Adolescents have been largely neglected from tuberculosis control efforts. In low- to medium burden settings much of the tuberculosis burden in this age group occurs from school outbreaks. We report on a large tuberculosis outbreak in adolescents from a boarding high school in Jiangsu Province, China. From March to June 2018, a tuberculosis outbreak occurred in a boarding high school. We conducted an outbreak investigation involving clinical diagnostic tests and molecular analysis to determine the outbreak origin. Cases were detected through symptom screening, tuberculin skin testing (TST), chest radiography, sputum smear, solid sputum culture and GeneXpert MTB/RIF. Mycobacterial interspersed repetitive-unit-variable-number tandem-repeat (MIRU-VNTR) genotyping and spoligotyping methods were performed on Mycobacterium tuberculosis (M. tuberculosis) isolates to identify the outbreak origin. A total of 845 students and 131 teachers/staff attended a TST screening for tuberculosis infection. The prevalence of elevated tuberculin reactions at ≥5, ≥10 and ≥15 mm was 12.19% (119/976), 6.35% (62/976) and 3.28% (32/976), respectively. Radiographic abnormalities were present in 5.73% (56 of 976) individuals, 40 students and 16 teachers/staff. Of these, 12 students were diagnosed with confirmed tuberculosis. In total, 14 students (two index cases and 12 confirmed cases) were diagnosed and reported in the tuberculosis outbreak, an attack rate of 1.7% (14/847) among students (two index cases and 845 screened students). Results from MIRU-VNTR typing and spoligotyping analyses demonstrated that three M. tuberculosis strains belong to the Beijing family with corresponding MIRU-VNTR alleles. This school-based tuberculosis outbreak among adolescents demonstrates that transmission among individuals in this age group is common and must be prioritised. It suggests that identifying and timely diagnosis of smear-positive cases, especially in the early phase of outbreaks, is the key to preventing further spread among close contacts.

Porcine enterovirus type 2 or porcine adenovirus type 3 were seeded into samples of pig slurry, and a bovine enterovirus was seeded into cattle slurry, and samples of the slurry were aerated in the laboratory for 21 days. The viruses were inactivated more rapidly in the aerated slurry than in control slurry which was not aerated. The difference in inactivation rate was greatest for the porcine adenovirus and least for the bovine enterovirus. Inactivation of the porcine enterovirus in aerated distilled water and in aerated, autoclaved pig slurry proceeded at a similar rate as in the same materials which were not aerated. Ten samples of aerated slurry were collected from an aeration tank which received weekly additions of raw pig slurry which was sampled at the same times. Each sample yielded a porcine enterovirus after concentration with the polyelectrolyte PE-60, but in three comparative titrations the viral infectivity titre in concentrates of the raw slurry was at least 1000 times greater than in the aerated slurry. Porcine enterovirus type 2 and porcine adenovirus type 3, which were seeded into pig slurry, and a bovine enterovirus seeded into cattle slurry, were inactivated by treatment of the slurry with calcium hydroxide at pH 11·5. The inactivation rate was highest for the bovine enterovirus and lowest for the porcine adenovirus.

The incidence of Staphylococcus aureus in the nose, throat and superficial wound infections of 99 office staff, 129 psychiatry staff and 115 surgical staff was studied over a 4-week period with the purpose of assessing the potential risk to hospital personnel of staphylococcal infection. Incidence rates, both average and cumulative, were essentially similar in the three groups but certain differences in the ecology of the staphylococcal phage groups were observed. Surgical staff appeared to have a more labile pattern of carriage. As in other Scandinavian studies throat carriage rates were high. Staphylococcal carriage seems largely to depend on individual characteristics rather than environmental factors.

Human brucellosis occurs when humans ingest or contact Brucella spp. from shedding animals or contaminated environments and food. In Georgia animal and human brucellosis is endemic, but the epidemiology has not been fully characterized. A case-control study was conducted in 2010 to identify risk factors for human brucellosis. Using multivariable logistic regression, the following risk factors were identified: animal-related work [odds ratio (OR) 77·8, 90% confidence interval (CI) 4·7–1278], non-animal-related work (OR 12·7, 90% CI 1·1–149), being unemployed or a pensioner (OR 13·1, 90% CI 1·7, 101), sheep ownership (OR 19·3, 90% CI 5·1–72·6), making dairy products (OR 12·4, 90% CI 1·4–113), living in eastern Georgia (Kakheti) (OR 278·1, 90% CI 9·5–8100), and being aged >44 years (OR 9·3, 90% CI 1·02–84·4). Education of at-risk groups about risk factors and control of disease in sheep may reduce the human disease risk. This is the first study of its kind in Georgia since the collapse of the Soviet Union.

ESBL-producing Enterobacteriaceae and particularly Escherichia coli ST131 isolates producing CTX-M enzymes are commonly found colonizing the intestine of nursing home (NH) residents, but ST131 subclonal structure has been scarcely explored in this vulnerable population. Our goal was to perform a pilot study to assess the faecal carriage rate and epidemiological features of ESBL- and/or carbapenemase-producing Enterobacteriaceae (ESBL-E and CPE, respectively) among NH residents. For this purpose, faecal samples from residents at 4 different NHs in the North of Portugal (representing 9·5% of the residents’ population, July 2014) were screened for ESBL-E and/or CPE by phenotypic and genotypic methods. Clonal structure and plasmid typing of ESBL-producing E. coli (ESBL-Ec) was performed by PCR and sequencing. Four ESBL-Ec isolates (2 CTX-M-15/2 CTX-M-14) were found in 20% of the samples, all belonging to the pandemic clonal lineage B2-ST131-O25b:H4. Two different clades were identified, the C2/H30-Rx-virotype C producing CTX-M-15 and an atypical B/H22-like-virotype D5 (producing CTX-M-14 and fluoroquinolone-resistant), firstly described in Portugal. This pilot study highlights the role of NH residents as a source of different ST131 clades, besides emphasizing the importance of E. coli B2-ST131 subtyping in different clinical settings, and understanding the transmission dynamics of the different variants.

We investigated the cost-effectiveness of different influenza control strategies in a school setting in Taiwan. A susceptible-exposure-infected-recovery (SEIR) model was used to simulate influenza transmission and we used a basic reproduction number (R0)–asymptomatic proportion (θ) control scheme to develop a cost-effectiveness model. Based on our dynamic transmission model and economic evaluation, this study indicated that the optimal cost-effective strategy for all modelling scenarios was a combination of natural ventilation and respiratory masking. The estimated costs were US$10/year per person in winter for one kindergarten student. The cost for hand washing was estimated to be US$32/year per person, which was much lower than that of isolation (US$55/year per person) and vaccination (US$86/year per person) in containing seasonal influenza. Transmission model-based, cost-effectiveness analysis can be a useful tool for providing insight into the impacts of economic factors and health benefits on certain strategies for controlling seasonal influenza.

In October 2021, the WHO published an ambitious strategy to ensure that all countries had vaccinated 40% of their population by the end of 2021 and 70% by mid-2022. The end of June 2022 marks 18 months of implementation of coronavirus disease 2019 (COVID-19) vaccination in the African region and provides an opportunity to look back and think ahead about COVID-19 vaccine set targets, demand and delivery strategies. As of 26 June 2022 two countries in the WHO African region have achieved this target (Mauritius and Seychelles) and seven are on track, having vaccinated between 40% and 69% of their population. By the 26 June 2022, seven among the 20 countries that had less than 10% of people fully vaccinated at the end of January 2022, have surpassed 15% of people fully vaccinated at the end of June 2022. This includes five targeted countries, which are being supported by the WHO Regional Office for Africa through the Multi-Partners' Country Support Team Initiative. As we enter the second semester of 2022, a window of opportunity has opened to provide new impetus to COVID-19 vaccination rollout in the African region guided by the four principles: Scale-up, Transition, Consolidation and Communication. Member States need to build on progress made to ensure that this impetus is not lost and that the African region does not remain the least vaccinated global region, as economies open up and world priorities change.

We studied hepatitis C virus (HCV) prevalence and risk factors for HCV infection in a sample of Brazilian HIV-positive patients. A cross-sectional study was conducted with 580 HIV-positive patients from a specialized HIV/AIDS diagnosis and treatment centre in southern Brazil. All patients were interviewed for socio-demographic and risk factors and tested for HCV antibodies and HCV-RNA detection. A multivariate analysis was performed to identify risk factors for HCV infection. A total of 138 (24%) patients had past or chronic hepatitis C. The following risk factors were associated with HCV infection for each gender: alcohol misuse and injecting drug use in women (P < 0·001) and low educational level, smoking drug use, and injecting drug use in men (P < 0·01). These results suggest that alcohol misuse, low educational level, smoking drug use, and injecting drug use are probable risk factors for HCV infection in HIV-positive patients. This information contributes to an understanding of the epidemiology of HIV/HCV co-infection in Brazil.

This investigation has been concerned with the changes that occur in the coliform and faecal coli content of water samples on storage at room and refrigerator temperature for 20–24 hr.

On examination by a seventy-tube method, using twofold diminishing volumes, twenty-three out of 151 samples of water stored overnight at room temperature showed a significant increase in the presumptive number of conform organisms and twenty-nine a significant decrease. Of the same number stored in the refrigerator, ten showed a significant increase and twenty-six a significant decrease.

Of 111 samples examined for faecal coli, eight showed a significant increase on storage at room temperature and twenty-nine a significant decrease. Of the same number stored in the refrigerator, seven showed a significant increase and fifteen a significant decrease. The effects of the source of the water, the time of year and the original number of coliform organisms in the sample were examined.

The present investigation has shown that in a considerable proportion of samples a significant change in the conform and faecal coli content does occur on overnight storage at room or refrigerator temperature. It may, perhaps, be safe to store samples under some conditions for shorter periods, but this is a matter for future investigation.

Burden of disease analyses can quantify the relative impact of different exposures on population health outcomes. Gastroenteritis where the causative pathogen was not determined and respiratory illness resulting from exposure to opportunistic pathogens transmitted by water aerosols have not always been considered in waterborne burden of disease estimates. We estimated the disease burden attributable to nine enteric pathogens, unspecified pathogens leading to gastroenteritis, and three opportunistic pathogens leading primarily to respiratory illness, in Ontario, Canada (population ~14 million). Employing a burden of disease framework, we attributed a fraction of annual (year 2016) emergency department (ED) visits, hospitalisations and deaths to waterborne transmission. Attributable fractions were developed from the literature and clinical input, and unattributed disease counts were obtained using administrative data. Our Monte Carlo simulation reflected uncertainty in the inputs. The estimated mean annual attributable rates for waterborne diseases were (per 100 000 population): 69 ED visits, 12 hospitalisations and 0.52 deaths. The corresponding 5th–95th percentile estimates were (per 100 000 population): 13–158 ED visits, 5–22 hospitalisations and 0.29–0.83 deaths. The burden of disease due to unspecified pathogens dominated these rates: 99% for ED visits, 63% for hospitalisations and 40% for deaths. However, when a causative pathogen was specified, the majority of hospitalisations (83%) and deaths (97%) resulted from exposure to the opportunistic pathogens Legionella spp., non-tuberculous mycobacteria and Pseudomonas spp. The waterborne disease burden in Ontario indicates the importance of gastroenteritis not traced back to a particular pathogen and of opportunistic pathogens transmitted primarily through contact with water aerosols.

Waterborne disease outbreaks (WBDO) of acute gastrointestinal illness (AGI) are a public health concern in France. Their occurrence is probably underestimated due to the lack of a specific surveillance system. The French health insurance database provides an interesting opportunity to improve the detection of these events. A specific algorithm to identify AGI cases from drug payment reimbursement data in the health insurance database has been previously developed. The purpose of our comparative study was to retrospectively assess the ability of the health insurance data to describe WBDO. Data from the health insurance database was compared with the data from cohort studies conducted in two WBDO in 2010 and 2012. The temporal distribution of cases, the day of the peak and the duration of the epidemic, as measured using the health insurance data, were similar to the data from one of the two cohort studies. However, health insurance data accounted for 54 cases compared to the estimated 252 cases accounted for in the cohort study. The accuracy of using health insurance data to describe WBDO depends on the medical consultation rate in the impacted population. As this is never the case, data analysis underestimates the total number of AGI cases. However this data source can be considered for the development of a detection system of a WBDO in France, given its ability to describe an epidemic signal.

Centrifuged deposits of washings of vegetables and fruits were plated on S.S. deoxycholate citrate and MacConkey agar for evidence of contamination.

Vegetables like beans, carrots, cabbage, celery, elabattu, leeks, kankum, pumpkin and spinach were found to be contaminated with Salmonella, Shigella and enteropathogenic E. coli. The extent of contamination of the vegetables which grew to a height of about 1 ft. above the ground was greater than that of the taller varieties. The rate of contamination among fruits was almost negligible.

The contamination might have originated from the water used for irrigation, from manure, or from the handlers of the vegetables.

Forty-one children in an Edinburgh nursery were observed for evidence of respiratory illness from November 1963 to April 1964. During this period serial specimens of serum from these children were examined for virus antibodies and serial throat swabs were investigated for the presence of virus. Well-defined outbreaks of respiratory illness occurred and could be associated with respiratory syncytial virus, parainfluenza 3 virus and influenza C virus infection. Infection with adenovirus followed a more endemic pattern. The antibody response in infants to respiratory syncytial virus as measured by the standard complement-fixation test was found to be much poorer than the response to parainfluenza 3 virus. It is suggested that this may play a part in the severity of respiratory syncytial virus infection in infants.

The prevalence of Vibrio cholerae in drinking water, lakes and sewage outfalls during July and August 1996 in Vellore, India was determined. Drinking water samples were collected on single occasions from 12 sites in different geographic areas of the town where cholera had been reported. Samples of water, plankton and sediment were collected from fixed sites at three lakes on three occasions separated by at least 3 days during the course of the study. Samples from open sewers were taken from two representative sites in four areas of the town. Bacteria isolated from samples were identified by standard biochemical tests and isolated strains of V. cholerae tested for their ability to agglutinate O1 and O139 antisera. Water samples from lakes were also tested for the presence of V. cholerae O1 and O139 by fluorescent antibody staining. Non-O1, non-O139 strains of V. cholerae were detected in 41% of drinking water samples and 100% of water, sediment and plankton samples from the test lakes. Eighty-seven per cent of open sewers sampled contained viable non-O1, non-O139 V. cholerae. Fluorescent antibody staining gave positive results for V. cholerae O1 and O139 for all water samples from the three lake sites. Strains of Aeromonas spp. were isolated from 58% of drinking water samples and from 66% of sediment, 77% of plankton and 55% of water samples from lakes. All open sewers sampled contained Aeromonas spp. PCR amplification employing specific primers demonstrated that none of the non-agglutinating V. cholerae isolates contained the ctx operon. The non-O1, non-O139 V. cholerae isolates showed different patterns of antibiotic resistance to ampicillin, ciprofloxacin, chloramphenicol, tetracycline and trimethoprim.

Both controls became infected, the glands of the alimentary tract showing widespread lesions and some dissemination, slight in one, a little more extensive in the other.

Of the nine vaccinated calves, five were found to have trivial tuberculous lesions in the glands adjoining the alimentary tract and four showed no macroscopic lesions, either in the glands of the alimentary tract or elsewhere.

Living bovine tubercle bacilli were not present in emulsions of mesenteric or thoracic glands of two of the four no-lesion calves and were demonstrated in the mesenteric glands but not in a bronchial gland of a third. The pooled glands of the fourth no-lesion calf caused general tuberculosis in two guinea-pigs.

Living bovine bacilli were very sparse in the thoracic glands of two of the calves with trivial lesions in the head or mesenteric glands and were not present in a bronchial gland of a calf which showed a few foci in the mesenteric glands.

Living bovine bacilli were present in lymphatic glands of one calf, but which were the glands that contained them could not be stated, as these were pooled before injection. The mesenteric glands only of the remaining calf were tested and proved infective.

No lesions were found after single vaccinations in three instances (two intravenous and one subcutaneous) and after two vaccinations in one instance, the periods between the single vaccinations and the resistance tests ranging from 2 to 6 months. There seems no advantage, therefore, in giving more than one dose of vole bacilli. The intravenous is, however, preferable to the subcutaneous method, because the former method does not produce an unsightly local lesion.

Culbertson (1932) has recently described a method for estimating the antibody content of antisera against crystalline egg-albumin. He determined by tests on supernatant fluids the point at which antigen and antibody neutralised each other. At this neutralisation point he found that antigen and antibody combined in a ratio of 1 to 13, and that the amount of precipitate nitrogen was maximal. The ratio 1 to 13, he stated, held for all the precipitates in the post-zone where antibody was in excess.

The effect of various concentrations of sodium thioglycollate (0–0·05 %) on the recovery of spores of four strains of clostridia was investigated. The results showed that thioglycollate at a concentration of 0·01 % can be inhibitory to some clostridia. However, the results also indicated that the inhibitory effect is dependent upon the composition of the growth medium. The presence of glucose appeared to be particularly important in reducing the inhibitory effect. These findings support the view that the use of sodium thioglycollate in sterility test media should be discontinued.

The outbreak of novel coronavirus pneumonia (coronavirus disease 2019 (COVID-19)), declared as a ‘global pandemic’ by the World Health Organization (WHO), is a public health emergency of international concern (PHEIC). The outbreak in multiple locations shows a trend of accelerating spread around the world. China has taken a series of powerful measures to contain the spread of the novel coronavirus. In response to the COVID-19 pandemic, in addition to actively finding effective treatment drugs and developing vaccines, it is more important to identify the source of infection at the community level as soon as possible to block the transmission path of the virus to prevent the spread of the pandemic. The implementation of grid management in the community and the adoption of precise management and control measures to reduce unnecessary personnel movement can effectively reduce the risk of pandemic spread. This paper mainly describes that the grid management mode can promote the refinement and comprehensiveness of community management. As a management system with potential to improve the governance ability of community affairs, it may be helpful to strengthen the prevention and control of the epidemic in the community.

Vaccination remains the best strategy to reduce invasive meningococcal disease. This study evaluated an investigational tetanus toxoid-conjugate quadrivalent meningococcal vaccine (MenACYW-TT) vs. a licensed tetanus toxoid-conjugate quadrivalent meningococcal vaccine (MCV4-TT) (NCT02955797). Healthy toddlers aged 12–23 months were included if they were either meningococcal vaccine-naïve or MenC conjugate (MCC) vaccine-primed (≥1 dose of MCC prior to 12 months of age). Vaccine-naïve participants were randomised 1:1 to either MenACYW-TT (n = 306) or MCV4-TT (n = 306). MCC-primed participants were randomised 2:1 to MenACYW-TT (n = 203) or MCV4-TT (n = 103). Antibody titres against each of the four meningococcal serogroups were measured by serum bactericidal antibody assay using the human complement. The co-primary objectives of this study were to demonstrate the non-inferiority of MenACYW-TT to MCV4-TT in terms of seroprotection (titres ≥1:8) at Day 30 in both vaccine-naïve and all participants (vaccine-naïve and MCC-primed groups pooled). The immune response for all four serogroups to MenACYW-TT was non-inferior to MCV4-TT in vaccine-naïve participants (seroprotection: range 83.6–99.3% and 81.4–91.6%, respectively) and all participants (seroprotection: range 83.6–99.3% and 81.4–98.0%, respectively). The safety profiles of both vaccines were comparable. MenACYW-TT was well-tolerated and demonstrated non-inferior immunogenicity when administered to MCC vaccine-primed and vaccine-naïve toddlers.

Hantavirus pulmonary syndrome (HPS) is the most frequently reported fatal rodent-borne disease in Brazil, with the majority of cases occurring in Santa Catarina. We analysed the clinical, laboratory and epidemiological data of the 251 confirmed cases of HPS in Santa Catarina in 1999–2011. The number of cases ranged from 10 to 47 per year, with the highest incidences in 2004–2006. Gastrointestinal tract manifestations were found in >60% of the cases, potentially confounding diagnosis and leading to inappropriate therapy. Dyspnoea, acute respiratory failure, renal failure, increased serum creatinine and urea levels, increased haematocrits and the presence of pulmonary interstitial infiltrate were significantly more common in HPS patients who died. In addition, we demonstrated that the six cases from the midwest region of the state were associated with Juquitiba virus genotype. The case-fatality rate in this region, 19·2%, was lower than that recorded for other mesoregions. In the multivariate analysis increase of serum creatinine and urea was associated with death by HPS. Our findings help elucidate the epidemiology of HPS in Brazil, where mast seeding of bamboo can trigger rodent population eruptions and subsequent human HPS outbreaks. We also emphasize the need for molecular confirmation of the hantavirus genotype of human cases for a better understanding of the mortality-related factors associated with HPS cases in Brazil.