Case fatality rate (CFR) and doubling time are important characteristics of any epidemic. For coronavirus disease 2019 (COVID-19), wide variations in the CFR and doubling time have been noted among various countries. Early in the epidemic, CFR calculations involving all patients as denominator do not account for the hospitalised patients who are ill and will die in the future. Hence, we calculated cumulative CFR (cCFR) using only patients whose final clinical outcomes were known at a certain time point. We also estimated the daily average doubling time. Calculating CFR using this method leads to temporal stability in the fatality rates, the cCFR stabilises at different values for different countries. The possible reasons for this are an improved outcome rate by the end of the epidemic and a wider testing strategy. The United States, France, Turkey and China had high cCFR at the start due to low outcome rate. By 22 April, Germany, China and South Korea had a low cCFR. China and South Korea controlled the epidemic and achieved high doubling times. The doubling time in Russia did not cross 10 days during the study period.

During the early phase of the influenza pandemic in 2009, all cases of laboratory-confirmed pandemic (H1N1) 2009 (pH1N1) infection required compulsory isolation in hospital. These cases were offered oseltamivir treatment and only allowed to be discharged from the hospital when three consecutive respiratory specimens were negative for the virus by reverse transcription–polymerase chain reaction (RT–PCR). We reviewed the case records of these patients to assess the viral shedding kinetics of the pH1N1 virus. We defined viral shedding duration as the interval from illness onset date to the date of collection of the last positive specimen from the patients. Fifty-six patients were included in the study, of whom 96% received oseltamivir. The median viral shedding duration of pH1N1 virus by viral culture and RT–PCR were 3 days and 4 days, respectively. Patients who started oseltamivir treatment >48 h after onset had a significantly longer median viral shedding duration by viral culture than those who started treatment within 48 h of onset (4 days vs. 2 days, P=0·014).

The purpose of the investigation was to examine the reason for the relative age shift in the incidence of diphtheria. The disease has been represented as now concentrating on children of school ages. We analysed, for various quinquennial periods beginning with 1901–5, the statistics of the notifications and deaths according to age and sex in the London boroughs which we classified into four social classes where I to IV represented descending order in the social scale. The conclusions arrived at were:

I. The age shift as represented by the ratio of the mortality at ages 0–4 to ages 5–9 years which has taken place in London has been found to occur mainly in the poorer districts. The ratio in the residential districts has not altered appreciably during the thirty years under review (Table V).

II. The age shift is also indicated by the morbidity statistics for the three quinquennial periods, 1901–5, 1909–13 and 1919–23, as there was a significant increase in the mean age of attack of children under 15 years of age.

The case rate at ages 5–14 during 1929–33 as compared with that in 1901–5 has increased most amongst children in the lowest social group.

III. Each of the variables (a) the decrease in the birth-rate between 1911 and 1931 in each London borough—an index of the change in the size of family—and (b) the decrease in infant mortality—a measurement of environmental improvement—is positively and significantly correlated with (c) the corresponding change in the size of the ratio of the case rates at ages 0–4 to 5–9 years. The coefficients were:

but the partial correlation coefficients

indicate that the change in the size of family is the more important factor as the value of rac.b is fairly large and significant, whereas the correlation between the change in the ratio and the environmental improvement when the effects of the decreasing birth-rate are made constant—rbc.a—becomes statistically unimportant.

In August 2012, an explosive outbreak of severe lower respiratory tract infection (LRTI) due to Streptococcus pneumoniae serotype-8 occurred in a highly vaccinated elderly institutionalized population in England. Fifteen of 23 residents developed LRTI over 4 days (attack rate 65%); 11 had confirmed S. pneumoniae serotype-8 disease, and two died. Following amoxicillin chemoprophylaxis and pneumococcal polysaccharide vaccine (PPV) re-vaccination no further cases occurred in the following 2 months. No association was found between being an outbreak-associated case and age (P = 0·36), underlying comorbidities [relative risk (RR) 0·84 95% confidence interval (CI) 0·34–2·09], or prior receipt of PPV (RR 1·4, 95% CI 0·60–3·33). However, the median number of years since PPV was significantly higher for cases (n = 15, 10·2 years, range 7·3–17·9 years) than non-cases (n = 8, 7·2 years, range 6·8–12·8 years) (P = 0·045), provided evidence of waning immunity. Alternative vaccination strategies should be considered to prevent future S. pneumoniae outbreaks in institutionalized elderly populations.

The seasonality of individual influenza subtypes/lineages and the association of influenza epidemics with meteorological factors in the tropics/subtropics have not been well understood. The impact of the 2009 H1N1 pandemic on the prevalence of seasonal influenza virus remains to be explored. Using wavelet analysis, the periodicities of A/H3N2, seasonal A/H1N1, A/H1N1pdm09, Victoria and Yamagata were identified, respectively, in Panzhihua during 2006–2015. As a subtropical city in southwestern China, Panzhihua is the first industrial city in the upper reaches of the Yangtze River. The relationship between influenza epidemics and local climatic variables was examined based on regression models. The temporal distribution of influenza subtypes/lineages during the pre-pandemic (2006–2009), pandemic (2009) and post-pandemic (2010–2015) years was described and compared. A total of 6892 respiratory specimens were collected and 737 influenza viruses were isolated. A/H3N2 showed an annual cycle with a peak in summer–autumn, while A/H1N1pdm09, Victoria and Yamagata exhibited an annual cycle with a peak in winter–spring. Regression analyses demonstrated that relative humidity was positively associated with A/H3N2 activity while negatively associated with Victoria activity. Higher prevalence of A/H1N1pdm09 and Yamagata was driven by lower absolute humidity. The role of weather conditions in regulating influenza epidemics could be complicated since the diverse viral transmission modes and mechanism. Differences in seasonality and different associations with meteorological factors by influenza subtypes/lineages should be considered in epidemiological studies in the tropics/subtropics. The development of subtype- and lineage-specific prevention and control measures is of significant importance.

The prediction of prognosis is an important part of management in hepatitis B virus (HBV)-related decompensated cirrhosis patients with high long-term mortality. Lactate is a known predictor of outcome in critically ill patients. The aim of this study was to assess the prognostic value of lactate in HBV-related decompensated cirrhosis patients. We performed a single-centre, observational, retrospective study of 405 HBV-related decompensated cirrhosis patients. Individuals were evaluated within 24 h after admission and the primary outcome was evaluated at 6-months. Multivariable analyses were used to determine whether lactate was independently associated with the prognosis of HBV-related decompensated cirrhosis patients. The area under the ROC (AUROC) was calculated to assess the predictive accuracy compared with existing scores. Serum lactate level was significantly higher in non-surviving patients than in surviving patients. Multivariable analyses demonstrated that lactate was an independent risk factor of 6-months mortality (odds ratio: 2.076, P < 0.001). Receiver operating characteristic (ROC) curves were drawn to evaluate the discriminative ability of lactate for 6-months mortality (AUROC: 0.716, P < 0.001). Based on our patient cohort, the new scores (Model For End-Stage Liver Disease (MELD) + lactate score, Child–Pugh + lactate score) had good accuracy for predicting 6-months mortality (AUROC = 0.769, P < 0.001; AUROC = 0.766, P < 0.001). Additionally, the performance of the new scores was superior to those of existing scores (all P < 0.001). Serum lactate at admission may be useful for predicting 6-months mortality in HBV-related decompensated cirrhosis patients, and the predictive value of the MELD score and Child–Pugh score was improved by adjusting lactate. Serum lactate should be part of the rapid diagnosis and initiation of therapy to improve clinical outcome.

Vaccination has proved a powerful defence against measles. We reappraise measles seroepidemiological data in Taiwan from 1974 to 2004 having robust age-stratified serological information on exposure and immunity to quantitatively characterize measles vaccination programmes. We dynamically model measles seroepidemiology to estimate age-dependent intensity of infection associated with the effects of different contact patterns on pre- and post-vaccination. The WAIFM (who acquires infection from whom) contact matrix is employed to describe the transmission between and within each age group. A deterministic SEIR (susceptible–exposed–infected–recovery) model is used to capture subpopulation dynamics. Our study shows that mass regional or nationwide vaccination programmes could greatly reduce the potential for a major measles epidemic and have strong direct effects on the potential impact of childhood vaccination. We parameterize a predictive model that should reduce the socio-economic costs of measles surveillance in Taiwan and thereby encourage its continuance, especially for preschool children.

Understanding the spatial distribution of disease is critical for effective disease control. Where formal address networks do not exist, tracking spatial patterns of clinical disease is difficult. Geolocation strategies were tested at rural health facilities in western Kenya. Methods included geocoding residence by head of compound, participatory mapping and recording the self-reported nearest landmark. Geocoding was able to locate 72·9% [95% confidence interval (CI) 67·7–77·6] of individuals to within 250 m of the true compound location. The participatory mapping exercise was able to correctly locate 82·0% of compounds (95% CI 78·9–84·8) to a 2 × 2·5 km area with a 500 m buffer. The self-reported nearest landmark was able to locate 78·1% (95% CI 73·8–82·1) of compounds to the correct catchment area. These strategies tested provide options for quickly obtaining spatial information on individuals presenting at health facilities.

In this study we collected and analysed data of the severe burn patients at our institution over an 11-year period in order to shed light on the controversial role of bloodstream infection (BSI) as a predictive factor for mortality in this burn population. The factors examined were age, total body surface area, smoke inhalation, presence of BSI, and BSI with resistant bacteria. In total 1081 burn patients were hospitalized from 2001 to 2011, of whom 4% died. We focused here on 158 severe burn patients, 74 of whom developed BSI, and 35 who died. Using univariate analysis, it appeared that the BSI group had a threefold greater chance of mortality compared to the non-BSI group. Patients with a Ryan score 3 had a 100% chance of mortality and those with a score 0 had 0%. Thus, focusing only on Ryan score 1 and score 2 patients, BSI did not contribute to mortality, nor was it shown to contribute to mortality in a multivariate analysis in which the score and BSI were included together. When BSI did occur, it predicted longer hospitalization periods. We conclude that BSI predicts longer length of hospitalization stay but does not contribute to the prediction of mortality beyond that offered by the Ryan score in a severe burn population.

Antimicrobial resistance is a major health threat worldwide as it brings about poorer treatment outcome and places economic burden to the society. This study aims to estimate the annual relative increased in inpatient mortality from antimicrobial resistant (AMR) nosocomial infections (NI) in Thailand. A retrospective cohort study was conducted at Ramathibodi Hospital, Bangkok, Thailand, over 2008–2012. Survival model was used to estimate the hazard ratio of mortality of AMR relative to those patients without resistance (non-AMR) after controlling for nine potential confounders. The majority of NI (73.80%) were caused by AMR bacteria over the study period. Patients in the AMR and non-AMR groups had similar baseline clinical characteristics. Relative to patients in the non-AMR group, the expected hazard ratios of mortality for patients in the AMR group with Acinetobacter baumannii, Escherichia coli, Pseudomonas aeruginosa and Staphylococcus aureus were 1.92 (95% CI 0.10–35.52), 1.25 (95% CI 0.08–20.29), 1.60 (95% CI 0.13–19.10) and 1.84 (95% CI 0.04–95.58), respectively. In the complete absence of AMR bacteria, this study estimated that annually, in Thailand, there would be 111 295 fewer AMR cases and 48 258 fewer deaths.

Between January 1994 and October 1997, we interviewed 2576 black in-patients with newly diagnosed cancer in Johannesburg and Soweto, South Africa. Blood was tested for HIV-1 and HHV-8 antibodies and the study was restricted to 2191 HIV-1 antibody-negative patients. We examined the relationship between infection with HHV-8 and sociodemographic and behavioural factors using unconditional logistic regression models. Of the 2191 HIV-1 negative patients who did not have Kaposi's sarcoma, 854 (39·1%) were positive for antibodies against the latent nuclear antigen of HHV-8 encoded by orf73 in a immunofluorescence assay. Infection with HHV-8 was independently associated with increasing age (P trend=0·02). For females, independent risk factors also included working in a paid domestic capacity (OR 1·63, 95% CI 1·09–2·44, P=0·02), defining occupational status as economically non-active unemployed (OR 1·70, 95% CI 1·06–2·72, P=0·03), having a state pension or being on a disability grant (OR 1·49, 95% CI 1·05–2·11, P=0·02), using oral contraceptives (OR 1·43, 95% CI 1·03–1·99, P=0·03) and having a delayed age at menarche (P trend=0·04). The relationship between these variables and HHV-8 antibody status requires further, prospective study.

The study objective was to determine the prevalence of Staphylococcus aureus colonisation in the nares and oropharynx of healthy persons and identify any risk factors associated with such S. aureus colonisation. In total 263 participants (177 adults and 86 minors) comprising 95 families were enrolled in a year-long prospective cohort study from one urban and one rural county in eastern Iowa, USA, through local newspaper advertisements and email lists and through the Keokuk Rural Health Study. Potential risk factors including demographic factors, medical history, farming and healthcare exposure were assessed. Among the participants, 25.4% of adults and 36.1% minors carried S. aureus in their nares and 37.9% of adults carried it in their oropharynx. The overall prevalence was 44.1% among adults and 36.1% for minors. Having at least one positive environmental site for S. aureus in the family home was associated with colonisation (prevalence ratio: 1.34, 95% CI: 1.07–1.66). The sensitivity of the oropharyngeal cultures was greater than that of the nares cultures (86.1% compared with 58.2%, respectively). In conclusion, the nares and oropharynx are both important colonisation sites for healthy community members and the presence of S. aureus in the home environment is associated with an increased probability of colonisation.

Varicella is one of the most common childhood diseases. The course of the disease is usually mild and uncomplicated. In Slovenia, varicella is a notifiable communicable disease which must be reported. Data collected from 1979–98 were analysed. Over the 20-year period the number of varicella cases reported ranged from a low of 11 086 (in 1994) to a maximum of 21 141 (in 1987). During the last 10 years, the highest incidence of varicella was reported in children aged from 12 months to 2 years. In adults over 20, incidence has slightly but steadily increased over the 20 year period. Overall, the number of males with varicella exceeded that of females. The proportion of females was higher only in the 20–30-year age group, probably as a consequence of more frequent and closer contact with infected children by mothers. The highest number of reported cases was during winter and early spring.

Measurements have been made of the extent of air exchange between patient rooms in a fully air-conditioned hospital using a tracer-gas method.

When the rooms were ventilated at about six air changes per hour, had an excess airflow through the doorway of about 0.1 m.3/sec. and the temperature difference between rooms and corridor was less than 0.5° C., concentrations of the tracer in rooms close to that in which it was being liberated were 1000-fold less than that in the source room. This ratio fell to about 200-fold in the absence of any excess airflow through the doorways. Considerable dilution took place along the corridors so that the concentration fell by around 10-fold for every 10 m. of corridor.

The serological examination of over 900 rhinovirus strains isolated in Britain over a 10-year period has demonstrated a wide variety of different serotypes. Their seasonal and temporal distribution are described and discussed.

The purpose of this study was to describe patterns of seroconversion to bovine leukaemia virus and to estimate the main parameters needed for future model building. A longitudinal study was carried out between February 1999 and November 2001 in seven commercial dairy farms in Argentina using 1535 lactating cows. Time-interval parameters were analysed using a parametric survival model with shared frailty, time until infection was analysed using a Bayesian interval-censoring survival model and the infection transmission parameter (β) was estimated by a generalized linear model. The reproduction ratio (R0) was calculated. In total, 1000 cows tested positive and 494 tested negative. The predicted median age at infection was 4·6 years for seroconverted cows. For infected herds, the proportion of positive calves was as high as for infected cows and showed a large proportion of infected breeding heifers. Peaks in the overall average incidence per season-year were observed during autumn and spring. Results reveal that the period around parturition is a high-risk period. Moreover, heavily infected herds seem to have an increased proportion of young stock infected. The overall β was estimated as 2·9/year (95% CI 1·9–3·7) and combined with a relatively long infectious period it resulted in a high reproductive ratio (R0=8·9). Therefore, a high effectiveness of control measures needs to be achieved to eradicate the disease.

A large proportion of postoperative infections after clean surgery are thought to be exogenous. For aerobic bacteria different routes of transmission have been thoroughly studied. Airborne infection has been considered very important in infections after total hip replacement (Charnley, 1972). Anaerobic non-sporing bacteria have been found in deep late infections after total hip replacement (Kamme et al. 1974; Schwan et al. 1977; Petrini, Nord & Welin-Berger, 1978). However, infections caused by anaerobic bacteria have been considered endogenous, and little is known about the routes of transmission for these bacteria.

1. In the spring of 1948 the health visitors of 422 authorities in Britain obtained information from 4683 mothers on accidental injuries sustained by their young children during the first 2 years of life. This study formed part of a questionnaire inquiry into the health and development of these young children, who had all been born in one week, 3–9 March 1946.

2. The mothers seem to have remembered accurately the more serious accidents which received professional treatment during the 2 years under review. It is possible that some of the minor injuries which had not been treated were not recalled or entered on the questionnaires.

3. The rate for all serious injuries which received professional care was 79·6 per 1000 children in the sample. Treated cuts were almost as frequent as treated burns or scalds, each being sustained by about 37 per 1000 children. There were only 7·5 fractures per 1000 children. The sum of the rates for each type of injury (81·3 per 1000) slightly exceeds the combined rate for all children injured (79·6 per 1000). This is due to the fact that in calculating the former rates eight children who were each involved in two serious accidents of different types were counted twice, i.e. once under each type of injury sustained.

4. In 1946–8 treatment of young children for burns or scalds and for serious cuts was most frequently given by general practitioners. Children under 2 years of age were admitted to accident wards of hospitals chiefly for the treatment of serious burns or scalds. Fractures were usually treated at out-patients’ departments.

5. Although almost all accidents occurred at home, variations in housing conditions, as measured by crowding and the domestic facilities available, had little effect on the incidence of accidents among children under 2 years of age. Accidents happened most frequently when the children were beginning to walk and becoming inquisitive, and most injuries occurred either because they were not steady on their feet or because they had not developed ‘heat-sense’.

6. Since domestic help was rare, most children had to play in the kitchen or living room while their mothers were doing the housework, cooking and laundry. In these circumstances, they were often exposed to the risk of injury.

In the records of the Registrar-General of England and Wales prior to the year 1940, diabetes was accorded by the rules of classification a high preference over other causes mentioned in association with it upon death certificates, the only important causes preferred to it being the infective diseases cancer, rheumatic fever, sequelae of syphilis, injuries, poisoning, acute intestinal obstruction and puerperal sepsis. It was ascertained from a sample of 123,000 deaths during 1921–30 that 91 % of all death certificates with mention of diabetes were classified to diabetes; in other words the death-rates represented 91 % of the total mortality suffered by persons recognized as diabetics and recorded on certificates as such. It is important to keep this fact in mind when seeking explanations for the trends of mortality at different ages between the years 1860 and 1940.

The detection of Legionella pneumophila in water via guinea-pig intraperitoneal injection has been compared with direct isolation of these organisms on semiselective BCYEα media. Both techniques were of similar sensitivity, detecting as few as 102L. pneumophila in 10 ml of water. However, at this concentration, detection using guinea-pig intraperitoneal injection was via the indirect parameters of antibody production and immunofluorescent microscopy. Isolation of L. pneumophila from guinea-pig tissue for further investigation required > 107 organisms injected and in this respect is relatively much less sensitive than direct isolation on semiselective BCYEα media. Since L. micdadei and L. longbeachae are inhibited by one of the selective supplements used, other supplements and techniques need to be developed in order to avoid possible inhibition of other Legionella species.