Epidemiological Sentinels Research Articles

P-765. Enhancing Tuberculosis (TB) Surveillance with Artificial Intelligence: Utilizing Latent Semantic Indexing (LSI) to Automatically Detect TB Cases

Abstract Background Reducing TB surveillance incurs significant costs, as effective control and societal impact minimization rely on robust, ongoing surveillance systems that integrate and analyze comprehensive data for prompt action. Our study supports integrating artificial intelligence (LSI) into TB and other notifiable disease monitoring frameworks to improve trackingFigure 1Binary Matrix of 125 Terms: Presence vs. Absence of Root Keywords Retrieved from the Patient ElectronicRecord for the LSI Automatic Retrieval System.Binary Matrix of 125 Terms: Presence vs. Absence of Root Keywords Retrieved from the Patient Electronic Record for the LSI Automatic Retrieval System. Methods In 2024, we developed a novel application within Datamart A.R.G.U.S.—Assistant for Recovery and Guarding of Urgent and Epidemiological Sentinels—a cloud-based platform hosted on AWS and developed by our team. This application integrates with hospital systems (MV) and laboratory systems (MATRIX and GAL) to enhance the surveillance of healthcare-associated infections (HAI) and notifiable diseases. Data from both hospital and outpatient care are encoded into a binary matrix of 125 terms (root keywords) extracted from patient electronic records. This matrix is then processed using Singular Value Decomposition (SVD) within an LSI-based information retrieval system (Fig. 1). In our model, each patient is represented as a point in a 125-dimensional hyperdimensional space. When projected into three-dimensional space, this framework allows for effective clustering and classification of notifiable Diseases (Fig. 2), specifically TB (Fig. 3).Figure 2:3D Visualization of High-Dimensional Data: Comparing Mandatory Notifiable Diseases versus Non-Notifiable Diseases. Both patient types are well separated in the space, enabling automatic clustering and classification.3D Visualization of High-Dimensional Data: Comparing Mandatory Notifiable Diseases versus Non-Notifiable Diseases. Both patient types are well separated in the space, enabling automatic clustering and classification. Results The LSI-based matrix was constructed using data from January 2023 to February 2024, encompassing a sample of 17,895 cases (lines) across 125 presence versus absence terms, with each case classified as either a notifiable or non-notifiable disease. The 125-dimensional matrix was reduced to 28 factors using SVD. The sensitivity and specificity of the Euclidean distance were better than those of cosine similarity when automatically identifying TB cases in 1,970 independent queries (Fig. 4).Figure 3:3D Visualization of High-Dimensional Data: Comparing Tuberculosis versus Other Mandatory Notifiable Diseases versus Non-Notifiable Diseases. The three types of patients are well separated in the space, enabling automatic clustering and classification.3D Visualization of High-Dimensional Data: Comparing Tuberculosis versus Other Mandatory Notifiable Diseases versus Non-Notifiable Diseases. The three types of patients are well separated in the space, enabling automatic clustering and classification. Conclusion Artificial Intelligence (LSI), significantly enhances the surveillance of TB and other notifiable diseases by enabling real-time, automated case identification up to one day prior (D-1). This advancement allows surveillance personnel to complete their tasks more efficiently, thereby preventing outbreaks and reducing the risk of unforeseen fatalities.Figure 4:Performance Comparison of Cosine vs. Euclidean Distance Metrics in Automatically Identifying TB Cases Using LSI: Euclidean Distance Demonstrates Superior Accuracy and Has Been Integrated into Datamart A.R.G.U.S. for Real-Time Identification of TB and Other Notifiable Diseases as of the Previous Workday (D-1).Performance Comparison of Cosine vs. Euclidean Distance Metrics in Automatically Identifying TB Cases Using LSI: Euclidean Distance Demonstrates Superior Accuracy and Has Been Integrated into Datamart A.R.G.U.S. for Real-Time Identification of TB and Other Notifiable Diseases as of the Previous Workday (D-1). Disclosures All Authors: No reported disclosures

Next-generation sequencing metabarcoding assays reveal diverse bacterial vector-borne pathogens of Mongolian dogs

Bacterial vector-borne pathogens (BVBPs) negatively impact canine health worldwide, with several also being zoonotic, posing an additional disease risk to humans. To date, BVBPs have been reported in humans and various sylvatic and domestic animal hosts across multiple Mongolian aimags (provinces); however, there has been no published data on these pathogens within Mongolia’s canine populations. Collection of such data is important given Mongolia’s size, diverse number of climatic regions, and large population of dogs, most of which closely share their environment with humans and livestock. Therefore, a bacteria-targeting next-generation sequencing metabarcoding (mNGS) assay was used to test the feasibility of mNGS as a proof-of-concept study to ascertain the detection of BVBP in 100 Mongolian dogs. The majority of dogs (n = 74) were infected with at least one of six BVBPs identified; including three species of haemoplasmas (also known as haemotropic mycoplasmas, n = 71), Bartonella rochalimae (n = 3), Ehrlichia spp. (n = 2) and Anaplasma platys (n = 1). Univariable analysis found sex, housing, and role of the dog to be associated with BVBP infection. Male dogs had 4.33 (95% CI: 1.61–11.62, P = 0.003) times the odds of infection with BVBPs compared to females. The majority of dogs included in this study were kept outdoors and had regular direct contact with both livestock and humans, indicating that dogs may contribute to the transmission and dissemination of BVBPs in Mongolia and could act as epidemiological sentinels. This study underscores the importance of pathogen surveillance studies in under-researched regions, reinforces the efficacy of mNGS as an explorative diagnostic tool, and emphasises the need for further larger-scale seroprevalence studies of Mongolian dogs.

343. Datamart A.R.G.U.S. - Assistant for Recovery and Guarding of Urgent and Epidemiological Sentinels

Abstract Background Surveillance of adverse events, healthcare-associated infections (HAI), and notifiable diseases is the foundation for controlling and preventing these occurrences. Typically, surveillance is carried out by trained professionals who manually review patient records and other data sources, using defined criteria for target events. The objective of this study is to present A.R.G.U.S. (Assistant for Recovery and Guarding of Urgent and Epidemiological Sentinels), a datamart that is part of the Datawarehouse for the Hospital Epidemiological Surveillance Unit (NUVEH) and the Hospital Infection Control Service (SCIH) project, from the Brazilian public hospital. Methods A.R.G.U.S. (Fig. 1) is a cloud-based platform (AWS) that connects with the hospital system (MV), laboratory system (MATRIX and GAL), and utilizes automatic detection algorithms for HAI, Influenza-Like Illness (ILI), Severe Acute Respiratory Infection (SARI), and other notifiable diseases, generated through logistic regression models based on text mining of justifications for antimicrobial prescriptions, patient demographic data, and lists of patient ICD-10 codes. In addition to logistic regression, tests were conducted with probabilistic, naive Bayesian classifier.Figure 1Currently, access to the A.R.G.U.S. system is available only in Portuguese and can be obtained at https://www.risoleta.sacihweb.com/#/loginFigure 2Automated search for Severe Acute Respiratory Infection (SARI): patients identified with a probability of more than 25% to be a SARI case. Results Text mining yielded 273 original terms, which were subsequently reduced to 173 root keywords for use in the modeling. Logistic regressions demonstrated an area under the ROC curve slightly below 0.8, while Naïve Bayes classifiers showed an area below 0.7. As a result, Naïve Bayes was excluded from A.R.G.U.S., which incorporates regression models along with algorithms utilizing ICD-10 codes for notifiable diseases. In parallel with the detection of HAI and notifiable diseases (Fig. 2), an automated algorithm for antimicrobial auditing was implemented, optimizing the Antimicrobial Stewardship Program (Fig. 3 and 4). Currently, access to the A.R.G.U.S. system is available only in Portuguese and can be obtained at https://www.risoleta.sacihweb.com/#/login.Figure 3Optimization of the Antimicrobial Stewardship Program: automated search for prophylactic antimicrobials with a prescription duration of more than 30 days.Figure 4Optimization of the Antimicrobial Stewardship Program: automated search for special therapeutic antimicrobials with a prescription duration of more than 10 days. Conclusion A.R.G.U.S. has significantly improved surveillance of healthcare-associated infections (HAI) and notifiable diseases. The Antimicrobial Stewardship Program was automated and optimized, enabling total control over antimicrobial use. Disclosures All Authors: No reported disclosures

Occurrence of Leishmania infantum in Wild Mammals Admitted to Recovery Centers in Spain.

Zoonotic leishmaniasis caused by Leishmania infantum is distributed worldwide and affects humans and domestic and wild mammals. In Europe, specifically in the Mediterranean basin, leishmaniasis is endemic due to the concurrence of the phlebotomine vectors and reservoir mammals, including carnivorous wildlife species and other less studied wild species. In this article, spleen, skin, and eye or oral swabs taken from 134 wild mammals admitted to five wildlife recovery centers in Spain were used. PCR employing fragments of the Repeat region, ITS1, and SSUrRNA were used for detection, and positive samples were processed for sequencing. L. infantum was detected in three out of the nine species analyzed, including European hedgehog, European badger, and red squirrel, with percentages ranging from 11.53 to 35.71%, depending on the species. Most of the species showed higher percentages of positivity in spleen samples than in skin samples. A small number of animals from the remaining six species tested negative, including Algerian hedgehog, stone marten, least weasel, garden dormouse, western polecat, and Egyptian mongoose. Hedgehogs and badgers are good candidates for consideration as epidemiological sentinels and pose a higher risk as potential reservoirs of leishmaniasis based on their percentage of infection and wide distribution.

Validity of the STOP-Bang Questionnaire in Identifying OSA in a Dental Patient Cohort.

Background and objectives: Obstructive Sleep Apnea represents a widespread problem in the population, but it is often not diagnosed and not considered a true pathology. Different diagnostic tools are available for the diagnosis of sleep apnea. This study aims to demonstrate the ability of the STOP-Bang (Snoring, Tiredness, Observed apnea, high blood Pressure, Body mass index, Age, Neck circumference, and Gender) questionnaire in identifying subjects with Obstructive Sleep Apnea (OSA) Syndrome, highlighting the role of dentists as epidemiological sentinels. Materials and methods: the STOP-Bang questionnaire was administered to a cohort of 1000 patients, assessing three private dental clinics in Italy. Excessive daytime sleepiness was measured using Epworth Sleepiness Scale (ESS) and defined as ≥ 10. Subjects were considered at risk of OSA if they had three or more positive items at STOP-Bang and were invited to undergo further examination with a type 3 polygraph. Presence of OSA was measured with the apnea-hypopnea index (AHI) and defined as AHI ≥ 5. Results: 482/1000 subjects (48.2%) had three or more positive items in the STOP-Bang questionnaire and were considered at risk for Obstructive Sleep Apnea Syndrome (OSAS). Excessive daytime sleepiness (EDS ≥ 10) was more frequent among subjects at risk for OSAS (73/482, 15.1%) vs. those not at risk for OSAS (30/518, 5.8%) (p < 0.0001). Moreover, 153/482 subjects at risk for OSAS (31.7%) accepted further examination with a type 3 polygraph. Presence of OSAS (AHI ≥ 5) was suggested in 121/153 subjects (79.1%, 95% CI 71.6% to 85.1%), with 76/121 subjects (62.8%) needing treatment (AHI ≥ 15). Conclusion: the high prevalence of OSAS highlights the role of dentists as “epidemiological sentinels”. The STOP-Bang questionnaire is a simple and efficacious instrument for screening sleep apnea patients.

Molecular detection and characterization of Bartonella spp. in pet cats and dogs in Shenzhen, China

Bartonella spp. are emerging vector-borne pathogens distributed worldwide that can infect humans and a wide range of mammals including small companion animals (cats and dogs). An increasing number of studies from the worldwide have reported cat and dog Bartonella infections in recently years. Cats and dogs are the primary reservoir or accidental hosts for Bartonella henselae, the main causal agent of human cat scratch disease. Since pet cat and dog sharing human living environment and have the direct and intimate contact with humans, pet cats and dogs may represent excellent epidemiological sentinels for Bartonella infection in humans. In this study, 475 blood samples were collected from pet cats and dogs in local animal hospitals located at five districts of Shenzhen City, and detected the presence of Bartonella. Bartonella DNA was detected in eight samples collected from pet cats, no positive sample was detected from pet dog samples. Sequence comparison and phylogenetic analysis revealed that the eight sequences of Bartonella identified here shared the highest identity with B. henselae. Given the intimate contact between pet animals and humans, many attentions should be paid to prevent the Bartonella infections originate from pet cats or dogs, although the Bartonella infection rate in pet cats and dogs might be rather low.

Prevention, education and counselling: the worldwide role of the community pharmacist as an epidemiological sentinel of headaches.

Headache disorders are the third among the worldwide causes of disability, measured in years of life lost to disability. Given the pharmacies' importance in general in headache patient and, in particular in migraine patient management, various studies have been carried out in recent years dealing with this issue. Indeed, in 2014, our research group first analysed publications on a number of studies conducted worldwide. As five years have passed since our first analysis of the literature and having carried out a number of specific studies in Italy since 2014, we wish to analyse once again the studies carried out globally on this topic to evaluate how the situation has evolved in the meantime. The key words used for the bibliographic search were "community pharmacy" and "headache"; we considered articles published between 2014 and 2018. The selected studies regarded Sweden USA, Belgium, Ireland, Jordan and Ethiopia. From the analysis of the international research papers, it is evident that, despite the time that has passed since the previous analyses and the general agreement that pharmacists find themselves in an ideal position to offer adequate levels of counselling to headache patients, the knowledge of pharmacists is not yet sufficient. Clearly, there is a strong need to develop training programmes specifically focused on this subject. Regarding Italy, a national study, commenced in 2016, was designed as a cross-sectional survey employing face-to-face interviews between pharmacist and patient using a questionnaire drawn up by experts in compliance with best practice from scientific literature. Six hundred ten pharmacists followed a specific training course; 4425 questionnaires were correctly completed. The use of pharmacies as epidemiological sentinels, given their capillarity and daily contact with the local population in Italy, enabled us to obtain an epidemiological snapshot closer to the real-life situation compared to specialist headache centres. Over the course of this study, data on headaches were gathered in Italian pharmacies with the highest levels of numerosity in the world.

Dengue, chikungunya, and Zika virus infections imported to Paris between 2009 and 2016: Characteristics and correlation with outbreaks in the French overseas territories of Guadeloupe and Martinique

BackgroundDengue virus (DENV), chikungunya virus (CHIKV), and Zika virus (ZIKV) infections are rapidly expanding across countries and are being diagnosed in returned travellers who represent epidemiological sentinels. The French Territories of America (FTA) such as Guadeloupe and Martinique see high levels of tourism and have experienced three consecutive outbreaks by these viruses in the last decade. ObjectiveThis study was performed to evaluate how ill returned travellers could have represented epidemiological sentinels for these three expanding arboviral diseases over eight consecutive years. The degree of correlation between the cases of ill returned travellers arriving at a French tertiary hospital in Paris and the three outbreaks that occurred in the FTA during the study period was estimated. MethodsAll consecutive ill returned travellers diagnosed at the hospital in Paris with imported DENV, CHIKV, or ZIKV infections from January 2009 to December 2016 were included. Epidemiological and clinical variables were evaluated. Data concerning the incidence of arboviruses in the FTA, as well as the temporal relationship between the occurrence of imported cases and outbreaks in the FTA, were analyzed. ResultsOverall, 320 cases of arboviral infection were reported: 216 DENV, 68 CHIKV, and 36 ZIKV. Most of the patients presented with fever and exanthema. One hundred and fifteen patients were exposed in Guadeloupe or Martinique, which were the at-risk destinations in 25% of patients with DENV, 59% of patients with CHIKV, and 58% of patients with ZIKV. The occurrence of cases diagnosed in returning travellers followed the same time pattern as the outbreaks in these areas. ConclusionsA temporal correlation was found between newly diagnosed imported cases of arboviruses and the three corresponding outbreaks that occurred in Martinique and Guadeloupe during 8 consecutive years. Thus, ill returned travellers act as epidemiological sentinels from the beginning up to the end of outbreaks occurring in touristic locations.

Obstructive Sleep Apnea Syndrome (OSAS): evaluation and treatment of odontostomatological problems.

The Obstructive Sleep Apnea Syndrome (OSAS) is a breathing disorder characterized by repeated episodes of apnea/hypopnea occurring during sleep and caused by the obstruction of the upper airway. As OSAS can have a significant impact on quality of life, an early diagnosis and a multi-specialized recognition become important. Therapeutic proposals include the Mandibular Advancement Devices (MADs), intraoral devices that induce a mandibular advancement during the night to eliminate snoring and apnea. Italian guidelines on dental aspects of OSAS in adults and children focus primarily on anamnestic and clinical methods by which the dentist, in a role of epidemiological sentinel, can first identify a patient with OSAS and then participate in the therapeutic process using specific orthodontic intraoral devices.

Community pharmacies as epidemiological sentinels of headache: first experience in Italy.

Migraine is a disabling neurovascular syndrome which affects 12-15% of the global population and it represents the third cause in years lived with disability in both males and females aged 15-49years. Among migraineurs, the symptomatic drug abuse may be a risk factor in the development of medication overuse headache (MOH). Detecting cases of MOH is not straightforward; community pharmacists may, therefore, be in a strategic position to identify individuals who self-medicate, particularly with respect to prevent the development of MOH. In 2014, our group published the results of a survey conducted in Piedmont, Italy, on the patterns of use and dispensing of drugs in patients requesting assistance from pharmacists for relief of a migraine attack. We decided, now, to expand the scope of the model to a national level. The study is based on cross-sectional face-to-face interviews using questionnaires, presented in this paper, consisting of a first part regarding the socio-economic situation and a second part which aimed to classify the disease and any excessive use of drugs. Of the 610 pharmacists trained with an online course, 446 gathered a total of 4425 correctly compiled questionnaires. The participation of community pharmacies has highlighted various criticalities especially of an organisational nature; however, it also revealed the power of this method as a means of gathering epidemiological data with a capillarity which few other methods can match. The objective was also to identify each territory's requirements and facilitate the decision-making process in terms of understanding what patients/citizens actually require.

Vectors as Epidemiological Sentinels: Patterns of Within-Tick Borrelia burgdorferi Diversity.

Hosts including humans, other vertebrates, and arthropods, are frequently infected with heterogeneous populations of pathogens. Within-host pathogen diversity has major implications for human health, epidemiology, and pathogen evolution. However, pathogen diversity within-hosts is difficult to characterize and little is known about the levels and sources of within-host diversity maintained in natural populations of disease vectors. Here, we examine genomic variation of the Lyme disease bacteria, Borrelia burgdorferi (Bb), in 98 individual field-collected tick vectors as a model for study of within-host processes. Deep population sequencing reveals extensive and previously undocumented levels of Bb variation: the majority (~70%) of ticks harbor mixed strain infections, which we define as levels Bb diversity pre-existing in a diverse inoculum. Within-tick diversity is thus a sample of the variation present within vertebrate hosts. Within individual ticks, we detect signatures of positive selection. Genes most commonly under positive selection across ticks include those involved in dissemination in vertebrate hosts and evasion of the vertebrate immune complement. By focusing on tick-borne Bb, we show that vectors can serve as epidemiological and evolutionary sentinels: within-vector pathogen diversity can be a useful and unbiased way to survey circulating pathogen diversity and identify evolutionary processes occurring in natural transmission cycles.

HIV EPIDEMIOLOGY IN THE REPUBLIC OF TAJIKISTAN

Study objective: The retrospective analysis of HIV incidence in the Republic of Tajikistan in 2009-2015, the period of the rise of HIV epidemic. Materials and methods: Epidemiological investigations and sentinel surveillance data obtained at the Republican Center for Prevention and Control of AIDS of the Ministry of Health and Social Protection of Population of the Republic of Tajikistan were analyzed. The data included the results of HIV testing using ELISA followed by immunoblot confirmation. HIV incidence per 100 000 population was found to increase from 10,7 in 2012 to 13,6 in 2015. The proportion of reproductive-age women (15-49 years) among the newly found HIV cases increased from 36,6% in 2012 to 40,8% in 2015. The significance of the sexual route of HIV transmission increased in 2012-2015 making it the leading cause of HIV infection. The proportion of HIV cases associated with the injection route decreased twofold in 2012-2015.

Infection of Domestic Dogs in Peru by Zoonotic Bartonella Species: A Cross-Sectional Prevalence Study of 219 Asymptomatic Dogs

Bartonella species are emerging infectious organisms transmitted by arthropods capable of causing long-lasting infection in mammalian hosts. Among over 30 species described from four continents to date, 15 are known to infect humans, with eight of these capable of infecting dogs as well. B. bacilliformis is the only species described infecting humans in Peru; however, several other Bartonella species were detected in small mammals, bats, ticks, and fleas in that country. The objective of this study was to determine the serological and/or molecular prevalence of Bartonella species in asymptomatic dogs in Peru in order to indirectly evaluate the potential for human exposure to zoonotic Bartonella species. A convenient sample of 219 healthy dogs was obtained from five cities and three villages in Peru. EDTA-blood samples were collected from 205 dogs, whereas serum samples were available from 108 dogs. The EDTA-blood samples were screened by PCR followed by nucleotide sequencing for species identification. Antibodies against B. vinsonii berkhoffii and B. rochalimae were detected by IFA (cut-off of 1∶64). Bartonella DNA was detected in 21 of the 205 dogs (10%). Fifteen dogs were infected with B. rochalimae, while six dogs were infected with B. v. berkhoffii genotype III. Seropositivity for B. rochalimae was detected in 67 dogs (62%), and for B. v. berkhoffii in 43 (40%) of the 108 dogs. Reciprocal titers ≥1∶256 for B. rochalimae were detected in 19% of dogs, and for B. v. berkhoffii in 6.5% of dogs. This study identifies for the first time a population of dogs exposed to or infected with zoonotic Bartonella species, suggesting that domestic dogs may be the natural reservoir of these zoonotic organisms. Since dogs are epidemiological sentinels, Peruvian humans may be exposed to infections with B. rochalimae or B. v. berkhoffii.

Bartonellosis, an increasingly recognized zoonosis

Cat scratch disease is the most common zoonotic infection caused by Bartonella bacteria. Among the many mammals infected with Bartonella spp., cats represent a large reservoir for human infection, as they are the main reservoir for Bartonella henselae, Bartonella clarridgeiae and Bartonella koehlerae. Bartonella spp. are vector-borne bacteria, and transmission of B.henselae by cat fleas occurs mainly through infected flea faeces, although new potential vectors (ticks and biting flies) have been identified. Dogs are also infected with various Bartonella species and share with humans many of the clinical signs induced by these infections. Although the role of dogs as source of human infection is not yet clearly established, they represent epidemiological sentinels for human exposure. Present knowledge on the aetiology, clinical features and epidemiological characteristics of bartonellosis is presented.

Acute respiratory diseases/influenza sentinel 2000/2001.

A sentinel surveillance system of the public health service for acute respiratory diseases (ARD), especially influenza, has been realized in the Free State of Saxony of Germany for 25 years. The epidemiological sentinel is based on weekly registration of morbidity and mathematical-statistical calculations. For a microbiological sentinel, a fast diagnosis by nucleic acid amplification techniques and improvements of sample management in connection with the rapid transmission of results have been introduced. In the present report, the ARD/influenza sentinel is demonstrated for the season 2000/2001. The sentinel system provides scientific and practical information for a prophylactic and therapeutic control program. Economic significance has been proved by verifiable numerical data derived from several epidemiological and microbiological investigations. The realized system has been considered superior to the influenza surveillance scheme of the Arbeitsgemeinschaft Influenza (AGI, Marburg, Germany) for all Germany and another system of a pharmaceutical company which is under construction.

Systematic Utilization of Data for Analysis of a Pediatric Emergency-Room Experience

This report describes the systematic use of emergency-room data to (1) define the experiences of a group of pediatric interns in their emergency-room rotation (especially as they relate to their role as future pediatric practitioners), (2) evaluate, supervise, and learn from their performance in this primary care setting, and (3) provide an ongoing weekly list of illnesses diagnosed in the emergency room as an epidemiological sentinel for the larger community. The future applications of this type of systematic approach, perhaps with computer technology, offer the opportunity for comparison of delivery, quality, and cost of health care between various sources of primary care (emergency-room facilities, private physicians' offices, neighborhood health centers, and health maintenance organizations.