During the period 1968–85 shigella organisms were isolated from stool specimens of 1562 patients attending Tygerberg Hospital, situated in the south-western province of the Cape of Good Hope of the Republic of South Africa. Shigella flexneri (72% of patients) was the commonest subgroup identified. Sh. sonnei was the second-commonest isolate (20%), with smaller number of Sh. boydii (5%) and Sh. dysenteriae (3%). Sh. dysenteriae has not been isolated since 1979. In 1985 30% of isolates were resistant to ampicillin and 52% to trimethoprim-sulphamethoxazole. During this period 12 cases of shigellaemia were seen, 11 in young infants less than 13 months of age who were malnourished in 6 cases. The single adult had had a previous gastrectomy and splenectomy.

Enzyme immunoassays (EIA) were used to measure serum antibodies to Cryptosporidium in four immunocompetent adults with recent proven cryptosporidial infection, 379 healthy children and 73 adult volunteers in Melbourne, Australia, and 205 children in Papua New Guinea (PNG) (47 healthy children; 158 with pneumonia). Antibodies peaked 3–6 weeks after infection and fell to baseline within a few months. A high level (5000 EIA units/ml) or a significant change between paired sera, of IgG or IgM, were taken as evidence of recent infection and found in 24% of PNG children and in 8% of children and 5% of adults in Melbourne. Among PNG children with pneumonia who had high cryptosporidial antibody levels, those with measles (6/8) were significantly more likely (P = 0·002) to have diarrhoea than the remainder (4/28). Symptomatic cryptosporidiosis may be associated with transient immune suppression due to viral infection. This study indicates that serological surveys can contribute to an understanding of the epidemiology of cryptosporidosis.

Shigella flexneri infections are one of the main causes of acute diarrhoea in Cuba. Twenty strains isolated from sporadic cases in nine different Cuban provinces were characterized. Serotyping, antibiotic-resistance typing, plasmid-typing and AFLP-typing were used to determine their suitability for use in epidemiological studies of S. flexneri. The predominant serotypes were serotype 6 (35%) and serotype 2 (35%). Eleven different plasmid profiles were detected (Diversity Index=0·92). AFLP-typing discriminated 12 different patterns (DI=0·95), these patterns were not coincident with plasmid-typing patterns. Both techniques combined distinguished 14 patterns among the 20 studied strains (DI=0·99). There was no consistent relationship between plasmid-typing and AFLP-typing patterns or antibiotic-resistance typing patterns. Ninety-five percent of S. flexneri strains were multiresistant.

Plaque neutralization on HEp 2 cells was used to determine the relationship between vaccinia, rabbitpox, cowpox and ectromelia using both 7 S and 19 S antibody. It was shown that for the strains of virus used vaccinia and rabbitpox were very similar but cowpox and particularly ectromelia were clearly distinguishable. The cross-titration relationships were the same for 7 S and 19 S antibody.

The titration slopes and kinetics of cross-neutralizations were interpreted on the basis of a hypothesis of antibody competition put forward in the preceding paper. It was tentatively concluded that these four viruses share a common critical antigen for neutralization and that differences in the structure or presentation of neighbouring antigens could give rise to some of the observed effects.

During an average follow-up time of about 2½ years after total hip or knee-joint replacement in 8052 patients, suspected joint infection was recorded in 85 patients whose joints had not been re-operated during that period. The hospital records of 72 of these patients were examined after a further period, averaging about 5 years. Thirty-five of these had suffered continuing major problems with the joint, 18 of which had been revised, and a further 9 joints needed such treatment. Infection was confirmed in 17 of the 35. These numbers are proportionately about three times greater than those observed among a set of matched controls followed-up for a similar period. The evidence from the extended follow-up suggests that the failure rate, unassociated with infection, reached about 5% by 7 years after operation and that late infections, manifested between about 2½ and 7 years after operation, were about as frequent as those confirmed during the first 2½ years.

In this study the putative protective seroprevalence (PPS) of IgG antibodies to the 27-kDa and 15/17-kDa Cryptosporidium antigens in sera of healthy participants who were and were not exposed to Cryptosporidium oocysts via surface water-derived drinking water was compared. The participants completed a questionnaire regarding risk factors that have been shown to be associated with infection. The PPS was significantly greater (49−61%) in settlements where the drinking water originated from surface water, than in the control city where riverbank filtration was used (21% and 23%). Logistic regression analysis on the risk factors showed an association between bathing/swimming in outdoor pools and antibody responses to the 15/17-kDa antigen complex. Hence the elevated responses were most likely due to the use of contaminated water. Results indicate that waterborne Cryptosporidium infections occur more frequently than reported but may derive from multiple sources.

An upsurge of fever cases of unknown origin, but resembling dengue and leptospirosis was reported in Havelock, Andaman & Nicobar Islands, an important tourism spot, during May 2014. Investigations were carried out to determine the aetiology, and to describe the epidemiology of the outbreak. The data on fever cases attending Primary Health Centre (PHC), Havelock showed that the average number of cases reporting per week over the last 2 years was 46·1 (95% confidence interval 19·4–72·9). A total of 27 (43·5%) patients out of the 62 suspected cases were diagnosed as having DENV infection based on a positive enzyme immunoassay or reverse transcriptase–polymerase chain reaction. The overall attack rate was 9·4 cases/1000 population and it ranged between 2·8 and 18·8/1000 in different villages. The nucleotide sequencing showed that the virus responsible was DENV-3. DENV-3 was first detected in the Andaman & Nicobar Islands in 2013 among wharf workers in Port Blair and within a year it has spread to Havelock Island which is separated from South Andaman by 36 nautical miles.

Drug use is a major mode of HIV transmission in Thailand. This study determined HIV incidence rates among drug users in a regional drug treatment centre in northern Thailand. A retrospective cohort of repeatedly-hospitalized drug users between 1993 and 1997 was formed and HIV incidence rates were calculated. The overall incidence was 11·44 per 100 person-years of observation. Gender, age, religion, ethnicity, education, employment, income, reasons for drug use, type of drugs, mode of use, spending on drugs, and referral for treatment are associated with HIV incidence. However, there are no associations between HIV incidence and history of treatment and mode of discharge from the centre. This implies that current treatment modality has no impact on HIV infection risk and other therapeutic approaches should be explored.

The protection afforded by a combined enteric and cholera vaccine administered by the intradermal route, and demonstrated by active and passive mouse protection tests and agglutination titres, is excellent and equal to that given individually by the component TAB and cholera vaccines.

In order to reduce the number of injections required and the unpleasant reactions provoked it is suggested that combined enteric and cholera vaccine administered by the intradermal route is of value, where appropriate, for the vaccination of travellers, and for the rapid protection of non-immune persons in the event of natural disasters or mobilization.

Measles is a highly infectious disease with a high reproduction rate [1]. For every index case occurring in a susceptible population, 15–17 secondary cases will occur [1]. The most effective way to control measles is by active immunization of a high proportion of the population [2]. MMR vaccine was introduced in the UK in October 1988 and achieved coverage levels in excess of 90% [3]. Prior to this measles vaccination coverage was low and transmission was largely unaffected. According to seroprevalence studies <1% of individuals born before 1970 and <10% born between 1970 and 1989 are antibody negative to measles [4, 5]; however, despite measles vaccination programmes residual susceptibility is present in young adults [6]. We describe an outbreak of measles occurring in a prison in Yorkshire that began in December 2012.

We studied the association that exists between the epidemiological type clustering of isolates of Mycobacterium tuberculosis and certain clinical, epidemiological and socio-economic characteristics of tuberculosis patients in the Elche health district of Spain. A total of 144 patients diagnosed between 1993 and 1999 and whose isolates had been genotyped by IS6110–RFLP in an earlier study were included. Multivariate analysis showed that the independent variables associated with clustering of strain types were: age (1–25 years, OR 2·92, 95% CI 0·83–10·3), a high percentage of infection in the first circle of contacts (OR 2·89, 95% CI 0·96–8·68), urban dwelling (OR 2·12, 95% CI 0·73–6·2), use of bronchoscopy to obtain samples (OR 16·3, 95% CI 2·3–11·5) and working contact with many people (OR 2·81, 95% CI 0·94–8·3). These data contribute to a better understanding of the epidemiology of tuberculosis and improved systems of control.

Because sentinel surveillance systems cannot obtain information about patients who visit non-sentinel medical facilities, the characteristics of patients identified by these systems may be biased. In this study, we evaluated the representativeness of a methicillin-resistant Staphylococcus aureus (MRSA) surveillance system using health insurance claim (HIC) data, which does not depend on physician notification. We calculated the age-specific incidence of MRSA patients using data from the Japan Nosocomial Infections Surveillance (JANIS) programme, which is based on sentinel surveillance systems, and inpatient HICs submitted to employee health insurance organizations in 2011, and then computed age-specific incidence ratios between the HIC and JANIS data. Age-specific MRSA incidence in both datasets followed J-shaped curves with similar shapes. For all age groups, the ratios between HIC and JANIS data were around 10. These findings indicate that JANIS notification of MRSA cases was not affected by patients’ age.

Two common forms of invasive disease due to Haemophilus influenzae type b (Hib) are epiglottitis and meningitis. It is not known why some children develop epiglottitis and others meningitis. To examine the hypothesis that epiglottitis occurs in children who may have been previously exposed to Hib, and who would therefore exhibit a more vigorous antibody response in convalescence, we measured levels of antibody to Hib capsule in 92 children. Geometric mean convalescent-phase IgG, IgA, IgM and total antibody levels were significantly higher in 45 children with epiglottitis than in 47 with meningitis, even after adjustment for age differences (mean total antibody, 95% confidence intervals: meningitis 0·38, 0·34–0·43; epiglottitis: 2·25, 2·0–2·54 μg/ml). However, contrary to previous reports, a poor antibody response was only observed in a minority of children with meningitis; the antibody response of the majority was indistinguishable from that observed in children with epiglottitis.

A Staphylococcus aureus strain grown once in vivo in rabbit pleural cavities was appreciably more resistant to killing by soluble polymorph bactericidins than its broth-grown counterpart. Parallel results were obtained using an adaptation of Solberg's drug-inhibition method of measuring intracellular killing after critical aspects of it had been evaluated and modified. Individual in vivo grown organisms were surrounded by a layer of less dense material which was not capsular in nature but which made the organisms clump together. This surface coating was lost on subculture in vitro, resulting in a reversion to broth-like susceptibility, thus indicating that the surface coating was largely responsible for the enhanced resistance and that it resulted from interactions between staphylococci and components of the rabbits' natural body fluids. Consequently, growth in plasma produced organisms which mimicked in vivo grown organisms in clumping, surface coating and in resistance to killing. The use of plasma-grown staphylococci in further studies of likely resistance mechanisms in vivo is discussed.

Phagocytosis prevents the multiplication of Streptococcus suis in blood samples from conventionally reared adult pigs. It is mediated by antibody, probably IgM, present in the serum of adults and specifically directed against the capsular polysaccharide of S. suis. The blood of young pigs reared in a ‘pathogen-free’ environment allows multiplication of encapsulated S. suis. Of 160 piglets conventionally reared, the blood of 92(58%) did not permit multiplication of S. suis. Blood from the remaining 68(42%) allowed multiplication but became bacteriostatic when the animals reached the age of 6 to 8 weeks. Serum from adult pigs confers bacterio static activity on blood from susceptible piglets in vitro and passively protects such piglets against experimental S. suis infection in vivo.

We thank Dr T. J. L. Alexander, formerly of Ontario Veterinary College, and Mr P. C. Trexler of the Royal Veterinary College, London, for providing us with serum from gnotobiotic pigs.

The work described in this report was carried out by one of us (K. K. A.) during the tenure of a Commonwealth Scholarship and was incorporated in a dissertation submitted for the Ph.D. degree of the University of Cambridge.

The fact that a substantial proportion of tuberculosis drug resistance (especially multidrug resistance) is due to transmission of resistant strains or treatment failure in the UK underlines the need to strengthen control in this country. Early identification and effective treatment of cases (including measures to support adherence and appropriate use of initial treatment regimes involving at least four drugs in those at risk of isoniazid resistance) would help to control the problem [1].

Calves which were the progeny of rinderpest-susceptible dams were inoculated with lapinized rinderpest virus when 1 day to 2 months old. Their serological response, as measured by neutralizing antibody titre 21 days later, did not differ from that of adult susceptible cattle.

In calves born of rinderpest-immune cows, the serological response to caprinized rinderpest virus depended upon the level of maternally derived antibody. There were two critical levels, one below which all calves produced antibodies (serum titre of 0.7 or less) and another above which no antibody was formed (serum titre of 2.2 or more). Thus all animals aged 8 months or more at the time of inoculation were actively immunized but no calf aged 3 months or less reacted in this manner.

The response of calves with maternally derived antibody titres between 0.9 and 2.0 varied. There was a significant inverse relationship between the preinoculation titre and the amount of antibody formed during the following 3 weeks. A similar inverse relationship was shown between the pre-inoculation titre and the rate of production of antibody and its titre 1 year following inoculation.

Calves which possessed colostral antibody, and which were actively immunized by caprinized virus inoculation, did not necessarily show the usual clinical reaction. When such animals failed to become actively immunized there was no sensitization of the antibody-forming mechanism, a fact demonstrated by the lack of an anamnestic response to subsequent exposure to rinderpest virus antigen.

I owe thanks to many people: to Dr S. E. Piercy, Deputy Director, E.A.V.R.O., for advice and encouragement; to Mr G. R. Scott, Senior Virologist, E.A.V.R.O., for advice and encouragement and, with Mr G. J. Knight, for help in the statistical analysis of the data; to Dr M. H. French lately head of Division and Mr G. Lampkin, Joint Animal Industry Division of E.A.A.F.R.O. and E.A.V.R.O. for facilities for the inoculation of calves from rinderpest-immune dams with rinderpest vaccine; Mr J. M. Nightingale, Sasamua Estate, South Kinangop, and Mr J. Armstrong, Naivasha, for facilities for immunizing calves from rinderpest-susceptible dams; Mr C. S. Rampton, Mr N. Kerani and Mr F. Mwithiga for technical assistance.

This and the previous paper (see p. 427) are published by permission of the Director, East African Veterinary Research Organization.

Antimicrobial drugs are used to treat pathogenic bacterial infections in animals and humans. The by-stander enteric bacteria of the treated host's intestine can become exposed to the drug or its metabolites reaching the intestine in antimicrobially active form. We consider which processes and variables need to be accounted for to project the antimicrobial concentrations in the host's intestine. Those include: the drug's fraction (inclusive of any active metabolites) excreted in bile; the drug's fractions and intestinal segments of excretion via other mechanisms; the rates and intestinal segments of the drug's absorption and re-absorption; the rates and intestinal segments of the drug's abiotic and biotic degradation in the intestine; the digesta passage time through the intestinal segments; the rates, mechanisms, and reversibility of the drug's sorption to the digesta and enteric microbiome; and the volume of luminal contents in the intestinal segments. For certain antimicrobials, the antimicrobial activity can further depend on the aeration and chemical conditions in the intestine. Model forms that incorporate the inter-individual variation in those relevant variables can support projections of the intestinal antimicrobial concentrations in populations of treated host, such as food animals. To illustrate the proposed modeling framework, we develop two examples of treatments of bovine respiratory disease in beef steers by oral chlortetracycline and injectable third-generation cephalosporin ceftiofur. The host's diet influences the digesta passage time, volume, and digesta and microbiome composition, and may influence the antimicrobial loss due to degradation and sorption in the intestine. We consider two diet compositions in the illustrative simulations. The examples highlight the extent of current ignorance and need for empirical data on the variables influencing the selective pressures imposed by antimicrobial treatments on the host's intestinal bacteria.

Hospital discharge reports have provided data for studies of methicillin-resistant Staphylococcus aureus (MRSA) skin and soft-tissue infection (SSTI) studies. This analysis determined the sensitivity and positive predictive value of International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) code combinations to calculate hospitalization incidence rates, representativeness of a set of three ICD-9-CM codes to define MRSA SSTI, and hospitalization incidence rate trends for paediatric MRSA SSTIs in Los Angeles County (LAC). Using 133 cases from 31 hospitals, we found that the set of three ICD-9-CM codes used to define laboratory-confirmed cases had one of the highest positive predictive values (49%). There was no difference in age and race between those categorized using three codes vs. other code combinations. A dramatic increase in paediatric MRSA SSTI cases occurred in LAC during 1998–2006. We conclude that this combination of codes may be used to determine the rise of MRSA SSTIs in paediatric populations.

Mycobacterial bone marrow (BM) infection is the most common diagnosis established by BM examinations for fever of unknown origin. In this study, clinical features and outcomes of patients who fulfilled the criteria for BM infection due to Mycobacterium tuberculosis (MTB) and non-tuberculous mycobacteria (NTM) at a medical centre in Taiwan from 2001 to 2009 were investigated. The BM histopathological findings were also analysed. A total of 24 patients (16 men, eight women) with mycobacterial BM infections were found. Of these, nine (38%) were positive for human immunodeficiency virus (HIV) and six (25%) had no pre-existing immunocompromised conditions. MTB isolates were obtained from 11 (46%) patients and NTM species were isolated from 10 (42%) patients, including M. avium complex (MAC, n = 7) and M. kansasii (n = 3). Patients with MTB infections were significantly older than those with NTM infections (60·5 vs. 47·7 years, P = 0·043) and were less likely to have a positive BM culture (45% vs. 100%, P = 0·012). The 90-day survival rates for MTB and NTM BM infections were 68% and 60%, respectively (P = 0·61). In addition, the presence of BM granulomas was significantly more common in patients with MTB BM infections than in those with NTM infections (82% vs. 30%, P = 0·030). In Taiwan, the importance of NTM was not inferior to MTB and besides MAC, M. kansasii might be an important pathogen in non-HIV-infected patients. The presence of BM granulomas and caseation provides valuable information regarding early treatment pending culture results.