A male Pariah-Irish terrier puppy, apparently about three months old, followed me home from the hospital in Krian. This was twelve months ago, so that the dog is now fifteen months old. Of his previous history I know nothing.

The Ukraine cholera epidemic of 1994 and 1995 was caused by Vibrio cholerae O1, serotype Ogawa, biotype El Tor. This epidemic was centred in the area around Respublika Krim (Crimea) and Mykolajiv, and spread to include parts of southern Ukraine. Cases of cholera occurred between September and November of 1994 and between June and October of 1995. The 32 fatalities among 1370 recorded cases (case fatality ratio, 2·3%) occurred throughout the course of the epidemic. V. cholerae from patients with cholera produced cholera toxin and were resistant to multiple antibiotics, though no resistance plasmids were found. Conjugation experiments suggested that resistance to multiple antibiotics may be present on a self-transmissible genetic element. Environmental sources of V. cholerae O1 El Tor included sewage, sea and surface water, and fresh water and marine fish. All but one of the environmental V. cholerae isolated during the epidemic were very similar to selected isolates from patients at the same time, supporting the role of these environmental sources in the spread of disease.

Since 2001 hepatitis B vaccination has been offered to prisoners on reception into prisons in England and Wales. However, short campaigns of vaccinating the entire population of individual prisons have achieved high vaccination coverage for limited periods, suggesting that short campaigns may be a preferable way of vaccinating prisoners. A model is used that describes the flow of prisoners through prisons stratified by injecting status to compare a range of vaccination scenarios that describe vaccination on prison reception or via regular short campaigns. Model results suggest that vaccinating on prison reception can capture a greater proportion of the injecting drug user (IDU) population than the comparable campaign scenarios (63% vs. 55·6% respectively). Vaccination on prison reception is also more efficient at capturing IDUs for vaccination than vaccination via a campaign, although vaccination via campaigns may have a role with some infections for overall control.

For many years strains of Escherichia coli belonging to particular serotypes (EPEC) were a common cause of outbreaks of infantile enteritis in Europe and North America. E. coli 0142. H6 was first isolated from infants with diarrhoea in Indonesia in 1960 and a further outbreak occurred in Mexico in 1965. Between 1967 and 1972 outbreaks of infantile enteritis caused by E. coli 0142 were reported in hospitals in Scotland, England, Northern Ireland and Eire. Sporadic cases occurred in Canada in 1972 and a further outbreak occurred in Arizona, U.S.A. in 1975. Strains from all these incidents were examined by biochemical and serological methods. Their resistance to antimicrobial drugs was determined and their resistance plasmids characterized; their plasmid profiles were visualized by agarose gel electrophoresis. The cumulative evidence suggests that strains isolated in the British Isles all belonged to a single clone and were related to those isolated in Indonesia, the U.S.A. and Canada. However, the strains from Mexico appeared to be unrelated. This study demonstrates that single clones of enteropathogenic E. coli may spread throughout the world, causing outbreaks of diarrhoeal disease and acquiring resistance to antimicrobial drugs.

Tularemia is a contagious infectious disease due to Francisiella tularensis that can cause serious clinical manifestations and significant mortality if untreated. Although the frequency and significance of the disease has diminished over the last decades in Central Europe, over the past few years, there is new evidence suggesting that tularemia has re-emerged worldwide. To know the real epidemiology of the disease is at the root of correct control measures. In order to evaluate whether tularemia is re-emerging in Italy, data on mortality and morbidity (obtained by the National Institute of Statistics; ISTAT), Italian cases described in the scientific literature and data concerning hospitalizations for tularemia (obtained by the National Hospital Discharge Database) were analysed. From 1979 to 2010, ISTAT reported 474 cases and no deaths. The overall number of cases obtained from the literature review was at least 31% higher than that reported by ISTAT. Moreover, the number of cases reported by ISTAT was 3·5 times smaller than hospitalized cases. In Italy tularemia is sporadic, rarely endemic and self-limiting; but, although the trend of reported tularemia does not support the hypothesis of a re-emerging disease, the study demonstrates a wide underreporting of the disease. The real frequency of the disease should be carefully investigated and taken into account in order to implement specific prevention measures.

Asymptomatic colonisation of the gastrointestinal tract by carbapenemase-producing Enterobacteriaceae is an important reservoir for transmission, which may precede infection. This retrospective observational case–control study was designed to identify risk factors for developing clinical infection with OXA-48-producing Klebsiella pneumoniae in rectal carriers during hospitalisation. Case patients (n = 76) had carbapenemase-producing K. pneumoniae (CPKP) infection and positive rectal culture for CPKP. Control patients (n = 174) were those with rectal colonisation with CPKP but without CPKP infection. Multivariate analysis identified the presence of a central venous catheter (OR 4·38; 95% CI 2·27–8·42; P = 0·008), the number of transfers between hospital units (OR 1·27; 95% CI (1·06–1·52); P < 0·001) and time at risk (OR 1·02 95% CI 1·01–1·03; P = 0·01) as independent risk factors for CPKP infection in rectal carriers. Awareness of these risk factors may help to identify patients at higher risk of developing CPKP infection.

Enteric pathogens are commonly known to be transmitted through food or water; however, contact with animals is another important transmission route. This study estimated the annual burden of illness attributable to animal contact for eight enteric pathogens in Canada. Using data from a Canadian expert elicitation on transmission routes, the proportion of enteric illnesses attributable to animal contact was estimated for each pathogen to estimate the annual number of illnesses, hospitalizations and deaths in Canada. For each estimate, a mean and probability intervals were generated. Of all illnesses caused by these eight pathogens, 16% were estimated attributable to animal contact. This estimate translates to 86 000 (31 000–166 000) illnesses, 488 (186–890) hospitalizations and 12 (2–28) deaths annually for the eight pathogens combined. Campylobacter spp. is the leading cause of illnesses annually, with an estimated 38 000 (14 000–71 000) illnesses occurring each year, followed by non-typhoidal Salmonella spp. (17 000, 6000–32 000). The majority of hospitalizations were attributable to non-typhoidal Salmonella spp. (36%) and Campylobacter spp. (31%). Non-typhoidal Salmonella spp. (28%) and Listeria monocytogenes (31%) were responsible for the majority of the estimated deaths. These results identify farm animal and pet/pet food exposure as key pathways of transmission for several pathogens. The estimated burden of illness associated with animal contact is substantial.

The pathophysiological mechanisms underlying the seasonal dynamic and epidemic occurrence of bacterial meningitis in the African meningitis belt remain unknown. Regular seasonality (seasonal hyperendemicity) is observed for both meningococcal and pneumococcal meningitis and understanding this is critical for better prevention and modelling. The two principal hypotheses for hyperendemicity during the dry season imply (1) an increased risk of invasive disease given asymptomatic carriage of meningococci and pneumococci; or (2) an increased transmission of these bacteria from carriers and ill individuals. In this study, we formulated three compartmental deterministic models of seasonal hyperendemicity, featuring one (model1-‘inv’ or model2-‘transm’), or a combination (model3-‘inv-transm’) of the two hypotheses. We parameterised the models based on current knowledge on meningococcal and pneumococcal biology and pathophysiology. We compared the three models' performance in reproducing weekly incidences of suspected cases of acute bacterial meningitis reported by health centres in Burkina Faso during 2004–2010, through the meningitis surveillance system. The three models performed well (coefficient of determination R2, 0.72, 0.86 and 0.87, respectively). Model2-‘transm’ and model3-‘inv-transm’ better captured the amplitude of the seasonal incidence. However, model2-‘transm’ required a higher constant invasion rate for a similar average baseline transmission rate. The results suggest that a combination of seasonal changes of the risk of invasive disease and carriage transmission is involved in the hyperendemic seasonality of bacterial meningitis in the African meningitis belt. Consequently, both interventions reducing the risk of nasopharyngeal invasion and the bacteria transmission, especially during the dry season are believed to be needed to limit the recurrent seasonality of bacterial meningitis in the meningitis belt.

Klebsiella vaccine was prepared from strains of Klebsiella aerogenes with capsular types Kl, K36, K44 and K Cross (a type which cross-reacts in vitro with sera from many klebsiella capsular types). The vaccine was extracted by dialysis and ultrafiltration from capsular material released during growth of the bacteria in a five-day batch culture.

Mice given one dose of vaccine from K1a (l·0 μg/mouse) survived lethal intraperitoneal challenge of 11/11 homologous klebsiella strains four days after vaccination; 14 days after vaccination protection against the same challenge strains had declined to 5/11 strains. Vaccines from Kla, b, c, K3G, K44 and K Cross induced homologous protection and protected mice against different ranges of heterologous klebsiella capsular types.

The protective response of the mice was greatly enhanced by administering three doses of the vaccines. Vaccines from Kl, K36, K44 and K Cross protected mice against 14/20, 11/20, 10/20 and 9/20 homologous and heterologous klebsiella challenge strains respectively.

None of the klebsiella vaccines was toxic for mice at the immunizing dose (l·0 μg/mouse). Vaccine from K36 was the most lethal, killing mice at 103 immunizing doses. The least toxic vaccine was from K44, which killed mice at 104 immunizing doses.

1. It has been shown that cows infected with brucellosis of the udder can usually be detected by an application of a modified milk ring test, based on the finding that milks from infected cows, in addition to showing a high bulk MRT titre also show considerable quarter variations. The effects of adult vaccination with strain 19 vaccine on the MRT are reported; low bulk titres with uniformity between quarters, except at the beginning and end of lactation and immediately following vaccinations, were observed, thus making differentiation between vaccinated and infected cows possible.

2. In a survey of raw milk samples from three areas in southern Scotland, 3·5, 5·3 and 9·0% of samples were shown to be infected with Br. abortus.

Dog faeces collected from a public park were cultured on selective media for Campylobacter spp. Campylobacter jejuni was isolated from 12 (4·6%) of 260 specimens. In contrast Salmonella spp. were found in only three (1·2%). Six of the 12 isolates were nalidixic acid-resistant thermophilic campylobacters (NARTC), whereas during the same period of study none were found among human isolates. Most of the campylobacter positive faeces were found during June and July. Dog faeces deposited in public places constitute only a small potential source of infection by this organism.

Cases of paratyphoid fever are often not diagnosed until the second, third or subsequent weeks of illness. When calculating clearance rates of a series of cases the calculations must be based only on the numbers known to be positive at the week under consideration. If based throughout on the total number of cases the rates of clearance in the early weeks are greatly reduced.

Cases for which laboratory records are incomplete must not be entirely rejected when calculating clearance rates but must be retained in the population for as long as they were known to be positive.

Analyses designed to show the duration of infection in paratyphoid fever can only be made with accuracy under the most favourable conditions.

A large number of cases of paratyphoid fever were repeatedly examined bacteriologically to establish the duration of the infection as distinct from the clinical illness. After an initial lag the proportion of cases remaining infected fell logarithmically until the carriers revealed themselves.

We are grateful to many medical officers for information about their cases, and to Dr Lewis Fanning and Dr Ian Sutherland for much helpful criticism.

Recent studies have established that the occurrence of common cold epidemics amongst men in Antarctica shows a pattern similar to that seen in other isolated communities such as Tristan da Cunha (Cameron & Moore, 1968; Shibli, Gooch, Lewis & Tyrrell, 1971). Colds occur during relief periods when ships and aircraft call, and disappear during the months of winter isolation, but no statistical analysis of the incidence of such colds is available.

A bacteriological study was carried out on the first Leisure Centre swimming pools in the United Kingdom to be disinfected with ozone/chlorine. Results suggested that a free chlorine concentration of approximately 0·8 mg/l was necessary to maintain the pools in a bacteriologically satisfactory condition. This amount of free chlorine was similar to that required when the pool was disinfected with chlorine alone. However, the associated amount of combined chlorine was much lower when disinfection was by ozone/chlorine and this gave more acceptable bathing conditions. Implications for the management of pools disinfected by this method are discussed.

A detailed analysis of equine (H3N8) influenza viruses isolated in Nigeria during early 1991 has been undertaken. Antigenic analysis and the complete nucleotide sequence of the HA gene of three Nigerian equine influenza viruses A/eq/Ibadan/4/91, A/eq/Ibadan/6/91 and A/eq/Ibadan/9/91 are presented and limited sequence analysis of each of the genes encoding the internal polypeptides of the virus has been carried out. These results establish that, despite the geographical location from which these viruses were isolated, two were similar to the viruses which were concurrently causing disease in Europe in 1989 and 1991 and were related to viruses that have been predominating in horses since 1985. The third was more closely related to viruses isolated from 1991 onward in Europe but also in other parts of the globe. A comparison of the nucleotide sequence of two of the viruses isolated in Nigeria (A/eq/Ibadan/4/91 and A/eq/Ibadan/6/91) with a European strain (A/eq/Suffolk/89) showed limited variation in the haemagglutinin gene which caused amino acid substitutions in one of the antigenic sites: this mutation resulted in the potential production of a new glycosylation site in antigenic site A. The other Nigerian virus (A/eq/Ibadan/9/91) showed only a single one amino acid change from another European strain (A/eq/Arundel/12369/91). The two distinct Nigerian viruses had several amino acid substitutions in the antigenic sites of the haemagglutinin glycoprotein.

Finally I wish to draw particular attention to the following facts:—

1. The striking diminution in the case-mortality at the Mile End Hospital which followed the systematic use of antitoxin.

2. The subsidence of the epidemic during the season when diphtheria is commonly most prevalent.

3. The opening of the schools in September without any increase in the prevalence of the disease.

4. The persistence of diphtheria bacilli for long periods in certain of the convalescents and contacts.

5. The success of preventive measures based upon the belief that diphtheria is spread mainly by personal contact, and through the inter-mediation of healthy persons and other who by the means usually employed are not recognised to be suffering from the disease.

Twenty progesterone-treated TO mice were infected intravaginally with Mycoplasma pulmonis. One month later, ten of the mice were given oestradiol which changed the reproductive cycle to the oestrous phase and within a week resulted in eradication of the organisms from six of them; vaginal persistence in the other mice may have been due, at least in part, to reinoculation of organisms from the oropharynx, a site heavily infected in all the mice. The majority of the mice not treated with oestradiol continued to shed the organisms from the vagina for at least 91 days. In another experiment, 19 oestradiol-treated BALB/c mice were infected intravaginally with M. hominis. One month later, nine of the mice were given progesterone which changed the reproductive cycle to the dioestrous phase and eradicated the organisms from seven within 2 weeks and from all of them within about a month. This was in contrast to the mice not given progesterone, the majority of which continued to shed the organisms for at least 167 days.

Steatorrhoea was a significant feature in an outbreak of rotavirus gastroenteritis which affected adults and infants in hospital. Fat globules or fatty acid crystals were obvious by light microscopy (LM) in faeces from 14 of 25 patients examined. Ten of the fatty stools and two of the remainder were very pale. By electron microscopy (EM) a rotavirus was seen in 11 of the 14 fatty faeces and in only two of 11 specimens without visible fat.

In a further study of pale or fatty faeces 20 such specimens sent for laboratory examination from patients not involved in the hospital outbreak were compared microbiologically with a similar number which were neither pale nor fatty. Viruses were found by EM in 11 (55%) of the pale or fatty stools; eight rotaviruses, two astroviruses and an uncultivable adenovirus were seen; one further patient had acute jaundice. In contrast, no viruses were seen by EM in the twenty specimens which were normally pigmented and without evident fat.

Steatorrhoea was significantly associated with rotavirus infection of the alimentary tract which usually presented as a fatty enteritis. We conclude that rotaviruses certainly, and other viruses possibly, can impede both the digestion of fat and the pigmentation of the faeces. Inspection and LM of faeces are easy. In acute enteritis a fatty or pale stool is an indication for virological examination.

The post-war need for large numbers of dwellings has promoted renewed inquiry into the basic criteria by which good practice in the design and construction of buildings may be judged. More emphasis than ever before is now being put upon the functional characteristics of buildings regarded as living-spaces rather than as structures.

The aim of this study was to estimate the burden of infectious intestinal disease (IID) and cost of illness at the community level from a societal aspect. A retrospective, age-stratified cross-sectional telephone study was carried out in Malta in 2004–2005. The number of cases, resources used and cost of resources were computed. The resources involved direct costs (health-care services, stool culture tests, medicines and personal costs) and indirect costs (costs from lost employment by cases and caregivers). This study estimated 0·421 (95% CI 0·092–0·771) separate episodes of IID per person per year in Malta which corresponds to 164 471 (95% CI 35 941–301 205) episodes of IID per year or 450 (95% CI 98–825) episodes of IID each day. The largest proportion of cost is due to provision of health-care services with €10 454 901 [Maltese liri (Lm) 4 558 970] per year; followed by €963 295 (Lm 2 209 393) in lost productivity; €1 286 286 (Lm 561 078) in medicines; €152 335 (Lm 66 452) in stool culture testing and €71 487 (Lm 31 183) in personal costs, giving a total cost of illness of over €16 million (7 million Lm) per year. The burden and cost of IID are high enough to justify efforts to control the illness. Such estimates are important to assess the cost-effectiveness of proposed specific interventions.