Enteric Disease Outbreaks Research Articles

Spatiotemporal Trend of Waterborne Disease in Enugu Urban, Nigeria: A Retrospective Study

Many water sources in Nigeria are contaminated with pathogens. Several towns have witnessed outbreaks of enteric diseases due to poor hygienic standards of available drinking water. This research was undertaken to determine the spatiotemporal trends of waterborne diseases (WBDs) in Enugu, Nigeria using retrospective records from January 2013 to December 2016. A total of 18,495 individual reported cases of WBDs were analysed. The analysis showed an increasing temporal trend from 2013 to 2015, with a slight decrease in 2016. Typhoid fever had the highest frequency (48.9%) followed by diarrhoea (40%) and then dysentery (11.1%). The highest (88.9%) incidence of waterborne diseases per 10,000 peoples was from Enugu North followed by Enugu South (62.6%) and least was Enugu East (44.4%). Highest occurrence of typhoid fever and dysentery per 10,000 peoples was also found in Enugu North while Enugu East had the highest occurrence of diarrhoea in the four-year trends. WBDs were highest between January and March and least in July. The months with peak occurrence of WBDs falls within the dry season. The importance of having drinking water in both quality and quantity cannot be overestimated as portrayed in this study. Drinking water quality in Enugu urban is very poor especially during the dry season. This suggests a need for setting up a modality to tackle challenges of limited water supply during the dry seasons of the year and to educate the populace on household water treatment and storage method.

Recovirus NS1-2 Has Viroporin Activity That Induces Aberrant Cellular Calcium Signaling To Facilitate Virus Replication.

Enteric viruses in the Caliciviridae family cause acute gastroenteritis in humans and animals, but the cellular processes needed for virus replication and disease remain unknown. A common strategy among enteric viruses, including rotaviruses and enteroviruses, is to encode a viral ion channel (i.e., viroporin) that is targeted to the endoplasmic reticulum (ER) and disrupts host calcium (Ca2+) homeostasis. Previous reports have demonstrated genetic and functional similarities between the nonstructural proteins of caliciviruses and enteroviruses, including the calicivirus NS1-2 protein and the 2B viroporin of enteroviruses. However, it is unknown whether caliciviruses alter Ca2+ homeostasis for virus replication or whether the NS1-2 protein has viroporin activity like its enterovirus counterpart. To address these questions, we used Tulane virus (TV), a rhesus enteric calicivirus, to examine Ca2+ signaling during infection and determine whether NS1-2 has viroporin activity that disrupts Ca2+ homeostasis. We found that TV increases Ca2+ signaling during infection and that increased cytoplasmic Ca2+ levels are important for efficient replication. Further, TV NS1-2 localizes to the endoplasmic reticulum, the predominant intracellular Ca2+ store, and the NS2 region has characteristics of a viroporin domain (VPD). NS1-2 had viroporin activity in a classic bacterial functional assay and caused aberrant Ca2+ signaling when expressed in mammalian cells, but truncation of the VPD abrogated these activities. Together, our data provide new mechanistic insights into the function of the NS2 region of NS1-2 and support the premise that enteric viruses, including those within Caliciviridae, exploit host Ca2+ signaling to facilitate their replication.IMPORTANCE Tulane virus is one of many enteric caliciviruses that cause acute gastroenteritis and diarrheal disease. Globally, enteric caliciviruses affect both humans and animals and amass >65 billion dollars per year in treatment and health care-associated costs, thus imposing an enormous economic burden. Recent progress has resulted in several cultivation systems (B cells, enteroids, and zebrafish larvae) to study human noroviruses, but mechanistic insights into the viral factors and host pathways important for enteric calicivirus replication and infection are still largely lacking. Here, we used Tulane virus, a calicivirus that is biologically similar to human noroviruses and can be cultivated by conventional cell culture, to identify and functionally validate NS1-2 as an enteric calicivirus viroporin. Viroporin-mediated calcium signaling may be a broadly utilized pathway for enteric virus replication, and its existence within caliciviruses provides a novel approach to developing antivirals and comprehensive therapeutics for enteric calicivirus diarrheal disease outbreaks.

Cyclospora cayetanensis and Cyclosporiasis: An Update.

Cyclospora cayetanensis is a coccidian parasite of humans, with a direct fecal–oral transmission cycle. It is globally distributed and an important cause of foodborne outbreaks of enteric disease in many developed countries, mostly associated with the consumption of contaminated fresh produce. Because oocysts are excreted unsporulated and need to sporulate in the environment, direct person-to-person transmission is unlikely. Infection by C. cayetanensis is remarkably seasonal worldwide, although it varies by geographical regions. Most susceptible populations are children, foreigners, and immunocompromised patients in endemic countries, while in industrialized countries, C. cayetanensis affects people of any age. The risk of infection in developed countries is associated with travel to endemic areas and the domestic consumption of contaminated food, mainly fresh produce imported from endemic regions. Water and soil contaminated with fecal matter may act as a vehicle of transmission for C. cayetanensis infection. The disease is self-limiting in most immunocompetent patients, but it may present as a severe, protracted or chronic diarrhea in some cases, and may colonize extra-intestinal organs in immunocompromised patients. Trimetoprim-sulfamethoxazole is the antibiotic of choice for the treatment of cyclosporiasis, but relapses may occur. Further research is needed to understand many unknown epidemiological aspects of this parasitic disease. Here, we summarize the biology, epidemiology, outbreaks, clinical symptoms, diagnosis, treatment, control and prevention of C. cayetanensis; additionally, we outline future research needs for this parasite.

Interpretation of Whole-Genome Sequencing for Enteric Disease Surveillance and Outbreak Investigation.

The routine use of whole-genome sequencing (WGS) as part of enteric disease surveillance is substantially enhancing our ability to detect and investigate outbreaks and to monitor disease trends. At the same time, it is revealing as never before the vast complexity of microbial and human interactions that contribute to outbreak ecology. Since WGS analysis is primarily used to characterize and compare microbial genomes with the goal of addressing epidemiological questions, it must be interpreted in an epidemiological context. In this article, we identify common challenges and pitfalls encountered when interpreting sequence data in an enteric disease surveillance and investigation context, and explain how to address them.

Evaluation of REDCap to Supplement Foodborne Disease Surveillance Systems

ObjectiveThe objective of this study is to evaluate the use of a supplementary data management application to meet surveillance demands for foodborne disease in Tennessee and to highlight successes, challenges, and opportunities identified through this process.IntroductionThe Tennessee Department of Health (TDH) Foodborne Disease Program conducts routine surveillance for foodborne illnesses and enteric disease outbreaks and participates in statewide enhanced surveillance as part of the Foodborne Disease Center for Outbreak Response Enhancement (FoodCORE) and the Foodborne Diseases Active Surveillance Network (FoodNet) supported by the Centers for Disease Control and Prevention (CDC). TDH uses the CDC NEDSS Base System (NBS) application for routine disease surveillance. However, NBS serves multiple disease programs within TDH and modifications to the system for the rapidly changing data demands, grant requirements, and outbreak needs of the foodborne program, may not be a priority for the system as a whole. In 2014, the TDH Foodborne Disease Program began using the Research Electronic Data Capture (REDCap) application as a solution to changing surveillance needs. FoodCORE, FoodNet, and routine surveillance data elements are entered into REDCap to supplement NBS, depending on program specific needs and system capability.MethodsREDCap was queried for FoodCORE, FoodNet, and routine surveillance projects. Projects were categorized by surveillance activity type. Epidemiologists provided qualitative feedback on successes and challenges in using REDCap to supplement NBS, which were then categorized into attributes according to existing frameworks for evaluating public health surveillance systems.1, 2ResultsAs of August 2018, the TDH Foodborne program housed 45 individual REDCap databases dedicated to surveillance. Four primary database categories were identified: routine case-based surveillance (8), enhanced/active surveillance (6), aggregate outbreak/cluster surveillance tracking (6), and outbreak-specific databases (25). The REDCap application programming interface (API) and an open database connection to NBS within SAS 9.4 (Cary, NC) were used to create unilateral data flow from NBS to REDCap, where possible. Successes and challenges in using REDCap fell into six main surveillance system attributes: Flexibility, Ease of Data Management, Stability, Simplicity, Efficiency, and Acceptability. Successes included the high level of control over data and databases offered by REDCap, the flexibility to rapidly implement program-specific changes, and the accessibility and reliability of REDCap as a de facto back-up of NBS data. Challenges included lack of interoperability between REDCap databases and with NBS, leading to dual data entry, overuse of REDCap resulting in unnecessarily complex and decentralized data storage (Figure 1), and increased personnel time on data management and extraction for metrics and reports.ConclusionsUsing REDCap in Tennessee to supplement an existing disease surveillance application increased flexibility and functionality of the foodborne disease surveillance system, but also added complexity and time involved in data management. The Nationally Notifiable Diseases Surveillance System Modernization Initiative (NMI) is developing a standardized message mapping guide (MMG) in collaboration with states and CDC, which incorporates FoodNet data elements and would transition data collection tools in NBS for foodborne diseases to a more portable and flexible format. Implementation of this MMG could minimize case-based data entry into REDCap. Tools that offer increased interoperability between NBS and REDCap and between REDCap databases could also improve the efficiency of using complementary applications for rapidly changing foodborne disease surveillance needs.

Clinically Unreported Salmonellosis Outbreak Detected via Comparative Genomic Analysis of Municipal Wastewater Salmonella Isolates.

Municipal wastewater includes human waste that contains both commensal and pathogenic enteric microorganisms, and this collective community microbiome can be monitored for community diseases. In a previous study, we assessed the salmonellosis disease burden using municipal wastewater from Honolulu, Hawaii, which was monitored over a 54-week period. During that time, a strain of Salmonella enterica serovar Paratyphi B variant L(+) tartrate(+) (also known as Salmonella enterica serovar Paratyphi B variant Java) was identified; this strain was detected simultaneously with a clinically reported outbreak, and pulsed-field gel electrophoresis patterns were identical for clinical and municipal wastewater isolates. Months after the outbreak subsided, the same pulsotype was detected as the dominant pulsotype in municipal wastewater samples, with no corresponding clinical cases reported. Using genomic characterization (including core single-nucleotide polymorphism alignment, core genome multilocus sequence typing, and screening for virulence and antibiotic resistance genes), all S Java municipal wastewater isolates were determined to be clonal, indicating a resurgence of the original outbreak strain. This demonstrates the feasibility and utility of municipal wastewater surveillance for determining enteric disease outbreaks that may be missed by traditional clinical surveillance methods.IMPORTANCE Underdetection of microbial infectious disease outbreaks in human communities carries enormous health costs and is an ongoing problem in public health monitoring (which relies almost exclusively on data from health clinics). Surveillance of municipal wastewater for community-level monitoring of infectious disease burdens has the potential to fill this information gap, due to its easy access to the mixed community microbiome. In the present study, the genomes of 21 S Java isolates (collected from municipal wastewater in Honolulu) were analyzed; results showed that the same Salmonella strain that caused a known salmonellosis clinical outbreak in spring 2010 remerged as the most dominant strain in municipal wastewater in spring 2011, indicating a new outbreak that was not detected by health clinics. Our results show that wastewater monitoring holds great promise to inform the field of public health regarding outbreak status within communities.

OzFoodNet quarterly report, 1 October to 31 December 2015

The Australian Government Department of Health established the OzFoodNet network in 2000 to collaborate nationally to investigate foodborne disease. In each Australian state and territory, OzFoodNet epidemiologists investigate outbreaks of enteric infection. In addition, OzFoodNet conducts studies on the burden of illness and coordinates national investigations into outbreaks of foodborne disease. This quarterly report documents investigations of outbreaks of gastrointestinal illness and clusters of disease potentially related to food, which commenced in Australia between 1 October and 31 December 2015. Data were received from OzFoodNet epidemiologists in all Australian states and territories. The data in this report are provisional and subject to change. During the 4th quarter of 2015 (1 October to 31 December), OzFoodNet sites reported 585 outbreaks of enteric illness, including those transmitted by contaminated food or water. Outbreaks of gastroenteritis are often not reported to health authorities, which results in current figures under-representing the true burden of enteric disease outbreaks within Australia. There were 10,184 people affected in these outbreaks and 240 hospitalisations. There were 22 deaths reported during these outbreaks. This represents an increase in the number of people affected compared with the 5-year average from 2010 to 2014 for the 4th quarter (n=9,077). The majority of reported outbreaks of gastrointestinal illness in Australia are due to person-to-person transmission. In this quarter, 80% (469/585) of outbreaks were transmitted via this route (see Table 1). This percentage was similar to the same quarter in 2014 (78%, 469/601). The total number and the proportion is also similar to the 5-year average (4th quarter, 2010-2014) of 409 outbreaks (79%, 409/518) outbreaks transmitted person-to-person. Of the person-to-person outbreaks in the 4th quarter of 2015, 46% (216/469) occurred in child care facilities and 41% (193/469) occurred in aged care facilities.

Effects of fish size and route of infection on virulence of a Danish Yersinia ruckeri O1 biotype 2 strain in rainbow trout (Oncorhynchus mykiss)

The comparative virulence of Yersinia ruckeri serotype O1 biotype 2 strain 07111224 from a Danish outbreak of enteric redmouth disease in rainbow trout (Oncorhynchus mykiss) was investigated in different sizes of rainbow trout (5, 19, 25 and 52 g) using a panel of challenge methods (bath, intraperitoneal (IP) injection, anal intubation and cohabitation).The results show that Y. ruckeri 07111224 is virulent enough to successfully cause mortality in 5–52 g rainbow trout through three different infection routes (bath, IP injection and anal intubation), and strongly suggests that susceptibility to Y. ruckeri infection is dependent on fish size. Bath challenge (108 CFU/ml) caused 79% mortality in 5 g fish, while the mortality in 19–52 g fish was approximately 26%. IP injection challenges (105–106 CFU/individual) resulted in high mortalites in fish of all sizes. Anal intubation challenges (109 CFU/individual) induced 82% mortality in 5 g fish and decreased with increasing fish weight. Finally, cohabitation challenges induced 45% mortality in 5 g test fish when test fish were cohabitated 1:1 with shedder fish, while mortalities in test fish of five other challenge groups were lower (5–25%). Statistical models were fit to the data from each challenge model. The model parameter predictions suggests statistically significant effects of fish weight for bath, IP and anal intubation challenges. Furthermore, they highlight the importance of the ratio of shedders to test fish in cohabitation challenges and of the challenge doses, in particular for the IP challenge model.

Epidemiological Considerations Concerning Food Poisoning Infections

What we eat and drink can become contaminated by bacteria, viruses, parasites, toxins or chemicals that can cause food-borne disease or named usual food poisoning, which is for CDC a common but preventable problem today. That for anyone can get sick from eating contaminated food. During the last 2 years: 2016-2017 it was received data for a complex epidemiological and clinical study, with several interesting interpretations and conclusions in Transylvania region from Romania. There were 109 Food borne diseases, with 2049 sick cases, almost during the summer season. The out breaks appeared in Urban or Rural parts as well in family or collectivity situations. Most of the illness appeared in usual forms-70% or 22 as middle forms and only 5% have needed hospitalization and only 3% from were just emergency cases. In our cases the microbiological etiology was: Salmonella spp-67%, mostly Salmonella enteritidis in 29%. Also 14% were determined by Staphylococcus aureus. To prevent such diseases in population, there are some food safety recommended steps. For a useful prevent and control activity in Food born infection, it has to be put together specialists for: laboratory, epidemiology, and environmental health, as all other with possible enteric disease outbreak and therapy responsibilities.

Isolation of avian nephritis virus from chickens showing enteric disorders.

Runting-stunting syndrome (RSS) is one of the diseases associated with many detected viruses. In Brazil, there were reports of several enteric disease outbreaks in chickens in which avian nephritis virus (ANV) was detected; however, the role of ANV in the outbreaks and whether the virus was a causative agent of these cases of enteric diseases were not determined. The aim of this study was to isolate ANV in specific pathogen-free (SPF) chicken embryonated eggs (CEE) from the enteric contents of chickens showing signs of RSS. For this purpose, 22 samples of chicken enteric contents that were positive only for ANV were inoculated into 7 and 14-day-old SPF-CEE via the yolk sac route and incubated for 5 d, with a total of 3 passages. Virus isolation was confirmed by the presence of embryo injuries, detection of viral RNA by RT-PCR, and visualization of viral particles using electron microscopy. Therefore, the 7-day-old inoculated embryos showed dwarfism, gelatinous consistency, hemorrhage, and edema in the embryos, whereas the 14-day-old did not show any alteration. Viral RNA was detected in the embryos of both ages of inoculation, and the same viral particles were visualized. The embryos from the mock group showed no alteration and were negative for all the tests. The viral cDNA was sequenced, and the molecular and phylogenetic analyses showed that the Brazilian isolates are more related with the ANV-1 serotype group; the sequences of these isolates showed a high percentage of nucleotide (86.4 to 94.9%) and amino acid (92.3 to 98.7%) similarity with other sequences from China, Japan, Australia, and the United States that belong to this serotype previously classified group. In this study, we isolated 8 samples of ANV in SPF-CEE from enteric content samples from chickens with RSS. In doing so, we showed the pathological injuries to the embryo caused by the virus and the molecular characterization of a part of the ORF 1b gene of the virus.

In-farm cost of an outbreak of diarrhoea in lambs

This article analyses the cost of diarrhoea in lambs on dairy sheep farms located in Grosseto (Italy). Farmers’ profits have recently declined due to a stable product price but increasing production costs. Animal diseases have a cascade of effects on farm productivity. Lamb enteric disease outbreaks, which result in mortality in the herd and reduced weight gain, can drastically compromise the income of farmers. An economic analysis of the impact of an outbreak of diarrhoea in lambs was thus performed, evaluating the cost of disease based on the main visible production losses (such as mortality, reduced weight gain and variation in milk production). A sensitivity analysis was also conducted by applying different observed ranges of prevalence and mortality associated with the disease. Finally, an economic scenario analysis was performed, considering different in-farm management options for delivering lambs to the abattoir, i.e. early, standard and late delivery. The results showed that a dairy sheep farm with around 300 lambs that delivers them to the abattoir at 30 days of age would experience a loss of between 50 and 1200 Euro during an outbreak of diarrhoea with a prevalence of 34.21 (23.54–44.88)% and a mortality of 15.69 (9.98–21.4)%.

Comparative Transcriptome Profiling Reveals a Potential Role of Type VI Secretion System and Fimbriae in Virulence of Non-O157 Shiga Toxin-Producing Escherichia coli.

Shiga toxin-producing Escherichia coli (STEC) cause both sporadic infections and outbreaks of enteric disease in humans, with symptoms ranging from asymptomatic carriage to severe disease like haemolytic uremic syndrome (HUS). Bacterial virulence factors like subtypes of the Shiga toxin (Stx) and the locus of enterocyte effacement (LEE) pathogenicity island, as well as host factors like young age, are strongly associated with development of HUS. However, these factors alone do not accurately differentiate between strains that cause HUS and those that do not cause severe disease, which is important in the context of diagnosis, treatment, as well as infection control. We have used RNA sequencing to compare transcriptomes of 30 stx2a and eae positive STEC strains of non-O157 serogroups isolated from children <5 years of age. The strains were from children with HUS (HUS group, n = 15), and children with asymptomatic or mild disease (non-HUS group, n = 15), either induced with mitomycin C or non-induced, to reveal potential differences in gene expression levels between groups. When the HUS and non-HUS group were compared for differential expression of protein-encoding gene families, 399 of 6,119 gene families were differentially expressed (log2 fold change ≥ 1, FDR < 0.05) in the non-induced condition, whereas only one gene family was differentially expressed in the induced condition. Gene ontology and cluster analysis showed that several fimbrial operons, as well as a putative type VI secretion system (T6SS) were more highly expressed in the HUS group than in the non-HUS group, indicating a role of these in the virulence of STEC strains causing severe disease.

Genome Characterization of a Pathogenic Porcine Rotavirus B Strain Identified in Buryat Republic, Russia in 2015.

An outbreak of enteric disease of unknown etiology with 60% morbidity and 8% mortality in weaning piglets occurred in November 2015 on a farm in Buryat Republic, Russia. Metagenomic sequencing revealed the presence of rotavirus B in feces from diseased piglets while no other pathogens were identified. Clinical disease was reproduced in experimentally infected piglets, yielding the 11 RVB gene segments for strain Buryat15, with an RVB genotype constellation of G12-P[4]-I13-R4-C4-M4-A8-N10-T4-E4-H7. This genotype constellation has also been identified in the United States. While the Buryat15 VP7 protein lacked unique amino acid differences in the predicted neutralizing epitopes compared to the previously published swine RVB G12 strains, this report of RVB in Russian swine increases our epidemiological knowledge on the global prevalence and genetic diversity of RVB.

Near Real-Time Surveillance of U.S. Norovirus Outbreaks by the Norovirus Sentinel Testing and Tracking Network - United States, August 2009-July 2015.

Norovirus is the leading cause of endemic and epidemic acute gastroenteritis in the United States (1). New variant strains of norovirus GII.4 emerge every 2-4 years (2-4) and are often associated with increased disease and health care visits (5-7). Since 2009, CDC has obtained epidemiologic data on norovirus outbreaks from state health departments through the National Outbreak Reporting System (NORS) (8) and laboratory data through CaliciNet (9). NORS is a web-based platform for reporting waterborne, foodborne, and enteric disease outbreaks of all etiologies, including norovirus, to CDC. CaliciNet, a nationwide electronic surveillance system of local and state public health and regulatory agency laboratories, collects genetic sequences of norovirus strains associated with gastroenteritis outbreaks. Because these two independent reporting systems contain complementary data, integration of NORS and CaliciNet records could provide valuable public health information about norovirus outbreaks. However, reporting lags and inconsistent identification codes in NORS and CaliciNet records have been an obstacle to developing an integrated surveillance system.

Analysis of enteric disease outbreak metrics, British Columbia Centre for Disease Control, 2005-2014.

For enteric disease outbreaks, effective control depends on timely intervention. Routine collection of metrics related to outbreak identification, investigation and control can help evaluate and improve interventions and inform further analyses and modelling of intervention effectiveness. To analyze data from enteric disease outbreaks in British Columbia, generate outbreak metrics and assess their use in evaluating the impact of outbreak interventions. This descriptive study analyzed data from 57 provincial and national enteric disease outbreak investigations involving the British Columbia Centre for Disease Control from 2005 to 2014. Data were extracted from internal files and the Canadian Network for Public Health Intelligence. Outbreak metrics analyzed included days to initiate investigation, days to intervention, number and type of interventions, duration of investigation, duration of outbreak and the total number of cases. The median time to initiate an outbreak investigation was 36 days and the median duration of investigations was 39 days. The median duration of outbreaks was 40 days and the median time to intervene was 10 days. Identification of the source was associated with use of one or more interventions (P<0.0001). The duration of outbreaks was correlated with the number of days to initiate an investigation (rs =0.72, P<0.0001) and number of days to intervene (rs =0.51, P=0.025). Identification and analysis of outbreak metrics establishes benchmarks that can be compared to other jurisdictions. This may support continuous quality improvement and enhance understanding of the impact of public health activities. Date information for public health actions is essential for evaluating the timing and effectiveness of outbreak interventions.

Analysis of enteric disease outbreak metrics, British Columbia Centre for Disease Control, 2005–2014

Analysis of enteric disease outbreak metrics, British Columbia Centre for Disease Control, 2005–2014

Salmonellagrowth and survival in rockmelon rind under different storage conditions

Consumption of fresh produce has been implicated in several serious outbreaks of food-borne enteric diseases in recent years, leading to renewed scrutiny of the supply chain to identify routes of contamination, improve safety assurance systems, and develop control strategies. Contaminated rockmelon (Cucumis melo L. var. reticulatus Naud.) has been associated with at least one large multi-state outbreak of salmonellosis in Australia and three in the United States since 2006. Rockmelons are conventionally stored at 5°C prior to retail; however some new rockmelon cultivars such as 'Carribean Gold' require storage at 13°C for 2-3 days to enable softening to an acceptable level of flesh firmness. Warm storage conditions may be conducive to Salmonella growth, which is known to adhere within the netted surface of the rind. In this paper, we present some preliminary research findings that confirm that raising the temperature of postharvest cool storage prior to retail from 5 to 13°C increased the persistence of Salmonella Typhimurium on contaminated rockmelon rind. A systematic analysis of the supply chain using a risk analysis framework to identify key phases and factors contributing to microbial food safety risk is needed to optimise monitoring and control measures that will mitigate fresh produce safety risks.

Near real-time space-time cluster analysis for detection of enteric disease outbreaks in a community setting

To enhance timely surveillance of bacterial enteric pathogens, space-time cluster analysis was introduced in Israel in May 2013. Stool isolation data of Salmonella, Shigella, and Campylobacter from patients of a large Health Maintenance Organization were analyzed weekly by ArcGIS and SaTScan, and cluster results were sent promptly to local departments of health (LDOHs). During eighteen months, we identified 52 Shigella sonnei clusters, two Salmonella clusters, and no Campylobacter clusters. S. sonnei clusters lasted from one to 33 days and included three to 30 individuals. Thirty-one (60%) of the S. sonnei clusters were known to LDOHs prior to cluster analysis. Clusters not previously known by the LDOHs prompted epidemiologic investigations. In 31 of the 37 (84%) confirmed clusters, educational institutes (nursery schools, kindergartens, and a primary school) were involved. Cluster analysis demonstrated capability to complement enteric disease surveillance. Scaling up the system can further enhance timely detection and control of outbreaks.

Sampling of elementary school playground equipment for total coliforms and E. coli

&#x0D; Background and Purpose: Outbreaks of enteric diseases in schools and daycares are common. It is possible that these outbreaks could be propagated via fomites in school settings, such as playground equipment that is not regularly cleaned. Studies thus far have provided conflicting results on the level of contamination present on fomites in the school setting. This project is intended to assess the level of microbial contamination present on elementary school playground surfaces as a result of hand contact from school children. Methods: Two categories of elementary school playground equipment were sampled in this study; those that are likely to see regular hand contact from children and those that were not likely see hand regular hand contact from children. 30 surfaces of each category were swabbed and the media will be plated and incubated to enumerate total coliforms and E. coli. Results: The mean number of total coliforms on high hand contact surfaces was 0.2333 cfu/100cm2, while the mean number of total coliforms on low hand contact surfaces was 0.2667 cfu/100cm2. The t-test analysis of total coliform results produced a p-value of 0.5566. The mean number of E. coli on high hand contact surfaces was 1.1333 cfu/100cm2, while the mean number of E. coli on low hand contact surfaces was 4.9000 cfu/100cm2. The t-test analysis of E. coli results produced a p-value of 0.8019. Discussion: Neither results for total coliforms or E. coli indicated significantly different numbers on high or low hand contact surfaces. This indicates that these total coliform and E. coli may not be present as a result of hand contact. Conclusion: These results do not support the deposition of coliforms or E. coli on playground equipment as a result of hand contact. However, there is still concern due to the number of samples positive for E. coli. These results suggest the need for practices such as regular hand washing in the school setting after using the playground, regular cleaning of playground materials and EHO inspections of school grounds.&#x0D;

A novel feline norovirus in diarrheic cats

By screening a collection of fecal samples from young cats housed in three different shelters in South Italy, noroviruses (NoVs) were found in 3/48 (6.2%) specimens of animals with enteritis signs while they were not detected in samples collected from healthy cats (0/57). Upon sequence analysis of the short RNA-dependent RNA polymerase (RdRp) region, the three strains displayed the highest nucleotide (nt) and amino acid (aa) identities to the prototype GIV.2 strain lion/Pistoia/387/06/ITA (91.0–93.0% nt and 97.0–98.0% aa). The sequence of ~3.4-kb portion at the 3′ end of the genome of a NoV strain, TE/77-13/ITA, was determined. In the full-length ORF2, encoding the VP1 capsid protein, the virus was genetically closest to the canine GVI.2 NoV strains C33/Viseu/2007/PRT and FD53/2007/ITA (81.0–84.0% nt and 93.0–94.0% aa identities), suggesting a recombination nature, with the cross-over site being mapped to the ORF1-ORF2 junction. Based on the full-length VP1 amino acid sequence, we classified the novel feline NoV, together with the canine strains Viseu and FD53, as a genotype 2, within the genogroup GVI. These findings indicate that, as observed for GIV NoV, GVI strains may infect both the canine and feline host. Unrestricted circulation of NoV strains in small carnivores may provide the basis for quick genetic diversification of these viruses by recombination. Interspecies circulation of NoVs in pets must also be considered when facing outbreaks of enteric diseases in these animals.