During the 1968 epidemic of meningococcal meningitis in Greece, 90% of the meningococci recovered from the spinal fluid of patients belonged to serological group A. In one army barracks and in one Naval Training Centre, where cases occurred, a rate of 52% and 38·9% respectively of healthy nasopharyngeal carriers of group A meningococci was found, despite repeated courses of sulpha-prophylaxis given to all the population of these military establishments shortly before the swabs were taken.

The susceptibility to sulphadiazine of 64 group A meningococci isolated from patients in different regions of the country and from healthy carriers was tested in vitro. It was found that only one strain was sensitive to a concentration of 0·1 mg./100 ml. of sulphadiazine and another to 1 mg./100 ml. For the remaining strains, the minimal inhibitory concentrations of sulphadiazine ranged from 5 mg./100 ml. to more than 20 mg./100 ml.

Thirty-six strains of group B meningococci were isolated from 34 healthy carriers and from two patients. Some of these strains were resistant to sulphadiazine. Only three strains of group C meningococci were isolated from healthy nasopharyngeal carriers in one army barracks.

We wish to express our thanks to Dr R. Faucon, Director of the International Reference Centre for meningococci, for the valuable help he gave to us during our investigation, as well as for the supply of the group-specific agglutinating antimeningococcal sera.

The incidence of Legionnaires' disease has an uneven geographical distribution in Denmark, ranging from 3 to 70 notified cases per million inhabitants per year in different towns. We investigated the prevalence of antibodies to Legionella in the one town with a consistently high incidence (Randers, Aarhus County) and compared it with that of an area of average incidence (Vejle, Vejle County). Blood samples were collected from healthy blood donors in Randers (n=308) and in Vejle (n=400), and analysed for antibodies to Legionella by indirect immunofluorescence antibody test with L. pneumophila, L. micdadei, and L. bozemanii as antigens. Overall 22·9% of the donors had antibody titres of ⩾1:128; indicating that antibodies to Legionella are common in healthy individuals, and reflecting that the bacteria may be widely distributed in the environment. Surprisingly, the study did not reveal a higher prevalence in the hyperendemic area. Thus, the high incidence of notified cases in this particular town may not be attributed to an overall increased exposure of the general population.

1. In two R.A.F. recruit stations between November 1958 and March 1959, there were 2603 admissions to Sick Quarters with respiratory illness. Throat swabs from 1129, and paired sera from 1197 were tested for certain respiratory viruses.

2. From the serological results it was estimated that 19% of the admissions were associated with influenza A infection, 7% with influenza B, 26% with adenovirus, 1% with para-influenza Type 1, 1% with para-influenza Type 3 and 8% with Coe virus, but as 21% of the identified infections were multiple the proportion of illness associated with one or more of these infections was only 50%. Thirty-four per cent of the Coe virus infections and 56% of the para-influenza virus infections were multiple.

3. Virus isolation test results led to a similar estimate of the frequency of adenovirus infection (23%) but to a lower estimate for Coe virus (3%) and for the para-influenza viruses, no systematic attempt was made to isolate influenza viruses. Reasons are given for thinking that most of the admissions associated with Coe virus infection in 1958, but few of those in 1959, were caused by this agent. The proportion of illnesses attributable to viruses of the para-influenza group was probably about 1%.

4. The main symptoms associated with Coe virus infection were upper respiratory. Hoarseness was rather more prominent than in other infections but the height and duration of fever and the frequency of febrile symptoms were less. The few illnesses associated with para-influenza virus infection had no obvious distinguishing features.

1960 survey

1. Blood specimens were taken from 205 recruits on their arrival at a recruit camp in January 1960 and immediately before their departure in March; 764 men in ten operational stations were bled in January and a sample of 260 were bled again in March.

2. The respiratory illness admission rate was 25% in the recruits and 4% in the trained men; 49% of the recruits showed a rise in antibody to one or more respiratory virus antigens compared with 2% in the other group. The high rate of infection in recruits was mainly due to adenovirus (36%) and Coe virus (20%).

3. It was estimated that about a third of the adenovirus infections and an eighth of the Coe virus infections were responsible for illness requiring admission. There was no indication that either infection caused any appreciable number of less severe illnesses not requiring admission.

4. Evidence from this survey and the earlier one suggests that the presence of neutralizing antibody to Coe virus does not prevent infection, though it appears to lower the probability of illness.

To determine the burden and distribution of acute gastrointestinal illness (AGI) in the population, a cross-sectional, monthly face-to-face survey of 10 959 residents was conducted in Jiangsu province between July 2010 and June 2011. The adjusted monthly prevalence was 4·7% with 0·63 AGI episodes/person per year. The prevalence was the highest in children aged <5 years and lowest in persons aged ⩾65 years. A bimodal seasonal distribution was observed with peaks in summer and winter. Regional difference of AGI prevalence was substantial [lowest 0·5% in Taicang, highest 15·1% in Xinqu (Wuxi prefecture)]. Healthcare was sought by 38·4% of the ill respondents. The use of antibiotics was reported by 65·2% of the ill respondents and 38·9% took antidiarrhoeals. In the multivariable model, gender, education, season, sentinel site and travel were significant risk factors of being a case of AGI. These results highlight the substantial burden of AGI and the risk factors associated with AGI in Jiangsu province, China.

In 1972 more than 20% of boys admitted to a closed community (Junior Detention Centre) developed acute tonsillitis and group-A streptococci were isolated from more than 40% of all boys at some time during their stay of two months. The most common serotype was M-type 5, which has frequently been associated with rheumatic fever in other epidemics; four cases of rheumatic fever occurred between 1972 and 1977. Various methods were tried to eliminate the infection, but only full penicillin prophylaxis (0·25 g oral penicillin 4 times a day for 10 days) to all boys on entry appeared to be effective.

In a sample of cases of acute tonsillitis, group-A haemolytic streptococci were isolated from 31·7% by the use of dry swabs or unenriched transport medium, but with enrichment medium duplicate swabs, 77·0% yielded positive results. We question the current practice in some laboratories of reporting positive cultures only when more than ten colonies of β-haemolytic streptococci are present. In this survey viruses did not appear to be an important cause of acute tonsillitis.

High titres of streptococcal antibodies (antistreptolysin O, anti-desoxyribonuclease B and anti-M associated protein) were found, not only in cases and carriers, but in boys on entry to the centre. This supports epidemiological evidence that adolescent boys on entry to the centre. This supports epidemiological evidence that adolescent boys are particularly prone to streptococcal throat infections.

Several methods were used to obtain serologically active materials from cultures of Micropolyspora faeni. From the results of immunodiffusion and immunoelectrophoresis tests on these materials it is suggested that preparations for the laboratory diagnosis of farmer's lung disease (FLD) should contain concentrated culture supernatant (CS) and extracts of mycelium obtained by ultrasonic treatment (MU). Although CS and MU have many serological activities in common they also possess activities unique to each.

Extraction of mycelium with trichloracetic acid, boiling water or methanol yielded a product which gave simple patterns in immunodiffusion tests. The products contained little protein but were rich in carbohydrates, particularly arabinose, galactose and glucosamine. A similar material was obtained from a cell-wall preparation by treatment with lysozyme. Antibodies to the serologically active substances in these materials occurred more frequently in sera of patients with FLD than antibodies to any other M. faeni antigen.

Attempts to obtain serologically active materials from spores were unsuccessful. Moreover antibodies to M. faeni could not be removed from patients' sera by absorption with partially purified spore preparations. It is suggested that the hypersensitivity in FLD arises from exposure to mycelial antigens.

Two hundred and fourteen patients who had a cough illness lasting at least 2 weeks were studied to investigate Bordetella pertussis as a cause of prolonged cough in adolescents and adults. Medical history and nasopharyngeal swab specimens for culture and polymerase chain reaction (PCR) were obtained at presentation. Three (1·4%) patients were B. pertussis culture-positive; 15 (7%) were B. pertussis PCR-positive (including the culture-positive patients) and 11 (5·1%) were Bordetella spp. PCR-positive. Symptom combinations were significantly high both in patients with pertussis and patients with indeterminate results (P < 0·05). We conclude that B. pertussis should be considered among differential diagnoses of prolonged cough in adolescents and adults and PCR and culture should be used to detect these cases and facilitate public health response.

Outbreak of Mycobacterium tuberculosis infections associated with acupuncture has not been reported. Thirteen patients with a painful swollen lump were referred to our hospital. The index patient received acupuncture and paraspinal muscular injection at a local acupuncture clinic in April 2011 and was diagnosed with M. tuberculosis 1 month later. From May 2011 to August 2011, 12 more patients with a swollen lump on the nuchal region or in the lower back or the buttocks region were referred to our hospital. Tuberculin skin test (TST), T-SPOT.TB, acid-fast stain, M. tuberculosis culture, chest radiograph, and lump magnetic resonance imaging (MRI) were performed and the patients were diagnosed with tuberculous abscess of the lump. All 13 patients received intramuscular injection at the paraspinal muscle by two acupuncturists at a local clinic and reported a swollen lump at the injection site. The needles and syringes were reused after autoclave sterilization. The TST was positive in all patients. Twelve patients had positive acid-fast stains. Mycobacterial cultures of abscess specimens were positive in all 13 patients. T-SPOT.TB tests were positive in all patients who underwent the test. The lesions and biopsies were subjected to polymerase chain reaction (PCR) and gene sequencing by the Disease Control Center of Zhejiang Province, China and the causative agent was identified as M. tuberculosis, Beijing type. In conclusion, physicians should consider the possibility of mycobacterial infections, apart from other bacterial agents, in patients with a swollen paraspinal lump following intramuscular injection.

1. 1614 strains of Corynebacterium diphtheriae have been typed and analysed and some anomalous varieties described.

2. The various types have been considered in their relation to case severity.

3. Some comments are offered on the colonial and biochemical characteristics of the various types of C. diphtheriae

4. and on the serology of the strains found in Glasgow.

5. Two gravis-like strains Types IV and VI have been observed and correlated with clinical findings, and their cultural and biochemical characteristics described.

6. Attempt has been made to confirm alleged change in fermentative characteristics by growth in serum broth, with negative results.

A one-year field-study has been carried out in a diarrhoea-endemic area in West Africa to determine the relationship between the bacteriostatic activity of fresh human milk for Escherichia coli in vitro and freedom from diarrhoea of the infant recipients of the milk. The specific contribution of E. coli gastroenteritis to gastrointestinal diseases of infants in general is not known, nor is its particular role in the Gambian infants studied. During the study period, however, both enteropathogenic and toxigenic strains of E. coli were isolated.

The incidence of diarrhoea in Gambian infants of seven age-groups from 2 days to 12 months was not significantly correlated with the bacteriostatic activity of milk. This was due rather to absence of diarrhoea in babies fed on low-activity milk than illness in those receiving highly bacteriostatic milk. Indeed, very active milk appeared to protect recipients almost completely, including seven babies of over 3 months of age, five of them during the rainy season, when the risk was high. Babies receiving lower-activity milk experienced more diarrhoea. In a situation where diarrhoeal disease is multifactorial, field evaluation of the protective action by one antibacterial property of milk is difficult. A better understanding of in vivo protection is important, and the factors which have to be taken into account are discussed.

These animal experiments corroborate the findings in the blood of anilin and nitro-benzine workers and enable us to follow the sequence of events, which appear to be the same in cases of poisoning by either of these bodies, though they are much more marked in the case of the latter.

These bodies may gain access to the body either by (1) inhalation of their vapours; (2) absorption through the skin; (3) absorption from the alimentary canal after being swallowed.

Probably the first method occurs most commonly, since cases of poisoning are much more frequent in hot close weather than during the colder seasons of the year. No matter how they are absorbed these bodies appear to have the same action on the blood, which is as follows:

They first convert the oxy-haemoglobin of the red corpuscles into met-haemoglobin, this is followed by haemolysis, degeneration of cytoplasm and escape of haemoglobin into the plasma.

If a considerable amount of met-haemoglobin is present in the blood, the respiratory capacity of the red corpuscles is diminished, the patient becomes cyanosed and the colour of the blood is changed to a chocolate brown. This fact renders the estimation of haemoglobin by the ordinary colour standards impossible, as they are based on the colour of pure oxy-haemoglobin, which is quite different from that of met-haemoglobin.

In the less severe cases of poisoning in which met-haemoglobin is not present in sufficient amount to be detected spectroscopically, the changes which may be found in the blood are sufficiently characteristic to enable a diagnosis of anilin or nitro-benzine poisoning to be made.

These consist in:

(1) A decrease in the percentage of haemoglobin as estimated from the specific gravity of the blood of from 5% to 50%.

(2) A decrease in the number of red corpuscles if the amount of poison absorbed is considerable; if the dose is very small this decrease is not found, blood formation apparently keeping pace with blood destruction.

(3) Degeneration and imperfect development of the red corpuscles as shown by the occurrence of basophil granulations, polychromasia, poikilocytosis, and variations in size.

(4) The presence of nucleated red corpuscles in severe cases.

(5) A decrease in leucocytes rapidly followed by an increase; the increase being principally due to the number of lymphocytes.

The simultaneous occurrence of all or several of these signs in the blood enables a diagnosis of poisoning by anilin or nitro-benzine to be made in quite mild cases.

Cessation from work for a short time enables the blood to recover rapidly from the effects of poisoning.

The best treatment in any severe case of poisoning by these bodies appears to be inhalation of oxygen.

Haldane, Makgill, and Mavrogordato found that mice could be kept alive in oxygen at a pressure of two atmospheres even when 90% of their blood had been converted into met-haemoglobin by injection of sodium nitrite. They also showed that animals showing severe symptoms of di-nitro-benzol poisoning recovered rapidly when placed in oxygen, and that as other substances besides met-haemoglobin are produced by the decomposition of the haemoglobin, the absence of a met-haemoglobin band is no evidence that the symptoms are not due to oxygen asphyxia.

Permission to publish this paper has kindly been given by Mr H. L. Samuel, Chairman of the Home Office Committee on Industrial Diseases.

Corynebacterium ulcerans (toxigenic C. ulcerans) produces the diphtheria toxin, which causes pharyngeal and cutaneous diphtheria-like disease in people, and this bacterium is commonly detected in dogs and cats that are reared at home. It is considered dangerous when a carrier animal becomes the source of infection in people. To investigate the carrier situation of toxigenic C. ulcerans of cats bred in Japan, bacteria were isolated from 37 cats with a primary complaint of rhinitis in 16 veterinary hospitals in Osaka. Toxigenic C. ulcerans was detected in two of the cats. By drug sensitivity testing, the detected bacterium was sensitive to all investigated drugs, except clindamycin. It appears necessary to create awareness regarding toxigenic C. ulcerans infection in pet owners because this bacterium is believed to be the causative organism for rhinitis in cats.

Salmonella spp. is a common zoonotic pathogen, causing gastrointestinal infections in people. Pigs and pig meat are a major source of infection. Although farm biosecurity is believed to be important for controlling Salmonella transmission, robust evidence is lacking on which measures are most effective. This study enrolled 250 pig farms across nine European countries. From each farm, 20 pooled faecal samples (or similar information) were collected and analysed for Salmonella presence. Based on the proportion of positive results, farms were categorised as at higher or lower Salmonella risk, and associations with variables from a comprehensive questionnaire investigated. Multivariable analysis indicated that farms were less likely to be in the higher-risk category if they had ‘<400 sows’; used rodent baits close to pig enclosures; isolated stay-behind (sick) pigs; did not answer that the hygiene lock/ anteroom was easy to clean; did not have a full perimeter fence; did apply downtime of at least 3 days between farrowing batches; and had fully slatted flooring in all fattener buildings. A principal components analysis assessed the sources of variation between farms, and correlation between variables. The study results suggest simple control measures that could be prioritised on European pig farms to control Salmonella.

This investigation of the incidence of tumours of the respiratory tract in Leeds was prompted by a paper read by Duguid before the Pathological Society of Great Britain and Ireland in January 1927, and published in the Lancet later in the same year. He analysed all the available post mortem records of the Manchester Royal Infirmary and showed that the incidence of intrathoracic cancer at autopsy in Manchester has steadily increased during the period of years 1886–1926 from 1·58 per cent, to 2·57 per cent.

The present study attempted to analyse human papillomavirus (HPV) genotype distribution and its association with cervical cytology results in women in western China. The present retrospective analysis was performed in 1089 female outpatients with a positive HPV test result who had undergone a cervical cytology test at the gynaecological clinic, West China Second Hospital, Sichuan University, China, between January 2014 and December 2016. Of the 1089 patients with HPV infection, multiple HPV genotypes were detected in 220 patients (20.20%). Among the 1368 HPV genotypes detected, 1145 (83.70%) were high-risk subtypes. The most common genotypes were HPV-52 (18.64%), HPV-16 (16.59%), HPV-58 (13.23%), HPV-18 (6.80%), HPV-56 (5.56%) and HPV-59 (5.56%). Cervical cytology revealed abnormal cells in 430 (39.49%) patients. The most common diagnoses were atypical squamous cells of undetermined significance (ASC-US; 236 cases, 54.88%), low-grade squamous intraepithelial lesions (LSIL; 151 cases, 35.12%), high-grade squamous intraepithelial lesions (HSIL; 63 cases, 14.65%) and atypical glandular cells (AGC; 21 cases, 4.88%). HPV-66 was significantly associated (P = 0.037) with ASC; HPV-52 and HPV-56 were significantly associated with LSIL (P = 0.009 and 0.026, respectively); HPV-16 (P < 0.001), HPV-33 (P = 0.014) and HPV-58 (P = 0.003) were significantly associated with HSIL; and HPV-16 (P = 0.005) was significantly associated with AGC. HPV-16, HPV-52 and HPV-58 are associated with different diagnoses in patients with positive cervical cytological findings.

Estimating the case fatality ratio (CFR) for COVID-19 is an important aspect of public health. However, calculating CFR accurately is problematic early in a novel disease outbreak, due to uncertainties regarding the time course of disease and difficulties in diagnosis and reporting of cases. In this work, we present a simple method for calculating the CFR using only public case and death data over time by exploiting the correspondence between the time distributions of cases and deaths. The time-shifted distribution (TSD) analysis generates two parameters of interest: the delay time between reporting of cases and deaths and the CFR. These parameters converge reliably over time once the exponential growth phase has finished. Analysis is performed for early COVID-19 outbreaks in many countries, and we discuss corrections to CFR values using excess-death and seroprevalence data to estimate the infection fatality ratio (IFR). While CFR values range from 0.2% to 20% in different countries, estimates for IFR are mostly around 0.5–0.8% for countries that experienced moderate outbreaks and 1–3% for severe outbreaks. The simplicity and transparency of TSD analysis enhance its usefulness in characterizing a new disease as well as the state of the health and reporting systems.

Influenza and respiratory syncytial virus (RSV) are common causes of respiratory tract infections and place a burden on health services each winter. Systems to describe the timing and intensity of such activity will improve the public health response and deployment of interventions to these pressures. Here we develop early warning and activity intensity thresholds for monitoring influenza and RSV using two novel data sources: general practitioner out-of-hours consultations (GP OOH) and telehealth calls (NHS 111). Moving Epidemic Method (MEM) thresholds were developed for winter 2017–2018. The NHS 111 cold/flu threshold was breached several weeks in advance of other systems. The NHS 111 RSV epidemic threshold was breached in week 41, in advance of RSV laboratory reporting. Combining the use of MEM thresholds with daily monitoring of NHS 111 and GP OOH syndromic surveillance systems provides the potential to alert to threshold breaches in real-time. An advantage of using thresholds across different health systems is the ability to capture a range of healthcare-seeking behaviour, which may reflect differences in disease severity. This study also provides a quantifiable measure of seasonal RSV activity, which contributes to our understanding of RSV activity in advance of the potential introduction of new RSV vaccines.

West Nile neuroinvasive disease (WNND) is a severe neurological illness that can result from West Nile virus (WNV) infection, with long-term disability and death being common outcomes. Although WNV arrived in North America over two decades ago, risk factors for WNND are still being explored. The objective of this study was to identify WNND comorbid risk factors in the Ontario population using a retrospective, population-based cohort design. Incident WNV infections from laboratory records between 1 January 2002 – 31 December 2012 were individually-linked to health administrative databases to ascertain WNND outcomes and comorbid risk factors. WNND incidence was compared among individuals with and without comorbidities using risk ratios (RR) calculated with log binomial regression.

Three hundred and forty-five individuals developed WNND (18.3%) out of 1884 WNV infections. West Nile encephalitis was driving most associations with comorbidities. Immunocompromised (aRR 2.61 [95% CI 1.23–4.53]) and male sex (aRR 1.32 [95% CI 1.00–1.76]) were risk factors for encephalitis, in addition to age, for which each 1-year increase was associated with a 2% (aRR 1.02 [95% CI 1.02–1.03]) relative increase in risk. Our results suggest that individuals living with comorbidities are at higher risk for WNND, in particular encephalitis, following WNV infection.

Group B Streptococcal isolates (n = 235) from the South of Ireland were characterised by serotyping, antimicrobial susceptibility and determination of the phenotypic and genotypic mechanisms of resistance. Resistance to erythromycin and clindamycin was observed in 21·3% and 20·4% of the total population, respectively. The c-MLSB phenotype was the most common phenotype detected (62%), with ermB being the predominant genetic determinant, present in 84% of resistant isolates. The rare L phenotype was observed in 2·9% (n = 7) of isolates, four of which harboured the lsaC gene responsible for clindamycin resistance. Serotypes Ia, III and II were the most common amongst the entire study population (28·1%, 24·7% and 14%, respectively). Four of the seven L phenotype isolates were serotype III and two of these strains were confirmed as the hypervirulent clone, ST-17 and harboured the hvgA gene. This is the first documented case of the L phenotype in Ireland to date and the study findings emphasise the need for continued monitoring of antibiotic resistance and serotype distribution in GBS isolates from Ireland.