Pneumococcal serotype replacement is an important issue after the introduction of pneumococcal conjugate vaccine (PCV) in children. After the introduction of 13-valent PCV, the incidence of invasive pneumococcal diseases (IPD) caused by Streptococcus pneumoniae serotype 12F (Sp12F) have increased in some countries; however, an outbreak of Sp12F has not reported in the post-13-valent PCV era. We experienced a local outbreak of Sp12F during March through May 2016 in Tsuruoka city, Japan after the introduction of 13-valent PCV in 2013. The IPD patients were two children and seven adults, three of whom died with a rapid disease progress. Although the clear transmission route was not determined, eight of the nine patients (89%) had close contact with children, which suggests that transmitted colonisation of Sp12F among children and adults might be the source of transmission. Continuous monitoring of IPDs, along with the determination of pneumococcal serotypes, is warranted in the post–13-valent PCV era. New IPD control strategies may be needed if this fatal outbreak continues to occur.

Adenovirus (AdV) can cause severe respiratory infections in children and immunocompromised patients, but less is known about severe AdV pneumonia in immunocompetent adults. In this retrospective study, we compared respiratory tract infections and pneumonia caused by AdV in immunocompromised and immunocompetent adult patients regarding clinical presentation and severity of infection. The results show that AdV can cause severe infections in both immunocompetent and immunocompromised patients, and the clinical presentation and need for hospitalisation, mechanical ventilation and antiviral treatment were equal in both groups. No underlying risk factors for severe AdV infection in healthy individuals were identified.

Sections of chorio-allantoic membranes fixed at intervals after infection with large doses of vaccinia virus showed almost homogeneous areas appearing in the cytoplasm after 4 hr.; these areas contained immature forms of virus which had a thin surface membrane and an eccentric ‘nucleoid’, and were surrounded by mitochondria. Mature forms of virus, having a larger central nucleus-like structure and a thicker cortex, were first found in areas of virus growth 10 hr. after inoculation. Similar immature and mature forms were found in cells infected with fowl-pox, myxomatosis and ectromelia viruses. It is concluded that the immature forms are of low infectivity or not infective.

We studied seasonal patterns of swine hepatitis E virus (HEV) infection in China. From 2008 to 2011, 4200 swine bile specimens were collected for the detection of HEV RNA. A total of 92/2400 (3·83%) specimens in eastern China and 47/1800 (2·61%) specimens in southwestern China were positive for HEV. Seasonal patterns differing by geographical area were suggested. In eastern China, the major peak of HEV RNA prevalence was during March–April, with a minor peak during September–October, and a dip during July–August. In southwestern China, the peak was during September–October and the dip during March–April. The majority of subtype 4a cases (63/82, 76·83%) were detected in the first half of the year, while the majority of subtype 4b cases (26/29, 89·66%) were concentrated in the second half of the year, suggesting that different subtypes contribute to different peaks. Our results indicate that the distribution of HEV subtypes is associated with seasonal patterns.

Trials were conducted in the Sierra Nevada Mountains of California to test the effectiveness of 10% DDT dust in insecticide bait-box stations against the fleas of native diurnal rodents. The principle host species involved were the chipmunks Eutamias amoenus and E. speciosus, and the golden-mantled ground squirrel, Citellus lateralis. The important flea species were Monopsyllus eumolpi and M. ciliatus on chipmunks, and Diamanus montanus and Oropsylla idahoensis on ground squirrels. When baited daily for 12 days and furnished with 50 g. of 10% DDT dust, the bait-box stations reduced fleas strikingly within 24 hr., but very little residual control was obtained. A second application in which boxes were baited only twice weekly but for 28 days, also resulted in rapid knockdown and a residual control still effective 42 days after removal of the bait-boxes. The effect of the DDT was apparent at a distance of 400 ft. from the nearest bait-box due to the relatively extensive home ranges of the hosts. Although, in these trials, bait-box stations were spaced 100 ft. apart, 200 ft. spacing probably would be as effective with these hosts.

1. Anti-mallein and anti-typhoid sera produced in various animal species, including man, have been examined for complement-absorbing antibodies using the complements of the pig, horse, cat, man, dog, and guinea-pig, which is possible if use is made of the conglutinating complement-absorption test as well as the haemolytic complement-fixation test.

2. Complement-fixing antibodies which are not demonstrable when some complements are used may be detected when other complements are used; for example, antibodies to mallein in human antisera were only detected when the sera were tested with horse and cat complements.

3. These early results are published at this stage because of the obvious possible application of these methods in laboratory serological diagnosis. Further work is in progress to elucidate the underlying reasons for these observations.

4. The implications of the results are discussed from the practical and theoretical aspects.

The Rappaport–Vassiliadis enrichment medium (RV medium)in 10 ml quantities (RV/43 °C, 10 ml) inoculated with 0·1 ml of pre-enrichment medium (P medium) was found more efficient in the isolation of salmonellae from 409 pre-enriched samples (mainly meat products), than the original Rappaport medium incubated at 43 °C (R/43 °C) and the RV medium in 5 ml quantities (RV/43 °C, 5 ml) inoculated with 0·01 ml of P medium (P < 0·001, in both instances). Therefore, the inoculum from pre-enriched foods should not be less than 0·l ml in 10 ml of RV medium.

The RV/43°, 10 ml was also better (P < 0·01) in detecting samples containing salmonellas than the original Rappaport medium incubated at 37 °C (R/37 °C, 10 ml) and the modification R25 of R medium incubated at 37 °C. The R25 modification was used in 10 ml quantities (R25/37 °C, 10 ml) inoculated with 0·1 ml of P medium and in 5 ml quantities (R25/37°, 5 ml) inoculated with 0·01 ml of P medium. The last two R25 procedures were of the same efficiency in isolating salmonellas from meat products.

The prevalence of antibody against hepatitis C virus (anti-HCV) and five hepatitis B virus markers (HBVM) was measured in 176 Chinese drug addicts, of whom 23 were AIDS patients. Of 176 drug addicts, 147 were members of ethnic minorities while 29 were Han, the majority ethnic group. The total prevalence rates of anti-HCV and HBVM were 35·8% and 50·6% respectively, significantly different (P<0·01). Anti-HCV and HBVM were together found in 22·7%. Similar prevalence rates were found among the different ethnic groups. Among the ethnic minorities, there was a significantly higher prevalence rate of anti-HCV in intravenous drug addicts (IVDA, 51·1%) than in oral drug addicts (20·3%). Furthermore, the prevalence of anti-HCV was significantly higher in needle-sharing abusers (60·4%) than in non-needle sharing ones (37·1%, P<0·05). The prevalence of HBVM was also significantly higher in needle-sharing abusers (69·8%) than in non-needle sharing ones (34·3%). Prevalence of HBsAg was significantly higher in drug abusers with AIDS (47·8%) than in IVDA only (16·1%). The anti-HCV positive rates among ethnic minority people were: for the Yi people 69·2%, the Hui 55·6%, the Bai 53·9%, the Dai 26·8% and the Wa 23·1%. No obvious difference was identified for HBVM. The prevalence rates of HCV, HBV and HCV+HBV in IVDA showed no significant difference (P>0·05) between the two regions. HIV, HCV and HBV infections may promote each other and be related to needle-sharing behaviour in drug abuse and to different subcultures and living habits.

Cryptosporidium is a protozoan parasite that causes the diarrhoeal disease, cryptosporidiosis. Although many species have been identified, the majority of human disease worldwide is caused by two species; Cryptosporidium parvum and Cryptosporidium hominis. In Australia, data from the National Notifiable Diseases Surveillance System (NNDSS) show that cryptosporidiosis outbreaks occur every few years. To better understand the transmission, trends and nature of cryptosporidiosis outbreaks in Western Australia, epidemiological and genomic data from three cryptosporidiosis outbreaks in 2003, 2007 and 2011 were reviewed. The 2007 outbreak was the largest (n = 607) compared with the outbreaks in 2003 (n = 404) and 2011 (n = 355). All three outbreaks appeared to have occurred predominantly in the urban metropolitan area (Perth), which reported the highest number of case notifications; increases in case notifications were also observed in rural and remote areas. Children aged 0–4 years and non-Aboriginal people comprised the majority of notifications in all outbreaks. However, in the 2003 and 2007 outbreaks, a higher proportion of cases from Aboriginal people was observed in the remote areas. Molecular data were only available for the 2007 (n = 126) and 2011 (n = 42) outbreaks, with C. hominis the main species identified in both outbreaks. Subtyping at the glycoprotein 60 (gp60) locus identified subtype IbA10G2 in 46.3% and 89.5% of C. hominis isolates typed, respectively, in the 2007 and 2011 outbreaks, with the IdA15G1 subtype was identified in 33.3% of C. hominis isolates typed in the 2007 outbreak. The clustering of cases with the IdA15G1 subtype in the remote areas suggests the occurrence of a concurrent outbreak in remote areas during the 2007 outbreak, which primarily affected Aboriginal people. Both the C. hominis IbA10G2 and IdA15G1 subtypes have been implicated in cryptosporidiosis outbreaks worldwide; its occurrence indicates that the mode of transmission in both the 2007 and 2011 outbreaks was anthroponotic. To better understand the epidemiology, sources and transmission of cryptosporidiosis in Australia, genotyping data should routinely be incorporated into national surveillance programmes.

The sera of 3522 women who attended an antenatal clinic in Birmingham. England were tested anonymously for antibodies against HTLV-1. Samples from 5 women (0·14%) were positive, one serum showed indeterminate reactivity. Two of the women (0·06%) were born in the West Indies (of Afro-Caribbean ethnic origin), one (0·03%) in Africa (of African ethnic origin), and three (0·09%) were white Caucasian women born in the UK. Thus, HTLV-1 infection in pregnant women in the UK, though comparatively rare, is not negligible. As transmission of HTLV-1 to the newborn via breast milk has been observed and as seropositive mothers can be advised to refrain from breastfeeding or to treat their milk, the question of routine screening for HTLV-1 infection during antenatal care is discussed.

The result of penicillin prophylaxis of experimental inhalation anthrax in the Rhesus monkey has been shown to be dependent upon the time of its initiation. If begun too early, it is unsuccessful. It may not be too long delayed, or the infection will have passed the point of no return. A brief, critical time period exists, during which successful prophylaxis may be initiated. This favourable outcome is attributed to the elaboration in vivo of sufficient antigen or antigens to stimulate an adequate immune response, prior to the initiation of antibiosis.

The ELISA and an immunoblotting technique were used to study F38-type mycoplasmas – an important cause of contagious caprine pleuropneumonia – and a number of related mycoplasma species, subspecies, types or serogroups.

Two-way ELISA cross-reactivity was demonstrated between five mycoplasmas, namely strain F38, Mycoplasma mycoides subsp. mycoides (LC strain), M. equigenilalium, M. primatum and bovine serogroup 7. In addition one-way cross-reactivity was demonstrated between F38 and each of the following mycoplasmas: M. mycoides subsp. mycoides (two SC strains), M. mycoides subsp. capri, and bovine serogroup L. F38 and M. capricolum did not cross-react.

Immunoblot analysis, unlike ELISA, revealed that F38 and M. capricolum were closely related. At least four major protein antigens were shared between F38, M. mycoides subsp. mycoides (SC and LC strains), M. mycoides subsp. capri and bovine serogroup 7. The ELISA cross-reactions (above) shown by M. equigenitalium and M. primatum with each other, with F38 and with other mycoplasmas were not apparent by immunoblotting.

Data were pooled from three Australian sentinel general practice influenza surveillance networks to estimate Australia-wide influenza vaccine coverage and effectiveness against community presentations for laboratory-confirmed influenza for the 2012, 2013 and 2014 seasons. Patients presenting with influenza-like illness at participating GP practices were swabbed and tested for influenza. The vaccination odds of patients testing positive were compared with patients testing negative to estimate influenza vaccine effectiveness (VE) by logistic regression, adjusting for age group, week of presentation and network. Pooling of data across Australia increased the sample size for estimation from a minimum of 684 to 3,683 in 2012, from 314 to 2,042 in 2013 and from 497 to 3,074 in 2014. Overall VE was 38% [95% confidence interval (CI) 24–49] in 2012, 60% (95% CI 45–70) in 2013 and 44% (95% CI 31–55) in 2014. For A(H1N1)pdm09 VE was 54% (95% CI–28 to 83) in 2012, 59% (95% CI 33–74) in 2013 and 55% (95% CI 39–67) in 2014. For A(H3N2), VE was 30% (95% CI 14–44) in 2012, 67% (95% CI 39–82) in 2013 and 26% (95% CI 1–45) in 2014. For influenza B, VE was stable across years at 56% (95% CI 37–70) in 2012, 57% (95% CI 30–73) in 2013 and 54% (95% CI 21–73) in 2014. Overall VE against influenza was low in 2012 and 2014 when A(H3N2) was the dominant strain and the vaccine was poorly matched. In contrast, overall VE was higher in 2013 when A(H1N1)pdm09 dominated and the vaccine was a better match. Pooling data can increase the sample available and enable more precise subtype- and age group-specific estimates, but limitations remain.

Lanoline-water cream containing 1% of antibiotic was applied for 7–14 days to the anterior nares of 124 carriers of antibiotic sensitive staphylococci. Nose swab cultures, examined during the administration of the cream, were negative for Staph. pyogenes in all carriers who received oxytetracycline, and in 80, 75, 70 and 67% of those who received penicillin, chlortetracycline, streptomycin and chloramphenicol respectively.

Seventy per cent of carriers gave nose-swab cultures negative for at least 2 weeks, 50% for at least 4 weeks and 25% for at least 20 weeks after the cessation of treatment. Over the same period only 1% of a control group ceased to be carriers.

The nares of 20% of carriers receiving antibiotic were temporarily colonized with antibiotic-resistant strains, but in only one case (0·8%) did the resistant organism persist throughout the period of examination.

The use of this method of controlling staphylococcal carriage in preventing staphylococcal infection is discussed.

I wish to thank Prof. T. J. Mackie for his advice.

In order to conduct a survey of influenza viruses entering Japan via travellers arriving by airplanes, gargle solutions were collected from passengers who reported to the quarantine station of Nagoya International Airport complaining of respiratory symptoms. From 504 samples collected between August 1996 and March 1999, 30 influenza virus strains were isolated. Twenty-eight of the isolates were influenza A (H3N2) viruses and two were influenza B viruses. No H1N1 virus was isolated. Among 28 isolates of H3N2 virus, 3 strains were obtained outside the influenza season. Nucleotide sequences of the haemagglutinin (HA) genes of these isolates along with those from domestic patients were analysed in order to determine the influence of imported influenza viruses by travellers on epidemics in Japan. From the phylogenetic and chronological aspects, the possibility was suggested in one case in 1997/8 and two in the 1998/9 season that imported virus by travellers may have influenced the domestic influenza epidemics.

Severe acute respiratory syndrome (SARS) struck Hong Kong bitterly in the spring of 2003, infecting 1755 persons and claiming nearly 300 lives. The epidemic was introduced by travellers from southern China, where the disease had originated. It started in late February and lasted until early June. Two notable ‘super-spreading’ events were reported, one inside a teaching hospital and the other in a private housing estate. Other than in the super-spreading events, the infectivity in the community appeared to be low, and there were few, if any, asymptomatic or subclinical infections. Health-care workers were at particular risk and accounted for 22% of all probable cases. The main modes of transmission were through droplet spread and close/direct contacts, but situations conducive to aerosol generation appeared to be associated with higher risk. Our review suggests that there are still many unknown factors concerning the mode of transmission and environmental risk that need to be clarified.

From 2007 to 2010, The Netherlands experienced a major Q fever outbreak with more than 4000 notifications. Previous studies suggested that Q fever patients could suffer long-term post-infection health impairments, especially fatigue. Our objective was to assess the Coxiella burnetii antibody prevalence and health status including fatigue, and assess their interrelationship in Herpen, a high-incidence village, 7 years after the outbreak began. In 2014, we invited all 2161 adult inhabitants for a questionnaire and a C. burnetii indirect fluorescence antibody assay (IFA). The health status was measured with the Nijmegen Clinical Screening Instrument (NCSI), consisting of eight subdomains including fatigue. Of the 70·1% (1517/2161) participants, 33·8% (513/1517) were IFA positive. Of 147 participants who were IFA positive in 2007, 25 (17%) seroreverted and were now IFA negative. Not positive IFA status, but age <50 years, smoking and co-morbidity, were independent risk factors for fatigue. Notified participants reported significantly more often fatigue (31/49, 63%) than non-notified IFA-positive participants (150/451, 33%). Although fatigue is a common sequel after acute Q fever, in this community-based survey we found no difference in fatigue levels between participants with and without C. burnetii antibodies.

Samples of 216 pâatés were examined for the presence of Listeria spp. Between May and August 1989; 35% were contaminated with L. monocytogenes, 5% of samples having counts of > 104/g. L. innocua was recovered from 2% of samples but no other species was isolated. Five serotypes of L. monocytogenes were represented (1/2, 4b, 4b(X), 4 not 4b or 4b(X), and NT). 4b was the predominant serotype and multiple serotypes were found in eight pâatés. The incidence of contamination with L. monocytogenes was greater in stored pâté (46%) than display pâté (30%). Sampling over a 21-day period showed an apparent increase in numbers of L. monocytogenes in 6 of 7 samples with multiple serotypes represented. There was no correlation between contamination of pâté by L.monocytogenes and the presence of coliforms. Comparisons are made between the contamination of soft cheese and pˇaté.

Discharge information for all Hong Kong government hospitals, which is routinely collected through the Clinical Management System (CMS), was used to assess the relative importance of all causes of diarrhoeal illness and to address the issue of under-diagnosis of rotavirus by linking discharge diagnostic codes with actual laboratory results for one hospital. Of all children less than 5 years of age hospitalized in Hong Kong in the 2-year period July 1997 to June 1999, 12257 (11%) were discharged with a primary diarrhoea diagnosis (74% coded as non-specified, 10·4% as rotavirus, 11% as Salmonella and 5% as other viral or bacterial). Linked laboratory and discharge data for one hospital demonstrated that 15% (n=1522) of all admissions had a primary diarrhoea diagnosis and that 40% of these had a specimen sent for rotavirus testing, of which 37% were positive. However, 46% (67/145) of children with a diagnosis of rotavirus infection had no virology result, and 69% (172/248) of positive rotavirus results were in children with no diagnosis indicating rotavirus infection. Modification of the CMS to routinely combine existing computerized laboratory data with the CMS discharge diagnoses and to develop mechanisms to enhance reliability of discharge diagnosis coding could produce a powerful resource for disease surveillance, auditing and for monitoring the impact of future vaccination and other prevention programmes.

Faecal specimens collected from outbreak (n = 253) and sporadic (n = 147) cases of acute gastroenteritis that occurred in western India between 2006 and 2014 were tested for group C rotavirus (GCR) using partial VP6 gene-based RT–PCR. All specimens were tested previously for the presence of other viral and bacterial aetiological agents by conventional methods. The rate of GCR detection was 8·6% and 0·7% in outbreak and sporadic cases, respectively. GCR infections prevailed in outbreaks reported from rural areas (10·9%) compared to urban areas (1·6%). Clinical severity score of the patients with GCR infection (n = 23) indicated severe disease in the majority (70%) of cases. The age distribution analysis indicated 52·1% of GCR infections in children aged <10 years. The male:female ratio in GCR-positive patients was 2·3:1. Of the 23 GCR-positive cases, 17 (73·9%) had a sole GCR infection and six had mixed infections with other viral and/or bacterial agents. Phylogenetic analysis of nucleotide sequences classified GCR strains of the study in to I2 genotype of the VP6 gene. This is the first study to show the occurrence of GCR in gastroenteritis outbreaks in India.