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A fatal case of neonatal cytomegalovirus (CMV) infection attributed to exchange transfusion is described. The incidence of CMV transmission by exchange and other neonatal transfusion was studied, and the use of CMV antibody-free blood for these procedures was shown to be effective in preventing CMV infection in neonates. [ABSTRACT FROM AUTHOR]

The fluorescent antibody technique was used for the identification of specific cytomegalovirus IgM in the sera of twenty-four of 1065 unmarried pregnant women. Seventeen of them were followed to term and five infected infants were identified. Two other infants had CMV IgM in neonatal serum samples but virus excretion was not demonstrated. The congenital infection rate in this study was 5·3 per 1000 births by virus excretion and 7·9 per 1000 if cases with specific IgM are included; from previous studies a rate of 8·8 per 1000 was expected. The reasons for the lack of relationship between specific IgM in the mothers' serum and infected babies is discussed. [ABSTRACT FROM PUBLISHER]

Immunohistology was used for the detection of Legionella pneumophila serogroup I in necropsy tissue. Study of pneumonic lung from the recent Stafford outbreak has shown that this technique has a high sensitivity. A retrospective postmortem examination showed that L pneumophila serogroup 1 was an unusual cause of pneumonia in Oxfordshire during the study period. L pneumophila serogroup 1 can be successfully subgrouped, using a panel of monoclonal antibodies on formalin fixed paraffin embedded sections. Immunohistological methods have a potentially useful role in the diagnosis of Legionellosis at postmortem examination and in the epidemiological investigation of individual cases and outbreaks. [ABSTRACT FROM PUBLISHER]

Specific IgG, IgA, and IgM immunoglobulin antibody responses to adenovirus infections were studied by the indirect immunofluorescent technique in six pairs of human sera obtained during acute and convalescent phases of the illness. In addition, 70 single specimens of sera showing adenovirus IgG antibody from different age groups from birth to the 60th year of life were titrated for the same antibody to adenovirus types 1, 2, 3, 5, and 7, and 170 serum specimens from the same age groups were screened for specific immunoglobulin antibodies against types 1 and 5. Specific immunoglobulin antibodies lacked type specificity and in acute infections measured heterologous antibody response as well. On the other hand, IgG antibodies detected in single specimens of sera by immunofluorescence correlate with surveys of the isolation of virus from patients and neutralizing antibody studies by other workers. Fluorescent antibodies appeared in all three fractions of the immunoglobulins in acute adenovirus infections. Although this technique may be used in the diagnosis of adenovirus infections there is no advantage compared to complement-fixation testing. However, the use of sera absorbed with group antigen may have a more useful place in serological epidemiology than in diagnostic work. In five pairs of sera obtained during acute and convalescent phases of adenoviral illness and in 70 random single specimens from different age groups, "T" antibodies were detected only in the IgG fraction. The paired sera did not show a significant rise to indicate the usefulness of "T" antibody study in diagnosis. [ABSTRACT FROM PUBLISHER]

The degree of inflammation in the trachea, bronchi, and lungs of 139 cot deaths has been analysed and each case allocated to one of four groups. In group I the changes were considered to be serious enough to have caused death, while group II cases showed similar abnormalities but of a less severe nature, and in this group there was some doubt as to whether they were a significant cause of death. Group III lesions were very minor in type and were not considered to be serious enough to have resulted in the death of the child. There was a good correlation between the degree of inflammation in the respiratory tract, and whether or not bacteria of any type were grown. The great majority of the bacterial pathogens were isolated from the first two groups. Respiratory viruses were isolated from three of the four cases of acute bronchiolitis included in group I, and also from a group II case which showed considerable bronchiolar inflammation. One-third of the cases with minor inflammation in the lung parenchyma (group III) showed some evidence of recent virus infection. [ABSTRACT FROM PUBLISHER]

The results found and the laboratory methods used for the isolation of viruses and β haemolytic streptococci in two MRC/PHLS surveys of respiratory disease in patients in hospital and general practice are described. 717 viruses and 82 β haemolytic streptococci were isolated from 2418 children in hospital and 835 viruses and 435 strains of β haemolytic streptococci from patients seen in general practice. Virus isolation rates in the two surveys were 28·9% and 21·0% respectively. Rates by age, sex, time and by clinical categories are given and discussed in relation to isolations from control subjects, the cause of deaths in twenty-two of the children tested, and the incidence of convulsions and meningism found in those examined in these surveys. [ABSTRACT FROM PUBLISHER]

Legionella pneumophila serogroup 1 can be subgrouped by panels of monoclonal antibodies. The Oxford panel divides serogroup 1 strains into three major subgroups, provisionally named Pontiac, Olda and Bellingham. Strains causing outbreaks tend to be in the Pontiac subgroup, with strains from the other subgroups appearing also in sporadic cases. Isolates from sources in the UK unassociated with outbreaks are mainly the Olda and Bellingham strains; only 10% are Pontiac, yet this strain has caused 80 to 90% of the cases of Legionnaires' Disease so far studied. We compared our method with other methods of subgrouping serogroup 1 strains.

Legionnaires' disease was diagnosed in two patients in a transplant unit, both patients having occupied the same postoperative cubicle shortly before onset of their illnesses. Legionella pneumophila was found in water taken from the cubicle shower bath and from other showers in the unit. To eradicate the legionellae, the water supply was treated with chlorine, but this had only a temporary effect.

A prospective study of viral infections occurring after 188 renal transplants in 167 patients showed active cytomegalovirus (CMV) infection after 52 per cent of transplantations. All 37 CMV seronegative cases who received grafts from seronegative donors remained free of infection, while 24 (70.6 per cent) of 34 seronegative recipients whose donors were seropositive developed primary CMV infection (p less than 0.001). The diagnosis of 92 per cent of these primary infections was made between one and two months after grafting. Secondary CMV infection was found in 71 (62 per cent) of 114 seropositive cases, and the frequency of infection was not affected by the CMV status of the renal donor. Neither acute rejection episodes nor total graft rejections were associated with primary or secondary infections. CMV was isolated from a colonic abscess and the relationship of the virus to the intestinal disease is discussed. Herpes simplex virus was isolated from 47 per cent of cases and 32 per cent had an increase in antibody titre. Zoster was seen in nine patients, representing an incidence of 3.4 per cent per year. Other viral or mycoplasmal infections diagnosed included 71 due to respiratory tract pathogens, and a single case of hepatitis B. None of these infections was particularly severe or frequent and no association with graft rejection was detected.

Swabs and water samples from a hospital water system were cultured for legionellae over an extended period. Legionella pneumophila serogroup 1, including outbreak associated strains, were isolated in small numbers from approximately 5% of these samples despite implementation of the current DHSS/Welsh Office regulations. No cases of nosocomial legionnaires' disease were proven during the study. Physical cleaning and chemical sterilization of taps, and replacement of washers with 'approved' brands did not eradicate the organisms. Eradication of legionellae in hospital water supplies appears to be unnecessary in preventing nosocomial legionnaires' disease provided the current DHSS/Welsh Office recommendations are implemented.

Between December, 1979, and July, 1980, 12 cases of legionnaires' disease were recognised in a district general hospital. 11 of the patients probably acquired their infection within the hospital. Epidemiological and environmental studies indicated that the plumbing system and possibly also the air-conditioning cooling-tower exhaust in the new building of the hospital were the sources of infection. Chlorination of the cold-water supply and raising the hot-water temperature appeared to terminate the outbreak.

A panel of 10 monoclonal antibodies was used to subgroup 326 strains of Legionella pneumophila serogroup 1. All but two strains could be classified into three major subgroups named after their representative strains Pontiac 1, Olda and Bellingham 1. Of the 50 isolates from patients, 44 representing 32 separate incidents were of the Pontiac subgroup. This subgroup was also found in 16 of 18 buildings epidemiologically associated with Legionnaires' Disease. In contrast, strains of the Olda subgroup predominated in buildings where no infections had occurred. In 9 of the 11 incidents where isolates were available from at least one patient as well as from the suspected environmental source, the monoclonal antibody reaction patterns of strains from patients were identical to those of one or more of their environmental counterparts.

Forty-one clinical isolates of Legionella pneumophila from sporadic cases of legionella pneumonia were collected from laboratories throughout the United Kingdom and were compared with 300 routine environmental isolates using two panels of monoclonal antibodies, covering serogroups 1-10. Eighty-five per cent of the clinical isolates belonged to the subgroup Pontiac of serogroup 1, whilst only 13% of the environmental isolates did. Approximately half of the clinical isolates tested came from patients with a recent history of foreign travel, mainly to southern Europe.

Ten laboratories collaborated in a study of minimum immune titre (MIT) of rubella haemagglutination-inhibiting (HI) antibody with one laboratory acting as a reference laboratory to provide a uniform basis for comparison of the HI results. The international unitage equivalent to the MIT used by the ten laboratories was found to vary from 24 to 98 units. Testing of the sera by immunofluorescence and by HI after flotation centrifugation indicated that residual non-specific inhibitors may interfere with HI antibody testing to an extent equivalent to 12-15 units. An acceptable MIT would therefore be equivalent to 24-48 units of rubella HI antibody. The single radial haemolysis (SRH) results on the sera indicate that this is a sensitive and specific test for rubella antibody.

The numbers of acquired and congenital rubella infections in the United Kingdom were obtained from clinical and laboratory reports and from notifications to the National Congenital Rubella Surveillance Programme. Since 1970 the annual frequency of clinical infection has varied from 150 to 450 cases per 100,000 population and laboratory reports of infection, from 800 to 4,100 per year. The number of notified congenital rubella infections varied from 12 to 86 per year. The largest recent epidemics occurred in 1978 and 1979, with an increase in the number of congenital rubella infections during the following winters. Increased numbers of cases occurred every one to three years, with troughs of two to three years, but peaks in different localities often did not coincide. Terminations of pregnancy associated with rubella or rubella vaccination during pregnancy are reported by the Office of Population Censuses and Surveys and vary with the incidence of acquired rubella; a maximum of 830 abortions were performed in 1978 for women who acquired the disease, and from 27 to 156 were performed each year for women vaccinated just before or soon after becoming pregnant. The effect of the vaccination program is discussed in relation to the decrease in the number of young women without rubella antibody.

Early antenatal serum specimens were collected from 25 women who subsequently gave birth to infants with anencephaly or spina bifida. Fluorescent-antibody test for influenza-specific IgA and IgM antibodies, although shown to be reliable for the detection of recent influenzal infection, failed to demonstrate such infection in any of these women. Early infection was detected in one of 50 control women who gave birth to a healthy infant. The results indicate that influenzal infection in pregnancy was not a major cause of neural-tubal defects in Oxford during 1972--76, if a cause at all.

From 22 patients with Legionnaires' disease, 86 sera were examined for specific serotype 1 IgM and IgG antibodies by the indirect immunofluorescence technique. No antibody was detectable until 8 days or more from the onset of symptoms. When produced the amount was widely variable and remained detectable for periods from less than 34 days to more than 1 year. Intially IgM antibody predominated, ten patients produced only IgM in the first 21 days, six produced only IgM in the first 28 days and three did not produce IgG at any time. One patient, and possibly a second, produced only IgG antibody. Since IgM antibody was still present in one patient after a year it is important not to accept the presence of this as evidence of very recent infection. It is advisable that any type of serological test for L. pneumophila infection should detect the production of both IgM and IgG antibodies.

Antibody to cytomegalovirus (CMV) was sought in sera from Malta using immunofluorescence. Seven per cent of the infants, 36% of the school children, increasing to 100% of the adults aged over 40 years were found to have antibody. Most infection occurred in pre-school children and adults over 25 years of age. This pattern of antibody acquisition appears different from that described for other countries.

Titres of haemagglutination-inhibiting antibody have been measured repeatedly in young women during a period of 6-8 years after the administration of RA27/3 and Cendehill attenuated rubella vaccines. Mean antibody titres were initially 217 after RA27/3 and 159 after Cendehill, but the difference diminished after the first year. Antibody titres were subsequently well maintained in both groups and did not reveal any need for regular revaccination. Mean titres in the Cendehill group were partly maintained by symptomless reinfection which was commoner after Cendehill than after RA27/3. Significant falls in titre were equally common after both vaccines, but low titres of 30 or less were more frequent in subjects who had received Cendehill. Mean neutralizing antibody titres were initially 15.4 after RA27/3 vaccine and 9 after Cendehill. Titres remained higher after RA27/3 for 3 years, but the difference then diminished and became insignificant during the fifth year. Revaccination of women with low antibody titres produced significant increases in 69% of subjects when standard RA27/3 vaccine was used; a special preparation of RA27/3 of higher potency produced a similar number of rises (70%) but elicited higher titres and might occasionally be useful for revaccinating women who are likely to come into contact with rubella. Challenge with RA27/3 vaccine produced weaker responses in women who had experienced natural infection than in those whose antibody was vaccine-induced. Rises in antibody titre after revaccination consisted mainly of IgG, but traces of IgM antibody were detected in one vaccinee who had recently experienced natural reinfection and in 1 woman with naturally acquired antibody who had been challenged with high titre RA27/3 vaccine.