Tuberculosis (TB) in children is a critical public health issue. In Bohol, Philippines, we found a high tuberculin skin test (TST)-positive prevalence (weighted prevalence = 6.4%) among 5476 children (<15 years) from 184 villages, with geographically isolated communities having prevalence as high as 29%. Therefore, we conducted a geospatial and hot spot analysis to examine the association between villages with high TST-positive prevalence (⩾6.5%) and access to medical care (distance (in kilometres and minutes of travel time) to the municipal Rural Health Units (RHU)), access to healthcare resources (distance to Provincial Health Office (PHO)) and socioeconomic determinants of health. Hot spot analysis revealed significant clusters of TST-positive prevalence in villages farthest from the PHO. Based on univariate analysis, the following variables associated with high prevalence were included in the multivariate model: minutes of travel time to the PHO, distance to the PHO, island villages and total deprivation based on socioeconomic indicators. In the final model, only distance to PHO in minutes was significant (P = 0.005). When evaluated further, greater than 1-hour drive significantly increased risk for TST-positivity (P = 0.003). Distance to healthcare resources likely increases the risk of TB transmission within the community. Expanding TB control efforts to geographically isolated areas is critical.

In these experiments the hook-worm anaemia of dogs does not appear to be exactly analogous to the corresponding disease in man, but differs from it in two essential particulars, namely, that only young animals suffer and that in them its course progresses much more rapidly to a fatal termination.

Older dogs, although not altogether insusceptible, acquire infection only to a moderate extent, which gives rise to a minor degree of anaemia. From this they gradually recover, even in spite of repeated and continued attempts at re-infection.

The anaemia in young dogs was characterised by great loss of weight, emaciation, prostration and intestinal haemorrhage, but in no case was expistaxis observed.

The blood volume of dogs suffering from the minor degree of hookworm anaemia is not materially altered, but if anything is somewhat diminished. The oxygen capacity of the blood per unit of body weight is also, on the average, somewhat decreased.

Infection is generally accompanied by distinct though not profuse haemorrhage, which is most marked in the early stages, but tends to disappear.

Eosinophilia was not a constant sign either of infection or of disease.

Evidence of blood regeneration was furnished by the appearance of large numbers of erythroblasts (normoblasts) which increased with the progress of the disease.

Cats are much less easily infected than dogs, and monkeys are altogether insusceptible. Man, also, were found to be insusceptible to infection with the dog hook-worm.

In a recent report (Greenwood et al. 1936) we included a short discussion of the few scattered observations that we had made on the effects of the dispersal of an infected herd (pp. 189–92). Briefly, we had found that the division of a herd, in which an epidemic due to Bact. typhi-murium was under way, into small isolated groups was followed by a greatly decreased rate of mortality in those groups when the dispersal was carried out at the beginning of the beginning of the epidemic period. Reaggregation of the groups resulted in a fresh spread of the disease, but the final mortality was lower than in a similar herd which had not been dispersed during the earlier stages of cage life (Topley, 1922). In a subsequent experiment (Topley & Wilson, 1925) dispersal was carried out at a later stage of epidemic spread, and very different results were obtained. For the first three weeks or so after division into small groups there was no material difference between the mortality experienced by the dispersed and not-dispersed mice. But at about the 25th day the death-rate in each of the dispersed herds showed a definite decline, while that in the undispersed herds continued unabated for some further length of time.

Subacute and chronic meningitis (SCM) presents significant diagnostic challenges, with numerous infectious and non-infectious inflammatory causes. This study examined patients aged 16 and older with SCM admitted to referral centers for neuroinfections and neuroinflammations in Mashhad, Iran, between March 2015 and October 2022. Among 183 episodes, tuberculous meningitis was the most common infectious cause (46.5%), followed by Brucella meningitis (24.6%). The cause of SCM was definitively proven in 40.4%, presumptive in 35.0%, and unknown in 24.6% of cases. In-hospital mortality was 14.4%, and 30.5% of survivors experienced unfavorable outcomes (Glasgow Outcome Scale 2–4). Patients with unknown causes had a significantly higher risk of death compared to those with presumptive or proven diagnoses (risk ratio 4.18). This study emphasizes the diagnostic difficulties of SCM, with one-quarter of cases remaining undiagnosed and over one-third having only a presumptive diagnosis. Improving diagnostic methods could potentially enhance prognosis and reduce mortality.

1. When fleas bit through films of Tuberculin, Vaccine Lymph, and Staphylococcus Emulsion lying upon the human skin, no inoculation was observed in 188 instances out of 195. In six of the experiments with Tuberculin, inoculation followed, which possibly was not due to the flea-bites. Controls gave positive results.

2. When the same materials were rubbed over recent flea-bites, no inoculations followed. Controls were positive.

3. A very minute dose of Tuberculin, such as might be conveyed by a flea's proboscis, will produce a recognisable reaction in a susceptible person.

4. The bearing of the results on the question of plague transmission is discussed.

Many studies have investigated the positivity rate of hepatitis B surface antibody (HBsAb) after hepatitis B vaccine (HepB) immunization. However, the antibody level, assessed monthly or at more frequent intervals after each of the three doses, particularly within the first year after birth, has not been previously reported. To elucidate the level of antibody formation at various times after vaccination, the current study used the available detection data of HBsAb in hospitalized children to analyze the HBsAb level after immunization combined with their vaccination history. Both the positivity rate and geometric mean concentration (GMC) increased sequentially with immunization doses, reaching their peaks earlier after the third dose than after the first two doses, and the rate of HBsAb positivity was able to reach 100% between 11 and 90 days after completing the three doses of HepB. Within one year after receiving the three doses, the antibody positivity rate and GMC were maintained above 90% and 100 mIU/mL, respectively, and subsequently steadily declined, reaching the lowest value in the 9th and 10th years. The current findings reveal, in more detail, the level of antibody formation at different times following each dose of HepB in hospitalized children, particularly in the age group up to one year after vaccination. For the subjects of this study, we prefer to believe that the proportion of HBsAb non-response should be less than 5% after full immunization with HepB, provided that the appropriate time for blood collection is chosen.

Healthcare workers’ (HCWs) safety and availability to care for patients are critical during a pandemic such as the one caused by severe acute respiratory syndrome coronavirus 2. Among providers of different specialities, it is critical to protect those working in hospital settings with a high risk of infection. Using an agent-based simulation model, various staffing policies were developed and simulated for 90 days using data from the largest health systems in South Carolina. The model considers staffing policies that include geographic segregation, interpersonal contact limits, and a combination of factors, including the patient census, transmission rates, vaccination status of providers, hospital capacity, incubation time, quarantine period, and interactions between patients and providers. Comparing the existing practices to various risk-adjusted staffing policies, model predictions show that restricted teaming and rotating schedules significantly (p-value <0.01) reduced weekly HCW unavailability and the number of infected HCWs by 22% and 38%, respectively, when the vaccination rates among HCWs were lower (<75%). However, as the vaccination rate increases, the benefits of risk-adjusted policies diminish; and when 90% of HCWs were vaccinated, there were no significant (p-value = 0.09) benefits. Although these simulated outcomes are specific to one health system, our findings can be generalised to other health systems with multiple locations.

The Salmonella group contains the organisms which are mainly responsible for outbreaks of food poisoning and the possibility of the production by these strains of bodies which are toxic, or which act as gastro-intestinal irritants, when administered by the oral route, is of practical as well as theoretical interest. This is especially the case if it can be shown that these irritant substances are heat resistant.

The villages selected for the present series of observations were Dhand and Kasel in the Arnritsar District of the Punjab. They are situated about 10 miles south-west of Amritsar City and within a distance of ¾ mile of each other. They are typical Punjab villages of about 2,000 and 4,000 inhabitants respectively.

This study aimed to investigate differences in the antimicrobial susceptibility of members of the Mycobacterium abscessus complex (MABC): subsp. massiliense and subsp. abscessus, and to identify associations between strain genotypes and antimicrobial resistance phenotypes. A total of 383 clinical MABC isolates (subsp. abscessus: n = 218, 56.9%; subsp. massiliense: n = 163, 42.6%; subsp. bolletii: n = 2, 0.5%) were characterised using multilocus variable number tandem repeat (VNTR) typing and drug susceptibility testing. Most isolates exhibited susceptibility to amikacin, clarithromycin and azithromycin but resistance to cefoxitin and minocycline was statistically more associated with isolates unclustered by VNTR type. The Simpson's diversity indexes of VNTR typing for M. abscessus and M. massiliense isolates were 0.999 and 0.997, respectively. Genotyping of M. abscessus and M. massiliense isolates by VNTR may provide valuable information for predicting resistance phenotype.

1. That the epidemic was due to infection of the water supply is borne out by the following points:

(a) The explosive character of the outbreak as shown in Graph II which is characterised by a rapid rise to peak at the end of third week followed by a sharp fall and a gradual tailing off to the end of the epidemic.

(b) The widespread distribution of cases (see Map), no area supplied by water from the city having escaped.

(c) The rapid decline which followed the adoption of appropriate measures to deal with the water supply.

2. 255 persons in the city area (including the 12 military cases) were definitely affected (equivalent to a rate of 3·1 per 1000 of the population). As shown by the rise in the death-rate for the rural area it is apparent that a far greater number of persons were actually attacked.

3. The outbreak had its origin in a defective manhole in the Mental Hospital grounds whereby the sewage overflowed into a rubble drain and infected the water supply. This defect had existed for twenty-five years, and an epidemic in the hospital fifteen years previously established the reservoir from which infection was disseminated through the city.

4. The spread of typhoid was favoured by unsatisfactory arrangements for the filtration of the water supply. This is borne out by the endemic character of the disease prior to the installation of an effective filtration plant.

5. The institution of this plant was followed by an immediate reduction in the incidence of the disease until, as at the present time, water-borne typhoid has been practically eliminated.

6. The value of such a plant combined with chlorination and bacteriological examination has been shown.

In view of the observations made of late years on the action of red light in variola, it was thought that it might be of interest to ascertain, if possible, whether the red, or other rays of daylight, exerted any influence in cases of vaccinia; that is to say, with a disease the specific virus of which differs from that of variola probably only in that its pathogenic capabilities are modified, while vaccinia presents clinically many points of resemblance to variola.

1. The incidence of haemolytic streptococci in the patients of a Hospital School for rheumatic children was determined over a period of 1 year.

2. In the total of 1644 throat and 1644 nasal swabs, group A strains were isolated from 20 throat and two nasal swabs. Eighty-seven strains of Lancefield's groups C and G and 54 strains of groups other than A, C, or G were isolated

3. There was no evidence of cross-infection.

4. Factors contributing to the low incidence of group A strains and the absence of cross-infection are discussed.

5. The carriage of groups C and G strains did not appreciably affect the erythrocyte sedimentation rate.

6. Although no direct evidence is available, the experience of the present study suggests that the incidence of streptococci in an institution for rheumatic children may be reduced by: (a) bacteriological screening before admission; (b) regular swabbing and Lancefield's grouping of streptococci isolated for the early detection of group A strains; and (c) administration of penicillin or sulphadiazine prophylactically to even a limited number of children.

We thank Prof. R. S. Illingworth for his advice in the writing of this paper, Dr J. L. Emery for laboratory facilities, Dr R. E. O. Williams for his advice in the planning of the investigation, and the matron and sisters of Ash House Hospital School, Sheffield, for their assistance.

The expenses of the investigation were defrayed by a grant from the Medical Research Council.

Two phenotypes of human influenza A(H1N1) virus are currently circulating in Japan. One (group 1) agglutinates both chicken and goose red blood cells (CRBC and GRBC), the other (group 2) agglutinates GRBC but not CRBC. In the 1995/6 season, group 2 viruses accounted for 70% of the H1N1 viruses isolated in MDCK cells. The 1995/6 viruses were located on two branches of the genetic tree. One branch contained both group 1 and group 2 viruses and the other branch contained only group 2 viruses. Group 2 viruses had aspartic acid at residue 225 in the haemagglutinin (HA) protein, the key amino acid residue for group 2 phenotype. The HA protein of group 1 viruses had a change from aspartic acid to asparagine at residue 225 and the expressed HA protein of these viruses adsorbed CRBC. Serial passage of group 2 viruses in MDCK cells or embryonated chicken eggs caused these viruses to gain the ability to agglutinate CRBC. MDCK-adapted viruses had the same amino acid sequences of HA polypeptide as the original ones, but egg-adapted viruses had changed amino acid sequences. The expressed HA protein from one egg-adapted virus that originally belonged to group 2 adsorbed CRBC.

About 25 years ago Dr J. S. Haldane, Dr A. E. Boycott and Capt. Damant, R.N., in the course of investigations for the British Admiralty, worked out a system of decompression for divers and compressed air workers. This system was adopted by the Admiralty, and by its use compressed air sickness has been practically eliminated entirely amongst naval divers. The system has become known as stage decompression, although in fact stages are not an essential feature of it, though a convenience in practical working. The system has been frequently and fully described. The latest explanation will be found in the last edition, 1935, revised by Haldane and Priestly, of Respiration, by J. S. Haldane (Clarendon Press). Its most essential feature is that the pressure is lowered quickly to approximately half the absolute pressure during decompression, and one of the most important assumptions for working out the decompression tables is that different parts of the body saturate and desaturate at different rates. Enquiries sent out by me during 1934 to the United States, the principal countries of Europe and to Japan indicate, so far as definite information has been received in reply, that stage decompression has been universally adopted for divers, but in no case has it been adopted for caisson and tunnel workers in countries where State regulations already existed, except in a modified form, and I conclude that the reason for this failure to adopt stage decompression is the existence of statutory regulations, either still in force, or only partly modified in accordance with new ideas.

Immunization experiments in guinea-pigs with high egg passage Flury virus gave the following results:

1. Intracerebral inoculation of the vaccine protects against subsequent intracerebral or peripheral challenge with fixed virus.

2. Intramuscular administration results in the development of a good immunity status to peripheral challenge.

3. Intramuscular or intravenous inoculation of the vaccine fails to protect against intracerebral challenge.

Two hundred and sixty-four samples of sera obtained from normal healthy persons belonging to different age groups were examined for haemagglutination-inhibiting antibodies against reovirus types 1–3 to assess the prevalence of reovirus infection in the northern part of India.

Reovirus infection appeared as early as 6 months to 1 year of age. With reovirus types 1 and 2, the maximum incidence of 67 and 48% respectively occurred by the age of 10–20 years, whereas with type 3 infection the maximum incidence (73%) was reached by the age of 25 years. The incidence of reovirus type 2 infection in all the age groups was remarkably low in this series. A drop in the incidence of reovirus type 2 infection was also noticed after the age of 20 years.

The difference in geometric mean titre of antibody in different ages against reovirus type 2 was highly significant, suggesting probably that most of the infection occurred by the age of twenty years. The difference in the geometric mean value of the titres of antibody against types 1 and 3 was not significant in different age groups. The levels of antibody against types 1 and 3 in all the age groups were almost the same, suggesting that infection, specially with reovirus type 3, was occurring in all the age groups even beyond 20 years of age.

The authors wish to express their sincerest thanks to Dr Leon Rosen, Pacific Research Section, National Institute of Allergy and Infectious Diseases, Honolulu, Hawaii, for the supply of prototype strains of reoviruses, to Drs B. K. Aikat, Director Professor of Pathology, R. N. Chakravarti, Department of Experimental Medicine, O. N. Bhakoo, and Sucheta Thukral, Department of Paediatrics, Post- Graduate Institute of Medical Education and Research, Chadigarh, for their invaluable help and co-operation, to Prof. P. V. K. Iyer, Department of Mathematics, Panjab University, and to Mr H. D. Gupta, Biostatistician, Post-Graduate Institute of Medical Education and Research, Chadigarh for their statistical analysis of the results.

The authors gratefully acknowledge the helpful criticism and suggestion of Dr C G. Pandit, Ex-Director, Indian Council of Medical Research, during the preparation of the paper.

The authors acknowledge also the technical assistance of Mr Jagmohan Lai Pipat, Mr Gurmeet Singh Khatra, and Mr Amar Singh Saini.

This work was partly supported by the Research Grant of the Indian Council of Medical Research sanctioned to one of the authors (S. R. P.).

Experiments I–VIII.

I shows that under the conditions shown the plates were covered with innumerable colonies 7 feet above ground level to ground level. The beds and trestles were used to keep the hut always uniform.

II shows that 8 feet above ground, i.e. on top of the crossbeams, the same conditions obtain.

III, IV, V, and VI show that the same condition exists in the area between the beds or trestles. The beds make no difference, better or worse.

VII shows practically the same condition high up on the beam between the beds. The inverted plates naturally show less colonies, as the organisms mostly fall on to the plates.

VIII confirms the above.

There is only one conclusion to draw from these experiments, and that is that practically speaking there is no difference in the number of organisms on the ground floor and 8 feet above it, in the ordinary men’s sleeping huts, Barrack Design 230/14.