We analysed data from 33741 patients with ICD-10-AM-defined sepsis from an Australian hospital morbidity dataset to investigate the relationships between specific types of organisms, potential risk factors for infection, organ dysfunction, ICU utilization and hospital mortality. A total of 24% of patients received some of their care in an intensive care unit, and the overall hospital mortality rate was 18%. Gram-positive bacteria were isolated in 27% of cases and Gram-negative bacteria in 20%. Sepsis due to Staphylococcus aureus was associated with vascular and joint devices whereas Pseudomonasaeruginosa and Gram-negative rods were more common with genitourinary devices and lymphoproliferative disease. Sepsis-associated organ dysfunction most commonly involved the respiratory system, followed by the renal and circulatory systems. These patterns may provide useful clues to the pathogenesis and therapy of this often fatal syndrome which is a major ongoing problem for hospitalized patients.

Salmonella typhimurium phage type DT 193 survived in small numbers, in stored static slurry derived from veal calves, for the 7-week period of observation. The viable coliform count fell by 1½ logs during the first 2 weeks of storage, thereafter there were only relatively small fluctuations in the coliform population. In all 735 of 752 Escherichia coli isolates examined from eight samples of slurry were resistant to 3–6 antibacterial drugs. There was no dramatic change in the overall level of drug resistance amongst the E. coli with time. Chloramphenicol resistance was recorded in 400 (55%) of the E. coli. It was always associated with multiple resistance, with 96% of the strains being resistant to 5 or 6 drugs, although the proportion of isolates of each of the ten most prevalent O-serotypes resistant to chloramphenicol was variable and ranged between none and 97·5%. The use of biotyping together with O-serotyping indicated that the E. coli population was extremely complex, although certain components of the population remained relatively stable within the dominant flora with time since several of the more common O-serotype/biotype combinations were isolated from more than half of the eight slurry samples examined.

The 2012 West Nile virus (WNV) epidemic was the largest since 2003 and the North Texas region was the most heavily impacted. We conducted a serosurvey of blood donors from four counties in the Dallas–Fort Worth area to characterize the epidemic. Blood donor specimens collected in November 2012 were tested for WNV-specific antibodies. Donors positive for WNV-specific IgG, IgM, and neutralizing antibodies were considered to have been infected in 2012. This number was adjusted using a multi-step process that accounted for timing of IgM seroreversion determined from previous longitudinal studies of WNV-infected donors. Of 4971 donations screened, 139 (2·8%) were confirmed WNV IgG positive, and 69 (1·4%) had IgM indicating infection in 2012. After adjusting for timing of sampling and potential seroreversion, we estimated that 1·8% [95% confidence interval (CI) 1·5–2·2] of the adult population in the Dallas–Fort Worth area were infected during 2012. The resulting overall estimate for the ratio of infections to reported WNV neuroinvasive disease (WNND) cases was 238:1 (95% CI 192–290), with significantly increased risk of WNND in older age groups. These findings were very similar to previous estimates of infections per WNND case, indicating no change in virulence as WNV evolved into an endemic infection in the United States.

Foot and mouth disease (FMD) is a highly contagious and economically important disease of cloven-hoofed animals, which is endemic in Ethiopia. An outbreak follow-up study was undertaken to quantify the transmission parameters of FMD in the crop–livestock mixed (CLM) system and commercial dairy farms in selected areas of northwest Ethiopia. The transmission parameters were quantified using a generalised linear model (GLM) based on a susceptible–infectious–recovered (SIR) epidemic model. The per day average transmission rate between animals was 0.26 (95% CI 0.22–0.32) and 0.33 (95% CI 0.21–0.57) in the CLM system and in the commercial dairy farms, respectively. The average basic reproduction ratio of FMD was 1.68 (95% CI 1.42–2.07) in the CLM system and 1.98 (95% CI 1.26–3.42) in the commercial dairy farms. The medium per day transmission rate and moderate basic reproduction ratio observed in this study indicated that a vaccination coverage needed to stop transmission of the disease in these populations might not be very high.

Prevention of Shiga toxin-producing Escherichia coli (STEC) foodborne outbreaks is hampered by its complex epidemiology. We assessed the distribution of virulence genes (VGs), main serogroups/serotypes for public health [haemolytic uraemic syndrome (HUS)-related], antimicrobial resistance (AMR) profiles and pulsed-field gel electrophoresis (PFGE) patterns in a collection of STEC isolates obtained from cattle hide (n = 149) and faecal (n = 406) samples collected during a national survey conducted in Spain in 2011 and 2013. Isolates were cultured using McConkey and CT-SMAC agar after enrichment, and confirmed as STEC by PCR. STEC prevalence in hides (15·4%) was higher than in faeces (10·7%) and O157:H7 was more frequent in the former (2·7% vs. 0·99%). Non-O157 HUS-related serogroups were present albeit at low frequencies. The non-O157 isolates were more heterogeneous than O157:H7 in their VG patterns, with 25/64 presenting VGs from both STEC and enterotoxigenic pathotypes (hybrid isolates). Of the STEC isolates, 62·5% were resistant at least to one antimicrobial, and no differences in AMR between O157:H7 and non-O157 were detected. All isolates had different profiles by PFGE and did not form a cluster. Overall, our results demonstrated that STEC in the cattle reservoir is still a matter of concern for human health due to the presence of HUS-related serogroups, the occurrence of certain VGs, AMR and the additional risks that hybrid isolates may pose, and thus warrants further investigation.

Seventy-five individuals with Salmonella infection were identified in the Portsmouth area during August and September 2009, predominantly Salmonella Enteritidis phage type 8. Five patients were admitted to hospital. A case-case comparison study showed that a local restaurant was the most likely source of the infection with a risk of illness among its customers 25-fold higher than that of those who did not attend the restaurant. A case-control study conducted to investigate specific risk factors for infection at the restaurant showed that eating salad was associated with a threefold increase in probability of illness. Changing from using ready washed lettuces to lettuces requiring washing and not adhering strictly to the 48 hours exclusion policy for food handlers with diarrhoea were likely to have contributed to the initiation and propagation of this outbreak. Possibilities for cross-contamination and environmental contamination were identified in the restaurant.

An outbreak of infections due to multiple antibiotic-resistant bacteria took place over a period of approximately 18 months in a renal unit. Strains of Escherichia coli, Enterobacter aerogenes, Klebsiella pneumoniae, Citrobacter spp. and Pseudomonas spp. were involved, and a variety of antibiotic resistances was encountered. Closely related plasmids encoding resistance to aztreonam, ceftazidime and piperacillin, possibly derived from an archetypal plasmid of 105 kb were found in the majority of isolates examined. After limiting the use of aztreonam the incidence of new patient isolates of multiple-resistant organisms was greatly reduced. This study demonstrated how molecular studies can contribute to the control of an outbreak situation in a hospital unit by providing an impetus to reduce the use of specific antibiotics.

In a cytological investigation of three branching and two non-branching strains grown on Loewenstein medium, it was found that avian tubercle bacilli contain chromatinic material which gives a positive Feulgen reaction and is readily stainable with Giemsa's solution after treatment of the fixed bacteria with hydrochloric acid.

Growing filamentous forms of both ‘bacterial’ and ‘mycelial’ strains from 1 to 2 day old cultures contain variable numbers of irregularly spaced, more or less spherical chromatinic bodies which vary in staining in the same bacillus, some being red, others purple. During the third or fourth day the chromatinic material in the bacteria increases very much until most of it is fused into an almost homogeneous deeply stained column. In the non-branching strains the filamentous forms with high chromatin content soon break up into small mono-or binucleate elements, and the same holds true for the ‘straight’ filamentous forms which are also present in cultures of branching strains. The ‘mycelial’ forms, on the other hand, disintegrate at this time (fourth or fifth day of cultivation), and it is uncertain whether they contribute (by partial fragmentation) to the masses of small mono- or binucleate forms which are the predominant element in old cultures of all the strains investigated.

The chromatinic structures of avian tubercle bacilli have the same staining properties as those of ordinary non-acid-fast bacteria but differ from them in their behaviour during the early development of the bacilli.

To determine the pathogenic potential of the vesiculoviruses Isfahan Chandipura for domestic animals, two ponies, two steers, three and three pigs were inoculated with each virus intradermally in the tongue or, in the case of the pigs, in the snout, heel and coronary band The Ponies were also inoculated intradcrmally in the right commissure o the mouth Animals inoculated with each virus were housed in one room and allowed to mingle freely with an equal number of uninoculated contact animals of each species.

Clinical signs of infection, consisting of ulcers at the inoculation sites, were observed in the Chandipura study in two inoculated ponies, one inoculated steer and one inoculated goat. No elevated temperature was observed. Virus was isolated from the ulcerated tongue tissue but not from serial blood samples, oesophagcal-pharyngeal mucus samples, or from the tissues which were collected at necropsy. Precipitating antibody was not detected by the immunoelectro osmophoresis(IEOP) test in any of the pre- or post-serum samples except from two inoculated sheep at 29 days post-inoculation (D.P.I.). Low levels of neutralizing activity were dtedted in pre-inoculation serum from all steers, pigs, contact sheep, and one contact goa. By 15 D.P.I. all inoculated animals and contact ponies and steers exhibited increased neutralizing antibody titres.

In studies with the Isfahan virus, lesions developed only at the inoculation sites in the two ponies, and the virus was isolated. No virus was isolated from any blood, oesophageal-pharyngeal mucus samples or tisues collected at necropsy. All pre-inoculation sera were negative for neutralizing and precipitating antibodies. By 14 D.P.I. all inoculated animals exhibited neutralizing antibody, while all the contacts remained negative. The IEOP test remained negative for all animals throughout the experiment. A subpassage of a suspension of Isfahan-infected tongue tissue injected in to ponies and steers also yielded only firm swellings of lesser extent than the original reaction at the inoculation sites.

With both viruses, lethal infections were produced by intraacranial or intraperitoneal inoculation of day-old mice and hamsters, and by allantoic inoculation of embryonating chicken eggs. Adult mice, hamsters, guinea-pigs and rabbits produced serum antibodies but lacked clinical signs.

Thirty six people suffered from severe vomiting and diarrhoea 15 min to 3 h after eating vanilla slices from the same bakery. Five patients were admitted to hospital, and one developed unusual skin lesions after admission. Staphylococcus aureus was isolated in large numbers from vanilla slices of the same batch as those giving rise to symptoms, and from five faecal specimens obtained from affected persons. Bacillus cereus and Bacillus subtilis were also isolated from the slices. Unbaked custard provides an ideal environment for bacterial multiplication, especially when (as on this occasion) the ambient temperature is persistently high.

Mycobacterium bovis causes bovine tuberculosis (bTB) in many mammals including cattle, deer and brushtail possum. The aim of this study was to estimate the strength of association, using model selection (AICc) regression analyses, between the proportion of cattle and farmed deer herds with bTB in New Zealand and annual costs of TB control, namely disease control in livestock, in wildlife or in a combination of the two. There was more support for curved (concave up) than linear models which related the proportion of cattle and farmed deer herds with bTB to the annual control costs. The curved, concave-up, best-fitting relationships showed diminishing returns with no positive asymptote and implied TB eradication is feasible in New Zealand.

Because syndromic surveillance systems use pre-diagnostic data for early detection of disease outbreaks, it is important to know how the earliest signs and symptoms of a disease might appear in these systems. The available medical literature describing the sequence of signs and symptoms of pneumonic plague reveals that, during the earliest stages, patients will most likely present with certain gastrointestinal and minimal, if any, respiratory signs. Without this knowledge, early evidence of pneumonic plague in syndromic surveillance systems may be missed until the respiratory signs become prevalent. Because plague is a zoonotic disease, new syndromic surveillance systems that use animal data from park rangers and veterinarians may provide useful evidence. This paper shows how a review of both human and animal literature can be used to design queries for syndromic surveillance systems.

An apparatus which prevents the distribution of infective droplets into the air of the laboratory during the intranasal inoculation of mice is described.

Experiments using Chr. prodigiosum as indicator organism are described to show the extent and duration of the droplet dissemination by inoculated mice, and the effect of the apparatus in reducing this dissemination.

We wish to express our thanks to Dr R. B. Bourdillon for many suggestions in the design of the apparatus, and to Mr C. D. Sutton for the photographs.

A mixture of sucrose, glycerol and bovine serum albumin produces a stable coating in a Petri dish which remains adhesive for up to an hour when exposed in a slit sampler. Virus aerosols can be collected on this surface followed the direct addition of cell cultures to demonstrate the presence of viable virus. The technique is applicable to the Andersen sampler. A modified version of this sampler has been produced with the same particle collection efficiency as the standard Andersen sampler. The plaque counts obtained the adhesive surface sampling technique are believed to give an indication of the number of particles collected bearing viable virus.

Case-control studies of sporadic Campylobacter infections have predominately been conducted in non-Hispanic populations. In Arizona, rates of campylobacteriosis have been historically higher than the national average, with particularly high rates in Hispanics. In 2010, health departments and a state university collaborated to conduct a statewide case-control study to determine whether risk factors differ in an ethnically diverse region of the United States. Statistically significant risk factors in the final multivariate model were: eating cantaloupe [odds ratio (OR) 7·64], handling raw poultry (OR 4·88) and eating queso fresco (OR 7·11). In addition, compared to non-Hispanic/non-travellers, the highest risk group were Hispanic/non-travellers (OR 7·27), and Hispanic/travellers (OR 5·87, not significant). Results of this study suggest Hispanics have higher odds of disease, probably due to differential exposures. In addition to common risk factors, consumption of cantaloupe was identified as a significant risk factor. These results will inform public health officials of the varying risk factors for Campylobacter in this region.

1. After inoculation of eggs with a large dose (108·6 ID50) of influenza virus, chorio-allantoic membranes harvested from the 3rd to at least the 21st hr. (but not at the 1st or 2nd hr.) gave rise to large amounts of soluble antigen in 6 hr. in the chorio-allantoic membranes of sub-inoculated eggs (6 hr. soluble antigen production test). These amounts were larger than resulted from inoculation of equivalent numbers of ID50 of standard allantoic fluid virus. By the conventional 72 hr. test, the infectivity of the chorio-allantoic membranes increased 1 hr. later, at the 4th hr. after inoculation.

2. Allantoic fluids and chorio-allantoic membranes harvested from passages of very large and of small amounts of influenza virus were tested by 6 hr. soluble antigen production. The relative amounts of soluble antigen formed by different seeds appeared to be determined by their ID50: HA ratios, irrespective of whether they were allantoic fluid or chorio-allantoic membrane preparations. Larger amounts of soluble antigen were formed in 6 hr. per ID50 inoculated by preparations having lower ID50: HA ratios, i.e. containing larger amounts of ‘incomplete’ virus, and vice versa.

3. It is suggested that high infectivity in the 6 hr. soluble antigen test per ID50 inoculated is due to a content of ‘incomplete’ virus, or of virus precursors: possibly these are in fact the same.

4. More particles of an incomplete virus preparation than of standard allantoic fluid virus must be inoculated to produce a given amount of soluble antigen in 6 hr. It is suggested that a process resembling multiplicity reactivation must occur in cells infected with more than one particle of ‘incomplete’ virus.

Glycopeptide resistance in enterococci is now a cause of clinical concern in the United States and Europe. However, details of vancomycin resistance in enterococci in Japan have been unknown. We measured minimum inhibitory concentrations (MICs) of various antimicrobial agents for a total of 218 clinical strains of enterococci isolated in our hospital in 1995–6 in addition to 15 strains with known genotypic markers of resistance. We also screened vancomycin resistance genes using a single step multiplex-PCR.

In clinical isolates, only two strains of Enterococcus gallinarum were of intermediate resistance to vancomycin (MIC, 8 μg/ml), while the others were all susceptible. Glycopeptides (vancomycin and teicoplanin) and streptogramins (RP 58500 and RPR 106972) showed potent antimicrobial effects for the isolates. In addition, ampicillin was also potent for Enterococcus faecalis, while ampicillin, minocycline and gentamicin were potent for Enterococcus avium. No vanA or vanB genes were detected, while vanC1 and vanC23 genes were detected from two and four strains, respectively. Our results suggest that incidence of VRE in Japan may be estimated as still very low at this time.

Salmonella enterica serovar Abortusovis is one of the most common pathogens responsible for abortion in sheep. In Iran, the spread of Abortusovis is highly dependent on the nomadic life style. In this study we performed IS200 fingerprinting to identify the clonal lines circulating in Iran. All the isolates contained 4 or 5 copies of the transposon and could be classified in 4 genotypes. A single genotype was highly prevalent and very likely it has circulated in Iran since 1970. All the isolates showed a high degree of relatedness.

The age distribution of influenza A(H5N1) cases reported during 2006–2013 varied substantially between countries. As well as underlying demographic profiles, it is possible that cross-immunity contributed to the age distribution of reported cases: seasonal influenza A(H1N1) and avian influenza A(H5N1) share the same neuraminidase subtype, N1. Using a mechanistic model, we measured the extent to which population age distribution and heterosubtypic cross-immunity could explain the observed age patterns in Cambodia, China, Egypt, Indonesia and Vietnam. Our results support experimental evidence that prior infection with H1N1 confers partial cross-immunity to H5N1, and suggest that more than 50% of spillover events did not lead to reported cases of infection as a result. We also identified age groups that have additional risk factors for influenza A(H5N1) not captured by demography or infection history.