This study examined the relationship between body mass index (BMI) and the risk of pneumonia in Aboriginal Australians. A total of 677 adults aged 20–60 years were followed up from the baseline examination during 1992–1995 to June 2012. The pneumonia events were identified through hospital records. Pneumonia incident rates were calculated according to BMI groups. Hazard ratios were computed using Cox regression adjusting for age, smoking and alcohol consumption status. The incident rate of pneumonia was 13·3/1000 person-years, and this rate was significantly higher in females than males (hazard ratio = 1·5). Compared to males with normal BMI (18·5–24·9 kg/m2), the adjusted hazard ratio was 3·5 for males with lowest BMI (P < 0·01). Low BMI was significantly associated with a higher risk of hospitalized pneumonia for Aboriginal males. However, the U-shaped trend of this association indicates that the risk of pneumonia is likely to be associated with both low and high BMI.

The virulence of field strains of myxoma virus is increasing in the Mallee region of Victoria where the resistance of the rabbit to myxomatosis is high. This suggests that the climax association will be a moderately severe disease.

Profiles of varicella-zoster virus (VZV) seroprevalence have shown large variability in European countries in which vaccination has not been implemented. Differences in micro and macro population structures (e.g. household and municipality, respectively) may explain such variability, which is the focus of a population-based study of varicella in 12 000 children from 7800 French households in Corsica. The cumulative incidence was 89% at age 11 years, as the median age at infection was 5 years in first-born children, but decreased to 3·9 years in younger siblings. Hazard of infection in households increased as the first-born child initially enrolled in primary school. Age at infection was higher in less populated areas. Household attack rates increased with age (55% in <6 months, >90% in >3 years) and household secondary attack rate was ∼70%. Several levels of population structure independently affect age at varicella infection.

An outbreak of influenza A(H1N1)pdm09 was detected during the ongoing community-based surveillance of influenza-like illness (ILI). Among reported 119 influenza A(H1N1)pdm09 cases (59 cases in the year 2012 and 60 cases in 2015) in summer months, common clinical features were fever (100%), cough (90·7%), sore throat (85·7%), nasal discharge (48·7%), headache (55·5%), fatigue (18·5%), breathlessness (3·4%), and ear discharge (1·7%). Rise in ILI cases were negatively correlated with the seasonal factors such as relative humidity (Karl Pearson's correlation coefficient, i.e. r = −0·71 in the year 2012 and r = −0·44 in the year 2015), while rise in ILI cases were positively correlated with the temperature difference (r = 0·44 in the year 2012 and r = 0·77 in the year 2015). The effective reproduction number R, was estimated to be 1·30 in 2012 and 1·64 in 2015. The study highlights the rise in unusual influenza activity in summer month with high attack rate of ILI among children aged ⩽9 years. Children in this age group may need special attention for influenza vaccination. Influenza A(H1N1)pdm09 outbreak was confirmed in inter-seasonal months during the surveillance of ILI in Pune, India, 2012–2015.

Pooling samples may provide a valuable alternative to individual testing for pathogen surveillance purposes. We studied the reliability of measuring the level of antibodies against Coxiella burnetii in bulk-tank milk (BTM) to estimate the seroprevalence of C. burnetii in dairy sheep in 34 flocks. We then estimated the seroprevalence of C. burnetii in 154 dairy sheep flocks according to the level of antibodies in BTM. We tested for the accuracy of our estimation at the population level by comparing predicted mean C. burnetii flock seroprevalence with that obtained in another survey performed on the same population. Our findings showed that testing BTM by ELISA is a cost-effective and relatively good index of the seroprevalence of C. burnetii in dairy sheep and may be a useful tool for epidemiological surveillance at the population level.

Salmonellosis is a leading cause of hospitalisation due to gastroenteritis in Australia. A previous source attribution analysis for a temperate state in Australia attributed most infections to chicken meat or eggs. Queensland is in northern Australia and includes subtropical and tropical climate zones. We analysed Queensland notifications for salmonellosis and conducted source attribution to compare reservoir sources with those in southern Australia. In contrast to temperate Australia, most infections were due to non-Typhimurium serotypes, with particularly high incidence in children under 5 years and strong seasonality, peaking in summer. We attributed 65.3% (95% credible interval (CrI) 60.6–73.2) of cases to either chicken meat or eggs and 15.5% (95% CrI 7.0–19.5) to nuts. The subtypes with the strongest associations with nuts were Salmonella Aberdeen, S. Birkenhead, S. Hvittingfoss, S. Potsdam and S. Waycross. All five subtypes had high rates of illness in children under 5 years (ranging from 4/100 000 to 23/100 000), suggesting that nuts may be serving as a proxy for environmental transmission in the model. Australia's climatic range allows us to conduct source attribution in different climate zones with similar food consumption patterns. This attribution provides evidence for environment-mediated transmission of salmonellosis in sub-tropical regions.

The results of routine bacterial and viral studies on 483 patients with whooping cough, investigated at one hospital over a five year period are presented. The possible role of respiratory viruses in the aetiology of the disease is discussed.

Studies of antenatal women form the predominant source of data on HIV-1 prevalence in Africa. Identifying factors associated with prevalent HIV is important in targeting diagnostic services and care. Between November 1997 and January 2000, 14 110 postnatal women from Harare, Zimbabwe were tested by ELISAs reactive to both HIV-1 and HIV-2; a subset of positive samples was confirmed with assays specific for HIV-1 and HIV-2. Baseline characteristics were elicited and modelled to identify risk factors for prevalent HIV infection. HIV-1 and HIV-2 prevalences were 32·0% (95% CI 31·2–32·8) and 1·3% (95% CI 1·1–1·5), respectively; 4% of HIV-1-positive and 99% of HIV-2-positive women were co-infected. HIV-1 prevalence increased from 0% among 14-year-olds to >45% among women aged 29–31 years, then fell to <20% among those aged >40 years. In multivariate analyses, prevalence increased with parity, was lower in married women than in single women, divorcees and widows, and higher in women with the lowest incomes and those professing no religion. Adjusted HIV-1 prevalence increased during 1998 and decreased during 1999. Age modified the effects of parity, home ownership and parental education. Among older women, prevalence was greater for women who were not homeowners. Among younger women, prevalence increased with parity and low parental education. None of these factors distinguished women co-infected with HIV-2 from those infected with HIV-1 alone. Prevalent HIV-1 infection is associated with financial insecurity and weak psychosocial support. The ZVITAMBO study apparently spanned the peak of the HIV-1 epidemic among reproductive women in Harare.

Salmonella Give is a rare serotype across Europe. In October 2016, a national outbreak of S. Give occurred in Malta. We describe the epidemiological, environmental, microbiological and veterinary investigations. Whole-genome sequencing (WGS) was performed on human, food, environmental and veterinary isolates. Thirty-six human cases were reported between October and November 2016, 10 (28%) of whom required hospitalisation. Twenty-six (72%) cases were linked to four restaurants. S. Give was isolated from ready-to-eat antipasti served by three restaurants which were all supplied by the same local food manufacturer. Food-trace-back investigations identified S. Give in packaged bean dips, ham, pork and an asymptomatic food handler at the manufacturer; inspections found inadequate separation between raw and ready-to-eat food during processing. WGS indicated two genetically distinguishable strains of S. Give with two distinct clusters identified; one cluster linked to the local food manufacturer and a second linked to veterinary samples. Epidemiological, environmental and WGS evidence pointed towards cross-contamination of raw and ready-to-eat foods at the local manufacturer as the likely source of one cluster. Severity of illness indicates a high virulence of this specific serotype. To prevent future cases and outbreaks, adherence to food safety practices at manufacturing level need to be reinforced.

In Finland, most cases of shigellosis are related to travel abroad. Antimicrobial drug resistance of 1814 Shigella strains isolated from Finnish patients during 1990–2005 was studied using discs of 12 antimicrobial agents. Since 2000, the E-test has been performed to determine ciprofloxacin minimum inhibitory concentrations of nalidixic acid-resistant isolates. The proportion of multi-resistant strains (resistant to ⩾4 antimicrobials) was highest among isolates from China and India, but is increasing significantly in other parts of Asia. Resistance to nalidixic acid has become common among the strains from the Far East, and the first isolates also resistant to ciprofloxacin were detected during 2004–2005. All the ciprofloxacin-resistant isolates belonged to the S. flexneri 2a serotype. All the nalidixic acid-resistant S. flexneri strains had reduced susceptibility to ciprofloxacin, whereas 23% of the nalidixic acid-resistant S. sonnei strains were still completely susceptible to ciprofloxacin.

In the search to find discriminative serological markers to differentiate between patients with acute brucellosis and those with chronic brucellosis, an enzyme-linked immunosorbent assay (ELISA) was used to determine and compare the brucella-specific IgE response in 80 sera from patients with acute brucellosis, 37 sera from patients with chronic brucellosis, 26 sera from patients with positive blood cultures for bacteria other than brucella and 51 sera from healthy controls. The IgE findings were compared to brucella-specific IgG, IgM, IgA and IgG1–4 demonstrated by ELISA, and to microagglutination test (MAT) results. Elevated (positive) antibrucella IgE titres were detected in 89 and 81 % of sera from patients with acute and chronic brucellosis respectively. The predominant antibodies found in patients with acute brucellosis were of the IgG, IgM, IgA, IgE, IgG1 and IgG3 types while in chronic brucellosis IgG, IgA, IgE and IgG4 were found. Although IgE can be detected in patients with brucellosis, it does not discriminate between the acute and chronic stages of the disease.

Viable counts of beta-haemolytic streptococci per ml. of saliva were made in the following groups: (1) children with acute streptococcal sore throat, (2) children with acute non-streptococcal sore throat, (3) children who had no sore throat but were streptococcal throat carriers, (4) children who neither had a sore throat nor were streptococcal throat carriers.

The mean counts from cases of streptococcal sore throat and from streptococcal carriers were respectively 1·4 × 106 and 2·5 × 105 per ml.

In a comparison of the efficiency of the throat swab, sublingual swab and specimen of saliva in isolating beta-haemolytic streptococci from the upper respiratory tract, culture of saliva produced the best results.

Coxiella burnetii, the causative agent of Q fever, is widely present in dairy products around the world. It has been isolated from unpasteurised milk and cheese and can survive for extended periods of time under typical storage conditions for these products. Although consumption of contaminated dairy products has been suggested as a potential route for transmission, it remains controversial. Given the high prevalence of C. burnetii in dairy products, we sought to examine the feasibility of transmitting the major sequence types (ST16, ST8 and ST20) of C. burnetii circulating in the United States. We delivered three strains of C. burnetii, comprising each sequence type, directly into the stomachs of immunocompetent BALB/c mice via oral gavage (OG) and assessed them for clinical symptoms, serological response and bacterial dissemination. We found that mice receiving C. burnetii by OG had notable splenomegaly only after infection with ST16. A robust immune response and persistence in the stomach and mesenteric lymph nodes were observed in mice receiving ST16 and ST20 by OG, and dissemination of C. burnetii to peripheral tissues was observed in all OG infected mice. These findings support the oral route as a mode of transmission for C. burnetii.

Recently, a number of outbreaks of measles and mumps have occurred within the UK and Europe. Healthcare workers (HCWs) are at risk of contracting and transmitting disease to patients and staff. To examine this risk at the point of entry to healthcare, we assessed the serological results of new HCWs presenting for pre-placement clearance without evidence of measles-mumps-rubella (MMR) immunity between 1 April 2010 and 31 March 2012. Overall rates of serological positivity to MMR across all age groups were 88·2%, 68·8% and 93·9%, respectively. With regard to measles and mumps, there were statistically significant decreases in the percentage of HCWs born after 1980 that had positive serology (P < 0·05). No such differences were seen between healthcare groups. Most seronegative HCWs accepted MMR vaccination. Despite our entry-level findings, the ongoing risk of a MMR outbreak within this cohort of HCWs appears low.

This report is a contribution to the joint investigation, organised by the Ministry of Health, into the bacteriology of Scarlet Fever. It has been carried out with the aid of a grant from the Ministry to whom I am indebted for permission to publish these results.

Puumala hantavirus (PUUV) causes haemorrhagic fever with renal syndrome in humans, an endemic disease in Finland. We aimed to study recent trends in PUUV infections in Finland, to evaluate whether there are regional differences in seasonality and long-term cycles and whether the patterns have changed over time. We analysed serologically confirmed acute PUUV infections reported to the National Infectious Disease Register from 1 April 1995 to 31 March 2014. A total of 30 942 cases of PUUV infections were identified during the study period. The average annual incidence was 31 cases/100 000 person-years with the highest in Eastern Finland and the lowest in Southwestern Finland. Throughout Finland there was not an increasing trend in incidence but changes in incidence, seasonality and long-term cycles differed regionally. Long-term cycles supported by high Bayesian posterior probabilities (73–100%) differed between the south and the north, shifting from 3 to 4 years, respectively. Temporal changes in seasonality were most prominent in Southwestern Finland. The pattern of human PUUV infection epidemiology probably primarily reflects the spatio-temporal interaction between bank-vole population dynamics and climate.

A single intranasal dose of 107.0 EID50 recombinant WRL 105 strain live attenuated influenza vaccine was administered intranasally to 193 volunteers either as nose drops or by one of three spray devices which produced sprays of differing physical characteristics. In volunteers with homologous haemagglutinating inhibiting antibody titres of ⋜ 20 before vaccination, seroconversion rates varied widely from 80% following the administration of drops to 71%, 57% and 28% with the three spray devices.

In the week following vaccination 16 (22%) of 74 volunteers who were found to show a fourfold or greater antibody response took analgesics to control symptoms in comparison with 4 (7%) of 58 volunteers who exhibited no sero-logical response to vaccination (P < 0.05). However, neither the occurrence of upper respiratory nor systemic symptoms were significantly different in these two groups and the degree of attenuation of the recombinant WRL 105 strain appears to be acceptable for future use.

We examined 20 300 raw shell chicken eggs sold at retail stores in Japan for Salmonella outside and inside eggs. The eggs were purchased at 220 retail stores throughout Japan between August 2007 and January 2008. Of 2030 pooled egg samples (10 eggs/sample), Salmonella was isolated from five shell samples (0·25%), but not from any of egg-content samples. The serovars of the isolates were Salmonella Enteritidis (2), S. Derby, S. Livingstone and S. Cerro. The samples positive for Salmonella originated from five different egg grading and packaging (GP) centres. All the GP centres washed their egg shells according to government guidelines for hygienic practice in GP centres. Thus, practical control measures at GP centres need to be reviewed and implemented to diminish Salmonella prevalence of egg shells because Salmonella contamination on eggs is a potential hazard for foodborne salmonellosis in Japan.

1. The potency of PPD tuberculin made from AN 5, a bovine strain, was high when WR medium was used and low when BAI medium was used. PPD tuberculin made from strains of the human type grown on BAI medium was intermediate in potency between the two bovine PPDs.

2. The standard deviation of the difference between responses to duplicate injections of human type PPD at 2·0 mg./ml. concentration was 2·59 in the Islington and 1·84 in the Weybridge experiment on tuberculous animals, and 1·11 at Islington and 1·13 at Weybridge on tubercle-free animals. Differences greater than 1·5 mm. were relatively infrequent on tubercle-free animals.

3. The Elliott ‘401’ electronic computer at Rothamsted was used to calculate discriminant functions and to estimate the discriminating power of different ‘tests’, each test involving an injection of a mammalian and an injection of avian tuberculin.

4. There were some differences between the mammalian preparations in their power to discriminate between tuberculous and tubercle-free animals, but these differences were closely allied to differences in potency. It seems probable that if concentrations of equivalent potency were used, there would be little if any difference in their discriminating power.

5. The contribution of avian tuberculin to the discrimination test was demonstrated; the greatest contribution came from a concentration of 0·25 mg./ml. used in the Islington experiment. The Weybridge results were quite consistent with the assumption that a maximum contribution is made by a concentration less than 0·5 mg./ml.

6. Methods for deducing rules for the interpretation of comparative tuberculin tests, using a mammalian and an avian tuberculin are illustrated and results given for the type of population sampled in these experiments.

7. The principle on which this rule might be modified where the population is believed to be free of infection, is outlined and discussed.

We should like to acknowledge the advice and constructive criticisms during the planning of the experiments of Dr A. W. Stableforth and Dr H. H. Green of Weybridge, and also the care with which Miss C. N. Hebert carried out the preliminary arrangement of the large quantity of data. Thanks are also due to the staff of the Islington abattoir for their willing co-operation.

In order to elucidate the effect of ceftriaxone therapy on the morphology of gut microflora, 11 human volunteers were treated with ceftriaxone, 1 g daily, given intramuscularly in one dose. Treatment continued for 5 days. Faecal microflora was analysed by digital image processing before, during and after the treatment period.

We derived simple numerical parameters which describe the morphologic composition of the flora. They were significantly influenced by the antibiotic, and returned to their baseline values more than 7 days after treatment was stopped. The procedure holds promise for clinical application.