Hand, foot and mouth disease (HFMD) is a common infection in the world, and its epidemics result in heavy disease burdens. Over the past decade, HFMD has been widespread among children in China, with Shanxi Province being a severely affected northern province. Located in the temperate monsoon climate, Shanxi has a GDP of over 2.5 trillion yuan. It is important to have a comprehensive understanding of the basic features of HFMD in those areas that have similar meteorological and economic backgrounds to northern China. We aimed to investigate epidemiological characteristics, identify spatial clusters and predict monthly incidence of HFMD. All reported HFMD cases were obtained from the Shanxi Center for Disease Control and Prevention. Overall HFMD incidence showed a significant downward trend from 2017 to 2020, increasing again in 2021. Children aged < 5 years were primarily affected, with a high incidence of HFMD in male patients (relative risk: 1.316). The distribution showed a seasonal trend, with major peaks in June and July and secondary peaks in October and November with the exception of 2020. Other enteroviruses were the predominant causative agents of HFMD in most years. Areas with large numbers of HFMD cases were primarily in central Shanxi, and spatial clusters in 2017 and 2018 showed a positive global spatial correlation. Local spatial autocorrelation analysis showed that hot spots and secondary hot spots were concentrated in Jinzhong and Yangquan in 2018. Based on monthly incidence from September 2021 to August 2022, the mean absolute error (MAE), mean absolute percentage error (MAPE), and root mean square error (RMSE) of the long short-term memory (LSTM) and seasonal autoregressive integrated moving average (SARIMA) models were 386.58 vs. 838.25, 2.25 vs. 3.08, and 461.96 vs. 963.13, respectively, indicating that the predictive accuracy of LSTM was better than that of SARIMA. The LSTM model may be useful in predicting monthly incidences of HFMD, which may provide early warnings of HFMD epidemics.

Escherichia albertii is an emerging foodborne enteropathogen associated with infectious diarrhoea in humans. In February 2023, an outbreak of acute gastroenteric cases was reported in a junior high school located in Hangzhou, Zhejiang province, China. Twenty-two investigated patients presented diarrhoea (22/22, 100%), abdominal pain (21/22, 95.5%), nausea (6/22, 27.3%), and vomiting (3/22, 13.6%). E. albertii strains were successfully isolated from anal swabs collected from six patients. Each isolate was classified as sequence type ST2686, harboured eae-β gene, and carried both cdtB-I and cdtB-II subtypes, being serotyped as EAOg32:EAHg4 serotype. A comprehensive whole-genome phylogenetic analysis revealed that the six isolates formed a distinct cluster, separate from other strains. These isolates exhibited minimal genetic variation, differing from one another by 0 to 1 single nucleotide polymorphism, suggesting a common origin from a single clone. To the best of our knowledge, this represented the first reported outbreak of gastroenteritis attributed to E. albertii outside of Japan on a global scale.

1. Early blood culture is the best method of laboratory diagnosis in the inoculated case of enteric fever, but agglutination tests may give useful information.

2. In inoculated cases of enteric fever O and Vi agglutinins may be absent or present only at low titres. Steadily rising titres are not the rule and the titres more often fluctuate.

3. Complete agglutination at titres over 1: 80 for TO, over 1: 40 for AO, or over 1: 10 for Vi is suggestive but not diagnostic of an active infection.

4. Non-specific stimulation of the O and Vi agglutinins in the inoculated affects mainly the lower range of titres which are probably of little diagnostic significance.

5. Previous inoculations increase the proportion of people with residual O agglutinins within 6 months of the last inoculation but do not affect the Vi agglutinins.

6. Vi agglutinins may be present in normal inoculated persons who are not carriers.

Legionellosis is a disease caused by the bacterium Legionella that most commonly presents as Legionnaires’ disease (LD), a severe form of pneumonia. From 2015 to 2019, an average of 438 LD cases per year were reported in Canada. However, it is believed that the actual number of cases is much higher, since LD may be underdiagnosed and underreported. The purpose of this study was to develop an estimate of the true incidence of illnesses, hospitalizations, and deaths associated with LD in Canada. Values were derived using a stochastic model, based on Canadian surveillance data from 2015 to 2019, which were scaled up to account for underdiagnosis and underreporting. Overall, there were an estimated 1,113 (90% CrI: 737–1,730) illnesses, 1,008 (90% CrI: 271–2,244) hospitalizations, and 34 (90% CrI: 4–86) deaths due to domestically acquired waterborne LD annually in Canada from 2015 to 2019. It was further estimated that only 36% of illnesses and 39% of hospitalizations and deaths were captured in surveillance, and that 22% of illnesses were caused by Legionella serogroups and species other than Legionella pneumophila serogroup 1 (non-Lp1). This study highlights the true burden and areas for improvement in Canada’s surveillance and detection of LD.

Hepatitis A virus (HAV) infection is a notifiable disease in Ireland, with national coverage of clinical and laboratory surveillance. In December 2020, a cluster of 11 HAV cases among the Irish Traveller community was detected. The outbreak investigation identified 61 total HAV cases from September 2020 to November 2021. Sequenced isolates were sub-genotype IA with identical genome sequence. Case-patients were predominantly aged under 18 (77%), hospitalised (46%) and lived on communal residential sites. Mass onsite HAV vaccination was employed following failure of initial ring vaccination to contain the outbreak. This is the largest outbreak of HAV described in Ireland, involving spillover to the UK and Netherlands. We recommend mass HAV vaccination and tailored communication for outbreak control in migratory subpopulations.

An outbreak of streptococcal throat infection which took place in a preparatory school for boys (some of whom were choristers) over three terms from November 1983 to June 1984 is described. Typing of the organism revealed that four successive outbreaks, each due to a different type, had occurred. Thirty-nine per cent of the boys were affected, the incidence of infection being higher among boarders than day boys. Infection seemed to spread via the forms, dormitories and choir. Recurrent attacks occurred in 32% of infected boys. The complication rate was 8%. Treatment with penicillin was always effective but did not prevent reinfection. Suggestions for the management of an outbreak of sore throat in a school are given.

Two phenotypes of human influenza A(H1N1) virus are currently circulating in Japan. One (group 1) agglutinates both chicken and goose red blood cells (CRBC and GRBC), the other (group 2) agglutinates GRBC but not CRBC. In the 1995/6 season, group 2 viruses accounted for 70% of the H1N1 viruses isolated in MDCK cells. The 1995/6 viruses were located on two branches of the genetic tree. One branch contained both group 1 and group 2 viruses and the other branch contained only group 2 viruses. Group 2 viruses had aspartic acid at residue 225 in the haemagglutinin (HA) protein, the key amino acid residue for group 2 phenotype. The HA protein of group 1 viruses had a change from aspartic acid to asparagine at residue 225 and the expressed HA protein of these viruses adsorbed CRBC. Serial passage of group 2 viruses in MDCK cells or embryonated chicken eggs caused these viruses to gain the ability to agglutinate CRBC. MDCK-adapted viruses had the same amino acid sequences of HA polypeptide as the original ones, but egg-adapted viruses had changed amino acid sequences. The expressed HA protein from one egg-adapted virus that originally belonged to group 2 adsorbed CRBC.

Four outbreaks of food-poisoning are described in which over 100 cases in all of gastro-enteritis occurred, one being fatal. In each outbreak the infecting bacteria were indistinguishable culturally and in serological behaviour from the “G” strain of B. suipestifer.

The reasons are given for following Andrewes and Neave and classifying these as B. suipestifer. (sub-group II).

Without protective immunity, recurrent sexually transmitted infections (STI) could occur. In this study, we retrospectively collected STI diagnosis records from public STI clinics attended by an average of 6,000 male patients annually in Hong Kong in 2009–2019. We estimated the prevalence of three bacterial STI (syphilis, chlamydia and gonorrhoea) coinfection from 2009 to 2019, and examined the factors associated with coinfection in 2014/15 and repeat infection in 2009–2019. We observed an increasing coinfection prevalence in male attendees with bacterial STI over the years, which reached the highest level of 15% in 2019. Among 3,698 male patients in 2014–2015, chlamydia/gonorrhoea coinfection was the commonest among all coinfections (77%). Factors such as young age (29 or below), HIV-positive status, and a history of concurrent genital warts/herpes were positively associated with coinfection in 2014/15 in multivariable logistic regression. Of all male patients with STI coinfection in 2014/15, those of age 30–49 and who self-reported as men who have sex with men (MSM) were more likely to have been repeatedly infected in 2009–2019. The results support the implementation of regular multi-STI testing as an STI control strategy for selected communities like MSM and people living with HIV.

We investigated whether there are differences between the natural history of B and C chronic hepatitis in a southern Italian population, and whether the chronic viral hepatitis population was modified by the introduction of the anti-HCV test in 1989. We examined clinical charts of 1120 patients consecutively admitted to our division from January 1979 to December 1998 with the histological diagnosis of chronic viral hepatitis (304 from 1979 to 1988; 816 from 1989 to 1998). We found significant differences only in age at diagnosis (higher in the second decade, P=0·001), and in aetiology (HBV decreased in the second decade, P<0·0001). We were able to follow up 449 patients for 2–20 years (311 with HCV and 138 with HBV infection), and found that chronic HCV evolved to cirrhosis more frequently than did chronic HBV; but in both types time to development of cirrhosis and the incidence of death were similar. Our data confirm that a higher onset age of HBV and of HCV is frequently observed in those subjects who have a faster disease progression.

Enteric fever occurs in both temperate and tropical countries, and its spread depends mainly on the sanitary conditions prevailing, on the degree of purity of the drinking water, particularly in the country districts where no general water supplies exist, and on the degree of efficiency of the sewage disposal systems.

(1) A number of Dysentery bacilli of the mannite-fermenting type have been isolated from an English asylum.

(2) These bacilli may be divided into two sub-groups, (a) those that do, and (b) those that do not (1) ferment sorbite and (2) form indol in peptone beef broth in six days.

(3) Several attempts to infect a monkey with sorbite-fermenting strains were not successful.

(4) No Dysentery bacilli were found in an examination of a considerable number of flies infesting the surroundings of chronic and acute cases of bacillary dysentery.

My thanks are due to Dr H. de R. Morgan for kindly co-operation in part of this work, to Dr J. C. G. Ledingham for his valuable advice and assistance at all times, and to Dr W. F. Menzies for supplying the material for examination.

Animals protected from fleas by means of a sufficiently broad layer of “tangle-foot” and placed in plague-infected houses do not contract plague, but the control animals, not so protected, on several occasions (24 per cent.) developed the disease. Out of 247 fleas caught on the “tangle-foot,” 60 p.c. were human, 34 p.c. were rat and 6 p.c. were cat fleas. Plague-like bacilli were demonstrated in the stomach contents of one out of 85 human fleas dissected, and of 23 out of 77 rat fleas.

Two hundred and sixty-four samples of sera obtained from normal healthy persons belonging to different age groups were examined for haemagglutination-inhibiting antibodies against reovirus types 1–3 to assess the prevalence of reovirus infection in the northern part of India.

Reovirus infection appeared as early as 6 months to 1 year of age. With reovirus types 1 and 2, the maximum incidence of 67 and 48% respectively occurred by the age of 10–20 years, whereas with type 3 infection the maximum incidence (73%) was reached by the age of 25 years. The incidence of reovirus type 2 infection in all the age groups was remarkably low in this series. A drop in the incidence of reovirus type 2 infection was also noticed after the age of 20 years.

The difference in geometric mean titre of antibody in different ages against reovirus type 2 was highly significant, suggesting probably that most of the infection occurred by the age of twenty years. The difference in the geometric mean value of the titres of antibody against types 1 and 3 was not significant in different age groups. The levels of antibody against types 1 and 3 in all the age groups were almost the same, suggesting that infection, specially with reovirus type 3, was occurring in all the age groups even beyond 20 years of age.

The authors wish to express their sincerest thanks to Dr Leon Rosen, Pacific Research Section, National Institute of Allergy and Infectious Diseases, Honolulu, Hawaii, for the supply of prototype strains of reoviruses, to Drs B. K. Aikat, Director Professor of Pathology, R. N. Chakravarti, Department of Experimental Medicine, O. N. Bhakoo, and Sucheta Thukral, Department of Paediatrics, Post- Graduate Institute of Medical Education and Research, Chadigarh, for their invaluable help and co-operation, to Prof. P. V. K. Iyer, Department of Mathematics, Panjab University, and to Mr H. D. Gupta, Biostatistician, Post-Graduate Institute of Medical Education and Research, Chadigarh for their statistical analysis of the results.

The authors gratefully acknowledge the helpful criticism and suggestion of Dr C G. Pandit, Ex-Director, Indian Council of Medical Research, during the preparation of the paper.

The authors acknowledge also the technical assistance of Mr Jagmohan Lai Pipat, Mr Gurmeet Singh Khatra, and Mr Amar Singh Saini.

This work was partly supported by the Research Grant of the Indian Council of Medical Research sanctioned to one of the authors (S. R. P.).

Hepatitis E virus infection is a major cause of acute hepatitis, typically self-limiting but occasionally leading to liver failure. Understanding disease progression factors could inform prevention strategies. This study aimed to analyse the characteristics of a large cohort of hospitalised hepatitis E patients in Tianjin, China, and explore factors influencing their progression to liver failure. A total of 1279 hospitalised patients with hepatitis E were included in this cross-sectional study in Tianjin, China. Student's t-test and the Mann–Whitney U-test were used for comparisons. Multiple logistic regression analysis was used to explore the association. Among these 1279 patients, 107 (8.4%) developed liver failure. Patients with diabetes mellitus (DM) (95% confidence interval [CI] 1.150–2.887, p = 0.011), liver cirrhosis (95% [CI] 2.229–7.224, p < 0.001), and hepatitis B (95% [CI] 1.159–4.512, p = 0.017) were more likely to progress to liver failure. Hepatitis E patients with comorbid DM, liver cirrhosis, or hepatitis B virus co-infection have higher risks of developing liver failure. Hepatitis E vaccination may be recommended for these vulnerable patients to curb disease severity.

In a previous paper (Twort, Baker, Finn & Powell, 1940) we were able to show that the bactericidal properties of phenolic -aerosols were correlated with their physical characters, though our experiments were not sufficiently numerous or varied to enable us to estimate separately the effect of the different factors operative. Here we propose to describe similar tests which we have carried out on the germicidal smokes used by Twort & Baker (1940, 1941), namely, those produced by smouldering cardboard impregnated with potassium nitrate, and by dropping incense and Peru balsam on to hot metal surfaces. There were also used mixtures obtained by distilling Peru balsam under reduced pressure: fraction I, b. p. 109–110° C; fraction II, b. p. 120–138° C; fraction III, bp 148–155° C, at 3 mm. Hg, and the residue from this operation.