We examined the impact of the neonatal hepatitis B immunization programme, first provided to all neonates born to mothers screened positive for hepatitis B surface antigen (HBsAg) in late 1983, on the age-specific prevalence of HBsAg carriage in teenage mothers managed in 1998–2008. HBsAg carriage was found in 2·5%, 2·7%, 8·8% and 8·0% of mothers aged ⩽16, 17, 18, and 19 years, respectively (P = 0·004), which was also correlated with advancing age (P = 0·011). While neither difference nor correlation with age was found in mothers born before 1984, the prevalence of 1·2%, 1·5%, 7·1% and 8·3%, respectively, was significantly different among (P = 0·008) and correlated with (P = 0·002) age in mothers born 1984 onwards. Regression analysis indicated there was a significantly higher incidence of HBsAg carriage from age 17 onwards (adjusted odds ratio 2·55, 95% confidence interval 1·07–6·10, P = 0·035), suggesting that the protective effect of the vaccine declined in late adolescence.

Pneumonia causes significant morbidity and mortality in Aboriginal populations in Australia's Northern Territory (NT). Kava, consumed in Arnhem Land since 1982, may be a risk factor for infectious disease including pneumonia. A case–control study (n=115 cases; n=415 controls) was conducted in 7001 Aboriginal people (4217 over 15 years). Odds ratios (OR) were calculated by conditional logistic regression with substance use and social factors as confounders. Pneumonia was not associated with kava use. Crude OR=1·26 (0·74–2·14, P=0·386), increased after controlling for confounders (OR=1·98, 0·63–6·23, P=0·237) but was not significant. Adjusted OR for pneumonia cases involving kava and alcohol users was 1·19 (0·39–3·62, P=0·756). In communities with longer kava-using histories, adjusted OR was 2·19 (0·67–7·14, P=0·187). There was no kava dose–response relationship. Crude ORs for associations between pneumonia and cannabis use (OR=2·27, 1·18–4·37, P=0·014) and alcohol use (OR=1·95, 1·07–3·53, P=0·026) were statistically significant and approached significance for petrol sniffing (OR=1·98, 0·99–3·95, P=0·056).

Hepatitis B virus (HBV) vaccination has been part of the Expanded Programme of Immunization (EPI) in Tunisia since 1995. The aim of this study was to evaluate, for the first time, the impact of mass vaccination in Tunisia 17 years after this programme was implemented, and in parallel, assess the long-term persistence of anti-HBs antibody in the vaccinated Tunisian population. A total of 1422 students were recruited (703 vaccinated, 719 non-vaccinated). HBV seromarkers were checked. None of the students from either group had positive HBsAg. The overall prevalence of anti-HBc was 0·8%. A Significantly higher prevalence of anti-HBc was noted in unvaccinated students than in vaccinated (1·4% vs. 0·3%, P = 0·02). The overall seroprotection rate (anti-HBs titre ⩾10 mIU/ml) was 68·9% in vaccinated subjects. Seroprotection rates and geometric mean titres decreased significantly with increasing age, reflecting waning anti-HBs titre over time. No significant difference was detected between seroprotection rates and gender or students’ area of origin. Incomplete vaccination was the only factor associated with an anti-HBs titre <10 mIU/ml. This study demonstrates the excellent efficacy of the HBV vaccination programme in Tunisia 17 years after its launch. However, a significant decline of anti-HBs seroprotection has been observed in ⩾15-year-old adolescents which places them at risk of infection. Additional studies are needed in hyperendemic regions in Tunisia.

Helicobacter pylori is a cause of stomach cancer and peptic ulcer. For prevention, improving the eradication rate of H. pylori is crucial. However, the association between eradication and lifestyle of infected patients, including alcohol consumption, remains unclear. We explored associations between failed primary eradication therapy and drinking status by sex. This study involved 356 patients who visited a pharmacy with prescriptions for primary H. pylori eradication therapy. We assessed drinking habits using a questionnaire. Data on patients with failed primary eradication were provided by the nearby local clinic. We performed logistic regression analysis to examine the effect of drinking habit and frequency of drinking on failed primary eradication by sex. The odds ratio of primary eradication failure in female patients with a drinking habit was 3.75 (P = 0.001), but that in male patients was not significant. The odds ratio tended to increase in relation to drinking frequency in women. Frequent consumption of alcohol is not only likely to affect eradication, but also has a large impact on the bodies of women, who are more susceptible than men to the effects of alcohol. Thus, women should take greater care in alcohol consumption.

1. The action in vitro of normal rabbit-serum upon B. coli commune consists usually of three or more phases, the duration of which is inversely related to temperature.

2. The latent period which occurs on first mixing bacteria and serum is followed by a period of bacterial growth, which in its turn yields to a period of bactericidal action. This may remain final or may be succeeded by a second period of growth.

3. The germicidal action, both in case of normal rabbit-serum upon B. coli commune and of normal goat-serum upon B. typhosus, takes place in accordance with a logarithmic law so that death-rate remains proportional to the concentration of surviving bacteria.

The bactericidal action of serum thus falls into line with all other cases of disinfection, hitherto investigated.

4. The temperature coefficient of the bactericidal action of serum is low in comparison with that found for other germicides, being 2·84 per 10°C. rise in temperature for normal rabbit-serum and B. coli commune and 1·93 in the case of normal goat-serum and B. typhosus.

5. Growth of B. coli commune in rabbit-serum takes place logarithmically so that the concentration of living bacteria after equal intervals of time form terms of a geometrical series.

The calculated value of the generation-time is slightly greater than that obtaining in broth at the same temperature.

6. The influence of temperature upon rate of bacterial growth in serum is comparable with the effect upon growth in other media. The generation-time is decreased 2·01-fold for a rise in temperature of 10°C.

7. The separate processes of bacteinal growth and death in serum being similarly influenced by temperature, there is no support for the view that the significance of fever might be concerned with a tendency to encourage either process relative to the other.

Six hundred and thirteen fresh diarrhoeal faeces were inoculated on Skirrow blood agar (SK), on Preston blood free agar (PBF), and in Campy-thioglycolate broth (CT). After 24 h of storage at 4 °C, specimens were again inoculated on SK and PBF, and in Campylobacter enrichment broth (CEB). CT tubes were placed overnight at 4 °C. Plates and CEB tubes were incubated at 43 °C in microaerophilic conditions. A total of 68 specimens was positive for campylobacter on direct plating. Sixty-four of them were also recovered after subculturing from CT, and only 51 from CEB. Delayed inoculation of plates after storage of samples at 4 °C yielded 57 isolates. The storage of faeces at 4 °C for 24 h significantly reduces the number of campylobacter isolates. When samples are not plated immediately we recommend inoculating a CT tube maintained at 4 °C overnight as a holding medium.

Serological markers and peak serum alanine aminotransferase (ALT) values of 140 in-patients with acute hepatitis, either type A (n = 90), or type B (n = 50) were prospectively assessed. In 23 out of the 90 patients with acute hepatitis A, evidence of previous experience with hepatitis B virus (HBV) was found, whereas 35 out of the 50 patients with acute hepatitis B had past contact with hepatitis A virus (HAV). The mean peak ALT values [S.D.] were significantly higher in hepatitis A patients with previous experience with HBV (1413 [704] i.u./l), when compared to those without such experience (842 [464] i.u./l, P < 0·001). Such a difference was not evident between acute hepatitis B patients, whether or not they had previous contact with HAV. We conclude that when acute hepatitis A is superimposed on past HBV infection an augmented transaminaemia, indicative of enhanced liver cell necrosis, takes place although a definite explanation is lacking. We suggest that individuals with markers of HBV infection should be early candidates for HAV immunization.

A better understanding of physician practices in requesting stool samples for patients with acute gastroenteritis (AG) is needed to more accurately interpret laboratory-based surveillance data. A survey was conducted in General Practitioners (GPs) between August 2013 and July 2014 to estimate the proportion of stool samples requested for patients with AG and to identify factors associated with GP requests for a stool sample. National health insurance (NHI) data together with surveillance data from a French Sentinel GP network were also used to estimate the proportion of stool samples requested. This proportion was estimated at 4·3% in the GP survey and 9·1% (95% confidence interval 8·7–9·6) using NHI data. Multivariate analysis indicated that the ratio of stool samples requested was almost five times higher in patients with bloody diarrhoea and 10–20 times higher in patients with a long duration of illness before consultation. Laboratory-based surveillance data underestimates the actual burden of disease as fewer than one in 10 AG cases consulting their GP will be requested to submit a stool sample for laboratory testing. This underestimation varies by pathogen as stool samples are more frequently requested for severe illness.

Sex and age differences in food preferences may be reflected in the demographics of outbreaks. Outbreaks from 1998–2015 with a single confirmed implicated food source in the Centers for Disease Control and Prevention Foodborne Disease Outbreak Surveillance System were analysed using logistic regression to assess associations between a food category, sex and age. Males were more likely to be involved in outbreaks attributed to beef, pork, game, dairy and shellfish; females were more likely to be involved in grains-beans, nuts-seeds, fruits, sprouts and vegetable row crops outbreaks. Children <5-years-old were more likely than other age groups to be involved in dairy outbreaks, children 5–19-years-old were most likely to be involved in beef and game outbreaks, adults 20–49-years-old were most likely to be involved in fish, shellfish and sprout outbreaks and adults ⩾50-years-old were most likely to be involved in turkey outbreaks. Age and sex are associated with specific food categories in outbreaks. This information may be useful in helping to identify sources of foodborne disease outbreaks.

Seroprevalence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) IgG antibodies, using dried blood spots, was determined in October–November 2020, among residents and staff randomly selected from 20 nursing homes (NH) geographically distributed in Flanders, Belgium. Sociodemographic and medical data [including coronavirus disease 2019 (COVID-19) symptoms and results of RT-PCR tests] were retrieved using questionnaires. The overall seroprevalence was 17.1% [95% confidence interval (CI) 14.9–19.5], with 18.9% (95% CI 15.9–22.2) of the residents and 14.9% (95% CI 11.9–18.4) of the staff having antibodies, which was higher than the seroprevalence in blood donors. The seroprevalence in the 20 NH varied between 0.0% and 45.0%. Fourteen per cent of the staff with antibodies, reported no typical COVID-19 symptoms, while in residents, 51.0% of those with antibodies had no symptoms. The generalised mixed effect model showed a positive association between COVID-19 symptoms and positive serology, but this relation was weaker in residents compared to staff. This study shows that NH are more affected by SARS-CoV-2 than the general population. The large variation between NH, suggests that some risk factors for the spread among residents and staff may be related to the NH. Further, the results suggest that infected people, without the typical COVID-19 symptoms, might play a role in outbreaks.

This study assessed the incidence and risk factors for dengue virus (DENV) infection among children in a prospective birth cohort conducted in the city of Recife, a hyperendemic dengue area in Northeast Brazil. Healthy pregnant women (n = 415) residing in Recife who agreed to have their children followed were enrolled. Children were followed during their first 24 months of age (May/2011–June/2014), before the 2015 Zika virus outbreak. DENV infection was detected by reverse-transcriptase polymerase chain reaction and/or serology (anti-DENV IgM/IgG). The incidence rates per 1000 person-years (py) and its association with risk factors by age bands (0–12, >12–30 months) were estimated through Poisson regression models. Forty-nine dengue infections were detected; none progressed to severe forms. The incidence rates were 107·6/1000py (95% CI 76·8–150·6) and 93·3/1000py (95% CI 56·1–154·4) in the first and second years of age, respectively. Male children (risk ratios (RR) = 2·33; 95% CI 1·09–4·98) and those born to DENV-naïve mothers (RR = 2·42; 95% CI 1·01–5·80) were at greater risk of infection in the first year of age. In the second year, children born to Caucasian/Asian descent skin colour mothers had a threefold higher risk of infection (RR = 3·34; 95% CI: 1·08–10·33). These data show the high exposure of children to DENV infection in our setting and highlight the role of biological factors in this population's susceptibility to infection.

Methicillin-resistant Staphylococcus aureus (MRSA) bacteraemia cause significant morbidity and mortality in hospitalized patients. Using a nested case-control design, 204 MRSA bacteraemia cases were compared to 301 unmatched methicillin-susceptible Staphylococcus aureus (MSSA) bacteraemia controls and were matched 1:2 with non-infected controls. The independent risk factors for MRSA bacteraemia compared to MSSA bacteraemia were older age (P = 0·048), major organ transplant during current hospital stay (P = 0·016) and quinolone use (P = 0·016). Cases were more likely than non-infected controls to have renal failure (P = 0·003), cirrhosis (P = 0·013), and a central venous catheter (P = 0·003) after controlling for other risk factors. This large case-control study made it possible to assess risk factors for MRSA bacteraemia using two sets of controls and showed that risk factors differed greatly depending on the control group chosen. These results confirm the need for careful selection of appropriate control groups and the need to carefully adjust for underlying severity of illness.

In a series of investigations on the epidemic spread of bacterial infection among mice (Topley, 1919, 1921), it has repeatedly been noted that, if an epidemic be started among a mouse-population by feeding certain animals on cultures of B. gaertner and subsequently introducing other susceptible mice into the cage, a varying proportion of these latter may succumb to infection with an organism morphologically and culturally identical with B. gaertner, but differing sharply from it in regard to its agglutination reactions. This organism has been referred to in previous communications as belonging to the B. suipestifer group, using that term to include B. aertrycke and other closely related types.

We analysed associations between exposure to nightlife businesses and severe acute respiratory syndrome coronavirus 2 PCR test results at a tertiary hospital in Tokyo between March and April 2020. A nightlife group was defined as those who had worked at or visited the businesses. We included 1517 individuals; 196 (12.9%) were categorised as the nightlife group. After propensity score matching, the proportion of positive PCR tests in the nightlife group was significantly higher than that in the non-nightlife group (nightlife, 63.8%; non-nightlife, 23.0%; P < 0.001). An inclusive approach to mitigate risks related to the businesses needs to be identified.

This retrospective study highlights the degree of losses and time-course through which the 2015 highly pathogenic avian influenza (HPAI) outbreaks in Ghana were managed. A total of 102 760 birds from 35 farms across five regions in Ghana included in this study were affected. Out of this, 89.3% was from the Greater Accra region. Majority of the birds were culled (94.2%). Adult layers were most affected and destroyed (64.0%), followed by broilers (13.7%). Event initiation to reporting averaged 7.7 ± 1.3 days (range: 1–30 days). Laboratory confirmation to depopulation of birds averaged 2.2 ± 0.5 (0–15) days while depopulation to disinfection took 2.2 ± 0.7 (0–20) days. Overall, some farms took as long as 30 days to report the outbreak to the authorities, 15 days from confirmation to depopulation and 20 days from depopulation to disinfection. On average, outbreak management lasted 12.3 (2–43) days from event initiation to depopulation. The study reveals a significant number of avian losses and delays in HPAI reporting and management by the authorities in Ghana during the 2015 outbreak. This poses a high risk of spread to other farms and a threat to public health. Awareness creation for poultry farmers is necessary for early reporting, while further study is required to set thresholds for the management of such outbreaks by veterinary departments.

Bacteriological monitoring of penicillin therapy in 30 children with streptococcal sore throats was performed by means of salivary and throat-swab culture, on the first, third, fifth and ninth days after therapy had started. Counts of beta-haemolytic streptococci per ml. of saliva were also performed.

Results showed that salivary culture and estimation of the numbers of beta-haemolytic streptococci in the saliva were much more sensitive indices of the effectiveness of penicillin treatment than throat-swab culture.

The undoubted fact that milk may act as a vehicle for the transmission of a number of diseases has directed considerable attention to the Bacteriological and Public Health aspects of milk. Yet it cannot be said, tuberculosis excepted, that the bacteriological examination of milk has afforded in the past much assistance in the prevention of disease, while only very occasionally has a subsequent examination served to elucidate the cause and origin of a milk-spread epidemic. A survey of the literature of the subject will show that although extensive work has been carried out upon the bacteriology of milk, the subject is so large and many-sided that what is known is but an insignificant proportion of what requires to be ascertained. A great deal of the work done has been in relation to tuberculosis. Almost all the milk examinations have been carried out with mixed milk samples, and not with quite fresh milk from individual cows.

Strains of Bordetella pertussis in which all the organisms contain agglutinogens 1 and 3 or 1, 2 and 4 are easy to identify as serotypes 1,0,3,0 and 1,2,0,4 respectively; and similarly, stable strains of serotype 1,0,3,4 are occasionally found. During repeated subcultures, passage in vivo, and lyophilization and preservation for many years, these serotypes do not change. Mixing 1,0,3,0 and 1,2,0,4 serotypes and culturing them together in vivo and in vitro produces cultures from which organisms of the same two serotypes can be isolated.

In contrast, strains which type as 1,2,3,4 are often a heterogeneous group. We have attempted to classify these as 'stable', 'variable' and 'mixed' cultures. Some strains comprise organisms all of which contain the four agglutinogens and are as easy to type as the strains described above. These we have called 'stable' 1,2,3,4 strains. Other 1,2,3,4 strains are made up of colonies possessing all four agglutinogens, as shown by agglutinin production, but in amounts varying from day to day so that direct typing is inconsistent. These we have called 'variable' 1,2,3,4 strains. The last category, 'mixed', is made up of organisms most of which give rise to stable 1,2,3,4 cultures; a few of the component organisms, however, have one or two of the four agglutinogens missing. The importance of the 'variable' cultures is emphasized for work on apparent change of serotype, e.g. during infection.

We assessed the role of tuberculosis (TB) disease and HIV infection on the level of physical activity. A combined heart rate and movement sensor was used to assess habitual physical activity in TB patients and non-TB controls. The association between sputum-negative TB, sputum-positive TB, HIV and physical activity estimates were assessed in multivariable linear regression models adjusted for age, sex, haemoglobin and alpha-1-acid glycoprotein (AGP). Sputum-positive [eB 0·43, 95% confidence interval (CI) 0·29–0·64] and sputum-negative (eB 0·67, 95% CI 0·47–0·94) TB as well as HIV infection (eB 0·59, 95% CI 0·46–0·75) were associated with reduced activity compared to controls. Anaemia accounted for a substantial part of the effects of HIV, while elevated AGP primarily mediated the TB effect. The level of physical activity is highly influenced by TB and HIV, and mainly mediated through anaemia of infection and associated with elevated acute phase response.