A bacterial spore test has been developed which enables the efficacy of the sterilizing cycle recommended by the British Pharmaceutical Codex (1973) for bottled fluids to be accurately monitored. During a 14-month period this test detected faults in 3.3% of the sterilizing cycles, representing five distinct episodes of sterilization failure that passed unnoticed by the conventional controls of physical measurements and sterility testing. There were no failures of sterilization as detected by conventional techniques which were not indicated by the spore test.

In 1930 the author (Graham-Smith, 1930) showed that of spores of B. anthracis inoculated on 7 July 1907, on to dry, sterile pieces of canvas, measuring about 0·5 × 0·5 in., which were kept in a Petri dish in a cupboard with a glass door in the laboratory and therefore exposed to diffuse daylight at room temperature in a dry atmosphere, large numbers were capable of germinating in ordinary laboratory media after 10 years and progressively smaller numbers after 17 and 20 years. Very few germinated after 22 years and none after 22½ years.

Older adults and people of colour are vulnerable to the COVID-19 pandemic, and mitigation behaviours reduce COVID-19 infection. We examined racial and ethnic differences in COVID-19 diagnosis and adherence to COVID-19 mitigation behaviours among U.S. older adults. Data were retrieved from the National Health and Aging Trends Study, a nationally representative prospective cohort with 3257 U.S. Medicare beneficiaries aged 65+. COVID-19 variables were collected in 2020; all other data in 2019. Odds of COVID-19 diagnosis and adherence to mitigation behaviours (handwashing, masking, social distancing) were analysed using logistic regression. Compared to White older adults, only Hispanic respondents had 2.7 times significantly higher odds of COVID-19 after adjusting for sociodemographics, health, and mitigation behaviours (aOR = 2.71, 95% CI = 1.20-6.12). Black older adults had 7.9 times significantly higher odds of masking (aOR = 7.94, 95% CI = 2.33-27.04) and 2.3 times higher odds of social distancing (aOR = 2.33, 95% CI = 1.28-4.24), after adjusting for sociodemographics and health. Among all racial and ethnic groups, only Hispanic older adults had a significantly elevated COVID-19 diagnosis. Despite higher adherence to COVID-19 mitigation behaviours among racial and ethnic minorities, especially Black older adults, odds of COVID-19 remained elevated. Research is needed to explore potential mechanisms for higher odds of COVID-19 among minority older adults.

A retrospective cohort study was performed following several reported cases of gastrointestinal illness after a catered event. The attack rate was 45/77 (58·4%) by clinical case definition, with four individuals confirmed to have Campylobacter. There was near universal exposure to most foodstuffs served; consumption of duck liver pâté [relative risk (RR) 2·53, 95% confidence interval (CI) 1·05–6·10], mixed leaf salad (RR 2·91, 95% CI 1·22–6·92) and table water (RR undefined, P < 0·01) were associated with illness in univariate analysis, with only the latter associated in the final multivariable model (P < 0·001). Samples of cooked duck liver pâté subsequently prepared using identical methods at the venue were contaminated with Campylobacter jejuni and C. coli; water sampling was negative. Making inferences about causation in the presence of near universal exposures in this study required consideration of the limitations of statistical analysis, with the most compelling evidence of the causal role of inadequately prepared duck liver pâté provided by environmental investigation.

Adult cockroaches were found to survive up to 22 weeks when provided with 1% Formalin (0·4% formaldehyde) in lieu of drinking water. Given 4% Formalin or 2% glutaraldehyde they survived up to 41 days. During the experiments eggs were laid and hatched and the offspring continued to grow. Combined with surface disinfection, this may hold out a simple method of rendering adult cockroaches gnotobiotic or even axenic.

1. The rigidity of agar gel in poured agar plates can be tested by a comparatively simple and easily repeatable method.

2. Commercial agar from different sources varies in the rigidity of gel it produces at a given concentration.

3. The rigidity of gel produced by any agar at a given concentration is affected by processing and by the mode of production of poured plates and to some extent by the diluent used.

4. The appearance of a spurious S-R change in colonies of Salmonella and Shigella on media with an increasing agar content is a measure of the rigidity of the agar gel used and not directly of the agar concentration of the medium.

5. The appearance of this spurious S-R change induced by rigid agar bears no relation to the agglutinability of the organism.

6. Both increased or decreased agglutinability of cultures of Salmonella and Shigella is associated with the appearance of colonies of an apparently rough morphology at a lower level of agar rigidity than that at which spurious S-R change develops in a normally agglutinable culture.

7. Without some standardization of the rigidity of the gel used in agar plates, erroneous conclusions may be drawn regarding the antigenic state of the organisms under test.

8. Samples of agar of differing gel rigidity can be blended to form a product producing a gel of a calculated 12 sec. value.

I am indebted to the Director-General, Army Medical Services, for permission to publish this article.

This study proposed a novel ensemble analysis strategy to improve hand, foot and mouth disease (HFMD) prediction by integrating environmental data. The approach began by establishing a vector autoregressive model (VAR). Then, a dynamic Bayesian networks (DBN) model was used for variable selection of environmental factors. Finally, a VAR model with constraints (CVAR) was established for predicting the incidence of HFMD in Chengdu city from 2011 to 2017. DBN showed that temperature was related to HFMD at lags 1 and 2. Humidity, wind speed, sunshine, PM10, SO2 and NO2 were related to HFMD at lag 2. Compared with the autoregressive integrated moving average model with external variables (ARIMAX), the CVAR model had a higher coefficient of determination (R2, average difference: + 2.11%; t = 6.2051, P = 0.0003 < 0.05), a lower root mean-squared error (−24.88%; t = −5.2898, P = 0.0007 < 0.05) and a lower mean absolute percentage error (−16.69%; t = −4.3647, P = 0.0024 < 0.05). The accuracy of predicting the time-series shape was 88.16% for the CVAR model and 86.41% for ARIMAX. The CVAR model performed better in terms of variable selection, model interpretation and prediction. Therefore, it could be used by health authorities to identify potential HFMD outbreaks and develop disease control measures.

Mycobacterial diseases are prevalent in cancer and rheumatoid arthritis (RA) patients, especially those receiving tumor necrosis factor-α inhibitor (TNFi). However, the impact of cancer development on the risk of mycobacterial diseases among RA patients is unknown. Data from the Taiwan National Health Insurance Research Database were used to conduct a retrospective study to assess the occurrence of mycobacterial diseases in RA patients developing cancer (cancer-positive), those using TNFi (TNFi-exposure), those with cancer and using TNFi (cancer-TNFi-comb), and those without cancer and not using TNFi (cancer-TNFi-free). Cancer and TNFi exposure were time-dependent, and independent risk factors of mycobacterial diseases were assessed by Cox regression. Among 1344 RA patients diagnosed during 2000–2013, 68 (5·1%) developed cancer before their end points. The incidence rates of mycobacterial diseases in the cancer-positive (n = 56), TNFi-exposure (n = 290), cancer-TNFi-comb (n = 12), and cancer-TNFi-free (n = 986) subgroups were 6·7, 2·0, 7·6, and 1·3 per 1000 person-years, respectively. As compared with the cancer-TNFi-free group, the risk for mycobacterial diseases increased for the TNFi-exposure group (adjusted HR = 3·6, 95% confidence interval (95% CI) 1·1–11·5, P = 0·032) and remained high for cancer-positive (adjusted HR = 14·6, 95% CI 3·3–63·7, P < 0·001) after adjustment. This study suggested that cancer development increased the risk of mycobacterial diseases in RA patients, and risk assessment for this subgroup should be considered.

We estimated prevalence and incidence of liver condition outcomes, and costs to the health service of diagnosed hepatitis B virus (HBV) in Tayside, UK. HBV patients were identified from electronic virology data between 1989 and 2003. The health resource costs of HBV for surface antigen-positive (HBsAg+) patients and HBV (HBsAg+ or immune, i.e. recovered) patients were calculated. A total of 633 patients had HBV (275 HBsAg+), and were more likely to be male (62% vs. 48%), older (mean age 42·6 vs. 39·2 years) and deprived than the general population. The prevalence of immune individuals increased steadily. Post-HBV diagnosis, 24% of immune and 13% of HBsAg+ patients were diagnosed with a liver condition. The median cost per immune patient (£3023) was greater than per HBsAg+ patient (£1498) (P = 0·02). While increasing prevalence of immune HBV patients highlights an increase in screening and treatment, the costs associated with this group are high.

During a disease outbreak, healthcare workers (HCWs) are essential to treat infected individuals. However, these HCWs are themselves susceptible to contracting the disease. As more HCWs get infected, fewer are available to provide care for others, and the overall quality of care available to infected individuals declines. This depletion of HCWs may contribute to the epidemic's severity. To examine this issue, we explicitly model declining quality of care in four differential equation-based susceptible, infected and recovered-type models with vaccination. We assume that vaccination, recovery and survival rates are affected by quality of care delivered. We show that explicitly modelling HCWs and accounting for declining quality of care significantly alters model-predicted disease outcomes, specifically case counts and mortality. Models neglecting the decline of quality of care resulting from infection of HCWs may significantly under-estimate cases and mortality. These models may be useful to inform health policy that may differ for HCWs and the general population. Models accounting for declining quality of care may therefore improve the management interventions considered to mitigate the effects of a future outbreak.

The incidence of tuberculosis (TB) in native ethnic minorities remains high in developed countries. Arabs, the major ethnic minority in Israel, comprise 21% of its population. This retrospective study compared TB incidence, demographic, clinical, laboratory, genotyping characteristics and treatment outcomes in all Israeli-born citizens diagnosed with TB between 1999 and 2011 by ethnicity, i.e. Israeli-born Arabs (IA) and Jews (IJ). A total of 831 Israeli-born TB patients were reported. Of those, there were 530 (64%) IJ and 301 (36%) IA, with an average annual TB rate of 1·1 and 1·6 cases/100 000 population, respectively, lower than the national average (7·0 cases/100 000 population). TB rates in IA and IJ declined and converged to 1 case/100 000 residents. IA TB patients were more likely to be older, have more pulmonary TB and have lower treatment success rates than IJ. Older age and HIV co-infection, but not ethnicity, were predictive of non-success in TB treatment. Ten mixed IA–IJ clades were detected by spoligotyping and three mixed IA–IJ clusters were identified by MIRU-VNTR typing. Only one IA–IJ couple recalled mutual contact. In conclusion, TB rate in IA was higher than in IJ, but declined and converged in both to 1 case/100 000. Treatment success was high in both groups, and was unrelated to ethnicity.

The various problems of infantile mortality are not only supremely interesting to the medical officer of health, but, with the continued decline in the birth rate, are calculated to assume even greater practical importance in the birth rate, are calculated to assume even greater practical importace in the near future. Of these problems none is more in need of solution than the exact etiology of infantile diarrhoea.

Plagge in 1886 observed that but few water filters prevented the direct transmission of micro-organisms and that all gave contaminated filtrates after being a few days in operation. This result has been widely confirmed, especially by Woodhead and Wood (1894, 1898), and by Bulloch and Craw (1906). Plagge considered that in the case of those filters which did not permit of the immediate or direct transmission of germs the subsequent failure of the filters was due to the gradual growth of the organisms through the filter mass, a view which has been adopted by v. Esmarch (1902) and is generally accepted.

Masturbation is a common sexual practice in men, and saliva is often used as a lubricant during masturbation by men who have sex with men. However, the role of saliva use during masturbation in the transmission of chlamydia is still unclear. We developed population-level, susceptible-infected-susceptible compartmental models to explore the role of saliva use during masturbation on the transmission of chlamydia at multiple anatomical sites. In this study, we simulated both solo masturbation and mutual masturbation. Our baseline model did not include masturbation but included transmission routes (anal sex, oral-penile sex, rimming, kissing and sequential sexual practices) we have previously validated (model 1). We added masturbation to model 1 to develop the second model (model 2). We calibrated the model to five clinical datasets separately to assess the effects of masturbation on the prevalence of site-specific infection. The inclusion of masturbation (model 2) significantly worsened the ability of the models to replicate the prevalence of C. trachomatis. Using model 2 and the five data sets, we estimated that saliva use during masturbation was responsible for between 3.9% [95% confidence interval (CI) 2.0–6.8] and 6.2% (95% CI 3.8–10.5) of incident chlamydia cases at all sites. Our models suggest that saliva use during masturbation is unlikely to play a major role in chlamydia transmission between men, and even if it does have a role, about one in seven cases of urethral chlamydia might arise from masturbation.

Mycoplasma pneumoniae outbreaks cause increased use of macrolides and tetracyclines. We aimed to investigate whether drug use data, in addition to laboratory data, could improve understanding of the spread of M. pneumoniae epidemics. Number of users of Mycoplasma antibiotics (erythromycin, doxycycline, clarithromycin) per week and county of residence in an indicator age group (6–12 years) was retrieved from the Norwegian prescription database for the epidemic season 2011–2012 and compared to non-epidemic seasons. In 2011, increased use of Mycoplasma antibiotics was first observed in September on the west coast of Norway. The Norwegian laboratory-based surveillance system showed the first increase in positive tests in August 2011 and an epidemic was announced on 25 October 2011. At that time the use of Mycoplasma antibiotics had already exceeded three times the use in non-epidemic periods. Data for three counties from the regional microbiological laboratories showed that the increase in number of positive samples coincided in time with the increase in prescription data. Laboratory data cannot accurately determine the extent of an epidemic, and drug use data cannot identify the cause. Establishing a systematic interaction between the two monitoring systems will enhance surveillance and probably contribute to improved infection control and prudent antibiotic prescribing.

1. Cultures of Gärtner's bacillus grown on broth do not excrete any large amount of toxin into the fluid medium.

2. Suspension in broth made from ordinary agar cultures and killed by means of heat (30 mins. at 60°C.) are fairly toxic.

3. The most toxic preparations were obtained by autolysis of the bacilli, especially in the presence of toluol.

4. Cultures grown on agar and killed by means of chloroform vapour lose their toxicity to a considerable extent.

5. Autolysis takes place best in the presence of distilled water or of normal saline.

6. Autolysed material sterilised by heat is more toxic than the filtrate obtained from the same digest.

7. Shaking the bottles during the process of autolysis increases the yield of toxic substances.

8. Gärtner toxin withstands heating to 100°C. for 30 mins.

9. Paratyphoid B. bacillus cultures on autolysis yield a filtrate quite as toxic as those from the Gärtner bacillus itself.

10. Paratyphoid toxin is also heat resistant (100° for 30 mins.).

11. A colon bacillus gave a toxin which was fatal to mice. It was not heat resistant.

12. Feeding experiments with Gärtner-infected meat, both cooked and uncooked, proved successful.

13. So far as the present experiments go the connection between virulence and toxicity does not appear to be very definite.

14. The Gärtner bacillus contains a toxin of the endotoxin type as is shown in comparing results 1 and 3. This toxin gives rise to very definite clinical symptoms of which the gluing together of the eyelids and the prolonged narcosis before death are the most notable. The post-mortem signs have much in common with those arising from other intestinal intoxications.

In the present paper we describe the results of further investigations on the morphology and staining characters of Piroplasma canis, as well as a large number of observations on the living parasites. Our previous papers (1905) contained the results of studies preliminary to the investigation of the life-history of the parasite, but further work was unavoidably interrupted owing to the difficulties attending this form of research—we unaccountably failed to transmit the disease after several passages through dogs, and met with great difficulties in rearing progeny from infected ticks. Consequently the observations had to be discontinued until, after several failures, infected ticks (Haemaphysalis leachi) capable of transmitting the disease, had been received from South Africa through the kindness of Mr C. P. Lounsbury, Government Entomologist, Cape Colony. With this fresh strain of the disease we have succeeded in demonstrating various points in the morphology of the parasite which have hitherto escaped observation, and have worked out its method of multiplication in the living blood. Further studies have also been made on the vitality of the parasite outside the body in culture fluids, but these and other studies on the cycle of development within the tick are reserved for future communications.

This study characterises changes in the incidence and mortality of hepatitis A in different age groups and provinces of China from 1990 to 2018, and evaluates the effect of the nation-wide expanded programme on immunisation (EPI). A mathematical model was used to estimate the relative change in incidence and mortality in different provinces and age groups. Interrupted time series regression was applied to evaluate the impacts of the inclusion of vaccination in the EPI during 2007–2018. The geographic clustering of hepatitis A incidence was assessed using global Moran's I and changing trends over time were estimated using joinpoint regression analysis. Both the incidence (odds ratio (OR) for overall relative change: 0.86; 95% confidence interval (CI): 0.85–0.87; P < 0.0001) and the mortality rate (OR for overall relative change: 0.84; 95% CI: 0.83–0.85; P < 0.0001) decreased. Most age groups had significant declines in reported incidence over time. The incidence and mortality of hepatitis A significantly reduced after inclusion of hepatitis A vaccine in EPI, showing that the EPI strategy had a continuous effect on the decreasing trend of hepatitis A burden. Increasing the coverage rate of the vaccine and improving hygiene conditions are the key measures for the control of hepatitis A in China.

“White Australia,” the pleasant dream of a peculiar political party, is a subject on which a few years ago it would have been inadvisable if not unsafe to venture too unrestrained opinions. There was a time when in certain quarters the euphonious phrase was almost tantamount to a war cry. To some political dreamers it may even have been a perennial dream, full of visions of whiteness and purity, just as to us in England the mention of the “Pearly Pacific” conjures up vistas of prattling palms, wimpling waters and silvery strands. The dream is a pretty one, fitting theme for the poet and artist; Samoa and R. L. Stevenson, what a perfect juxtaposition! What delectable tales our romance weavers indulge us with! The gorgeous colouring, the wondrous life, the glorious moon, the ocean's unceasing sigh—all fine, all beautiful, all seeming perfect—but all superficial or tempered with prosaic features which mar the picture.

Due to the high incidence of COVID-19 case numbers internationally, the World Health Organization (WHO) declared a Public Health Emergency of global relevance, advising countries to follow protocols to combat pandemic advance through actions that can reduce spread and consequently avoid a collapse in the local health system. This study aimed to evaluate the dynamics of the evolution of new community cases, and mortality records of COVID-19 in the State of Pará, which has a subtropical climate with temperatures between 20 and 35 °C, after the implementation of social distancing by quarantine and adoption of lockdown. The follow-up was carried out by the daily data from the technical bulletins provided by the State of Pará Public Health Secretary (SESPA). On 18 March 2020, Pará notified the first case of COVID-19. After 7 weeks, the number of confirmed cases reached 4756 with 375 deaths. The results show it took 49 days for 81% of the 144 states municipalities, distributed over an area of approximately 1 248 000 km2 to register COVID-19 cases. Temperature variations between 24.5 and 33.1 °C did not promote the decline in the new infections curve. The association between social isolation, quarantine and lockdown as an action to contain the infection was effective in reducing the region's new cases registration of COVID-19 in the short-term. However, short periods of lockdown may have promoted the virus spread among peripheral municipalities of the capital, as well as to inland regions.