During the 10-year period 1978–87 there were 48 outbreaks of food poisoning in Scottish hospitals affeeting a total of 2287 persons of whom 12 died. This compared with 50 outbreaks during the previous 5 years (1973–77) when over 1500 persons and 7 deaths were recorded. Although the incidence of outbreaks has decreased the average number of persons affected in outbreaks has increased. A marked reduction was seen in the incidence of outbreaks due to Clostridium perfringens, in contrast to foodborne salmonellosis which remains a problem. Thirty-four hospitals, of which 10 reported two or more outbreaks, were involved. The type of hospitals most frequently affected were general (14), psychiatric (13), geriatric (9) and hospitals for the mentally subnormal (7). Meat, including poultry meat, was incriminated in over 90% of outbreaks where a food vehicle was identified. In modern or re-equipped kitchens cooking in advance with subsequent reheating is being progressively discontinued as more food is being cooked on the day of consumption, a practice which may readily explain the decreasing incidence of outbreaks due to Cl. perfringens. Bacterial cross-contamination from poultry-meat and other raw foods, compounded by inadequate temperature control, however, continues to be a problem in some hospitals. It is too early as yet to determine whether the removal of Crown immunity will have any effect on the future incidence of hospital ‘food poisoning’.

Echovirus type 11 (echo 11) has been isolated at the virus laboratory of Fairfield Hospital, Melbourne, Australia, in 20 of the 28 years since the laboratory was established. During this time two major epidemics have occurred; the first, in 1971–2 involved 90 patients with aseptic meningitis or respiratory illness. The second began in June 1979 and lasted for 11 months, during which echo 11 was isolated from 174 patients admitted to Fairfield Hospital, other Victorian and Tasmanian hospitals and a children's reception centre. The patients' illnesses included viral meningitis (66%), fever (10%), respiratory infections (7%) and gastroenteritis (2%). One baby died.

Echo 11 was recovered from nasopharyngeal swabs or aspirates, cerebrospinal fluid and faecal specimens and was isolated most frequently in the Borrie cell line. Isolates were readily identified by immune electron microscopy and/or neutralization tests.

In this 1 year cross-sectional study of personnel being discharged from compulsory military service, an available database of health-related information was used to examine the association of meningococcal carriage with socio-demographic factors. A representative, systematic sample of 1632 personnel was interviewed and had throat cultures taken. The overall meningococcal carriage rate was 16%. Serogroups B and Y accounted for 76% and 13% of the isolates respectively. In univariate analysis, carriage was associated with male gender (P<0·0001), <12 years school education (P=0·002), smoking (P=0·014), and service at a ‘closed’ base, reflecting greater interpersonal contact (P<0·0001). In multivariate analysis, only service on a closed base and male gender retained significance. School education of <12 years remained significant for females only. Variables not associated with carriage included number of siblings, intensity of smoking, and use of the contraceptive pill. In this setting, meningococcal carriage was associated with the type of base on which soldiers served; and smoking was not an independent risk factor for carriage.

1. Conditions are described under which the three types of live or formalin-inactivated poliomyelitis viruses can be concentrated 10–100 times in good yield, with elimination of approximately 90% of the extraneous protein normally present in poliovaccines.

2. It was shown that 0·1–0·2 mg./ml. AlPO4 almost quantitatively adsorbed the antigens, provided the adsorptions were carried out at a pH round about 5. Re-elution of the antigens occurred readily at pH 7–pH 8.

3. No noticeable conversion of the ‘D-antigen’ to the ‘C-antigen’ occurred during the concentration.

A radioimmunoassay (RIA) has been developed to measure antibodies against Brucella abortus in bovine serum and can be used in the diagnosis of bovine brucellosis. The RIA measures the amount of specific antibody of the IgG1 and IgG2 subclasses but is insensitive to 1gM, a characteristic which may make it more suitable than the complement fixation test (OFT) or the serum agglutination test for distinguishing infected animals from those which have been vaccinated with Br. abortus strain 19. The RIA is not subject to prozoning or ambiguous reactions, both of which interfere with the interpretation of the CFT.

Since the original definition of the coli-aerogenes group of organisms by MacConkey (1905,1909), research has been continually directed in an endeavour to find a more rapid and definite distinction between its respective members.

In general, for the purposes of water analysis, the conform organisms can be divided into two main groups: faecal coli, of which Bact. colitype I can be considered the typical member, and the non-faecal organisms comprising the intermediate-aerogenes-cloacae (I.A.C.) organisms. All available evidence tends to show that Bact. colitype I is by far the most frequent organism in the human and animal intestine. Levine (1921) has summarized the figures of various workers and obtained a percentage ratio of 93·4:6·6 as the ratio of coli:aerogenes in faeces, while Bardsley (1938) has shown that in only a very few cases does the number of I.A.C. organisms exceed the faecal coli in faeces.

Human leptospirosis is found throughout the world, albeit with a higher incidence in tropical regions. In temperate regions it is associated with certain occupational and recreational activities. This paper reports both on the incidence of human leptospirosis in Ireland and on possible associated exposures, using leptospirosis case notification, enhanced surveillance, hospital discharge data and death registrations. Based on official notification data, there was a threefold increase in the reported incidence of leptospirosis in Ireland between 1995–1999 and 2004–2009, which appears partially to be due to improved reporting. The exposures most associated with infection were those involving contact with livestock or water-based recreational sports, in particular kayaking. Advice on prevention should continue to be targeted in the first instance at these groups. The variety of potential transmission routes reported should inform clinicians to consider leptospirosis in individuals with a compatible clinical profile who were not from occupational groups historically considered at risk.

This study aimed to determine the epidemiology and association of antimicrobial resistance (AMR) among Escherichia coli and Salmonella in Thailand. The E. coli (n = 1047) and Salmonella (n = 816) isolates from pigs, pork and humans were screened for 18 replicons including HI1, HI2, I1-γ, X, L/M, N, FIA, FIB, W, Y, P, FIC, A/C, T, FIIAs, F, K and B/O using polymerase chain reaction-based replicon typing. The E. coli (n = 26) and Salmonella (n = 3) isolates carrying IncF family replicons, ESBL and/or mcr genes were determined for FAB formula. IncF represented the major type of plasmids. Sixteen and eleven Inc groups were identified in E. coli (85.3%) and Salmonella (25.7%), respectively. The predominant replicon patterns between E. coli and Salmonella were IncK-F (23.7%) and IncF (46.2%). Significant correlations (P < 0.05) were observed between plasmid-replicon type and resistance phenotype. Plasmid replicon types were significantly different among sources of isolates and sampling periods. The most common FAB types between E. coli and Salmonella were F2:A-:B- (30.8%) and S1:A-:B- (66.7%), respectively. In conclusion, various plasmids present in E. coli and Salmonella. Responsible and prudent use of antimicrobials is suggested to reduce the selective pressures that favour the spread of AMR determinants. Further studies to understand the evolution of R plasmids and their contribution to the dissemination of AMR genes are warranted.

Community-acquired pneumonia (CAP) results in substantial numbers of hospitalisations and deaths in older adults. There are known lifestyle and medical risk factors for pneumococcal disease but the magnitude of the additional risk is not well quantified in Australia. We used a large population-based prospective cohort study of older adults in the state of New South Wales (45 and Up Study) linked to cause-specific hospitalisations, disease notifications and death registrations from 2006 to 2015. We estimated the age-specific incidence of CAP hospitalisation (ICD-10 J12-18), invasive pneumococcal disease (IPD) notification and presumptive non-invasive pneumococcal CAP hospitalisation (J13 + J18.1, excluding IPD), comparing those with at least one risk factor to those with no risk factors. The hospitalised case-fatality rate (CFR) included deaths in a 30-day window after hospitalisation. Among 266 951 participants followed for 1 850 000 person-years there were 8747 first hospitalisations for CAP, 157 IPD notifications and 305 non-invasive pneumococcal CAP hospitalisations. In persons 65–84 years, 54.7% had at least one identified risk factor, increasing to 57.0% in those ⩾85 years. The incidence of CAP hospitalisation in those ⩾65 years with at least one risk factor was twofold higher than in those without risk factors, 1091/100 000 (95% confidence interval (CI) 1060–1122) compared with 522/100 000 (95% CI 501–545) and IPD in equivalent groups was almost threefold higher (18.40/100 000 (95% CI 14.61–22.87) vs. 6.82/100 000 (95% CI 4.56–9.79)). The CFR increased with age but there were limited difference by risk status, except in those aged 45 to 64 years. Adults ⩾65 years with at least one risk factor have much higher rates of CAP and IPD suggesting that additional risk factor-based vaccination strategies may be cost-effective.

An increase in the incidence of invasive and non-invasive infections caused by group A β-haemolytic streptococci (GAS) was noted in and around the town of Glynneath (population approx. 4000) in West Glamorgan, South Wales between 1 January and 30 June 1995. A total of 133 cases was ascertained with 127 (96%) occurring between 1 March and 30 June 1995. Six patients had invasive disease (one died) and all presented at the peak of the outbreak. There were 127 non-invasive cases of whom 7 were hospitalized. The outbreak was investigated to determine its extent and whether it was caused by a single M-serotype of GAS. Serotyping showed that 13 different M-serotypes were involved with the M1 serotype predominating. The overall incidence of GAS invasive disease in West Glamorgan (population 365000) increased sevenfold from a crude incidence of 0·5/105 per year in 1994 to 3·5/105 per year in 1995, but fell back to 0·75/105 per year in 1996. Eighty-two (80%) out of 102 individuals affected by GAS replied to a health questionnaire; sore throat was the commonest symptom reported (97%). Thirty-nine of these index cases identified at least one other member of their household who had experienced similar symptoms. The interval between the onset of illness in members of a single household was 0·83 days with a mean of 22 days. The mean duration of illness was 13·5 days and 61% of patients were treated with penicillin V for a mean duration of 9·3 days. Twenty-one per cent of GAS isolates were erythromycin-resistant and the M4 and M6 serotypes were especially resistant to erythromycin (87·5 and 100% resistance, respectively). Penicillin V failed to eradicate GAS from the throats of 25% of assessable patients. In this community, an outbreak of non-invasive disease caused by GAS was linked in time and place with an outbreak of serious invasive disease.

On 16–17 January 2020, four suspected mumps cases were reported to the local Public Health Authorities with an epidemiological link to a local school and football club. Of 18 suspected cases identified, 14 were included in this study. Laboratory results confirmed mumps virus as the cause and further sequencing identified genotype G. Our findings highlight that even with a high MMR vaccine coverage, mumps outbreaks in children and young adults can occur. Since most of the cases had documented immunity for mumps, we hypothesise that waning immunity or discordant mumps virus strains are likely explanations for this outbreak.

In this study, we analysed the relationship between meteorological factors and the number of patients with coronavirus disease 2019 (COVID-19). The study period was from 12 April 2020 to 13 October 2020, and daily meteorological data and the daily number of patients with COVID-19 in each state of the United States were collected. Based on the number of COVID-19 patients in each state of the United States, we selected four states (California, Florida, New York, Texas) for analysis. One-way analysis of variance ( ANOVA), scatter plot analysis, correlation analysis and distributed lag nonlinear model (DLNM) analysis were used to analyse the relationship between meteorological factors and the number of patients with COVID-19. We found that the significant influencing factors of the number of COVID-19 cases differed among the four states. Specifically, the number of COVID-19 confirmed cases in California and New York was negatively correlated with AWMD (P < 0.01) and positively correlated with AQI, PM2.5 and TAVG (P < 0.01) but not significantly correlated with other factors. Florida was significantly correlated with TAVG (positive) (P < 0.01) but not significantly correlated with other factors. The number of COVID-19 cases in Texas was only significantly negatively associated with AWND (P < 0.01). The influence of temperature and PM2.5 on the spread of COVID-19 is not obvious. This study shows that when the wind speed was 2 m/s, it had a significant positive correlation with COVID-19 cases. The impact of meteorological factors on COVID-19 may be very complicated. It is necessary to further explore the relationship between meteorological factors and COVID-19. By exploring the influence of meteorological factors on COVID-19, we can help people to establish a more accurate early warning system.

Rabies is endemic in Bangladesh. To identify risk factors, a case-control study was conducted based on hospital-reported rabid animal bite (RAB) cases in domestic ruminants, 2009 − 2018. RAB cases (n = 449) and three controls per case were selected. Dogs (87.8%) and jackals (12.2%) were most often identified as biting animals. In the final multivariable model, the risk of being a RAB case was significantly higher in cattle aged >0.5–2 years (odds ratio (OR) 2.89; 95% confidence interval (CI): 1.56–5.37), >2–5 years (OR 3.63; 95% CI: 1.97–6.67) and >5 years (OR 6.42; 95% CI: 3.39–12.17) compared to those aged <0.5 years. Crossbred cattle were at higher risk of being a RAB case (OR 5.48; 95% CI: 3.56–8.42) than indigenous. Similarly, female cattle were more likely to be a RAB case (OR 1.26; 95% CI: 1.15–2.29) than males. Cattle in rural areas (OR 39.48; 95% CI: 6.14–254.00) were at a much higher risk of being RAB cases than those in urban areas. Female, crossbred and older cattle, especially in rural areas should either be managed indoors during the dog breeding season (September and October) or vaccinated. A national rabies elimination program should prioritise rural dogs for mass vaccination. Jackals should also be immunised using oral bait vaccines. Prevention of rabies in rural dogs and jackals would also reduce rabies incidence in humans.

1. The total reproductive performance of two groups each of twenty-four mice over a period of one year under two different systems of mating has been recorded.

2. In the first system (monogamous pairs) the male was kept continuously with the female; in 78% of cases the females became pregnant again at post-partum oestrus and were thus subjected for the most part to unbroken intensive breeding.

3. In the second system (polygynous groups) several females were kept with one male and were removed to individual cages for the birth and rearing of the litters and were returned to the male again only after the litter had been weaned.

4. Under the first system 1149 young were successfully reared to weaning in one year by the twenty-four females; under the second system 559 young were weaned during the same period.

5. Mortality of breeding females, litter size, weight of young at weaning, the effect of parity, loss of litters and of young between birth and weaning and the sex-ratio of the young weaned were alike for both methods of mating.

6. The interaction of concurrent gestation and lactation upon the length of the gestation period is discussed, and regression lines showing the relation between the number of young suckled, the number of young in the uterus and the length of the gestation period are given.

My best thanks are due to Dr A. S. Parkes, F.R.S., for advice during the course of the work and for help in the preparation of the manuscript. I should also like to thank Dr C. W. Emmens for the statistical analyses and the calculation of the regression lines.

West Nile virus (WNV) infection is an emerging zoonosis that threatens global public health. In this study, a total of 95 bird serum samples from 14 species and 341 horse serum samples were collected from 2008 to 2010 in Shanghai, China. All serum samples were screened initially for WNV-reactive antibodies using a competitive ELISA. The positive samples detected by ELISA were further confirmed using a plaque-reduction neutralization test (PRNT) for WNV and its most closely related flaviviruses in the area to avoid false positives due to cross-reactivity. Five (5·3%) of the bird serum samples and none (0·0%) of the horse serum samples tested positive for WNV antibodies. The findings strongly suggest that some of the birds, specifically the resident birds in China, had been exposed to WNV.

The aim of the study was to measure the positive predictive value (PPV) and sensitivity of operational case definitions of 13 syndromes in a surveillance system based on the Emergency online database of the Lazio region. The PPVs were calculated using electronic emergency department (ED) medical records and subsequent hospitalizations to ascertain the cases. Sensitivity was calculated using a modified capture–recapture method. The number of cases that fulfilled the case definition criteria in the 2004 database ranged from 27 320 for gastroenteritis to three for haemorrhagic diarrhoea. The PPVs ranged from 99·3 to 20; sepsis, meningitis-like and coma were below 50%. The estimated sensitivity ranged from 90% for coma to 22% for haemorrhagic diarrhoea. Syndromes such as gastroenteritis, where the signs, symptoms, and exposure history provide immediate diagnostic implications fit this surveillance system better than others such as haemorrhagic diarrhoea, where symptoms are not evident and a more precise diagnosis is needed.

This study presents enhanced surveillance data from 2004 to 2018 for all community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) specimens collected in Western Australia (WA), and describes the changing epidemiology over this period. A total of 57 557 cases were reviewed. Annual incidence rates increased from 86.2 cases per 100 000 population to 245.6 per 100 000 population (IRR = 2.9, CI95 2.7–3.0). The proportion of isolates carrying Panton–Valentine leucocidin (PVL)-associated genes increased from 3.4% to 59.8% (χ2 test for trend 7021.9, P < 0.001). The emergence of PVL-positive, ‘Queensland CA-MRSA’ (ST93-IV) and ‘WA 121’ (ST5-IV) accounted for the majority of increases in CA-MRSA across the study period. It is unclear why some clones are more prolific in certain regions. In WA, CA-MRSA rates increase as indices of temperature and humidity increase after controlling for socioeconomic disadvantage. We suggest climatic conditions may contribute to transmission, along with other socio-behavioural factors. A better understanding of the ability for certain clones to form ecological niches and cause outbreaks is required.

Eighteen strains of Salmonella choleraesuis subsp. choleraesuis serovar Typhi (S. typhi) isolated from blood of patiens in Japan who had visited Indonesia and returned before the onset of typhoid fever were found to possess the H-antigen z66reported by Guinée et al. (1981) but had the naturally occuring H-antigen d. They were not lysed by any of the phages of the Vi phage typing system. After passage through semi-solid medium containing H-z66 antiserum, H-antigens of 11 of 18 cultures with H-z66 phage changed to H-j and those of 2 others to H-d, while the remaining 5 were immobilized. With cultures in the H-d or H-j phages, change of the H-antigens did not occur when they were cultured in semi-solid medium containing homologous H-antiserum. These phase induction experiments as well as colony examination of original cultures suggest that H-z66 phase is unstable and tends to change of H-antigen to H-d or H-j occured without difficulty probably represented a mixed population of cells in the H-z66 and H-d or H-j phases. Since none of 856 isolates from Japan or fromimported cases of typhoid fever from Southeast Asia other than Indonesia exhibited the H-z66 antigen, it was concluded that the focus of typhois fever caused by S. typhi in H–z66 phase was probably in Indonesia.

We report an outbreak associated with a dinner cruise on Lake Michigan. This took place on the same day as heavy rainfall, which resulted in 42·4 billion liters of rainwater and storm runoff containing highly diluted sewage being released into the lake. Of 72 cruise participants, 41 (57%) reported gastroenteritis. Stool specimens were positive for Shigella sonnei (n=3), Giardia (n=3), and Cryptosporidium (n=2). Ice consumption was associated with illness (risk ratio 2·2, P=0·011). S. sonnei was isolated from a swab obtained from the one of the boat's ice bins. Environmental inspection revealed conditions and equipment that could have contributed to lake water contaminating the hose used to load potable water onto the boat. Knowledge of water holding and distribution systems on boats, and of potential risks associated with flooding and the release of diluted sewage into large bodies of water, is crucial for public health guidance regarding recreational cruises.