The aim of this study was to compare the incidence of community-acquired Legionnaires' Disease in Nottingham with England and Wales and to explore reasons for any difference observed. Based on data from the National Surveillance Scheme for Legionnaires' Disease (1980–1999), the rate of infection in England and Wales was 1·3 per million/year compared with 6·6 per million/year in Nottingham. Domestic water samples were obtained from 41 (95%) of 43 Nottingham cases between 1997 and 2000. In 16 (39%) cases, Legionella sp. were cultured in significant quantities. Proximity to a cooling tower was examined using a 1[ratio ]4 case-controlled analysis. No significant difference in the mean distance between place of residence to the nearest cooling tower was noted (cases 2·7 km vs. controls 2·3 km; P=0·5). These data suggest that Nottingham does have a higher rate of legionella infection compared to national figures and that home water systems are a source.

1. In many parts of the Caribbean there is a high mortality between 6 months and 2 years due to malnutrition and gastro-enteritis. These two conditions are so closely inter-connected that they can conveniently be regarded as a single syndrome, for which the term ‘weanling diarrhoea’ has recently been suggested. The clinical picture revealed by visits to children's wards was in line with the vital statistics.

2. The prevalence of malnutrition and gastro-enteritis in infants and young children is the result of child-feeding practices characteristic of the area. The duration of breast-feeding is shorter than in Africa and Asia. After 3 months or so breast-feeding, if it does not cease altogether, becomes partial, and in general there is a steady change in the direction of less breast milk. In some territories weaning at an even earlier stage in infancy seems to result in the common occurrence of malnutrition in infants under 6 months of age.

3. The foods given to supplement or replace breast milk include processed cow's milk, starch roots and fruits and cereals. Imported processed milk supplies good quality protein otherwise lacking in the child's diet, but the use of expensive proprietory infant milk foods, out of line with family purchasing power and given in over-diluted form, is among the causes of malnutrition. The use in infant and child feeding of dried skim milk-much the cheapest kind of milk in terms of nutritive value-is increasing and this trend should be encouraged.

4. Most of the malnutrition is of the ‘marasmic’ type. Classical kwashiorkor, now comparatively rare, was seen more often 5–10 years ago.

5. It is suggested that the conventional practice of grouping deaths in the periods 0 to 1 and 1 to 4 has, in the Caribbean and other developing areas, retarded recognition of the importance of malnutrition and gastro-enteritis as the principal cause of death during and after the weaning period. The analysis of mortality statistics according to shorter age intervals is desirable.

6. Further studies and action are recommended concerned with the following: the continuing analysis of mortality and morbidity statistics to elicit relationships with malnutrition; child feeding practices in the different territories; the social and economic background of individual victims of malnutrition and of the feeding errors responsible for their condition; improvement in the treatment of malnourished children; the scope and efficiency of maternal and child health services; the distribution of dried skim milk and its extension.

7. The establishment of a Caribbean Nutrition Centre will contribute to the prevention of malnutrition and help in solving long-term problems of food supply and nutrition in the area.

The majority (85%) of shigella isolated in 1980 and 1981 in Korea were Shigella flexneri, the others were Sh. sonnei (14%) with only a small number of Sh. dysenteriae. Only 14 of the 459 strains of shigella isolated were susceptible to all 12 drugs tested, and 445 were resistant to three or more drugs. Strains multiply resistant to the six drugs, chloramphenicol (Cm), tetracycline (Tc), streptomycin (Sm), sulfisomidine (Su), ampicillin (Ap) and trimethoprim (Tp) were most frequently encountered, followed by those resistant to Cm, Tc, Sm, Su and Tp. The complete patterns of resistance to drugs except nalidixic acid and rifampin in approximately 73% of drug-resistant strains were co-transferred to Escherichia coli by conjugation, indicating that the resistance was R plasmid-mediated. Randomly selected R plasmids conferring various patterns of resistance markers were tested for the incompatibility groups, and almost all of them were classified into Inc FII. Two of three R plasmids conferring resistance to Cm, Tc, Sm and Su were classified into Inc B and one to Inc FII. Two R types with resistance markers of Cm, Tc, Sm and Ap were not classified with our standard plasmids used.

We analysed two large national surveys conducted in 2001 and 2008 to examine incidence and outcomes of gastroenteritis in older Australians. A case was someone reporting ⩾3 loose stools or ⩾1 episode of vomiting in 24 h, excluding non-infectious causes. We compared cases arising in the elderly (⩾65 years) and in other adults (20–64 years). Elderly people experienced 0·33 [95% confidence interval (CI) 0·24–0·42] episodes of gastroenteritis/person per year, compared to 0·95 (95% CI 0·74–1·15) in other adults. Elderly cases reported less stomach cramps, fever and myalgia than younger cases, and were more likely to be hospitalized, although this was not statistically significant. In multivariable analysis, gastroenteritis in elderly people was associated with travelling within the state (odds ratio 1·35, 95% CI 1·07–1·71). Elderly people were less concerned about food safety than other adults. Older Australians were less likely to report gastroenteritis and experienced different symptoms and outcomes from other adults.

It has recently been reported that the worldwide increase in the number of pertussis cases is a result of the waning of whole-cell vaccine-induced immunity. Thus, in this study, we aimed to investigate the pertussis immunity status of primary and secondary school students in a district of Ankara, Turkey. A total of 997 healthy students, aged 9–17 years, who had been immunized with four doses of whole-cell pertussis vaccine were included in the study. The subjects were divided into two age groups: 9–14 and 15–17 years. To determine the immune status, serum levels of IgG anti-pertussis toxin (aPT) antibody were tested by in-house ELISA and arbitrarily evaluated as non-immune [<10 ELISA units (EU)/ml], immune (10–100 EU/ml), and recent infection (>100 EU/ml). Serum samples of 997 students (559 females, 438 males) aged between 9 and 17 years (mean 13·02±2·25, median 13 years) were tested. Non-immune, immune and recent infection levels of aPT were found in 27·3%, 59·3% and 13·4% of individuals, respectively. The immune group did not have statistically significant differences between males and females (P=0·68). In the 9–14 and 15–17 years age groups, serum aPT antibody levels ⩾10 EU/ml were 73·1% and 72·2%, respectively, which did not represent any statistical difference (P=0·81). Students aged 15–17 years had a higher immunity rate than the 9–14 years group, and the percentage of students with recent infection in the 9–14 years group was higher than the 15–17 years group (P<0·001). The peak age of non-immunized subjects was 9 years (47·0%), and decreased to a minimum at age 12–13 years, and began to increase again from age 13–14 years. In contrast, the ratio of recent infection was least at age 9–10 years, began to increase, and reached a peak at 12 years, and then decreased. On the other hand, it was observed that household size and monthly income were not associated with the immunity status (P=0·65, P=0·37, respectively). The results of the present study show that levels of antibody against pertussis decreased in the younger age groups and, as a result, there is an increase in the number of pertussis cases. Thus, in order to decrease the incidence of pertussis and protect infants, we recommend the application of booster doses at regular intervals.

The effect of hypochlorite concentration on Mycoplasma mycoides ssp. mycoides viability was tested under a variety of conditions. The experimental variables employed included chlorine-cell contact time, chlorine concentration, carrier system and organic loading. Initial populations of 106 c.f.u./ml were killed (no survivors in 1 ml) by hypoehlorite solution containing 25 p.p.m. available chlorine in 15 s in the absence of organic load and 50 p.p.m. available chlorine in 5 min in the presence of 1% protein. Higher concentrations of hypochlorite were required to disinfect a porous carrier system in the absence or presence of protein. The results are in contrast to previous reports that M. bovis is killed only by high hypochlorito concentrations.

To date many studies have measured the effect of key child survival interventions on the main cause of mortality while anecdotally reporting effects on all-cause mortality. We conducted a systematic literature review and abstracted cause-specific and all-cause mortality data from included studies. We then estimated the effect of the intervention on the disease of primary interest and calculated the additional deaths prevented (i.e. the indirect effect). We calculated that insecticide-treated nets have been shown to result in a 12% reduction [95% confidence interval (CI) 0·0–23] among non-malaria deaths. We found pneumonia case management to reduce non-pneumonia mortality by 20% (95% CI 8–22). For measles vaccine, seven of the 10 studies reporting an effect on all-cause mortality demonstrated an additional benefit of vaccine on all-cause mortality. These interventions may have benefits on causes of death beyond the specific cause of death they are targeted to prevent and this should be considered when evaluating the effects of implementation of interventions.

1. Rickettsia burneti has been isolated from the tick Haemaphysalis punctata collected from sheep in an endemic area of Q fever in south-east England.

2. Isolation from one batch may have been due to contamination from the wool of sheep excreting R. burneti, but evidence is presented that isolation from another batch was due to the presence of the rickettsia in the tick tissues.

We should like to express our gratitude to Mr R. D. Brown, M.R.C.V.S., Mr F. L. J. Kett, F.R.E.S., and Mr J. Carey, who helped to collect the specimens. We are also indebted to Dr A. D. Lees (Agricultural Research Council Unit of Insect Physiology) for his help with the identification of the ticks. Finally we wish to acknowledge the valuable laboratory assistance given by Mr P. C. Collings, Miss Z. Page and Miss K. Arnold.

(1)Statistical evidence cannot be deduced from such a small series of cases, but it would seem that the extent to which agglutinins for B. proteus X. 19 (Weil-Felix) were formed in the blood varied directly as the severity of the illness, since with the older and more ill patients a much higher dilution of serum agglutinated the organism at or near crisis than was the case with the younger patients, who were less acutely ill. An exception to this rule was met with in one case (Mrs E. R.), whose serum did not agglutinate the organism in a dilution beyond 1: 250, although she was the most severely ill of all the patients. It is possible that failure of agglutinin-formation resembles the absence of leucocytosis in the severely ill case of pneumonia and may be regarded as a bad prognostic feature.

(2)A positive Weil-Felix reaction was not obtained before the fifth day of illness, nor in any case before the characteristic rash appeared, so that the reaction is of little value as a factor in the early diagnosis of typhus. Later, a reaction in which a dilution of the serum of 1: 50 agglutinates the organism may be regarded as diagnostic of typhus.

(3)The Weil-Felix reaction remained positive for the longest period in those cases whose serum agglutinated in highest dilution, and in these patients a positive reaction (1: 25–1: 50) was still present nine to twelve weeks after infection, whereas in the milder cases, and in Mrs E. R., the reaction became negative in six to eight weeks from the onset of illness.

(4)In view of this heterologous reaction in typhus, it is interesting to record that the Wassermann reaction obtained before crisis was positive in four out of six cases. It was still positive in two of the most severely ill patients a week after crisis, but was negative in all cases a week later.

1. Methods are described for altering the susceptibility of the surviving allantois to infection by influenza viruses.

2. Under natural conditions susceptibility is a linear function of age between 10 and 18 days of incubation. The drop is 0·11 log10 unit per day for all strains of influenza tested.

3. In whole eggs this decline is masked by the effect of acid allantoic fluid which prevents infection when the pH falls below 6. The effect is not directed against the virus particle, nor does it do permanent damage to the cell, as surviving tissues are equally susceptible whatever the pH of the allantoic fluid that bathed them in ovo.

4. Surviving membranes can be made less susceptible by incubating the eggs at 35° rather than 38° C.; by maintenance for 24 hr. in vitro; by use of deficient or inappropriate medium. These methods lower susceptibility more for some strains than for others.

5. All treatments which lower susceptibility also increase its variation from egg to egg.

Investigations in the Mossman districts of North Queensland showed the maintaining hosts of leptospiral serotype medanensis to be Perameles nasuta and Isoodon macrourus in canefields, secondary woodland and rain forest. Rattus sordidus conatus is the maintaining host of grippotyphosa in canefields. The host range of six serotypes was extended by the cultural studies.

We would like to express our thanks to Dr G. Alberts, superintendent of Mossman District Hospital, for his co-operation, and also to Miss H. MacDonald and Mr A. Wood for technical assistance.

This paper applies a scenario planning approach, to outline some current uncertainties related to COVID-19 and what they might mean for plausible futures for which we should prepare, and to identify factors that we as individual faculty members and university institutions should be considering now, when planning for the future under COVID-19. Although the contextual focus of this paper is Canada, the content is likely applicable to other places where the COVID-19 epidemic curve is in its initial rising stage, and where universities are predominantly publicly funded institutions.

Immunoglobulin A (IgA)-based tests have been evaluated in different studies for their utility in diagnosing dengue infections. In most of the studies, the results were inconclusive because of a small sample size. Hence, a meta-analysis involving nine studies with 2096 samples was performed to assess the diagnostic accuracy of IgA-based tests in diagnosing dengue infections. The analysis was conducted using Meta-Disc software. The results revealed that IgA-based tests had an overall sensitivity, specificity, diagnostic odds ratio, and positive and negative likelihood ratios of 73·9%, 95·2%, 66·7, 22·0 and 0·25, respectively. Significant heterogeneity was observed between the studies. The type of test, infection status and day of sample collection influenced the diagnostic accuracy. The IgA-based diagnostic tests showed a greater accuracy when the samples were collected 4 days after onset of symptoms and for secondary infections. The results suggested that IgA-based tests had a moderate level of accuracy and are diagnostic of the disease. However, negative results cannot be used alone for dengue diagnosis. More prospective studies comparing the diagnostic accuracy of combinations of antigen-based tests with either IgA or IgM are needed and might be useful for suggesting the best strategy for dengue diagnosis.

This study aims to describe in detail the temporal dynamics of E. coli O157 shedding and risk factors for shedding in a grass-fed beef herd. During a 9-month period, 23 beef cows were sampled twice a week (58 sampling points) and E. coli O157 was enumerated from faecal samples. Isolates were screened by PCR for presence of rfbE, stx1 and stx2. The prevalence per sampling day ranged from 0% to 57%. This study demonstrates that many members of the herd were concurrently shedding E. coli O157. Occurrence of rainfall (P < 0·01), feeding silage (P < 0·01) and lactating (P < 0·01) were found to be predictors of shedding. Moving cattle to a new paddock had a negative effect on shedding. This approach, based on short-interval sampling, confirms the known variability of shedding within a herd and highlights that high shedding events are rare.

A total of 1601 adult industrial workers were vaccinated with either monovalent inactivated vaccine of the Hong Kong strain of influenza A virus, or with polyvalent vaccine containing only pre-1968 Asian viruses. Serological investigations on a random sample of volunteers showed that 53/56 (95 %) given Hong Kong vaccine developed a significant rise in specific haemagglutination-inhibiting antibody; final titres were 1/48 or greater in 39 (70%) and the GMT (geometric mean titre) was 96·5. After polyvalent Asian vaccine, 40/67 (60%) also produced antibody against Hong Kong virus, but only 21 (31 %) had final titres of 1/48 or above, and the GMT rose only to 14·1. An intranasal spray of the Hong Kong vaccine in addition to injected Asian vaccine gave no additional increase in antibody.

Each type of vaccine stimulated a recall of pre-existing antibody against Asian viruses. The possible significance of heterologous responses to the two vaccines is discussed.

The incidence of clinical influenza in the trial population was sporadic, and the infection rates were too low to allow any accurate estimate of the protective efficiency of the two vaccines.

1. Rabbits were infected with virulent bovine tubercle bacilli in three ways: by (1) intravenous, (2) intrasplenal and (3) intrapulmonary injection. In series (1) and (2) part of the spleen, and in series (3) part of the draining lymph glands were sectioned for histological examination, and usually explants for tissue culture were made from the rest of the organ.

2. A histological study of the infected spleens and lymph glands fixed after different periods of infection showed the usual picture of progressive tuberculous infection; acid-fast bacilli were rare and often difficult to find.

3. After a few days' cultivation in vitro, explants of the infected spleens often became densely infiltrated with bacilli.

4. Previous investigators have expressed the view that acid-fast bacilli are so few in tuberculous lesions in vivo, because large numbers become unstainable. If this is true, and if the unstained bacilli remain viable, it would readily account for the extraordinarily rapid bacillary infiltration of tissue cultures of infected organs. Alternatively, it must be assumed that the few scattered acid-fast rods in the original tissue grow at a prodigious rate under the conditions of life in vitro.

5. These alternatives and other theoretical implications of the results are discussed.

In a prison in Victoria, Australia, our objectives were contact tracing of inmates and staff at risk of exposure to an identified index case; and to determine risk factors for prevalent and incident infection. Inmates and staff who were potentially exposed to the index case were screened with a Mantoux skin test and a questionnaire. Inmate movements within the prison were compared to movements of the index case. Logistic regression was used to determine risk factors for infection. The index case had smear positive, cavitating pulmonary tuberculosis (TB), which was undiagnosed for 3 months. This was the period of potential exposure. The prevalence of positive skin test reactions in 190 inmates and staff at the prison was 10%. Significant predictors of a positive skin test were being an inmate (odds ratio (OR) 15·5), older age (OR 8·3) and being born overseas (OR 10·7). Bacille Calmette Guerin (BCG) vaccination, proximity to the index case in various prison sites, duration of incarceration, number of incarcerations and number of inmates per cell were not significant. There were three recent skin test conversions from negative to positive, representing a conversion rate of 3·5%. We did not find evidence of significant transmission of TB from a single index case. The prevalence of infection in this Australian prison was lower than published rates in other countries. Better prison conditions and different demographics of prison inmates in Australia may explain these differences.

1. The Tworts' potency measures correlate highly with all the reasonable alternative single measures of potency which have been examined.

1. Section A of this report is introductory; Section B deals with the correlations between the Tworts' measures of carcinogenic potency and certain alternative measures, and their use in testing the significance of differences between the potencies of different oils. Section C deals with the relation of potency to physical characteristics and place of origin of the oil. Section D deals with the relations between the saturation, refractivity, carcinogenic potency and place of origin of oils.

Hand-foot-mouth disease (HFMD) is a frequently occurring epidemic and has been an important cause of childhood mortality in China. Given the disease's significant impact nationwide, the epidemiological characteristics and spatio-temporal clusters in Fuyang from 2008 to 2013 were analysed in this study. The disease exhibits strong seasonality with a rising incidence. Of the reported HFMD cases, 63·7% were male and 95·2% were preschool children living at home. The onset of HFMD is age-dependent and exhibits a 12-month periodicity, with 12-, 24- and 36-month-old children being the most frequently affected groups. Across the first 60 months of life, children born in April [relative risk (RR) 8·18], May (RR 9·79) and June (RR 8·21) exhibited an elevated infection risk of HFMD relative to January-born children; the relative risk compared with the reference (January-born) group was highest for children aged 24 months born in May (RR 34·85). Of laboratory-confirmed cases, enterovirus 71 (EV71), coxsackie A16 (Cox A16) and other enteroviruses accounted for 60·1%, 7·1% and 32·8%, respectively. Spatio-temporal analysis identified one most likely cluster and several secondary clusters each year. The centre of the most likely cluster was found in different regions in Fuyang. Implications of our findings for current and future public health interventions are discussed.

Completion of treatment is key to tuberculosis control. Using national surveillance data we assessed factors associated with tuberculosis patients being lost to follow-up before completing treatment (‘lost’). Patients reported in England, Wales and Northern Ireland between 2001 and 2007 who were lost 12 months after beginning treatment were compared to those who completed, or were still on treatment, using univariable and multivariable logistic regression. Of 41 120 patients, men [adjusted odds ratio (aOR) 1·29; 95% confidence interval (CI) 1·23–1·35], 15- to 44-year-olds (P<0·001), and patients with pulmonary sputum smear-positive disease (aOR 1·25, 95% CI 1·12–1·45) were at higher risk of being lost. Those recently arrived in the UK were also at increased risk, particularly those of the White ethnic group (aOR 6·39, 95% CI 4·46–9·14). Finally, lost patients had a higher risk of drug resistance (aOR 1·41, 95% CI 1·17–1·69). Patients at risk of being lost require enhanced case management and novel case retention methods are needed to prevent this group contributing towards onward transmission.