Foodborne Disease Surveillance Research Articles

Estimating completeness of foodborne disease registration in North West Morocco

This study aims to estimate the total number of poisoning cases and completeness of foodborne disease surveillance in the region of Tanger-Tétouan-Al Hoceima in North West Morocco. This retrospective study was conducted to assess the completeness of food poisoning surveillance system in the Tanger-Tétouan-Al Hoceima region over a three-year period from January 1, 2014 to December 31, 2016. The data used for this study were obtained from two sources, including the national poisoning database of the Moroccan Poison Control Center (MPCC) and provincial hospital registries in the study area. The completeness of foodborne disease reporting was estimated using the capture-recapture method. During the study period, 235 cases of foodborne diseases were reported to the Moroccan Poison Control Center, 725 cases were notified to the provincial hospital registries and 98 cases were common to both sources. The estimated total number of poisoning cases was 1,739 (95% CI: 1,494-1,983). The completeness of foodborne disease surveillance for the national database of poisoning and hospital registries was estimated to be 13.5% and 41.7%, respectively. Improvement of the completeness of poisoning surveillance system is needed to estimate the true incidence of poisoning in Morocco.

Virulence and resistance genes profiles and clonal relationships of non-typhoidal food-borne Salmonella strains isolated in Tunisia by whole genome sequencing

Whole genome sequencing (WGS) has made impressive progress in the field of molecular biology. Its most common application for public health is in the area of surveillance of food-borne diseases. WGS has the potential for providing a large amount of information, such as the identification of the strain type, the characterization of antibiotic resistance and virulence, and phylogeny. In our study, thirty-nine non-typhoidal Salmonella strains were isolated from diverse sources in Tunisia. Non-typhoidal Salmonella are among the most common pathogens contaminating food animals. The presence of virulence and antimicrobial resistance determinants in those strains were investigated using whole genome sequencing (WGS) and appropriate data analysis. The genomes were screened for several Salmonella virulence genes using the Virulence Factor Database VFDB. Twelve different virulence profiles, which correspond to the 12 identified serovars, were recognized. Several antimicrobial resistance genes were also detected: aac (6′)-Iaa, sul1, tetA, bla-TEM and qnrS genes. Phylogenetic relationships among the strains were further assessed by a cgMLST analysis. The resulting phylogenetic tree consisted of several clusters consistently with the in silico multilocus sequence typing (MLST) and serotyping. Our findings demonstrated that WGS and subsequent data analysis provided an accurate tool for genetic characterization of bacterial strains compared to usual molecular typing techniques. To the best of our knowledge, this is the first report of an application of WGS for genetic characterization of food-borne Tunisian strains.

An analecta of visualizations for foodborne illness trends and seasonality

Disease surveillance systems worldwide face increasing pressure to maintain and distribute data in usable formats supplemented with effective visualizations to enable actionable policy and programming responses. Annual reports and interactive portals provide access to surveillance data and visualizations depicting temporal trends and seasonal patterns of diseases. Analyses and visuals are typically limited to reporting the annual time series and the month with the highest number of cases per year. Yet, detecting potential disease outbreaks and supporting public health interventions requires detailed spatiotemporal comparisons to characterize spatiotemporal patterns of illness across diseases and locations. The Centers for Disease Control and Prevention’s (CDC) FoodNet Fast provides population-based foodborne-disease surveillance records and visualizations for select counties across the US. We offer suggestions on how current FoodNet Fast data organization and visual analytics can be improved to facilitate data interpretation, decision-making, and communication of features related to trend and seasonality. The resulting compilation, or analecta, of 436 visualizations of records and codes are openly available online.

Estimating burden of foodborne diseases where public health impact is higher and data scarcer: a study in four African countries

Abstract Low and middle-income countries, in particular from Africa, bear the highest burden of foodborne disease (FBD). However, because research and disease surveillance data from Africa are limited, previous burden estimates are subject to uncertainty. The main challenge to estimating burden of FBD in Africa is lack of data, where factors ranging from lack of capacity to lack of political commitment, and a focus on priority diseases, limit existing surveillance systems. To address this, we are working with Ethiopia, Mozambique, Nigeria, and Tanzania, to estimate the burden of, and strengthen surveillance systems for, FBD in Africa. We are conducting a population survey (to estimate incidence and distribution of diarrhea in the community), a systematic literature review (to estimate proportions of diarrheal disease caused by different agents), and an active review of available FBD reports (to estimate the extent of under-reporting in existing surveillance). Together, these findings will provide more accurate estimates of the burden of FBD for African countries. Lessons from this large-scale project can be extrapolated to other countries and regions where the burden is high but data are scarce. We highlight applying leadership attributes, including delegation of duties, setting milestones, regular meetings, transparency, and risk mitigation plans. The leading role of experts in this project helps to reduce hurdles. We have also adapted existing data collection tools for use across our diverse African study populations. We are engaging stakeholders who will use our research outputs, by involving them at all stages of the project. This integrated Knowledge Translation approach is translatable to other settings. These studies are part of FOCAL (Foodborne Disease Epidemiology, Surveillance, and Control in African LMIC), a multi-partner, multi-study project co-funded by the Bill and Melinda Gates Foundation and the United Kingdom's Department for International Development.

Estimating the Incubation Period of Salmonella Urinary Tract Infections Using Foodborne Outbreak Data.

Urinary tract infections (UTIs) are common and may occur in foodborne Salmonella outbreaks. Using data from PulseNet, the U.S. national molecular subtyping network for foodborne disease surveillance, we analyzed the 9781 Salmonella isolates associated with the 110 outbreaks from 2004 to 2013 that included at least one urine isolate. Within each outbreak, we calculated standardized isolation dates, using these dates in a linear mixed model to estimate the difference in incubation period for infections yielding stool versus urine isolates. We estimate that the incubation period for Salmonella UTIs is on average 10.6 (95% confidence interval 6.0-15.2) days longer than for gastrointestinal illness, suggesting that outbreak investigators should interview UTI patients about a longer time period before illness onset to identify sources of infection.

Persistent Asymptomatic Human Infections by Salmonella enterica Serovar Newport in China.

Salmonella enterica serovar Newport (S Newport) infections are gradually on the rise in China from the last decade. For humans' infections, S Newport has been ranked among the top five serovars responsible for persistent infections, globally. A total of 290 S. Newport strains with their relevant clinical metadata were analyzed, and the strains were subjected to whole-genome sequence analysis. Among these, 62.4% (n = 181) were from diarrheic patients and 28.9% (n = 84) were from asymptomatic individuals (including adults and youngsters) while 8.6% (n = 25) were from cases of persistent diarrhea in infants (28%, n = 7) and toddlers (72%, n = 18). The association between the sequence types (STs) and the variations in the clinical presentation was statistically significant (P = 0.0432), with ST46 causing diarrhea or representing asymptomatic patients and ST31 or ST68 causing persistent diarrhea. Genomic analysis revealed that the highest proportion of the isolates (98.5%, n = 279), primarily from patients with or without diarrhea rather than from asymptomatic individuals, carried antimicrobial resistance determinants corresponding to the aminoglycosides and beta-lactams, highlighting the need for cautionary usage of antimicrobials in such patients. These findings also suggest that cases of nontyphoidal Salmonella infection with symptoms of acute diarrhea or persistent diarrhea caused by S Newport should be handled with caution, due to the high chance of development of an antimicrobial resistance phenotype that might lead to therapeutic failures. Together, S Newport ST31 and ST46, which have the highest frequency of carriage of multidrug resistance, are potentially responsible for antimicrobial-resistant diarrhea/persistent diarrhea in infants and children, while adult humans are more likely to be (asymptomatic) carriers of the S Newport strains.IMPORTANCE Human infections caused by Salmonella Newport generally lead to gastrointestinal diseases. These infections are normally self-limiting; however, in certain cases, broad-spectrum antimicrobials are prescribed for the treatment. The Chinese National Foodborne Disease Surveillance Network has reported a gradual increase in the incidence of multidrug-resistant S Newport infections in humans. After careful evaluation of the dynamic relationship among the clinical findings, the age group, and the genomic sequence data, it was found that young patients represented the major group with persistent diarrhea, whereas adults were either asymptomatic or diarrheic. Furthermore, all these strains contained multiple acquired antimicrobial resistance determinants, which limited the use of antimicrobials for human patients of all age groups. This analysis of the laboratory-confirmed cases, coupled with genetic analysis of the corresponding pathogen, revealed that antimicrobial treatment of persistent infections by S Newport in infants and toddlers, and in asymptomatic or diarrheic adults, may not be successful. If the antimicrobials must be prescribed at all, they must be used with caution because of the presence of multiple acquired antimicrobial resistance determinants in such strains.

Molecular epidemiology of Listeria monocytogenes isolated from ready-to-eat food in 2017 in China

Objective: To analyze the molecular characteristics of Listeria monocytogenes strains from ready-to eat food in China. Methods: A total of 239 Listeria monocytogenes strains isolated from ready-to-eat food in 2017, all strains underwent whole-genome sequencing (WGS) , and comparisons uncovered population structure derived from lineages, clonal complex, serogroups, antimicrobial susceptibility and virulence, which were inferred in silico from the WGS data. Core genome multilocus sequence typing was used to subtype isolates. Results: All strains were categorized into three different lineages, lineage Ⅱ was the predominant types in food, and IIa was the main serogroups. CC8, CC101 and CC87 were the first three prevalent CCs among 23 detected CCs, accounting for 49.4%. Only 4.6% (11 isolates) of tested strains harbored antibiotic resistance genes, which were mostly trimethoprim genes (7 isolates, 2.9%). All strains were positive for LIPI-1, and only a part of strains harbored LIPI-3 and LIPI-4, accounting for 13.8% (33 isolates) and 14.2% (34 isolates), respectively. ST619 carried both LIPI-3 and LIPI-4. 51.5% (123 isolates) of strains carried SSI-1, and all CC121 strains harbored SSI-2. Different lineages, serogroups and CCs can be separated obviously through cgMLST analysis, and 24 sublineages were highly concordant with CCs. Conclusion: Ⅱa was the main serogroups in ready-to-eat food isolates in China; CC8, CC101 and CC87 were the prevalent CCs, and CC87 isolates was hypervirulent isolates, cgMLST method can be adopted for prospective foodborne disease surveillance and outbreaks detection.

Detection and Analysis of Antimicrobial Resistance of Salmonella in Faeces of Foodborne Disease Patients

Objective: To detect the drug resistance of Salmonella isolated from the faeces samples of patients with food-borne diseases, and to know the drug resistance status and development trend of food-borne pathogens in our province. Methods: Enrichment, color medium separation, API20E biochemistry and Thai serum Identification. The minimal inhibitory concentration (MIC) of Salmonella to 15 kinds of antibiotics were quantitatively determined by micro broth dilution method. Results: 123 food-borne Salmonella strains were resistant to ampicillin (AMP), NALIDIXIC acid (NAL), tetracycline (TET), trimethoprim/sulfamethoxazole (SXT), ampicillin / sulbactam (AMS), CEFAZOLIN (CFZ), chloramphenicol (CHL), CEFOTAXIME (CTX), ciprofloxacin (CIP), azithromycin (AZM), gentamicin (GEN), cefoxitin (CFX), ceftazidime (CAZ). The drug resistance rates were 87.80%, 84.6%, 69.1%, 50.4%, 39.0%, 34.1%, 26.0%, 26.0%, 26.0%, 24.3%, 19.5%, 2.4% and 0.8% respectively. IMP and ERY were both sensitive. Among them, 90 strains were resistant to more than 3 kinds of antibiotics, and the multidrug resistance rate was 73.2%. MIC results ranged from 1μg / mL to > 64 μg / mL. The total strains were divided into 15 serotypings, including Salmonella Enteritidis (58.5%), Salmonella Typhimurium (16.3%), and Salmonella Stanley (4.9%). The most common distribution of the 57 resistant strains were AMP-TET-NAL-and AMP-NAL-11 strains, followed by NAL-10 strains, AMP-AMS-TET-NAL-7 strains, and multi-resistant strains ranged from 3 to 11 antibiotics. Conclusion: The serotypings of Salmonella isolated from faeces samples of patients from food borne disease surveillance sites in hospitals in Jilin province were mainly S. Enteritis and S. Enterica, and the strains were resistant to multiple antibiotics. The surveillance of drug resistance of Salmonella in food-borne diseases should be strengthened to ensure food safety and human health.

Shiga Toxin-Producing Escherichia coli Infections Associated With Romaine Lettuce-United States, 2018.

Produce-associated outbreaks of Shiga toxin-producing Escherichia coli (STEC) were first identified in 1991. In April 2018, New Jersey and Pennsylvania officials reported a cluster of STEC O157 infections associated with multiple locations of a restaurant chain. The Centers for Disease Control and Prevention (CDC) queried PulseNet, the national laboratory network for foodborne disease surveillance, for additional cases and began a national investigation. A case was defined as an infection between 13 March and 22 August 2018 with 1 of the 22 identified outbreak-associated E. coli O157:H7 or E. coli O61 pulsed-field gel electrophoresis pattern combinations, or with a strain STEC O157 that was closely related to the main outbreak strain by whole-genome sequencing. We conducted epidemiologic and traceback investigations to identify illness subclusters and common sources. A US Food and Drug Administration-led environmental assessment, which tested water, soil, manure, compost, and scat samples, was conducted to evaluate potential sources of STEC contamination. We identified 240 case-patients from 37 states; 104 were hospitalized, 28 developed hemolytic uremic syndrome, and 5 died. Of 179 people who were interviewed, 152 (85%) reported consuming romaine lettuce in the week before illness onset. Twenty subclusters were identified. Product traceback from subcluster restaurants identified numerous romaine lettuce distributors and growers; all lettuce originated from the Yuma growing region. Water samples collected from an irrigation canal in the region yielded the outbreak strain of STEC O157. We report on the largest multistate leafy greens-linked STEC O157 outbreak in several decades. The investigation highlights the complexities associated with investigating outbreaks involving widespread environmental contamination.

Sentinel Listeriosis Surveillance in Selected Hospitals, China, 2013-2017.

During 2013–2017, a total of 211 cases of listeriosis were reported by 64 sentinel hospitals in China to a national foodborne disease surveillance network. The average case-fatality rate was 31.2% for perinatal cases and 16.4% for nonperinatal cases. Sequence types 87 and 8 were the most prevalent types.

Improved MALDI-MS method for the highly sensitive and reproducible detection of biomarker peaks for the proteotyping of Salmonella serotypes.

The rapid identification and classification of pathogenic microorganisms, including Salmonella enterica, is important for the surveillance and prevention of foodborne diseases. Matrix-assisted laser desorption\ionization time-of-flight mass spectrometry (MALDI-TOFMS) has been shown to be an effective tool for the rapid identification of microorganisms. In a previous report, a mass database consisting of 12 biomarker proteins, S8, L15, L17, L21, L25, S7, superoxide dismutase (SodA), peptidylprolyl cis-trans isomerase C, Gns, YibT, YaiA, and YciF, was introduced for the serotyping of S. enterica via MALDI-MS (Applied Microbiology and Biotechnology, 2017, 101, 8557-8569). However, the reproducibility of peak detection of biomarkers such as SodA at m\z 23 000 was poor. We report here an optimized MALDI-MS method for detecting these biomarkers with high sensitivity and reproducibility. The issue was solved by controlling the bacterial concentration at 1 × 10 to 1 × 102 MFU (3 × 106 to 3 × 107 CFU\μL, as calculated from the MFU), using the colony suspension supernatant obtained by centrifugation, and using matrix additives such as methylenediphosphonic acid and N-decyl-β-D-maltopyranoside. We propose that the method including the above steps is one of the best for detecting biomarkers with high sensitivity and reproducibility.

PulseNet and the Changing Paradigm of Laboratory-Based Surveillance for Foodborne Diseases.

PulseNet, the National Molecular Subtyping Network for Foodborne Disease Surveillance, was established in 1996 through a collaboration with the Centers for Disease Control and Prevention; the US Department of Agriculture, Food Safety and Inspection Service; the US Food and Drug Administration; 4 state public health laboratories; and the Association of Public Health Laboratories. The network has since expanded to include 83 state, local, and food regulatory public health laboratories. In 2016, PulseNet was estimated to be helping prevent an estimated 270 000 foodborne illnesses annually. PulseNet is undergoing a transformation toward whole-genome sequencing (WGS), which provides better discriminatory power and precision than pulsed-field gel electrophoresis (PFGE). WGS improves the detection of outbreak clusters and could replace many traditional reference identification and characterization methods. This article highlights the contributions made by public health laboratories in transforming PulseNet's surveillance and describes how the transformation is changing local and national surveillance practices. Our data show that WGS is better at identifying clusters than PFGE, especially for clonal organisms such as Salmonella Enteritidis. The need to develop prioritization schemes for cluster follow-up and additional resources for both public health laboratory and epidemiology departments will be critical as PulseNet implements WGS for foodborne disease surveillance in the United States.

1432. Estimating the Incubation Period of Salmonella Urinary Tract Infection (UTI) Using Foodborne Outbreak Data

BackgroundUrinary tract infections (UTI) are common bacterial infections that may occur as a part of foodborne outbreaks. Salmonella, a less common cause of UTI, has been identified during foodborne outbreaks, but the epidemiology and pathogenesis are poorly understood.MethodsPulseNet, the United States national molecular subtyping network for foodborne disease surveillance, was used to identify Salmonella isolates associated with outbreaks from 2004 to 2013 containing at least one urine and one stool isolate in which the duration was ≤1 year and a food vehicle was suspected or confirmed. We standardized isolation dates across outbreaks by calculating the mean date for stool isolation within an outbreak and subtracting this from the date of each stool/urine isolate in that outbreak. A linear-mixed model with random effect for stool/urine was used to estimate the difference in incubation periods between stool/urine isolates. We also surveyed patients from a 2012 Salmonella Cubana outbreak with many urinary isolates and associated with sprouts, to ask about diarrhea, UTI symptoms, diagnosis, and treatment. Descriptive statistics were calculated.ResultsUrine isolates had later isolation dates than stool isolates for 102 of the 110 outbreaks identified. The average difference between stool and urine isolates was 10.6 days (95% CI: 6.0, 15.2). Seven women from the Salmonella Cubana outbreak were reached. All women were diagnosed with either a UTI (6/7 = 86%) and/or kidney infection (2/7 = 29%) and were treated with antibiotics (7/7 = 100%). All six women completing the survey reported multiple signs and/or symptoms including frequency, urgency, dysuria, and hematuria with only two women reporting diarrhea prior to UTI.ConclusionSalmonella UTI seen during foodborne outbreaks are symptomatic foodborne infections not associated with diarrhea and appear to have a longer incubation period than Salmonella gastrointestinal (GI) illness. A 13- to 16-day incubation period for Salmonella UTI may be more appropriate, calculated by adding a 3- to 4-day GI illness incubation period plus delay in obtaining a stool isolate. Foodborne UTI investigation may need to change as the current method of obtaining a food history for the 6–72 hours prior to illness does not accurately reflect the incubation period for Salmonella UTI.Disclosures All authors: No reported disclosures.

Epidemic characteristics of household outbreaks of foodborne diseases in China, 2010 – 2016

Objective To analyze epidemiological characteristics of household foodborne disease outbreaks in China during 2010 – 2016 and to provide references for developing effective prevention and control strategies on foodborne disease outbreaks. Methods We collected national data on household foodborne disease outbreaks reported to China National Foodborne Diseases Surveillance Network from January 1, 2010 through December 31, 2016, and analyzed spatial and temporal distribution, isolated pathogens, related food consumption, and associated factors of the outbreaks. Results During the 7-year period, totally 5 197 household foodborne disease outbreaks were reported, involving 29 210 illnesses and 780 deaths, with a case fatality rate of 2.7%. The reported annual number of the outbreaks increased from 1 873 in 2010 to 7 842 in 2016. More outbreaks were reported during May – October in a year and in Southern China and the provincial level region with the highest number of reported foodborne disease cases was Yunnan province. The most frequently verified etiological factor of the outbreaks was consumption of poisonous mushroom, being attributed to 9 438 cases and 32.3% of all the cases and being the leading cause for the outbreaks from 2014 to 2016, and food contaminated by pathogenic organisms (to 8 277 cases and 28.3% of all the cases and the leading cause for the outbreaks from 2010 to 2013). Salmonella was the most frequently isolated pathogen (3 891 cases, 59.2% of the pathogens identified) for all the outbreaks. The most frequently verified food related to the foodborne disease cases was mushroom (9 592 cases, 32.8% of all the cases), followed by contaminated meat (4 854 cases, 16.6% of all the cases). Of all the foodborne disease cases reported, 7 901 cases (27.0%) were linked to multiple factors and 7 647 cases (26.2%) were induced by eating poisonous food by mistake. Conclusion In China from 2010 to 2016, the incidence of household foodborne disease outbreaks is relatively high during May to October in a year and more outbreaks occurred in southern regions; intake of poisonous mushroom by mistake is a main cause of the reported household foodborne disease outbreaks.

An investigation of Salmonella Fluntern illnesses linked to leopard geckos-United States, 2018.

Reptile contact can result in zoonotic non-typhoidal salmonellosis. In April 2018, Oregon Public Health Division contacted CDC about a cluster of four Salmonella serovar Fluntern (SF) illnesses in four states (OR, CA, IA, NY); patients reported contact with geckos, a popular reptile pet. PulseNet, the national molecular subtyping network of food-borne disease surveillance, subsequently identified additional SF clinical isolates. Twelve cases in 11 states were identified; median age was 5years (range: <1-58years). Three patients were hospitalized; no deaths were reported. Of those with exposure information (n=10), all reported reptile exposure; 9 (90%) specified contact with leopard geckos. No common source of geckos was identified from reported purchase locations. Los Angeles County (LAC) health officials isolated SF from one patient's leopard gecko. Five reptile/gecko isolates were identified from the USDA National Veterinary Services Laboratories (NVSL) from 2015 to 2018. Five countries responded to an Epidemic Intelligence Information System post by PulseNet; reptile isolate sequence data were received from Czech Republic. A clinical case from England was identified through the National Center for Biotechnology Information pathogen detection pipeline; the patient did not report contact with leopard geckos. Whole genome sequencing analysis revealed substantial genetic diversity between clinical and animal isolates; however, gecko and clinical isolates from LAC were highly related (1 allele difference). This investigation linking SF illnesses to leopard geckos highlights an important public health risk from pets. A better understanding of how geckos are distributed by the pet industry in the United States could improve traceability to points of origin and mitigate Salmonella transmission at gecko breeders. Earlier NVSL reports of SF isolates from geckos suggest the risk of human SF infection from geckos is not new. This investigation demonstrates a need to educate gecko breeders, retailers and gecko owners about the continued Salmonella infection risk from pet geckos.

Metagenomic Approaches for Public Health Surveillance of Foodborne Infections: Opportunities and Challenges.

Foodborne disease surveillance in the United States is at a critical point. Clinical and diagnostic laboratories are using culture-independent diagnostic tests (CIDTs) to identify the pathogen causing foodborne illness from patient specimens. CIDTs are molecular tests that allow doctors to rapidly identify the bacteria causing illness within hours. CIDTs, unlike previous gold standard methods such as bacterial culture, do not produce an isolate that can be subtyped as part of the national molecular subtyping network for foodborne disease surveillance, PulseNet. Without subtype information, cases can no longer be linked using molecular data to identify potentially related cases that are part of an outbreak. In this review, we discuss the public health needs for a molecular subtyping approach directly from patient specimen and highlight different approaches, including amplicon and shotgun metagenomic sequencing.

PulseNet Latin America and the Caribbean Network: Present and Future.

PulseNet Latin America and Caribbean (PNLAC) was established in 2003 and is one of seven Regional networks within PulseNet International. The main objectives of the network are to strengthen national and regional laboratory-based foodborne disease surveillance for early detection and investigation of outbreaks to setup control and prevention strategies in contribution to Public Health. Participants perform standardized pulsed-field gel electrophoresis (PFGE) protocols and analysis. For functioning, it is important for the network, the development of national and regional databases (RDBs) and the communication between countries, regionally and internationally. Metadata from over 8600 cases/outbreaks are profiled and isolated by PFGE and are incorporated into the RDB, hosted by the Pan American Health Organization. Currently PNLAC is moving toward whole-genome sequencing to use as a complementary strategy for surveillance. The aim of this article was to describe the experience of the construction of PNLAC, and its contribution to the surveillance of the foodborne diseases at the country and regional levels.

Investing in Food Safety for Developing Countries: Opportunities and Challenges in Applying Whole-Genome Sequencing for Food Safety Management.

Whole-genome sequencing (WGS) has become a significant tool in investigating foodborne disease outbreaks and some countries have incorporated WGS into national food control systems. However, WGS poses technical challenges that deter developing countries from incorporating it into their food safety management system. A rapid scoping review was conducted, followed by a focus group session, to understand the current situation regarding the use of WGS for foodborne disease surveillance and food monitoring at the global level and identify key limiting factors for developing countries in adopting WGS for their food control systems. The results showed that some developed nations routinely use WGS in their food surveillance systems resulting in more precise understanding of the causes of outbreaks. In developing nations, knowledge of WGS exists in the academic/research sectors; however, there is limited understanding at the government level regarding the usefulness of WGS for food safety regulatory activities. Thus, incorporation of WGS is extremely limited in most developing nations. While some countries lack the capacity to collect and analyze the data generated from WGS, the most significant technical gap in most developing countries is in data interpretation using bioinformatics. The gaps in knowledge and capacities between developed and developing nations regarding use of WGS likely introduce an inequality in international food trade, and thus, relevant international organizations, as well as the countries that are already proficient in the use of WGS, have significant roles in assisting developing nations to be able to fully benefit from the technology and its applications in food safety management.

Knowledge and Practice of Emergency Physicians Regarding Food-borne Disease Surveillance at Hamad General Hospital in Qatar.

IntroductionAccording to the World Health Organization (WHO), foodborne diseases (FBD’s) have become a global health issue. In Qatar, foodborne diseases are among the top ten events reported to the Ministry of Public Health. Efforts to enhance FBD surveillance cannot succeed without involving the emergency department (ED), which is typically the first point of contact for the FBD victims with the healthcare system. Therefore, we aimed to explore the knowledge and practices of emergency physicians regarding stool sample collection as part of FBD surveillance efforts in Qatar.MethodsA cross-sectional study was conducted at the ED of Hamad General Hospital (HGH) between July 22 and September 12 of 2018. The enrolled participants were invited to participate in an online survey at the “QSurvey” platform. The data was analyzed using Microsoft Excel (Version 2016). Descriptive statistics such as frequency tables, proportions, and percentages were applied as appropriate.ResultsA total of 65 responses (response rate: 29.27%) were received within the duration of the study. Most participants were specialists (45%), graduated between 2000 and 2013 (64%), and worked for one year or more at HGH-Hamad Medical Corporation (95%). Regarding their knowledge of FBD surveillance, most participants (80%) reported that a stool culture is a necessary laboratory investigation for patients with acute bloody diarrhea and fever. Also, a large percentage of physicians identified salmonella (75%), Clostridium difficile (70%), and E.coli O157:H7 (70%) as pathogens of nationally notifiable diseases. Regarding the respondents’ practice towards FBD surveillance, almost three-quarters of the physicians (72%) who encountered a patient with acute diarrhea did not order a stool culture. Subsequently, about two-thirds (62%) of the participants who requested a stool culture reported not following up on the results of such request. Regarding the history taken from patients with acute diarrhea, a large percentage of respondents reported asking about the patient’s travel history (100%), presence of any sick contacts (93.6%), and presence of any associated symptoms (abdominal pain, fever, bloody stool) as well as other details.ConclusionThe current research identified several gaps regarding the knowledge and practice of emergency physicians towards the surveillance of foodborne disease. Such results serve as a basis for future research and intervention strategies to augment surveillance activities related to food-borne diseases in the State of Qatar.

Infection and etiological characteristics of Vibrio cholerae in diarrhea patients in Shunyi district of Beijing, 2015–2017

ObjectiveTo understand the infection status and etiological characteristics of Vibrio cholerae in patients with food-borne diseases in Shunyi district of Beijing, and provide evidence for effective prevention, control and treatment of V. cholera infection. MethodsV. cholerae isolation and culture were conducted by using stool samples collected from diarrhea cases in surveillance from 2015 to 2017. PCR test of virulence genes, pulsed-field gel electrophoresis (PFGE), matrix-assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF MS) and antibiotic susceptibility analysis were carried out for the isolates of V. cholerae. ResultsA total of 1 105 diarrhea patients were surveyed in three years. The detection rate of V. cholerae was 0.54% (6/1 105). The detection results of cholera toxin genes ctxAB were negative. Serological typing indicated that all the strains were non-O1/O139. PCR indicated that 5 of the 6 V. cholerae strains were type III secretion system (T3SS) gene positive. The clustering results of PFGE were consistent with the clustering results of MALDI-TOF MS. ConclusionIt is necessary to attach importance to the infection and etiological surveillance of V. cholerae in food-borne disease surveillance system