Data were extracted from the case records of UK patients admitted with laboratory-confirmed influenza A(H1N1)pdm09. White and non-White patients were characterized by age, sex, socioeconomic status, pandemic wave and indicators of pre-morbid health status. Logistic regression examined differences by ethnicity in patient characteristics, care pathway and clinical outcomes; multivariable models controlled for potential confounders. Whites (n = 630) and non-Whites (n = 510) differed by age, socioeconomic status, pandemic wave of admission, pregnancy, recorded obesity, previous and current smoking, and presence of chronic obstructive pulmonary disease. After adjustment for a priori confounders non-Whites were less likely to have received pre-admission antibiotics [adjusted odds ratio (aOR) 0·43, 95% confidence interval (CI) 0·28–0·68, P < 0·001) but more likely to receive antiviral drugs as in-patients (aOR 1·53, 95% CI 1·08–2·18, P = 0·018). However, there were no significant differences by ethnicity in delayed admission, severity at presentation for admission, or likelihood of severe outcome.

The diameter of the virus of rabbit fibroma has been estimated by filtration through graded membranes to be about the same as that of vaccinia (125–175 mµ) and by centrifugation to be 126–141 mµ.

That of the rabbit papilloma virus appeared by filtration to be 23–35 mµ and by centrifugation 32–50 mµ.

This study provides a comprehensive epidemio-clinical picture of sporadic, domestically acquired cases of amoebiasis, cryptosporidiosis and giardiasis in one Canadian community based on patient symptom, outcome and exposure data from an enhanced surveillance system. It yields valuable data for estimating the burden of those diseases including the proportion of bloody diarrhoea, hospitalization, and disease duration. Age differences were observed by incidence rate and for some clinical information and exposures to risk factors. For each of the three diseases, the animal/environment-to-person route was the most common possible main transmission route according to the exposure reported, whereas the person-to-person route was the least common. Exposure was higher for the 10–24 years age group of giardiasis cases for swimming in recreational waters (79%) and attending a barbeque (50%). Therefore, comparisons between groups of cases or extrapolation of results when estimating the burden of illness should be adjusted for age.

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.

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.

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.

While studying the infection of Trypanosoma dimorphon in mice at the Pasteur Institute some five months ago, I noticed in one of the fresh blood preparations made from a brown mouse (A) infected with the trypanosomes, a small and very active spirochaete. At first I was of the opinion that its presence in the blood was due to contamination from the skin, but, as it was constantly present and was constantly present and was found in blood taken from any part of the body, it was evident that it was parasitic in the blood.

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.

Samples were collected at two abattoirs from four sites on pig carcasses as they were being placed in a chiller. Bacteriological examination showed that no single sampling site could be used to assess the microbiological status of pig carcass surfaces. Sampling from multiple sites on a carcass may be required to assess the degree of contamination by different bacteria. It is suggested that the hygiene of slaughtering and dressing of pig carcasses at an abattoir cannot be assessed on a single visit and that a number of visits are necessary to establish a hygiene pattern.

Epidemic intelligence activities are undertaken by the WHO Regional Office for Africa to support member states in early detection and response to outbreaks to prevent the international spread of diseases. We reviewed epidemic intelligence activities conducted by the organisation from 2017 to 2020, processes used, key results and how lessons learned can be used to strengthen preparedness, early detection and rapid response to outbreaks that may constitute a public health event of international concern. A total of 415 outbreaks were detected and notified to WHO, using both indicator-based and event-based surveillance. Media monitoring contributed to the initial detection of a quarter of all events reported. The most frequent outbreaks detected were vaccine-preventable diseases, followed by food-and-water-borne diseases, vector-borne diseases and viral haemorrhagic fevers. Rapid risk assessments generated evidence and provided the basis for WHO to trigger operational processes to provide rapid support to member states to respond to outbreaks with a potential for international spread. This is crucial in assisting member states in their obligations under the International Health Regulations (IHR) (2005). Member states in the region require scaled-up support, particularly in preventing recurrent outbreaks of infectious diseases and enhancing their event-based surveillance capacities with automated tools and processes.

Sera of 1255 individuals from Novi Sad, varying in age from <1 month to 69 years, have been tested for neutralization antibodies to Herpes simplex virus type 1.

The eight newborns tested and 97% of the 507 adults were positive, with titres ranging from 1/4 to 1/256. The titres in newborns were significantly lower than the titres in adults.

After birth the maternal antibodies declined rapidly and 94% of infants at the age of >6 months and <2 years were negative.

After the first year infants in Novi Sad start to acquire herpes-neutralizing antibodies actively, reaching a 50% incidence of positives between the 2nd and 3rd year of age.

Age-specific incidence rates of herpes positives found in Novi Sad have been compared with those reported from Edinburgh, Freiburg i. Br. and Louisiana. Possible influences of several circumstances upon the incidence rate of positives detected by the neutralization test are discussed.

African horse sickness virus serotype 9 (AHSV-9) has been known for some time to be circulating amongst equids in West Africa without causing any clinical disease in indigenous horse populations. Whether this is due to local breeds of horses being resistant to disease or whether the AHSV-9 strains circulating are avirulent is currently unknown. This study shows that the majority (96%) of horses and donkeys sampled across The Gambia were seropositive for AHS, despite most being unvaccinated and having no previous history of showing clinical signs of AHS. Most young horses (<3 years) were seropositive with neutralizing antibodies specific to AHSV-9. Eight young equids (<3 years) were positive for AHSV-9 by serotype-specific RT–PCR and live AHSV-9 was isolated from two of these horses. Sequence analysis revealed the presence of an AHSV-9 strain showing 100% identity to Seg-2 of the AHSV-9 reference strain, indicating that the virus circulating in The Gambia was highly likely to have been derived from a live-attenuated AHSV-9 vaccine strain.

The costs and projected benefits of universal screening for hepatitis B virus (HBV) infection in pregnant women in East Anglia are calculated and compared with current practice. By adjusting data from West Midlands region for ethnicity, the prevalence of maternal hepatitis B surface-antigen (HBsAg) positivity in East Anglia is predicted to be 0·083% (1 in 1200). Published data on health risks of perinatal HBV infection and on immunisation efficacy are used to derive benefits of screening. The marginal direct cost of screening is identified from regional sources. Current clinical practice in East Anglia identifies 7 surface-antigen positive mothers per year, whereas 22 are expected. Routine antenatal screening in East Anglia would prevent 2·6 additional childhood carriers per year (compared with current practice), resulting in the prevention of 0·7 deaths per year occuring 40–50 years in the future. The direct cost per (undiscounted) life-year saved would be £2437, not including savings on treatment for chronic hepatitis B infection. Routine prenatal screening for maternal HBsAg should be introduced without delay and continue even if HBV vaccination is introduced into the UK childhood immunisation schedule.

Although infection by the pathogenic bacterium Listeria monocytogenes is relatively rare, consequences can be severe, with a high case-fatality rate in vulnerable populations. A quantitative, probabilistic risk assessment tool was developed to compare estimates of the number of invasive listeriosis cases in vulnerable Canadian subpopulations given consumption of contaminated ready-to-eat delicatessen meats and hot dogs, under various user-defined scenarios. The model incorporates variability and uncertainty through Monte Carlo simulation. Processes considered within the model include cross-contamination, growth, risk factor prevalence, subpopulation susceptibilities, and thermal inactivation. Hypothetical contamination events were simulated. Results demonstrated varying risk depending on the consumer risk factors and implicated product (turkey delicatessen meat without growth inhibitors ranked highest for this scenario). The majority (80%) of listeriosis cases were predicted in at-risk subpopulations comprising only 20% of the total Canadian population, with the greatest number of predicted cases in the subpopulation with dialysis and/or liver disease. This tool can be used to simulate conditions and outcomes under different scenarios, such as a contamination event and/or outbreak, to inform public health interventions.

Although post-weaning mortality (PWM) in pig farming is mainly due to the effect of pathogens, farm type or swine management are also directly or indirectly involved. In this work, we used null models and the partial least squares approach (PLS) to structural equation modelling, also known as PLS path modelling (PLS-PM), to explore whether farm type, swine management and pathogens, including porcine circovirus type 2, swine influenza virus, porcine reproductive and respiratory syndrome virus and Aujeszky's disease virus, directly or indirectly influenced PWM in 42 Spanish indoor pig farms. The null model analysis revealed that contact with multiple combinations of viruses could occur by chance. On the other hand, PLS-PM showed that farm characteristics do not influence virus infections, and thus neither farm type nor associated management practices shaped PWM due to pathogens. Accordingly, preventive programmes aimed at controlling PWM in intensive farming should prioritize the control of major pig pathogens.

Enterotoxigenic Escherichia coli (ETEC) were the most frequently identified enteric pathogens associated with diarrhoea in 0–5 year old Aboriginal children in tropical north-west Australia with an incidence similar to those from other tropical regions. Heat-stable toxin-producing (ST + ) strains were associated with diarrhoea throughout the year but heat-labile toxin-producing (LT + ) strains were more important in the monsoonal summer season. ST + strains were commonest in children with diarrhoea between 6 and 18 months of age while LT + strains were associated with diarrhoea in children aged 18–24 months. Verotoxigenic E. coli (VTEC) which produced VT1, but not VT2, and enteroadherent (EAF + ) E. coli were significant causes of diarrhoea, mainly in children below 18 months but without a seasonal pattern.

F4+ Escherichia coli is an important agent of post-weaning diarrhoea in piglets. Piglets that express an adhesion site for F4+ E. coli in their small intestine (F4R+) shed higher numbers of F4+ E. coli than piglets lacking this site (F4R−). We hypothesized that F4R+ piglets are more infectious and more susceptible for F4+ E. coli. This implies that in populations with F4R+ and F4R− piglets, the transmission would be dependent on the frequency of both types of animals. To quantify the difference in infectiousness and susceptibility, a one-to-one transmission experiment was performed with 20 pairs consisting of one inoculated and one contact piglet. Based on the contact infections observed, transmission parameters were estimated with generalized linear models. F4R+ piglets were infectious for other piglets and the reproduction ratio (R0) for homogeneous F4R+ populations, that is the average number of secondary infections that one F4R+ pig will cause during its entire infectious period in a population of susceptible F4R+ individuals only, was estimated as 7·1. F4R+ piglets were more susceptible than F4R− piglets and reducing the fraction of F4R+ piglets of a population will reduce transmission. It was calculated that in order to prevent major outbreaks of F4+ E. coli (R0<1), the fraction of F4R+ piglets must be lower than 0·14.

Syndromic surveillance systems in England have demonstrated utility in the early identification of seasonal gastrointestinal illness (GI) tracking its spatio-temporal distribution and enabling early public health action. There would be additional public health utility if syndromic surveillance systems could detect or track subnational infectious disease outbreaks. To investigate using syndromic surveillance for this purpose we retrospectively identified eight large GI outbreaks between 2009 and 2014 (four randomly and four purposively sampled). We then examined syndromic surveillance information prospectively collected by the Real-time Syndromic Surveillance team within Public Health England for evidence of possible outbreak-related changes. None of the outbreaks were identified contemporaneously and no alerts were made to relevant public health teams. Retrospectively, two of the outbreaks – which happened at similar times and in proximal geographical locations – demonstrated changes in the local trends of relevant syndromic indicators and exhibited a clustering of statistical alarms, but did not warrant alerting local health protection teams. Our suite of syndromic surveillance systems may be more suited to their original purposes than as means of detecting or monitoring localized, subnational GI outbreaks. This should, however, be considered in the context of this study's limitations; further prospective work is needed to fully explore the use of syndromic surveillance for this purpose. Provided geographical coverage is sufficient, syndromic surveillance systems could be able to provide reassurance of no or minor excess healthcare systems usage during localized GI incidents.