From January 1985 to May 1991, herald strains of influenza B virus were isolated in 1987 and 1989 in Japan. In both cases, influenza epidemics caused by the same type followed in the next winter season. The HA gene sequences of the influenza B viruses isolated in Japan from 1987–91, which covers two herald waves of influenza B viruses, were analysed and located on the phylogenetic tree for influenza B viruses after the B/Singapore/64 strain. Co-circulation of at least two evolutionary lineages of the HA genes existed for influenza B viruses in Japan during the period of this study. The herald viruses in one wave (1987) were genetically close to the winter isolates and were considered to be the parental viruses for the following influenza season, while in the other wave (1989) winter isolates belonged to another lineage on which one of the herald viruses was located, but they were genetically and antigenically different from the herald viruses.

The association between opportunistic infection (OI) and anaemia among HIV-infected patients remains to be studied. We investigated the prevalence and risk factors of anaemia in hospitalised HIV-infected patients to reveal the association between OI and anaemia. We conducted a retrospective study of HIV-positive hospitalised patients from June 2016 to December 2017 in Mengchao Hepatobiliary Hospital of Fujian Medical University. Patients’ information on socio-demographic and clinical characteristics were carefully collected. The comparison of anaemia prevalence between groups was conducted with χ2 test. A logistic regression model was carried out to analyse the predictors of anaemia. The total prevalence of anaemia in hospitalised HIV-infected patients was 55.15%. The prevalence of mild, moderate and severe anaemia was 41.42%, 11.08% and 2.64%, respectively. Predictors independently associated with anaemia were: CD4 counts <50 cells/μl (odds ratio (OR): 6.376, 95% confidence interval (CI) = 1.916–21.215, P = 0.003), CD4 counts 50–199 cells/μl (OR: 6.303, 95% CI = 1.874–21.203, P = 0.003), co-infection with tuberculosis (TB) (OR: 2.703, 95% CI = 1.349–5.414, P = 0.005) or Penicillium marneffei (PM) (OR: 7.162, 95% CI = 3.147–15.299, P < 0.001). In Fujian, China, more than half inpatients with HIV were anaemic, but severe anaemia is infrequent. Lower CD4 counts, co-infection with TB or PM were independent risk factors for anaemia. Chinese HIV patients especially with TB, PM infection and low CD4 level should be routinely detected for anaemia to improve therapy.

Typhus Fever is a disease which modern sanitary reform has banished from the midst of progressive communities. As a result few opportunities are now afforded for investigating the disease by the bacteriological methods of to-day. Sporadic cases and small epidemics occur from time to time in the few insanitary districts that remain in Belfast. Dr Ernest H. Milligan and I made some observations of a bacteriological nature on this disease which we communicated to the Ulster Medical Society in 1908. Since that time I have continued the investigations when any opportunity occurred and in this paper are recorded the results which have been obtained. Recently some new light has been thrown on the etiology of typhus fever, so the present time appeared to me to be opportune to publish our own observations, to analyse the findings of other observers and to discover what is truly established with regard to this subject.

Varicella, usually a mild disease of childhood, can also cause complications and hospitalization. Universal varicella immunization is implemented in several countries worldwide, but not in Denmark. Taking advantage of unique national registers, we aimed to estimate the incidence of paediatric varicella hospitalizations and assess determinants for hospitalization. For this purpose, we designed a nationwide, retrospective register study of paediatric varicella hospitalizations and applied a case–cohort design and logistic regression analysis comparing hospitalized varicella patients to a sample of the entire paediatric population in Denmark. Varicella patients were identified in The Danish National Patient Register and referents were randomly selected from the Danish Civil Registration System. The incidence of paediatric varicella admissions was 11/100 000 children 0–18 years of age/year. Of admitted children 67·1% had complications and 30·0% had underlying disease. All categories of underlying disease significantly increased the odds of hospitalization as well as male gender and not having been born in Denmark. In conclusion, we found a considerable burden of paediatric varicella disease in Danish hospitals, of similar magnitude as in other European countries comparable to Denmark. With this study we have provided epidemiological data needed for considering implementation of varicella vaccine in Denmark.

An investigation has been described in which the complement fixing antibody titres of selected groups of the population have been correlated with the occurrence of epidemic and sporadic influenza and of other cases of respiratory disease which it was thought might be due to the virus of epidemic influenza.

During two non-epidemic seasons the influenza virus could not be isolated from cases of apparent influenza neither could any serological evidence be obtained of the existence of any form of respiratory disease caused by the virus.

With rare exceptions individual antibody titres either remain constant, or if they are high show a tendency to fall during non-epidemic times, and periodic investigations of sample groups each consisting of several hundred sera show a wave-like fluctuation in the titres of the population consisting of a sudden rise followed by a gradual fall, the former being an accompaniment of an epidemic. Such a wave-like fluctuation appears to be an indication of variations in the immunity of the population, and to be responsible in part, at least, for the occurrence of large influenza epidemics.

I wish to acknowledge the help received from all who took part in this investigation, and in particular to thank the students of the University Halls of Residence in Manchester, the numerous doctors who helped by supplying particulars of cases of influenza and to Dr R. W. Fairbrother who has given advice and maintained a constant interest throughout the investigation.

Prevalence of skin sores and scabies in remote Australian Aboriginal communities remains unacceptably high, with Group A Streptococcus (GAS) the dominant pathogen. We aim to better understand the drivers of GAS transmission using mathematical models. To estimate the force of infection, we quantified the age of first skin sores and scabies infection by pooling historical data from three studies conducted across five remote Aboriginal communities for children born between 2001 and 2005. We estimated the age of the first infection using the Kaplan–Meier estimator; parametric exponential mixture model; and Cox proportional hazards. For skin sores, the mean age of the first infection was approximately 10 months and the median was 7 months, with some heterogeneity in median observed by the community. For scabies, the mean age of the first infection was approximately 9 months and the median was 8 months, with significant heterogeneity by the community and an enhanced risk for children born between October and December. The young age of the first infection with skin sores and scabies reflects the high disease burden in these communities.

A comparison was made of different culture media and procedures for detection of Serratia marcescens from faecal, pharyngeal and ocular swabs collected from 213 neonates. MacConkey agar and MacConkey agar with sorbitol (1%) and/or colistin (200 i.u./ml) were used both for primary isolation and after enrichment using Mossel Enterobacteriaceae broth with colistin (200 i.u./ml). The use of MacConkey agar supplemented with colistin for primary isolation improved considerably the isolation rate of S. marcescens from faecal swabs but not from pharyngeal swabs; the number of ocular isolations were insufficient to demonstrate differences between procedures. Moreover the enrichment procedures consistently increased the number of S. marcescens isolates especially from pharyngeal and ocular swabs. Use of sorbitol made detection of S'. marcescens from clinical specimens easier and time– and cost–efficient.

1. Standard Bact. coli cultures have been heated at 51° C. in phosphate buffered media having pH values ranging from 2·8 to 8·8, and survivor curves obtained.

2. Except at pH 3·9, the first continuous decline in viable numbers was followed by the establishment of a small fluctuating residual population which was apparently permanent.

3. The colony counts showed a moderate excess of unduly high values of x2, the bulk of which were encountered when the mortality was between 95 and 99·999%.

4. Prolonged incubation of the plates led to increased colony counts, but the rise was confined to the active disinfection phase. It occurred chiefly in the 95–99·999% mortality range and was moderate in degree. The x2 values were little affected.

5. The log survivors-time graphs of the disinfection phase were convex in type but approached linearity in the faster reactions. The logarithmic death-rate became maximal at about 90 % mortality and thereafter remained constant, though under the more acid conditions a somewhat lower rate was maintained. At pH 7·0 and 6·4 the curves were exceptionally straight.

6. Standardization of all the curves revealed a continuous change in shape with pH but, nevertheless, they could be placed in three closely knit overlapping groups which were best revealed by the variation in maximum death-rate.

7. The 50–99·99% mortality times were obtained either from the calculated regressions of log survivors on time over the linear portions of the curves or, outside that range, from the freehand curves. Maximum survival at all mortality levels occurred at about pH 6·5–6·6, i.e. close to the neutral point of pure water at 51° C. On both sides of this point sensitivity increased regularly but was abnormally high at pH 7·0 and 6·4.

8. Within these zones of abnormally high sensitivity the assessment of the effect of a given change in pH varied in amount and direction according to the mortality level chosen.

9. The enhanced resistance of a culture regenerated from the survivors of a disinfection at 51° C. and pH 7.0, as previously reported, could possibly have been largely due to a small increase in acidity but not to a slight shift towards alkalinity.

Characterization of the incubation time from infection to onset is important for understanding the natural history of infectious diseases. Attempts to estimate the incubation time distribution for novel A(H1N1v) have been, up to now, based on limited data or peculiar samples. We characterized this distribution for a generic group of symptomatic cases using laboratory-confirmed swine influenza case-information. Estimates of the incubation distribution for the pandemic influenza were derived through parametric time-to-event analyses of data on onset of symptoms and exposure dates, accounting for interval censoring. We estimated a mean of about 1·6–1·7 days with a standard deviation of 2 days for the incubation time distribution in those who became symptomatic after infection with the A(H1N1v) virus strain. Separate analyses for the <15 years and ⩾15 years age groups showed a significant (P<0·02) difference with a longer mean incubation time in the older age group.

A total of 522 Danish blood donors were followed during 2004–2005 to describe the seroepidemiology of Legionella infections in healthy individuals from a general population. Antibodies to Legionella spp. were measured by indirect immunofluorescence antibody test. The prevalence of Legionella antibodies (titre ⩾1:128) was 26·8% and remained fairly constant during the year of follow-up. However, 6·9% of the blood donors developed a fourfold or greater rise in antibody titres. A history of visits to Danish summer cottages was associated with both Legionella seropositivity (OR 1·53, 95% CI 1·02–2·30) and seroconversion (OR 2·66, 95% CI 1·21–5·83). There were no consistent associations between either levels of antibody titres or seroconversion and self-reported health symptoms, absence from work due to illness, or to any risk factors. We conclude that community-acquired Legionella infections are frequent; however, they rarely result in severe illness.

The two processes involved in the phagocytosis of bacilli (B. typhosus) by polymorphonuclear leucocytes in the presence of a sensitising fluid, viz. (1) the sensitisation of the micro-organism, and (2) the phagocytosis of the sensitised micro-organism, have been separately investigated. A single guinea-pig end-piece acted as the sensitising fluid throughout all the experiments.

The removal of opsonin by bacillary emulsions was found to run the course of an adsorption process as evidenced by the numerical relations found to subsist between the bound and free opsonin in equilibrium.

Also the actual phagocytosis of sensitised or partially sensitised micro-organisms suspended in a neutral fluid (physiological saline) was found, on analysis by similar numerical methods, to proceed as an adsorption process.

1. Sera from an outbreak of about forty cases of dengue fever due to dengue-1 virus have been studied using the neutralization, haemagglutinin-inhibition, and complement-fixation tests.

2. The neutralization test was the most specific and the complement-fixation test the least so.

3. The neutralization test is essential for clear identification of the causal virus by serological means, and serial serum specimens from each patient must be examined.

4. The haemagglutinin-inhibition test can be used to screen patients in outbreaks where some cases have been fully identified by neutralization tests.

5. Homologous neutralizing antibodies persist in high titre for at least 30 weeks after infection, while heterologous antibodies have disappeared by that time.

6. Both haemagglutinin-inhibiting and complement-fixing antibodies to homologous and heterologous viruses usually persist for at least 30 weeks, although the homologous titres tend to be highest.

7. The implications of these findings in serological surveys are discussed.

8. Some evidence suggesting the occurrence of inapparent infections during the epidemic is presented.

I am greatly indebted to my staff for help with this work: especially to my senior technician, Che Ali bin Mohamed Amin, and to Che Mohamed bin Omar who drew the figures.

Between April and July 2011 there was an outbreak of measles virus, genotype D4, in Berlin, Germany. We identified 73 case-patients from the community and among students of an anthroposophic school, who participated in a 4-day school trip, as well as their family and friends. Overall, 27% were aged ⩾20 years, 57% were female and 15% were hospitalized. Of 39 community case-patients, 38% were aged ⩾20 years, 67% were female and 63% required hospitalization. Unvaccinated students returning from the school trip were excluded from school, limiting transmission. Within the group of 55 school-trip participants, including 20 measles case-patients, a measles vaccine effectiveness of 97·1% (95% confidence interval 83·4–100) for two doses was estimated using exact Poisson regression. Our findings support school exclusions and the recommendation of one-dose catch-up vaccination for everyone born after 1970 with incomplete or unknown vaccination status, in addition to the two-dose routine childhood immunization recommendation.

The relationship between the serological findings for brucellosis and the epidemiological factors has been studied in veterinary surgeons in Northern Ireland. The anti-human globulin (Coombs) test and the complement-fixation test for brucella were used in two groups of veterinary surgeons, those self-employed and those employed by the Ministry of Agriculture.

Significant serological differences were found to exist between the two groups. Those in private practice showed changes related to age, cattle skin rash, reactions to S. 19 vaccine accidents and symptoms suggestive of brucellosis in the past or the last year. But those working for the Ministry only showed titre changes related to the length of their private practice experience before joining the Ministry. In neither group was there a relationship between serological findings and the type of milk drunk or any particular group of symptoms suggestive of brucellosis.

The findings indicate that high titres to brucella by the Coombs and complement-fixation test can occur in people repeatedly exposed to infection at work. Titres which would be of diagnostic importance in the rest of the population may be of little diagnostic significance even when they are as high as 160 Coombs and 128 complement fixation.

The aim of this study was to determine changes in the epidemiology of hepatitis A virus (HAV) infection in the Basque Country, Spain, and to evaluate their implications for vaccination strategies. A total of 1356 persons were enrolled in a study of the prevalence of anti-HAV in 2004 and compared with two previous studies (1986–1987 and 1992). The selection method and the characteristics of the population were similar in the three studies. A marked decline in the seroprevalence in all age groups (P<0·001) and in the incidence of cases/100000 inhabitants (from 38·0 in 1986–1988 to 2·9 in 2002–2004) were observed. The mean age of patients with hepatitis A increased from 17·7 years in 1986–1992 to 21·2 years in 1993–1998 and 25·3 years in 1999–2004 (P<0·001). Between 1997 and 2004, 20% of patients were hospitalized. The changes observed have occurred rapidly causing a change in the epidemiological pattern from middle-high endemicity (1986) to low endemicity (2004).

Newborns often present with skin conditions ranging from transient benign to severe. An occasional cause of neonatal exanthemic rash is infection due to Gram-positive bacteria, but Gram-negative infection is uncommon. We describe an outbreak of sepsis in 10 neonates over a 2-week period, caused by Klebsiella pneumoniae in a level III neonatal intensive care unit (NICU). Seven babies developed an exanthematous maculopapular rash. Molecular analysis by pulsed-field gel electrophoresis showed that all the babies with rash were infected by a single strain of K. pneumoniae which was distinct from the strain recovered from babies without rash.

We used the clustered lot quality assurance sampling (clustered-LQAS) technique to identify districts with low immunization coverage and guide mop-up actions during the last 4 days of a combined oral polio vaccine (OPV) and yellow fever (YF) vaccination campaign conducted in Cameroon in May 2009. We monitored 17 pre-selected districts at risk for low coverage. We designed LQAS plans to reject districts with YF vaccination coverage <90% and with OPV coverage <95%. In each lot the sample size was 50 (five clusters of 10) with decision values of 3 for assessing OPV and 7 for YF coverage. We ‘rejected’ 10 districts for low YF coverage and 14 for low OPV coverage. Hence we recommended a 2-day extension of the campaign. Clustered-LQAS proved to be useful in guiding the campaign vaccination strategy before the completion of the operations.

A retrospective study of 258 children admitted to Ruchill Hospital, Glasgow, with croup between 1966 and 1972 indicated that the viruses most frequently associated with the syndrome were parainfluenza types 1 and 3 and influenza A. Most cases were admitted in the late autumn and winter months, with a small peak in May and June. This seasonal distribution mirrored the circulation of the main causative agents in the community, parainfluenza 1 being principally associated with the autumn cases, influenza A the winter cases and parainfluenza 3 the summer cases. Two of these ‘croup associated’ viruses showed regular periodicity, parainfluenza 1 occurring biennially in even years and influenza A in most years. The periodicity of parainfluenza 3 is as yet undetermined.

Current knowledge of methicillin-resistant Staphylococcus aureus (MRSA) colonisation in relation to epidemiological characteristics is incomplete. We conducted a cross-sectional study at an acute-care tertiary infectious diseases hospital of MRSA isolates identified through routine surveillance from January 2009 to December 2011. We randomly selected 205 MRSA isolates (119 inpatients) from 798 isolates (427 inpatients) for molecular profiling using multilocus sequence typing. Multilevel multinomial logistic regression was used to estimate odds ratio (OR) assessing the predilection of MRSA strains for anatomic sites, and associations of strains with human immunodeficiency virus (HIV) infection. The most frequent sequence types (STs) were 239, 22 and 45. The proportion of ST22 increased over the sampling period, replacing ST239 as the dominant lineage. However, ST239 remained the most prevalent among HIV-seropositive individuals who were six times more likely to be colonised with this strain than non-HIV patients (adjusted OR (aOR) 6.44, 95% confidence interval (CI) 1.94–21.36). ST45 was >24 times more likely to be associated with perianal colonisation than in the nares, axillae and groin sites (aOR 24.20, 95% CI 1.45–403.26). This study underlines the clonal replacement of MRSA in Singapore as previously reported but revealed, in addition, key strain differences between HIV-infected and non-infected individuals hospitalised in the same environment.

Genomic profiles were obtained for 76 strains of Campylobacter jejuni isolated from bacteraemic patients in England and Wales over the period 1981–94. Genotyping was performed by restriction fragment length polymorphism (RFLP) analysis using a random cloned DNA probe, and by ribotyping with a PCR-generated C. jejuni 16S ribosomal DNA probe. Phenotypic characterization was achieved by heat-stable (HS) and heat-labile (HL) serogrouping, and Preston phagetyping and biotyping. The blood isolates were genomically heterogenous, with 24 RFLP/16S profiles occurring within the 76 strains. Forty-four percent of isolates belonged to one of three RFLP/16S genotypes, reflecting the patterns seen in faecal isolates, except that genotypes usually associated with the HS 1 antigen were uncommon. The two most prevalent genotypes, characteristic of HS 2 and HS 4 strains, showed similarity by cluster analysis. Further evidence was seen of associations between phenotypic and genotypic characters within some HS serogroups. Chromosomal profiling by RFLP analysis does not indicate that particular genotypes have a predisposition to invade the bloodstream.