Outbreaks In Europe Research Articles

Genomic Features and Phylogenetic Analysis of Antimicrobial-Resistant Salmonella Mbandaka ST413 Strains.

In recent years, Salmonella enterica subsp. enterica serovar Mbandaka (S. Mbandaka) has been increasingly isolated from laying hens and shell eggs around the world. Moreover, this serovar has been identified as the causative agent of several salmonellosis outbreaks in humans. Surprisingly, little is known about the characteristics of this emerging serovar, and therefore, we investigated antimicrobial resistance, virulence, and prophage genes of six selected Brazilian strains of Salmonella Mbandaka using Whole Genome Sequencing (WGS). Multi-locus sequence typing revealed that the tested strains belong to Sequence Type 413 (ST413), which has been linked to recent multi-country salmonellosis outbreaks in Europe. A total of nine resistance genes were detected, and the most frequent ones were aac(6')-Iaa, sul1, qacE, blaOXA-129, tet(B), and aadA1. A point mutation in ParC at the 57th position (threonine → serine) associated with quinolone resistance was present in all investigated genomes. A 112,960 bp IncHI2A plasmid was mapped in 4/6 strains. This plasmid harboured tetracycline (tetACDR) and mercury (mer) resistance genes, genes contributing to conjugative transfer, and genes involved in plasmid maintenance. Most strains (four/six) carried Salmonella genomic island 1 (SGI1). All S. Mbandaka genomes carried seven pathogenicity islands (SPIs) involved in intracellular survival and virulence: SPIs 1-5, 9, and C63PI. The virulence genes csgC, fimY, tcfA, sscA, (two/six), and ssaS (one/six) were absent in some of the genomes; conversely, fimA, prgH, and mgtC were present in all of them. Five Salmonella bacteriophage sequences (with homology to Escherichia phage phiV10, Enterobacteria phage Fels-2, Enterobacteria phage HK542, Enterobacteria phage ST64T, Salmonella phage SW9) were identified, with protein counts between 31 and 54, genome lengths of 24.7 bp and 47.7 bp, and average GC content of 51.25%. In the phylogenetic analysis, the genomes of strains isolated from poultry in Brazil clustered into well-supported clades with a heterogeneous distribution, primarily associated with strains isolated from humans and food. The phylogenetic relationship of Brazilian S. Mbandaka suggests the presence of strains with high epidemiological significance and the potential to be linked to foodborne outbreaks. Overall, our results show that isolated strains of S. Mbandaka are multidrug-resistant and encode a rather conserved virulence machinery, which is an epidemiological hallmark of Salmonella strains that have successfully disseminated both regionally and globally.

Mpox Virus in the Pharynx of Men Having Sex with Men: A Case Series.

The recent Mpox virus (MPV) outbreak in Europe and North America, primarily among men who have sex with men (MSM), raised concerns about various transmission sources. We examined patients with Mpox from an urban STI center in Lombardy, Italy, between May and August 2022. Demographic, transmission, and clinical data were collected using a standardized form. Initial and subsequent tests were conducted using the RealStar Orthopoxvirus PCR Kit 1.0 (Altona Diagnostics, Hamburg, Germany) for skin lesions and oropharyngeal swabs. A total of 15 patients were recruited, all MSM, with 40% being HIV-positive. Almost all reported recent unprotected sexual activity. Oropharyngeal symptoms were observed in a minority, and oral cavity lesions were present in 20% of cases. MPV DNA was detected in skin lesions of 93% of patients and in oropharyngeal swabs of 87%. Skin samples exhibited a higher viral load than pharyngeal samples, with the latter persisting longer. Prospective follow-up of 11 individuals revealed an average pharyngeal persistence of 5.3 days beyond skin lesion clearance, reaching up to 80 days in an immunosuppressed case. Our findings indicate that MPV replication can persist in the pharynx asymptomatically and for an extended period.

The representation of Africa as a geography of disease: how the global north media reporting of the monkeypox virus reinforce stereotypes about Africa

This paper examines how the international media reporting on the monkeypox epidemic reinforces stereotypes about Africa and what this means for Africa in global power relations. How European and Western media depict Africa in their reporting of an epidemic creates and reinforces power dynamics and political bias along the lines of Africa being portrayed as a diseased-poor continent. The effect of these global inequalities is evident in the travel ban policies and the unequal distribution of vaccines. The concepts of hegemony, stigma, and labeling theory were used as theoretical approaches to analyze how foreign media hegemony creates and reinforces stereotypes about Africa through media reporting of an epidemic like the 2022 monkeypox virus. Online publications and tweets by Western and European media outlets were used as data to analyze foreign media hegemony while reporting the monkeypox outbreak in Europe and North America. As a counter-hegemony, African journalists reacted to foreign media agencies using African images to report disease outbreaks in the Global North. The conclusion and recommendation of this paper call for investment in African journalism to help Africa tell their own story and for African literature and researchers from Africa to contribute to global biomedical literature.

Genomic epidemiology of hypervirulent Listeria monocytogenes CC619: Population structure, phylodynamics and virulence

Listeria monocytogenes is a ubiquitous foodborne pathogen causing human and animal listeriosis with high mortality. Neurological and maternal-neonatal listeriosis outbreaks in Europe and the United States were frequently associated with clonal complexes CC1, CC2 and CC6 harboring Listeria Pathogenicity Island-1 (LIPI-1), as well as CC4 carrying both LIPI-1 and LIPI-4. However, human listeriosis in China was predominantly linked to CC87 and CC619 from serotype 1/2b. To understand the genetic evolution and distribution patterns of CC619, we characterized the epidemic history, population structure, and transmission feature of CC619 strains through analysis of 49,421 L. monocytogenes genomes globally. We found that CC619 was uniquely distributed in China, and closely related with perinatal infection. As CC619 strains were being mainly isolated from livestock and poultry products, we hypothesized that pigs and live chicken were the reservoirs of CC619. Importantly, all CC619 strains not only harbored the intact LIPI-1 and LIPI-4, but these also carried LIPI-3 that could facilitate host colonization and invasion. The deficiency of LIPI-3 or LIPI-4 markedly decreased L. monocytogenes colonization capacity in a model of intragastric infection in the mouse. Altogether, our findings suggest that the hypervirulent CC619 harboring three pathogenicity islands LIPI-1, LIPI-3 and LIPI-4 is a putatively persistent population in various foods, environment, and human population, warranting the further research for deciphering its pathogenicity and strengthening epidemiological surveillance.

2299. Genomic Epidemiology of SARS-CoV-2 in Metropolitan Detroit

Abstract Background The COVID-19 pandemic, resulting from the rapidly evolving SARS-CoV-2 virus, has drastically impacted health systems and economies worldwide. Genomic sequencing is critical for the surveillance of SARS-CoV-2 to monitor the rapidly evolving virus and identify new strains. Methods 583 isolates from Henry Ford Health were retrospectively profiled across 3 years (117 isolates in 2020; 39 in 2021; 427 in 2022). DNA was extracted using Kingfisher viral isolation kit; RT-PCR screening was used to identify isolates with cycle threshold < 32 for whole genome sequencing (WGS). Libraries were generated using QIAseq DIRECT SARS-CoV-2 Kit, followed by Illumina sequencing (MiSeq or NovaSeq 6000; 300 cycles). Lineage analysis of the SARS-CoV-2 consensus genome sequences generated from samtools variant analysis pipeline was determined using Nextclade and Pangolin software. Results Sequences were classified into 11 unique clades across 108 lineages by Nextclade and Pangolin, respectively. Almost three-fourths of the sequenced isolates were from 2022. 117 (20%) genomes were from the early pandemic (2020) and were clustered into 8 clades: 19A, 19B, 20A, 20B, 20C, 21 J (Delta) and 21L (Omicron). Most of the 2022 genomes (72%) were in clade 20C from lineage B.1, identified during the outbreak in Europe. 15 (13%) genomes had clade 19A (lineage B) and 1 had 19B (lineage A.3), identified early in the pandemic in Wuhan, China. Of the 39 (7%) genomes from 2021, the majority (82%) clustered into clade Delta 21J that originated in India. Only 2 (5%) of the genomes from 2021 had Alpha variant of concern (21I) from the lineage B1.1.7, which were suspected to be more transmissible. Of the 427 (73%) genomes from 2022, 393 (92%) had variants within Omicron variant of concern (21L), with 79 different lineages; 1 was Omicron variant 21K from the lineage BA1.1. Other clades observed in the 2022 batch were 19A (6%), 20A (0.2%), 20B (0.2%), 20C (0.2%) and 21M (1%). Conclusion Our genomic surveillance data suggest that SARS-CoV-2 infections at the local level mirrored global outbreaks. This underscores the importance of robust genomic surveillance efforts to inform public health planning and practice. Disclosures Marcus Zervos, MD, Contrafect: Advisor/Consultant|GSK: Grant/Research Support|Johnson and Johnson: Grant/Research Support|Pfizer: Grant/Research Support

Indication of West Nile Virus (WNV) Lineage 2 Overwintering among Wild Birds in the Regions of Peloponnese and Western Greece.

West Nile virus (WNV), a zoonotic mosquito-borne virus, has recently caused human outbreaks in Europe, including Greece. Its transmission cycle in nature includes wild birds as amplifying hosts and ornithophilic mosquito vectors. The aim of this study was to assess WNV circulation among wild birds from two regions of Greece, Peloponnese and Western Greece, during 2022. To this end, a total of 511 birds belonging to 37 different species were sampled and molecularly screened. WNV RNA was detected from February to November in a total of 71 wild birds of nine species originating from both investigated regions. The first eight positive samples were sequenced on a part of NS3 and, according to the phylogenetic analysis, they belonged to evolutionary lineage 2 and presented similarity to previous outbreak-causing Greek strains (Argolis 2017, Macedonia 2010 and 2012). It was more likely to identify a PCR positive bird as the population density and the distance from water sources decreased. The present report provides evidence of WNV occurrence in both Peloponnese and Western Greece during 2022 and underlines its possible overwintering, highlighting the need for avian species surveillance to be conducted annually and throughout the year. Magpies are proposed as sentinels for WNV monitoring.

Cold wintertime air masses over Europe: where do they come from and how do they form?

Abstract. Despite the general warming trend, wintertime cold-air outbreaks in Europe have remained nearly as extreme and as common as decades ago. In this study, we identify six principal 850 hPa cold anomaly types over Europe in 1979–2020 using self-organizing maps (SOMs). Based on extensive analysis of atmospheric large-scale circulation patterns combined with nearly 2 million kinematic backward trajectories, we show the origins and contributions of various physical processes to the formation of cold wintertime 850 hPa air masses. The location of the cold anomaly region is closely tied to the location of blocking; if the block is located farther to the east, the cold anomaly is also displaced eastwards. Considering air mass evolution along the trajectories, the air parcels are typically initially (5–10 d before) colder than at their arrival in Europe, but initially warmer air parcels also sometimes lead to cold anomalies over Europe. Most commonly the effect of adiabatic warming on the temperature anomalies is overcompensated for by advection from regions that are climatologically colder than the target region, supported by diabatic cooling along the pathway. However, there are regional differences: cold anomalies over western Europe and southeastern Europe are dominantly caused by advection and over eastern Europe by both advective and diabatic processes. The decadal-scale warming in the site of air mass origin has been partly compensated for by enhanced diabatic (radiative) cooling along the pathway to Europe. There have also been decadal changes in large-scale circulation patterns and air mass origin. Our results suggest that understanding future changes in cold extremes will require in-depth analyses of both large-scale circulation and the physical (adiabatic and diabatic) processes.

Complete genome reconstruction of the global and European regional dispersal history of the lumpy skin disease virus.

Lumpy skin disease virus (LSDV) has a complex epidemiology involving multiple strains, recombination, and vaccination. Its DNA genome provides limited genetic variation to trace outbreaks in space and time. Sequencing of LSDV whole genomes has also been patchy at global and regional scales. Here, we provide the first fine-grained whole genome sequence sampling of a constrained LSDV outbreak (southeastern Europe, 2015-2017), which we analyze along with global publicly available genomes. We formally evaluate the past occurrence of recombination events as well as the temporal signal that is required for calibrating molecular clock models and subsequently conduct a time-calibrated spatially explicit phylogeographic reconstruction. Our study further illustrates the importance of accounting for recombination events before reconstructing global and regional dynamics of DNA viruses. More LSDV whole genomes from endemic areas are needed to obtain a comprehensive understanding of global LSDV dispersal dynamics.

Knowledge, Attitudes, and Practices of European Healthcare Professionals towards Hepatitis A and Hepatitis B Vaccination in at-Risk Adults.

Despite the occurrence of several hepatitis A (hepA) and hepatitis B (hepB) outbreaks in Europe in the last few decades, not all European countries have implemented hepA and hepB vaccinations in their national immunization programs, especially for adults at risk for hepA and/or hepB infection, such as men who have sex with men or patients with chronic liver disease. Currently, little is known on the attitudes of European healthcare professionals (HCPs) towards hepA and hepB vaccinations for at-risk adults. We conducted an online survey among HCPs in Germany, Spain, and the United Kingdom to assess their awareness of and adherence to their national hepA and hepB vaccination guidelines for at-risk adults. Among the 698 HCPs who took the survey, most (91.1%) were familiar with their national vaccination recommendations and always followed them or followed them most of the time when advising or prescribing hepA or hepB vaccines. Major and moderate barriers for recommending or administering such vaccines were the non-disclosure of risk factors by the patient (53.0-57.6%) and the patient's lack of motivation or knowledge about the risk of the disease (50.3-52.9%). These results may help inform strategies to improve and accelerate hepA and hepB vaccination in European at-risk adults.

Complex network analysis techniques for the early detection of the outbreak of pandemics transmitted through air traffic

Air transport has been identified as one of the primary means whereby COVID-19 spread throughout Europe during the early stages of the pandemic. In this paper we analyse two categories of methods – dynamic network markers (DNMs) and network analysis-based methods – as potential early warning signals for detecting and anticipating COVID-19 outbreaks in Europe on the basis of accuracy regarding the daily confirmed cases. The analysis was carried out from 15 February 2020, around two weeks before the first COVID-19 cases appeared in Europe, and 1 May 2020, approximately two weeks after all the air traffic in Europe had been shut down. Daily European COVID-19 information sourced from the World Health Organization was used, whereas air traffic data from Flightradar24 has been incorporated into the analyses by means of four alternative adjacency matrices. Some DNMs have been discarded since they output multiple time series, which makes it very difficult to interpret their results. The only DNM outputting a single time series does not emulate the COVID-19 trend: it does not detect all the main peaks, which means that peak heights do not match up with the increase in the number of infected people. However, many combinations of network analysis based methods and adjacency matrices output good results (with high accuracy and 20-day advance forecasts), with only minor differences from one to another. The number of edges and the network density methods are slightly better when dynamic flight frequency information is used.

Psychological Resilience Factors and Their Association With Weekly Stressor Reactivity During the COVID-19 Outbreak in Europe: Prospective Longitudinal Study.

Cross-sectional relationships between psychosocial resilience factors (RFs) and resilience, operationalized as the outcome of low mental health reactivity to stressor exposure (low "stressor reactivity" [SR]), were reported during the first wave of the COVID-19 pandemic in 2020. Extending these findings, we here examined prospective relationships and weekly dynamics between the same RFs and SR in a longitudinal sample during the aftermath of the first wave in several European countries. Over 5 weeks of app-based assessments, participants reported weekly stressor exposure, mental health problems, RFs, and demographic data in 1 of 6 different languages. As (partly) preregistered, hypotheses were tested cross-sectionally at baseline (N=558), and longitudinally (n=200), using mixed effects models and mediation analyses. RFs at baseline, including positive appraisal style (PAS), optimism (OPT), general self-efficacy (GSE), perceived good stress recovery (REC), and perceived social support (PSS), were negatively associated with SR scores, not only cross-sectionally (baseline SR scores; all P<.001) but also prospectively (average SR scores across subsequent weeks; positive appraisal (PA), P=.008; OPT, P<.001; GSE, P=.01; REC, P<.001; and PSS, P=.002). In both associations, PAS mediated the effects of PSS on SR (cross-sectionally: 95% CI -0.064 to -0.013; prospectively: 95% CI -0.074 to -0.0008). In the analyses of weekly RF-SR dynamics, the RFs PA of stressors generally and specifically related to the COVID-19 pandemic, and GSE were negatively associated with SR in a contemporaneous fashion (PA, P<.001; PAC,P=.03; and GSE, P<.001), but not in a lagged fashion (PA, P=.36; PAC, P=.52; and GSE, P=.06). We identified psychological RFs that prospectively predict resilience and cofluctuate with weekly SR within individuals. These prospective results endorse that the previously reported RF-SR associations do not exclusively reflect mood congruency or other temporal bias effects. We further confirm the important role of PA in resilience.

A tale of three vines: current and future threats to wild Eurasian grapevine by vineyards and invasive rootstocks

AbstractAimEurasian grapevine (Vitis vinifera), one of the most important fruit crops worldwide, diverged from its wild and currently endangered relative (V. vinifera ssp. sylvestris) about 11,000 years ago. In the 19th century, detrimental phylloxera and disease outbreaks in Europe forced grapevine cultivation to use American Vitis species as rootstocks, which have now become naturalized in Europe and are starting to colonize similar habitats to the wild grapevine. Accordingly, wild grapevine now faces two additional threats: the expansion of vineyards and invasive rootstocks. Furthermore, climate change is expected to have significant impacts on the distribution of all grapevines in Europe. In this study, we quantified the distributional and bioclimatic overlap between grapewine's wild relative and the taxa associated with viticulture, under current and future climate.LocationEurope, North America.MethodsThe distributions of wild Eurasian grapevine, cultivated Eurasian grapevine and five American grapevine species used in rootstock breeding programs were linked to climate variables to model their bioclimatic niches. These ecological niche models were used to quantify the spatial and bioclimatic overlap between these seven Vitis taxa in Europe.ResultsNiche and spatial overlap is high between the wild, cultivated and rootstock grapevines, suggesting that existing conflicts between vineyards and wild grapevine conservation may be further complicated by naturalized rootstocks outcompeting the wild grapevine, especially under future scenarios of climate change. In the hottest scenario, only 76.1% of the current distribution of the Eurasian grapevine remains in suitable area.Main ConclusionsAs wild grapevine may ultimately provide a valuable gene pool for adapting viticulture to a changing world, these findings demonstrate the need for improved management of the wild grapevine and its natural habitat, to counteract the harmful effects of global change on the wild relatives of viticulture.

Using surveillance data for early warning modelling of highly pathogenic avian influenza in Europe reveals a seasonal shift in transmission, 2016–2022

Avian influenza in wild birds and poultry flocks constitutes a problem for animal welfare, food security and public health. In recent years there have been increasing numbers of outbreaks in Europe, with many poultry flocks culled after being infected with highly pathogenic avian influenza (HPAI). Continuous monitoring is crucial to enable timely implementation of control to prevent HPAI spread from wild birds to poultry and between poultry flocks within a country. We here utilize readily available public surveillance data and time-series models to predict HPAI detections within European countries and show a seasonal shift that happened during 2021–2022. The output is models capable of monitoring the weekly risk of HPAI outbreaks, to support decision making.

Data-driven estimation of the instantaneous reproduction number and growth rates for the 2022 monkeypox outbreak in Europe.

To estimate the instantaneous reproduction number Rt and the epidemic growth rates for the 2022 monkeypox outbreaks in the European region. We gathered daily laboratory-confirmed monkeypox cases in the most affected European countries from the beginning of the outbreak to September 23, 2022. A data-driven estimation of the instantaneous reproduction number is obtained using a novel filtering type Bayesian inference. A phenomenological growth model coupled with a Bayesian sequential approach to update forecasts over time is used to obtain time-dependent growth rates in several countries. The instantaneous reproduction number Rt for the laboratory-confirmed monkeypox cases in Spain, France, Germany, the UK, the Netherlands, Portugal, and Italy. At the early phase of the outbreak, our estimation for Rt, which can be used as a proxy for the basic reproduction number R0, was 2.06 (95% CI 1.63 - 2.54) for Spain, 2.62 (95% CI 2.23 - 3.17) for France, 2.81 (95% CI 2.51 - 3.09) for Germany, 1.82 (95% CI 1.52 - 2.18) for the UK, 2.84 (95% CI 2.07 - 3.91) for the Netherlands, 1.13 (95% CI 0.99 - 1.32) for Portugal, 3.06 (95% CI 2.48 - 3.62) for Italy. Cumulative cases for these countries present subexponential rather than exponential growth dynamics. Our findings suggest that the current monkeypox outbreaks present limited transmission chains of human-to-human secondary infection so the possibility of a huge pandemic is very low. Confirmed monkeypox cases are decreasing significantly in the European region, the decline might be attributed to public health interventions and behavioral changes in the population due to increased risk perception. Nevertheless, further strategies toward elimination are essential to avoid the subsequent evolution of the monkeypox virus that can result in new outbreaks.

Impact of the COVID-19 pandemic on community antibiotic consumption in the EU/European Economic Area: a changepoint analysis.

A decrease in community antibiotic consumption in Europe has been observed during the COVID-19 pandemic. The magnitude of this decrease, how fast after the outbreak it occurred, whether it was sustained during the pandemic and whether the seasonal variation in antibiotic consumption was affected, have not yet been evaluated in detail. Data on community antibiotic consumption were available from the European Surveillance of Antimicrobial Consumption Network for 28 EU/European Economic Area (EEA) countries between 2010 and 2021. Antibiotic consumption was expressed as DDDs per 1000 inhabitants per day (DID). The impact of the pandemic on antibiotic consumption was investigated using descriptive statistics and non-linear mixed changepoint models for quarterly and yearly data. The decrease in overall antibiotic consumption between 2019 and 2020 (-3.4 DID; -18.6%) was mainly due to a decrease in the consumption of penicillins [Anatomical Therapeutic Chemical (ATC) code J01C] (-1.9 DID; -23.0%), other β-lactam antibacterials (J01D) (-0.6 DID; -25.8%) and macrolides, lincosamides and streptogramins (J01F) (-0.5 DID; -17.4%) and was sustained during 2021. The changepoint analysis of yearly data (28 countries) estimated a decrease of 3.3 DID in overall antibiotic consumption (J01) between 2019 and 2020. The analysis of quarterly data (16 countries) estimated a decrease in overall antibiotic consumption (J01) of 4.0 DID and a decrease in seasonal variation of 1.2 DID between the first and second quarters of 2020. The changepoint analysis indicated a significant, sudden and steep decrease in community antibiotic consumption in the EU/EEA immediately after the start of the COVID-19 outbreak in Europe, as well as a decrease in its seasonal variation.

Genetic Characteristics of the Virus Detected in the First Mpox Imported Case in Tokyo, Japan.

Mpox, caused by the mpox virus (MPXV), produces symptoms similar to those of smallpox when transmitted to humans. Since 1970, this disease has been endemic, particularly in Africa. However, since May 2022, the number of patients without a history of travel to endemic areas has increased rapidly globally. Under these circumstances, in July 2022, two different real-time PCR methods were used on specimens brought to the Tokyo Metropolitan Institute of Public Health. MPXV was detected in the skin samples, and it was inferred that the virus was a West African strain. Furthermore, a more detailed analysis of the genetic characteristics of the detected MPXV using next-generation sequencing revealed that the MPXV detected in Tokyo was strain B.1, which corresponds to the same strain that is prevalent in Europe and the USA. This suggests that mpox reported for the first time in Japan was imported and related to outbreaks in Europe and the USA. Therefore, it is necessary to continue monitoring outbreaks in Japan in conjunction with global epidemics.

14th century Yersinia pestis genomes support emergence of pestis secunda within Europe.

Pestis secunda (1356-1366 CE) is the first of a series of plague outbreaks in Europe that followed the Black Death (1346-1353 CE). Collectively this period is called the Second Pandemic. From a genomic perspective, the majority of post-Black Death strains of Yersinia pestis thus far identified in Europe display diversity accumulated over a period of centuries that form a terminal sub-branch of the Y. pestis phylogeny. It has been debated if these strains arose from local evolution of Y. pestis or if the disease was repeatedly reintroduced from an external source. Plague lineages descended from the pestis secunda, however, are thought to have persisted in non-human reservoirs outside Europe, where they eventually gave rise to the Third Pandemic (19th and 20th centuries). Resolution of competing hypotheses on the origins of the many post-Black Death outbreaks has been hindered in part by the low representation of Y. pestis genomes in archaeological specimens, especially for the pestis secunda. Here we report on five individuals from Germany that were infected with lineages of plague associated with the pestis secunda. For the two genomes of high coverage, one groups within the known diversity of genotypes associated with the pestis secunda, while the second carries an ancestral genotype that places it earlier. Through consideration of historical sources that explore first documentation of the pandemic in today's Central Germany, we argue that these data provide robust evidence to support a post-Black Death evolution of the pathogen within Europe rather than a re-introduction from outside. Additionally, we demonstrate retrievability of Y. pestis DNA in post-cranial remains and highlight the importance of hypothesis-free pathogen screening approaches in evaluations of archaeological samples.

Estimated incubation period distributions of mpox using cases from two international European festivals and outbreaks in a club in Berlin, May to June 2022.

BackgroundSince May 2022, an mpox outbreak affecting primarily men who have sex with men (MSM) has occurred in numerous non-endemic countries worldwide. As MSM frequently reported multiple sexual encounters in this outbreak, reliably determining the time of infection is difficult; consequently, estimation of the incubation period is challenging.AimWe aimed to provide valid and precise estimates of the incubation period distribution of mpox by using cases associated with early outbreak settings where infection likely occurred.MethodsColleagues in European countries were invited to provide information on exposure intervals and date of symptom onset for mpox cases who attended a fetish festival in Antwerp, Belgium, a gay pride festival in Gran Canaria, Spain or a particular club in Berlin, Germany, where early mpox outbreaks occurred. Cases of these outbreaks were pooled; doubly censored models using the log-normal, Weibull and Gamma distributions were fitted to estimate the incubation period distribution.ResultsWe included data on 122 laboratory-confirmed cases from 10 European countries. Depending on the distribution used, the median incubation period ranged between 8 and 9 days, with 5th and 95th percentiles ranging from 2 to 3 and from 20 to 23 days, respectively. The shortest interval that included 50% of incubation periods spanned 8 days (4-11 days).ConclusionCurrent public health management of close contacts should consider that in approximately 5% of cases, the incubation period exceeds the commonly used monitoring period of 21 days.

West Nile virus emergence in humans in Extremadura, Spain 2020.

In Spain, the largest human West Nile virus (WNV) outbreak among humans was reported in 2020, constituting the second most important outbreak in Europe that season. Extremadura (southwestern Spain) was one of the affected areas, reporting six human cases. The first autochthonous human case in Spain was reported in Extremadura in 2004, and no other human cases were reported until 2020. In this work, we describe the first WNV human outbreak registered in Extremadura, focusing on the most important clinical aspects, diagnostic results, and control actions which followed. In 2020, from September to October, human WNV infections were diagnosed using a combination of molecular and serological methods (an in-house specific qRT-PCR and a commercial ELISA for anti-WNV IgM and IgG antibodies) and by analysing serum, urine, and/or cerebrospinal fluid samples. Serological positive serum samples were further tested using commercial kits against related flaviviruses Usutu and Tick-borne encephalitis in order to analyse serological reactivity and to confirm the results by neutralisation assays. In total, six cases of WNV infection (five with neuroinvasive disease and one with fever) were identified. Clinical presentation and laboratory findings are described. No viral RNA was detected in any of the analysed samples, but serological cross-reactivity was detected against the other tested flaviviruses. Molecular and serological methods for WNV detection in various samples as well as differential diagnosis are recommended. The largest number of human cases of WNV infection ever registered in Extremadura, Spain, occurred in 2020 in areas where circulation of WNV and other flaviviruses has been previously reported in humans and animals. Therefore, it is necessary to enhance surveillance not only for the early detection and implementation of response measures for WNV but also for other emerging flaviviruses that could be endemic in this area.

Ecogeographic Drivers of the Spatial Spread of Highly Pathogenic Avian Influenza Outbreaks in Europe and the United States, 2016-Early 2022.

H5Nx highly pathogenic avian influenza (HPAI) viruses of clade 2.3.4.4 have caused outbreaks in Europe among wild and domestic birds since 2016 and were introduced to North America via wild migratory birds in December 2021. We examined the spatiotemporal extent of HPAI viruses across continents and characterized ecological and environmental predictors of virus spread between geographic regions by constructing a Bayesian phylodynamic generalized linear model (phylodynamic-GLM). The findings demonstrate localized epidemics of H5Nx throughout Europe in the first several years of the epizootic, followed by a singular branching point where H5N1 viruses were introduced to North America, likely via stopover locations throughout the North Atlantic. Once in the United States (US), H5Nx viruses spread at a greater rate between US-based regions as compared to prior spread in Europe. We established that geographic proximity is a predictor of virus spread between regions, implying that intercontinental transport across the Atlantic Ocean is relatively rare. An increase in mean ambient temperature over time was predictive of reduced H5Nx virus spread, which may reflect the effect of climate change on declines in host species abundance, decreased persistence of the virus in the environment, or changes in migratory patterns due to ecological alterations. Our data provide new knowledge about the spread and directionality of H5Nx virus dispersal in Europe and the US during an actively evolving intercontinental outbreak, including predictors of virus movement between regions, which will contribute to surveillance and mitigation strategies as the outbreak unfolds, and in future instances of uncontained avian spread of HPAI viruses.