The membrane methods described in Report 71 on the bacteriological examination of water supplies (Report, 1969) for the enumeration of coliform organisms and Escherichia coli in waters, together with a glutamate membrane method, were compared with the glutamate multiple tube method recommended in Report 71 and an incubation procedure similar to that used for membranes with the first 4 hr. at 30°C., and with MacConkey broth in multiple tubes. Although there were some differences between individual laboratories, the combined results from all participating laboratories showed that standard and extended membrane methods gave significantly higher results than the glutamate tube method for coliform organisms in both chlorinated and unchlorinated waters, but significantly lower results for Esch. coli with chlorinated waters and equivocal results with unchlorinated waters. Extended membranes gave higher results than glutamate tubes in larger proportions of samples than did standard membranes. Although transport membranes did not do so well as standard membrane methods, the results were usually in agreement with glutamate tubes except for Esch. coli in chlorinated waters. The glutamate membranes were unsatisfactory. Preliminary incubation of glutamate at 30° C. made little difference to the results.

We report two cases of respiratory toxigenic Corynebacterium diphtheriae infection in fully vaccinated UK born adults following travel to Tunisia in October 2019. Both patients were successfully treated with antibiotics and neither received diphtheria antitoxin. Contact tracing was performed following a risk assessment but no additional cases were identified. This report highlights the importance of maintaining a high index of suspicion for re-emerging infections in patients with a history of travel to high-risk areas outside Europe.

The work began with efforts to isolate a type II Vi phage from local sewage. When this attempt failed, typing material was obtained from Dr J. Craigie and Dr A. Felix.

The typing method was applied to 495 strains of typhoid bacilli, the technique laid down by Craigie being followed throughout.

It was found that in South Africa the distribution of the various types of typhoid bacilli is different from that obtaining in other countries where this typing method has so far been applied.

During further investigations of type F strains the fact came to light that by means of a simple biochemical test type F strains can be subdivided into two sub-types, which subdivision will be useful in further epidemiological work. No such biochemical subdivision was found possible in any other type.

It did not prove possible to type all South African strains with the available phage preparations. Some of these strains must represent new types. Workers in other countries have had similar experiences and it will become necessary to compare all these unusual strains directly with one another in order to reach uniformity in nomenclature. It has already been possible to co-operate with workers in England, and they have been assisted by my finding that a strain, unique in England and supposed to have been brought there by a carrier, who had typhoid fever in South Africa 40 years ago, was endemic in South Africa.

During the course of the work, two outbreaks of typhoid fever occurred in which the typing method proved most useful, not only for linking up a particular carrier with a particular outbreak, but also for excluding an already known carrier who was under grave suspicion.

I have to thank Dr Craigie and Dr Felix for supplying material, and Prof. Pijper, of the Pretoria University, for placing laboratory facilities at my disposal. I thank all others for cultures received for typing.

THe experiments recorded here were initiated following upon the occurrence in this country of foot-and-mouth disease in a cow, which a short time previously had been injected for the purpose of inducing oestrus with a pituitary extract imported from the Continent. Mr D. A. E. Cabot, M.R.C.V.S., Chief Veterinary Officer of the Ministry of Agriculture, made reference to this interesting case in a discussion on foot-and-mouth disease at the First Imperial Veterinary Conference held in London (1938). Confirmation of the nature of the infection was obtained by the inoculation of test animals under experimental conditions with suitable material collected from the injected animal. Further investigations were made. Three ampoules containing pituitary extract were obtained from the distributors in London of the imported commercial preparation under discussion. These ampoules belonged to the same batch as the ampoule with the extract from which the cow had been inoculated. Messrs A. Eccles, M.R.C. V.S. and A. M. Graham, M.R.C.V.S., at the Experimental Station of the Foot-and-Mouth Disease Research Committee at Pirbright, tested this material for virus infectivity by the inoculation of cattle and guinea-pigs. They reported that all three samples of pituitary extract were contaminated with the virus of footand-mouth disease. In addition they produced evidence that the immunological type of the virus recovered from the extract in the ampoules was the same as that of the virus recovered from the cow, viz. Vallée and Carré 0. This and additional information left no doubt that the outbreak of the disease had been produced by the inoculation of the pituitary extract, and further that this extract had been prepared from the pituitary glands of cattle, which were very probably in the early stages of infection with foot-and-mouth disease at the time of slaughter.

In a previous paper (Williams and Hoy, 1927) it was shown that living and virulent tubercle bacilli could be demonstrated in the faeces of six apparently healthy cows from among a total of 391 which were examined. All these cows were living the normal life of the herds in which they were discovered, and three of them were brought to the Institute in order that a study might be made of the frequency with which tubercle bacilli could be found in their faeces.

Recent New Zealand and Australian isolates of Salmonella typhimurium phage type 179 were studied for relatedness by colony incompatibility. This established that all but one strain of the New Zealand groups probably formed a clone despite carrying a variety of plasmids. The Australian strains showed a far greater diversity. This study demonstrates the epidemiological usefulness of the colony incompatibility reactions.

In a study of the influence of environmental and other conditions on the growth and nutrition of the children of the poorer classes in the city of Glasgow, it seemed desirable to determine how far a homogeneous stock was being dealt with since there was some danger that racial variations might modify the results of the investigation.

Multidrug-resistant Pseudomonas aeruginosa (MDRPA) infections are major threats to healthcare-associated infection control and the intrinsic molecular mechanisms of MDRPA are also unclear. We examined 348 isolates of P. aeruginosa, including 188 MDRPA and 160 non-MDRPA, obtained from five tertiary-care hospitals in Guangzhou, China. Significant correlations were found between gene/enzyme carriage and increased rates of antimicrobial resistance (P < 0·01). gyrA mutation, OprD loss and metallo-β-lactamase (MBL) presence were identified as crucial molecular risk factors for MDRPA acquisition by a combination of univariate logistic regression and a multifactor dimensionality reduction approach. The MDRPA rate was also elevated with the increase in positive numbers of those three determinants (P < 0·001). Thus, gyrA mutation, OprD loss and MBL presence may serve as predictors for early screening of MDRPA infections in clinical settings.

A group specific agar-gel immunodiffusion test was used to demonstrate that there is a frequent and widespread distribution of bluetongue virus throughout the Sultanate of Oman. The Culicoides midges C. imicola and C. schultzei, both capable of transmitting bluetongue group viruses, were recorded throughout the year. Although these studies did not establish that bluetongue is enzootic in Oman, type-specific neutralizing antibody results supported previous evidence for the existence of a Saudi Arabian bluetongue ecosystem. Variations in antibody evidence of virus activity within a restricted locality suggested a hot-spot theory concerning the perpetuation of the virus.

An LD 50 dose S. typhi (strain Ty was injected intraperitoneally into white mice, and the number of micro-organisms was determined after 1 min. and subsequently, in the blood, and after 3 hr. and subsequently, in the spleen and liver. The course of the infection was observed for 34 days.

The number of bacteria gradually increased in the blood stream during the first post-infective hours. It was possible to differentiate by external signs from the sixth post-infective hour and onwards between sick animals and recovering ones. This difference corresponded to the bacterial concentration in the blood stream and internal organs.

In the sick animals the increase in the bacterial count of blood stream continued till 9–10 hr. after the inoculation, when it reached its first peak. During the following 8 hr. a clear decrease in the blood count was evident which was attributed to the ‘clearing mechanism’ of the blood. The onset of a new bacterial rise in the blood stream appeared 18 hr. after the inoculation and reached a second peak during the further 6–8 hr.

In contrast to the observed decrease in the bacterial blood count, a steady and gradual increase in the count of the internal organs was seen; it was steadily progressive till the exitus.

In the recovering animals a steady decrease in the bacterial blood count was recorded. Between 24 and 26 hr. the number of micro-organisms in the blood and spleen was found to be 400 times less in the recovering animals than in the moribund ones. From 48 hr. and onwards a slow and gradual decrease in the bacterial count of the surviving animals was observed. The blood became sterile after 25 days. In the spleen and liver of the surviving animals after 48 hr. a new increase in the bacterial count is evident, accompanied by hyperplasia of the spleen. The number of bacteria reached a new peak in the liver on the third day and in the spleen on the fourth day after the infection.

Subsequently a slow and gradual decrease in the bacterial count was observed in both organs, but even after 34 days a small number of persisting bacteria in the spleen and liver tissue may be found.

At the University Hospital of Besançon (département of Doubs, France), an unusually high number of patients were hospitalized for hepatitis A during the 1999–2000 period, some of whom had not travelled abroad. This prompted us to conduct an investigation on a population basis and search for clusters of cases possibly related to local sources of contamination. Accordingly, case definition was restricted to autochthonous cases. During the 1999–2002 period, 45 autochthonous cases were classified as possibly originating from local environmental sources. A space–time scan statistic detected one most likely cluster (standardized incidence ratio 20·63, 95% confidence interval 10·6–37·1), consisting of 11 persons (of whom five children had attended the same swimming pool). It remained significant in a sensitivity analysis, strongly supporting the hypothesis of an environmental source of contamination. This study reveals the necessity of regular surveillance for hepatitis A and raises the issue of virological surveys of pool waters.

Pneumonia is a leading cause of mortality and morbidity worldwide with radiographically confirmed pneumonia a key disease burden indicator. This is usually determined by a radiology panel which is assumed to be the best available standard; however, this assumption may introduce bias into pneumonia incidence estimates. To improve estimates of radiographic pneumonia incidence, we applied Bayesian latent class modelling (BLCM) to a large database of hospitalized patients with acute lower respiratory tract illness in Sa Kaeo and Nakhon Phanom provinces, Thailand from 2005 to 2010 with chest radiographs read by both a radiology panel and a clinician. We compared these estimates to those from conventional analysis. For children aged <5 years, estimated radiographically confirmed pneumonia incidence by BLCM was 2394/100 000 person-years (95% credible interval 2185–2574) vs. 1736/100 000 person-years (95% confidence interval 1706–1766) from conventional analysis. For persons aged ⩾5 years, estimated radiographically confirmed pneumonia incidence was similar between BLCM and conventional analysis (235 vs. 215/100 000 person-years). BLCM suggests the incidence of radiographically confirmed pneumonia in young children is substantially larger than estimated from the conventional approach using radiology panels as the reference standard.

Accurate data on the incidence of West Nile virus (WNV) disease are important for directing public health education and control activities. The objective of this project was to assess the underdiagnosis of WNV neuroinvasive disease through laboratory testing of patients with suspected viral meningitis or encephalitis at selected hospitals serving WNV-endemic regions in three states. Of the 279 patients with cerebrospinal fluid (CSF) specimens tested for WNV immunoglobulin M (IgM) antibodies, 258 (92%) were negative, 19 (7%) were positive, and two (1%) had equivocal results. Overall, 63% (12/19) of patients with WNV IgM-positive CSF had WNV IgM testing ordered by their attending physician. Seven (37%) cases would not have been identified as probable WNV infections without the further testing conducted through this project. These findings indicate that over a third of WNV infections in patients with clinically compatible neurological illness might be undiagnosed due to either lack of testing or inappropriate testing, leading to substantial underestimates of WNV neuroinvasive disease burden. Efforts should be made to educate healthcare providers and laboratorians about the local epidemiology of arboviral diseases and the optimal tests to be used in different clinical situations.

Contradictory opinions are at present held on the subject of bacterial standards of purity of water in India. My recent researches tend to throw some light on some of the causes of this divergence of opinion. The presence of frogs in water has been found to be responsible for an increase in faecal bacilli which, though negligible in the case of large bodies of water, is apt to be misleading in the case of waters of great purity. Stasis in reservoirs and passage through pipes may be responsible for a considerable increase in faecal bacilli in water, so that a mere increase in the number of faecal bacilli in a reservoir or pipe water does not necessarily indicate faecal contamination but may simply be due to stasis in reservoirs or flow through pipes. These findings lead to two conclusions of importance in regard to the bacteriological examination of water: (1) in testing for the bacterial efficiency of sand filters, samples should be collected from the filter well and not from the clear water reservoir where water is usually stagnant for some hours; (2) in interpreting the results of the examination of pipe waters the possibility of an increase of B. coli having occurred through multiplication in the pipes should always be borne in mind before inferring that such increase is indicative of faecal contamination or leakage in the mains.

The object of the present investigation was to determine the relation between the variations in hair and eye colours and variations of weight and stature; so that one might know what allowances, if any, would be necessary to make for variations of the proportion of children in different classes of hair and eye colour in different age groups and in the two sexes in the different schools under investigation with respect to the factors influencing bodily growth and nutrition. Incidentally, the analysis might reveal racial differentiation if such were present in this population.

This paper presents the results of a preliminary study of conditions affecting the movement of leucocytes. It demonstrates experimental facts which confirm the assumptions that osmotic force present in aqueous solutions and the permeability of leucocytes for water are the factors responsible for the movement of these cells from place to place.

Data concerning numerous severe epidemics of poliomyelitis were surveyed for information useful in estimating the size of the immune component of the population by age groups of 1 year. The New York epidemic of 1916 and the Mauritius epidemic of 1945 were chosen as the most suitable for this purpose. It is shown that there was a regularly progressive decline in attack rates for successively older age groups from 2 to 8 years in New York. The attack rate in 8-year-olds was less than 10 % as large as that in 2-year-olds. It is noted that a difference of this magnitude could be accounted for by immunizing infections amounting to 30 % per year for 6 years.

A similar analysis of age specific attack rates during the Mauritius epidemic shows progressive declines of 28, 60, 50 and 53 % for the successive age groups 5–9. An average annual infection rate of 45 % over a 4 year period could account for the ten-fold difference in infection rates between 5-year-olds and 9-year-olds.

An immunizing infection rate of 30 % a year would lead to a pattern of immunity in which the seven youngest age groups had a total susceptible component of 30 % at the beginning of a ‘ poliomyelitis season’. Twenty per cent would remain susceptible at the end of the season when spread of virus terminated.

An annual immunizing infection rate of 45 % would bring about a situation in which 21 % of the five youngest age groups were susceptible at the start of a period of viral prevalence and 12 % at the end. Alternatively, one could consider that on Mauritius there may have been a continuous prevalence of virus in a population in which approximately 15 % of the five youngest age groups were susceptible at any time.

It is suggested that the essentially similar attack rates among children 3–5 years old on Mauritius may have reflected a 3-year period during which homotypic virus was not prevalent, in contrast to its great prevalence during the years prior to that time.

A more detailed discussion and analysis of additional data concerning age-specific attack rates in poliomyelitis will be found in the thesis submitted by Dr Sample to the University of Washington School of Medicine entitled, ‘Some observations on statistical and theoretical epidemiology of infectious diseases, principally poliomyelitis’, in 1955. This is obtainable by Inter-library Loan from the Health Sciences Library, University of Washington, Seattle.

We wish to express our sincere thanks to Dr Blair M. Bennett and Dr William E. Reynolds of the University of Washington for their advice on the statistical and epidemiologic aspects of this study.

A carrier has been found of at least three phage types of Salmonella paratyphi B. Investigation has shown that phage-mediated conversion could account for this multiplicity of types according to the following scheme.

It is not possible, however, to exclude the actual occurrence of repeated infection with different phage types.

I am grateful to Dr E. S. Anderson of the Central Enteric Reference Laboratory, Colindale, for his interest and advice during the course of this investigation, and to Dr Helen A. Wright of the University of Edinburgh who provided the many cultures and so introduced me to this problem.

The use of fumigants against insects attacking stored products involves two possible dangers. In the first place workers may be poisoned by inhaling the fumigant either during its use or its manufacture. Secondly the fumigant may be adsorbed onto food-stuffs thereby hazarding the health of consumers.

Any description of the outbreaks of venereal disease is of necessity bound up with the migration of races, or parts of races, with wars and the consequent dislocation of the social system resulting from them. There are many inferences available from current writers showing how this contagious disease was spread and there is a good deal of reason to believe that some, at least, of the numerous cases of “leprosy” for which provision was made on frequent trade routes in past times were really cases of venereal disease.