In recent years the number of pregnant women susceptible to rubella has increased markedly. In the West Midlands the proportion has risen from 1·4% in 2004 to 6·9% in 2011. Locally, the proportion of non-immune women ranges from 1·6% in those born prior to 1976 to 17·8% in those born since 1986. The latter group comprises those given MMR in their second year with no further booster doses. The number of non-immune women will continue to rise as a consequence of low MMR uptake in the late 1990s. Repeat testing of samples with values <10 IU/ml and the need to vaccinate women postnatally have increased the workload of laboratory and maternity units. Screening for rubella in pregnancy has no advantages for the current pregnancy and it may be time to review the universal MMR vaccination programme which in turn would remove the need for continuing this practice.

There are few data on circulatory pro-inflammatory cytokine levels and cytokine gene polymorphisms in H. pylori-positive patients. A cross-sectional study was conducted to examine the effects of H. pylori infection, gastric atrophy, and the IL-8 T-251A polymorphism on plasma IL-8 levels in 98 Japanese adults. Seventy-one subjects were positive for H. pylori infection. The geometric mean of plasma IL-8 concentration was significantly higher in subjects with H. pylori infection than in those without (P=0·001). The development of atrophy was negatively associated with IL-8 levels in the H. pylori-positive subjects, although not significantly. Plasma IL-8 levels in the T/T genotype were associated with H. pylori infection and atrophy status (P=0·016). Our findings suggested that circulating IL-8 levels were associated with H. pylori infection. The effect of H. pylori infection on plasma IL-8 levels was not clearly modified by the IL-8 T-251A polymorphism.

A comparison was made of the antibody response and subjective reactions to zonally-purified influenza vaccine in aqueous suspension and in peanut oil adjuvant 65-4. Both preparations contained 700 CCA units of A/Aichi/2/68, and 300 CCA units of B/Mass/1/71.

Subjective reactions were recorded by asking the volunteers to complete a record daily for 5 days. Pain at the injection site was recorded by 64% of the recipients of the oil adjuvant vaccine compared with 35% of the aqueous recipients, but local redness was more frequent after aqueous vaccine. Systemic symptoms were recorded a little more frequently after aqueous than oil adjuvant vaccine.

When measured 7½ weeks after a single dose of vaccine, the HAI geometric mean antibody titre (G.M.T.) to the A/Hong Kong/1/68 antigen (antigenically similar to the A/Aichi/2/68 antigen in the vaccine) increased 2·7-fold after aqueous and 16·4-fold after adjuvant vaccine. Sixty-two weeks after vaccination the antibody titres remained higher in those given adjuvant vaccine. The G.M.T. to B/Mass/1/71 increased 1·9-fold 7½ weeks after aqueous vaccine and 3·7-fold after adjuvant vaccine.

The antibody response to both influenza A and B antigens was broader in the recipients of adjuvant vaccine. The G.M.T. to A/England/42/72 increased 2·8-fold after aqueous and 13-fold after adjuvant vaccine; and to B/England/847/73 it increased 1·3-fold after aqueous and 1·9-fold after adjuvant vaccine.

The chemotactic response of Vibrio cholerae O1 towards the mucilaginous sheath of Anabaena sp. was investigated by capillary tube method using a virulent strain of V. cholerae O1, El Tor, Ogawa (3083-T) and its isogenic mutant (HAP-1-T) that lacks the hap gene, which codes for mucinase (HA/protease). Homogenates of Anabaena sp. and purified mucin were used in this study as chemoattractants. Results showed 5·7% bacterial accumulation of wild-type V. cholerae O1 towards 4% homogenates of Anabaena sp. whereas, its mutant (hap−) showed 2·9% accumulation after 90 min. The higher percentage of attraction of wild-type V. cholerae O1 than the mutant (hap−) towards mucin and the homogenates of Anabaena sp. might be due to the activity of mucinase. These results indicate the role of mucinase in the chemotactic motility of V. cholerae O1 towards Anabaena sp.

In recent years, the control or eradication of scrapie and any other transmissible spongiform encephalopathies (TSEs) possibly circulating in the sheep population has become a priority in Britain and elsewhere in Europe. A better understanding of the epidemiology of scrapie would greatly aid the development and evaluation of control and eradication strategies. Here we bound the range of key epidemiological parameters using a combination of relatively detailed pathogenesis and demography data, more limited data on susceptibility and incubation times, and recent survey data on scrapie incidence in Great Britain. These data are simultaneously analysed using mathematical models describing scrapie transmission between sheep and between flocks. Our analysis suggests that occurrence of scrapie in a flock typically provokes changes in flock management that promote termination of the outbreak, such as the adoption of selective breeding, and that a large fraction of cases (possibly over 80%) goes undetected. We show that the data analysed are consistent with the within-flock reproduction number of scrapie lying in the range 1·5–6, consistent with previous epidemiological studies.

The material on which this enquiry is based consisted of tuberculous tissue, pus, or fluid obtained from the sources specified in Table II, pp. 260–268.

The coypu (Myocastor coypus Molina) is an aquatic rodent that has become a widespread pest in the south-east of England. Since the natural habitat of this animal is aquatic, the possibility of infection with leptospires was investigated. Twenty-nine coypu were trapped and examined by serological, histological and cultural methods. Of these, there was serological evidence of infection in seven coypus and Leptospira interrogans var. Wolffii was isolated from a further animal. This appears to be the first report of the isolation of leptospira from a coypu in Great Britain.

A micro-drying method is described, which is simple, rapid and reproducible. It has been shown to give results in reasonable agreement with the Karl Fischer method, and with the vapour-pressure method. The results on samples of low moisture content are, however, considerably higher than those by the so-called American standard method. The method has been in routine use for over 3 years.

The main clinical and pathological features of the naturally occurring canine virus hepatitis were reproduced in dogs, using four strains of virus from different parts of the world and by various routes of inoculation. Young puppies seemed to be most susceptible. A kitten was also infected. An unusual type of kerato-conjunctivitis occurred after both intraocular and intraperitoneal injection.

Specific antigen was detected in the blood for short periods at irregular intervals during the acute stages of the illness and up to 6 months after complete clinical recovery.

Specific antibodies were detected in the blood of recovered animals 3 to 10 weeks after the inoculation and 2–6 weeks after the onset of clinical illness.

The four strains of virus were similar in their serological and immunological characters.

Evidence is presented that virus can persist for some months in recovered animals.

Virus was demonstrated in lice collected from affected dogs.

The importance of clinically inapparent infections is stressed.

Seven more carriers, all possessing appreciable quantities of Vi agglutinins, are added to those already known.

Vi agglutination tests performed on 2526 inhabitants of the Transvaal, both native and white, showed that 5·3 % had similar quantities of Vi agglutinins.

A fair number of these positive reactors were further examined for the presence of typhoid bacilli in their excreta, but the number of positive findings was very small.

It is argued that there are a large number of typhoid faecal carriers who are such minimal excreters that the typhoid bacilli in their stools escape detection.

We wish to thank Dr T. Lötter, Acting Medical Officer of Health of Pretoria, and his staff, for their kindly help in collecting the material for this paper. Our special thanks are due to Lieut.-Col. H. Nelson, Medical Officer of Health of Pretoria, now on active service, for his never-failing interest in our work which has been such a great encouragement.

Little is known about Clostridium difficile infection (CDI) in Asia. The aims of our study were to explore (i) the prevalence, risk factors and molecular epidemiology of CDI and colonization in a tertiary academic hospital in North-Eastern Peninsular Malaysia; (ii) the rate of carriage of C. difficile among the elderly in the region; (iii) the awareness level of this infection among the hospital staffs and students. For stool samples collected from hospital inpatients with diarrhea (n = 76) and healthy community members (n = 138), C. difficile antigen and toxins were tested by enzyme immunoassay. Stool samples were subsequently analyzed by culture and molecular detection of toxin genes, and PCR ribotyping of isolates. To examine awareness among hospital staff and students, participants were asked to complete a self-administered questionnaire. For the hospital and community studies, the prevalence of non-toxigenic C. difficile colonization was 16% and 2%, respectively. The prevalence of CDI among hospital inpatients with diarrhea was 13%. Out of 22 C. difficile strains from hospital inpatients, the toxigenic ribotypes 043 and 017 were most common (both 14%). In univariate analysis, C. difficile colonization in hospital inpatients was significantly associated with greater duration of hospitalization and use of penicillin (both P < 0·05). Absence of these factors was a possible reason for low colonization in the community. Only 3% of 154 respondents answered all questions correctly in the awareness survey. C. difficile colonization is prevalent in a Malaysian hospital setting but not in the elderly community with little or no contact with hospitals. Awareness of CDI is alarmingly poor.

Group B streptococci (GBS) were isolated from bovine bulk milk and from vaginas and throats of antenatal and postnatal women using TKT and rapid GBS media. Sixty-three of 529 (12%) bovine bulk milk samples, 9 of 48 (19%) vaginal and 3 of 48 (6%) throat samples were positive. Both bovine and human beta haemolytic isolates were characterized biochemically and serologically. Pigment production was a characteristic of both human and bovine beta haemolytic isolates. The majority (88%) of human isolates fermented salicin and not lactose and most bovine isolates were either lactose positive/salicin positive (41%) or lactose positive/salicin negative (38%). Human and bovine isolates were 100% and 85% typable respectively. Serotype distribution was similar in the bovine and human populations with serotype la, lc and lll being most common in both. Fermentation of sugars showed major differences between bovine and human isolates but similarity in serotype distribution suggests some genetic relationship.

Limited prospective severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) data in children regarding the impact of Omicron variant in seropositivity have been reported. We investigated SARS-CoV-2 seropositivity in children between 1 September 2021 and 30 April 2022, representing Delta and Omicron predominance periods. Serum samples from children admitted to the major tertiary Greek paediatric hospital for any cause, except for COVID-19, were randomly collected and tested for SARS-CoV-2 natural infection antibodies against nucleocapsid antigen (Elecsys® Anti-SARS-CoV-2 reagent). A total of 506/1312 (38.6%) seropositive children (0–16 years) were detected (males: 261/506(51.6%); median age (IQR): 95.2 months(24–144)). Seropositivity rates (%) increased from Delta to Omicron period from 29.7% to 48.5% (P-value<0.0001). Seropositivity increased for all age groups, except for the age group of 0–1 year (P-value:0.914). The highest seropositivity rate was detected in April 2022 (52.6%) and reached 73.9% specifically for the age group 12–16 years. No significant differences were detected in seropositivity with respect to gender, origin, or hospitalisation status. Median (IQR) antibody titres were higher in the Omicron vs. Delta period in all age groups, especially in 12–16 years [32.2 COI (7–77.1) vs. 11.4 COI(2.8–50.2), P-value:0.009). During Omicron variant period increased SARS-CoV-2 seropositivity was detected in paediatric population, especially in adolescents, implicating either increased transmissibility or reinfection rates.

Clostridium difficile, the most common cause of hospital-associated diarrhoea in developed countries, presents major public health challenges. The high clinical and economic burden from C. difficile infection (CDI) relates to the high frequency of recurrent infections caused by either the same or different strains of C. difficile. An interval of 8 weeks after index infection is commonly used to classify recurrent CDI episodes. We assessed strains of C. difficile in a sample of patients with recurrent CDI in Western Australia from October 2011 to July 2017. The performance of different intervals between initial and subsequent episodes of CDI was investigated. Of 4612 patients with CDI, 1471 (32%) were identified with recurrence. PCR ribotyping data were available for initial and recurrent episodes for 551 patients. Relapse (recurrence with same ribotype (RT) as index episode) was found in 350 (64%) patients and reinfection (recurrence with new RT) in 201 (36%) patients. Our analysis indicates that 8- and 20-week intervals failed to adequately distinguish reinfection from relapse. In addition, living in a non-metropolitan area modified the effect of age on the risk of relapse. Where molecular epidemiological data are not available, we suggest that applying an 8-week interval to define recurrent CDI requires more consideration.

Established methods of recruiting population controls for case–control studies to investigate gastrointestinal disease outbreaks can be time consuming, resulting in delays in identifying the source or vehicle of infection. After an initial evaluation of using online market research panel members as controls in a case–control study to investigate a Salmonella outbreak in 2013, this method was applied in four further studies in the UK between 2014 and 2016. We used data from all five studies and interviews with members of each outbreak control team and market research panel provider to review operational issues, evaluate risk of bias in this approach and consider methods to reduce confounding and bias. The investigators of each outbreak reported likely time and cost savings from using market research controls. There were systematic differences between case and control groups in some studies but no evidence that conclusions on the likely source or vehicle of infection were incorrect. Potential selection biases introduced by using this sampling frame and the low response rate are unclear. Methods that might reduce confounding and some bias should be balanced with concerns for overmatching. Further evaluation of this approach using comparisons with traditional methods and population-based exposure survey data is recommended.

We report an outbreak of confirmed Mycoplasma pneumoniae community-acquired pneumonia (CAP) in Nord Franche-Comté Hospital, France, from 14 November 2023 to 31 January 2024. All 13 inpatients (11 adults with a mean age of 45.5 years and 2 children) were diagnosed with positive serology and/or positive reverse transcription polymerase chain reaction (RT-PCR) on respiratory specimens. All patients were immunocompetent and required oxygen support with a mean duration of oxygen support of 6.2 days. Two patients were transferred to the intensive care unit (ICU) but were not mechanically ventilated. Patients were treated with macrolides (n = 12, 92.3%) with recovery in all cases. No significant epidemiological link was reported in these patients.

The English HCV lookback programme has identified some individuals with transfusion-transmitted HCV infection. The path from the collection of donations from HCV-infected donors to the identification of infected recipients was constructed. The probability of different outcomes at each branch was derived from data collected during this programme. This path of probabilities was then used to produce a complete estimate of the number of recipients infected by blood transfusions (dead and alive at the end of 1995) by re-entry of blood components that fell out of the lookback at various steps prior to recipient testing, and entry of components from HCV-infected donations that were never identified for lookback. Less than 14 000 recipients were estimated to have been infected with HCV during the decade prior to the start of donation testing. Over 60% of these were expected to have died by the end of 1995. Transfusion has infected a large group of individuals. However, this group constitutes a very small, and declining, proportion of all HCV infections in the population.

d-Tartrate dehydrase of Salmonella java is an oxygen-sensitive enzyme active in cultures incubated under the poorly aerated conditions of static culture but not in fully aerated shaken cultures nor on plates incubated aerobically. On plates of d-tartrate minimal agar incubated anaerobically the enzyme or the degradation products of d-tartrate are exported from d-tartrate-positive cells and are available to d-tartrate-negative bacteria. This may give misleading growth results when d-tartrate-positive and d-tartrate-negative strains are tested for growth on the same plate of d-tartrate minimal agar.

The lead-acetate test terminated at 24 h, the 24 h turbidity test and the ability to grow on d-tartrate minimal agar within 48 h differentiated 53 S. paratyphi B strains that were negative in each of the three tests from 76 S. java that were positive in each of the tests. An intermediate group of eight strains utilized d-tartrate in Difco bacto-peptone water to give a positive lead acetate reaction at 2 days, were stimulated to a varying degree by d-tartrate in Oxoid peptone water within the same period of incubation and grew poorly on d-tartrate minimal agar. These latter strains may be deficient in a permease controlling uptake of d-tartrate or export of d-tartrato dehydrase.

Inability to utilize d-tartrate is unlikely to be the single character accountable for the reputed enhanced pathogenicity of S. paraptyphi B when compared with S. java. Indications for the existence of an enzyme, complementary to and mutually exclusive with d-tartrate dehydrase, that has a positive correlation with pathogenicity are discussed.

A computer model was constructed to mimic the 1967–8 foot-and-mouth epizootic in Shropshire and Cheshire, but the daily spatial distribution of outbreaks was randomized. This pattern of outbreaks was then examined to determine what percentage of outbreaks would fulfil an arbitrary set of criteria for milk-lorry-borne disease, or the primary movement of milk. Some 21% of herds visited subsequent to a ‘source farm’ were affected, as were 4% of herds visited after any infected herd. The relevance of these results to the true risk of disease through the primary movement of milk off affected farms is discussed.

Shigellosis is common among children in the Andaman and Nicobar islands. Our experience showed two distinct features of shigellosis within a span of 3 years in 1994–6: (i) changing patterns of serotype or subtype specific shigellosis and (ii) emergence of multidrug resistant isolates with changing R-patterns. The rate of isolation was 10·4–27·9% with the rate of isolation of Shigella flexneri interchanging with S. dysenteriae alternately. In 1994, S. flexneri superseded S. dysenteriae (48·6% vs. 33·3%; P<0·05) while S. dysenteriae dominated over S. flexneri in 1995 (54·7% vs. 34·0%; P<0·05). The picture reversed again in 1996 (63·0% vs. 22·2%; P<0·05). Among shigellae isolates, the commonest serotypes were S. dysenteriae type 1 and S. flexneri type 2a. Isolated shigellae were of multidrug resistant type. Seven R-patterns were observed in 1994, while 8R-patterns were observed during the next year with the emergence of nalidixic acid resistance. In 1996, emergence of gentamicin resistance was also observed. All isolates were resistant to ampicillin and sensitive to quinolones. The MIC of nalidixic acid and gentamicin are [egs ]128 μg/ml and [egs ]64 μg/ml respectively. These changing trends in shigellosis has important public health significance.