A two year prospective study identified 1922 cases of meningitis in children under 1 year of age. A further 201 cases were identified from other sources. The annual incidence of meningitis during the first year of life was 1-6/ 1000; during the first 28 days of life it was 0-32/1000, and among postneonatal infants it was 1-22/1000. The male:female ratio was 1-4:1. The overall case fatality rate was 19-8% for neonates and 5-4% for postneonatal infants. Two thirds of deaths identified in the study, 50% of all deaths, were not attributed to meningitis by the Office of Population Censuses and Surveys. Group B f6 haemolytic streptococci (28%), Escherichia coli (18%), and Listeria monocytogenes (5%) were most frequently isolated from neonates and Neisseria meningitidis (31%), Haemophilus influenzae (30%), and Streptococcus pneumoniae (10%) from postneonatal infants. At 2-6 months of age N meningitidis meningitis was most common, and at 7-12 months H influenzae predominated. Meningitis caused by group B ,B haemolytic streptococci occurred up to 6 months of age and had a consistent mortality of 25%. Neonatal meningitis due to Gram negative enteric rods had a mortality of 32%. Low birth weight was a significant predisposing factor for both neonates and postneonatal infants. In both groups mortality was significantly higher among children admitted in coma. There was no seasonal variation in incidence in either group. Neonates were treated with either chloramphenicol (50%) or gentamicin (48%) usually in combination with a penicillin; 40% received a third generation cephalosporin. Of the 1472 postneonatal infants treated 84% received chloramphenicol with a penicillin and 10% received a third generation cephalosporin. Relapse occurred in 49 patients and three died. Eighteen babies coned as a result of raised intracranial pressure, including four neonates, and four died. Mortality among the 133 (7%) children who received steroids was significantly higher than in the rest of the study group.Meningitis in infancy is a life threatening infection with a high mortality. Neurological sequelae are common, especially in the newborn where long term effects are found in more than a quarter of survivors.' 2 Despite its serious nature there is little information on the incidence of meningitis in England and Wales. Although a number of centres, including the Communicable Diseases Surveillance Centre of the Public Health Laboratory Service and the Meningococcal Reference Laboratory, collect data provided to them on a voluntary basis there is known to be considerable under reporting. There is a high level of under reporting also in local studies, even for meningococcal meningitis.' The only comprehensive information on the recent incidence of meningitis in Great Britain comes from a few independent studies with small numbers of patients. A study of cases from the North West Thames health region for the period 1969-73 identified 76 cases in newborn babies and 231 cases in postneonatal infants (28-365 days of age); the case fatality ...

Thev d i f f d r i n t h e i r b i r t h -r a t e . l i f e s t v l e and n u t r i t i o n a l and-growth batterns.W e r e p o r t a ; epidemiilogical study of acute RVD among <3 y r olds i n 2 small urban comnunities a) Bedouin w i t h 700 b i r t h s / y r b) Jewish w i t h 500 b i r t h s / y r . 60% w i t h diarrhoea and a l l c o n t r o l s were studied as outpatients. Median age was lorn i n both groups.RVD was detected i n 64/444 (14%) w i t h diarrhoea against 3/163 (2%) o f controls (p<0.001).RVD was more comnon than C j e j u n i (9%). Shigella (4%), Salmonella (3%), E.P.E.C.(8%) G. lamblia (8%) and Cryptosporidium (5%). No differences i n r e l a t i v e frequency of diarrhoea were found between hospital ized and non-hospi t a l ized, Jews and Bedouins o r well and mal-nourished patients.The percentage o f RVO was highest during winter (30%) (p<0.01).W e estimated t h a t 2% o f the Bedouins, but only 0.2% o f the Jews w i t h RVD during t h e i r f i r s t year o f l i f e were hospitalized. V m i t i n g was more frequent among patients w i t h RVD (43/57)-75%) than among patients w i t h other causes o f diarrhoea (194/360-54%) (p<0.005). No differences were observed i n other c l i n i c a l variables o r stool appearances between p a t i e n t s w i t h o r without RVD. RVD i s a leading cause o f morbidity o f young c h i l d r e n i n our camnunity. E f f o r t s should be concentrated on appropriate imnunization.T Ruuska, T Vesikari, A Delem, e t a l .Dept ~lin-ical Sciences, Univ o f Tampere, Finland; Biological Division, Smith K l i n e RIT, Rixensart. Be1 gium; W H O Human Rotavi rus centre, B i rmi ngham, England. I n a randomized double-blind olaceho-controlled t r i a l o f the RIT 4237 bovine-rotavirus vaccine 741 babies were given a single oral dose o f vaccine o r placebo a t 5 dys o f age; one t h i r d o f the group was given a second dose o f vaccine o r placebo a t 7 mths o f age. The c h i l d r e n remained i n follow-up f o r a mean o f 2.3 years.There was a t o t a l o f 502 diarrhoea1 episodes i n the group during the follow-up; o f these 121 (24.1%) were a t t r i butable t o rotavirus. At follow-up 17.5% o f c h i l d r e n had experienced an episode o f r o t a v i r u s diarrhoea; no c h i l d had more than one detectable episode w i t h rotavirus. Vaccine protection was analyzed using a severity score f o r acute diarrhoea. Vaccine-induced protection against severe episodes (score >9) was 79% and aginst m i l d t o moderately severe episodes (score >4) i t was 35%. The mean s e v e r i t y score was 6.5 i n the vacinees and 10.6 i n the placebo group. Protection was s l i g h t l y b e t t e r i n the vacinees who responded s e r o l o g i c a l l y (mean score 5.9) than i n those who d i d not; however non-responders were p a r t i a l l y protected.A and L. monocytogenes f o r 5%. I n 48% o f neonates treatment was based on chloramphenicol, i n 24% on gentamicin and i n 14% on cefotaxime.The overall m o r t a l i t y among the newborn was 20% (ranging from 30% w i t ...