Information To Public Health Authorities Research Articles

WAVES (Web-based tool for Analysis and Visualization of Environmental Samples)-a web application for visualization of wastewater pathogen sequencing results.

Environmental monitoring of pathogens provides an accurate and timely source of information for public health authorities and policymakers. In the last 2 years, wastewater sequencing proved to be an effective way of detection and quantification of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants circulating in population. Wastewater sequencing produces substantial amounts of geographical and genomic data. Proper visualization of spatial and temporal patterns in these data is crucial for the assessment of the epidemiological situation and forecasting. Here, we present a web-based dashboard application for the visualization and analysis of data obtained from sequencing of environmental samples. The dashboard provides multi-layered visualization of geographical and genomic data. It allows to display frequencies of detected pathogen variants as well as individual mutation frequencies. The features of WAVES (Web-based tool for Analysis and Visualization of Environmental Samples) for early tracking and detection of novel variants in the wastewater are demonstrated in an example of BA.1 variant and the signature Spike mutation S: E484A. WAVES dashboard is easily customized through the editable configuration file and can be used for different types of pathogens and environmental samples. WAVES source code is freely available at https://github.com/ptriska/WavesDash under MIT license. A demo version of this application can be accessed at: https://wavesdashboard.azurewebsites.net/.

Using ecological niche modeling to predict the potential distribution of scrub typhus in Fujian Province, China

BackgroundDespite the increasing number of cases of scrub typhus and its expanding geographical distribution in China, its potential distribution in Fujian Province, which is endemic for the disease, has yet to be investigated.MethodsA negative binomial regression model for panel data mainly comprising meteorological, socioeconomic and land cover variables was used to determine the risk factors for the occurrence of scrub typhus. Maximum entropy modeling was used to identify the key predictive variables of scrub typhus and their ranges, map the suitability of different environments for the disease, and estimate the proportion of the population at different levels of infection risk.ResultsThe final multivariate negative binomial regression model for panel data showed that the annual mean normalized difference vegetation index had the strongest correlation with the number of scrub typhus cases. With each 0.1% rise in shrubland and 1% rise in barren land there was a 75.0% and 37.0% increase in monthly scrub typhus cases, respectively. In contrast, each unit rise in mean wind speed in the previous 2 months and each 1% increase in water bodies corresponded to a decrease of 40.0% and 4.0% in monthly scrub typhus cases, respectively. The predictions of the maximum entropy model were robust, and the average area under the curve value was as high as 0.864. The best predictive variables for scrub typhus occurrence were population density, annual mean normalized difference vegetation index, and land cover types. The projected potentially most suitable areas for scrub typhus were widely distributed across the eastern coastal area of Fujian Province, with highly suitable and moderately suitable areas accounting for 16.14% and 9.42%, respectively. Of the total human population of the province, 81.63% reside in highly suitable areas for scrub typhus.ConclusionsThese findings could help deepen our understanding of the risk factors of scrub typhus, and provide information for public health authorities in Fujian Province to develop more effective surveillance and control strategies in identified high risk areas in Fujian Province.

Social capital and spread of COVID-19 in Poland – do membership, trust, norms and values or shared narratives matter?

The experience of the SARS-CoV-19 pandemic can be a source of valuable information for public health authorities. As we have seen, the incidence is not evenly distributed in space, and the factors influencing it are not fully understood. Aspects of biological, demographic, economic, environmental, and political nature are considered, but it is believed that the social factor may be of critical importance. The density and intensity of social relations, general trust and trust in the authorities, norms and values – i.e., social capital – may have a key impact on the scale of infections. The research conducted so far on this subject does not provide clear conclusions, and the post-communist society, inferior in social capital, has hardly been analyzed. Using data for 73 subregions of Poland and performing regression analysis, we investigate how social capital explains the level of infection rate in the first three waves of the epidemic. The analysis results have shown that the factor of “political leaning” was strongly and negatively related to the infection rate in Poland. The research results indicate that, contrary to the previous studies, structural capital has the same positive effect on reducing the epidemic. However, relational social capital promotes more significant morbidity.

Spatio-temporal dynamics of three diseases caused by Aedes-borne arboviruses in Mexico

BackgroundThe intensity of transmission of Aedes-borne viruses is heterogeneous, and multiple factors can contribute to variation at small spatial scales. Illuminating drivers of heterogeneity in prevalence over time and space would provide information for public health authorities. The objective of this study is to detect the spatiotemporal clusters and determine the risk factors of three major Aedes-borne diseases, Chikungunya virus (CHIKV), Dengue virus (DENV), and Zika virus (ZIKV) clusters in Mexico.MethodsWe present an integrated analysis of Aedes-borne diseases (ABDs), the local climate, and the socio-demographic profiles of 2469 municipalities in Mexico. We used SaTScan to detect spatial clusters and utilize the Pearson correlation coefficient, Randomized Dependence Coefficient, and SHapley Additive exPlanations to analyze the influence of socio-demographic and climatic factors on the prevalence of ABDs. We also compare six machine learning techniques, including XGBoost, decision tree, Support Vector Machine with Radial Basis Function kernel, K nearest neighbors, random forest, and neural network to predict risk factors of ABDs clusters.ResultsDENV is the most prevalent of the three diseases throughout Mexico, with nearly 60.6% of the municipalities reported having DENV cases. For some spatiotemporal clusters, the influence of socio-economic attributes is larger than the influence of climate attributes for predicting the prevalence of ABDs. XGBoost performs the best in terms of precision-measure for ABDs prevalence.ConclusionsBoth socio-demographic and climatic factors influence ABDs transmission in different regions of Mexico. Future studies should build predictive models supporting early warning systems to anticipate the time and location of ABDs outbreaks and determine the stand-alone influence of individual risk factors and establish causal mechanisms.

Impacts of exposure to air pollution, radon and climate drivers on the COVID-19 pandemic in Bucharest, Romania: A time series study

During the ongoing global COVID-19 pandemic disease, like several countries, Romania experienced a multiwaves pattern over more than two years. The spreading pattern of SARS-CoV-2 pathogens in the Bucharest, capital of Romania is a multi-factorial process involving among other factors outdoor environmental variables and viral inactivation. Through descriptive statistics and cross-correlation analysis applied to daily time series of observational and geospatial data, this study aims to evaluate the synergy of COVID-19 incidence and lethality with air pollution and radon under different climate conditions, which may exacerbate the coronavirus’ effect on human health. During the entire analyzed period 1 January 2020–21 December 2021, for each of the four COVID-19 waves were recorded different anomalous anticyclonic synoptic meteorological patterns in the mid-troposphere, and favorable stability conditions during fall-early winter seasons for COVID-19 disease fast-spreading, mostly during the second, and the fourth waves. As the temporal pattern of airborne SARS-CoV-2 and its mutagen variants is affected by seasonal variability of the main air pollutants and climate parameters, this paper found: 1) the daily outdoor exposures to air pollutants (particulate matter PM2.5 and PM10, nitrogen dioxide-NO2, sulfur dioxide-SO2, carbon monoxide-CO) and radon - 222Rn, are directly correlated with the daily COVID-19 incidence and mortality, and may contribute to the spread and the severity of the pandemic; 2) the daily ground ozone-O3 levels, air temperature, Planetary Boundary Layer height, and surface solar irradiance are anticorrelated with the daily new COVID-19 incidence and deaths, averageingful for spring-summer periods. Outdoor exposure to ambient air pollution associated with radon is a non-negligible driver of COVID-19 transmission in large metropolitan areas, and climate variables are risk factors in spreading the viral infection. The findings of this study provide useful information for public health authorities and decision-makers to develop future pandemic diseases strategies in high polluted metropolitan environments.

COVID-19 vaccine uptake among healthcare workers in the fourth country to authorize BNT162b2 during the first month of rollout

BackgroundThe Kingdom of Saudi Arabia (KSA) was the fourth country in the world to authorize the BNT162b2 coronavirus disease 2019 (COVID-19) vaccine, which it rolled out on December 17, 2020 and first targeted at healthcare workers (HCWs). This study assesses vaccine uptake among this group during the first month of its availability. MethodsA national cross-sectional, pilot-validated, self-administered survey was conducted among HCWs in the KSA between December 27, 2020 and January 3, 2021. The survey included sociodemographic details, previous contact with COVID-19 patients, previous infection with COVID-19, receiving (or registering with the Ministry of Health website to receive) the COVID-19 vaccine, sources of HCWs’ information on vaccines, awareness of emerging variants of concern, and anxiety level using the 7-item Generalized Anxiety Disorder assessment. A descriptive bivariate analysis and multivariate logistic binary regression analysis were performed. The primary evaluated outcome was vaccine uptake. ResultsOf the 1058 participants who completed the survey, 704 (66.5%) were female, and 626 (59.2%) were nurses. Of all the respondents, 352 (33.27%) were enrolled to receive or had already received the vaccine, while 706 (66.73%) had not enrolled. In a bivariate analysis, not enrolling for vaccination was more likely in females than males (78.5% vs. 21.5%, P < 0.001), HCWs between the ages of 20 and 40 years than those >40 years (70.4% vs. 29.6%, P = 0.005), Saudi HCWs than expatriates (78% vs 22%, P < 0.001), and among HCWs who used social media as a source of information than those who did not (69.8% vs. 38.6%, P < 0.001). In a multivariate analysis, independent factors associated with uptake were being a Saudi national (aOR = 1.918, 95 %CI = 1.363–2.698, P < 0.001), working in an intensive care unit (aOR = 1.495, 95 %CI = 1.083–2.063, P = 0.014), and working at a university hospital (aOR = 1.867, 95 %CI = 1.380–2.525, P < 0.001). ConclusionsA low level of vaccine uptake was observed especially in female HCWs, those younger than 40 years old, and those who used social media as their source of vaccine information. This survey provides important information for public health authorities in order to scale up vaccination campaigns targeting these HCWs to increase vaccine enrollment and uptake.

Consumers' perceptions of intrinsic and extrinsic attributes as indicators of safety and quality of chicken meat: Actionable information for public health authorities and the chicken industry.

Understanding consumers' perceptions toward chicken meat safety and quality could provide valuable information to public health educators since it is the most consumed meat. This study explores perceptions of a group of South African consumers on the safety and quality of chicken meat based on intrinsic and extrinsic attributes and identifies related safety risks. Data were collected through a web-based survey (863 participants). A substantial proportion of consumers considered supermarkets as the most trusted outlets to sell safe and good quality chicken (compared with butcheries, wholesalers, farmers' markets, street vendors, or "other retailers"). The majority of respondents (53%) most trusted refrigerated chicken to be of good quality compared with 36% trusting frozen chicken or 11% chicken at room temperature. Frozen chicken was considered most safe by 48% of consumers while 43% regarded refrigerated chicken as most safe. At point of purchase and home, smell, use-by date, sell-by date, and color were perceived as important attributes when judging chicken safety and quality. Consumers considered the absence of brine use and growth-promoting hormones in chicken feed as relatively important. The majority of consumers can be classified as highly involved during purchasing. It is essential that consumers apply safe chicken handling practices from point of purchase to consumption, irrespective of the type of retailer, perceived sensory characteristics, and date labels to reduce or eliminate microbial risks. Addressing consumer's knowledge and expectations regarding factors such as growth-promoting hormones and free range may improve safety and quality perceptions. PRACTICAL APPLICATION: This study gives insight into perceptions of a group of South African consumers toward safety and quality of chicken meat. Understanding consumers' perceptions can provide valuable information to public health educators since chicken meat is a common vehicle for Salmonella spp. and Campylobacter spp., which are human pathogens. Additionally, this information can assist the chicken industry to meet consumer expectations.

Spatiotemporal analysis of the dengue outbreak in Guangdong Province, China

BackgroundDengue is becoming a major public health concern in Guangdong (GD) Province of China. The problem was highlighted in 2014 by an unprecedented explosive outbreak, where the number of cases was larger than the total cases in previous 30 years. The present study aimed to clarify the spatial and temporal patterns of this dengue outbreak.MethodsBased on the district/county-level epidemiological, demographic and geographic data, we first used Moran’s I statistics and Spatial scan method to uncover spatial autocorrelation and clustering of dengue incidence, and then estimated the spatial distributions of mosquito ovitrap index (MOI) by using inverse distance weighting. We finally employed a multivariate time series model to quantitatively decompose dengue cases into endemic, autoregressive and spatiotemporal components.ResultsThe results indicated that dengue incidence was highly spatial-autocorrelated with the inclination of clustering and nonuniformity. About 12 dengue clusters were discovered around Guangzhou and Foshan with significant differences by district/county, where the most likely cluster with the largest relative risk located in central Guangzhou in October. Three significant high-MOI areas were observed around Shaoguan, Qingyuan, Shanwei and Guangzhou. It was further found the districts in Guagnzhou and Foshan were prone to local autoregressive transmission, and most region in southern and central GD exhibited higher endemic components. Moreover, nearly all of districts/counties (especially the urban area) have cases that were infected in adjacent regions.ConclusionsThe study can help to clarify the heterogeneity and the associations of dengue transmission in space and time, and thus provide useful information for public health authorities to plan dengue control strategies.

A single-arm study to evaluate skin tolerance, effectiveness and adherence to use of an alcohol-based hand rub solution among hospital nurses

Background: Hand hygiene is considered as the most important strategy for preventing healthcare infections. Objective: In this single-arm study, skin tolerance, effectiveness and prolonged efficacy, and adherence to use an alcohol-based hand rub (ABHR) solution among hospital nurses was evaluated. Methods: Nurses were recruited in the main hospital of Molise Region, Central Italy. Skin reactions during 12-week follow-up were self-reported by nurses and, when occurring examined by hospital dermatologist. Samples were collected from palms and fingertips before and after ABHR, also at random times during work. Results: Dermatological reactions were not reported by 20 nurses (15 female and 5 male, aged 30–59 years) after product use. Microbial counts decreased by 99% (2Log10) in 75%, with higher reduction in palm than fingertips (99% vs 70% respectively). Analysis of six randomly collected samples after 10–20 and 30–40 min from the last use showed a satisfactory prolonged efficacy. Discussion: Beyond high effectiveness to reduce transient microbiota, no skin reactions were observed, likely due to the camomile, thyme and eucalyptus extracts contained within the gel. This study, addressing technical questions of a commercialised product, provides useful information for public health authorities faced with a choice of hand disinfectants, evaluating cost-effectiveness and cost-benefit in the light of the huge amount of these products needed at hospital level.

Multilocus microsatellite typing (MLMT) reveals host-related population structure in Leishmania infantum from northeastern Italy.

BackgroundVisceral leishmaniasis (VL) caused by Leishmania infantum is an ongoing health problem in southern Europe, where dogs are considered the main reservoirs of the disease. Current data point to a northward spread of VL and canine leishmaniasis (CanL) in Italy, with new foci in northern regions previously regarded as non-endemic.Methodology/Principal findingsMultilocus microsatellite typing (MLMT) was performed to investigate genetic diversity and population structure of L. infantum on 55 samples from infected humans, dogs and sand flies of the E-R region between 2013 and 2017. E-R samples were compared with 10 L. infantum samples from VL cases in other Italian regions (extra E-R) and with 52 strains within the L. donovani complex. Data displayed significant microsatellite polymorphisms with low allelic heterozygosity. Forty-one unique and eight repeated MLMT profiles were recognized among the L. infantum samples from E-R, and ten unique MLMT profiles were assigned to the extra E-R samples. Bayesian analysis assigned E-R samples to two distinct populations, with further sub-structuring within each of them; all CanL samples belonged to one population, genetically related to Mediterranean MON-1 strains, while all but one VL cases as well as the isolate from the sand fly Phlebotomus perfiliewi fell under the second population. Conversely, VL samples from other Italian regions proved to be genetically similar to strains circulating in dogs.Conclusions/SignificanceA peculiar epidemiological situation was observed in northeastern Italy, with the co-circulation of two distinct populations of L. infantum; one population mainly detected in dogs and the other population detected in humans and in a sand fly. While the classical cycle of CanL in Italy fits well into the data obtained for the first population, the population found in infected humans exhibits a different cycle, probably not involving a canine reservoir. This study can contribute to a better understanding of the population structure of L. infantum circulating in northeastern Italy, thus providing useful epidemiologic information for public health authorities.

Seroprevalence of Anti-Chikungunya Virus Antibodies in Children and Adults in Managua, Nicaragua, After the First Chikungunya Epidemic, 2014-2015.

Chikungunya is a viral disease transmitted by Aedes aegypti and Ae. albopictus mosquitoes. In late 2013, chikungunya virus (CHIKV) was introduced into the Caribbean island of St. Martin. Since then, approximately 2 million chikungunya cases have been reported by the Pan American Health Organization, and most countries in the Americas report autochthonous transmission of CHIKV. In Nicaragua, the first imported case was described in July 2014 and the first autochthonous case in September 2014. Here, we conducted two studies to analyze the seroprevalence of anti-CHIKV antibodies after the first chikungunya epidemic in a community-based cohort study (ages 2–14 years) and in a cross-sectional survey of persons aged ≥15 years in the same area of Managua, Nicaragua. Routine annual serum samples collected from 3,362 cohort participants in March/April 2014 and 2015, and 848 age-stratified samples collected from persons ≥15 years old at the end of May-beginning of June 2015 were used to estimate the seroprevalence of anti-CHIKV antibodies after the first epidemic (October 2014 to February 2015 in the study population). Using an Inhibition ELISA assay that measures total anti-CHIKV antibodies, the seroprevalence was significantly higher in those aged ≥15 (13.1% (95%CI: 10.9, 15.5)) than in the pediatric population (6.1% (95%CI: 5.3, 6.9)). The proportion of inapparent infections was 58.3% (95%CI: 51.5, 65.1) in children and 64.9% (95%CI: 55.2, 73.7) in the ≥15 study population. We identified age, water availability, household size, and socioeconomic status as factors associated with the presence of anti-CHIKV antibodies. Overall, this is the first report of CHIKV seropositivity in continental Latin America and provides useful information for public health authorities in the region.

Detection of pathogenic Escherichia coli and microbiological quality of chilled shrimp sold in street markets.

Foodborne illnesses caused by Escherichia coli are one of the most important gastrointestinal diseases and therefore represent a public health risk. The presence of E.coli in water or in products such as shrimp indicates faecal contamination. However, indicator micro-organisms can be used to evaluate the microbiological quality of food sold in markets. This study focused on detecting isolates of E.coli containing the genes stx1A, stx2A, eae, LTI, STa, STb, aggR and pCVD432 in chilled shrimp sold in street markets in the municipality of São Paulo, Brazil, and to assess the microbiological quality of this product. Enteropathogenic and enterotoxigenic E.coli pathotypes were detected on the surface of two chilled shrimp samples. Salmonella spp. was not isolated. In addition, contamination of surface and muscle of the shrimp samples was found to be correlated. The detection of EPEC and ETEC pathotypes in chilled shrimp sold in street markets in Brazil provides useful epidemiological information for public health authorities to improve food safety and public health. Shrimps are crustaceans commonly produced and consumed in Brazil. Specimens of Farfantepenaeus brasiliensis and Litopenaeus schmitti sold in street markets were examined by PCR to detect the presence of Escherichia coli pathotypes (enteropathogenic, enterotoxigenic, enterohemorrhagic and enteroinvasive). EPEC and ETEC strains were detected in whole shrimp. These findings provide useful information for public health authorities to improve the food safety and health of the Brazilian population.

Prevalence and type distribution of human papillomavirus among women older than 18 years in Egypt: a multicenter, observational study

Persistent infection with high-risk (HR) human papillomavirus (HPV) is associated with premalignant lesions and cervical cancer, the third most common cancer amongst women globally and the second most frequent in Egypt. We studied the prevalence and type distribution of HPV and documented HPV infection awareness and health-related behaviours for HPV infection. This was a multicenter, hospital-based observational study of women ≥18 years of age who attended for a gynaecological examination during October 2010-August 2011. Cervical samples were tested using Linear Array HPV genotyping. Two questionnaires on awareness and health-related behaviour were completed. Four hundred and forty-three women with a mean age of 39.3±14.0 years were included in the analysis. HPV DNA was detected in 10.4% of women; a single HPV-type infection was found in 6.5% and multiple infections in 3.8%. The most prevalent HR types among HPV-positive women were HPV-16 (19.6%) and HPV-31 and HPV-51 (15.2% each); low-risk types included HPV-62 (17.4%) and HPV-84 (10.9%). The prevalence of HPV-18 was low (6.5%). The prevalence of any HR HPV-type was highest in women aged 45-54 years (9.2%). The overall prevalence of HPV in Egypt was 10.4% and was highest (9.2%) amongst women aged 45-54 years. These data provide important reference information for public health authorities considering HPV prevention in Egypt.

Epidemiology of hip fractures in Ecuador

To report the age-, sex-, and type-specific hip fracture incidence rates in Ecuador. A secondary objective was to examine hip fracture geographic variations in Latin America. The Anuario de Egresos Hospitalarios was analyzed to determine the number of persons aged 50 years or older hospitalized with a principal diagnosis of hip fracture (ICD-10 S72) in 2005. Census estimates of the population were used as the denominator to calculate hip fracture incidence rates per 100,000 inhabitants. Age-adjusted rates were calculated by the direct method using the 2000 U.S. population as the standard to examine hip fracture geographic variations. A total of 1 005 persons were hospitalized with a diagnosis of hip fracture (664 women and 341 men) during the study period. The crude annual incidence rate of hip fractures was 49.5 per 100,000 (34.8 per 100,000 men and 63.2 per 100,000 women). In general, the number and incidence of hip fractures increased exponentially with age in both sexes. However, the increase was more relevant in women. Age-adjusted rates in Latin America ranged from a low of 15.1 per 100,000 in women and 6.7 per 100,000 in men for Sobral, Brazil, to a high of 499.0 per 100,000 in women for La Plata, Argentina. The results of this study indicate a low incidence of hip fractures in Ecuador and geographic differences of hip fracture rates in Latin America. Because the population of Ecuador is aging, this study provides valuable information for public health authorities to start planning and implementing prevention strategies aimed at reducing the burden of hip fractures in the near future.

Acute respiratory infections in children living in two low income communities of Rio de Janeiro, Brazil.

Community studies of non-hospitalized children are essential to obtain a more thorough understanding of acute respiratory infections (ARI) and provide important information for public health authorities. This study identified a total ARI incidence rate (IR) of 4.5 per 100 child-weeks at risk and 0.78 for lower respiratory tract infections (LRI). Disease duration averaged less than one week and produced a total time ill with ARI of 5.8% and for LRI 1.2%. No clear seasonal variation was observed, the sex-specific IR showed a higher proportion of boys becoming ill with ARI and LRI and the peak age-specific IR occurred in infants of 6-11 months. Correlation with risk factors of the child (breastfeeding, vaccination, diarrheal disease, undernourishment) and the environment (crowding, living conditions, maternal age and education) showed marginal increases in the rate ratios, making it difficult to propose clear-cuts targets for action to lower the ARI and LRI morbidity. The importance of an integral maternal-child health care program and public education in the early recognition of LRI is discussed.