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This summary of adverse reactions to rifampicin has been prepared with the intention that it will be made available to all those involved in the administration of rifampicin in tuberculosis and leprosy control programmes. The reactions covered comprise those to both daily and intermittent administration, namely cutaneous and gastrointestinal reactions, hepatitis, and thrombocytopenic purpura, and those to intermittent administration only, namely "flu" syndrome, shock, shortness of breath, haemolytic anaemia, and renal failure.

In tropical countries, where there is generally a high prevalence of non-specific sensitivity, the tuberculin test is inadequate for detecting tuberculosis infection. A method is proposed by which the prevalence of infection in the population can be determined under such circumstances thus making possible meaningful epidemiological surveillance of the disease. This method compares levels of tuberculin sensitivity in individuals before and after BCG vaccination. If BCG vaccination fails to produce an increase in tuberculin sensitivity, the individual must have been infected with human or bovine tubercle bacilli.

This is a selective review, which, after recalling some immunological aspects, analyses the present knowledge on the protective efficacy of BCG vaccination, the vaccination reactions and complications that may be observed, and current methods of vaccine production and control. As regards the application of BCG vaccination, particular attention is given to dosage and vaccination techniques, direct and simultaneous vaccination, and revaccination. Finally, the evaluation of BCG vaccination programmes is briefly discussed.

Acute respiratory infections (ARI) constitute one of the principal causes of morbidity and mortality in many countries. Data from 88 countries in five continents, with a total population of nearly 1200 million, showed that deaths due to ARI in 1972 amounted to 666 000. Pneumonia, both viral and bacterial, accounted for 75.5% of the total deaths from ARI. Mortality from ARI represents 6.3% of deaths from all causes. Considerable differences in mortality rates exist both between and within continents. Mortality from ARI is highest in infants and old people. The data suggest that in some areas of the world mortality due to ARI is extremely high.

Recent work carried out at the Tuberculosis Chemotherapy Centre, Madras, and at the Postgraduate Medical School of London has shown that isoniazid-sensitive cultures of tubercle bacilli obtained before the start of chemotherapy from South Indian patients with pulmonary tuberculosis are of lower average virulence than corresponding cultures from British patients. The present paper from the Centre extends these studies to areas outside India by comparing isoniazid-sensitive cultures from 81 Thai patients and 67 British patients for their guinea-pig virulence. As assessed by the amount of disease visible at post-mortem examination six weeks after intramuscular injection of the cultures, by the mortality of the guinea-pigs and by the results of spleen culture, the Thai cultures were less virulent than the British cultures. However, a retrospective comparison with the earlier studies suggests that the Thai cultures were intermediate in their virulence between British and Indian cultures. These findings contribute to the over-all study of the geographical distribution of attenuated tubercle bacilli.