Examination of the faeces of 50 babies born at home showed that bottle-fed babies carried significantly more Klebsiella, Proteus and Pseudomonas spp. and antibiotic-resistant Escherichia coli than did breast-fed babies. Bottle-fed babies born in hospital had a less mixed faecal flora than bottle-fed babies born at home. The possibility that bacterial contamination of home-prepared feeds may account for these differences requires investigation.

The relationship of Esch. coli 0.26, 0.55 and 0.111 to the incidence and spread of infantile gastro-enteritis in a defined area has been studied over a period of 5 years in the Public Health Laboratory, Southampton.

In the main, the study was concerned with infants up to 1 year of age suffering from gastro-enteritis, and from this age group faecal specimens from 1234 individuals were examined for three sero-types of Esch. coli (0.55 and 0.111 from the autumn of 1949 until September 1954 and 0.26 from May 1953 until September 1954). Esch. coli O.111 was isolated from 66 infants of whom 56 had enteritis, type 0.55 from 159 infants of whom 126 had acute symptoms, and type 0.26 from 14 infants all but two of whom had enteritis.

During widespread outbreaks there were sometimes multiple foci of infection. The determination of the H-antigen carried by the O sero-types showed, for instance, that the 0.55 outbreak in 1952 was almost entirely due to subtype 0.55 H.2, but that a second subtype 0.55 H.7 was also incriminated. Similarly, an 0.111 outbreak in 1953 was due to a mixture of two subtypes (0.111 H. 2 and 0.111 H. 12), but in 1954 the former subtype was not seen and only O. 111 H. 12 was identified.

During epidemic times Esch. coli 0.55 was isolated from 37·2% of the infants examined, whereas in non-epidemic periods the figure was only 1·2%. In the case of type 0.111 the figureswere 26·9 and 1·4% respectively.

Symptomless excreters were found throughout the period of the study and at all ages, but the proportion as compared with cases was significantly higher in children over 1 year of age. Nevertheless, there were several symptomless excreters less than 4 weeks old. While there was some evidence to suggest that the young child who was a symptomless excreter might be responsible for maintaining a low-grade infection in a community, there was no indication that the rare adult-carrier played any significant part in this.

The specific types of these coliform organisms can survive for long periods outside the body. Naturally infected dust contained viable organisms 12 days after it was first found to be so contaminated; the dust was maintained in a cool shady room.

There is great variety in the clinical severity of the disease as seen in comparable groups of infants, from a very grave illness to the very mildest of diarrhoeas. The very young and those with some other complicating illness are always at a greater risk.

The pattern of the outbreaks as seen in this study suggests a gradual enhancement of virulence of the two main types of Esch. coli with local spread at first and then wide dispersal throughout the district followed by a reversion to the poorly invasive type.

Between February 1988 and March 1989 chicken carcases delivered to the kitchen of a long stay psycho–geriatric hospital were screened every week for salmonella contamination. While 214 of 477 (45▒) individual carcases carried one or more salmonella types, every single consignment examined contained affected carcases.

Simultaneously sewers draining the residential accommodation and excluding kitchen effluent, were also monitored. Thirty out of 79 (38▒) of Moore's swabs were positive for salmonella. There was a statistically significant association between the salmonella types isolated from chicken and those isolated from sewers the following week.

Following a change in kitchen policy to order only cooked chicken there was a significant reduction in the isolation of salmonella from the sewers.

IN a previous communication we (Pulvertaft, Lemon & Walker, 1939), gave an account of a method of sterilizing air by means of finely atomized antiseptic solutions, founded on the principles outlined by Trillat (1938). His claims were fully confirmed.

The mists used in this method may be produced by a number of different appliances, and in the experiments here described were produced by the “Phantomyst” (Andre Components, Ltd.). The essential appliances are:(1) a mechanical compressor, electrically driven, and (2) an atomizer, usually of scent-spray type, provided with (3) a baffling system which returns to the reservoir droplets above a certain size, thus avoiding much wastage.

Hospital discharge data from 1990–4 for 26 hospitals were used to estimate and compare the cost and describe the epidemiology of severe giardiasis and cryptosporidiosis in Scotland, UK. The incidence of severe cryptosporidiosis was almost double that of severe giardiasis and the median duration of hospitalization was longer for cryptosporidiosis than giardiasis. Impaired immunity was frequently listed as co-diagnosis with cryptosporidiosis and associated with extended hospitalization. Although both infections were associated with infants, the median age was lower for cryptosporidiosis (5 years compared with 30 years). Whereas hospitalization was not significantly longer for infants with cryptosporidiosis, hospitalization for this age group with giardiasis was longer (4 days compared with 3 days). Comparison with similar data for giardiasis from USA revealed various differences and similarities. These points are discussed in relation to the epidemiology of these infections and published data were used to estimate costs of hospitalization.

Plague is a re-emerging disease endemic in at least 24 countries. Non-endemic countries should be able to confirm plague to prevent outbreaks due to imported cases. We established a combination of a IgG/IgM screening ELISA and a confirmation immunoblot employing F1 capsular antigen (CA) for the serodiagnosis of plague in countries where yersiniosis is present. The ELISA and the immunoblot assay showed a specificity of 96·1% and 100% among sera from healthy German blood donors. This group had a seroprevalence of 39% of anti-yersinia outer protein (YOP) antibodies obviously caused by previous Y. enterocolitica infection. The ELISA detected anti-F1 CA antibodies in 22 and the immunoblot in 20 out of 26 sera of plague vaccinees. Five control sera from bacteriologically confirmed plague cases from Madagascar reacted positively. It can be concluded that anti-YOP antibodies do not affect assays based on purified F1 CA.

Most normal bovine whey samples contain a fraction that survives heating at 56° C. for 30 min., passes through a dialysis membrane and kills a maximum of seven out of ten of the different bovine mycoplasma species tested. Some whey samples appear more active than others but not all affect the same strains of mycoplasma indicating some specificity in their action. Absorption of the active factor from whey by heterologous and homologous mycoplasmas and by erythrocytes was observed. Binding of the factor to mycoplasmas appears to be temperature-dependent and non-specific, but subsequent mycoplasmacidal action shows some specificity.

Purified tuberculin in concentrations equivalent to 1x/20 standard Old Tuberculin had no apparent effect on the outgrowth in vitro of liver and kidney epithelium derived from sensitized guinea-pigs.

Acknowledgement is made with thanks to Miss Florence Taylor for technical assistance, and to Mr L. Jones for help with the microphotography.

In England, hospital admissions for severe staphylococcal boils and abscesses trebled between 1989 and 2004. We investigated this trend using routine data from primary and secondary care. We used The Health Improvement Network (THIN), a large primary-care database and national data on hospital admissions from Hospital Episode Statistics (HES). Time trends in the incidence of primary-care consultations for boils and abscesses were estimated for 1995–2010. HES data were used to calculate age-standardized hospital admission rates for boils, abscesses and cellulitis. The incidence of boil or abscess was 450 [95% confidence interval (CI) 447–452] per 100 000 person-years and increased slightly over the study period (incidence rate ratio 1·005, 95% CI 1·004–1·007). The rate of repeat consultation for a boil or abscess increased from 66 (95% CI 59–73) per 100 000 person-years in 1995 to peak at 97 (95% CI 94–101) per 100 000 person-years in 2006, remaining stable thereafter. Hospital admissions for abscesses, carbuncles, furuncles and cellulitis almost doubled, from 123 admissions per 100 000 in 1998/1999 to 236 admissions per 100 000 in 2010/2011. Rising hospitalization and recurrence rates set against a background of stable community incidence suggests increased disease severity. Patients may be experiencing more severe and recurrent staphylococcal skin disease with limited treatment options.

As China implements the voluntary vaccination programme of one-dose of varicella vaccine (VarV) for decades, robust estimates of the impact of voluntary vaccination era on epidemiology of varicella are needed. We estimated the vaccination coverage (VC) of VarV by using surveillance data on immunisation. The descriptive epidemiological method was used to describe the changing epidemiology of varicella from 2007 to 2018. The screening method was used to estimate the vaccine effectiveness (VE) of VarV. The overall VC for VarV was 71.7%, ranged from 47.7% to 79.5% among 2008–2017 birth cohorts. In total, 16 660 varicella cases were reported during 2007–2018, the incidence increased from 10.0 cases per 100 000 population in 2007 to 65.2 cases per 100 000 population in 2018. A shift in age group of varicella was observed since 2012, with the age increased from 5–9 years to 10–14 years. The overall VE was 79.9%, and the VE increased from 60.1% in 2008 birth cohort to 96.2% in 2017 birth cohort. We found that the overall VE for VarV is moderate, but appears highly effective within 5 years after vaccination. In addition, a shift varicella infection to older ages has occurred at the long-term moderate level VC of one-dose VarV. Therefore, to contain the incidence of varicella and prevent any potential shift to older ages, the introduction of VarV into routine immunisation programme is likely needed in Lu'an.

In recent years, men who have sex with men (MSM) constitute a major group of HIV transmission in China. High primary drug-resistance (PDR) rate in MSM also represents a serious challenge for the Chinese antiretroviral therapy (ART) program. To assess the efficiency of ART in controlling HIV/AIDS infection among MSM, we developed a compartmental model for the annually reported HIV/AIDS MSM from 2007 to 2019 in the Zhejiang Province of China. R0 was 2.3946 (95% CI (2.2961–2.4881)). We predict that 90% of diagnosed HIV/AIDS individuals will have received treatment till 2020, while the proportion of the diagnosed remains as low as 40%. Even when the proportion of the diagnosed reaches 90%, R0 is still larger than the level of AIDS epidemic elimination. ART can effectively control the spread of HIV, even in the presence of drug resistance. The 90-90-90 strategy alone may not eliminate the HIV epidemic in Chinese MSM. Behavioural and biologic interventions are the most effective interventions to control the HIV/AIDS epidemic among MSM.

Methicillin-resistant Staphylococcus aureus isolates from an outbreak of 17 cases of wound infection in a municipal hospital were typed by conventional methods, phage typing by three sets of phages, reverse phage typing and plasmid profiles, as well as by genomic DNA fragment patterns obtained after Sma-I digestion and pulsed-field electrophoresis. These isolates were non-typable by phages, only some were typable by reverse phage typing and were not uniform in plasmid profile. Only the genomic DNA fragment patterns resulted in a clear discrimination of 2 strains (12 isolates for the first and 7 isolates for the second). Both strains were disseminated in different wards of the same hospital and one strain had obviously spread to another clinic in the same city.

The burden of respiratory infections is mainly seen in primary healthcare. To evaluate the potential impact of new preventive strategies against respiratory infections, such as the implementation of pneumococcal conjugate vaccines for infants in 2006 in The Netherlands, we conducted a baseline retrospective cohort study of electronic primary-care patient records to assess consultation rates, comorbidities and antibiotic prescription rates for respiratory infections in primary care. We found that between 1995 and 2005, overall registered consultation rates for lower respiratory tract infections had increased by 42·4%, upper respiratory infections declined by 4·9%, and otitis media remained unchanged. Concomitantly, there was a steady rise in overall comorbidity (75·7%) and antibiotic prescription rates (67·7%). Since Dutch primary-care rates for respiratory infections changed considerably between 1995 and 2005, these changes must be taken into account to properly evaluate the effect of population-based preventive strategies on primary-care utilization.

Swedish nationals about to travel abroad were immunized against typhoid with a monovalent heat-inactivated vaccine which was administered intra- or subcutaneously. No major differences in serum antibody response were noted in the two groups of vaccinees as determined with direct agglutination and indirect hemagglutination techniques. As the intracutaneous route caused fewer adverse reactions this way of administration seems to be preferable.

As a result of the extensive investigations in America and on the Continent into the relationship of Br. abortus to undulant fever in man, attention in this country has been directed to cases of fever due to obscure causes, with the result that an increasing number of cases of undulant fever are being reported. So far, however, the cases in Great Britain appear to be less numerous than those in the United States and in Denmark where every effort has been directed to tracing sources of infection and where the conclusion has been reached that, although a certain number are infected by contact with the secretions and carcasses of infected animals, many infections occur through ingesting milk containing Br. abortus.

We compared the impact of a commercial chlorination product (brand name Air RahMat) in stored drinking water to traditional boiling practices in Indonesia. We conducted a baseline survey of all households with children <5 years in four communities, made 11 subsequent weekly home visits to assess acceptability and use of water treatment methods, measured Escherichia coli concentration in stored water, and determined diarrhoea prevalence among children <5 years. Of 281 households surveyed, boiling (83%) and Air RahMat (7%) were the principal water treatment methods. Multivariable log-binomial regression analyses showed lower risk of E. coli in stored water treated with Air RahMat than boiling (risk ratio (RR) 0·75, 95% confidence interval (CI) 0·56–1·00). The risk of diarrhoea in children <5 years was lower among households using Air RahMat (RR 0·43, 95% CI 0·19–0·97) than boiling, and higher in households with E. coli concentrations of 1–1000 MPN/100 ml (RR 1·54, 95% CI 1·04–2·28) or >1000 MPN/100 ml (RR 1·86, 95% CI 1·09–3·19) in stored water than in households without detectable E. coli. Although results suggested that Air RahMat water treatment was associated with lower E. coli contamination and diarrhoeal rates among children <5 years than water treatment by boiling, Air RahMat use remained low.

Klebsiella of capsular type K2 were investigated to find out whether a single epidemic clone was the source of many outbreaks of infection in different hospitals, in different areas over a period of five years. The klebsiellas studied were found to be very similar; they were of the same biotype, had similar klebecin sensitivity patterns and carried multiple drug-resistance plasmids; however, characterization of these plasmids showed that they were heterogeneous. Thus there was not a single epidemic bacterial clone.

Quantitative bacterial counts, concentrations of bile acids and bacterial enzyme profiles were measured in faecal samples from three tribal groups with distinctive dietary patterns in a rural area of northern Nigeria. Samples were obtained from Maguzawa (with a predominantly cereal diet), Hausa (cereal with regular meat consumption) and Fulani (cereal with frequent consumption of cows' milk). Numbers of bacteroides, clostridia and concentrations of bile acids were lower in the Maguzawa than the other dietary groups but these differences were not statistically significant. Bacterial enzyme profiles in each group were similar. The results are discussed with respect to possible influences of diet on the human intestinal microflora.

Scabies outbreaks in England have been reported in hospitals, long-stay wards, acquired immune deficiency syndrome (AIDS) units and residential homes for the elderly. This paper describes the control of an outbreak in a further education college for persons with learning disabilities. In March 2004, four confirmed cases of scabies were reported among a subset of 108 students and 41 staff members. Staff had considerable physical contact with the students who were housed in five groups of homes, individual homes and support centres. Mass prophylaxis was offered to all staff and students, through 39 general practice surgeries. Challenges overcome were: ensuring complete case ascertainment, accessing of up-to-date information about students and staff, achieving a coordinated approach to treatment, securing informed consent and media management. No further outbreaks have been reported. The college has revised its information request form for new students.

1. The severity of measles in infants and young children in Ilesha in Nigeria suggested this as a suitable centre for a trial of measles vaccine.

2. The trial was divided into three stages. In the first the vaccine was given to a group of 26 children who could be kept under close observation and were seen twice daily. In the second the vaccine was given to 120 children, a similar group receiving gamma globulin and an inert material. In the third stage the effect of vaccine and gamma globulin given as separate injections to 378 children, was compared with that of gamma globulin and inert material given to another control group. The second and third stages were run on the ‘double blind’ principle.

3. The children receiving vaccine alone showed fairly severe reactions but none were disabled by them; for example, 19 % had fever over 103° F. The reactions were similar to those observed in American children, with the one exception that diarrhoea was seen amongst African children receiving vaccine without gamma globulin. Those receiving vaccine and gamma globulin had only minor reactions. In the vaccinated children there was a notable absence of the severe complications seen with the natural disease in Nigeria.

4. Children who were well below the average weight for their age and sex in this community did not show more severe reactions than those above the average weight.