The Ebola virus disease (EVD) outbreak in West Africa may affect healthcare attendance. We describe, in the Guinean prefecture of Guéckédou, trends in attendance of public healthcare structures and the main reported diagnoses over the year following the EVD outbreak notification (March 2014). Monthly numbers of visits and main diagnoses such as malaria, schistosomiasis and measles reported by Guéckédou health centres and health posts were described from January 2012 to March 2015. The median number of visits was 15 724/month. From 1 April to 30 September 2014 (EVD outbreak peak), 90 947 visits were reported, representing decreases of 4·8% and 7·4% compared to 2013 and 2012, respectively. Following December 2014 (last EVD notification in Guéckédou), visits increased from 12 540 in January to 16 032 in March 2015. Malaria seasonality was observed in 2014 with 22 519 notifications from 1 April to 31 July. No seasonality was observed for intestinal schistosomiasis (median 485 cases/month); however, a peak was notified in March 2014 (824 cases). Over the study period, all measles cases were notified in 2015 (183 cases). Reduction in healthcare attendance in Guéckédou was modest during the EVD outbreak. Enhanced infectious disease surveillance is a challenge in this context, due to the impact of EVD on traditional prevention programmes.

The presence of 10 virulence genes was examined using polymerase chain reaction (PCR) in 365 European O157 and non-O157 Escherichia coli isolates associated with verotoxin production. Strain-specific PCR data were analysed using hierarchical clustering. The resulting dendrogram clearly separated O157 from non-O157 strains. The former clustered typical high-risk seropathotype (SPT) A strains from all regions, including Sweden and Spain, which were homogenous by Cramer's V statistic, and strains with less typical O157 features mostly from Hungary. The non-O157 strains divided into a high-risk SPTB harbouring O26, O111 and O103 strains, a group pathogenic to pigs, and a group with few virulence genes other than for verotoxin. The data demonstrate SPT designation and selected PCR separated verotoxigenic E. coli of high and low risk to humans; although more virulence genes or pulsed-field gel electrophoresis will need to be included to separate high-risk strains further for epidemiological tracing.

1. The lysis of Bact. coli by glycine is inhibited completely by various treatments: (a) by heating the bacteria at 65 or 100° C.; (b) by the action of Cr, Fe, and Al salts at concentrations which cause agglutination of the organisms, (c) by various heavy metals, including particularly Hg and Ag salts, at low concentrations (d) by lethal concentrations of formaldehyde and phenol.

2. The lysis is not inhibited by sodium fluoride, potassium cyanide, or sodium monoiodoacetate at concentrations which suppress the action of certain enzymes.

3. This evidence on the whole supports the rejection of the view that a simple physical process is responsible for lysis by glycine, but does not yet enable us to distinguish between the other possible mechanisms of the lysis because the treatments used might equally interfere either with the structural proteins of the bacteria, or with the hypothetical enzymes which might be concerned in producing the lysis.

A material (LS) analogous to that described by Craigie & Wishart (1936a) has been detected in extracts of vaccinia-infected rabbit dermis. Gel-diffusion tests on this material support the view that it is a single substance possessing two distinct serologically reactive sites. The tests also show that under some conditions rabbit LS may give two lines of precipitation against suitable antisera and that this is not due usually to the dissociation of LS into discrete L and S substances.

A study of vaccinia-infected sheep dermis failed to give evidence of a single LS substance. Instead two chemically different substances were isolated, one having the serological specificity of L, the other that of S. The physical, chemical and quantitative serological properties of sheep S were such that it could not have arisen by degradation of an LS material similar to that found in vaccinia-infected rabbit dermis. On this evidence it is suggested that vaccinia virus is not necessarily synthesized in the same way in different host tissues.

Vitamin D (VD) deficiency has been linked to increased incidence and morbidity of tuberculosis (TB). Chile has large variations in solar radiation (SR; a proxy of VD status) and high prevalence of VD deficiency in its southernmost regions with low SR. We investigated the correlation between regional SR and rates of TB incidence, admissions and deaths in Chile by reviewing national records on prospectively collected mandatory disease notifications, admissions and mortality between 2001 and 2011. Over the study period, 26 691 new TB notifications were registered. The TB incidence rate was 14·77 (95% confidence intervals (CIs) 14·60–14·95), admission rate was 12·12 (95% CI 11·96–12·28) and mortality rate was 1·61 (95% CI 1·55–1·67) per 100 000 population per year. Multivariable linear regressions adjusting for significant demographic TB risk factors in Chile (regional prevalence of HIV infection, rates of migration from TB-endemic countries and rates of imprisonment) revealed an independent and highly statistically significant inverse association between SR and TB incidence rate (β −1·05, 95% CI −1·73 to −0·36, P = 0·007), admission rate (β −1·58, 95% CI −2·23 to −0·93, P < 0·001), and mortality rate (β −0·15, 95% CI −0·23 to −0·07, P = 0·002). These findings support a potential pathogenic role of VD deficiency in TB incidence and severity.

The Limulus test detected endotoxins in the plasma of burned and unburned mice infected with different species of gram-negative bacteria. Individual strains of different species of gram-negative bacteria produced different amounts of endotoxin in the plasma of infected mice. Plasma from mice given lethal infections showed very high concentrations of endotoxin. Low concentrations of endotoxin in the plasma were tolerated by mice but high concentrations were invariably fatal. A polyvalent pseudomonas vaccine reduced endotoxin in the plasma of mice given lethal infections of Pseudomonas aeruginosa.

The Joint Commission Centre for Transforming Healthcare's Web-based Targeted Solutions Tool (TST) for improving hand hygiene was implemented to elucidate contributing factors to low compliance rates of hand hygiene. Monitoring of compliance was done by trained unknown and known observers and rates of hospital-acquired infections were tracked and correlated against the changes in hand hygiene compliance. In total, 5669 of hand hygiene observations were recorded by the secret observers. The compliance rate increased from 75·4% at baseline (May–August 2014) to 88·6% during the intervention (13 months) and the control periods (P < 0·0001). Reductions in healthcare-associated infection rates were recorded for Clostridium difficle infections from 7·95 (CI 0·8937–28·72) to 1·84 (CI 0·02411–10·26) infections per 10 000 patient-days (P = 0·23), central line-associated blood-stream infections from 5·9 (CI 1·194–17·36) to 2·9 (0·7856–7·475) per 1000 device days (P = 0·37) and catheter-associated urinary tract infections from 5·941 (CI 1·194–17·36) to 0 per 1000 device days (P = 0·42). The top contributing factors for non-compliance were: improper use of gloves, hands full of supplies or medications and frequent entry or exit in isolation areas. We conclude that the application of TST allows healthcare organisations to improve hand hygiene compliance and to identify the factors contributing to non-compliance.

In 2013, an unusual increase of paratyphoid fever cases in travellers returning from Cambodia was reported in Japan. From December 2012 to September 2013, 18 cases of Salmonella Paratyphi A infection were identified. Microbiological analyses revealed that most isolates had the same clonal identity, although the epidemiological link between these cases remains unclear. It was inferred that the outbreak was caused by a common and persistent source in Cambodia that was likely to have continued during 2014. The information of surveillance and laboratory data from cases arising in travellers from countries with limited surveillance systems should be timely shared with the country of origin.

Antifungal susceptibility of Candida species is decreasing. Successful treatment for antifungal-resistant candida infection is challenging and associated with significant mortality. We performed a prospective observational study to identify the species and antifungal susceptibilities of invasive isolates of Candida species over a 5-year period at a university hospital in southern Thailand. Between 2017 and 2021, the species distribution was 39.1% Candida tropicalis, 24.8% Candida albicans, 20.3% Candida parapsilosis complex, 10.5% Candida glabrata, and 5.2% miscellaneous Candida spp. Notable observations include elevated minimal inhibitory concentration (MIC) and decrease susceptibility of C. tropicalis and C. glabrata to echinocandin and all tested triazoles. A shift of MIC90 value in the COVID-19 era was seen in C. albicans and C. tropicalis with azoles and echinocandins. Azole resistance increased among C. tropicalis isolates, and echinocandin resistance also increased among C. parapsilosis and C. glabrata isolates. Novel alterations in FKS1 HS1 and HS2 were detected in both isolates of anidulafungin-resistant C. parapsilosis. As Candida species have become more resistant to azoles and less susceptible to echinocandin development, the need arose to observe the emergence of resistance to both antifungal classes in candida clinical isolates, for a more effective infection control in the hospital.

To examine the pathogenesis of USA300 MRSA infection in long-term care residents, we performed a retrospective cohort study of 1691 adult residents of two extended-care facilities from 2003 to 2007 to assess whether the risk of subsequent MRSA infection is higher in USA300 MRSA-colonized residents compared to non-colonized residents or non-USA300 MRSA colonized residents. Six per cent of residents were colonized with USA300 MRSA; 12% of residents were colonized with non-USA300 MRSA; and 101 residents developed MRSA infection. The risk of infection was twofold higher in residents colonized with USA300 MRSA compared to residents not colonized with MRSA [adjusted hazard ratio 2·3, 95% confidence interval (CI) 1·1–4·5]. The risk of infection in USA300 MRSA-colonized residents was similar to USA300 MRSA non-colonized residents (relative risk 1·1, 95% CI 0·5–2·3). Our findings show that colonization with USA300 MRSA increases the risk of MRSA infection suggesting a similar pathogenesis.

Estimating the coronavirus disease-2019 (COVID-19) infection fatality rate (IFR) has proven to be particularly challenging –and rather controversial– due to the fact that both the data on deaths and the data on the number of individuals infected are subject to many different biases. We consider a Bayesian evidence synthesis approach which, while simple enough for researchers to understand and use, accounts for many important sources of uncertainty inherent in both the seroprevalence and mortality data. With the understanding that the results of one's evidence synthesis analysis may be largely driven by which studies are included and which are excluded, we conduct two separate parallel analyses based on two lists of eligible studies obtained from two different research teams. The results from both analyses are rather similar. With the first analysis, we estimate the COVID-19 IFR to be 0.31% [95% credible interval (CrI) of (0.16%, 0.53%)] for a typical community-dwelling population where 9% of the population is aged over 65 years and where the gross-domestic-product at purchasing-power-parity (GDP at PPP) per capita is $17.8k (the approximate worldwide average). With the second analysis, we obtain 0.32% [95% CrI of (0.19%, 0.47%)]. Our results suggest that, as one might expect, lower IFRs are associated with younger populations (and may also be associated with wealthier populations). For a typical community-dwelling population with the age and wealth of the United States we obtain IFR estimates of 0.43% and 0.41%; and with the age and wealth of the European Union, we obtain IFR estimates of 0.67% and 0.51%.

The association between herpes zoster and subsequent cancer risk is still unclear. Consequently, doubts remain regarding the need for investigation of herpes patients for co-existing or subsequent malignancy. This is a retrospective cohort study comparing cancer risk in patients after herpes zoster and age-/sex-matched non-herpes zoster patients, in a primary care-based continuous morbidity database. We tested for interaction by gender, age, diabetes, HRT use or antiviral therapy. Analyses were repeated for patients with and without herpes simplex. The hazard ratio (HR) comparing cancer risk in herpes zoster vs. control patients was significant in all women, women aged > 65 years and subgroups of breast and colorectal cancer (HRs 1·60, 1·82, 2·14, 2·19, respectively). For men, a significant association was found for haematological cancers (HR 2·92). No associations were found with herpes simplex. No interaction was identified with antiviral therapy, diabetes or HRT treatment. We concluded that there was a moderate significant association between herpes zoster and subsequent cancer risk in women aged > 65 years, without any influence of antiviral therapy. No association was found with herpes simplex. There is insufficient reason for extensively testing older patients with herpes zoster or herpes simplex for the presence of occult cancer.

In a multi-laboratory trial, lauryl tryptose mannitol broth (LTMB) and minerals-modified glutamate medium with added tryptophan (MMGM + T) were compared as single tube tests for the confirmation of Escherichia coli in water; the confirmed results were also compared with the production of gas from minerals-modified glutamate medium without added tryptophan (MMGM). LTMB and MMGM + T gave similar gas and indole results with about 90% of the water samples in most of the laboratories. When compared with the ‘correct’ results as judged by acid and gas production from lactose peptone water and indole from tryptone water, the difference in the rate of false positive reactions between LTMB and MMGM + T was insignificant; but LTMB gave a significantly lower rate of false negative reactions than MMGM + T. Gas production from MMGM without added tryptophan gave significantly higher rates of both false positive and false negative reactions. Lauryl sulphate is therefore a suitable inhibitory surfactant for use in single tubemedia for the confirmation of E. coli, which can be recommended.

The diagnosis and control of Mycobacterium bovis infection (bovine tuberculosis: TB) continues to present huge challenges to the British cattle industry. A clearer understanding of the magnitude and duration of immune response to M. bovis infection in the European badger (Meles meles) – a wildlife maintenance host – may assist with the future development of diagnostic tests, and vaccination and disease management strategies. Here, we analyse 5280 diagnostic test results from 550 live wild badgers from a naturally-infected population to investigate whether one diagnostic test (a gamma interferon release [IFNγ] assay, n = 550 tests) could be used to predict future positive results on two other tests for the same disease (a serological test [n = 2342 tests] and mycobacterial culture [n = 2388 tests]) and hence act as an indicator of likely bacterial excretion or disease progression. Badgers with the highest IFNγ optical density (OD) values were most likely to subsequently test positive on both serological and culture tests, and this effect was detectable for up to 24 months after the IFNγ test. Furthermore, the higher the original IFNγ OD value, the greater the chance that a badger would subsequently test positive using serology. Relationships between IFNγ titres and mycobacterial culture results from different types of clinical sample suggest that the route of infection may affect the magnitude of immune response in badgers. These findings identify further value in the IFNγ test as a useful research tool, as it may help us to target studies at animals and groups that are most likely to succumb to more progressive disease.

The global spread of non-tuberculous mycobacteria (NTM) may be due to HIV/AIDS and other environmental factors. The symptoms of NTM and tuberculosis (TB) disease are indistinguishable, but their treatments are different. Lack of research on the epidemiology of NTM infections has led to underestimation of its prevalence within TB endemic countries. This study was designed to determine the prevalence and clinical characteristics of pulmonary NTM in Bamako. A cross-sectional study which include 439 suspected cases of pulmonary TB. From 2006 to 2013 a total of 332 (76%) were confirmed to have sputum culture positive for mycobacteria. The prevalence of NTM infection was 9.3% of our study population and 12.3% of culture positive patients. The seroprevalence of HIV in NTM group was 17.1%. Patients who weighed <55 kg and had TB symptoms other than cough were also significantly more likely to have disease due to NTM as compared to those with TB disease who were significantly more likely to have cough and weigh more than 55 kg (OR 0.05 (CI 0.02–0.13) and OR 0.32 (CI 0.11–0.93) respectively). NTM disease burden in Bamako was substantial and diagnostic algorithms for pulmonary disease in TB endemic countries should consider the impact of NTM.

Foodborne pathogen Listeria monocytogenes may cause serious, life-threatening disease in susceptible persons. We combined data from Finnish national listeriosis surveillance, patient interview responses, and laboratory data of patient samples and compared them to listeria findings from food and food production plants collected as part of outbreak investigations during 2011–2021. The incidence of invasive listeriosis in Finland (1.3/100000 in 2021) is higher than the EU average (0.5/100000 in 2021), and most cases are observed in the elderly with a predisposing condition. Many cases reported consuming high-risk foods as well as improper food storage. Since ongoing patient interviews and whole genome sequencing were introduced, several listeriosis outbreaks were detected and food sources identified. Recommendations about high-risk foods for listeriosis and proper food storage should be better communicated to susceptible people. In Finland, patient interviews and typing and comparing listeria isolates in foods and patient samples are crucial in solving outbreaks and determining measures to control invasive listeriosis.

This study aims to develop a typology of generic meeting places based on social contact and mixing of relevance for infectious disease transmission. Data were collected by means of a contact diary survey conducted on a representative sample of the Swedish population. The typology is derived from a cluster analysis accounting for four dimensions associated with transmission risk: visit propensity and its characteristics in terms of duration, number of other persons present and likelihood of physical contact. In the analysis, we also study demographic, socio-economic and geographical differences in the propensity of visiting meeting places. The typology identifies the family venue, the fixed activity site, the family vehicle, the trading plaza and the social network hub as generic meeting places. The meeting place typology represents a spatially explicit account of social contact and mixing relevant to infectious disease modelling, where the social context of the outbreak can be highlighted in light of the actual infectious disease.

Human behaviours, which are influenced by social, cultural, economic and political factors, can increase or decrease the risk of dengue infection, depending on the relationship with the insect vector. Because no vaccine is currently available, the spread of dengue can only be curtailed by controlling vector populations (Aedes aegypti and others) and by protecting individuals. This study tested the hypothesis that dengue-affected populations are likely to relax their vector-control habits if a potentially protective vaccine becomes available. The hypothesis was tested using two approaches: a mathematical model designed to describe dengue transmission and an empirical field test in which the local population of an endemic area was interviewed about their vector-control habits given the presence of a theoretical vaccine. The model demonstrated that depending on the level of vector-control reduction, there is a threshold in vaccine efficacy below which it is better not to introduce the vaccine. The interview showed that people who were informed that a very effective vaccine is available would reduce their vector-control habits significantly compared to a group that was informed that the vaccine is not very effective.

Normal virulent B. anthracis all possess the genetical potentiality of producing capsules, but the capsule is only produced in vivo or under special cultural conditions suitable for capsule formation, especially in the presence of CO2.

During multiplication the potentially capsulated cells regularly produce a small number of a stable non-capsulated avirulent variant. All laboratory stock cultures of B. anthracis examined were found to contain from 0·14 to 32·4% of this avirulent variant. The variant has also been demonstrated in hair and wool from anthrax endemic areas, which suggests that the dissociation may also occur in nature.

Both the normal potentially capsulated cell and the variant incapable of producing capsules grow on plain agar in air as rough colonies with apparently non-capsulated cells. But when they are grown on serum agar in the presence of CO2, the normal potentially capsulated cell gives rise to a smooth mucoid colony with fully capsulated cells, while the variant still produces a rough colony with non-capsulated cells. If we regard the smooth mucoid colony produced by normal virulent B. anthracis on serum agar in CO2 as the normal colony form of B. anthracis, then the dissociation of the avirulent non-capsulated variant with the rough colony form falls in line with the usual S-R dissociation of other bacteria.

The more widely known variation of B. anthracis, which had long been held as an exception to the usual S-R variation of other bacteria, refers to colonies grown on plain agar in air. This variation is different from the one just described and is not so clear-cut and significant. Its underlying cause is not quite clear except that the chain length of the growth appears to play some part.

A summarized picture showing the whole range of variation in colony appearance and cell structure of B. anthracis is presented.

(a) This paper is a study of a poliomyelitis epidemic in the Central Auckland Health District which commenced in November 1947, and by the end of April 1949 had produced 345 cases in a population of about 350,000.

(b) Incidence per 10,000 reached 8·0 in the city, 15·4 in the country districts, and 21·5 in certain urban areas lying between city and country.

(c) In general, incidence was inversely related to population density. Abnormally high incidences in some urban areas was attributed to influx of rural dwellers in recent years. Unusually low incidence in one city area may have been related to the periodic effect of race meetings in increasing the local density.

(d) The three previous Auckland epidemics showed a successively declining incidence, and were linked by periods of grumbling activity. The present epidemic was preceded by a lull, and its toll has approached that of the 1916 epidemic. It is probable that a new cycle has begun which will imitate the first, but on a lower scale.

(e) Spot maps showed that the disease was already widespread before the first positive cases revealed its presence. Some ebb and flow, but no actual movement from one area to another, occurred during its course. An interesting feature was the comparative rarity of cases in the neighbourhood of the city's sewage-polluted bathing beaches.

(f) An inverse correlation was noted between the ratios of ‘suspect’ to positive cases established in a previous inquiry, and the incidence of cases with paralysis or paresis in various age/sex groups. High ratios indicated lower severity.

(g) It was estimated that by the end of April 1949, all boys 10–15 years in Auckland had been affected by poliomyelitis, either ‘suspect’ or positive. Less than half the girls of this age had been affected. Estimates are given for the other age groups.

(h) Families of cases showed no significant difference in composition from the average in the area.

(i) No correlation, whether inverse or direct, was found between sanitary conditions in schools and the incidence of positive cases.

(j) The cycle of poliomyelitis in the community is discussed in the light of these findings.