During the summer and autumn of 1964, echovirus 4 was found widely distributed in northern Japan; this virus was associated with localized outbreaks of iaseptic meningitis in many regions. The evidence that the echovirus was aetio-logically related to aseptic meningitis was shown by the virus isolation from cerebrospinal fluids and faeces and the serodiagnosis of paired sera in many patients: Age-specific sero-immunity and morbidity rate suggested that echovirus 4 had spread extensively in about 1954. The strains of echovirus 4 isolated in the 1964; epidemic were similar to the prototype strain, Pesascek, in biological characteristics.

It has been shown that in all cultures of B. proteus and B. coli a large-cell type with two to four ‘chromosomes’ develops first and produces, after a few hours of growth, by sudden subdivision the smallest unit, a generation of small cells, each with one nuclear structure only. This cell type, singly or in filaments, persists until the end of the growing period. On a ‘swarming plate’ of B. proteus a number of these biphasic growing periods may follow each other.

‘Fusion cells’, in which the chromatinic structures have contracted into a longitudinally arranged bar, are formed when young cultures are stored in the cold.

Most mathematical models of sexually transmitted infections (STIs) assume that infected individuals become susceptible to re-infection immediately after recovery. This paper assesses whether extending the standard model to allow for temporary immunity after recovery improves the correspondence between observed and modelled levels of STI prevalence in South Africa, for gonorrhoea, chlamydial infection and trichomoniasis. Five different models of immunity and symptom resolution were defined, and each model fitted to South African STI prevalence data. The models were compared in terms of Bayes factors, which show that in the case of gonorrhoea and chlamydial infection, models that allow for immunity provide a significantly better fit to STI prevalence data than models that do not allow for immunity. For all three STIs, estimates of the impact of changes in STI treatment and sexual behaviour are significantly lower in models that allow for immunity. Mathematical models that do not allow for immunity could therefore overestimate the effectiveness of STI interventions.

We report an outbreak of hepatitis A that occurred in the city of Bari (Apulian region) in June 2002. Overall, 26 cases were observed over a 4-week period. These were traced back to the index case, a food handler who prepared various food products for sale over the counter at a store in the district (OR 5·36, CI 95% 1·58–19·25). Laboratory investigations confirmed that the outbreak was due to a point source and identified a new genotype IB variant. There is a possible indication for administration of hepatitis A vaccine to food handlers, although further evidence of an acceptable cost–benefit ratio needs to be ascertained.

Cefotaxime, a cephalosporin drug, has been shown to be active in vitro against nocardiae, a finding confirmed in this study. Pharmacokinetic studies were performed in mice to define regimens which provided peak serum levels comparable to that achieved in man with currently used doses. These regimens were shown to be effective with only short courses of therapy of rapidly progressive and highly lethal N. asteroides infection, produced by pulmonary challenge of mice. This suggests the possible utility of this drug in human nocardiosis.

To analyse sociodemographic, viroimmunological and clinical parameters in different HIV-transmission categories at baseline and during treatment, 3039 patients were followed up for 12 months after the initiation of a nelfinavir-based regimen. Multiple baseline parameters were significantly different in the diverse categories, including CD4 counts (P<0·0001) and viral load (P=0·02). There were differences in the groups regarding the CD4 response (P=0·01), but not the virological response (P=0·4), to therapy over time. Multivariate analyses revealed that transmission categories were significantly related to baseline CD4 counts (P=0·01), viral load at 12 months (P=0·0006), poorer adherence to therapy of injecting drug users (IDUs) vs. each of the other groups (P<0·001) and failure to complete the 12-month evaluation of IDU vs. heterosexual (P=0·003) and men who have sex with men (MSM) groups (P=0·02). We conclude that transmission categories had a significant influence on several baseline parameters and viroimmunological outcomes following highly active antiretroviral therapy (HAART), as well as on adherence to therapy and to medical appointments.

A seroepidemiological survey was conducted on subjects who had received a full vaccination course with live attenuated poliovirus 2–16 years before. For strains 1 and 2 prevalence of seropositives and median values dropped gradually during the first 10 years; strain 3 showed a much earlier decline. Environmental displacement of wild poliovirus by the attenuated, less immunogenic strain might eventually induce a ‘gap’, should complacency hamper needed vaccination efforts.

The fungal skin flora of a sample of 205 elderly persons in Alexandria, drawn by cluster sampling probability technique, was investigated. Pathogenic yeasts were isolated from 18·6% and 10·3% of skin and nails respectively. Candida albicans (16·1% and 7·3%) was prominent. A low prevalence of dermatophytes grown on agar (2·4% from skin and 2·9% from nails) was observed. In contrast, saprophytic filamentous fungi comprised 45·4 and 50·7% of skin and nails samples respectively. This study showed no statistically significant effect of sociodemographic variables (sex, marital status, crowding index, and income per capita) on the skin flora. There was no statistical significant difference between elderly diabetics and non-diabetics as regards fungal skin flora.

Results are presented of the laboratory examination of faeces specimens from 20,273 patients with acute diarrhoea. These were household index cases seen in general practice in a London borough during the years 1953–68. An annual average of about 2% of households in the area were affected, but there was considerable fluctuation with year and season. Half the patients were children although only one-fifth of the population at risk was under 15 years of age. The greatest incidence of diarrhoea was among children under 5 years old. Male children, but female adults predominated.

Specimens were sent for laboratory diagnosis at the discretion of the general practitioner. The laboratory found some abnormality in nearly a third and there were indications that transmissible infection was involved in about one-fifth of patients. The most common diagnosis was Sonne dysentery (9%) which came in epidemic waves and made its greatest impact among young school children. Microscopy was useful, and giardiasis was diagnosed in 1·4% of index patients. Other parasites were less commonly found. Fatty globules characteristic of an infectious condition we have called ‘fatty diarrhoea’ were frequently observed by microscopy in stools from young children and occasionally from older persons. Blood or pus cells were seen in less than half the shigella and salmonella infections and in a much smaller proportion of the remainder. A test for occult blood performed on specimens from all patients of 40 years or older was positive, in the absence of visible red cells, in a tenth of these cases.

Other studies on the bacteriology of diarrhoea in general practice are referred to and some epidemiological comparisons made. The possible place of unidentified infective agents in the aetiology of undiagnosed diarrhoeas and of ‘fatty diarrhoea’ is discussed.

Serological evaluations of foot-and-mouth disease type SAT 2 viruses isolated in Kenya between 1979 and 1982 were performed using the two-dimensional microneutralization test. Nine field isolates of epizootiological significance were compared with four vaccine viruses. The results obtained identified Tan 5/68 as the most appropriate reference vaccine virus strain since it had the broadest serological spectrum. Potent Tan 5/68 vaccines would be expected to provide adequate protection against the contemporary SAT 2 field viruses. In the case of K 83/74, which also was shown to have a broad spectrum with viruses isolated in Kenya, the results show that the 1982 isolate from central Kenya was significantly divergent (r < 1·00 at P = 0·01) and warranted tactical revaccination for its control. The study highlighted the fact that strain R1215 which had been isolated from the oesophageal-pharyngeal swabs of asymptomatic carrier cattle had a narrow serological spectrum suggesting that such viruses could be unsuitable as vaccine for the national campaign.

A high attack rate (17·3/100 000) of meningococcal disease in army recruits in Italy, with 95% of the cases due to serogroup C, constituted the motivating factors to make bivalent serogroup A + C meningococcal vaccination compulsory by law for army recruits starting January 1987. Because the vaccine was given only to the new recruits entering the army, full coverage was not achieved until January 1988. Nearly 900 000 subjects (300 000 yearly) were vaccinated between January 1987 and December 1989. There were no reports of any untoward reactions to the vaccine. Of the 300 000 recruits in service each year, 52, 21, 15, 5 and 4 cases of the disease occurred in 1985, 1986, 1987, 1988 and 1989, respectively (P < 0·001).

Of the 24 cases occurring since the start of the vaccination, only two (due to serogroup C) were attributable to vaccine failure. The remaining cases were in unvaccinated recruits (15 cases) or were due to serogroups other than A or C (7 cases). The cumulative incidence of meningococcal serogroup C in the 600 000 vaccinated recruits during the period 1988–89 was 0·2/100 000 (1 case amongst 600 000 recruits), while the corresponding figure in the 600 000 unvaccinatred recruits during the period 1985–6 was 11·3/100000 (68 cases amongst 600 000 recruits) (P < 0·001). The protective efficacy of the vaccine in 1987 was 91·2% (12 cases of meningococcal serogroup A and C disease from an average of 150 000 unvaccinated recruits observed for 1 year, and 1 case from the corresponding average of 150 000 vaccinated ones). In 1988 and in 1989 this figure could not be calculated because all recruits were vaccinated.

The incidence of meningitis caused by other serogroups of meningococci remained low, both before and after the mass vaccination campaign.

At the commencement of this paper it was pointed out that anthrax has been associated with the manipulation of hair and other raw animal materials for at least a century and a half, but that it has only been studies from an industrial point of view during the last 30 years, with the result that in 1895 cases of anthrax, occurring in workshops and factories, became notifiable. From that time to the end of 1907, over 500 cases have been brought to the notice of the Home Office. Beside these cases of industrial anthrax many others arise, chiefly from contact with animals or animal carcases affected with anthrax; these are not notifiable in this country.

The proportion of industrial to non-industrial cases of anthrax is about 4 to 3.

An analysis of cases of anthrax notified between 1898 and 1907 shows:

(1) A progressive increase in the number of cases in the woollen and worsted-industries, probably due to the increased use of dangerous classes of wool.

(2) A progressive increase in the rate of mortality, due to the larger number of internal cases among manipulators of wool.

(3) A lower rate of mortality among workers on horsehair and bristles than in other industries.

(4) A high rate of mortality in the group of miscellaneous industries in which anthrax is not usually suspected, the diagnosis being then made too late for effective treatment.

In order to make an early diagnosis it is essential for anthrax to be suspected from the nature of the employment.

Among bristle and horsehair workers:

(1) Anthrax is more fatal to the women than to the men.

(2) The occupational risk is greater for the men than for the women, because the former are more often employed in the earlier, more dangerous manipulations.

(3) The occupational risk is greater and the mortality higher among the manipulators of horsehair than in brushmaking.

(4) Horsehair is from 8 to 10 times as likely to give risk to cases of anthrax as are bristles, and the risk of infection is greatest from Chinese, Russian and Siberian raw materials; this is confirmed by actual experience not only in this country but abroad.

(5) The risk to workers on horsehair is greater than the risk to workers on wool.

The nature of the lesion varies considerably with the industry, inhalation of spores being uncommon in any but the woollen industry, though internal cases undoubtedly occur among horsehair manipulators. This is not surprising as many of the processes in these industries are similar.

The position of the pustule varies slightly with the occupation; for example, pustules on the neck are most frequent among hide and skin workers, due to the frequent carrying of skins on the shoulder. Malignant pustule is most common on the exposed parts, and to the latter those less frequently washed, as the neck and face. The infection is in most cases by the nails, which harbour the dust containing anthrax spores.

In agricultural cases lesions on the upper extremity are most common.

The mortality varies with the situation. Difficulty of operation, frequent absence of the diagnostic signs of local necrosis, looseness of the cellular tissues increase the mortality.

In all countries except Great Britain agricultural anthrax is the most common, and consequently there is a close relation between the number of cases of human and animal anthrax.

Variations in the prevalence and mortality of anthrax among human beings occur in different countries, and may to some extent be accounted for by natural constitution and environment.

There has been a progressive increase of cases in Italy, but a decrease of the death-rate, roughly corresponding to the introduction of Sclavo's serum treatment.

French statistics, as do the English, emphasize the greater risk to horsehair workers, though the risk and mortality in Great Britain compare very favourably with those in Franch, and still more so with those in Germany.

The danger of infection from anthrax in the manipulations of animal hair and bristles depends on the origin, king and cleanliness of the materials, and the processes they have to undergo.

Bristles as imported vary immensely, some being well cleansed and prepared, others in an extremely dirty state, but they are always in a far more prepared state than the horsehair.

The long tail horsehair, being more valuable, is better cleansed and less likely to cause infection than the shorter mane horsehair.

Cases of anthrax occur in practically all the processes to which hair is subjected from its time of arrival even to the finished products. Further, incidence is greatest among workers in short hair as brush-makers, and in the earlier processes, i.e. when the hair is in a less prepared state.

Infection may be carried in clothes or nails to people outside by workers.

Anthrax spores may retain their vitality for years on hair and other materials.

The dangerous classes of hair are very generally used. This is not so in the woollen and worsted trades.

Anthrax is common among animals all over Europe and Asia, and in most countries there is an increased incidence during the hot summer months. It is probable that in certain districts special conditions exist which make them permanent centres of anthrax infection. Here too hides and hair from contact with the soil may possibly become infected without the animals actually contracting anthrax.

The susceptibility of laboratory reared Zimbabwean Amblyomma hebraeum and A. variegatum ticks to infection with geographically distinct Cowdria ruminantium strains was investigated by feeding both species simultaneously on individual sheep infected with one of the four strains (Crystal Springs [Zimbabwe], Ball 3 [South Africa]. Gardel [Guadeloupe] and Nigeria [Nigeria]). A. hebraeum ticks demonstrated a high susceptibility to infection with all four C. ruminantium strains. In comparison. A. variegatum were less susceptible to infection with the Crystal Springs and Ball 3 strains (P < 0·001), but showed a similar susceptibility to the Gardel and Nigeria strains. The differences in susceptibility of A. variegatum to infection with the four strains of C. ruminantium correlated with the origin of these strains. The consistently higher susceptibility of A. hebraeum ticks to infection with geographically different C. ruminantium strains may be one explanation for the observation that heartwater is a more serious problem where A. hebraeiun is the vector of the disease.

Influenza surveillance in Danish intensive care units (ICUs) was performed during the 2009/10 and 2010/11 influenza seasons to monitor the burden on ICUs. All 44 Danish ICUs reported aggregate data for incidence and point prevalence, and case-based demographical and clinical parameters. Additional data on microbiological testing, vaccination and death were obtained from national registers. Ninety-six patients with influenza A(H1N1)pdm09 were recorded in 2009/10; 106 with influenza A and 42 with influenza B in 2010/11. The mean age of influenza A patients was higher in 2010/11 than in 2009/10, 53 vs. 44 years (P = 0·004). No differences in other demographic and clinical parameters were detected between influenza A and B patients. In conclusion, the number of patients with severe influenza was higher in Denmark during the 2010/11 than the 2009/10 season with a shift towards older age groups in influenza A patients. Influenza B caused severe illness and needs consideration in clinical and public health policy.

This study assessed the seroprevalence of brucellosis and its risk factors in migratory nomads in the Fars province of Iran. Active brucellosis was defined as the combination of clinical symptoms, including fever, chills, night sweats, headache, low back pain, arthralgia, or myalgia, and positive laboratory testing, including either a serum agglutination test (SAT) ⩾1:80 with a 2-mercaptoethanol (2-ME) test ⩾1:40, or a SAT <1:80 combined with a positive Coombs Wright test (CWT) at a titre of at least threefold higher than SAT titre results. For the 536 participants, the female (316, 59%) to male (220, 41%) ratio was 1·4 and the participants' mean age was 32·4 ± 18·9 (range 1–96) years. Of all participants, 325 (60·6%) showed clinical symptoms; in symptomatic participants, the Rose Bengal plate test was positive in 33 (6·1%) cases, the SAT was positive in 18 (3·3%) cases, and the 2-ME test was positive in 30 (5·5%) cases. Positive SAT and 2-ME results were seen in 18 (3·3%) cases, but a negative SAT and a positive CWT were found in 36 (6·7%) cases. As a result, active brucellosis was detected in 54 cases, indicating a prevalence of 10% (95% confidence interval 8–12). In conclusion, we determined that brucellosis is a prevalent yet neglected disease in this nomadic population. Brucellosis control is not possible as long as these high-risk populations remain neglected.

Antisera prepared in the rabbit by injection of crystalline horse-serum albumin or crystalline human-serum albumin show a considerable diminution in specificity after more than one course of six to eight injections has been given.

The ratio of precipitate nitrogen to antigen nitrogen at the optimal point is smaller in antisera obtained after one course of injections than in antisera derived from subsequent bleedings.

In the case of antisera obtained from first bleedings, the ratio of precipitate nitrogen to antigen nitrogen determined at the optimal point with homologous antigen is of approximately the same value in both the antigen-antibody systems studied. The increase in the values of the ratios for antisera from subsequent bleedings is also the same for both systems.

A questionnaire survey was undertaken to determine the exposure of a study population to campylobacteriosis source risk factors (environmental, water, food) and results were stratified by age, population density and deprivation. Data were gathered using an exposure assessment carried out by telephone in the Grampian region of Scotland. Univariate analysis showed that children aged 5–14 years, living in low population density (0–44·4 persons/km2) and affluent areas had elevated exposure to environmental and water risk factors. Multivariate logistic regression analysis revealed that younger age groups and lower population density were significant indicators for most environmental risk factors. The results compared to reported disease incidence in Grampian showed that greater exposure to risk factors does not necessarily coincide with greater disease incidence for age groups, particularly for the 0–4 years age group. Further research is required to explain the relationship between exposure and disease incidence.

Antimicrobial resistance (AR) is a growing problem worldwide and international travel, cross-border migration, and antimicrobial use may contribute to the introduction or emergence of AR. We examined AR rates and trends along the US–Mexico border by analysing microbiology data from eight US hospitals in three states bordering Mexico. Microbiology data were ascertained for the years 2000–2006 and for select healthcare and community pathogens including, three Gram-negative (Escherichia coli, Pseudomonas aeruginosa, Klebsiella pneumoniae) and three Gram-positive (Staphylococcus aureus, Enterococcus, Streptococcus pneumoniae) pathogens and 10 antimicrobial–pathogen combinations. Resistance was highest in S. aureus (oxacillin resistance 45·7%), P. aeruginosa (quinolone resistance 22·3%), and E. coli (quinolone resistance 15·6%); six (60%) of the 10 antimicrobial–pathogen combinations studied had a significantly increasing trend in resistance over the study period. Potential contributing factors in the hospital and community such as infection control practices and antimicrobial use (prescription and non-prescription) should be explored further in the US–Mexico border region.

In 2015–2016, simultaneous circulation of dengue, Zika and chikungunya in the municipality of Rio de Janeiro (Brazil) was reported. We conducted an ecological study to analyse the spatial distribution of dengue, Zika and chikungunya cases and to investigate socioeconomic factors associated with individual and combined disease incidence in 2015–2016. We then constructed thematic maps and analysed the bivariate global Moran indices. Classical and spatial models were used. A distinct spatial distribution pattern for dengue, Zika and chikungunya was identified in the municipality of Rio de Janeiro. The bivariate global Moran indices (P < 0.05) revealed negative spatial correlations between rates of dengue, Zika, chikungunya and combined arboviruses incidence and social development index and mean income. The regression models (P < 0.05) identified a negative relationship between mean income and each of these rates and between sewage and Zika incidence rates, as well as a positive relationship between urban areas and chikungunya incidence rates. In our study, spatial analysis techniques helped to identify high-risk and social determinants at the local level for the three arboviruses. Our findings may aid in backing effective interventions for the prevention and control of epidemics of these diseases.

1. Morphologically B. abortus and B. melitensis are identical. The “coccoid” form is not a constant feature and a more satisfactory generic name would be “Brucella.”

2. The organisms cannot be differentiated by cultural, bio-chemical, or staining methods, or by the agglutination reaction.

3. From absorption experiments, it would appear that B. melitensis is a sub-strain of B. abortus.

4. Dose for dose B. abortus is much less virulent for the guinea-pig than B. melitensis, approximately about 1: 6.

5. Immunisation of monkeys (one experiment only) with killed suspensions of B. abortus protected against subsequent infection with B. melitensis.

In conclusion I wish to thank Professor Ledingham for much valuable advice throughout the investigation, and Dr R. St John Brooks for supplying me with cultures from the National Collection.