This study evaluated whether antibiotic cycling programmes using broad-spectrum agents including carbapenems were associated with increased rates of colonization or infection by Stenotrophomonas maltophilia. Retrospective analyses of colonization or infection by S. maltophilia from 1992 to 2002 were conducted using University of Virginia Hospital clinical microbiology records of patients with any culture positive for S. maltophilia and hospital epidemiology records of nosocomial S. maltophilia infections. Incidence rates were calculated and compared for cycling and non-cycling periods. No significant differences were found in incidence rates of S. maltophilia isolates between cycling and non-cycling periods, but there was a significant secular increase in the hospital-wide rate of infections caused by S. maltophilia (P=0·01728). Antibiotic cycling protocols were not associated with a significantly increased rate of colonization of S. maltophilia as determined by the frequency of patients having at least one positive routine clinical culture in this hospital.

After the introduction of conjugate vaccines, a strong rearrangement of pneumococcal serotypes was observed globally. Probably most concerning was the emergence of serotype 19A, which has not only high invasive disease potential, but also high antibiotic resistance. In the current study we focused on the increased prevalence of serotype 19A after the PCV vaccination rate became widely used in Hungary. A total of 2262 children aged 3–6 years were screened for pneumococcus carriage using nasal swabs. Children were divided into two groups according to the vaccination rates, low level (group 1) vs. high level (group 2). While the carriage rate did not change over time (average 32·9%), the serotype distribution differed greatly in the two groups. The prevalence of serotype 19A increased >eightfold. Almost all 19A isolates had high-level macrolide resistance and elevated penicillin minimum inhibitory concentrations. Genotyping methods revealed that these new 19A isolates are different from the previously frequent Hungary19A−6 PMEN clone. Both the carriage rate and the overall penicillin and macrolide resistance remained stable over time, but while several serotypes were represented in group 1, serotype 19A alone was clearly dominant in group 2.

Transbaikalia or Zabaikalia is a vast stretch of land lying to the north-west of Manchuria, bounded on the east by River Argun from China and on the west by Lake irkutsk and Irkutsk Mountains from the Irkutsk region. Its most important cities are Chita (capital), Stretinsk, Nerchinsk, Kiakhta and Borzia. The region around borzia for a hundred miles is composed of undulating hillocks inhabited by a species of large (cat-size) marmots or tarabagans (Arctomys bobac) whose skin is much sought after for the manufacture of imitation sable. The Russians and Buriats find the flesh of these animals whole-some, and often bunt them for the meat and the fat which they use for greasing shoes. It is among the trappers and eaters of tarabagans that the early case of bubonic plague are usually reported.

The aim of this study, carried out in 1993, was to evaluate diphtheria immunity in Siena. Diphtheria antitoxin levels were measured by means of the immunoenzymatic test (ELISA) in serum samples of 602 apparently healthy subjects (239 males and 363 females) of all ages residing in Siena. According to widely used criteria, 6% of the total population were susceptible to diphtheria (antibody levels <0·01 IU/ml), 71% had basic protection (0·01–0·09 IU/ml) and 23% were fully protected ([ges ]0·1 IU/ml). The results suggested that a high proportion of young population had a protective level of immunity against diphtheria, that susceptibility increased with age and a smaller proportion of males (2·9%) than females (8·3%) were unprotected; this difference was statistically significant. Our results suggest that it may be useful to revaccinate adults with low levels of diphtheria toxoid so that the percentage that remains unprotected does not put the community at risk of an outbreak of diphtheria.

A study of the kinetics of inactivation of foot-and-mouth disease virus type SAT 2 strains revealed that in most cases the rate of neutralization was not rectilinear. Deviations from first-order kinetics observed represented biphasic or parabolic and stepwise reactions. The initial rate was rapid and showed no lag phase or shoulder. The effects of deviations from linearity could be minimized by dilution of antiserum to a suitable extent. Treatment of virus–antibody mixtures with anti-species globulin resulted in enhancement of the rate of neutralization of homologous and heterologous reactions without significantly altering the relation between the two. This treatment also considerably reduced the amount of the persistent fraction. In attempt to disaggregate virus it was observed that sodium dodecyl sulphate inhibited neutralization of virus by specific antiserum.

In the present study an attempt has been made to determine the relative importance of several factors on the mortality rates of infancy. In view of the differences in the rates at the several ages under one year and of the differential decline in these rates within recent years, it has been suggested that for any complete consideration of the death rates in infancy, some subdivision of the rate, either of a biological or temporal character, must be effected, and each of these subdivisions examined separately. The infant mortality rate has been treated in three broad categories, namely, the antenatal, neo-natal and post-natal death rates; and it has been shown that each of these depends on different factors.

Considered as death rates per unit of time the neo-natal rate is much higher than at any other period of life. The ante-natal death rate is much lower than this, and the post-natal rate lowest of all.

In relation to these rates, the influence of three, presumably important, factors have been measured. These are:

1. The provision of skilled attendance to mothers in childbed.

2. The health of the mothers.

3. Environmental and social conditions.

The indices used as measures of these three variables and their limitations have been pointed out. The author feels only too conscious of these limitations and, with such vital statistical data as the only indices available of the factors the influence of which on the mortalities of infancy it is desired to measure, it is probable that any conclusions drawn from such an analysis should be accepted with some degree of caution and reserve. Nevertheless. I am firmly convinced that even these (to the clinician and administrator) rather crude results are immeasurably superior to expressions of opinion, unsupported by facts, so frequently found forming the basis of much of the medical literature on the subject. That we have so relatively little exact quantitative knowledge of the influential factors concerned in the growth, nutrition and mortality of infants is surely not for lack of opportunity of collecting the requisite data. An admirable machinery for such a purpose—the various maternity and child welfare centres—is in extensive operation throughout this country; and if the medical officers in charge of these centres could only be persuaded to collect and analyse (or have analysed) periodically the data contained in suitably framed and completed questionnaires, many questions of scientific importance as well as of the efficacy of administrative efforts would soon cease to be subjects of controversy.

Our results show that, of these factors, only the provision of skilled medical assistance to mothers in childbed is of importance in connection with antenatal mortality. The general health of the mother and external environmental conditions have no direct influence on the death rate at this period of life. The magnitude of the correlation leads to the further conclusion that a great part of the still-birth rate is not to be controlled by improvements in even all of these factors.

The neo-natal death rate is related both to variations in external environment and in the obstetrical assistance available for mothers in childbed. At this state of life, again, the health of the mother has no substantial influence on the death rate. External surroundings and the quality of the obstetrical assistance afforded to the mother are of approximately equal importance in determining these rates; but here again the conclusion is advanced that the greater part of the death rate at this stage of life is beyond human efforts of control.

The post-natal death rate seems to offer the greatest scope for administrative measures. In this case the health of the mother would appear to come first in order of importance, environment also is of some importance, whereas the effects of variations in obstetrical services have now ceased to be reflected on the mortality of infancy.

In isolated rural communities there is a part of the post-natal death rate which could be eliminated by the speedy arrival of skilled medical assistance.

Foreign statistics have been collected and analysed to enquire into the causation of still-births. An obvious defect in these was pointed out, namely, the large proportion of deaths due to unknown causes. A comparison of these figures with those collected from several maternity hospitals has shown that hospital figures give a biassed view of the problem. The proportion of deaths due to causes in which the life of the mother as well as that of the foetus is endangered is greatly magnified, and consequently will produce a too optimistic estimate of the amount of amelioration which will result from increased attention to pregnant and parturient women. The statistics which have been given in this section show that in a really random sample of the population only a small proportion of still-births is the result of causes which can be controlled by this method, and that the chief causes of ante-natal death are developmental defects of the foetus and prematurity.

A short study has been made of certain statistico-anatomical features of the foetus and infant. From this it has been inferred that the foetus is physically in a state of extreme instability, that the conditions which kill in utero are rapidly fatal to the foetus, and that this instability is a somewhat more prominent feature in the male than in the female. As infancy advances, visceral variability decreases steadily, so that it would seem probable that some time is necessary for the foetus to adapt itself to its new mode of existence after birth. This state of unstable equilibrium in early life may provide some reason for the higher mortalities at these ages.

Isolations of subgenus III salmonellas (arizonas) made in the regional Public Health Laboratory, Cardiff, between 1959 and 1971 are reviewed. The techniques of isolation are listed for the various materials examined. The necessity of using bismuth sulphite agar as a plating medium is stressed, as some strains might appear on brilliant green MacConkey agar as rapid lactose fermenters and be missed. The serotypes isolated in Cardiff are discussed with reference to isolations by other authors. The culture of a subgenus III salmonella from pig faeces is described. It is thought that this is the first record of such an isolation from a pig in the United Kingdom.

A method for typing Haemophilus species is described, based on the analysis of genomic DNA from Haemophilus parainfluenzae. The DNA was extracted by a rapid method and digested with the restriction enzyme BamHI to provide a characteristic ‘fingerprint’. The pattern of fragments in the ranges 1–1·6 kb, 1·6–2 kb and 2–3 kb were used to produce a numerical profile of each isolate. In total 97 isolates were examined; 88 from throat swab material isolated from the 15 members of a British Antarctic Survey base and 9 type strains. Seventy-two of the 88 antarctic isolates were H. parainfluenzae and were found to be very diverse, comprising 41 identifiable strains with up to 5 strains being isolated from a single throat swab sample. There was evidence for both carriage and transmission within the isolated community. The technique provided a highly discriminatory method for characterizing Haemophilus strains which is suitable for epidemiological studies.

The phage types and antimicrobial susceptibilities of 226 isolates of Salmonella enterica serovar Typhi from imported cases in Japan between 2001 and 2006 were investigated. Most (93·8%) had travelled to Asian countries, particularly South East Asia. Twenty-one phage types were identified with E1 (30·5%), UVS (15·9%) and B1 (9·3%) being the most common. The frequency of multidrug-resistant strains reached 37·0% in 2006 with phage types E1 and E9 predominating. Almost half (48·2%) of the isolates were resistant to nalidixic acid and two isolates displayed high-level fluoroquinolone resistance. Three mutations, two in gyrA and one in parC, were identified in both isolates.

The Salmonella Reference Centre in Johannesburg received 14059 strains of human origin between 1979 and 1984. A significant proportion (6·3%) proved to belong to subspecies II. The majority were cultured from faecal material, usually associated with symptoms related to the gastrointestinal tract. They comprised 884 isolates, represented by 203 serotypes, of which 45 were new serotypes.

The poor hygienic conditions found in many rural areas, together with possible contamination of food and water by wild animals, may contribute to the greater frequency of human S.II infections and the widespread occurrence of unusual serotypes in man in this geographic region.

The prevalence and genotype distribution of human papillomavirus (HPV) infection in women with normal cervical cytology varies widely according to the population studied. Two non-overlapping population-based cohort studies of women aged ⩾30 years for the periods 2008–2009 (n=5026) and 2004–2005 (n=10 014) were analysed. The prevalence rate of HPV was 11·0% (95% CI 10·5–11·6). HPV infection was significantly associated with age, menopausal status, and inversely associated with hormone replacement therapy. There was an increasing trend of α3/α15, α5/α6, and multiple HPV infections with increasing age. The five most common types were HPV52, 18, 53, 58 and 70, while HPV16, 31, 33 ranked 21st, 25th, and 16th, respectively, in the merged cohort with normal cytology (n=14 724). HPV16, 31, and 33 were significantly associated with abnormal cytology, which could have resulted in their rarity in the total merged cohort (n=15 040).

In several lately published studies, the association between single-nucleotide polymorphism (SNP, rs12252) of IFITM3 and the risk of influenza is inconsistent. To further understand the association between the SNP of IFITM3 and the risk of influenza, we searched related studies in five databases including PubMed published earlier than 9 November 2017. Ten sets of data from nine studies were included and data were analysed by Revman 5.0 and Stata 12.0 in our updated meta-analysis, which represented 1365 patients and 5425 no-influenza controls from four different ethnicities. Here strong association between rs12252 and influenza was found in all four genetic models. The significant differences in the allelic model (C vs. T: odds ratio (OR) = 1.35, 95% confidence interval (CI) (1.03–1.79), P = 0.03) and homozygote model (CC vs. TT: OR = 10.63, 95% CI (3.39–33.33), P < 0.00001) in the Caucasian subgroup were discovered, which is very novel and striking. Also novel discoveries were found in the allelic model (C vs. T: OR = 1.37, 95% CI (1.08–1.73), P = 0.009), dominant model (CC + CT vs. TT: OR = 1.48, 95% CI (1.08–2.02), P = 0.01) and homozygote model (CC vs. TT: OR = 2.84, 95% CI (1.36–5.92), P = 0.005) when we compared patients with mild influenza with healthy individuals. Our meta-analysis suggests that single-nucleotide T to C polymorphism of IFITM3 associated with increasingly risk of severe and mild influenza in both Asian and Caucasian populations.

Many clinics in rural western Kenya lack access to safe water and hand-washing facilities. To address this problem, in 2005 a programme was initiated to install water stations for hand washing and drinking water in 109 health facilities, train health workers on water treatment and hygiene, and motivate clients to adopt these practices. In 2008, we evaluated this intervention's impact by conducting observations at facilities, and interviewing staff and clients about water treatment and hygiene. Of 30 randomly selected facilities, 97% had water stations in use. Chlorine residuals were detectable in at least one container at 59% of facilities. Of 164 interviewed staff, 79% knew the recommended water-treatment procedure. Of 298 clients, 45% had received training on water treatment at a facility; of these, 68% knew the recommended water-treatment procedure. Use of water stations, water treatment, and client training were sustained in some facilities for up to 3 years.

Following the subcutaneous injection of typhoid vaccine into rabbits the average antibody response was estimated from day to day, and found to vary for agglutination, bactericidal action, phagocytosis (including tropins), “precipitation” and probably for complement-fixation according to the dose of vaccine.

As estimated by the maximal value reached by the serum the response increases with increasing dose in nearly all cases. This increase becomes relatively less and less as the dose increases, and its progress suggests that with a sufficiently large dose a limiting-value might be reached, which if not actually a true limit would be practically one.

The observed relationship between dose and effect is such as to suggest that the combination of antigen and reacting-cell takes place in accordance with the rules governing adsorption processes; but this does not hold for the response in bactericidal power.

With increasing vaccine-dose the date at which the maximal value is reached gets later for the various antibodies, with again exception of the bactericidal power.

The precipitation observed differs from the usual precipitation reaction and is perhaps really an agglutination-phenomenon.

Phagocytosis was observed in three ways, and the bearing of the results on the mechanism of the action of the antibody concerned is considered; and the relationship between the bactericidal and other antibodies is also discussed.

We examined the association between water exposures and acute diarrhoeal illness (ADI) in children under non-outbreak conditions in a major US metropolitan area. We used a nested case-control study of children seen in an urban/suburban emergency department. Cases were those seen for a complaint of diarrhoea, while controls were age-matched children with a non-gastrointestinal complaint. Parents of subjects completed a validated water-use survey. Stratum-specific adjusted odds ratios (aOR) were calculated for the three main water effects: water source [surface vs. ground (well)], drinking-water type (tap vs. bottled), and use of water filters. Of 2472 subjects, 45% drank mostly or only bottled water. Well-water use was associated with increased odds of ADI compared to surface water [aOR 1·38, 95% confidence interval (CI) 1·01–1·87]. Use of bottled water did not affect the odds of ADI in well-water users, but increased the odds of ADI for surface-water users (aOR 1·27, 95% CI 1·02–1·57). We conclude that well-water use and bottled-water use are associated with increased odds of ADI in children.

Risk populations for HIV infections tend to neglect condom use, making alternative preventive approaches necessary. Accordingly, we modelled the risk of sexual HIV transmission for condom use vs. use of rapid diagnostic test (RDT) systems with subsequent exclusion of potential sexual partners with a correctly or falsely positive test from unprotected sex with and without the use of HIV pre-exposure prophylaxis (PrEP) in a bio-statistical approach. We combined a previously described model of transmission risk for HIV-exposed individuals with a newly suggested model of risk of HIV exposure for sexually active HIV-negative individuals. The model was adapted for several stages of infection and different strategies of HIV infection prevention.

HIV prevention with RDTs can reduce the transmission risk by up to 97% compared with having sex without any prevention and up to 80% compared with condom use. Nevertheless, RDT-based prevention strategies demonstrate a lack of protection in several stages of infection; in particular, RNA-based RDT systems may fail under treatment. RDT-based pre-screening of potential sex partners prior to unprotected sexual contacts substantially reduces HIV transmission risk. Combination of different prevention strategies is advisable for high-risk groups.

In a multi-laboratory trial, minerals-modified glutamate medium (MMGM) was compared with lauryl tryptose lactose broth (LTLB) in the multiple tube method for the enumeration of coliform organisms, including Escherichia coli, in water. Samples of raw and chlorinated waters yielded a total of 2313 positive tube-reactions with MMGM and 2174 with LTLB. These were interpreted either as E. coli; other coliform organisms; or as false positive reactions. The results at first reading (18 or 24 h) and at 48 h have been analysed statistically in terms of (i) most probable numbers of coliform organisms; (ii) positive reactions and their interpretation; and (iii) whether or not the sample yielded any E. coli or other coliform organisms. All three analyses indicated the same trends. For the detection of E. coli in raw waters LTLB was better than MMGM at 18–24 h, but MMGM was better at 48 h with waters containing small numbers of coliform organisms; for raw waters with greater numbers of organisms, both media performed equally well. Analysis of a subset of samples read at both 18 and 24 h indicated that the superiority of LTLB over MMGM with raw waters disappeared by 24 h. For chlorinated waters, LTLB yielded more positive gas reactions at 18–24 h, but fewer of these were E. coli than with MMGM; at 48 h MMGM was clearly better than LTLB for total coliform organisms including E. coli – especially if the numbers were small. MMGM therefore remains the medium of choice for the detection of E. coli as an indicator of faecal contamination of chlorinated drinking water supplies. It is also better for the detection of small numbers of E. coli in other waters.

Mycobacterium bovis infects the wildlife species badgers Meles meles who are linked with the spread of the associated disease tuberculosis (TB) in cattle. Control of livestock infections depends in part on the spatial and social structure of the wildlife host. Here we describe spatial association of M. bovis infection in a badger population using data from the first year of the Four Area Project in Ireland. Using second-order intensity functions, we show there is strong evidence of clustering of TB cases in each the four areas, i.e. a global tendency for infected cases to occur near other infected cases. Using estimated intensity functions, we identify locations where particular strains of TB cluster. Generalized linear geostatistical models are used to assess the practical range at which spatial correlation occurs and is found to exceed 6 in all areas. The study is of relevance concerning the scale of localized badger culling in the control of the disease in cattle.

The objective of this study was to compare the occurrence of Salmonella spp. found in the animal environment in pig herds with different Salmonella risks (61 herds with low seroprevalence, 81 herds with high seroprevalence) on a broad scale. The environmental samples were divided into two types: direct (n=1105) and indirect (n=1220) environmental samples. All samples were tested for Salmonella spp. via real-time polymerase chain reaction. Most of the indirect environments were more often Salmonella-positive in the high-seroprevalence herds than in the low-seroprevalence herds; significantly higher were compartment aisles [odds ratio (OR) 3·45, 95% confidence interval (CI) 1·61–7·41], driving boards (OR 3·06, 95% CI 1·38–6·92) and the central aisle of the barn (OR 3·03, 95% CI 1·35–6·83). The overall results show that especially areas in the indirect environment are the major, but mostly underestimated causes of residual Salmonella.