Norovirus (NoV) is a leading cause of outbreaks of gastroenteritis worldwide, and a major burden for healthcare facilities. This study investigated the NoV genotypes responsible for outbreaks in Edinburgh healthcare facilities between June 2008 and July 2011, and studied their temporal distribution to enable a better understanding of the epidemiology of the outbreaks. A total of 287 samples positive for NoV genogroup II (GII) RNA by reverse transcription–polymerase chain reaction (RT–PCR) during routine diagnostic testing were investigated. Nested RT–PCR (nRT–PCR) and sequencing was used to genotype the NoV strains. Overall, a total of 69 NoV strains belonging to six different genoclusters (GII.1, GII.2, GII.3, GII.4, GII.6, GII.13) were detected. The predominant genotype was GII.4 that included four variants, GII.4 2006a, GII.4 2006b, GII.4 2007 and GII.4 2010. Importantly, increases in NoV activity coincided with the emergence of new GII.4 strains, highlighting the need for an active surveillance system to allow the rapid identification of new strains.

The disease which is the subject of this paper is one of a group of diseases affecting different animals, and caused by parasites possessing very similar characters. The diseases produced by parasites of the genus Piroplasma appear to closely resemble each other, and for this reason it is well to follow the terminology adopted by French investigators in speaking of any one of the diseases in question as a Piroplasmosis. Not only are the parasites similar in these diseases, but they also appear, in all cases where the subject has been worked out, to be transmitted by species of Ixodoidea or Ticks.

Accuracy of titration may be taken as a measure of the reliability of the methods and work of a laboratory.

With such a small number of titrations as four, a convincing mean, representing the most probable true titre, is hard to calculate. A fairly close approximation, however, is possible in the form of the geometrical mean.

It is also possible to correct for constant local factors which cause the titrations of a given laboratory to run above or below the mean. By all methods of titration a surprisingly large proportion of large errors are recorded.

The most consistent results, with the smallest proportion of large errors, are obtained by the prearranged standard method with a single standardized suspension. The H titres are rather more consistent than the O; probably because H agglutination is easier than O to read correctly.

Local methods give greater differences than the agreed (standard) method. Since the H suspensions used in one laboratory were also sensitive to O agglutination the supposed H titres are unreal, and cannot be treated statistically.

Local O methods give a considerably greater range of error than the standard method, as is shown by a comparison of the mean errors of Tables II and IV, and by the percentages of errors over and under 100 per cent given in Table VI.

The full titres (H or O or both) of the serums measured by local routine Widal methods, with living suspensions in two laboratories and killed ones in the other two, show a considerably greater proportion of large differences than are shown by the titrations with the standard method. They do not, however, differ more widely than the titres obtained with local O suspensions.

The results of the laboratories that use killed H and O suspensions in routine work are more consistent and accurate than those of the laboratories that use living suspensions.

It is suggested that gross technical mistakes are a commoner cause of error than is usually supposed. Errors of dilution of the serums and other technical variations must also be responsible for a part of the very wide range of differences observed.

The use of old strains, tending to roughness, is to be avoided.

The incidence of Mediterranean spotted fever (MSF) in Catalonia (Spain) has decreased in the last two decades. The prevalence of antibodies to Rickettsia conorii in human beings and dogs in the region of Vallès Occidental (Catalonia) was assessed by indirect immunofluorescence, and the results compared with those obtained in a similar study from 1987. Nineteen (5·0%) out of 383 human serum samples had antibodies to R. conorii. This seroprevalence was significantly lower (11·5%) (P = 0·003) than that recorded in the 1987 survey. Forty-two out (42·0%) of 100 canine serum samples had antibodies to R. conorii. A high proportion of the studied dogs (91·0%) were receiving anti-tick treatment, mainly with permethrin-imidacloprid spot-on (Advantix, Bayer, Germany). The current canine seroprevalence was not significantly different from that recorded in the 1987 survey (36.9%). In conclusion, this study shows a significant decrease in the prevalence of antibodies to R. conorii in the human population of Catalonia in the last 20 years, which corresponds with a decrease in the number of cases of MSF. We suggest that the widespread use of anti-tick treatment in dogs could limit the introduction of ticks to humans due to a reduction of infestation duration in dogs, thus contributing to the decrease in MSF incidence.

Wildlife reservoir hosts of bovine tuberculosis (bTB) include Eurasian badgers (Meles meles) and brushtail possum (Trichosurus vulpecula) in the UK and New Zealand, respectively. Similar species warrant further investigation in the northern lower peninsula of Michigan, USA due to the continued presence of bTB on cattle farms. Most research in Michigan, USA has focused on interactions between white-tailed deer (Odocoileus virginianus) and cattle (Bos taurus) for the transmission of the infectious agent of bTB, Mycobacterium bovis, due to high deer densities and feeding practices. However, limited data are available on medium-sized mammals such as Virginia opossum (Didelphis virginiana; hereafter referred to as opossum) and their movements and home range in Michigan near cattle farms. We conducted surveillance of medium-sized mammals on previously depopulated cattle farms for presence of M. bovis infections and equipped opossum with Global Positioning System (GPS) technology to assess potential differences in home range between farms inside and outside the bTB core area that has had cattle test positive for M. bovis. On farms inside the bTB core area, prevalence in opossum was comparable [6%, 95% confidence interval (CI) 2·0–11·0] to prevalence in raccoon (Procyon lotor; 4%, 95% CI 1·0–9·0, P = 0·439) whereas only a single opossum tested positive for M. bovis on farms outside the bTB core area. The prevalence in opossum occupying farms that had cattle test positive for M. bovis was higher (6·4%) than for opossum occupying farms that never had cattle test positive for M. bovis (0·9%, P = 0·01). Mean size of home range for 50% and 95% estimates were similar by sex (P = 0·791) both inside or outside the bTB core area (P = 0·218). Although surveillance efforts and home range were not assessed on the same farms, opossum use of farms near structures was apparent as was selection for farms over surrounding forested habitats. The use of farms, stored feed, and structures by opossum, their ability to serve as vectors of M. bovis, and their propensity to ingest contaminated sources of M. bovis requires additional research in Michigan, USA.

The skin temperatures of industrial workers, mainly women and girls, engaged in very light occupations, have been correlated with environmental conditions. The temperatures of the forehead and of the palm of the hand were measured with a Moll radiation thermopile, and for the temperature of the foot a thermo-junction was used. Altogether 3085 sets of observations were made.

Various measures of environmental warmth (dry-bulb air temperature, equivalent temperature, effective temperature, and dry kata cooling power) were correlated with skin temperature. The dry-bulb air temperature is about as good an index of skin temperature as any of the other measures used, while it appears that skin temperature may be slightly less closely associated with dry kata cooling power than with the other measures of warmth conditions.

At an average air temperature of 18° C., the average skin temperatures observed were: on the forehead 34·25° C.; on the palm of the hand 29·2° C.; and on the foot 24·4° C. The average increases in skin temperature for a rise of 1° in air temperature were: on the forehead 0·139°; on the hand 0·465°; and on the foot 0·806° C.

There was much variation in the skin temperatures recorded at any particular air temperature. The root-mean-square errors of estimation of skin temperature from air temperature were 0·81, 2·51, and 2·80° C., for the forehead, hands and feet respectively.

Correlations between the temperatures of different areas of skin were rather lower than those between air and skin temperature.

Diagnosis and treatment of endemic infectious disease is crucial for productivity of cattle in rural sub-Saharan Africa, but shortages of trained veterinary professionals necessitate support for less well-trained cadres of animal health worker. A Delphi survey of veterinary experts provided quantitative information on key clinical signs associated with eight endemic bovine diseases, then heuristics and dendrogram analysis identified a reduced sign set to be incorporated in a diagnostic decision support tool implemented as a simple colour-banded card. One hundred and seventy disease-sign questionnaire returns were obtained from 32 veterinary research scientists and 14 veterinary practitioners. Preliminary validation of the decision support tool for 16 prototypical cases resulted in ‘correct’ diagnosis over 90% of the time. The card potentially serves as a training aid and aide-mémoire, and could improve the diagnostic competence of animal healthcare providers.

In an outbreak of gastroenteritis on board a cruise ship 251 passengers and 51 crew were affected and consulted the ship's surgeon during a 14-day period. There was a significant association between consumption of cabin tap water and reported illness in passengers. Enterotoxigenic Escherichia coli were isolated from passengers and crew and coliforms were found in the main water storage tank. Contamination of inadequately chlorinated water by sewage was the most likely source of infection.

A low level of reported illness and late recognition of the outbreak delayed investigation of what was probably the latest in a series of outbreaks of gastrointestinal illness on board this ship. There is a need for a national surveillance programme which would monitor the extent of illness on board passenger cruise ships as well as a standard approach to the action taken when levels of reported illness rise above a defined level.

Studies investigating the association between Enterobius vermicularis and allergic conditions have shown conflicting results. This study was conducted to test for any such associations in Norwegian children. Parents were asked to answer questionnaires concerning their children's history of allergies, wheezing or eczema and pinworm infections. Current pinworm infections were diagnosed by microscopic examination of anal scotch tape samples. The data were analysed using logistic regression. Atopic eczema, allergy or wheezing was reported to be confirmed by a physician in 23% of the children (84/364). A possible association between current pinworm infections and food allergy was found, with 17·5% of children without food allergy testing positive for pinworms, compared to 36·8% of children with food allergy (odds ratio 2·9, 95% confidence interval 1·1–8·0). No association was found between past pinworm treatments and present atopic conditions. The association between current E. vermicularis infections and food allergy warrants further study.

Necropsy blood from cases diagnosed as dying from influenza A was examined for specific antibody in the IgG, IgA and IgM fractions and a specific diagnosis of recent infection was made if either IgM or IgA antibody and low titres of IgG antibody were found. By these criteria a diagnostic rate of 77% was found in those cases from whom no virus was isolated. The use of infected cell monolayers grown on polytetrafluoroethylene-coated slides gave a simple method of carrying out these antibody assays, and the use of necropsy blood did not require any special methods of transport of specimens to the virus laboratory.

Ornithosis outbreaks in poultry processing plants are well-described, but evidence for preventive measures is currently lacking. This study describes a case-control study into an outbreak of ornithosis at a poultry processing plant in the East of England, identified following three employees being admitted to hospital. Workers at the affected plant were recruited via their employer, with exposures assessed using a self-completed questionnaire. Cases were ascertained using serological methods or direct antigen detection in sputum. 63/225 (28%) staff participated, with 10% of participants showing evidence of recent infection. Exposure to the killing/defeathering and automated evisceration areas, and contact with viscera or blood were the main risk factors for infection. Personal protective equipment (goggles and FFP3 masks) reduced the effect of exposure to risk areas and to self-contamination with potentially infectious material. Our study provides some evidence of effectiveness for respiratory protective equipment in poultry processing plants where there is a known and current risk of ornithosis. Further studies are required to confirm this tentative finding, but in the meantime respiratory protective equipment is recommended as a precautionary measure in plants where outbreaks of ornithosis occur.

1. The nasal carriage of Staph. aureus and its relation to disease was studied in new recruits, boy apprentices and trained men of the Royal Air Force.

2. The proportions of Staph. aureus that were penicillin-resistant ranged from 15% in new recruits to 29% in trained men. In a school for apprentices the rate in new arrivals was 18%, and 23% for boys after the initial training. We were unable to find when these changes occurred.

3. 31% of strains isolated from septic lesions were penicillin-resistant and the rate was similar in all types of unit. Resistant strains were not apparently more virulent than sensitive strains.

4. About 1% of all strains isolated were resistant to tetracycline and streptomycin and much smaller proportions to chloramphenicol and erythromycin.

5. The phage-group distribution was similar for nasal and lesion strains, but nearly half the penicillin-resistant lesion strains belonged to Group I, and types 52A and 3C/55/71 were much commoner in lesions than in the nose.

6. Penicillin-resistant strains were more readily acquired and more rapidly lost than the sensitive strains.

7. Nasal carriers suffered from septic lesions more frequently than non-carriers, and those with a lesion tended to suffer further lesions. There was no evidence of cross-infection among bedroom contacts.

8. The proportion of penicillin-resistant strains rose from 30 to 40% between admission to and discharge from service hospitals. Resistant strains were not carried for long after discharge.

9. Penicillin treatment resulted in a fall in the total carrier rate and a rise in the resistance rate. Phage type analysis showed that this was mainly due to elimination of sensitive strains and recolonization with resistant strains.

We are greatly indebted to Miss Susan Green for the large amount of work that she did in the laboratory. We should like to thank also many Royal Air Force medical officers for their assistance, in particular Wing Commander E. S. Odbert, Wing Commander M. White, Squadron Leader M. Shearer and Flight Lieutenant A. J. Zuckerman; and the Director-General of the Royal Air Force Medical Services for permission to publish the results.

Clinical features, treatment and outcome were assessed retrospectively by means of a questionnaire in 174 patients in general practice whose vaginal swabs yielded bcta-haemolytic streptococci. These were compared with 96 patients whose swabs yielded no recognized microbial pathogens. Patients with group B streptococci did not differ in any of these parameters from the control group, but those with group A streptococci were more likely to have vaginal soreness, a purulent discharge. and to respond to anti-streptococcal antibiotics. Implications for laboratory reporting are discussed.

Dengue fever, a mosquito-borne viral disease, has become a major public health problem with marked expansion in recent decades. Dengue has now become hyperendemic in India with co-circulation of all the four serotypes. Herein, we report an unprecedented outbreak which occurred during August to October 2011 in Odisha, eastern India. This is the first report of a large epidemic in Odisha. Detailed serological and molecular investigation was carried out to identify the aetiology. Almost half of the samples were found to be dengue antigen (NS1) positive. Further molecular assays revealed circulation of mixed dengue serotypes (DENV-2 and DENV-3). Cosmopolitan genotype of DENV-2 and -3 were identified as the aetiology by phylogenetic analysis. Interestingly, a new lineage of DENV-3 within cosmopolitan genotype was incriminated in this outbreak. The emergence of the unprecedented magnitude of the dengue outbreak with the involvement of a novel lineage of DENV in a newer state of India is a major cause for concern. There is an urgent need to monitor phylodynamics of dengue viruses in other endemic areas.

Measles is an important childhood infection targeted to be eliminated by the World Health Organization (WHO). Virus circulation has not been interrupted in the European Region because high vaccination rates could not be achieved among some countries of the WHO European Region including Turkey. The purpose of this study was to evaluate the laboratory findings of measles cases confirmed in the last nine years, to assess the epidemiological data of the cases, to determine the molecular genotyping studies and to emphasise the importance of laboratory-based surveillance in measles. From 2007 to 2010, only 18 imported cases were detected in Turkey. However, this number increased with a local outbreak of 111 cases in 2011, followed by another outbreak in 2012 in Istanbul that spread countrywide in the following two years; a total of 8661 laboratory-confirmed measles cases were reported from 2012 to 2015. After ELISA detection of a measles IgM-positive result in serum samples of potential measles cases, RT–PCR was performed with urine or nasopharyngeal swab samples of patients, and amplicons were subjected to sequencing. In the samples of 2010 and 2011, D4 and D9 genotypes were mainly detected; as of 2012, the D8 genotype has gained importance. Although D8 was also identified in 2014, in the same year genotype H1 viruses were detected in Turkey for the first time. Therefore, it is important to perform a genotypic analysis of the virus causing the outbreak, analyse epidemiological connections of the contact, determine the source of the outbreak and plan measures based on this information.

Brachyspira (B.) pilosicoli, the causative agent of intestinal spirochaetosis in pigs, is a quite common laboratory finding from faecal samples of weaned and growing pigs in Finland. A better understanding of the epidemiology of B. pilosicoli in and between Finnish pig farms is needed. Altogether 131 B. pilosicoli isolates from 49 Finnish sow herds were studied by pulsed-field gel electrophoresis. MluI was used as a restriction enzyme for all the isolates, and SmaI for 70 isolates. The isolates were divided into 54 different macrorestriction profiles (MRP) by MluI. Most farms had distinct B. pilosicoli genotypes, and common genotypes among herds were rare. B. pilosicoli was re-isolated after 3 years in three herds; the same MRP persisted in each of these herds. A genetic clustering of B. pilosicoli isolates between two major pork production areas was not detected.

Surveys of arbovirus activity in Fiji were conducted over a 10-year period from December 1959 to December 1969. No arboviruses were isolated from over 200,000 mosquitoes, 9000 ticks, or 575 serum samples. Eight thousand human and 1117 bird, bat and animal sera were tested for haemagglutination-inhibiting arbovirus antibody using a variety of group A, group B and Bunyamwera group antigens. Only a small number of low-titre reactions were found among the non-human sera, but 14% of all human sera were found to contain Group B antibody. The antibody prevalence increased with increasing age, from less than 1 % for persons born since 1950, to 70% for persons born before 1900. The age differences in prevalence could be used to estimate the time and size of previous epidemics. Differences were found in antibody prevalence between the sexes, between ethnic groups and between persons from different regions. These differences could be explained in terms of climate, location and custom.

Historical and serological evidence both suggest that all the antibody detected was due to past exposure to dengue virus. The very high proportion of the population with no dengue antibody makes Fiji a high-risk area for a further dengue epidemic. Dengue virus is known to be active in the Pacific and South-East Asia.

Recently, a changing pattern of hepatitis A epidemiology has been reported in the Indian population indicating a rise in the rate of hepatitis A infection among adults. The study's objective was to assess anti-HAV prevalence in voluntary blood donors from middle and high socioeconomic strata. Serum samples collected from voluntary blood donors from Pune city and its suburbs in the years 2002 and 2004–2005 were tested for anti-HAV IgG antibodies. Serum samples collected during 2004–2005 were examined for anti-HAV IgM antibodies. Positive samples were tested for HAV-RNA. Agewise anti-HAV positivity was significantly low in adults aged 18–25 years (90·4%) compared to those aged >25 years (97·4%) (P<0·01). A decline in anti-HAV prevalence was significant in 2004–2005 compared to that in 2002 (96·5% vs. 92·1%) (P<0·01). Overall, in both adult age groups, the proportion of anti-HAV positivity was remarkably low in the high socioeconomic group (HSG) (88·96%) compared to that of the middle socioeconomic group (MSG) (95·86%) (P<0·01). Anti-HAV IgM positivity was not significant (~1%), however, presence of HAV-RNA in one of the samples indicated the possibility of horizontal transmission of HAV. Increase in seronegativity to HAV in HSG implicates a rise in the susceptible pool and indicates the need for vaccination against hepatitis A.

We observed an outbreak of Q fever in a prison population. Overall, 65 of the 600 prison inmates developed the disease. The location of the prison cells had no apparent effect on the risk of infection. The outbreak was probably due to exposure to dust contaminated by a passing flock of sheep, which at the time of the outbreak was engaged in lambing. These findings highlight the possible emergence of Q fever in settings and populations not normally thought of as being at risk of exposure to the infection.

The objective of our analysis was to describe the aetiology, clinical features, and socio-demographic background of adults with diarrhoea attending different urban and rural diarrhoeal disease hospitals in Bangladesh. Between January 2010 and December 2011, a total of 5054 adult diarrhoeal patients aged ⩾20 years were enrolled into the Diarrhoeal Disease Surveillance Systems at four different hospitals (two rural and two urban) of Bangladesh. Middle-aged [adjusted odds ratio (aOR) 0·28, 95% confidence interval (CI) 0·23–0·35, P < 0·001] and elderly (aOR 0·15, 95% CI 0·11–0·20, P < 0·001) patients were more likely to present to rural diarrhoeal disease facilities than urban ones. Vibrio cholerae was the most commonly isolated pathogen (16%) of the four pathogens tested followed by rotavirus (5%), enterotoxigenic Escherichia coli (ETEC) (4%), and Shigella (4%). Of these pathogens, V. cholerae (19% vs. 11%, P < 0·001), ETEC (9% vs. 4%, P < 0·001), and rotavirus (5% vs. 3%, P = 0·013) were more commonly detected from patients presenting to urban hospitals than rural hospitals, but Shigella was more frequently isolated from patients presenting to rural hospitals than urban hospitals (7% vs. 2%, P < 0·001). The isolation rate of Shigella was higher in the elderly than in younger adults (8% vs. 3%, P < 0·001). Some or severe dehydration was higher in urban adults than rural adults (P < 0·001). Our findings indicate that despite economic and other progress made, conditions facilitating transmission of V. cholerae and Shigella prevail in adults with diarrhoea in Bangladesh and further efforts are needed to control these infections.