A series of spontaneous epidemics of a paratyphoid infection among guinea-pigs is described. It is shown that an epidemic may result from the introduction of a fresh susceptible population into an infected area and vice versa. Such epidemics developed only when the new population was exposed during certain months. The bringing in of a fresh population at the end of November was not followed at the time by an epidemic outbreak; the epidemic did not occur until the following July.

The observed seasonal occurrence was not due to a change in virulence. The strains isolated at the end of the 1926 epidemic did not differ in virulence from those cultivated at the height of the 1927 epidemic.

The guinea-pig may remain a carrier for a long time whilst eliminating bacteria in the faecal discharges only intermittently and in small numbers. In general, even in the case of infected animals, the discharge of pathogenic bacteria is relatively small, except a few days before death.

Attention is called to the parallelism between the seasonal prevalence of human typhoid epidemics in this country and the epidemics of paratyphoid observed in our guinea-pig stock.

It is pointed out that a sound theory of the epidemiology of certain diseases must take into account the seasonal variation in host susceptibility.

The association between time to positivity (TTP) of blood culture and the clinical prognosis of patients with Klebsiella pneumoniae bloodstream infection (BSI) remains unclear. A retrospective study of 148 inpatients with BSI caused by K. pneumoniae was performed at Shanghai Tongji Hospital, China, from October 2016–2020. The total in-hospital fatality rate was 32%. The median TTP was 11.0 (7.7–16.1) h and the optimal cutoff for prediction of in-hospital mortality was 9.4 h according to the ROC curve. Early TTP (<9.4 h) was a risk factor for in-hospital mortality by univariate analysis (OR = 2.5, 95% CI 1.2–5.0, P = 0.01), but not by multivariate analysis (OR = 2.7, 95% CI 1.0–7.4, P = 0.06). Old age, serum creatinine, white blood cells, and C-reactive protein values were risk factors for in-hospital mortality by multivariate analysis. Early TTP was not a risk factor for septic shock (OR = 1.8, 95% CI 0.6–5.1, P = 0.27) or ICU admission (OR = 1.0, 95% CI 1.0–1.0, P = 0.32). In conclusion, the in-hospital fatality rate of patients with K. pneumoniae BSI was relatively high and associated with an early TTP of blood cultures. However, no increased risk of mortality, septic shock or ICU admission was evident in early TTP patients.

In the handling of milk no single factor is of more importance than the cleanliness of the vessels used, and steam sterilisation is an essential part of correct cleansing technique of dairy utensils. Although several hundred dairy farmers have installed apparatus for steam sterilisation, the majority are still content with less efficient methods and rely upon “scalding” as the final operation in washing a utensil, although the water used for scalding is seldom at a sufficiently high temperature to kill many bacteria, and it is usually poured from one vessel to another in the hopes of efficiently finishing the cleansing processes although it is only comfortably warm to the fingers.

In our previous paper in this Journal it was shown that the temperature of 46°C.1 recommended by Eijkman and Bulir in their fermentation test is excessively high, as in water cultures it has a destructive effect on Bact. coli. This was in accordance with the previous work of Brown and Skinner (1930) and Skinner and Brown (1934). At the same time we were able to show that in cultures in Bulir's medium at 43° not only is the destructive effect of the excessively high temperature on Bact. coli removed but the reproduction and fermentation activity of this organism is distinctly stimulated. At 43° Eijkman's and Bulir's tests effectively distinguish between true Bact. coli communis and other strains.

In this short report, we describe an outbreak of COVID-19 caused by Omicron subvariant BA.5.2.1 in highly vaccinated patients in a respiratory ward in a large acute general hospital in North West London, United Kingdom. The attack rate was high (14/33 (42%)) but the clinical impact was relatively non-severe including in patients who were at high risk of severe COVID-19. Twelve of fourteen patients had COVID-19 vaccinations. There was only one death due to COVID-19 pneumonitis. The findings of this outbreak investigation suggest that while the transmissibility of Omicron BA.5.2.1 subvariant is high, infections caused by this strain are non-severe in vaccinated patients, even if they are at high risk of severe COVID-19 infection.

The bronchial constriction occurring in death from acute anaphylaxis has been demonstrated radiologically by the use of lipiodol.

The efficacy of the conventional bacille Calmette-Guérin (BCG) vaccine is often questioned because of conflicting trial results [1]. In this context, a new BCG vaccine developed by Grode et al. [2] has been seen as a favourable development in tuberculosis (TB) control [3]. BCG vaccine development is a challenge for many reasons, not least of which is the complex immunology of mycobacterial infections. The pathogenesis of TB, and prevention of TB by BCG, is predominantly a function of cell-mediated immunity. Mycobacterium tuberculosis (MTB) and BCG are phagocytosed, but remain viable for some time within the phagosome. There, BCG antigens must be presented to major histocompatibility complex (MHC) class II molecules to activate CD4+ cells, and to MHC class I molecules to activate CD8+ cells [3]. However, both MTB and BCG fail to activate CD8+ cells sufficiently. The relative failure of activation of CD8+ cells is thought to be related to the enzyme urease, which keeps the intracellular pH high and thus inhibits presentation of antigens to T cells which would otherwise activate the CD8+ response. Grode et al. [2] have engineered a BCG strain which overcomes this problem and allows release of antigen into the cell and thereby stimulates a CD8+ cell response in addition to the CD4 response seen with conventional BCG. They did this first by engineering a strain of BCG which secretes listeriolysin (Hly), an enzyme from Listeria monocytogenes which perforates cell membranes.

To mitigate the known high transmission risk in day-care facilities for children aged 0–6 years, day-care staff were given priority for SARS-CoV-2 vaccination in Rhineland-Palatinate, Germany, in March 2021. This study assessed direct and indirect effects of early vaccination of day-care staff on SARS-CoV-2 transmission in daycares with the aim to provide a basis for the prioritisation of scarce vaccines in the future. Data came from statutory infectious disease notifications in educational institutions and from in-depth investigations by the district public health authorities. Using interrupted time series analyses, we measured the effect of mRNA-based vaccination of day-care staff on SARS-CoV-2 infections and transmission. Among 566 index cases from day-care centres, the mean number of secondary SARS-CoV-2 infections per index case dropped by −0.60 case per month after March 2021. The proportion of staff among all cases reported from daycares was around 60% in the pre-interruption phase and significantly decreased by 27 percentage points immediately in March 2021 and by further 6 percentage points each month in the post-interruption phase. Early vaccination of day-care staff reduced SARS-CoV-2 cases in the overall day-care setting and thus also protected unvaccinated children. This should inform future decisions on vaccination prioritisation.

While tetanus toxoid vaccination has reduced the incidence of tetanus in the developed world, this disease remains a substantial health problem in developing nations. Tetanus immune globulin (TIG) is used along with vaccination for prevention of infection after major or contaminated wounds if vaccination status cannot be verified or for active tetanus infection. These studies describe the characterisation of a TIG produced by a caprylate/chromatography process. The TIG potency and presence of plasma protein impurities were analysed at early/late steps in the manufacturing process by chromatography, immunoassay, coagulation and potency tests. The caprylate/chromatography process has been previously shown to effectively eliminate or inactivate potentially transmissible agents from plasma-derived products. In this study, the caprylate/chromatography process was shown to effectively concentrate TIG activity and efficiently remove pro-coagulation factors, naturally present in plasma. This TIG drug product builds on the long-term evidence of the safety and efficacy of TIG by providing a product with higher purity and low pro-coagulant protein impurities.

The organisms examined have been killed, (a) by temperatures which should not have destroyed the reducing enzyme, (b) by sodium fluoride and four other antiseptics, derivatives of phenol, and (c) by acetone. In each case there has been total destruction of the reducing power, any apparent production of nitrite from nitrate being too slight to justify the assumption that it is due to anything more than experimental error. Filtrates of fluid cultures have also failed to reduce. The results may be summed up as follows:

(1) The reduction of nitrite by certain dysentery bacilli is not due to a soluble extra-cellular enzyme.

(2) Dysentery bacilli and B. coli killed by a minimal degree of heat have little if any effect in reducing nitrites.

(3) Organisms killed by antiseptics or by acetone do not reduce nitrates and nitrites.

(4) Even where all the organisms are not dead, reduction may be prevented by antiseptics.

(5) The high antiseptic value of tetrachlor-o-biphenol, tetrabrom-o-kresol, p-chlor-m-kresol and hexabrom-dioxy-diphenyl-carbinol has been established for the organisms of the dysentery group.

1. Of 123 dysentery bacilli isolated, forty-seven were B. dysenteriae Shiga, seventy-six were mannite fermenters.

2. The biochemical activities of forty-nine strains of the latter were investigated immediately after isolation and again six months later. They showed variability as regards the fermentation of maltose, saccharose, dextrin, raffinose, arabinose, isodulcite, sorbite and glycerin and in the formation of indol. The same strain varied at different times, some gaining, others losing one or other of the above properties.

Similar observations by other observers and the authors are discussed and the conclusion is arrived at that the separation of the mannite fermenting dysentery bacilli into groups on the ground of their action upon the above carbohydrates is unsound and that the only carbo-hydrates of service for their identification are glucose, mannite, lactose and dulcite.

3. An experiment conducted during two and a half months upon a particular strain of dysentery bacillus shows that the fermentation of saccharose was in this strain a “recessive character” and only maintained by artificial selection.

4. One-sixth of the mannite fermenting dysentery organisms isolated were not agglutinated by a univalent Y (rabbit's) serum at the time of isolation but half of these acquired this property by cultivation. Others were well agglutinated by the patient's serum. An experiment is described in which agglutinability to Y serum was lost under prolonged cultivation on saccharose peptone media. In this experiment successive cultures were made every few days and the material for subcultivation was taken from daughter colonies (buds), which arose in the saccharose plates. Agglutinability was rapidly regained by propagation in broth. From the author's experience and from a survey of the literature, the conclusion is arrived at that no one univalent serum will agglutinate all dysentery bacilli of the mannite fermenting type and that a bacillus with the morphological, cultural, and biochemical characters of dysentery bacilli of this type is not discredited as an etiological factor because it is not agglutinated by any particular univalent serum.

In conclusion we express our indebtedness to Miss Rhodes of the Lister Institute for retesting many of the cultures in London, in January, 1917, and convey to her our grateful appreciation of her kindness in so doing.

Immunoelectrophoresis of ultrasonically disrupted Haemophilus equigenitalis (contagious equine metritis organism) cells against rabbit and equine antisera disclosed at least 11 precipitating antigens. Two of these, a polysaccharide and a lipopolysaccharide–protein complex, were of high molecular weight and located on the cell surface. The remaining antigens were intracellular and were small- to medium-sized proteins.

The surface antigens were the most significant in relation to the serological response in infected horses. They also reacted with sera from apparently healthy cattle, but the reason for this was not determined. No serological cross-reaction between H. equigenitalis and species of Achromobacter and Moraxella was detected.

Water samples from home filters in nine residential areas of a Nigerian university community were studied. The membrane filter technique was used to determine the total coliform and faecal coliform counts/100 ml of water. Most of the 100 samples studied were grossly contaminated with total coliform counts/100 ml ranging from 0–442, faecal coliform counts/100 ml, 0–216 and the total aerobic plate count per millilitre ranged from 3·0 × 103 to 1·9 × 109 c.f.u. The source (dams) of water, fitness of filter candles, frequency of cleaning candles and pH of water did not significantly (P > 0·05; X2) affect the microbial quality of either filtered boiled or unboiled tap water.

Escherichia coli type I was isolated from 17·9% of the faccal coliforms tested but from only 2·3% of total coliforms. Enterobacter aerogenes was most predominant (38·5%) amongst faecal coliforms isolated while Enterobacter cloacae was the most frequent (37·2%) of the total coliform isolates.

The gross contamination of filltered water from all households sampled calls fpr am englightenment of residents on the proper use of home water filters.

For the measles-mumps-rubella (MMR) vaccine, the World Health Organization-recommended coverage for herd protection is 95% for measles and 80% for rubella and mumps. However, a national vaccine coverage does not reflect social clustering of unvaccinated children, e.g. in schools of Orthodox Protestant or Anthroposophic identity in The Netherlands. To fully characterise this clustering, we estimated one-dose MMR vaccination coverages at all schools in the Netherlands. By combining postcode catchment areas of schools and school feeder data, each child in the Netherlands was characterised by residential postcode, primary and secondary school (referred to as school career). Postcode-level vaccination data were used to estimate vaccination coverages per school career. These were translated to coverages per school, stratified by school identity. Most schools had vaccine coverages over 99%, but major exceptions were Orthodox Protestant schools (63% in primary and 58% in secondary schools) and Anthroposophic schools (67% and 78%). School-level vaccine coverage estimates reveal strong clustering of unvaccinated children. The school feeder data reveal strongly connected Orthodox Protestant and Anthroposophic communities, but separated from one another. This suggests that even at a national one-dose MMR coverage of 97.5%, thousands of children per cohort are not protected by herd immunity.

Rubella is a highly contagious mild viral illness. It is a leading cause of congenital rubella syndrome (CRS). Routine data of rubella do not exist in Ethiopia. However, laboratory-based conformation of rubella cases from measles negative samples were collected from a measles surveillance system. The current study was to analyse the epidemiological distribution of rubella cases from measles-suspected cases in Ethiopia from 2011 to 2015. National-based secondary data analysis of rubella through measles-based surveillances was carried out. Measles-suspected cases were investigated using the case investigation form, and a serum sample collected and sent to the Ethiopian laboratory for conformation. Samples tested for measles immunoglobulin M (IgM) were tested for rubella. The investigation results were entered into an electronic database using SPSS version 25 for analysis. Out of 11749 samples tested for rubella IgM from 2011 to 2015, 2295 (19.5%) were positive for rubella IgM and 51% of rubella-positive cases were female. Five per cent of all cases were female aged between 15 and 49. Cases were confirmed from all regions, two administrative towns and seasonal variations were observed with peaks in the first and fourth seasonal periods of the years. As fear of congenital abnormality (CRS), the Ethiopian government should focus on rubella syndrome surveillance with the aim of starting a rubella vaccine.

The microporous polyethylene hollow fibre membrane is capable of adsorbing small-sized lipopolysaccharides (LPS) prepared by sonication dispersion, column chromatography on Sephadex G-75 and filtration through a filter membrane with a nominal pore size of 0·025 μg. Small-sized LPS had a one-thousandth of endotoxin activity as compared to intact LPS, when determined by the Synthetic Chromogenic Substrate method of LAL with a specific endotoxin activity of 73·7 ng/μg LPS. Fluorescent microscopy of fluorescein conjugated LPS on a microporous polyethylene hollow fibre showed that fiuorescein-LPS was adsorbed through the entire depth of the membrane texture. Accordingly the adsorption capacity of the filter for small-sized LPS was determined as 1·65 mg LPS/3·68 m2 surface/116 mg fibre/module.

Nosocomial outbreak of varicella zoster virus (VZV) has been reported when susceptible individuals encounter a case of chicken pox or shingles. A suspected VZV outbreak was investigated in a 50-bedded in-patient facility of Physical Medicine and Rehabilitation in a tertiary care multispecialty hospital. A 30-year-old female patient admitted with Pott’s spine was clinically diagnosed with chicken pox on 31 December 2022. The following week, four more cases were identified in the same ward. All cases were diagnosed as laboratory-confirmed varicella zoster infection by PCR. Primary case was a housekeeping staff who was clinically diagnosed with chicken pox 3 weeks prior (9 December 2022). He returned to work on eighth day of infection (17 December 2022) after apparent clinical recovery but before the lesions had crusted over. Thirty-one HCWs were identified as contacts a and three had no evidence of immunity. Two of these susceptible HCWs had onset of chickenpox shortly after first dose of VZV vaccination was inoculated. All cases recovered after treatment with no reported complications. VZV infection is highly contagious in healthcare settings with susceptible populations. Prompt identification of cases and implementation of infection prevention and control measures like patient isolation and vaccination are essential for the containment of outbreaks.

This study compares the presence and level of measles haemagglutination inhibiting antibody in the sera of primary school children in selected rural and urban areas of Kaduna State, Nigeria following a vaccination campaign. The results, analysed by Mann-Whitney statistical test at α=0·05, showed significantly higher levels of haemagglutination inhibiting antibody in all the age groups in urban areas when compared with rural areas. The implications of these findings on measles vaccination campaigns are discussed.