Although elimination of measles virus (MV) by 2010 was a revised target, a new epidemic has been ongoing in Greece and other European countries. The purpose of this study was the molecular and phylogenetic analysis of the Greek MV circulating strain. Twenty-four MV strains isolated from clinical samples during the 2010 outbreak were genotyped and studied in terms of nucleotide variation and phylogeny. All of the detected viruses were of the D4 genotype, which is circulating in Greece in the Roma population of Bulgarian nationality, the Greek Roma population and the Greek non-minority population, as well as in other EU countries. Phylogenetic analysis revealed that these viruses belonged to subgroup 4 of D4 MV strains. It is essential to continue epidemiological surveillance of measles in Greece to monitor the transmission pattern of the virus and the effectiveness of measles immunization, which eventually will lead to its elimination.

(1) Inoculation of pathologically active crusts on guinea-pigs caused no reaction, and in this respect a marked difference was demonstrated clinically between the disease of which the crusts were a product, and vaccinia.

(2) On calves the disease tended to show some vaccino-variolal relationship, from the appearance of its vesicles, but it appeared to be distinct on the one hand from vaccinia, and from variola on the other.

(3) Calf experiments, two only in number, suggested that vaccinia and variola failed to protect against Australian disease, and that Australian disease failed to protect against vaccinia or variola.

(4) On monkeys the vesicles of Australian disease were undistinguishable in appearance from those of vaccinia or variola, but the evidence for immunity relationship between Australian disease and vaccinia and variola was of the slightest; Australian disease affording no protection against vaccinia or variola, vaccinia possibly protecting against Australian disease in 25 per cent, of the cases, and variola possibly protecting against Australian disease in 40 per cent, of the cases. Vaccinia protected against variola in 100 per cent, of the cases, and variola against vaccinia in 50 per cent, of the cases.

Utilising routine surveillance data, this study presents a method for generating a baseline comparison that can be used in future foodborne outbreak investigations following a case–case methodology. Salmonella and Campylobacter cases (2012–2015) from Maricopa County, AZ were compared to determine differences in risk factors, symptoms and demographics. For foods and other risk factors, adjusted odds ratios were developed using Campylobacter as the reference. Comparisons were also made for three major Salmonella subtypes, Typhimurium, Enteritidis and Poona as compared with Campylobacter. Salmonella cases were younger, while Campylobacter cases were more Hispanic and female. Campylobacter cases reported consuming peppers, sprouts, poultry, queso fresco, eggs and raw nuts more and reported contact with animal products, birds, visiting a farm or dairy, owning a pet, a sick pet, swimming in a river, lake or pond, or handling multiple raw meats more. Salmonella cases reported visiting a petting zoo and contact with a reptile more. There were significant variations by Salmonella subtype in both foods and exposures. We recommend departments conduct this analysis to generate a baseline comparison and a running average of relevant odds ratios allowing staff to focus on trace-back of contaminated food items earlier in the outbreak investigation process.

In a case of suppurative cholecystitis with cholelithiasis a bacillus was isolated from the pus, gall bladder, and stools which has the morphological, biological and cultural characters of B. enteritidis Gaertner. This bacillus is pathogenic for the rat, rabbit and guinea-pig, and gives rise to the characteristic lesions produced by the Gaertner bacillus. The serum of the patient agglutinated the three strains of bacilli isolated from the above mentioned sources and the original Gaertner strain in a dilution of 1 in 40. A serum, prepared by injecting B. enteritidis Gaertner (original strain) into a rabbit, agglutinated the three strains isolated from the case and the homologous bacillus in almost the same dilutions.

A serum prepared from any of the three bacilli agglutinates the homologous organism, the other two strains and the original Gaertner bacillus in almost the same titre. The sera homologous to allied organisms do not agglutinate these bacilli. Absorption tests confirm these results and prove that the bacilli isolated are identical with the Gaertner bacillus.

The chief points of interest in the case are that:

1. It forms a link in the chain of evidence showing that as in the case of the paratyphoid bacillus the B. enteritidis Gaertner may give rise, not only to the more acute toxic from of poisoning, but also to a sub-acute paratyphoid type of the disease.

2. It establishes the association of B. enteritidis Gaertner with suppurative cholecystitis and with cholelithiasis.

3. It proves that this bacillus may have its habitat in the gall bladder and be shed out at intervals into the faeces, in a manner exactly analogous to what occurs in the case of typhoid and paratyphiod infections.

In Greece the public health surveillance for most infectious diseases, including shigellosis, is not well developed. However, four waterborne outbreaks of shigellosis have been recorded in Greece in the last three decades, in different areas of the country, under different environmental and socioeconomic conditions. This study presents the epidemiological characteristics of these four outbreaks in order to examine common points and differences and to investigate their possible association with environmental and socioeconomic conditions. All four outbreaks were caused by Shigella sonnei and related to drinking water. Epidemic curves, distribution of cases by age and gender, hospitalization rates, environmental conditions and laboratory results were compared. The outbreaks seemed to correspond to two different ‘models’ presenting two characteristic types of epidemic waves related to specific environmental conditions. The attack rates for the general population varied from about 9 to 13% and were similar for both sexes. Children were affected mostly. In these outbreaks there was a strong suspicion of contamination of the water distribution system from the sewage network, highlighting the importance of environmental health control measures.

The surveillance of Clostridium difficile (CD) in Denmark consists of laboratory based data from Departments of Clinical Microbiology (DCMs) sent to the National Registry of Enteric Pathogens (NREP). We validated a new surveillance system for CD based on the Danish Microbiology Database (MiBa). MiBa automatically collects microbiological test results from all Danish DCMs. We built an algorithm to identify positive test results for CD recorded in MiBa. A CD case was defined as a person with a positive culture for CD or PCR detection of toxin A and/or B and/or binary toxin. We compared CD cases identified through the MiBa-based surveillance with those reported to NREP and locally in five DCMs representing different Danish regions. During 2010–2014, NREP reported 13 896 CD cases, and the MiBa-based surveillance 21 252 CD cases. There was a 99·9% concordance between the local datasets and the MiBa-based surveillance. Surveillance based on MiBa was superior to the current surveillance system, and the findings show that the number of CD cases in Denmark hitherto has been under-reported. There were only minor differences between local data and the MiBa-based surveillance, showing the completeness and validity of CD data in MiBa. This nationwide electronic system can greatly strengthen surveillance and research in various applications.

The aim of the study was to estimate the sensitivity and specificity of enzyme-linked immunosorbent assay (ELISA) and immunoblot (IB) for detecting antibodies of Neospora caninum in dairy cows, in the absence of a gold standard. The study complies with STRADAS-paratuberculosis guidelines for reporting the accuracy of the test. We tried to apply Bayesian models that do not require conditional independence of the tests under evaluation, but as convergence problems appeared, we used Bayesian methodology, that does not assume conditional dependence of the tests. Informative prior probability distributions were constructed, based on scientific inputs regarding sensitivity and specificity of the IB test and the prevalence of disease in the studied populations. IB sensitivity and specificity were estimated to be 98.8% and 91.3%, respectively, while the respective estimates for ELISA were 60% and 96.7%. A sensitivity analysis, where modified prior probability distributions concerning IB diagnostic accuracy applied, showed a limited effect in posterior assessments. We concluded that ELISA can be used to screen the bulk milk and secondly, IB can be used whenever needed.

The KwaZulu Natal and Eastern Cape provinces of South Africa have experienced a serious dog rabies epidemic over the past three decades. Towards a better understanding of this epidemic, we have previously analysed nucleotide sequences of 142 rabies virus specimens that were obtained from these regions during 2003–2004 and provided a molecular description of the geographical distribution of rabies viral variants in the affected provinces. Here, as an extension, we studied five human cases that occurred during 2002–2003 and demonstrated the use of the sequence database in tracking unknown human rabies case histories. We were able to identify the geographical origin of viruses responsible for each human infection and in one case obtained evidence that suggested a non-bite transmission of rabies virus from an infected dog to a child. We argue for the value of this information in surveillance and epidemiological study and in the follow-up and management of potential exposures.

This paper is the result of an attempt to determine if, in the different social classes obtained by a grading of a large section of the male working population of England and Wales for the triennial period 1910–12, as described by the Registrar-General in the Supplement to his 75th Annual Report, there was shown any special susceptibility to cancer in particular parts of the body. From a comparison of the standardised mortality-rates from cancer in 16 different sites in (1) men of three social grades, namely, the upper and middle classes, skilled workmen and unskilled workmen, (2) two sub-groups of the upper and middle classes and (3) men of two social classes, a higher and a lower intermediate to classes 1 and 3 and 3 and 5 respectively, it seems reasonable to draw the following conclusions:

1. The mortality-rates from cancer in the majority of the parts of the body considered, including amongst others the tongue, oesophagus and stomach, which altogether account for 92 per cent, of the total deaths, are definitely higher in the men of lowest social status; the incidence decreases, though not always regularly, with ascent in the social scale.

2. The mortality from cancer in other parts of the body, namely, the bowel, the prostate and probably the pancreas, is definitely highest, however, in men of the best social status.

3. Though the relatively high cancer mortality-rates in these sites in the best social class may probably be attributed in some measure, which it is difficult or impossible to assess, to improved facilities for, and methods of diagnosis in this class, as compared with those in the lowest classes, this cannot be the whole explanation as the differences are considerable and as no increased mortality from cancer is evident in any of the sites except the pancreas with such an ascent in the social scale as takes place in passing from social group 1 b, to social group 1 a, where the influence of more skilful diagnosis might also be expected to reveal itself. If we may accept the mortality from hepatic cancer in the different social classes as an approximate index of the general accuracy of diagnosis of malignant disease therein, then varying accuracy of diagnosis can have little influence in producing the divergencies in mortality from cancer in these special sites that are found in the social groups under review.

4. The excessive mortality from cancer of the bowel amongst males of the best social class cannot reasonably be ascribed to their habits of life such as high-feeding and easy-living or to their alleged greater liability to autointoxication. If this were so, cancer of the stomach and cancer of the rectum might also be expected to show a higher incidence in the same social class; the mortality-rates from cancer in these sites, however, are not higher in this class than in the lower social classes.

Toxoplasma antibodies were absent from the sera of 32 adult Hong Kong women and were present in only two of 35 adult males and five of 46 meat workers, an overall incidence of 6·2%. This is the lowest incidence recorded in a large tropical city and lower than the incidence reported for most areas of the world, whether rural or urban. The reasons for this are unknown. Of 31 sera from swine imported from China and slaughtered in Hong Kong, 22 (71%) were positive for toxoplasma antibodies.

A survey of the extent of bovine type human tuberculosis in Northern Ireland has been made from unselected material during the past 5 years.

Only one case of bovine type pulmonary tuberculosis was found out of more than 1000 cases.

The proportion of bovine type cases in the non-respiratory group was 4·3%; 3·3% of meningitis cases were of bovine origin.

A marked decline in the extent of bovine type infection is shown to have occurred during the past 10 years. This is believed to be due to a great increase in the pasteurization of milk during this period. Milk was a particularly valuable food during the war, and pasteurization facilitated its distribution.

Extensively drug-resistant (XDR) tuberculosis (TB) poses a threat to public health due to its complicated, expensive and often unsuccessful treatment. A cluster of three XDR TB cases was detected among foreign medical students of a Romanian university. The contact investigations included tuberculin skin testing or interferon gamma release assay, chest X-ray, sputum smear microscopy, culture, drug susceptibility testing, genotyping and whole-genome sequencing (WGS), and were addressed to students, personnel of the university, family members or other close contacts of the cases. These investigations increased the total number of cases to seven. All confirmed cases shared a very similar WGS profile. Two more cases were epidemiologically linked, but no laboratory confirmation exists. Despite all the efforts done, the source of the outbreak was not identified, but the transmission was controlled. The investigation was conducted by a team including epidemiologists and microbiologists from five countries (Finland, Israel, Romania, Sweden and the UK) and from the European Centre for Disease Prevention and Control. Our report shows how countries can collaborate to control the spread of XDR TB by exchanging information about cases and their contacts to enable identification of additional cases and transmission and to perform the source investigation.

In spring 2009 a new strain of influenza A(H1N1) emerged and caused a worldwide pandemic. This study utilized a large collection of respiratory specimens from suspected cases of influenza A(H1N1) in the UK West Midlands during the pandemic in order to investigate which other respiratory viruses were circulating and whether they played any role in the increased hospitalization rates seen during that period. Study specimens were selected from community and hospitalized patients positive and negative for influenza A(H1N1) and tested by PCR for other respiratory viruses. A number of infections diagnosed as influenza during the summer influenza outbreak were found to be due to other virus infections (most commonly rhinovirus). No statistically significant difference was found between the rates of respiratory virus co-infection with H1N1 in patients from community or hospital locations suggesting underlying factors were likely to be more significant than viral co-infections in determining severity of influenza A(H1N1) disease.

Influenza A(H1N1) viruses of the 2009 pandemic (A(H1N1)pdm09) continue to cause outbreaks in the post-pandemic period. During January to May 2015, an upsurge of influenza was recorded that resulted in high fatality in central India. Genetic lineage, mutations in the hemagglutinin (HA) gene and infection by quasi-species are reported to affect disease severity. The objective of this study is to present the molecular and epidemiological trends during the 2015 influenza outbreak in central India. All the referred samples were subjected to qRT–PCR for diagnosis. HA gene sequencing (23 survivors and 24 non-survivors) and cloning were performed and analyzed using Molecular Evolutionary Genomic Analyzer (MEGA 5·05). Of the 3625 tested samples, 1607 (44·3%) were positive for influenza A(H1N1)pdm09, of which 228 (14·2%) individuals succumbed to death. A significant trend was observed in positivity (P = 0·003) and mortality (P < 0·0001) with increasing age. The circulating A(H1N1)pdm09 virus was characterized as belonging to clade-6B. Clinically significant mutations were detected. Patients infected with the quasi-species of the virus had a greater risk of death (P = 0·009). This study proposes a robust molecular and clinical surveillance program for the detection and characterization of the virus, along with prompt treatment protocols to prevent outbreaks.

Vaccinating monkeys against yellow fever (YF) has been a common practice in the beginning of the 17D vaccine development. Although it may seem strange at first sight, vaccinating monkeys as a public health strategy is, we think, feasible and theoretically could eliminate the infection among non-human primates, interrupting the virus circulation (or significantly reducing it) and therefore reducing the risk of spilling over to the human population. We propose a series of studies that could demonstrate (or not) the efficacy and feasibility of vaccinating non-human primates YF reservoirs living in green areas of urban centres to cut off or curb the virus circulation that recurrently spill over to the human population. Therefore, vaccinating monkeys in relatively small green areas of the urban centres is perhaps the ultimate solution for the Brazilian recurrent YF epizootics.

The spread of Staphylococcus aureus was studied in three general surgical wards of identical design which consisted of a number of separate rooms, and the results were compared with those in the same unit previously studied, in subdivided wards elsewhere and in large open wards.

The nasal carrier rate of Staph. aureus by patients rose during their stay in the ward, but its peak rate was comparable with minimum rates reported in other subdivided wards and was lower than in open wards.

Staphylococcal sepsis rates were lower than in most open wards and were also much lower than those found previously in the same unit when overcrowding was common and each sex had its own ward.

A simple method of breeding large numbers of rabbit fleas in a rabbit house with minimal disruption to the general routine is described.

Although Finland has not experienced a classical swine fever (CSF) epidemic since 1917, the concern about early detection is relevant. The time until detection of CSF on a pig-breeding farm was predicted by simulation, and earlier detection of CSF-infected farms was assessed. Eight to 12 weeks will pass before CSF is detected on a Finnish pig-breeding farm, which resembles detection of the index farm for actual CSF epidemics in Europe. Although notification of suspected CSF on the infected farm accelerates detection the most, interventions aimed at promoting investigations of the general health problem noticed on the farm, or a more comprehensive testing of samples currently arriving from pig farms to the investigating laboratory could shorten detection time by 3 weeks. Results are applicable for further simulation of an event of a CSF epidemic in Finland, and for studying contingency options to promote more rapid detection of infectious diseases of swine not found at present in the country.

The distribution of neutralizing antibody to Yaba virus and 1211 agent in the sera of three Asian and one African monkey species was examined.

Cynomolgus (Macaca irus), bonnet (M. radiata) and rhesus (M. mulatta) monkeys possessed antibody to Yaba virus at incidences of 19·9, 8·4 and 0%, respectively. In African green monkeys (Cercopithecus aethiops) the incidence was as high as 76·4%.

As for 1211 agent, no Asian monkeys had neutralizing antibody and 5·5% of African green monkey sera neutralized the virus.

The following paper embodies the main facts obtained during a prolonged investigation as regards the pollution of Tidal Waters and of Shell Fish, undertaken on behalf of the Royal Commission on Sewage Disposal.