepsis than elsewhere; this has not been substantiated by the present survey.

Figures for the amount of time lost per year through sepsis, tonsillitis and catarrhal disease are compared with those of Branson (1933) of 20 years ago, and perhaps illustrate the beneficial effect of surgery in cutaneous sepsis, and of sulphonamides in tonsillitis, as against the negligible therapeutic advances in catarrhal disease. The amount of tonsillitis sustained by nurses in the children's ward is shown as being out of proportion to the number of nurses employed.

Finally suggestions are made for promoting the health of nurses, which include: (i) the provision of a ‘welfare officer’ in the nurses' home; (ii) illness allowance proposals; (iii) remarks on the technique of ‘reporting sick’; (iv) staffing children's ward with senior nurses only.

A testing rate for measles above 80% is required by the WHO European Region Measles Elimination strategy to verify elimination. To comply with this rate, we explored factors associated with the return of oral fluid kits (OFK) by suspected measles cases. We described the cases and conducted a mixed-effects analysis to assess the relationship between socio-demographic and public health management characteristics and the likelihood of returning an OFK to the reference laboratory. Of 3,929 cases who were sent a postal OFK, 2,513 (67%) returned the kit. Adjusting for confounding, registration with a general practitioner (GP) (aOR:1.48, 95%CI:1.23–1.76) and living in a less deprived area (aOR:1.35, 95%CI:1.04–1.74) were associated with an increased likelihood of returning the OFK. The odds of returning the OFK also increased if the HPT contacted the parents/guardians of all cases prior to sending the kit and confirmed their address (aOR:2.01, 95%CI:1.17–3.42). Cases notified by a hospital (aOR:1.94, 95%CI:1.31–2.87) or GP (aOR:1.52; 95%CI:1.06–2.16) also had higher odds of returning the OFK. HPTs may want to consider these factors when managing suspected cases of measles since this may help in increasing the testing rates to the WHO-recommended level.

This study presents surveillance data from 1 July 2003 to 30 June 2023 for community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) notified in the Kimberley region of Western Australia (WA) and describes the region’s changing CA-MRSA epidemiology over this period. A subset of CA-MRSA notifications from 1 July 2003 to 30 June 2015 were linked to inpatient and emergency department records. Episodes of care (EOC) during which a positive CA-MRSA specimen was collected within the first 48 hours of admission and emergency presentations (EP) during which a positive CA-MRSA specimen was collected on the same day as presentation were selected and analysed further. Notification rates of CA-MRSA in the Kimberley region of WA increased from 250 cases per 100,000 populations in 2003/2004 to 3,625 cases per 100,000 in 2022/2023, peaking at 6,255 cases per 100,000 in 2016/2017. Since 2010, there has been an increase in notifications of Panton-Valentine leucocidin positive (PVL+) CA-MRSA, predominantly due to the ‘Queensland Clone’. PVL+ CA-MRSA infections disproportionately affect younger, Aboriginal people and are associated with an increasing burden on hospital services, particularly emergency departments. It is unclear from this study if PVL+ MRSA are associated with more severe skin and soft-tissue infections, and further investigation is needed.

The residential home was investigated to study the endemic virus population. During this study, oral poliovirus vaccine was given to the children and the effect of vaccination on endemic enteroviruses and adenoviruses was investigated. In the light of these findings, the problem of virus interference is discussed. The health of the children is related to their virus infections.

We are indebted to Prof. S. D. M. Court and Prof. C. A. Green for the active interest they have taken in this investigation; to Miss J. McQuillin, B.Sc., F.I.M.L.T., for her technical assistance; also to the matron of the home and her staff for their co-operation in supplying the specimens, and to Mr L. J. Whitlock of the Royal Victoria Infirmary and his staff for arranging their transport to the laboratory.

We carried out a retrospective study of acute gastroenteritis (AGE) outbreaks reported between 1 January 2015 and 31 December 2021 in Catalonia (Spain) to compare the incidence from 2015 to 2019 with that observed from 2020 to 2021. We observed a higher incidence rate of outbreaks during the prepandemic period (16.89 outbreaks/1,000,000 person-years) than during the pandemic period (6.96 outbreaks/1,000,000 person-years) (rate ratio (RR) 0.41; 95% confidence interval (CI) 0.34 to 0.51). According to the aetiology of the outbreak, those of viral aetiology decreased from 7.82 to 3.38 outbreaks/1,000,000 person-years (RR 2.31; 95% CI 1.72 to 3.12), and those of bacterial aetiology decreased from 5.01 to 2.78 outbreaks/1,000,000 person-years (RR 1.80; 95% CI 1.29 to 2.52). There was a great reduction in AGE outbreaks in Catalonia. This reduction may have been due to the effect of the nonpharmaceutical measures applied to reduce the transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), but the collapse of the healthcare system and epidemiological surveillance services may also have had a strong influence.

Bovine tuberculosis (bTB) is prevalent among livestock and wildlife in many countries including New Zealand (NZ), a country which aims to eradicate bTB by 2055. This study evaluates predictions related to the numbers of livestock herds with bTB in NZ from 2012 to 2021 inclusive using both statistical and mechanistic (causal) modelling. Additionally, this study made predictions for the numbers of infected herds between 2022 and 2059. This study introduces a new graphical method representing the causal criteria of strength of association, such as R2, and the consistency of predictions, such as mean squared error. Mechanistic modelling predictions were, on average, more frequently (3 of 4) unbiased than statistical modelling predictions (1 of 4). Additionally, power model predictions were, on average, more frequently (3 of 4) unbiased than exponential model predictions (1 of 4). The mechanistic power model, along with annual updating, had the highest R2 and the lowest mean squared error of predictions. It also exhibited the closest approximation to unbiased predictions. Notably, significantly biased predictions were all underestimates. Based on the mechanistic power model, the biological eradication of bTB from New Zealand is predicted to occur after 2055. Disease eradication planning will benefit from annual updating of future predictions.

The study aimed to explore the relationship between eosinophils and the prognosis of varicella in adults. We retrospectively reviewed the medical records of patients who were hospitalised in The Fifth People's Hospital of Suzhou with a diagnosis of adult varicella during the period between 1 January 2012 and 31 December 2020. Of the 359 patients, 228 (63.51%) had eosinopenia. The proportion of patients with mild type disease was significantly lower in the eosinopenia group than that in the non-eosinopenia group (50.44% vs. 65.65%, P = 0.006). The proportion of the patients with common type disease was significantly higher in the eosinopenia group than that in the non-eosinopenia group (39.47% vs. 28.24%, P = 0.039). The proportion of the patients with severe type disease was higher in the eosinopenia group, although the difference did not reach statistical significance (10.09% vs. 6.11%, P = 0.243). The rates of high fever (47.81% vs. 32.82%, P = 0.008; relative risk (RR) 1.296, 95% confidence interval (CI) 1.091–1.540), headache (43.42% vs. 22.14%, P < 0.001; RR 1.415, 95% CI 1.233–1.623), anorexia (53.51% vs. 35.88%, P = 0.001; RR 1.367, 95% CI 1.129–1.655) and complications (82.89% vs. 64.12%, P < 0.001; RR 2.106, 95% CI 1.460–3.038) were also significantly higher in the eosinopenia group. Among the complications, the liver injury and skin infection were more serious in the eosinopenia group. The disease course was significantly longer in the eosinopenia group than that in the non-eosinopenia group (9.43 ± 1.89 days vs. 8.73 ± 1.25 days, P < 0.001). The improvement rate of liver injury in the recovery period was lower in the eosinopenia group than that in the non-eosinopenia group (35.38% vs. 50%, P = 0.012). The study found that adult varicella patients with eosinopenia had a more serious condition, a higher morbidity of complications and a slower recovery. Blood eosinophils can be used as a new predictor of the severity of adult varicella.