After instituting laboratory screening for Escherichia coli O157. H7, a Connecticut hospital isolated the organism from four persons in September 1993. As a result, an outbreak of E. coli O157.H7 associated with a country club was detected. The club had served hamburger from the same shipment at two picnics. Attendees of two picnics were interviewed, stool cultures were obtained from symptomatic persons, and the remaining hamburger was cultured. Twenty (22%) of 89 persons who ate hamburger became ill, compared with 1 of 60 who did not eat hamburger (relative risk = 13·5, 95% confidence interval 3·2–56·3). Among persons who ate hamburgers, illness was strongly associated with eating hamburger that was not thoroughly cooked (P < 0·001). All 20 samples from 5 remaining boxes of patties yielded E. coli O157.H7. Isolates from hamburger and case-patients were indistinguishable by pulsed-field gel electrophoresis. Heightened surveillance can rapidly identify outbreaks and may mitigate their impact. However, continued review of food safety issues is necessary if E. coli O157.H7 outbreaks are to be prevented.

The efficacy of iodophor germicides containing different concentrations of available iodine against transient (inoculated) bacteria and the natural hand microflora was compared with chlorhexidine gluconate (2 and 4%) liquid detergent (Hibitane), non-germicidal soap and a tap water rinse. The tap water rinse was ineffective compared with all other treatments. Only 4% chlorhexidine gluconate liquid detergent and iodophor containing 0·75% available iodine were significantly better than the non-germicidal soap for reduction of transient bacteria, Escherichia coli and Pseudomonas fluorescens, that had been inoculated onto hands. These agents also caused a significant reduction in the number of ‘natural’ micro-organisms released from hands after a standard 15 s hand wash. The low-concentration iodophor products and the product containing 2% chlorhexidine gluconate failed to give results significantly better than the non-germicidal control soap. Baird-Parker medium and standard aerobic plate counts were highly correlated (r = 0·82), so that for studies of Gram-negative bacteria inoculated onto hands as a transient microflora, counts on Baird-Parker medium give a reasonable indication of the natural (residual) hand microflora.

The aim of this study was to explore the frequency and distribution of gene mutations that are related to isoniazid (INH) and rifampin (RIF)-resistance in the strains of the multidrug-resistant tuberculosis (MDR-TB) Mycobacterium tuberculosis (M.tb) in Beijing, China. In this retrospective study, the genotypes of 173 MDR-TB strains were analysed by spoligotyping. The katG, inhA genes and the promoter region of inhA, in which genetic mutations confer INH resistance; and the rpoB gene, in which genetic mutations confer RIF resistance, were sequenced. The percentage of resistance-associated nucleotide alterations among the strains of different genotypes was also analysed. In total, 90.8% (157/173) of the MDR strains belonged to the Beijing genotype. Population characteristics were not significantly different among the strains of different genotypes. In total, 50.3% (87/173) strains had mutations at codon S315T of katG; 16.8% (29/173) of strains had mutations in the inhA promoter region; of them, 5.5% (15/173) had point mutations at −15 base (C→T) of the inhA promoter region. In total, 86.7% (150/173) strains had mutations at rpoB gene; of them, 40% (69/173) strains had mutations at codon S531L of rpoB. The frequency of mutations was not significantly higher in Beijing genotypic MDR strains than in non-Beijing genotypes. Beijing genotypic MDR-TB strains were spreading in Beijing and present a major challenge to TB control in this region. A high prevalence of katG Ser315Thr, inhA promoter region (−15C→T) and rpoB (S531L) mutations was observed. Molecular diagnostics based on gene mutations was a useful method for rapid detection of MDR-TB in Beijing, China.

The difficulties encountered in distinguishing pneumococci from streptococci, particularly S. salivarius, have been enumerated and the morphological and cultural similarities between the two groups of organisms have been pointed out. If bile-solubility is taken as the distinguishing mark of a pneumo-coccus it will be found that there are a large number of bile-insoluble streptococci commonly met with in the respiratory tract and sometimes playing an important part in disease, which bear very strong resemblances to pneumococci both in shape, colony, and broth culture. The similarities are specially confusing in mixed cultures on agar plates and a number of the routine tests applied quite failed to distinguish them. There naturally follows the corollary that some of these tests fall wide of the mark, and they should therefore be left out of the bacteriologist's armamentarium when the identification of pneumococci is under consideration. Morphological and cultural properties are insufficient guides to species, while the same is true of the widely recommended tests of inulin fermentation and capsule formation. Not only do some pneumococci fail to ferment inulin, but so many strains of S. salivarius show active inulin fermentation that, in the present series of organisms taken at random, the incidence of inulin fermenters amongst S. salivarius is actually higher than amongst pneumococci. Capsules were found in all the strains of streptococci in which they were sought and in all the pneumococci investigated, so that encapsulation may be regarded as a property common to members of both species.

Cervids represent a mammal group which plays an important role in the maintenance of ecological balance. Recent studies have highlighted the role of these species as reservoirs for several arthropods-borne pathogens. Globally, hemotropic mycoplasmas (haemoplasmas) are emerging or remerging bacteria that attach to red blood cells of several mammals species causing hemolytic anaemia. Therefore, the aim of this study was to investigate the occurrence and assess the phylogenetic positioning of Mycoplasma ovis in free-ranging deer from Brazil. Using a polymerase chain reaction targeting the 16S rRNA region, 18 (40%) out of 45 sampled deer were positive to M. ovis. Among the nine sequences analysed, four distinct genotypes were identified. The sequences detected in the present study were closely related to sequences previously identified in deer from Brazil and the USA. On the other hand, the Neighbour-Net network analysis showed that the human-associated M. ovis genotypes were related to genotypes detected in sheep and goats. The present study shows, for the first time, the occurrence of M. ovis in Mazama gouazoubira and Mazama bororo deer species, expanding the knowledge on the hosts harbouring this haemoplasma species. Once several deer species have your population in decline, additional studies are needed to evaluate the pathogenicity of M. ovis among deer populations around the world and assess its potential as reservoir hosts to human infections.

Rabies post-exposure prophylaxis (R-PEP) including wound treatment, vaccination and application of rabies immunoglobulin (RIG) is essential in preventing rabies mortality. Today, Germany is officially declared free from terrestrial rabies and rabies is only found in bats. However, physicians in A&E Departments are frequently consulted on the need for R-PEP. We retrospectively analysed patients who received R-PEP at the A&E Department of the University Hospital Bonn between 01.01.2013 and 30.06.2019. Demographic data, travel history, clinical and laboratory findings, previous rabies vaccinations and R-PEP vaccination regimen were recorded. During the study period, 90 patients received R-PEP at the University Hospital Bonn, in 10 cases without indication for R-PEP. Altogether, we found deviations from R-PEP guidelines in 51% (n = 41/80). Infiltration of RIG was missed in 12 patients and incorrectly administrated in 24 patients. Furthermore, vaccination scheme was incorrect in 11 patients. Correct wound washing and documentation of tetanus status was missing in 14% and 63% of patients, respectively. Despite rabies elimination in Germany patients frequently seek advice for R-PEP, the majority returning from foreign travel. Our data show that there is a high need for education on indication for R-PEP before and after travel and for implementation of precise R-PEP guidelines in daily clinical practice.

Cyclospora cayetanensis is a parasite causing cyclosporiasis (an illness in humans). Produce (fruits, vegetables, herbs), water and soil contaminated with C. cayetanensis have been implicated in human infection. The objective was to conduct a scoping review of primary research in English on the detection, epidemiology and control of C. cayetanensis with an emphasis on produce, water and soil. MEDLINE® (Web of ScienceTM), Agricola (ProQuest), CABI Global Health, and Food Science and Technology Abstracts (EBSCOhost) were searched from 1979 to February 2020. Of the 349 relevant primary research studies identified, there were 75 detection-method studies, 40 molecular characterisation studies, 38 studies of Cyclospora in the environment (33 prevalence studies, 10 studies of factors associated with environmental contamination), 246 human infection studies (212 prevalence/incidence studies, 32 outbreak studies, 60 studies of environmental factors associated with non-outbreak human infection) and eight control studies. There appears to be sufficient literature for a systematic review of prevalence and factors associated with human infection with C. cayetanensis. There is a dearth of publicly available detection-method studies in soil (n = 0) and water (n = 2), prevalence studies on soil (n = 1) and studies of the control of Cyclospora (particularly on produce prior to retail (n = 0)).

A large outbreak of streptococcal sore throat in a Royal Air Force Training Camp resulted in five cases of rheumatic fever among the 16- to 18-year-old apprentices, and one case in a 33-year-old airman. The most prevalent type of group A streptococcus isolated from throat swabs was M-type 5 and there was serological evidence that at least four of the rheumatic fever (R.F.) cases were due to this type.

Among the patients with uncomplicated throat infection the anti-streptolysin O (ASO) and anti-deoxyribonuclease B (anti-DNAase B) responses were in general rather low, even where there was evidence of protective antibody against type 5. However, a combination of the results of the ASO and anti-DNAase B tests gave an estimate of the extent of streptococcal infection 15–25% higher than did either test alone.

The titres of antibody to M-associated protein (MAP) were ≥ 60 in all the r.f. patients, and in about 50% of the other patients with ASO titres ≥ 200. This figure is unusually high compared with data from several other outbreaks of streptococcal infection due to different serotypes and also greatly exceeds comparable figures for cases of sporadic sore throat and acute glomerulonephritis.

This cross-sectional prevalence study investigates meningococcal carriage for the first time in a Southeast Asian population. Posterior pharyngeal swabs were collected between August 2013 and March 2014 from 937 healthy Filipinos aged 5–24 years attending school or university in Manila. Of these, 35 were found to be carriers giving an overall carriage prevalence of 3·7% [95% confidence interval (CI) 2·6–5·2]. Carriage was associated with age (P < 0·001) and was highest (9·0%, 95% CI 5·5–13·8) in subjects aged 10–14 years, but was comparatively low (<3%) in all other age groups considered. This suggests that an immunization programme in the Philippines designed to reduce carriage acquisition and induce herd immunity may require a vaccine dose before the age of 10 years. Serogroup B was most commonly carried (65·7%, 95% CI 47·8–80·9), with a small number of carriers for serogroups C, Y and W also present. Two individuals (5·7%, 95% CI 0·7–19·2) who were simultaneously carrying multiple serogroups were identified. This exploratory study provides valuable insight into the asymptomatic carriage of Neisseria meningitidis in a healthy subset of the Filipino population and illustrates the importance of generating local carriage data.

Human rabies is known to be endemic in countries bordering Lebanon, but its prevalence in Lebanon has not been studied before. All eight cases of human rabies reported to the Lebanese Ministry of Public Health between 1991 and 1999 were reviewed, as well as three other cases admitted to the American University of Beirut Medical Center. A total of 1102 cases of animal bites to humans, the majority of which were dog bites, were reported to the Ministry of Public Health between 1991 and 1996. In this period, 2487 doses of rabies vaccine were administered to the above group, as post-exposure prophylaxis. Veterinarians, a high risk and educated group, were interviewed, and only 7 out of 72 were found to have been vaccinated. Major improvements in surveillance and reporting, better control of animal rabies, more awareness especially among high risk groups, and regional cooperation, are all needed to prevent and control this deadly infection.

1. Of 585 strains of lactose-fermenting aerobes each isolated from faeces of a different person, 501 did not utilise citrate or ferment cellobiose; 20 were citrate negative and cellobiose positive; 27 were cellobiose negative and citrate positive; and 37 were positive to both tests.

2. Almost 10 per cent, of the strains isolated were indol negative.

3. One culture was methyl-red negative and Voges-Proskauer positive. Two were positive to both tests. The rest were methyl-red positive and Voges-Proskauer negative.

4. It is concluded that the results are not favourable to the use of the citrate or the cellobiose test in routine water analysis.

5. A discussion of the taxonomy of the lactose-fermenting aerobes is given. Only two species, Bacterium coli (Escherich) L. and N., and Bacterium aerogenes (Escherich) Chester, are recognised.

1. One per cent of samples of farm milk were found to contain pathogenic varieties of Bacterium coli of the O groups associated with infantile gastroenteritis.

2. Unheated cows' milk is a dangerous food for babies.

3. Summer diarrhoea was probably, for the most part, milk-borne infection by special O groups of Bact. coli.

4. Thirteen per cent of chickens on farms were found to be excreting Bact. coli of the O groups associated with infantile gastro-enteritis but only a few of the strains possessed H antigens of varieties known to have an association with human disease.

5. Possible reservoirs of infection cannot be adequately searched for until a selective method is devised to aid the separation of pathogenic O groups of Bact. coli from the non-pathogenic.

We studied the evolution, genotypes, and the molecular clock of dengue virus serotype 1 (DENV-1), between 2001 and 2014 in Guangzhou, China. The analysis of the envelope (E) gene sequences of 67 DENV-1 strains isolated in Guangzhou, together with 58 representative sequences downloaded from NCBI, have shown shifts in viral genotypes. The genotype changed several times, from genotype I to IV in 2002, from IV to I in 2005, and from I to V in 2014. These genotype shifts may be the cause of DENV outbreaks. The diversity of genotypes and clades demonstrates a high risk of future outbreaks in Guangzhou. The mean rate of virus nucleotide substitution in Guangzhou was determined to be 7·77 × 10−4 per site per year, which represents a medium substitution rate compared to two other countries. Our research can point to different ancestors of the isolated strains, which may further reveal the different origins and transmission of DENV-1 strains in Guangzhou.

In Spain hepatitis A is a compulsory notifiable disease and individual cases are reported to the national epidemiological surveillance network. Incidence rates show variations in different regions. The aim of this study was to analyse the space–time pattern of hepatitis A risk at municipal level in Spain and at global and local levels during the period 1997–2007. At global level we used two estimates of risk: the standardized incidence ratio (SIR) and the posterior probability that the smoothed relative risk is >1 (PP). At local level we used the scan statistic method to analyse the space–time clusters. The SIR and significant PP (>0·8) showed the highest risk concentrated in areas of the Mediterranean coast. The most likely cluster gave a relative risk of 53·530. These spatial statistics methodologies can be complementary tools in the epidemiological surveillance of infectious diseases.

In April 2018, Public Health England was notified of cases of Shigella sonnei who had eaten food from three different catering outlets in England. The outbreaks were initially investigated as separate events, but whole-genome sequencing (WGS) showed they were caused by the same strain. The investigation included analyses of epidemiological data, the food chain and microbiological examination of food samples. WGS was used to determine the phylogenetic relatedness and antimicrobial resistance profile of the outbreak strain. Ultimately, 33 cases were linked to this outbreak; the majority had eaten food from seven outlets specialising in Indian or Middle Eastern cuisine. Five outlets were linked to two or more cases, all of which used fresh coriander although a shared supplier was not identified. An investigation at one of the venues recorded that 86% of cases reported eating dishes with coriander as an ingredient or garnish. Four cases were admitted to hospital and one had evidence of treatment failure with ciprofloxacin. Phylogenetic analysis showed that the outbreak strain was part of a wider multidrug-resistant clade associated with travel to Pakistan. Poor hygiene practices during cultivation, distribution or preparation of fresh produce are likely contributing factors.

Serum samples were obtained from 281 heifers vaccinated with Brucella abortus strain 19, and from 50 heifers that had received two injections of killed B. abortus strain 45/20 adjuvant (K45/20A) vaccine. The serological response measured by the brucellosis radioimmunoassay (RIA) was compared with responses measured by other tests.

The serological responses of cattle during the first weeks after strain 19 vaccination were found to give little guide to the frequency of persistent reactions.

In the case of strain 19, persistent reactions were considered to be those occurring 12 or more months after vaccination. In heifers vaccinated at the recommended age, small numbers of persistent reactions were given by the RIA (four in 374 sera), the complement fixation test using warm fixation (CFTW) (six in 383) and cold fixation (one in 185), the serum agglutination test (two in 222) and the indirect haemolysis test (IHLT) (two in 369). The Rose Bengal plate test gave 74 persistent reactions in 374 sera.

Five of the 50 heifers gave particularly prolonged responses to K45/20A vaccine. In these animals the RIA and IHLT remained positive for longer than the CFTW.

By gathering 680 publicly available Sequence Read Archives from isolates of Mycobacterium tuberculosis complex (MTBC) including 190 belonging to the lineage 2 Beijing, and using an in-house bioinformatical pipeline, the TB-Annotator, that analyses more than 50 000 characters, we describe herein a new L2 sublineage from 20 isolates found in the Tochigi province, (Japan), that we designate as asia ancestral 5 (AAnc5). These isolates harbour a number of specific criteria (42 SNPs) and their intra-cluster pairwise distance suggests historical and not epidemiological transmission. These isolates harbour a mutation in rpoC, and do not fulfil, any of the modern Beijing lineage criteria, nor any of the other ancestral Beijing lineages described so far. Asia ancestral 5 isolates do not possess mutT2 58 and ogt 12 characteristics of modern Beijing, but possess ancestral Beijing SNPs characteristics. By looking into the literature, we found a reference isolate ID381, described in Kobe and Osaka belonging to the ‘G3’ group, sharing 36 out of the 42 specific SNPs found in AAnc5. We also assessed the intermediate position of the asia ancestral 4 (AAnc4) sublineage recently described in Thailand and propose an improved classification of the L2 that now includes AAnc4 and AAnc5. By increasing the recruitment into TB-Annotator to around 3000 genomes (including 642 belonging to L2), we confirmed our results and discovered additional historical ancestral L2 branches that remain to be investigated in more detail. We also present, in addition, some anthropological and historical data from Chinese and Japan history of tuberculosis, as well as from Korea, that could support our results on L2 evolution. This study shows that the reconstruction of the early history of tuberculosis in Asia is likely to reveal complex patterns since its emergence.

Pig farmers and veterinarians have high prevalence of methicillin-resistant Staphylococcus aureus (MRSA) due to the occupational livestock exposure, while few reported this association on slaughterhouse workers. We conducted this cross-sectional study to explore the phenotypic and molecular characteristics of S. aureus and MRSA in slaughterhouse pig-related workers and control workers in Guangdong Province, China. Participants were interviewed and provided two nasal swabs. Swabs were tested for S. aureus, and isolates were further tested for antimicrobial susceptibility, virulence genes and multi-locus sequence typing. Compared with control workers, pig-related workers have significantly higher prevalence of MRSA carriage (adjusted odd ratio (aOR) 3·70, 95% CI 1·63–8·40). The proportions of MRSA resistant to clindamycin, erythromycin, tetracycline or chloromycetin were significantly higher in pig-related workers than in control workers. The predominant phenotypes of S. aureus were resistant to penicillin, clindamycin, erythromycin and tetracycline. Three MRSA CC9 isolates with livestock-associated characteristics (resistance to tetracycline and absence of immune evasion cluster (IEC) genes) were detected in pig-related workers but not in control workers. For human-associated CCs (CC7, CC59, CC6, and CC188), there was no significant difference in IEC profile or antimicrobial resistance between the groups. These findings reveal that there may be a potential risk for livestock-to-human transmission of LA-MRSA and human-to-human transmission of human-associated MRSA.

Rates of acute hepatitis B are high in Moldova, but the prevalence of chronic infection is unknown. In 1994, we surveyed children and pregnant women, collected demographic information, and drew blood for laboratory testing. Among the 439 children (mean age, 5 years), the prevalence of antibody to hepatitis B core antigen (anti-HBc) and hepatitis B surface antigen (HBsAg) were 17·1 and 6·8%, respectively. Among the 1098 pregnant women (mean age, 26 years), 52·4% were anti-HBc-positive and 9·7% were HBsAg-positive. Of the HBsAg-positive pregnant women, 35·6% were hepatitis B e antigen (HBeAg) positive and 18·3% had antibodies to hepatitis D virus. The prevalence of antibody to hepatitis C virus was 1·4% in children and 2·3% in pregnant women. The high HBeAg prevalence among HBsAg-positive pregnant women and the high anti-HBc prevalence among children indicate that both perinatal and early childhood transmission contribute to the high hepatitis B virus endemicity in Moldova.

Between June 1976 and August 1977 faeces were collected from 599 wild British birds caught during ringing operations at two sewage treatment works in south-east England. Samples were incubated with selenite-F broth to detect the presence of Salmonella. Salm. anatum was isolated from one bird, a Dunnock Prunella modularis an incidence of O.17 % of the total birds examined and 3.23 % of the Dunnocks. Comparisons are drawn with previously reported studies and it is suggested that sewage treatment works play little part in the transmission of Salmonella infections to wild birds feeding there.