Infectious Disease Surveillance Research Articles

Leaving no disease behind: The roadmap to securing universal health security and what this means for the surveillance of infectious diseases in Ghana as a precedent for sub-Saharan Africa.

Ghana is the first country in sub-Saharan Africa (SSA) to aim for universal health coverage (UHC). Based on Ghana's UHC system, the accessibility and distribution of healthcare facilities were evaluated for 2020. Projecting into 2030, this study aimed at providing geographical information data for guiding future policies on siting required healthcare facilities. Ghana as a precedent for SSA was evaluated and proposed to "leave no disease behind" in the surveillance of infectious diseases (IDs). This is to reinforce the sustainable development goals (SDG) 3 agenda on health that underpins monitoring equity in "leaving no one behind." Geospatial accessibility, travel time data, and algorithms were employed to evaluate the universality and accessibility of healthcare facilities, and their future projections to meet UHC by 2030. Healthcare facilities as surveillance sites were compared to community-based surveillance to identify which would be more applicable as a surveillance system to leave no disease behind in Ghana. Ghana has 93.8%, 6.1% and 0.1% as primary, secondary and tertiary healthcare facilities respectively. It has 26.1% of healthcare facilities remaining to meet the SDG 3 health target by 2030. In terms of providing quality healthcare, 29.3% and 67.2% of the additional required healthcare facilities for optimal allocation and achieving the UHC target need to be secondary and tertiary respectively. In assessing the broad spectrum of IDs studied from 2000 to 2020, an average of 226 IDs were endemic or potentially endemic to Ghana. The majority of the studies carried out to identify these IDs were done through community-based surveillance. Establishing community-based surveillance sites to leave no disease behind and also providing the required healthcare facilities to reinforce leaving no one behind will enhance the universal health security of Ghana as a precedent for SSA.

Spatial relationship between COVID-19 and previous infectious disease outbreaks: Evidence from South Korea

As the novel coronavirus disease (COVID-19) has been rapidly spreading across the world, scholars have started paying attention to risk factors that affect the occurrence of the infectious disease. While various urban characteristics have been shown to influence the outbreak, less is known about whether COVID-19 is more likely to be transmitted in areas with a greater number of incidents of previous infectious diseases. This study examines a spatial relationship between COVID-19 and previous infectious diseases from a spatial perspective. Using the confirmed cases of COVID-19 and other types of infectious diseases across South Korea, we identified spatial clusters through regression and spatial econometric models. We found that COVID-19-confirmed case rates tended to be clustered despite no similarity with the spatial patterns of previous infectious diseases. Existing infectious diseases from abroad were associated with the occurrence of COVID-19, while the effect diminished after controlling for the spatial effect. Our findings highlight the importance of regional-level infectious disease surveillance for the effective prevention and control of COVID-19.

Features of the system of epidemiological surveillance of infectious diseases in the Socialist Republic of Vietnam

The results of the analysis of the system of epidemiological surveillance of infectious diseases in the Socialist Republic of Vietnam and the assessment of the possibilities of its improvement are presented . The levels of organization of epidemiological surveillance in Vietnam , their compliance with the administrative division of the country ( state , provincial , district and commune levels ) are shown . It is noted that epidemiological surveillance has a passive nature and is based on the online reporting system of the Department of Preventive Medicine , which has been the official notification channel for 42 infectious diseases since 2016. For the purposes of epidemiological surveillance , all registered infectious diseases are divided into 3 groups according to the potential for epidemic spread (A, B and C), on which strategies for carrying out sanitary and anti-epidemic ( preventive ) measures depend . It has been established that modern computer technologies , including geoinformation systems , in Vietnam have found their application in certain areas of epidemiological surveillance of current infectious diseases , but further i mprovement o f t he m ethods o f t heir u se f or t hese p urposes i s r equired .

Design, Rationalization, and Automation of a Catalytic Sensing Mechanism for Homogeneous SERS Biosensors

The current pandemic has shown that we need sensitive and deployable diagnostic technologies. Surface-enhanced Raman scattering (SERS) sensors can be an ideal solution for developing such advanced point-of-need (PON) diagnostic tests. Homogeneous (reagentless) SERS sensors work by directly responding to the target without any processing step, making them capable for simple one-pot assays, but their limitation is the achievable sensitivity, insufficient compared to what is needed for sensing of viral biomarkers. Noncovalent DNA catalysis mechanisms have been recently exploited for catalytic amplification in SERS assays. These advances used catalytic hairpin assembly (CHA) and other DNA self-assembly processes to develop sensing mechanisms with improved sensitivities. However, these mechanisms have not been used in OFF-to-ON homogeneous sensors, and they often target the same biomarker, likely due to the complexity of the mechanism design. There is still a strong need for a catalytic SERS sensor with a homogeneous mechanism and a rationalization of the catalytic sensing mechanism to translate this sensing strategy to different targets and applications. We developed and investigated a homogeneous SERS sensing mechanism that uses catalytic amplification based on DNA self-assembly. We systematically investigated the role of three domains in the fuel strand (internal loop, stem, and toehold), which drives the catalytic mechanism. The thermodynamic parameters determined in our studies were used to build an algorithm for automated design of catalytic sensors that we validated on target sequences associated with malaria and SARS-CoV-2 strains. With our mechanism, we were able to achieve an amplification level of 20-fold for conventional DNA and of 36-fold using locked nucleic acids (LNAs), with corresponding improvements observed in the sensor limit of detection (LOD). We also show a single-base sequence specificity for a sensor targeting a sequence associated with the omicron variant, tested against a delta variant target. This work on catalytic amplification of homogeneous SERS sensors has the potential to enable the use of this sensing modality in new applications, such as infectious disease surveillance, by improving the LOD while conserving the sensor's homogeneous character.

Drivers of SARS-CoV-2 testing behaviour: a modelling study using nationwide testing data in England

During the COVID-19 pandemic, national testing programmes were conducted worldwide on unprecedented scales. While testing behaviour is generally recognised as dynamic and complex, current literature demonstrating and quantifying such relationships is scarce, despite its importance for infectious disease surveillance and control. Here, we characterise the impacts of SARS-CoV-2 transmission, disease susceptibility/severity, risk perception, and public health measures on SARS-CoV-2 PCR testing behaviour in England over 20 months of the pandemic, by linking testing trends to underlying epidemic trends and contextual meta-data within a systematic conceptual framework. The best-fitting model describing SARS-CoV-2 PCR testing behaviour explained close to 80% of the total deviance in NHS test data. Testing behaviour showed complex associations with factors reflecting transmission level, disease susceptibility/severity (e.g. age, dominant variant, and vaccination), public health measures (e.g. testing strategies and lockdown), and associated changes in risk perception, varying throughout the pandemic and differing between infected and non-infected people.

Large Multicountry Outbreak of Invasive Listeriosis by a Listeria monocytogenes ST394 Clone Linked to Smoked Rainbow Trout, 2020 to 2021.

Whole-genome sequencing (WGS) has revolutionized surveillance of infectious diseases. Disease outbreaks can now be detected with high precision, and correct attribution of infection sources has been improved. Listeriosis, caused by the bacterium Listeria monocytogenes, is a foodborne disease with a high case fatality rate and a large proportion of outbreak-related cases. Timely recognition of listeriosis outbreaks and precise allocation of food sources are important to prevent further infections and to promote public health. We report the WGS-based identification of a large multinational listeriosis outbreak with 55 cases that affected Germany, Austria, Denmark, and Switzerland during 2020 and 2021. Clinical isolates formed a highly clonal cluster (called Ny9) based on core genome multilocus sequence typing (cgMLST). Routine and ad hoc investigations of food samples identified L. monocytogenes isolates from smoked rainbow trout filets from a Danish producer grouping with the Ny9 cluster. Patient interviews confirmed consumption of rainbow trout as the most likely infection source. The Ny9 cluster was caused by a MLST sequence type (ST) ST394 clone belonging to molecular serogroup IIa, forming a distinct clade within molecular serogroup IIa strains. Analysis of the Ny9 genome revealed clpY, dgcB, and recQ inactivating mutations, but phenotypic characterization of several virulence-associated traits of a representative Ny9 isolate showed that the outbreak strain had the same pathogenic potential as other serogroup IIa strains. Our report demonstrates that international food trade can cause multicountry outbreaks that necessitate cross-border outbreak collaboration. It also corroborates the relevance of ready-to-eat smoked fish products as causes for listeriosis. IMPORTANCE Listeriosis is a severe infectious disease in humans and characterized by an exceptionally high case fatality rate. The disease is transmitted through consumption of food contaminated by the bacterium Listeria monocytogenes. Outbreaks of listeriosis often occur but can be recognized and stopped through implementation of whole-genome sequencing-based pathogen surveillance systems. We here describe the detection and management of a large listeriosis outbreak in Germany and three neighboring countries. This outbreak was caused by rainbow trout filet, which was contaminated by a L. monocytogenes clone belonging to sequence type ST394. This work further expands our knowledge on the genetic diversity and transmission routes of an important foodborne pathogen.

Increased clonality among Neisseria gonorrhoeae isolates during the COVID-19 pandemic in Amsterdam, the Netherlands.

Distancing measures during the COVID-19 lockdown led to a temporary decrease of casual sex partners among clients of the Centre for Sexual Health (CSH) in Amsterdam, the Netherlands. We investigated the effect of this change on the genotypic and phenotypic distribution of Neisseria gonorrhoeae (Ng) isolates from CSH patients. From each Ng-positive patient we sequenced one isolate, resulting in 322 isolates which constituted two groups: 181 isolates cultured from 15 January to 29 February 2020 (before the first lockdown) and 141 cultured from 15 May to 30 June 2020 (during the first lockdown). Patient characteristics showed significantly more symptomatic patients and significantly fewer reported sex partners during the lockdown. Phenotypic data showed an increase in low-level azithromycin resistance and ceftriaxone susceptibility during the lockdown, and this remained after the study period. The diversity in sequence types (STs) decreased slightly during the lockdown. A shift occurred from ST 8156 being predominant before lockdown to ST 9362 during lockdown and a remarkably low median SNP distance of 17 SNPs was found between ST 9362 isolates obtained during lockdown. These findings reflect restricted travel and the change in sexual behaviour of CSH clients during the lockdown, with a potentially increased local transmission of the ST 9362 strain during this period, which led to genotypic and phenotypic changes in the Ng population. This shows that public health measures have far-reaching consequences and should be considered in the surveillance of other infectious diseases.

Emerging data inputs for infectious diseases surveillance and decision making.

Infectious diseases create a significant health and social burden globally and can lead to outbreaks and epidemics. Timely surveillance for infectious diseases is required to inform both short and long term public responses and health policies. Novel data inputs for infectious disease surveillance and public health decision making are emerging, accelerated by the COVID-19 pandemic. These include the use of technology-enabled physiological measurements, crowd sourcing, field experiments, and artificial intelligence (AI). These technologies may provide benefits in relation to improved timeliness and reduced resource requirements in comparison to traditional methods. In this review paper, we describe current and emerging data inputs being used for infectious disease surveillance and summarize key benefits and limitations.

Prevalence of hepatitis C virus among fatal drug overdoses in Tennessee: an analysis using 2019-2020 Tennessee State Unintentional Drug Overdose Reporting System Data.

Given the nature of the co-occurring epidemics of hepatitis C virus (HCV) and fatal stimulant overdose, we sought to assess the prevalence of HCV among opioid and stimulant-positive overdoses. We conducted a cross-sectional study to examine theprevalence of HCV among fatal drug overdoses in Tennessee using 2019-2020 data from the State Unintentional Drug Overdose Reporting System. We defined history of HCV using surveillance data and autopsy reports. Descriptive statistics were calculated for circumstances of overdose deaths for different categories of opioid and stimulant positivity on toxicology. Between 2019 and 2020, 3570 unintentional or undetermined drug overdose deaths occurred in Tennessee with an available autopsy. History of HCV was found in 24.6% of deaths. When assessing different involvement between stimulants and opioids, the highest prevalence of HCV was found for deaths where methamphetamine and opioids were present in toxicology (35.4%). Scene evidence of injection drug use occurred more frequently among decedents with a history of HCV (P<.0001). This analysis while descriptive highlights the importance of linking datasets to enhance infectious disease and drug overdose surveillance. Partnership between communicable disease and drug overdose surveillance teams should continue toidentify relationships between disease and drug overdose and strengthen the evidence to tailor crucial treatment and prevention activities.

Comparative Analysis of Methods of Environmental Surface Sampling for Assessment of Viral and Bacterial Contamination

Introduction: One of the key elements of the infectious disease surveillance system is microbiological monitoring of contamination of environmental objects and health care personnel hands. In the context of the COVID-19 pandemic, virology testing of swabs from hospital objects and personal protective equipment of workers of infectious disease hospitals for patients with COVID-19 has acquired special importance. According to the current regulatory documents, however, greater priority in microbiological monitoring is given to determination and identification of bacterial pathogens, thus necessitating the development and implementation of an advanced technique of a simultaneous assessment of viral and bacterial contamination. Objective: To compare different environmental surface sampling techniques used to assess viral and bacterial contamination. Materials and methods: Samples for environmental swab testing were collected in accordance with the “Scheme for sampling environmental swabs for simultaneous assessment of viral and bacterial contamination” patented by the authors (Industrial Design Patent No. 132971 of September 5, 2022). We applied bacteriological, molecular genetic, and statistical methods in the study. Results: Overall, 343 wipe samples were tested, of which 68 were atypical (two 38-swab portions, 11.1 % each, contained SARS-CoV-2 RNA and opportunistic microorganisms). Among the opportunistic microorganisms, 42 bacterial strains were identified, including 16 strains of Enterococcus faecalis (38.1 %), 9 strains of Klebsiella pneumoniae (21.4 %), 7 strains of Escherichia coli (16.7 %), 3 strains of Enterococcus faecium (7.1 %), 3 strains of Staphylococcus aureus (7.1 %), 2 strains of Pseudomonas aeruginosa (4.9 %), and 2 strains of Pantoea agglomerans (4.9 %). Eleven variants of viral and bacterial associations were identified. The comparison of environmental swabbing performed by the technique under study with that performed by the standard method, based on test results, indicated a significant 11.1 and 12.3-fold difference in the proportion of non-standard findings for SARS-CoV-2 and opportunistic microorganisms, respectively. Conclusions: The study results prove that our technique of environmental swabbing meets all modern requirements and facilitates an objective assessment of the level of viral and bacterial contamination of the study objects. This approach can be used for laboratory testing within state and industrial control at institutions of various specialties (healthcare, food industry, childcare facilities, etc.).

Big data and infectious disease epidemiology: A bibliometric analysis and research agenda.

Infectious diseases represent a major challenge for health systems worldwide. With the recent global pandemic of COVID-19, the need to research strategies to treat these health problems has become even more pressing. Although the literature on big data and data science in health has grown rapidly, few studies have synthesized these individual studies, and none has identified the utility of big data in infectious disease surveillance and modeling. This paper aims to synthesize research and identify hotspots of big data in infectious disease epidemiology. Bibliometric data from 3054 documents that satisfied the inclusion criteria were retrieved from the Web of Science database over 22 years (2000-2022) were analyzed and reviewed. The search retrieval occurred on October 17, 2022. Bibliometric analysis was performed to illustrate the relationships between research constituents, topics, and key terms in the retrieved documents. The bibliometric analysis revealed internet searches and social media as the most utilized big data sources for infectious disease surveillance or modeling. It also placed the US and Chinese institutions as leaders in this research area. Disease monitoring and surveillance, utility of electronic health (or medical) records, methodology framework for infodemiology tools, and machine/deep learning were identified as the core research themes. Proposals for future studies are made based on these findings. This study will provide healthcare informatics scholars with a comprehensive understanding of big data research in infectious disease epidemiology.

Infection diseases that can be seen post-earthquake

Due to uncontrolled urbanization and rapid population growth, earthquakes can have major effects on human life, society and economic systems. Infectious diseases can be seen depending on the factors that facilitate the development of infection in the long term after earthquakes. Lack of clean water, food and hygiene are important causes of infection for individuals. Problems in the city's mains systems such as water and electricity are also among the reasons that increase the possibility of infection. Lack of adequate medication may cause delays in treatment. For this reason, the surveillance of infectious diseases, which increased after the earthquake, has an important place in the fight against infectious diseases and epidemics. Latent infections such as skin and soft tissue infections, gastroenteritis due to contaminated food and water, respiratory system infections transmitted by droplets, rash diseases and meningitis, tuberculosis due to migrations and limited treatments increase after earthquakes.

Antibody Immunity to Zika Virus among Young Children in a Flavivirus-Endemic Area in Nicaragua.

Objective: To understand the dynamics of Zika virus (ZIKV)-specific antibody immunity in children born to mothers in a flavivirus-endemic region during and after the emergence of ZIKV in the Americas. Methods: We performed serologic testing for ZIKV cross-reactive and type-specific IgG in two longitudinal cohorts, which enrolled pregnant women and their children (PW1 and PW2) after the beginning of the ZIKV epidemic in Nicaragua. Quarterly samples from children over their first two years of life and maternal blood samples at birth and at the end of the two-year follow-up period were studied. Results: Most mothers in this dengue-endemic area were flavivirus-immune at enrollment. ZIKV-specific IgG (anti-ZIKV EDIII IgG) was detected in 82 of 102 (80.4%) mothers in cohort PW1 and 89 of 134 (66.4%) mothers in cohort PW2, consistent with extensive transmission observed in Nicaragua during 2016. ZIKV-reactive IgG decayed to undetectable levels by 6-9 months in infants, whereas these antibodies were maintained in mothers at the year two time point. Interestingly, a greater contribution to ZIKV immunity by IgG3 was observed in babies born soon after ZIKV transmission. Finally, 43 of 343 (13%) children exhibited persistent or increasing ZIKV-reactive IgG at ≥9 months, with 10 of 30 (33%) tested demonstrating serologic evidence of incident dengue infection. Conclusions: These data inform our understanding of protective and pathogenic immunity to potential flavivirus infections in early life in areas where multiple flaviviruses co-circulate, particularly considering the immune interactions between ZIKV and dengue and the future possibility of ZIKV vaccination in women of childbearing potential. This study also shows the benefits of cord blood sampling for serologic surveillance of infectious diseases in resource-limited settings.

Tracing COVID-19 Trails in Wastewater: A Systematic Review of SARS-CoV-2 Surveillance with Viral Variants

The emergence of new variants of SARS-CoV-2 associated with varying infectivity, pathogenicity, diagnosis, and effectiveness against treatments challenged the overall management of the COVID-19 pandemic. Wastewater surveillance (WWS), i.e., monitoring COVID-19 infections in communities through detecting viruses in wastewater, was applied to track the emergence and spread of SARS-CoV-2 variants globally. However, there is a lack of comprehensive understanding of the use and effectiveness of WWS for new SARS-CoV-2 variants. Here we systematically reviewed published articles reporting monitoring of different SARS-CoV-2 variants in wastewater by following the PRISMA guidelines and provided the current state of the art of this study area. A total of 80 WWS studies were found that reported different monitoring variants of SARS-CoV-2 until November 2022. Most of these studies (66 out of the total 80, 82.5%) were conducted in Europe and North America, i.e., resource-rich countries. There was a high variation in WWS sampling strategy around the world, with composite sampling (50/66 total studies, 76%) as the primary method in resource-rich countries. In contrast, grab sampling was more common (8/14 total studies, 57%) in resource-limited countries. Among detection methods, the reverse transcriptase polymerase chain reaction (RT-PCR)-based sequencing method and quantitative RT-PCR method were commonly used for monitoring SARS-CoV-2 variants in wastewater. Among different variants, the B1.1.7 (Alpha) variant that appeared earlier in the pandemic was the most reported (48/80 total studies), followed by B.1.617.2 (Delta), B.1.351 (Beta), P.1 (Gamma), and others in wastewater. All variants reported in WWS studies followed the same pattern as the clinical reporting within the same timeline, demonstrating that WWS tracked all variants in a timely way when the variants emerged. Thus, wastewater monitoring may be utilized to identify the presence or absence of SARS-CoV-2 and follow the development and transmission of existing and emerging variants. Routine wastewater monitoring is a powerful infectious disease surveillance tool when implemented globally.

Influencing factors of the adverse outcome of pulmonary tuberculosis among adolescents in Hangzhou City between 2005 and 2020: a school-based retrospective cohort study

Objective: To explore the influencing factors of the adverse outcome of pulmonary tuberculosis (PTB) among adolescents in Hangzhou City between 2005 and 2020. Methods: A retrospective cohort study was used to collect the information of adolescent PTB patients with the onset of PTB occurring from January 1, 2005 to December 31 in 12 designated tuberculosis hospitals in Hangzhou, mainly including demographic, epidemiological, clinical manifestations, bacteriological characteristics and other data, through the China Management Information System for Infectious Disease Surveillance and Reporting and the follow-up survey. All patients were followed up and the end time was December 31, 2021. Multivariate Cox regression model was used to analyze the factors affecting the adverse outcome of these patients. Results: The mean age of 4 921 adolescent PTB patients was (18.9±3.6) years old, and the number of male and female patients were 3 074 and 1 847 respectively. The adverse outcome accounted for 14.7% (725) of all patients. Multivariate Cox regression model showed that eight risk factors, including management model from patients themselves or family members (HR=5.87, 95%CI: 4.55-7.64), molecular biology examination positive for PTB (HR=4.62, 95%CI: 2.98-7.19), the number of sputum smears-positive≥1 (HR=3.72, 95%CI: 2.87-4.83), non-standardized therapy regimens of PTB (HR=3.69, 95%CI: 2.95-4.64), history of retreated PTB (HR=2.22, 95%CI: 1.46-3.36), migrant adolescents (HR=1.89, 95%CI: 1.54-2.34), the number of chest X-ray scan (HR=1.83, 95%CI: 1.65-2.04), and severe PTB (HR=1.38, 95%CI: 1.02-2.05), were associated with the adverse outcome of adolescent PTB patients. Age (HR=0.94, 95%CI: 0.92-0.96), as the only protective factor, was associated with the adverse outcome of these patients. Conclusion: The management mode, molecular biological examination, chemotherapy program, history of tuberculosis, sputum smear examination, severity of tuberculosis, household residence, chest X-ray examination and age are associated with the adverse outcomes of adolescent PTB patients in Hangzhou.

ANALYSIS OF APPROACHES OF INDIVIDUAL ASIAN COUNTRIES TO ASSESS BIOLOGICAL RISKS

Оver the past decade, the increase in outbreaks of infectious diseases such as COVID-19, monkeypox, etc. has forced us to reconsider the approach to assessing biological risks in ensuring biological safety. The rapid global spread of these diseases is putting enormous pressure on governments and international agencies to diagnose, treat and control outbreaks. In this regard, it is necessary to study their potential in the field of biosecurity, including the diagnosis, treatment, and research of infectious diseases and improve the rules and guidelines for biodefense. An analysis of foreign experience, including China, Pakistan, Kyrgyzstan, Tajikistan and Kazakhstan was carried out on biological risk assessment, which requires constant monitoring and assessment of emerging threats and evolving risks. Monitoring includes conducting regular infectious disease surveillance, analyzing trends and patterns of disease transmission, and evaluating the effectiveness of prevention and control measures. Countries can adapt their approaches and strategies to address new and emerging threats by continuously monitoring and reassessing biological risks. In conclusion, the experience of foreign countries in biological risk assessment provides valuable information on best practices, strategies and technologies that can help improve global biological risk management and mitigation efforts. This review article highlights the importance of reliable surveillance systems, effective communication and cooperation, investment in research and development, constant vigilance and preparedness for biological threats.

Health inequities around gender, disability and internal migration: are local governments doing enough.

The Kerala health system in India has more than 25 years of decentralised implementation experience. Decentralization could assist in addressing health disparities such as gender, disability, and migration. To explore how inequity issues comprising gender, disability and internal migrations were being addressed at present by the decentralised Kerala health system. Our approach was qualitative, using document review, key informant interviews and in-depth interviews with policy makers, health staff and other stakeholders. Gender aspects were incorporated into planning and budgeting, with 10% funds earmarked for women. Projects were gender-specific to women, and within conventional social roles of livelihood, welfare or reproductive health. Recently, transgender focused projects were also initiated. Schemes for people with disabilities remained welfare-centric and driven by top-down policies. The local governments performed beneficiary identification and benefit disbursal. Migrant health aspects were focused on infectious diseases surveillance and later living conditions of migrant workers. The importance that health systems place on socioeconomic determinants of health and fundamental human rights is reflected in the health interventions for marginalised communities. In Kerala, there is now a passive application of central rules and a reluctance to utilise local platforms. Changing this is a necessary condition for achieving equal development.

Wastewater surveillance as an epidemiological tool at mass gathering events: A FIFA World Cup Qatar 2022 perspective and implication to other mass gathering events.

Dear Editor, The ongoing FIFA World Cup 2022 hosted by Qatar is one of the most popular and largest international mass gathering (MG) sports events in the world1. Genomic investigations over the past year have revealed cryptic, ominous transmission of severe acute respiratory syndrome coronavirus 2, monkeypox, poliovirus, influenza, and antibiotic-resistant microbes at MG events. Qatar’s public health authorities have spent a lot of time and effort preparing and planning to ensure the health and safety of millions of international and national spectators, athletes, and organizers. However, there are still several major public health challenges, both perceived and real, that threaten global health security. The FIFA World Cup in 2022 is taking place during the ongoing global outbreaks of coronavirus disease 2019, monkeypox, antibiotic-resistant bacteria, influenza, respiratory syncytial virus, and drug-resistant tuberculosis, among others. Recently, a new hybrid virus formed from fusion of influenza A and respiratory syncytial virus is a worrying development2. Therefore, the risk of transmission of infectious diseases, amplification, and local and international spread of known and unknown pathogens during and after the FIFA World Cup remains significant. Historically, pathogens transmitted by the waterborne and fecal-oral routes have been evaluated through wastewater-based surveillance (WBS)3. Wastewater surveillance is more sensitive and cost-effective than clinical or epidemiological surveillance4. WBS was used in the polio eradication effort and has most recently been used for tracking the spread of severe acute respiratory syndrome coronavirus 2 and its variants2. In particular, there is no consensus on wastewater monitoring techniques and standardized global protocols for collecting and analyzing data4. There remains an urgent need to develop a global consensus for standardized global guidelines for sampling methods, sample pretreatment, and quantification, which is very practical at these times. WBS for pre-empting potential disease outbreaks could provide crucial information when used together with rapid detection laboratory techniques such as genomics and biosensors5,6. Early detection of disease outbreaks during MG events provides host countries with unique opportunities to develop evidence-based decisions for timely scientific-based public health interventions. Since a sample of wastewater reflects the entire contributing population, wastewater-based epidemiology can be used to learn about the spread of gastrointestinal and other viruses at the community level without the need to test many people7. Independent of the appearance of clinical symptoms or socioeconomic biases related to case reporting, WBS has been shown to be effective in detecting infection and transmission in the population. Adopting wastewater surveillance for infectious diseases during the FIFA World Cup 2022 and other future MG events could serve as an important tool to early alert the host country and global public health authorities (Fig. 1). Movements of attendees of MG events across Qatari municipalities should be wastewater-based epidemiology-based decisions, and consequent vaccination, countermeasures, and nonpharmaceutical interventions could be required. The wastewater-based epidemiology enabled Qatar officials to conduct a health survey during tournament days at a community level. Furthermore, it would give other countries an indication of potential pathogens being brought in by returning travelers8. WBS provides a powerful platform for detecting emerging and re-emerging viruses, antimicrobial resistance pathogens, and antimicrobial resistance genes. Its potential to alert host countries and global health authorities to imminent or emerging waterborne disease will add further to preparedness and proactive prevention control plans in place. Ultimately, this perspective is novel for MGs in the midst of mega sporting events, which should be further studied and considered.Figure 1: Wastewater surveillance as an epidemiological tool amidst the mega sporting events.Ethical approval Not applicable. Sources of funding None. Authors contribution A.R.A.S., A.A.M., P.C., and O.P.C. developed the original draft; A.M., B.K.P., and R.S. reviewed and edited the manuscript. All authors read and approved the final manuscript. Conflict of interest The authors declare that they have no financial conflict of interest with regard to the content of this report. Research registration unique identifying number (UIN) None. Guarantor R. Sah.

Surveillance Study of Acute Respiratory Infection (ARI) Incidence in The Pekauman Health Center Work Area

Abstract&#x0D; Acute Respiratory Infection (ARI) is a disease with the highest incidence (1044 cases in 2021) in the work area of ​​Pekauman Health Center, Banjarmasin City. Acute Respiratory Infection disease surveillance activities need to be carried out to obtain an overview of the related factors so that a health promotion program can be planned to control the incidence of the disease. The purpose of this study was to determine the incidence of ARI based on factors of age, gender, region, and trend of cases in a year. The results obtained that most ARI occurred in the age category ≥5 years (73.27%) and most of them were female (52%). The incidence of ARI per region is known to occur the most in Kelayan Selatan Village (29%) and the highest occurred in December 2021 (15.32%). It was concluded that in formulating health promotion programs, it could be focused on the age group 5 years, female, and mainly carried out in the Kelayan Selatan Sub-District, possibly before December. &#x0D; Keywords. Acute Respiratory Infection (ARI); age; gender; region

Incidence of Guillain-Barré syndrome in South Korea during the early COVID-19 pandemic.

Guillain-Barré syndrome (GBS) is an immune-mediated polyradiculoneuropathy, often triggered by infection. We aimed to investigate how the incidence of GBS changed in the early stages of the coronavirus 2019 (COVID-19) pandemic when nationwide infections declined due to non-pharmaceutical interventions. We conducted a nationwide population-based retrospective GBS cohort study using data from the Health Insurance Review and Assessment Service of Korea. Patients with new-onset GBS were defined as those who were first hospitalized between 1 January 2016 and 31 December 2020 with an International Classification of Disease, 10th Revision code, for GBS (G61.0) as a primary diagnosis. The incidence of GBS in the pre-pandemic years (2016-2019) was compared with that in the first pandemic year (2020). Nationwide epidemiological data for infections were collected from the national infectious disease surveillance system. A correlation analysis was performed to determine the incidence of GBS and nationwide trends of various infections. Overall, 3,637 new-onset GBS cases were identified. The age-standardized incidence of GBS in the first pandemic year was 1.10 (95% confidence interval, 1.01-1.19) per 100,000 persons. Compared to the first pandemic year, the incidence of GBS during the pre-pandemic years (1.33-1.68/100,000 persons/year) was significantly higher, with incidence rate ratios of 1.21-1.53 (P < 0.001). Nationwide cases of upper respiratory viral infections were significantly reduced in the first pandemic year; however, Campylobacter infections peaked in the summer of the pandemic. The nationwide epidemiology of parainfluenza virus, enterovirus, and Campylobacter infections correlated positively with GBS incidence. The overall GBS incidence decreased in the early stages of the COVID-19 pandemic, which can be attributed to the dramatic reduction in viral illnesses due to public measures.