Limited Public Health Resources Research Articles

The Hand, Foot, and Mouth Disease Sentinel Surveillance System in South Korea: Retrospective Evaluation Study.

South Korea has implemented a hand, foot, and mouth disease (HFMD) surveillance system since 2009 to monitor incidence trends and identify disease burden. This nationwide surveillance involves a network of approximately 100 pediatric clinics that report all probable and confirmed HFMD cases. Following the COVID-19 pandemic, infectious disease surveillance systems must be evaluated to ensure the effective use of limited public health resources. This study aimed to evaluate the HFMD sentinel surveillance system in South Korea from 2017 to 2022, focusing on the transition period after the COVID-19 pandemic. We retrospectively reviewed the HFMD sentinel surveillance system from the Korea Disease Control and Prevention Agency using systematic guidelines for public health surveillance system evaluation developed by the US Centers for Disease Control and Prevention. We assessed the system's overall performance in 5 main factors: timeliness, stability, completeness, sensitivity, and representativeness (ie, the age and geographic distribution of sentinels). We rated these factors as weak, moderate, or good. Our study showed that the completeness, sensitivity, and age representativeness of the HFMD surveillance performance were temporarily reduced to moderate levels from 2020 to 2021 and recovered in 2022, while the timeliness and geographic representativeness were maintained at a good level throughout the study period. The stability of the surveillance was moderate from 2017 to 2021 and weak in 2022. This is the first study to evaluate the HFMD surveillance system after the acute phase of the COVID-19 pandemic. We identified a temporarily reduced level of performance (ie, completeness, sensitivity, and age-specific representativeness) during the acute phase of the pandemic and good performance in 2022. Surveillance system evaluation and maintenance during public health emergencies will provide robust and reliable data to support public health policy development. Regular staff training programs and reducing staff turnover will improve HFMD surveillance system stability.

The importance of meropenem resistance, rather than imipenem resistance, in defining carbapenem-resistant Enterobacterales for public health surveillance: an analysis of national population-based surveillance

BackgroundIn Japan, carbapenem-resistant Enterobacterales (CRE) infections were incorporated into the National Epidemiological Surveillance of Infectious Diseases (NESID) in 2014, necessitating mandatory reporting of all CRE infections cases. Subsequently, pathogen surveillance was initiated in 2017, which involved the collection and analysis of CRE isolates from reported cases to assess carbapenemase gene possession. In this surveillance, CRE is defined as (i) minimum inhibitory concentration (MIC) of meropenem ≥2 mg/L (MEPM criteria) or (ii) MIC of imipenem ≥2 mg/L and MIC of cefmetazole ≥64 mg/L (IPM criteria). This study examined whether the current definition of CRE surveillance captures cases with a clinical and public health burden.MethodsCRE isolates from reported cases were collected from the public health laboratories of local governments, which are responsible for pathogen surveillance. Antimicrobial susceptibility tests were conducted on these isolates to assess compliance with the NESID CRE definition. The NESID data between April 2017 and March 2018 were obtained and analyzed using antimicrobial susceptibility test results.ResultsIn total, 1681 CRE cases were identified during the study period, and pathogen surveillance data were available for 740 (44.0%) cases. Klebsiella aerogenes and Enterobacter cloacae complex were the dominant species, followed by Klebsiella pneumoniae and Escherichia coli. The rate of carbapenemase gene positivity was 26.5% (196/740), and 93.4% (183/196) of these isolates were of the IMP type. Meanwhile, 315 isolates were subjected to antimicrobial susceptibility testing. Among them, 169 (53.7%) fulfilled only the IPM criteria (IPM criteria-only group) which were susceptible to meropenem, while 146 (46.3%) fulfilled the MEPM criteria (MEPM criteria group). The IPM criteria-only group and MEPM criteria group significantly differed in terms of carbapenemase gene positivity (0% vs. 67.8%), multidrug resistance rates (1.2% vs. 65.8%), and mortality rates (1.8% vs 6.9%).ConclusionThe identification of CRE cases based solely on imipenem resistance has had a limited impact on clinical management. Emphasizing resistance to meropenem is crucial in defining CRE, which pose both clinical and public health burden. This emphasis will enable the efficient allocation of limited health and public health resources and preservation of newly developed antimicrobials.

Risk of transmission of SARS-CoV-2 on international flights, a retrospective cohort study using national surveillance data in England

BackgroundIt is not yet fully understood to what extent in-flight transmission contributed to the spread of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). This study aimed to determine the occurrence and extent of SARS-CoV-2 transmission in-flight and assess factors associated with transmission risk to inform future control strategies.MethodsRetrospective cohort study using data obtained from contact tracing of international flights arriving in England between 02/08/2021–15/10/2021. Transmission risk was estimated by calculating the secondary attack rate (SAR). Univariable and multivariable analyses of the SAR by specific risk factors was undertaken, including: number of in-flight index cases; number of symptomatic index cases; contact vaccination status; flight duration; proximity to the index case(s); contact age.Results11,307 index cases linked to 667,849 contacts with 5,289 secondary cases reported. In-flight SAR was 0.79% (95% CI: 0.77–0.81). Increasing numbers of symptomatic cases (when > 4 index cases compared to one index case aOR 1.85; 95% CI: 1.40–2.44) and seating proximity to an index case (seated within compared to outside of two rows OR 1.82; 95% CI: 1.50–2.22) were associated with increased risk of secondary cases. Full vaccination history was protective (aOR 0.52; 95% CI: 0.47–0.57).ConclusionsThis study confirms that in-flight transmission of SARS-CoV-2 occurred. There are factors associated with increased risk of infection. Contact tracing identified exposed persons who subsequently developed infection. A targeted approach to contact tracing passengers with the highest exposure risk could be an effective use of limited public health resources.

Navigating misinformation and political polarization of COVID-19: interviews with Milwaukee, Wisconsin county public health officials.

The spread of misinformation combined with the political polarization of the COVID-19 vaccine created major challenges for public health officials responding to the COVID pandemic and vaccine roll-out. The challenges public health officials faced when making safety recommendations and promoting the vaccine only exacerbated the already exhausting work conditions they experienced since the start of the pandemic. Combating misinformation while receiving inadequate political support led to burnout for many public health officials. As such, they had to adapt and develop new strategies for increasing vaccine acceptance and decreasing vaccine hesitancies. This study was conducted through qualitative interviews with seven Milwaukee County public health officials. This study aimed to determine how public health officials perceived misinformation and political polarization during the pandemic. Additionally, the study aimed to learn more about strategies county health officials used to combat misinformation while increasing vaccine uptake in their communities. Thematic analysis of the interviews identified three major challenges faced by public health officials in promoting vaccination: dissemination of misinformation in media, political polarization of COVID and its contribution to vaccine acceptance and COVID fatigue, and assessment of the risks associated with disease severity versus vaccine safety considering limited public health resources. Learning from public health officials allows us to better understand their perceptions of the extent of local vaccine hesitancies and their advice on how to counteract fears and misinformation and to promote COVID vaccine uptake. Political polarization of COVID and misinformation affected community vaccine acceptance and challenged local public health leadership.

Foodborne Illness Complaint Systems Detect, and Restaurant Inspection Programs Prevent Restaurant-Associated Foodborne Illness Outbreaks.

Restaurants are important settings for foodborne illness transmission. Environmental health agencies routinely inspect restaurants to assess compliance with food safety regulations. They also evaluate foodborne illness complaints from consumers to detect potential outbreaks of foodborne illness. Local environmental health agencies were surveyed to identify methods used to conduct surveillance for consumer complaints of foodborne illness, link them to inspection grading and disclosure practices, and evaluate the association between these practices and the number of foodborne illness outbreaks in restaurant settings reported to the Centers for Disease Control and Prevention. We developed a novel framework for assessing the effectiveness of restaurant inspection grading and disclosure of inspection results while accounting for any biases introduced by surveillance factors that affect outbreak detection. Our findings showed the importance of routine restaurant inspection grading and disclosure practices as prevention measures and having a centralized database to manage consumer complaints as a useful surveillance tool for detecting outbreaks. Improving consumer complaint system structure and management can bolster outbreak detection and maximize limited public health resources while increasing the efficiency of complaint-based surveillance.

Risk factors for COVID-19 mortality among telehealth patients in Bangladesh: A prospective cohort study.

Estimating the contribution of risk factors of mortality due to COVID-19 is particularly important in settings with low vaccination coverage and limited public health and clinical resources. Very few studies of risk factors of COVID-19 mortality used high-quality data at an individual level from low- and middle-income countries (LMICs). We examined the contribution of demographic, socioeconomic and clinical risk factors of COVID-19 mortality in Bangladesh, a lower middle-income country in South Asia. We used data from 290,488 lab-confirmed COVID-19 patients who participated in a telehealth service in Bangladesh between May 2020 and June 2021, linked with COVID-19 death data from a national database to study the risk factors associated with mortality. Multivariable logistic regression models were used to estimate the association between risk factors and mortality. We used classification and regression trees to identify the risk factors that are the most important for clinical decision-making. This study is one of the largest prospective cohort studies of COVID-19 mortality in a LMIC, covering 36% of all lab-confirmed COVID-19 cases in the country during the study period. We found that being male, being very young or elderly, having low socioeconomic status, chronic kidney and liver disease, and being infected during the latter pandemic period were significantly associated with a higher risk of mortality from COVID-19. Males had 1.15 times higher odds (95% Confidence Interval, CI: 1.09, 1.22) of death compared to females. Compared to the reference age group (20-24 years olds), the odds ratio of mortality increased monotonically with age, ranging from an odds ratio of 1.35 (95% CI: 1.05, 1.73) for ages 30-34 to an odds ratio of 21.6 (95% CI: 17.08, 27.38) for ages 75-79 year group. For children 0-4 years old the odds of mortality were 3.93 (95% CI: 2.74, 5.64) times higher than 20-24 years olds. Other significant predictors were severe symptoms of COVID-19 such as breathing difficulty, fever, and diarrhea. Patients who were assessed by a physician as having a severe episode of COVID-19 based on the telehealth interview had 12.43 (95% CI: 11.04, 13.99) times higher odds of mortality compared to those assessed to have a mild episode. The finding that the telehealth doctors' assessment of disease severity was highly predictive of subsequent COVID-19 mortality, underscores the feasibility and value of the telehealth services. Our findings confirm the universality of certain COVID-19 risk factors-such as gender and age-while highlighting other risk factors that appear to be more (or less) relevant in the context of Bangladesh. These findings on the demographic, socioeconomic, and clinical risk factors for COVID-19 mortality can help guide public health and clinical decision-making. Harnessing the benefits of the telehealth system and optimizing care for those most at risk of mortality, particularly in the context of a LMIC, are the key takeaways from this study.

Demographic risk factors for extra-pulmonary tuberculosis: a rising public health threat in Bhutan

BackgroundRecently, extra-pulmonary tuberculosis (EPTB) has been increasingly reported in Bhutan, rising from 26% in 2001 to 39% in 2010. In 2016, almost half (49%) of all reported TB cases were classified as EPTB. Thus, this study was conducted to understand the epidemiology and identify risk factors contributing to increasing notification of EPTB in Bhutan. MethodsA case-control study was conducted by recruiting all 110 cases of nationally notified EPTB (Extrapulmonary bacteriologically confirmed/EPBC) as cases and 235 Pulmonary TB (Pulmonary bacteriologically confirmed/PBC) as controls. Data were collected on socio-demography, clinical and diagnostic, behavioral and lifestyle and environmental exposures using a structured questionnaire between April and September, 2018. ResultsThe median age of the cases was 25 years, ranged 9–79 years. Lymphatic TB was predominant (n = 78; 70.91%) followed by genitourinary TB (n = 4 (3.64%). The likelihood of EPTB decreased with increase in age (p = 0.023). The odds of EPTB in females was 1.65 times higher than the males (p = 0.038). Increase in Body Mass Index (adjusted odds ratio (AOR): 1.1; 95% confidence interval (CI): 1.052–1.200) and urban residency were (AOR 1.6; 95% CI 1.016–2.805) were found to have higher odds of developing EPTB. ConclusionFemales, urban residents, and those with higher BMI are at increased risk of developing EPTB. These at-risk groups can be used to target limited public health resources to control EPTB in Bhutan.

Examining the outcomes of the first one hundred residents in a community based residential rehabilitation unit for people affected by severe and persistent mental illness.

Community-based residential rehabilitation for people experiencing severe and persistent mental illness (SPMI) is increasingly available as an alternative to psychiatric inpatient care. Understanding who accesses these services and their outcomes will inform the optimal allocation of limited public mental health resources. This retrospective cohort study explored the outcomes of the first 100 consumers supported by a new Australian Community Care Unit (CCU). The primary outcome focus was acute mental health service use (emergency department presentations, acute mental health inpatient admission days), and secondary outcome foci were accommodation independence and substance use. When the 365 days before and after CCU support were compared, significant reductions in acute mental health bed days were observed (22days, W = 3.373, p = .001); greater reductions were noted for those staying >182 days (31days, W = 3.373, p = .001). Additionally, significant improvements in accommodation independence were found, (W = 3.373, p = .001). CCU consumers experienced reductions in acute mental health inpatient service use and improved accommodation independence. These observations are consistent with the intended functioning of the residential rehabilitation service.

The Gas and Brake Policy: Indonesia's COVID-19 Securitization Dilemmas

AbstractIndonesia, like many other countries, has encountered a slew of social, political, economic, and public health challenges in the aftermath of the COVID-19 pandemic. In response to these challenges, the Indonesian government implemented security measures by instituting large-scale social restrictions (Indonesian: Pembatasan Sosial Berskala Besar) and, later, micro-scale social restrictions (Pemberlakukan Pembatasan Kegiatan Masyarakat) to restrict people's mobility and virus transmission. Using securitisation theory as a framework, this article examines how the nationwide dilemma between public health and economic security arose. Based on official documents, government papers, and political speeches, this study reveals how the country's COVID-19 responses were largely defined by carefully constructed and flexible measures known as the ‘gas and brake’ policy (Kebijakan Gas dan Rem), which were aimed at resolving the health-economic dilemma. This policy is deemed appropriate given the country's limited public health and economic resources, despite the fact that many argue that such an approach reflects indecisiveness and a lack of coordination among the country's authorities. This article also demonstrates that policymakers in Indonesia use this policy to resolve the securitisation dilemma by reinforcing the hierarchical ordering of security sectors as a readjustment strategy. The policy is used to justify tightening or easing social restrictions by changing the security narrative throughout the pandemic.

Health Equity in Sickle Cell Research and Access to Therapy

Health Equity in Sickle Cell Research and Access to Therapy

Temporal Trends and Characteristics of Adult Patients in Emergency Department Related to Suicide Attempt or Self-Harm in Korea, 2016-2020.

The implementation of an effective suicide prevention program requires the identification and monitoring of subpopulations with elevated risks for suicide in consideration of demographic characteristics, to facilitate the development of tailored countermeasures for tackling the risk factors of suicide. We examined the annual trends in emergency department (ED) visits for suicide attempts (SAs) or self-harm and investigated the sex- and age-specific characteristics of individuals who visited the ED for SA and self-harm. Data on ED visits for SAs or self-harm in Korea from 2016 to 2020 were extracted from the National Emergency Department Information System and assessed. We evaluated the age-standardized incidence rate of ED visits for SAs or self-harm, and hospital mortality among individuals who visited the ED for SAs or self-harm. In addition, the characteristics of the individuals were compared according to sex and age. We identified 145,963 ED visits for SAs or self-harm (0.42% of the total ED visits) during the study period. The rate of ED visits increased in the youngest age group (19-29 years old), and was more prominent among women (increased by an annual average of 22.5%), despite the coronavirus disease pandemic. The middle-aged group (45-64 years old) had a higher rate of mortality than other age groups, and the highest proportion of individuals on Medical Aid. It is necessary to plan age- and gender-specific suicide prevention programs that focus on improving the limited public mental health resources for the vulnerable populations.

Field Services-Facilitated Treatment and Prevention: Challenges and Opportunities.

Assisted partner services (APS) is a longstanding public health strategy to reduce transmission of sexually transmitted infection (STI) and human immunodeficiency virus in the United States. However, with rapidly increasing rates of STI, innovations to APS are needed to allow health departments to conserve limited public health resources while improving the effectiveness of APS. Disease Intervention Specialists (DIS), public health staff who conduct APS, have a wealth of experience in identifying, locating, and interviewing index patients and their sexual partners, but are currently limited in the services that they are able to provide in the field. Although several state and local health departments are working to expand the role of DIS to incorporate less traditional APS activities, such programs are uncommon. We discuss several services that DIS could conceivably provide in the field, such as STI testing, treatment, and vaccination, and identify critical issues to be addressed to implement these changes in DIS activities on a larger scale. Broadening the scope of DIS activities may result in multiple benefits to health departments, including more effectively delivering STI testing and treatment to hard-to-reach populations, imparting more responsibility to DIS, thereby potentially increasing job satisfaction, and building a workforce that is better prepared for public health crises. Effective approaches to address variable state level regulations governing DIS scope of practice are needed.

Mapping under-five child malaria risk that accounts for environmental and climatic factors to aid malaria preventive and control efforts in Ghana: Bayesian geospatial and interactive web-based mapping methods

BackgroundUnder-five child malaria is one of the leading causes of morbidity and mortality globally, especially among sub-Saharan African countries like Ghana. In Ghana, malaria is responsible for about 20,000 deaths in children annually of which 25% are those aged < 5 years. To provide opportunities for efficient malaria surveillance and targeted control efforts amidst limited public health resources, the study produced high resolution interactive web-based spatial maps that characterized geographical differences in malaria risk and identified high burden communities.MethodsThis modelling and web-based mapping study utilized data from the 2019 Malaria Indicators Survey (MIS) of the Demographic and Health Survey Program. A novel and advanced Bayesian geospatial modelling and mapping approaches were utilized to examine predictors and geographical differences in under-five malaria. The model was validated via a cross-validation approach. The study produced an interactive web-based visualization map of the malaria risk by mapping the predicted malaria prevalence at both sampled and unsampled locations.ResultsIn 2019, 718 (25%) of 2867 under-five children surveyed had malaria. Substantial geographical differences in under-five malaria risk were observed. ITN coverage (log-odds 4.5643, 95% credible interval = 2.4086–6.8874), travel time (log-odds 0.0057, 95% credible interval = 0.0017–0.0099) and aridity (log-odds = 0.0600, credible interval = 0.0079–0.1167) were predictive of under-five malaria in the spatial model. The overall predicted national malaria prevalence was 16.3% (standard error (SE) 8.9%) with a range of 0.7% to 51.4% in the spatial model with covariates and prevalence of 28.0% (SE 13.9%) with a range of 2.4 to 67.2% in the spatial model without covariates. Residing in parts of Central and Bono East regions was associated with the highest risk of under-five malaria after adjusting for the selected covariates.ConclusionThe high-resolution interactive web-based predictive maps can be used as an effective tool in the identification of communities that require urgent and targeted interventions by programme managers and implementers. This is key as part of an overall strategy in reducing the under-five malaria burden and its associated morbidity and mortality in a country with limited public health resources where universal intervention is practically impossible.

796. HIV transmission clusters among people who inject drugs in North Carolina, 2010 to 2021

Abstract Background The marked increase in injecting drug use (IDU) in the past decade presents concern for increased HIV transmission among people who inject drugs (PWID) and explosive outbreaks. Among statewide HIV molecular surveillance, we assessed demographic, clinical, and reported behavioral risk factors associated with HIV clusters involving PWID in North Carolina (NC). Methods Persons ≥ 13 years old with HIV-infection residing in NC with ≥ 1 partial pol sequence collected between April 2010 and December 2021 were included in the study. We used an automated cluster analysis pipeline to detect genetic clusters (nextHIV2), defined as ≥ 2 sequences with a pairwise genetic distance &amp;lt; 1.5%. Logistic regression was used to estimate the risk and adjusted odds ratios of the relationship between the demographic factors that were likely associated with HIV clustering. Graphics were generated using the R packages ggplot2 and igraph. Results Among 19,641 persons with a sequence, 1,611 were PWID. Of these, 347 (21.5%) PWID were members of 248 clusters involving a total of 2,083 persons (size ranged 2–104). Sixty-four clusters (25%) had ≥2 PWID, whereas 2 (1%) included at least 5 PWID. The most commonly injected drug among cluster members was methamphetamine (19%). Overall, in a univariate analysis, younger age, dual risks of male-to-male sex and IDU, having sex under the influence of drugs, recent IDU (past 12 months), acute HIV infection, higher viral loads and higher CD4 T-cell count at the time of HIV diagnosis were significantly associated with clustering PWID individuals (all P&amp;lt; 0.001). In multivariate analyses, only recent IDU and higher CD4 T-cell count at the time of HIV diagnosis were significantly associated with clustering (P&amp;lt; 0.01). In addition, the proportion of PWID in clusters increased from 11.2% in 2010–2013 to 28.5% in 2018–2021 (P&amp;lt; 0.001). Nodes are colored by their reported PWID in darkred and reported non-PWID in blue. Conclusion We detected an increase in HIV genetic clusters among PWID in NC in recent years. Our results support the use of routine local molecular HIV surveillance to identify high priority clusters and offer prevention interventions for specific risk groups to prioritize limited public health resources. Disclosures Joseph J. Eron, MD, GSK: Advisor/Consultant|Merck: Advisor/Consultant.

SARS-CoV-2 antibody prevalence in a pediatric cohort of unvaccinated children in Mérida, Yucatán, México.

The prevalence of SARS-CoV-2 exposure in children during the global COVID-19 pandemic has been underestimated due to lack of testing and the relatively mild symptoms in adolescents. Understanding the exposure rates in the pediatric population is essential as children are the last to receive vaccines and can act as a source for SARS-CoV-2 mutants that may threaten vaccine escape. This cross-sectional study aims to quantify the prevalence of anti-SARS-CoV-2 serum antibodies in children in a major city in México in the Spring of 2021 and determine if there are any demographic or socioeconomic correlating factors. We obtained socioeconomic information and blood samples from 1,005 children from 50 neighborhood clusters in Mérida, Yucatán, México. We then tested the sera of these participants for anti-SARS-CoV-2 IgG and IgM antibodies using lateral flow immunochromatography. We found that 25.5% of children in our cohort were positive for anti-SARS-CoV-2 antibodies and there was no correlation between age and antibody prevalence. Children that lived with large families were statistically more likely to have antibodies against SARS-CoV-2. Spatial analyses identified two hotspots of high SARS-CoV-2 seroprevalence in the west of the city. These results indicate that a large urban population of unvaccinated children has been exposed to SARS-CoV-2 and that a major correlating factor was the number of people within the child's household with a minor correlation with particular geographical hotspots. There is also a larger population of children that may be susceptible to future infection upon easing of social distancing measures. These findings suggest that in future pandemic scenarios, limited public health resources can be best utilized on children living in large households in urban areas.

Remote Health Interventions: Effectiveness, Cost, and Cost-Effectiveness Considerations.

Remote Health Interventions: Effectiveness, Cost, and Cost-Effectiveness Considerations.

Empirical Analysis of the Dynamics of the COVID-19 Epidemic in Urban Embedded Social Networks.

BackgroundDue to the continual recurrence of COVID-19 in urban areas, it is important to know more about the evolution of the epidemic within this setting to mitigate the risk of the situation getting worse. As the virus spreads through human society, the social networks of confirmed cases can provide us with crucial new insights on this question.MethodsBased on the epidemiological reports of 235 COVID-19 cases in Nanjing, we constructed a social contact network for the epidemic. By analyzing the structure of this network, we explored the transmission characteristics of the epidemic, to provide evidence-based explanations for its transmission.ResultsIn our constructed transmission network, more than half (95/165, 57.58%) of patients were found not to have transmitted the infection, with only 15 (9.10%) source patients accounting for more than a third of the contagion (60, 36.36%), suggesting that the transmission of COVID-19 varies per individuals. Patients in the 31 to 50 age group were the main source of infectious clusters, with females playing a more active role in passing on the infection. Network component analysis identified nine components with disproportionate concentrations of influential patients, accounting for 49.09% (81) of the patients and 59.09% (78) of epidemiological network contacts. Family aggregation may favor disease transmission, and parenthood is the relationship with the highest infection risk within the family cluster. In addition, some specific public places, such as chess and card parlors, were found to be notable hotspots for community infection.ConclusionThis study presents the evolution of the urban epidemic from the perspective of individual-level and socially interactive processes. This real-world evidence can help to increase public awareness of the epidemic, formulate countermeasures, and allocate limited public health resources for urban management.

Demand and supply-side barriers and opportunities to enhance access to healthcare for urban poor populations in Kenya: a qualitative study

ObjectiveTo explore the barriers to and options for improving access to quality healthcare for the urban poor in Nairobi, Kenya.Design and participantsThis was a qualitative approach. In-depth interviews (n=12), focus...

Understanding factors influencing total coliform and E. coli sampling outcomes in new private water wells in North Carolina, USA

Provision of safe drinking water is critical for human health and survival. Indicator bacteria (i.e., total coliforms and fecal coliforms) are typical indicators of microbial water quality. In North Carolina (NC), new private drinking water wells are required for total coliform and E. coli testing. Such wells are typically only tested once before use in NC, so consistent and accurate testing is critical. Herein, we analyzed a large data set (n = 32,839) of water samples collected from private drinking water wells, representing 80 of North Carolina's 100 counties, and analyzed for significant differences in E. coli and total coliform positive rates depending on county and region of collection, transport method, sampling collection point, day of week, month, year, season, treatment method, time elapsed between collection and incubation, method used for detection, and the personnel reporting sample results. Our results showed that 34.1% of samples tested positive for total coliform, while 1.38% tested positive for E. coli. The total coliform positive rate ranged from 16.4% to 60.0% among the 80 counties. While nine counties reported no positive E. coli samples, positive E. coli rates for the remaining counties ranged from 0.17% to 12.7%. Samples from the Inner Coastal Plain were more likely to be positive for total coliforms, while samples from the Outer Coastal Plain were more likely to be positive for both the E. coli and total coliforms. Delivery method, sampling site, month, year and season of collection, treatment type, elapsed time between collection and analysis, and person reporting sample results were correlated with positive total coliform results. Similarly, sampling point, month, treatment type, test type, and the person reporting the results were correlated with positive E. coli results. These results can be used to prioritize limited public health resources for maximum impact on new private well drinking water safety. Further, providing clear and complete information by the sample collector could improve future research to better inform well water sampling practices.

Estimating COVID Risk During a Period of Pandemic Decline.

Background: Many parts of the world that succeeded in suppressing epidemic coronavirus spread in 2020 have been caught out by recent changes in the transmission dynamics of SARS-CoV-2. Australia's early success in suppressing COVID-19 resulted in lengthy periods without community transmission. However, a slow vaccine rollout leaves this geographically isolated population vulnerable to leakage of new variants from quarantine, which requires internal travel restrictions, disruptive lockdowns, contact tracing and testing surges.Methods: To assist long term sustainment of limited public health resources, we sought a method of continuous, real-time COVID-19 risk monitoring that could be used to alert non-specialists to the level of epidemic risk on a sub-national scale. After an exploratory data assessment, we selected four COVID-19 metrics used by public health in their periodic threat assessments, applied a business continuity matrix and derived a numeric indicator; the COVID-19 Risk Estimate (CRE), to generate a daily spot CRE, a 3 day net rise and a seven day rolling average. We used open source data updated daily from all Australian states and territories to monitor the CRE for over a year.Results: Upper and lower CRE thresholds were established for the CRE seven day rolling average, corresponding to risk of sustained and potential outbreak propagation, respectively. These CRE thresholds were used in a real-time map of Australian COVID-19 risk estimate distribution by state and territory.Conclusions: The CRE toolkit we developed complements other COVID-19 risk management techniques and provides an early indication of emerging threats to business continuity.