Respiratory infections among infants constitute a major burden to health care systems in developed nations, yet the course and risk factors leading to these conditions are poorly understood. We examine the longitudinal patterns of respiratory infection hospitalisation (RIH) and how these patterns are influenced by neonatal pulmonary morbidities. We included all live births (n = 429 058) occurring in the Australian state of Queensland between January 2009 and December 2015. Data were structured so that each participant had a record (present/absent) of RIH for each month from birth to 12 months. Initially, latent class growth analysis was used to identify the trajectories of RIH adjusted for spatial–temporal factors; using the identified trajectories of RIH as outcomes, we built a multinomial logistic regression model to identify neonatal predictors of RIH trajectories. Our results indicated that a four-class solution was the best fit to the data, comprising a ‘no-risk’ trajectory, a ‘low-risk’ trajectory, an ‘early-risk’ trajectory and a ‘chronic-risk’ trajectory. Compared with the no-risk trajectory, membership in the other trajectories was predicted by a range of neonatal pulmonary morbidities, with transient tachypnoea of newborn showing a specific relationship with the early-risk group and sleep apnoea showing a specific and strong risk with the chronic-risk group. Our findings suggest the possibility of identifying neonates at risk of recurrent RIH and implementing effective intervention strategies prior to neonatal discharge.

Neuraminidase inhibitor (NI) dispensing has emerged as a possible automated data source for influenza surveillance. We aimed to evaluate its timeliness, correlation, and predictive accuracy in relation to influenza activity in Quebec, Canada, 2010–2013. Our secondary objective was to use the same metrics to compare NI dispensing to visits for influenza-like illness (ILI) in emergency departments (EDs). Provincial weekly counts of positive influenza laboratory tests were used as a reference measure for the level of influenza circulation. We applied ARIMA models to account for serial correlation. We computed cross-correlations to measure the strengths of association and lead-lag relationships between NI dispensing, ILI ED visits, and our reference indicator. Finally, using an ARIMA model, we evaluated the ability of NI dispensing and ILI ED visits to predict laboratory-confirmed influenza. NI dispensing was significantly correlated (R = 0·68) with influenza activity with no lag. The maximal correlation of ILI ED visits was not as strong (R = 0·50). Both NI dispensing and ILI ED visits were significant predictors of laboratory-confirmed influenza in a multivariable model; predictive potential was greatest when NI counts were lagged to precede laboratory surveillance by 2 weeks. We conclude that NI dispensing data provides timely and valuable information for influenza surveillance.

Strongyloides stercoralis is a neglected parasite that can cause death in immunocompromised individuals. There were no data on the epidemiology of S. stercoralis infection in San Marino Republic until two patients (one of whom died) were diagnosed with severe strongyloidiasis (hyperinfection) between September 2016 and March 2017. A serology test for Strongyloides spp. was introduced in routine practice in the laboratory of the State Hospital to test patients considered to be at risk for strongyloidiasis. Between August 2017 and August 2018, of 42 patients tested with serology, two (4.8%) were positive. An additional case was found by gastric biopsy. Two of the positive cases were presumably autochthonous infections (elderly people with no significant travel history), while the other was a probable imported case (young man born in Nigeria and settled in Europe since 2003). Epidemiology of strongyloidiasis in San Marino might be similar to Northern Italy, where a relevant proportion of cases was diagnosed in immigrants (mainly from sub-Saharan Africa) and in elderly Italians with eosinophilia. Screening for strongyloidiasis might be worthwhile in inhabitants of San Marino in the same categories of individuals, particularly those at risk of immune suppression.

A field experiment was conducted from July 1958 to February 1959 in the San Francisco Bay region to test the effect on flea populations of prolonged exposure of the native meadow vole, Microtus californicus, to 5% DDT powder in insecticide-bait-boxes. Previous studies had shown that two important vectors of sylvatic plague, Malaraeus telchinum and Hystrichopsylla linsdalei, could be controlled both on their hosts and in the host nests by this method. However, the question of possible resistance was postulated since the control of H. linsdalei on its host was inferior to control of other flea species.

Bait-boxes with DDT powder were maintained in the field for 6 months. Records of flea populations on Microtus during this period showed equally good control of all flea species. Observations on vole nests at termination of the study revealed deposits of DDT and good control of all flea species in them. During the period of study, the evidence suggested that none of the flea species involved exhibited DDT resistance.

The major portion of the field routine was done by Messrs A. R. Kinney and R. L. Martin. Flea identifications were made by Mr H. E. Stark. Analyses of nests and rodents for DDT were performed by Mr C. Cueto, Technical Development Laboratories, CDC, Savannah, Georgia.

Nasal swabs were taken from 369 four-year-old children in two South Wales towns and cultured for Streptococcus pneumoniae. The organism was isolated in 34% of the specimens, similar rates being found in boys and girls in the two towns. The children were swabbed again a year later, when the prevalence of nasal pneumococci had fallen to 25%. There was no association between the presence of the organism on the two occasions. Types 6 and 23 were most often isolated. After excluding children who had received an antibiotic, the proportion carrying a pneumococcus was higher in those who had recently had a respiratory infection than in the rest, although the difference was not quite statistically significant. There was a significant negative association between the presence of Staphylococcus aureus and Strep. pneumoniae.

An outbreak of measles in the Netherlands in 2013–2014 provided an opportunity to assess the effect of MMR vaccination on severity and infectiousness of measles.

Measles is notifiable in the Netherlands. We used information on vaccination, hospitalisation, complications, and most likely source(s) of infection from cases notified during the outbreak. When a case was indicated as a likely source for at least one other notified case, we defined it as infectious. We estimated the age-adjusted effect of vaccination on severity and infectiousness with logistic regression.

Of 2676 notified cases, 2539 (94.9%) were unvaccinated, 121 (4.5%) were once-vaccinated and 16 (0.6%) were at least twice-vaccinated; 328 (12.3%) cases were reported to have complications and 172 (6.4%) cases were hospitalised. Measles in twice-vaccinated cases led less often to complications and/or hospitalisation than measles in unvaccinated cases (0% and 14.5%, respectively, aOR 0.1 (95% CI 0–0.89), P = 0.03). Of unvaccinated, once-vaccinated and twice-vaccinated cases, respectively, 194 (7.6%), seven (5.1%) and 0 (0%) were infectious. These differences were not statistically significant (P > 0.05).

Our findings suggest a protective effect of vaccination on the occurrence of complications and/or hospitalisation as a result of measles and support the WHO recommendation of a two-dose MMR vaccination schedule.

The actiology, epidemiology and clinical presentation of 137 bacteriologically confirmed cases of superficial mycobacterial lymphadenitis identified at the Liverpool Public Health Laboratory between 1969 and 1984 were reviewed. Despite a fall in pulmonary and total extrapulmonary isolates, the annual recovery of mycobacteria from lymph nodes remained relatively constant. Mycobacterium tuberculosis was the cause of infection in 121 patients (88·3%), M. bovis in 6 and the remaining 10 isolates were atypical mycobacteria. In European patients (68·6%) the highest incidence was in the elderly, whereas in non-Europeans (31·4%) the disease almost exclusively occurred in the third and fourth decades. The proportion of isolates from non-Europeans reflected the size of the immigrant population and increased during the period of study.

1. In the introduction, the characteristics of the people are given from the observations of administrative and medical officers well acquainted with the area, fertility of the land and ample rainfall being the main theme of each observation.

2. The topography, climate and local conditions are given, including notes on crop production, habitations, clothing, domestic animals, origin of the people and food.

3. The population figures and rat and human plague figures are discussed. The rat and flea population figures over a twelve month trapping period are given and notes made on interesting biological problems arising out of these figures.

4. The male and female ratios in a Rattus population in plague endemic areas offer an interesting problem for further investigation. It would be instructive to find out what are the factors responsible for high female ratios and the significance of such female dominance being peculiar to endemic areas.

5. The field rodent and flea survey figures are discussed. Although an interchange of fleas takes place between them and house rats, plague remains absent from such communities.

6. There is no evidence to show that there is carriage of infection from endemic centres, either by rats, fleas, merchandise or man.

7. A comparison is drawn between a Kenya endemic centre and an Indian one, similarities and differences being noted. The similarities are that both areas are extremely fertile, large crops of cereals being grown, and the diets of both man and rats are confined to this inadequate source of nourishment. The great differences between Indian and Kenyan endemic centres are the flea species present and that India suffers a much heavier mortality rate in man than does Kenya.

8. It is suggested that the low incidence of plague in man in Kenya is partly explained by the habits of Rattus, which in the typical dwellings of native areas nests in the thatch. Its ectoparasites are then unlikely to come into contact with man. In buildings where rats nest underground contact between its flea (then Xenopsylla cheopis) and man is likely to be very close and constant, and areas containing such buildings are usually distinguished by the epidemic nature of the disease.

During the period 1961–91 a total of 567 635 strains of Staphylococcus aureus from hospitalized patients in Denmark have been characterized according to their antibiotic resistance, site of isolation and phage type. Strains of phage group II (typed by the phages 3A, 3C, 55 and 71) have been analysed further. The occurrence of group II strains was relatively constant (approximately 16%) from 1961 until 1983. Since then the frequency of group II strains increased; in 1991 they accounted for 22.7% of all S. aureus strains isolated. Strains of group II can, on the basis of their phage types, be divided in four subgroups: 3A, 71, 71 + and the ‘rest of group II’. Furthermore, within these groups strains may differ from one another in respect to their sensitivity to phages.

The increased isolation of group II strains during recent years was because of an increase in strains of subgroups 71 + and the ‘rest of group II strains’. In 1991 these two subgroups accounted for 89.7% of all group II strains. Furthermore, an increasing number of group II strains, 71.4% in 1991, was typable only at RTD × 100. The increase in the number of group II strains was even throughout Denmark. All four subgroups of group II have, during the observation period, become more frequently resistant to penicillin and/or tetracycline. Strains typed at 100 × RTD of subgroup 71 + and the ‘rest of group II’ are more frequently antibiotic resistant than the rest of the group II strains.

Strains of the increasing subgroups occurred most often in abscesses.

Infusoria have the same bactericidal power as flagellates. Emulsions containing Bacillus typhosus, Vibrio cholerae, V. Dunbar, V. El Tor, B. megatherium and Spirillum volutans, to which Colpoda cucullus is added, are soon cleared. Before the clearage the Colpodae multiply actively.

This bactericidal effect does not depend upon the production of toxic substances by the Infusoria. The fluid obtained from filtered cultures of the Infusoria exerts no bactericidal effect. Only living Colpodae are able to clear the emulsions.

Direct sunlight does not prevent the clearing of the emulsions by the Infusoria, but temperatures below 10°C. and above 30°C. and absence of oxygen (anaerobic culture) are unfavourable to their exerting a bactericidal effect.

The polluted water of the canals of Amsterdam slightly delayed the clearage of the emulsions; the sewage of starch factories and gas factories completely prevented this clearage.

Consequently under natural conditions Infusoria will only play a part in purifying river water (1) if the temperature is above 10° and under 30°C., (2) if the aquatic vegetation is rich enough to supply the necessary quantity of oxygen, (3) if the water is not highly polluted by adjoining factories.

Jerusalem is the resort of so many tourists and pilgrims who chiefly visit the country in the healthy spring season and see little of the conditions in which the poor of the land live, that it may be difficult for them to realize that it is a city where malaria is exceedingly rife and where the most elementary sanitary regulations are utterly neglected.There is no proper public water supply, no sewers worth the name, vaccination is not enforced even when small-pox is epidemic and there is no attempt to isolate those suffering from infectious diseases. This state of things is undoubtedly largely due to remissness and ignorance on the part of the Turkish Government, but the situation is made very complicated and difficult on account of the “ Capitulations ” by which all foreign subjects are practically independent of the Local Authority "and accept no orders except through their own Consuls.

Enquiries have frequently been received at the National Institute for Research in Dairying concerning the efficiency of the Fermentation-Reductase Test as a method for the grading of milk, and the suggestion has been made that this test, which is now in use in some European countries, might with advantage be substituted for the standard methods of counting bacteria and demonstrating the presence or absence of B. coli, which at present form the basis for the grading of milk in England. A study of this question was therefore undertaken, and since similar enquiries are still being received, it is thought advisable to publish a résumé of the results that have already been obtained.

Anthrax is still a severe public health problem and threat to human health. A cutaneous anthrax outbreak occurred in Jiangsu Province, a non-endemic anthrax region of eastern China, from July to August 2012. Epidemiological and laboratory investigation were initiated to trace the source of infection and identify the risk factors of the outbreak. On 25 July 2012, 17 persons were exposed to a sick cow, which had been imported from northeast China a few days previously. Of the 17 exposed, eight developed symptoms between 1 and 8 days and were diagnosed as cutaneous anthrax cases. Three main genes of Bacillus anthracis were detected from both human and cow meat samples, indicating that the outbreak was associated with this infected cow. A retrospective cohort study showed that contact with blood and presence of skin damage contributed to the case infection with B. anthracis. The outbreak highlights the need to enhance quarantine for imported livestock, which should have been vaccinated prior to importation, the significance of education for high-risk individuals, and training for primary healthcare workers even in anthrax-free areas.

Chickenpox is caused by varicella-zoster-virus (VZV) and is highly contagious. Immigration detention settings are a high-risk environment for primary VZV transmission, with large, rapidly-changing populations in close quarters, and higher susceptibility among non-UK-born individuals. During outbreaks, operational challenges occur in detention settings because of high-turnover and the potential need to implement population movement restriction for prolonged periods. Between December 2017 and February 2018, four cases of chickenpox were notified amongst 799 detainees in an immigration removal centre (IRC). Microbiological investigations included case confirmation by vesicular fluid polymerase chain reaction, and VZV serology for susceptibility testing. Control measures involved movement restrictions, isolation of cases, quarantining and cohorting of non-immune contacts and extending VZV immunity testing to the wider detainee population to support outbreak management. Immunity was tested for 301/532 (57%) detainees, of whom 24 (8%) were non-immune. The level of non-immunity was lower than expected based on the existing literature on VZV seroprevalence in detained populations in England. Serology results identified non-immune contacts who could be cohorted and, due to the lack of isolation capacity, allowed the placement of cases with immune detainees. The widespread immunity testing of all detainees was proving challenging to sustain because it required significant resources and was having a severe impact on operational capacity and the ability to maintain core business activities at the IRC. Therefore, mathematical modelling was used to assess the impact of scaling back mass immunity testing. Modelling demonstrated that interrupting testing posed a risk of one additional case compared to continuing with testing. As such, the decision was made to stop testing, and the outbreak was successfully controlled without excessive strain on resources. Operational challenges generated learning for future outbreaks, with implications for a local and national policy on IRC staff occupational health requirements, and proposed reception screening of detainees for VZV immunity.

The remarkable paper by Fred. Griffith on the significance of pneumococcal types, reproduced in the preceding pages of this Journal, in which it was first published 38 years ago (Griffith, 1928), describes a series of careful and painstaking experiments which show beyond doubt that the ability to produce a polysaccharide capsule can regularly be restored to ‘rough’ (R) strains of pneumococci which have lost it, by the subcutaneous inoculation of mice with a mixture of a small number of the living R bacteria and an excess of heat-killed, capsulated (S) virulent bacteria. The inoculated mice frequently died from septicaemia and virulent, capsulated S organisms could be isolated from the blood. On the other hand, in control experiments, the injection of suspensions of heat-killed S bacteria alone never yielded living organisms, while recovery of virulent S organisms by (mutational) reversion, following inoculation of living R bacteria alone, was a rare event. Griffith called this phenomenon ‘transformation’ and, at least in the field of bacterial genetics, this name is still specifically used to describe it.

Men engaged in slaughtering and dressing meat show a higher incidence of Brucella abortus agglutinins than those in similar age and sex groups who are otherwise employed, where titres of 1 in 20 and upwards are observed.

This applies especially to men who deal with cattle and sheep; no such increased incidence has been noted in men dealing with pigs.

It would seem that a titre in the vicinity of 1 in 40 serves to indicate evidence of Brucella infection definitely greater than that likely to be found in the generality of the community.

The three experiments with which this report deals were undertaken with the object of re-examining the conversion factor 1600 which had been provisionally allotted by the Second International Conference on Vitamin Standardization (1934) for converting the results of spectrophotometric tests for vitamin A into international units.

1. In a controlled experiment prontosil was used in the treatment of four cases of streptococcal tonsillitis. These cases subsequently developed acute rheumatism.

2. Two cases of otitis media and one case of streptococcal pneumonia, not in the controlled experiment, were treated with sulphonamide and sulphapyridine respectively. These cases developed rheumatism as a complication.

3. Haemolytic streptococci were recovered from twelve cases of respiratory tract infection which subsequently developed acute rheumatic fever.