A co-operative study was made of the incidence of infection acquired by patients in medical wards. Records were collected of 6740 admissions to 21 wards in 13 hospitals.

There were 384 clinical infections (5·7 per 100 patients admitted); 135 of them (35%) were infections of the lower respiratory tract, 72 (19%) were septic skin lesions or infected wounds, and 81 (21%) were urinary tract infections.

Infection was believed to have contributed to the death of 59 patients—17% of those infected or 8% of those dying in hospital. Nearly three-quarters of the deaths were attributed to ‘pneumonia’.

Acquired infections were most common and most severe at the extremes of age. There was an excess of males over females in staphylococcal infections and in infections of the lower respiratory tract, and of females over males in urinary tract infections.

The incidence of infection was above average in patients suffering from malignant disease, diabetes, rheumatoid arthritis, cerebral thrombosis and haemorrhage, and from diseases of the urinary tract and of the skin.

There were 110 acquired infections with Staph, aureus and 12 deaths were attributed to them. Over half of these infections were due to staphylococcal strains which caused only one clinical infection in a ward in the course of a year.

Pneumonia was difficult to diagnose in severely ill or moribund patients, and its clinical significance was hard to assess. It was not possible to obtain a reliable estimate of the part played by bacterial infection in its causation.

The assemblages of Giardia duodenalis in 25 children with and 25 children without diarrhoea and 24 adults with gastrointestinal symptoms in South India were determined. Polymerase chain reaction–restriction fragment length polymorphism (PCR–RFLP) targeting the glutamate dehydrogenase (gdh), β-giardin and triosephosphate isomerase (tpi) genes was used. The tpi PCR was the most sensitive and detected G. duodenalis in all 74 microscopy-positive samples, while gdh and β-giardin PCR were positive in 62·2% and 56·8% of the samples. Assemblage B was predominant in both children and adults (82·4%) followed by assemblage AII (9·4%); assemblage AI was not detected. Infections with both assemblages A and B (detected by tpi PCR–RFLP) were seen exclusively in children and the mixed assemblage BIII and BIV (detected by gdh PCR–RFLP) was more common in children than adults (P=0·058).

Tularemia has sustained seroprevalence in Eurasia, with estimates as high as 15% in endemic regions. The purpose of this report is to characterise the current epidemiology of Francisella tularensis subspecies holarctica in Georgia. Three surveillance activities are summarised: (1) acute infections captured in Georgia's notifiable disease surveillance system, (2) infectious disease seroprevalence study of military volunteers, and (3) a study of seroprevalence and risk factors in endemic regions. Descriptive analyses of demographic, exposure and clinical factors were conducted for the surveillance studies; bivariate analyses were computed to identify risk factors of seropositivity using likelihood ratio χ2 tests or Fisher's exact tests. Of the 19 incident cases reported between 2014 and August 2017, 10 were confirmed and nine met the presumptive definition; the estimated annual incidence was 0.12/100 000. The first cases of tularemia in Western Georgia were reported. Seroprevalences of antibodies for F. tularensis were 2.0% for military volunteers and 5.0% for residents in endemic regions. Exposures correlated with seropositivity included work with hay and contact with multiple types of animals. Seroprevalence studies conducted periodically may enhance our understanding of tularemia in countries with dramatically underestimated incidence rates.

Data on the impact of the recently recommended maternal pertussis vaccination are promising, but still insufficient to universalise this approach. We thus compared the epidemiological data prior to the implementation of this vaccination strategy in Argentina (2012) with the figures reported after 2012. During that 2010–2016 period, two outbreaks occurred, one in 2011 and another in 2016. In the former, the incidence was 6.9/100 000 inhabitants and the case-fatality rate 2.6%. Thereafter, a decline in incidence was detected until 2014. During 2015 and 2016 an increase in the incidence transpired, but this rise was fortunately not accompanied by one in the case fatality ratio. Indeed, in 2016 the case fatality ratio was the lowest (0.6%). Moreover, during the 2016 outbreak, the incidence (3.9/100 000 inhabitants) and the case severity detected in the most vulnerable population (infants 0–2 months) were both lower than those in 2011. Consistent with this pattern, in 2016, in the most populated province of Argentina (Buenos Aires), the case percentage with laboratory-positive results indicating a high number of symptoms (59.1% of the total cases) diminished compared with that detected in the 2011 outbreak without maternal immunisation (71.9%). Using the mathematical model of pertussis transmission we previously designed, we assessed the effect of vaccination during pregnancy on infant incidence. From comparisons between the epidemiological data made through calculations, emerged the possibility that vaccinating women during pregnancy would benefit the infants beyond age 2 months, specifically in the 2–12-month cohort.

An outbreak of SARS-CoV2 infection in a Barcelona prison was studied. One hundred and forty-eight inmates and 36 prison staff were evaluated by rt-PCR, and 24.1% (40 prisoners, two health workers and four non-health workers) tested positive. In all, 94.8% of cases were asymptomatic. The inmates were isolated in prison module 4, which was converted into an emergency COVID unit. There were no deaths. Generalised screening and the isolation and evaluation of the people infected were key measures. Symptom-based surveillance must be supplemented by rapid contact-based monitoring in order to avoid asymptomatic spread among prisoners and the community at large.

Lack of reliable data about street vendors, who are difficult to survey, has hampered efforts to improve the safety of street-vended food. A two-phase method for sampling vendors, surveying first in areas of concentrated vending activity identified by local authorities and second in randomly selected areas, was developed and implemented in two Guatemalan cities where street-vended food had been implicated in cholera transmission. In a 4-day survey in Escuintla, 59 vendors (42 from phase 1, 17 from phase 2) were interviewed. They demonstrated good knowledge of food safety and cholera but unsafe practices, implying that more effective, practical training was needed. In a 6-day survey in Guatemala City, 78 vendors (77 from phase 1, 1 from phase 2) were interviewed. Sixty-eight (87%) vendors stored water, usually in wide-mouthed vessels prone to contamination; this led to a field test of a new system for safe water storage. Useful information for public health planning and intervention can be gathered rapidly with this new method for surveying street vendors.

Skin and soft tissue infections (SSTIs) due to Staphylococcus aureus have become increasingly common in the outpatient setting; however, risk factors for differentiating methicillin-resistant S. aureus (MRSA) and methicillin-susceptible S. aureus (MSSA) SSTIs are needed to better inform antibiotic treatment decisions. We performed a case-case-control study within 14 primary-care clinics in South Texas from 2007 to 2015. Overall, 325 patients [S. aureus SSTI cases (case group 1, n = 175); MRSA SSTI cases (case group 2, n = 115); MSSA SSTI cases (case group 3, n = 60); uninfected control group (control, n = 150)] were evaluated. Each case group was compared to the control group, and then qualitatively contrasted to identify unique risk factors associated with S. aureus, MRSA, and MSSA SSTIs. Overall, prior SSTIs [adjusted odds ratio (aOR) 7·60, 95% confidence interval (CI) 3·31–17·45], male gender (aOR 1·74, 95% CI 1·06–2·85), and absence of healthcare occupation status (aOR 0·14, 95% CI 0·03–0·68) were independently associated with S. aureus SSTIs. The only unique risk factor for community-associated (CA)-MRSA SSTIs was a high body weight (⩾110 kg) (aOR 2·03, 95% CI 1·01–4·09).

Rapid spread of methicillin-resistant staphylococci (MeRS) in a children's hospital is described. Within 4 months of the first isolation MeRS had been isolated from infections in all clinical units. MeRS were also regularly isolated at the out-patient department. Protective isolation of one of the clinical units had no effect on the infection rate by MeRS. The use of antiseptics (Hexachlorophene and chlorhexidine) and gentamicin nose cream in children and staff members in three out of five clinical units resulted in a significant reduction of the prevalence of nose colonization by MeRS in children. In staff members a non-significant reduction of the prevalence of colonization and a significant reduction of the acquisition of MeRS was found. After a few months the infection rate decreased to zero in the units where the measures were introduced. It remained unchanged in the other units. Phage typing of two sets of strains collected at an interval of 6 months showed that the infections were mainly caused by two endemic strains of MeRS. The majority of the infections caused by MeRS was of minor importance. In 16 % of the infections a strain was isolated repeatedly and for more than 1 week. After the introduction of antiseptics a relative increase of infections by Gram-negative bacteria was observed. The significance of this phenomenon is discussed.

We investigated which vaccination schedule gives best protection to the vaccinating population, in case there is a measles epidemic in an area with low vaccine coverage. We considered combinations of an early measles vaccination (none, at 6 months or at 9 months), a measles–mumps–rubella (MMR) vaccination around the first birthday (at either 11 or 14 months), and MMR vaccination at an older age (at either 4 or 9 years). The different estimates on measures of protection (percentage of susceptibles, number of reported cases in an epidemic year, percentage of lifetime spent susceptible) relied on a mathematical model of decline of maternal antibody levels with age, and the impact of that antibody level on seroconversion and immunity. Model parameters were estimated from a Dutch population-based serological survey on measles antibodies. Different measures of protection favoured different vaccination schedules, but dropping the age of second MMR vaccination prevents considerably more cases than an extra early measles vaccination or dropping the age of first MMR vaccination.

Forty-one rats examined—internal organs and intestinal contents—for presence of Gaertner group bacilli. Bacilli identical with B. enteritidis isolated from five rats in each case from the spleen (in two from liver also). No members of this group isolated from the intestinal contents.

Several of the rat sera were capable of agglutinating Gaertner group bacilli in high dilution. These facts point to the view that old infection with Gaertner group bacilli had taken place.

The general result of the investigation is in favour of the view that while rats are lible to be infected with Gaertner group bailli and to be ill in consequence these bailli are not natural intestnal inhabitants. If this be accepted it may be stated that this group of bacilli are not natural intestinal inhabitants, of any known animal species.

Rats infected with Gaertner group bacilli may serve as a means of infecting meat with these bacilli and may possibly in this way be a cause of meat poisoning outbreaks.

This study determined the carriage rate and serotype distribution of group B Streptococcus (GBS) in women of child-bearing age in the southern region of Ireland. A total of 2000 vaginal swabs collected in two periods in 2004 and 2006 were examined and revealed a GBS carriage rate of 16·1%. Serotyping of isolates showed that serotypes Ia, II, III, IV, and V were the most prevalent. A high prevalence of serotype IV was found, increasing from 7·6% to 15·2% between 2004 and 2006. Random amplified polymorphic DNA analysis demonstrated considerable genetic heterogeneity in the serotype IV isolates. This serotype should be considered for inclusion in potential vaccines for use in Ireland.

Influenza and pertussis are the two most common vaccine-preventable infections notified in Australia. We assessed the role of polymerase chain reaction (PCR) diagnosis in influenza and pertussis cases notified to the Australian National Notifiable Diseases Surveillance System (NNDSS). There were a total of 2 10 786 notified influenza cases (2001–2013) and 2 55 866 notified pertussis cases (1991–2013). After 1 January 2007, the majority of influenza and pertussis notifications were PCR-based (80·5% and 59·6%, respectively). Before 31 December 2006, PCR-based notifications were limited (29·1% and 11·7%, respectively). By 2013, PCR-based notifications had largely replaced all other diagnostic methods, with the exception of serology-based notifications in pertussis cases in adults aged ⩾25 years.

This paper consists of an epidemiological study of 52 cases of Q fever occurring in metropolitan Adelaide in 1957 and also a description of the results of a survey of 516 sera obtained from abattoir workers.

The only case occurring outside the abattoirs was a dairy farmer who probably became infected while visiting the abattoirs. If this were so the incubation period (35 days) of his disease would have been exceptionally long.

The general features of the outbreak, which lasted several months, differed from those on the North American continent in that the latter occurred explosively within a few days with very high attack rates. The situation in the Adelaide abattoirs is similar to that in Brisbane, where the disease appears to be endemic. However, unlike in Adelaide, cases are commonly recognized outside the abattoirs in Brisbane.

In the abattoirs the disease affected mainly inspectors, those working on killing beef, and those working on offal. Mutton workers were not so severely affected. However, all these groups had similar incidences of low titre antibodies suggesting that in the past Q fever spread equally in all killing departments. In departments not directly associated with slaughtering the incidence both of cases in 1957 and low titre antibodies was relatively small.

It was suggested that the epidemiological features of Q fever in Adelaide could be explained by the irregular appearance of animals from infected herds situated perhaps in Queensland—a known endemic area. Perhaps the appearance of such animals in the Adelaide abattoirs might be governed by meteorological conditions such that they were prevented from going to the ordinarily most convenient slaughterhouse.

Patagonia in southern South America is among the few world regions where direct human impact is still limited but progressively increasing, mainly represented by tourism, farming, fishing and mining activities. The sanitary condition of Patagonian wildlife is unknown, in spite of being critical for the assessment of anthropogenic effects there. The aim of this study was the characterization of Salmonella enterica strains isolated from wild colonies of Magellanic penguins (Spheniscus magellanicus) located in Magdalena Island and Otway Sound, in Chilean Patagonia. Eight isolates of Salmonella were found, belonging to Agona and Enteritidis serotypes, with an infection rate of 0·38%. Resistance to ampicillin, cefotaxime, ceftiofur and tetracycline antimicrobials were detected, and some of these strains showed genotypic similarity with Salmonella strains isolated from humans and gulls, suggesting inter-species transmission cycles and strengthening the role of penguins as sanitary sentinels in the Patagonian ecosystem.

Because the international basic set of staphylococcus typing phages includes only one member of group IV—phage 42 D—the group is insufficiently characterized. This set of phages is therefore not suitable for typing bovine strains of Staph. aureus. The addition of several further group IV phages would remedy this deficiency.

Immediately following on the International Plague Conference held in Mukden in April, 1911, the Chinese Government, anxious to carry out the recommendations of the Conference, instituted the North Manchurian Plague Prevention Service. The chief of these recommendations were briefly:

(a) Systematic investigations should be made as to whether epizootic plague occurs among Tarbagans and other rodents, and, if such exists, an accurate investigation should be made of the nature of the infection.

(b) A general improvement in the sanitary condition of cities and villages, especially with regard to overcrowding, is desirable.

(c) Education of the public by lectures and the issue of pamphlets and handbills, explaining preventive measures in simple language.

(d) The need for isolation of pneumonic-plague patients being urgent, permanent hospitals should be available.

(e) Hospital accommodation for suspected cases of plague should be provided.

(f) Contact quarantine stations should be constructed.

Surveillance reports and prevalence studies have indicated that injecting drug users (IDUs) contribute more to the hepatitis C epidemic in the United Kingdom than any other risk group. Information on both the prevalence and incidence of hepatitis C in IDUs is therefore essential to understanding the epidemiology of this infection. The prevalence of hepatitis C in specimens from the Unlinked Anonymous Prevalence Monitoring Programme collected in 1995, 1996, 1998, 1999, 2000, and 2001 was determined using residual syphilis serology specimens from IDUs attending 15 genitourinary medicine (GUM) clinics in and outside London. These specimens were tested for antibodies to hepatitis C virus (anti-HCV). Using this cross-sectional design, anti-HCV-negative specimens were tested for HCV RNA to identify incident infections during the ‘window’ period of infection, and thus to estimate HCV incidence. Results of the multivariable analysis showed that there was marked variation in prevalence by clinic (P<0·0001) and age (P<0·0001). Overall the majority of infections were in males and the overall prevalence in injectors declined over the study period from 36·9% to 28·7%. The annual incidence in these injectors was estimated as being 3·01% (95% CI 1·25–6·73). Over the study period HCV incidence decreased by 1·2% per year. Genotyping of the incident infections identified the most common genotype as type 1 with type 3 being more frequently seen after 1998. Of the prevalent infections, genotype 1 was the most common. The study has confirmed a higher prevalence of anti-HCV in IDUs in the London area compared to those outside London. How representative of the current injecting drug user population are IDUs attending GUM clinics is unclear. Even so, such studies allow prevalence and incidence to be estimated in individuals who have ever injected drugs and inform ongoing public health surveillance.

The names Citrobacter koseri and C. diversus are synonyms for a species of enterobacterium with a particular ability to cause neonatal meningitis. 517 strains belonging to this species were examined using biotyping and serotyping techniques. 40 % of the strains belonged to serogroups O2 and O1 and 72 % belonged to biotypes d and a. Strains isolated from cerebrospinal fluid belonged to several different serogroups and biotypes but serogroups O2 and O3 and biotypes d and e were the most common. All the strains were resistant to ampicillin, 42 % were resistant to neomycin/kanamycin and 38 % were resistant to cephaloridine. 37 % of the strains were resistant to three or more drugs.

Giardia duodenalis and Cryptosporidium spp. are common intestinal protozoa that can cause diarrhoeal disease. Although cases of infection with Giardia and Cryptosporidium have been reported in Alaska, the seroprevalence and correlates of exposure to these parasites have not been characterised. We conducted a seroprevalence survey among 887 residents of Alaska, including sport hunters, wildlife biologists, subsistence bird hunters and their families and non-exposed persons. We tested serum using a multiplex bead assay to evaluate antibodies to the Giardia duodenalis variant-specific surface protein conserved structural regions and to the Cryptosporidium parvum 17- and 27-kDa antigens. Approximately one third of participants in each group had evidence of exposure to Cryptosporidium. Prevalence of Giardia antibody was highest among subsistence hunters and their families (30%), among whom positivity was associated with lack of community access to in-home running water (adjusted prevalence ratio [aPR] 1.15, 95% confidence interval (CI) 1.02–1.28) or collecting rain, ice, or snow to use as drinking water (aPR 1.09, 95% CI 1.01–1.18). Improving in-home water access for entire communities could decrease the risk of exposure to Giardia.

Campylobacter is a common cause of intestinal disease in humans and is often linked to the consumption of contaminated poultry meat. Despite considerable research on the topic there is a large amount of uncertainty associated with Campylobacter epidemiology. A Bayesian model framework was applied to multiple longitudinal datasets on Campylobacter infection in UK broiler flocks to estimate the time at which each flock was first infected with Campylobacter. The model results suggest that the day of first infection ranges from 10 to 45 days; however, over half had a time of infection between 30 and 35 days. When considering only those flocks which were thinned, 48% had an estimated day of infection within 2 days of the day of thinning, thus suggesting an association between thinning and Campylobacter infection. These results demonstrate how knowledge of the time of infection can be correlated to known events to identify potential risk factors for infection.