Influenza vaccine effectiveness (VE) wanes over the course of a temperate climate winter season but little data are available from tropical countries with year-round influenza virus activity. In Singapore, a retrospective cohort study of adults vaccinated from 2013 to 2017 was conducted. Influenza vaccine failure was defined as hospital admission with polymerase chain reaction-confirmed influenza infection 2–49 weeks after vaccination. Relative VE was calculated by splitting the follow-up period into 8-week episodes (Lexis expansion) and the odds of influenza infection in the first 8-week period after vaccination (weeks 2–9) compared with subsequent 8-week periods using multivariable logistic regression adjusting for patient factors and influenza virus activity. Records of 19 298 influenza vaccinations were analysed with 617 (3.2%) influenza infections. Relative VE was stable for the first 26 weeks post-vaccination, but then declined for all three influenza types/subtypes to 69% at weeks 42–49 (95% confidence interval (CI) 52–92%, P = 0.011). VE declined fastest in older adults, in individuals with chronic pulmonary disease and in those who had been previously vaccinated within the last 2 years. Vaccine failure was significantly associated with a change in recommended vaccine strains between vaccination and observation period (adjusted odds ratio 1.26, 95% CI 1.06–1.50, P = 0.010).

On 30 May 2012, Surrey and Sussex Health Protection Unit was called by five nurseries reporting children and staff with sudden onset vomiting approximately an hour after finishing their lunch that day. Over the following 24 h 50 further nurseries supplied by the same company reported cases of vomiting (182 children, 18 staff affected). Epidemiological investigations were undertaken in order to identify the cause of the outbreak and prevent further cases. Investigations demonstrated a nursery-level attack rate of 55 out of 87 nurseries (63·2%, 95% confidence interval 52·2–73·3). Microbiological tests confirmed the presence of Bacillus cereus in food and environmental samples from the catering company and one nursery. This was considered microbiologically and epidemiologically consistent with toxin from this bacterium causing the outbreak. Laboratory investigations showed that the conditions used by the caterer for soaking of pearl haricot beans (known as navy bean in the USA) used in one of the foods supplied to the nurseries prior to cooking, was likely to have provided sufficient growth and toxin production of B. cereus to cause illness. This large outbreak demonstrates the need for careful temperature control in food preparation.

Symptoms are currently used as testing indicators for SARS-CoV-2 in England. In this study, we analysed national contact tracing data for England (NHS Test and Trace) for the period 1 December to 28 December 2021 to explore symptom differences between the variants, Delta and Omicron. We found that at least one of the symptoms currently used as indicators (fever, cough and loss of smell and taste) were reported in 61.5% of Omicron cases and 72.2% in Delta cases, suggesting that these symptoms are less predictive of Omicron infections. Nearly 40% of Omicron infections did not report any of the three key indicative symptoms, reinforcing the importance of the entire spectrum of symptoms for targeted testing. After adjusting for potential confounding factors, fever and cough were more commonly associated with Omicron infections compared to Delta, showing the importance of considering age and vaccination status when assessing symptom profiles. Sore throat was also more commonly reported in Omicron infections, and loss of smell and taste more commonly reported in Delta infections. Our study shows the value of continued monitoring of symptoms associated with SARS-CoV-2, as changes may influence the effectiveness of testing policy and case ascertainment approaches.

A number of sophisticated modelling approaches are available to investigate potential associations between antimicrobial use (AMU) and resistance (AMR) in animal health settings. All have their advantages and disadvantages, making it unclear as to which model is most appropriate. We used advanced regression modelling to investigate AMU-AMR associations in faecal non-type-specific Escherichia coli (NTSEC) isolates recovered from 275 pens of feedlot cattle. Ten modelling strategies were employed to investigate AMU associations with resistance to chloramphenicol, ampicillin, sulfisoxazole, tetracycline and streptomycin. Goodness-of-fit statistics did not show a consistent advantage for any one model type. Three AMU-AMR associations were significant in all models. Recent parenteral tetracycline use increased the odds of finding tetracycline-resistant NTSEC [odds ratios (OR) 1·1–3·2]; recent parenteral sulfonamide use increased the odds of finding sulfisoxazole-resistant NTSEC (OR 1·4–2·5); and recent parenteral macrolide use decreased the odds of recovering ampicillin-resistant NTSEC (OR 0·03–0·2). Other results varied markedly depending on the modelling approach, emphasizing the importance of exploring and reporting multiple modelling methods based on a balanced consideration of important factors such as study design, mathematical appropriateness, research question and target audience.

Measles mortality fell prior to the introduction of vaccines or antibiotics. By examining historical mortality reports we sought to determine how much measles mortality was due to epidemiological factors such as isolation from major population centres or increased age at time of infection. Age-specific records were available from Aberdeen; Scotland; New Zealand and the states of Australia at the end of the 19th and beginning of the 20th centuries. Despite the relative isolation of Australia, measles mortality was concentrated in very young children similar to Aberdeen. In the more isolated states of Tasmania, Western Australia and Queensland adults made up 14–15% of measles deaths as opposed to 8–9% in Victoria, South Australia and New South Wales. Mortality in Iceland and Faroe Islands during the 1846 measles epidemic was used as an example of islands isolated from respiratory pathogens. The transition from crisis mortality across all ages to deaths concentrated in young children occurred prior to the earliest age-specific mortality data collected. Factors in addition to adult age of infection and epidemiological isolation such as nutritional status and viral virulence may have contributed to measles mortality outcomes a century ago.

Escherichia coli O157:H7 is the largest cause of hemolytic uremic syndrome (HUS). Previous studies proposed that HUS risk varies across the E. coli O157:H7 phylogenetic tree (hypervirulent clade 8), but the role of age in the association is unknown. We determined phylogenetic lineage of E. coli O157:H7 isolates from 1160 culture-confirmed E. coli O157:H7 cases reported in Washington State, 2004–2015. Using generalised estimating equations, we tested the association between phylogenetic lineage and HUS. Age was evaluated as an effect modifier. Among 1082 E. coli O157:H7 cases with both phylogenetic lineage and HUS status (HUS n = 76), stratified analysis suggested effect modification by age. Lineages IIa and IIb, relative to Ib, did not appear associated with HUS in children 0–9-years-old. For cases 10–59-years-old, lineages IIa and IIb appeared to confer increased risk of HUS, relative to lineage Ib. The association reversed in ⩾60-year-olds. Results were similar for clade 8. Phylogenetic lineage appears to be associated with HUS risk only among those ⩾10-years-old. Among children <10, the age group most frequently affected, lineage does not explain progression to HUS. However, lineage frequency varied across age groups, suggesting differences in exposure and/or early disease manifestation.

1. A peptone salt agar appears to be the medium of choice in the preparation of suspensions of V strains of B. typhosus for Vi agglutination. The presence of heart extract may have a definite inhibitory effect on Viagglutination but the effect is irregular.

2. A safe method for the preparation of anti-Vi serum with virulent cultures is described.

3. Repeated endeavours to produce an anti-Vi serum by the use of formolized vaccines were unsuccessful.

4. A suspension of a V strain killed at 55° C. can be used as a vaccine for producing Vi agglutination.

5. The thermostability of the Vi antigen is discussed.

6. An analysis is made of the presence of Vi antigen in a number of freshly isolated and stock strains of B. typhosus.

7. A series of typhoid cases has been examined for Vi agglutination, and it is concluded that the latter is unlikely to be of any clinical value either in diagnosis or prognosis.

Acknowledgements. The writer wishes to express his thanks to his colleagues, Dr R. M. Humphreys, Senior Physician, Khartoum and Dr J. S. Hovell, Omdurman, for their valuable co-operation; and to Dr Ali Bedri, Khartoum Hospital, he is much indebted for assistance in analysing the clinical data and records of the typhoid cases.

Hypertension represents one of the most common pre-existing conditions and comorbidities in Coronavirus disease 2019 (COVID-19) patients. To explore whether hypertension serves as a risk factor for disease severity, a multi-centre, retrospective study was conducted in COVID-19 patients. A total of 498 consecutively hospitalised patients with lab-confirmed COVID-19 in China were enrolled in this cohort. Using logistic regression, we assessed the association between hypertension and the likelihood of severe illness with adjustment for confounders. We observed that more than 16% of the enrolled patients exhibited pre-existing hypertension on admission. More severe COVID-19 cases occurred in individuals with hypertension than those without hypertension (21% vs. 10%, P = 0.007). Hypertension associated with the increased risk of severe illness, which was not modified by other demographic factors, such as age, sex, hospital geological location and blood pressure levels on admission. More attention and treatment should be offered to patients with underlying hypertension, who usually are older, have more comorbidities and more susceptible to cardiac complications.

A controlled trial of Naseptin cream, as an anti-staphylococcaiprophylactic, made in two adult wards, showed the cream to be effective in reducing nasal carriage, including antibiotic resistant strains. There was no marked effect on wound infection.

A controlled trial of Naseptin cream and Sterzac powder prophylactically in maternity nurseries was found to be effective in reducing nasal carriage and infection.

These findings are discussed, and recommendations on the use of Naseptin cream as a prophylactic are made.

The objective of this study was to investigate the genetic diversity of methicillin-resistant Staphylococcus aureus (MRSA) clonal complex (CC) 398 using pulsed-field gel electrophoresis (PFGE). Dust and pigs at five age groups were sampled in six Danish MRSA-positive pig farms. MRSA CC398 was isolated from 284 of the 391 samples tested, including 230 (74%) animal and 54 (68%) environmental samples. PFGE analysis of a subset of 48 isolates, including the six strains previously isolated from farm workers, revealed the existence of farm-specific pulsotypes. With a single exception, human, environmental and porcine isolates originating from the same farm clustered together in the PFGE cluster analysis, indicating that spread of MRSA CC398 in Danish pig farms is mainly due to clonal dissemination of farm-specific lineages that can be discriminated by PFGE. This finding has important implications for planning future epidemiological studies investigating the spread of CC398 in pig farming.

Several species of Leptospira have been studied by means of the electron microscope. Their morphology is described. The Leptospira consists in a long homogeneous cylinder of protoplasm, enveloped in a very thin anistic membrane and wrapped around a slender axistyle. Vibratile structures and granules generally are lacking.

The appearance of Leptospiras differs according to different methods of fixation used and according to different physical or chemical treatments to which they are subjected.

In a residential estate of 4000 persons, containing neither industry nor retail butchers shops, salmonellas were regularly found in the sewerage system. They were frequently found in the sewage of a portion of the estate housing 1000 persons. The range of serotypes found was wide and some types suggested an exotic origin. No overt salmonella infection in the estate was reported during the period of survey, although local general practitioners had been previously alerted. Overt infection due to serotypes found in the survey were, however, reported in other areas of Glamorgan. Multiple sampling points in the sewerage system and a serological technique for examining samples contaminated with multiple salmonella serotypes were essential for the technical success of the survey.

We should like to thank Prof. Scott Thomson for his advice in the preparation of this paper; Dr E. S. Anderson of the Central Enteric Reference Laboratory and Bureau, Colindale, for phage-typing the strains of S. typhimurium and S. paratyphi B; and Dr G. J. G. King of the Public Health Laboratory, Bournemouth, for identifying the serotypes isolated. We should also like to thank Mr T. R. Liddington and Mr J. H. Price for their technical assistance.

We determined the extent by which mandatory reporting on isolates of Shigella and Salmonella underestimates the burden of diarrhoeal diseases in individuals aged <17 years in Israel and examined paediatricians' knowledge, attitudes and practices related to patient visits with diarrhoeal diseases. Sources of data were a nationwide population-based telephone survey for presence of diarrhoeal diseases, Maccabi Healthcare Services databases and a mail survey among its paediatricians. Monte Carlo simulation and rate estimates for all stages, from visit to physician to reporting on a culture-confirmed case of shigellosis or salmonellosis, were used to determine the underestimation factor. Of 1492 children, 5·7% reported a diarrhoeal episode during the 2 weeks prior to interview. The rate of visiting a physician with and without fever was 86% and 16%, respectively. A stool culture was performed for around 20% of patients and the isolation rates were 7·1% for Shigella and 2·1% for Salmonella. Paediatricians (n=214) ranked very young age of patient and the complaint ‘bloody diarrhoea’ as the most important determinants. We estimated that one reported isolate of Shigella or Salmonella represented 152 diarrhoeal episodes of all aetiologies. This estimate is important for further assessments of the true burden of diarrhoeal diseases.

Identification of societal activities associated with SARS-CoV-2 infection may provide an evidence base for implementing preventive measures. Here, we investigated potential determinants for infection in Denmark in a situation where society was only partially open. We conducted a national matched case-control study. Cases were recent RT-PCR test-positives, while controls, individually matched on age, sex and residence, had not previously tested positive for SARS-CoV-2. Questions concerned person contact and community exposures. Telephone interviews were performed over a 7-day period in December 2020. We included 300 cases and 317 controls and determined odds ratios (ORs) and 95% confidence intervals (95% CI) by conditional logistical regression with adjustment for household size and country of origin. Contact (OR 4.9, 95% CI 2.4–10) and close contact (OR 13, 95% CI 6.7–25) with a person with a known SARS-CoV-2 infection were main determinants. Contact most often took place in the household or work place. Community determinants included events with singing (OR 2.1, 95% CI 1.1–4.1), attending fitness centres (OR 1.8, 95% CI 1.1–2.8) and consumption of alcohol in a bar (OR 10, 95% CI 1.5–65). Other community exposures appeared not to be associated with infection, these included shopping at supermarkets, travel by public transport, dining at restaurants and private social events with few participants. Overall, the restrictions in place at the time of the study appeared to be sufficient to reduce transmission of disease in the public space, which instead largely took place following direct exposures to people with known SARS-CoV-2 infections.

The results of the study reported here are part of an ongoing integrated research programme aimed at producing additional, robust, evidence on the genetic resistance to classical scrapie in goats, with particular reference to codon 146. The study targeted animals aged ⩾6 years, which were born and raised in infected herds and were being culled for management reasons. A total of 556 animals were tested, and all positive animals (n = 117) were of the susceptible NN genotype. A total of 246 goats heterozygous or homozygous for putatively resistant alleles (S146 and D146) were screened with no positive results. The outcome of this study supports the hypothesis that the D146 and S146 alleles could be used as the basis for a nationwide strategy for breeding for resistance in the Cypriot goat population.

The present study was undertaken to investigate the occurrence of antibiotic resistance in enteric flora in 64 children in rural Bangladesh over a 12-month period. The antibiotic resistance pattern of the isolates varied throughout the year and multiple resistance was highest during the post monsoon period. Seventythree percent of children had isolates resistant to more than three antibiotics throughout the year. Resistance to streptomycin was highest (78%), followed closely by ampicillin (72%). Of 82 multiply resistant isolates, plasmid DNA was demonstrated in 75%. Plasmid sizes ranged between 3·7 and 110 MDa, the commonest plasmids were of 70, 98 and 110 MDa. Complete or partial resistance was transferred by conjugation from 52% of the isolates, most frequently by single plasmids. The commonest plasmid incompatibility group was F11-A (46%) followed by incompatibility group P (22%). Plasmids of molecular weight 98 MDa most often hybridized with F11-A probes and those of 110 MDa with H11 probes. Plasmids from 10 transconjugants were digested with restriction enzymes and digest patterns demonstrated the presence of common plasmids. The findings show that there is a diverse, and mobile, genetic pool of resistance genes in this rural community. This genetic reservoir is potentially transferable to enteric pathogens, with major implications for public health and diarrhoeal disease control.

We investigated the epidemic pattern of chickenpox incidence among 47 prefectures in Japan. There were two peaks in chickenpox incidence in all prefectures. The first peaks appear at almost the same time in a year, while the second peaks occur at different times with relatively different types of size and shape. The feature of the second peak might characterize the epidemic pattern of chickenpox. We first introduced the second peak index, that is, the ratio of the difference between the incidence at the point of the second peak and the minimum incidence between the first and second peaks to the difference between the incidence at the point of the second peak and the minimum incidence in the year. There was a close correlation between the second peak index and the magnitude of variation in temperature within a year corresponding to the difference between the maximum and the minimum of the monthly mean of the highest daily temperature. This is the first article focusing on the close relationship between the second peak of epidemic pattern of chickenpox incidence and the variation of temperature within a year.

(1) Chickens fed on a 1/20th their body-weight daily of padi, cured or parboiled unpolished rice, or fresh (partly polished) rice, remain free from polyneuritis for at least 28 to 100 days.

(2) Chickens fed on the same ration of polished Siam rice develop symptoms of polyneuritis in from 20 to 70 days.

(3) When the polished rice is soaked in excess of water for 24 hours the birds succumb to polyneuritis in from 10 to 35 days; when the rice is soaked for 48 hours the disease appears still more readily, viz. in 15 days.

(4) Chickens fed on 1/20th their body-weight of parboiled rice which had been soaked for 24 hours also develop polyneuritis in from 13 to 39 days. This fact is of practical importance, as epidemics of beri-beri have been traced to the practice of soaking unpolished rice prior to cooking and discarding the water.

(5) Although birds fed on diets of polished rice, sago, or glucose develop polyneuritis, when fed on commercial starch they often fail to do so and merely lose considerably in weight. An explanation is offered.

(6) While fowls fed on 1/20th their body-weight of padi remain free from polyneuritis for at least 60 to 100 days, when this ration is supplemented by 1/6th the body-weight of washed unpolished rice or 1/10th of polished rice polyneuritis appears in from 20 to 30 days.

(7) On the other hand, chickens fed on rations varying from 1/5th to 1/30th of their body-weight of washed unpolished rice develop polyneuritis in about the same time, 10 to 20 days.

(8) On dietaries composed of rations of polished rice varying from 1/20th to 1/40th the body-weight and of yeast varying from 1/2500th to 1/3500th the body-weight pigeons and chickens do not develop polyneuritis until at least 32 to 100 days have elapsed, but when the carbohydrate ration is doubled by the addition of polished rice or sago the birds fall ill in from 13 to 46 days.

(9) Even when daily rations of polished rice as large as 1/10th the body-weight are fed to chickens together with varying amounts of yeast, 93 to 98 per cent, of the carbohydrate is digested and absorbed and the excreta contain no anti-neuritic substance. This shows that the rapid development of polyneuritis induced by feeding large rations of starch is not due to interference of undigested carbohydrate with the absorption of the active material.

(10) Intestinal bacteria, unlike yeast, contain little anti-neuritic substance.

The microbiological quality of eight halogenated and two u.v.-treated hydrotherapy pools in hospitals was investigated. The microbiological quality of halogenated hydrotherapy pools was comparable to halogenated public swimming pools, although in some Pseudomonas aeruginosa and faecal pollution indicators were more frequent due to bad management.

On the other hand u.v.-treated hydrotherapy pools had very bad microbiological quality. Apart from faecal pollution indicators, P. aeruginosa was present in very high numbers.

Halogenated hydrotherapy pools were not highly contaminated with amoebae, and Naegleria spp. were never detected. On the other hand u.v.-treated pools contained very high numbers of thermophilic Naegleria. The Naegleria isolates were identified as N. lovaniensis, a species commonly found in association with N. fowleri.

Isoenzyme analysis showed a different type of N. lovaniensis was present in each of two u.v.-treated pools.

Central line-associated bloodstream infections (CLABSIs) in intensive care units (ICUs) result in poor clinical outcomes and increased costs. Although frequently regarded as preventable, infection risk may be influenced by non-modifiable factors. The objectives of this study were to evaluate organisational factors associated with CLABSI in Victorian ICUs to determine the nature and relative contribution of modifiable and non-modifiable risk factors. Data captured by the Australian and New Zealand Intensive Care Society regarding ICU-admitted patients and resources were linked to CLABSI surveillance data collated by the Victorian Healthcare Associated Infection Surveillance System between 1 January 2010 and 31 December 2013. Accepted CLABSI surveillance methods were applied and hospital/patient characteristics were classified as ‘modifiable’ and ‘non-modifiable’, enabling longitudinal Poisson regression modelling of CLABSI risk. In total, 26 ICUs were studied. Annual CLABSI rates were 1·72, 1·37, 1·00 and 0·93/1000 CVC days for 2010–2013. Of non-modifiable factors, the number of non-invasively ventilated patients standardised to total ICU bed days was found to be independently associated with infection (RR 1·07; 95% CI 1·01–1·13; P = 0·030). Modelling of modifiable risk factors demonstrated the existence of a policy for mandatory ultrasound guidance for central venous catheter (CVC) localisation (RR 0·51; 95% CI 0·37–0·70; P < 0·001) and increased number of sessional specialist full-time equivalents (RR 0·52; 95% CI 0·29–0·93; P = 0·027) to be independently associated with protection against infection. Modifiable factors associated with reduced CLABSI risk include ultrasound guidance for CVC localisation and increased availability of sessional medical specialists.