It is unknown which intervention strategies are used or effective to increase influenza vaccine uptake by healthcare workers (HCWs) in acute hospitals in England. We undertook a survey in acute hospitals, described strategies employed from 2008 to 2012 and used multivariable binomial regression to identify those effective. Eighty out of 166 trusts responded and reported 25 strategies. Every intervention showed increased use: peer vaccination from 3·8% to 38·8% (+921%); educational DVDs from 3·8% to 22·5% (+492%); Twitter from 2·5% to 12·5% (+400%) and Facebook from 1·3% to 6·3% (+384%). Peer vaccination increased uptake by 7·3% [95% confidence interval (CI) 1·1–13·6, P = 0·02] overall; educational DVDs by 9·7% overall (95% CI 1·8–17·6, P = 0·02), 11·9% in non-doctor, non-nurse HCWs (95% CI 0·9–22·8, P = 0·03). For doctors, using a champion doctor increased uptake by 17·8% (95% CI 7·6–28·0, P < 0·01). No intervention increased uptake by nurses. Increasing uptake requires multi-intervention strategies targeted at different HCW groups.

A Register of HIV-infected persons who have had a negative antibody test within 3 years of their first antibody positive test (seroconverters) is being set up in the UK to monitor the distribution of times from HIV seroconversion to AIDS (the incubation period) and to death. It will also provide a national resource for use by those designing studies in this group of individuals. Clinicians caring for HIV-positive persons in Genito-Urinary Medicine, Infectious Disease and other departments throughout the UK were asked to participate by providing information on eligible subjects. Most laboratories undertaking HIV antibody testing were also contacted and asked to provide the name of the attending clinician for all seroconverters identified through the HIV laboratory reporting systems of the PHLS Communicable Disease Surveillance Centre (CDSC) and the Scottish Centre for Infection and Environmental Health (SCIEH) and for any other seroconverters known to them but not identified by CDSC or SCIEH. Data items sought for the Register include: sex, ethnic group, probable route of HIV transmission, annual CD4 counts, details of therapy and prophylaxis prescribed, AIDS-defining events and vital status. Follow up information is collected annually. Wherever possible, all seroconverters known to a clinic have been identified, whether currently alive or dead, either from clinic records or laboratory reporting or both. The objective is to establish and update a complete register of seroconverters on a long-term basis to provide reliable estimates of the incubation period on which future projections of AIDS cases in the UK can be made.

Sixty soil samples were collected from the redeveloped site of the former Metropolitan (Caledonian) Cattle Market, Islington, London. Of these, 15 (25%) contained Clostridium botulinum and no less than four types (B, C, D and E) were demonstrated.

Early British soil surveys suggested that only 4–8% of samples contained Cl. botulinum (type A or B). Although there can be no absolute proof, it seems likely that the striking prevalence at the Market site was the result of faecal contamination by a small proportion of the many millions of farm animals brought there from elsewhere.

The distribution of Clostridium tetani was uneven, but of 18 soil samples taken from one area of the Market site, 16 (89%) were positive.

1. Whole cultures of Bact. coli grown under carefully controlled conditions have been subjected to the action of heat at temperatures ranging from 47 to 55° C. and the survivor curves determined.

2. The occurrence of excessive variation between replicate plates of counts made when the mortality exceeds 95 % was very much less evident than when phenol was the lethal agent.

3. At temperatures of 35° C. and below, disinfection of the cultures was never complete, as a permanent population of cells became established. In some cases the numbers of heat-resistant cells reached nearly 0·01 % of the original population, but great fluctuations were observed.

4. The death-rate during the active part of the disinfection was not constant but, in general, increased with time. In the faster disinfections this increase was difficult to detect and the logarithmic death-rate appeared to be virtually constant, but the increase is nevertheless believed to have been present in all cases.

5. The data for all the experiments have been combined to give a composite disinfection curve from which it was concluded that the death-rate was low at first but rose to a maximum at which it remained constant until the mortality had reached at least 99·99%.

6. This finding led to the decision to treat all the experiments as if the regression of log survivors on time had been linear between mortalities of 90 and 99·99%. The standard errors of the calculated regression coefficients were small, so that this method of treating the experimental data appears to be justified.

The authors wish to express their gratitude to Messrs I.C.I. (Pharmaceuticals) Ltd. for their valuable financial assistance, which has enabled one of us (H. E. F. D.) to devote his full time to this work.

A new B/Shangdong/7/97-like influenza virus (Victoria/2/87 lineage) predominated during the 2002/2003 epidemic season in Finland and was estimated to account for 2246 of the 13496 feverish upper respiratory tract infections (URIs) occurring among conscripts in the Finnish army. The incidence (1716/10000 conscripts) was indicative of moderate epidemic activity at most. Analysis of the cross-reactive antibodies induced in 1988 suggests that the basis of the protection was probably established during the childhood of the conscripts. Vaccination in autumn 2002 prevented 42% of the URIs during the influenza B outbreak and 71% (95% CI 42–85) of infections interpreted as influenza B. Despite the low genetic variability of the Shangdong/7/97-like viruses, breakages of a potential glycosylation site in haemagglutinin (HA1, position 197) were frequent; their biological significance is discussed. The Shangdong/7/97-like strains were HA1/NA reassortants, as were also the less abundant strains that for HA1 belonged to the B/Yamagata/16/88 lineage. A further reassortment, which probably emerged during the outbreak in one of the garrisons, supports our hypothesis that circumstances in these settings may especially favour the emergence of diversity by reassortment.

An outbreak of diarrhoea due to Salmonella worthington in five newborn babies, 5 weeks after a similar outbreak in 13 babies for which no cause had been found, occurred in the nursery of a maternity ward. The source of infection was traced to the contaminated rubber tubing of a mechanical suction apparatus. S. worthington was isolated from the rubber tubing and the Y connexion of the suction apparatus from which all the five infected babies had received suction. Reflux of contaminated amniotic fluid into the sterile catheter connected to the apparatus some time before use could have been the means of introducing the infected material to the oropharynx of the newborn babies, and amniotic fluid, acting as a good medium to support the growth of S. worthington, might be responsible for the long-lasting contamination.

Babesiosis is an emerging tick-transmitted zoonosis prevalent in large parts of the world. This study was designed to determine the rates of Babesia microti infection among small rodents in Yunnan province, where human cases of babesiosis have been reported. Currently, distribution of Babesia in its endemic regions is largely unknown. In this study, we cataloged 1672 small wild rodents, comprising 4 orders, from nine areas in western Yunnan province between 2009 and 2011. Babesia microti DNA was detected by polymerase chain reaction in 4·3% (72/1672) of the rodents analyzed. The most frequently infected rodent species included Apodemus chevrieri and Niviventer fulvescens. Rodents from forests and shrublands had significantly higher Babesia infection rates. Genetic comparisons revealed that Babesia was most similar to the Kobe- and Otsu-type strains identified in Japan. A variety of rodent species might be involved in the enzootic maintenance and transmission of B. microti, supporting the need for further serological investigations in humans.

Although typhoid bacilli were liberally supplied to larvae of Musca domestica, all attempts to demonstrate B. typhosus in the pupae or imagines were unsuccessful, until recourse was had to disinfection of the ova. After this preliminary disinfection both larvae and pupae gave pure growths of B. typhosus but hitherto it has not been possible to examine the imagines.

In the experiments with unsterilised ova great difficulty was experienced in determining whether B. typhosus was present in MacConkey plates owing to the almost invariable occurrence of the colourless typhoid-like colonies of the Bacillus “A” which was evidently an organism throughly adapted to the conditions prevailing in the interior of the larvae, pupae and imagines.

The fact also that this organism like B. typhosus fermented mannite without the production of gas, rendered the search for B. typhosus still more difficult.

By the employment of sorbite—in place of lactose-media, a preliminary differentiation might have been possible but was not considered practicable in the first place owing to the expense of sorbite, and secondly owing to the fact that the fermentation of sorbite by B. typhosus though constant, is sometimes delayed. The most satisfactory plan was to pick off as many colonies as possible and inoculate them on litmus-milk. Bacillus “A” invariably rendered litmus-milk intensely alkaline.

From the practical point of view the main conclusion to be drawn from the experiments detailed in this communication is that the typhoid bacillus can lead only a very precarious existence in the interior of larvae or pupae which possess, at least in so far as these investigations warrant, a well-defined bacterial flora of their own.

Even under the highly artificial conditions of the final series of experiments, it was not possible to decide whether the B. typhosus though recoverable from the pupa was really actively multiplying in the pupal interior or gradually dying out. There was some indication that the latter was the case, as the typhoid colonies recovered from the pupa in the one successful instance, were extremely few in number, while the larvae which had been feeding on B. typhosus contained enormous numbers as evidenced both by cultural and microscopical examination.

Since the above experiments were concluded, some further researches by Graham-Smith (1911) on the carriage of bacteria by flies have appeared in the form of a Local Government Board Report. This author has succeeded in recovering B. anthracis from blow-flies bred from larvae fed on meat infected with spores of this organism, but has failed to recover B. typhosus or B. enteritidis under similar experimental conditions.

Appropriate skin care of newborns is performed partly to prevent infection but also for aesthetic and cleansing purposes. Skin care should involve cleansing with a non-toxic, non-abrasive neutral material. This study compared the relative risks and benefits of washing versus bathing with regard to bacterial colonization rate, clinical infection rate, body temperature and crying. The results confirm our clinical impression that bathing and washing routines do not differ with regard to signs of infection or other clinical complications. However, the washing routine does increase the babies heat loss and make them less comfortable.

Genetic association studies of the cytokine interleukin-10 (IL-10) and sepsis have provided inconsistent results. This work attempts to further quantitatively assess the association of three widely evaluated polymorphisms of IL-10 (−592C/A, −819C/T, −1082A/G) with sepsis susceptibility through a meta-analysis. A search of Pubmed, Web of Science and EMBASE databases was performed. Overall, the three polymorphisms have no strong association with sepsis risk. Subgroup analysis by ethnicity showed there was association between sepsis susceptibility with −592C/A in Caucasians (A vs. C: OR 0·78, 95% CI 0·62–1·00, P = 0·05; AA + CA vs. CC: OR 0·75, 95% CI 0·56–1·00, P = 0·05), and with −1082A/G in Asians (G vs. A: OR 1·41, 95% CI 1·04–1·91, P = 0·03; GG + AG vs. AA: OR 2·11, 95% CI 1·07–4·16, P = 0·03). This meta-analysis suggests that −592C/A and −1082A/G polymorphisms are associated with sepsis susceptibility in Caucasian, and Asian populations, respectively.

Shigellosis causes significant morbidity and mortality in developing and developed countries, mostly among infants and young children. The World Health Organization estimates that more than one million people die from Shigellosis every year. In order to evaluate trends in Shigellosis in Israel in the years 2002–2015, we analysed national notifiable disease reporting data. Shigella sonnei was the most commonly identified Shigella species in Israel. Hospitalisation rates due to Shigella flexenri were higher in comparison with other Shigella species. Shigella morbidity was higher among infants and young children (age 0–5 years old). Incidence of Shigella species differed among various ethnic groups, with significantly high rates of S. flexenri among Muslims, in comparison with Jews, Druze and Christians. In order to improve the current Shigellosis clinical diagnosis, we developed machine learning algorithms to predict the Shigella species and whether a patient will be hospitalised or not, based on available demographic and clinical data. The algorithms’ performances yielded an accuracy of 93.2% (Shigella species) and 94.9% (hospitalisation) and may consequently improve the diagnosis and treatment of the disease.

Crimean-Congo haemorrhagic fever virus (CCHFV) has the propensity to cause nosocomial infections with a high fatality rate. Handling the virus requires biosafety level-4 facilities, limiting accessibility for many laboratories. Advances in molecular techniques have allowed preparation of safe recombinant antigens that have application in diagnosis and serosurveillance of CCHFV. The aim of this study was to determine genetic diversity in CCHFV based on all available complete sequence data for the S gene encoding CCHFV nucleoprotein (NP) and antibody cross-reactivity between the NP of a South African isolate and the NP of a Greek isolate (AP92), the most genetically diverse CCHFV strain. The nucleotide sequence diversity and amino-acid diversity between genotypes, within genotypes and the pairwise distances were calculated for a dataset of 45 CCHFV isolates retrieved from GenBank. The most diverse virus, AP92, isolated from a tick in Greece, displayed the highest amino-acid difference (8·7%) with SPU415/85, isolated from a human infection in South Africa. Recombinant NP encoded for by codon-optimized S genes of SPU415/85 and AP92 were expressed in a bacterial host system and used to develop an in-house ELISA to detect IgG antibody against CCHFV in South African patients who survived infection. A total of 14/14 sera reacted with the South African recombinant NP and 13/14 reacted with the Greek recombinant NP. The serological cross-reactivity of the two NP antigens suggests that recombinant antigens prepared from geographically distinct CCHFV will have diagnostic and epidemiological applications worldwide.

There is limited knowledge about the effect of livestock-associated methicillin-resistant Staphylococcus aureus (LA-MRSA) carriage on health-related quality of life (QoL). With this study, we explored whether LA-MRSA causes infections or affects health-related QoL in pig farmers. This prospective cohort study surveyed persons working on 49 farrowing pig farms in The Netherlands for 1 year (2010–2011). On six sampling moments, nasal swabs, environmental samples and questionnaires on activities and infections were collected. At the end of the study year, persons were asked about their QoL using the validated SF-36 and EQ-5D questionnaires. Of 120 persons, 44 (37%) were persistent MRSA carriers. MRSA carriage was not associated with infections, use of antimicrobials, healthcare contact and health-related QoL items in univariate or multivariate analysis, most likely due to the ‘healthy worker effect’. Despite high carriage rates, the impact of LA-MRSA carriage in this population of relatively healthy pig farmers on health and health-related QoL appears limited; more research is needed for confirmation.

An attempt has been made to establish the nature of the ringworm flora of Birmingham, comprising: (1) the species encountered; (2) their relative concentration; (3) their distribution.

A marked increase in the number of cases due to fungi of animal origin has been demonstrated.

It has been shown that the main reservoir of infection in the city is centred upon Sparkbrook and Balsall Heath, with a rather smaller focus in the Hockley–Lozells area.

In recent years, outbreaks of hand–foot–mouth disease (HFMD) in China, Singapore and other Western Pacific Region, involving millions of children, have become a big threat to public health. This study aimed to quantitatively assess all qualified studies and identify the risk factors for HFMD death. A systematic search of the databases PubMed, Medline, Embase and the Cochrane Library was performed. Study heterogeneity and publication bias were estimated. Seven case–control studies involving 1641 participants (634 died and 1007 survived) were included in the meta-analysis. Human enterovirus 71 infection, male, age ⩽3 years, vomiting, cyanosis, convulsion, duration of fever ⩾3 days, atypical rashes and abdominal distention were not significantly related to HFMD death (P ⩽ 0.05). Lethargy (odds ratio (OR) = 6.62; 95% CI 3.61–12.14; I2 = 0%; P < 0.0001), pneumonoedema/pneumorrhagia (OR = 4.09; 95% CI 2.44–6.87; I2 = 0%; P < 0.0001), seizures (OR = 6.85; 95% CI 2.37–19.74; I2 = 0%; P = 0.0004), dyspnoea (OR = 8.24; 95% CI 2.05–33.19; I2 = 83%; P = 0.003) and coma (OR = 3.76; 95% CI 1.85–7.67; I2 = 0%; P = 0.0003) were significantly associated with HFMD death, which were risk factors for HFMD death.

Six strains of bluetongue virus were compared by cross complement-fixation tests performed on Perspex sheets according to the method of Fulton & Dumbell using antigens derived from crude saline extracts, and acetone and ether extracts, of infected suckling mouse brains. Only minor differences were encountered with the former and no significant differences with the latter. The reasons for this are discussed.

In the neutralization tests important differences were demonstrated between strains.

There is evidence that the soluble antigen is composed of particles of varying size, that the smaller particles are responsible for the marked overlapping in the complement-fixation tests, and that increasing complexity associated with increasing particle size may be concerned with increasing serological specificity.

A simple method for the bacteriocine typing of Serratia marcescens without the use of induction was sought. The results of a mutual inhibition experiment with 89 unrelated cultures indicated that a bacteriocine-susceptibility method would give more discrimination between strains than would a bacteriocine-production method. A cross-streaking technique for bacteriocine-susceptibility typing without previous induction was developed, and its performance was compared with that of another susceptibility-typing method in which cell-free lysates of the producer strains were obtained by induction with mitomycin C.

Replicate typing of the same collection of cultures by both methods indicated that small variations in pattern were common and that larger variations occurred occasionally. Differences in pattern of less than two strong reactions in the mito-mycin-C induction method, and of less than three strong reactions in the cross-streaking method, should therefore not be taken as evidence that strains can be distinguished.

Sets of cultures of Ser. marcescens, 178 in total, from a number of supposed incidents of infection in hospitals, were used to evaluate the two bacteriocine-typing methods; all of the cultures were also O serogrouped. Comparison of the typing patterns of members of the same O serogroup from clear-cut incidents of infection confirmed that results of acceptable reliability could be obtained by either bacteriocine-typing method by the application of the appropriate 'difference' rule. When so interpreted, the cross-streaking method appeared to be slightly the more discriminatory.

The greatest discrimination between strains was obtained by the use of a 'hierarchical' typing system in which the strains were first O serogrouped, and the cross-streaking method of bacteriocine typing was then used to make subdivisions within O serogroups.

Two tests are described for detecting antibody to the type-specific opacity factor (OF) of group A streptococci. This antibody was detected among patients convalescent from streptococcal sore throat in two communities in which out-breaks due to opacity factor-producing strains of group A streptococci occurred.

In an outbreak due to streptococci of M-type 22 there was a close correspondence between the distribution of anti-OF and of bactericidal M-antibody for the type. In a smaller outbreak due to M-type 58 streptococci, however, M-antibody was detected more often than antibody of OF.