Major Outbreaks Research Articles

Burnout in Infection Control Practitioners During Public Health Crisis Events: A Mixed Methods Systematic Review Protocol

Background Infection prevention and control work environments are highly complex in nature and have long been associated with crisis events including serious infectious disease outbreaks. The role of infection control practitioners shifted exponentially during the COVID-19 pandemic and with this rapid and nebulous change came anxiety, emotional exhaustion and ultimately burnout. Burnout at work generally occurs as a response to chronic and prolonged exposure to emotionally challenging events, causing emotional exhaustion, feelings of cynicism, and lack of accomplishment at work. This systematic review aims to investigate burnout in infection control practitioners during public health crisis events (major outbreaks, epidemics, and pandemics) in upper-middle and high-income countries on a global scale. Methods A mixed-methods systematic review will be carried out and will include qualitative, quantitative and primary mixed-methods studies that investigate the different elements of burnout, during public health crisis events. After an initial scoping literature search, up to six databases will be searched for studies on burnout in relation to infection prevention practitioners. Study quality will be checked using standardised JBI critical appraisal tools. The proposed review will follow the JBI convergent integrated approach for mixed methods systematic reviews. Following data extraction, quantitative data will then be converted into ‘qualitized data’ in the form of textual descriptions. Discussion It is well documented that adverse conditions during public health crisis events can lead to burnout. This systematic review will investigate of burnout in infection control practitioners in upper-middle and high-income countries during public health crisis events. The findings will inform healthcare professionals, senior policy makers and researchers and will help contribute to a richer understanding of burnout and associated factors in infection control practitioners. Protocol registration number PROSPERO 2024 CRD42024508996.

Analysis of the interrelationship between precipitation and confirmed dengue cases in the city of Recife (Brazil) covering climate and public health information

Large-scale epidemics of arboviruses, such as dengue, have heightened societal awareness regarding the necessity of combating the primary transmission vectors. Equally critical is the identification of environmental conditions and variables that influence vector population dynamics. Aedes aegypti, the primary vector of arboviruses such as dengue and Zika in Brazil, is closely associated with the climatic and geographical conditions of urban environments. This study examines the relationship between precipitation and confirmed dengue cases in Recife (Brazil), employing regression and quantile analyses to evaluate the influence of meteorological conditions on the disease’s spread. The findings reveal a direct correlation between monthly averages of precipitation and confirmed cases, although this is apparent only when excluding years of epidemic peaks. The highest number of cases generally aligns with the rainy season, and the lowest with the dry season, with weak, moderate and strong precipitation events being closely linked to increased dengue incidence. However, notable discrepancies were identified: four out of six major outbreaks occurred in drier months, challenging the assumption of a straightforward relationship between rainfall and dengue incidence. These findings underscore the multifaceted nature of dengue dynamics, suggesting that while precipitation plays a significant role, other factors, including serotype circulation and broader climatic phenomena, are equally critical in driving outbreaks. This complexity highlights the need for a more comprehensive understanding of the mechanisms influencing dengue epidemics.

Non-pharmaceutical infection prevention measures in nosocomial SARS-CoV-2 outbreaks: a retrospective multicentre cohort study

Hospital severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outbreaks are relevant for patients and healthcare systems within and beyond the pandemic. We aimed to explore the characteristics of SARS-CoV-2 outbreaks and their infection prevention and control (IPC) measures during the different pandemic waves. A comprehensive structured template for SARS-CoV-2 outbreaks was developed and filled out by six university hospitals. The main outcome variable was outbreak size (OS). A total of 80 outbreaks and 734 infection cases were enrolled between 03/2020-02/2023. In the majority of outbreaks (85%) a contact tracing (CT) team was in place. In 13 (16%) outbreaks the CT team was exclusively responsible for CT, which was negatively linked to OS when adjusting for SARS-CoV-2 waves (Estimate (β)=-1.350; Standard Error (SE) =.274; p<0 .0001). Patients as index had a greater association with OS than healthcare workers (HCWs) (β=-0.29; SE=0.098; p=0.003). Additionally, the mandatory use of facemasks by patients in the presence of HCWs was negatively linked to OS (β=-0.237; SE=0.08; p=0.003). The frequency of patient screening during outbreaks varied considerably, whereby higher frequency screenings for SARS-CoV-2 were negatively associated with OS (β=-0.358; SE=0.109; p=0.001). Our data provides insights in non-pharmaceutical outbreak prevention and management revealing that the mandatory use of facemasks by patients in the presence of HCWs and a high patient screening frequency in ongoing outbreaks were significantly associated with smaller outbreaks. Further studies are required to allow for generalizability.

Determining the New Norm Elements in Emergency Departments in Malaysia During a Pandemic: A Fuzzy Delphi Method.

Emergency departments (EDs) have had to cope with various pandemics, such as HIN1, Ebola and the currently ongoing COVID-19. This study aimed to determine the elements of the new norm that has introduced changes into healthcare systems, particularly EDs, during the COVID-19 pandemic and to obtain consensus from the experts, the Emergency physicians in EDs across Malaysia. No previous study has been conducted on this topic. This study used the fuzzy Delphi method (FDM) to acquire expert consensus. There were two phases in this study. The first involved extracting the elements to be assessed by the selected experts from a literature review. Three major domains were considered: infrastructure, governance and human resources. A total of 35 items were identified and divided into the three domains. In the second phase, the selected items were sent to a group of 15 ED physicians, who were asked to rate the items on a Likert-type scale. The data were then analysed using FDM. A total of 35 items were identified as possible new norms from a literature search for the three domains (governance, infrastructure and human resources). The first step of the FDM analysis showed that 9 out of the 35 items did not fulfil the initial requirement of the FDM, since the threshold value (d) must be lower than 0.2 (d </ 0.2). In meeting the second condition for the FDM, 25 out of the 35 items had an expert consensus of > 75%. Regarding the third requirement for FDM, only 1 out of the 35 items did not meet the criteria of an average fuzzy number (A value) of > 0.5. Finally, 25 items fulfilled all three requirements of FDM, so these were retained and the remaining 10 items were discarded. The FDM used in this study had identified 25 items achieved the required level of agreement by the chosen experts. The results of this study can be used to guide EDs in Malaysia to utilise the new norms items in mitigating major outbreak affecting the ED services.

A protocol for a living mapping review of global research funding for infectious diseases with a pandemic potential - Pandemic PACT.

The COVID CIRCLE initiative Research Project Tracker by UKCDR and GloPID-R and associated living mapping review (LMR) showed the importance of sharing and analysing data on research at the point of funding to improve coordination during a pandemic. This approach can also help with research preparedness for outbreaks and hence our new programme the Pandemic Preparedness: Analytical Capacity and Funding Tracking Programme (Pandemic PACT) has been established. The LMR described in this protocol builds on the previous UKCDR and GloPID-R COVID-19 Research Project database with addition of the priority diseases from the WHO Blueprint list plus initial additions of pandemic influenza, mpox and plague. We capture data on new funding commitments directly from funders and map these against a core ontology (aligned to existing research roadmaps). We will analyse regularly collated new research funding commitments to provide an open, accessible, near-real-time overview of the funding landscape for a wide range of infectious disease and pandemic preparedness research and assess gaps. The periodicity of updates will be increased in the event of a major outbreak. We anticipate that this LMR and the associated online tool will be a useful resource for funders, policy makers and researchers. In the future, our work will inform a more coordinated approach to research funding by providing evidence and data, including identification of gaps in funding allocation with a particular focus on low- and middle-income countries.

Unexpected Delayed Incursion of Highly Pathogenic Avian Influenza H5N1 (Clade 2.3.4.4b) Into the Antarctic Region.

The current highly pathogenic avian influenza H5N1 panzootic is having substantial impacts on wild birds and marine mammals. Following major and widespread outbreaks in South America, an incursion to Antarctica occurred late in the austral summer of 2023/2024 and was confined to the region of the Antarctic Peninsula. To infer potential underlying processes, we compiled H5N1 surveillance data from Antarctica and sub-Antarctic Islands prior to the first confirmed cases.

A scoping review of cultural issues concerning institutional quarantine and isolation during major multi‐country outbreaks in Africa: 2000–2023

AbstractBackground and AimsInfectious disease outbreaks pose significant challenges in Africa due to its ecology, socioeconomic conditions, and weak health systems. Implementing institutional quarantine and isolation (Q&amp;I) measures is crucial for managing major outbreaks. However, the cultural context often determines the success of these measures. This scoping review aims to examine existing evidence on the cultural aspects of institutional Q&amp;I in Africa over the past two decades, focusing on the COVID‐19 pandemic and other major multi‐country disease outbreaks.MethodsThis scoping review's protocol was registered with the Open Science Framework registry. Nine research databases were systematically searched to retrieve all relevant literature, followed by deduplication and a two‐stage screening process using the Rayyan web application. The inclusion of any literature into this review was based on a set of eligibility criteria. Also, manual searching of the reference lists of included literature was done to retrieve any other eligible literature. From the included literature, data were charted, collected, and summarized.FindingsOut of the 787 articles retrieved from the database searches, this review found only one to be eligible for inclusion. Also, no other eligible article was obtained after manual searching of the reference list for this article. The reviewed article presented empirical findings on the impact of COVID‐19 Q&amp;I protocols on traditional burial rites in Ghana. Many Ghanaian families were against their country's protocol because they felt it was insensitive to their traditional values and burial practices. Also, the way the protocol was implemented made some Ghanaian families feel that foreign burial practices were imposed on them, which bred feelings of cultural exclusion and neglect (by the government) among Ghanaians.ConclusionResearch evidence on the cultural implications of Q&amp;I in Africa is very scanty. More research is needed on this topic of public health interest.

Wide circulation of type 1 vaccine-derived poliovirus strains in clinical specimens from suspected cases of poliomyelitis, their contacts and in wastewater in Madagascar since late 2020

Madagascar has faced three major outbreaks of vaccine-derived polioviruses (VDPVs) in recent decades, with VDPV type 1 reemerging in late 2020. Here, we report the molecular characterization of these cVDPV1 strains. WHO protocols were used for poliovirus detection in stool and wastewater samples. Molecular genotyping was based on the 5′ non-coding (5′NC), VP1, and 3Dpol regions. From 2020 to 2022, 92 of 5690 stool samples and 129 of 1046 wastewater samples tested positive for cVDPV1. Genetic analysis of the VP1 gene revealed 1.3%–6.1% variability compared to the Sabin strain. Most sequences showed mutations at neurovirulence attenuation sites. Phylogenetic analysis distributed strains into four genogroups originating from Southern Madagascar. All analyzed cVDPV1 strains were recombinant, containing mutated oral polio vaccine sequences in VP1 and type C enterovirus sequences in other regions. This study demonstrated that all strains were closely related during this epidemic.

Effects of public concerns on favorable attitudes to pandemic containment policies: a two-wave panel survey study in Hong Kong.

Regions worldwide experienced uncontrolled COVID-19 outbreaks at different times, leading to increased health concerns yet decreased support for stringent containment measures. We aimed to understand this contradiction by examining the factors influencing attitudes toward COVID-19 containment policies in Hong Kong. Using two waves of panel data collected before and after the 2022 major outbreak N = 1148), we determined that concerns over politicization and economic implications, rather than health concerns, led to a decline in favorable attitudes. The study also revealed that political stance moderated the effect of politicization but not economic concern. Based on these findings, we offer several suggestions for public health institutions to improve public favorability: Institutions should undertake sustained efforts to reduce the politicization of containment policies. Providing economic support measures and detailed explanations to the public can help mitigate concerns. Additionally, institutions should respond more promptly to the public's economic concerns during health crises.

Evaluation of Etest and MICRONAUT-AM Assay for Antifungal Susceptibility Testing of Candida auris: Underestimation of Fluconazole Resistance by MICRONAUT-AM and Overestimation of Amphotericin B Resistance by Etest.

Multidrug-resistant Candida auris has recently caused major outbreaks in healthcare facilities. Rapid and accurate antifungal susceptibility testing (AST) of C. auris is crucial for proper management of invasive infections. The Commercial Sensititre Yeast One and Vitek 2 methods underestimate or overestimate the resistance of C. auris to fluconazole and amphotericin B (AMB). This study evaluated the AST results of C. auris against fluconazole and AMB by gradient-MIC-strip (Etest) and broth microdilution-based MICRONAUT-AM-EUCAST (MCN-AM) assays. Clinical C. auris isolates (n = 121) identified by phenotypic and molecular methods were tested. Essential agreement (EA, ±1 two-fold dilution) between the two methods and categorical agreement (CA) based on the Centers for Disease Control and Prevention's (CDC's) tentative resistance breakpoints were determined. Fluconazole resistance-associated mutations were detected by PCR-sequencing of ERG11. All isolates identified as C. auris belonged to South Asian clade I and contained the ERG11 Y132F or K143R mutation. The Etest-MCN-AM EA was poor (33%) for fluconazole and moderate (76%) for AMB. The CA for fluconazole was higher (94.2%, 7 discrepancies) than for AMB (91.7%, 10 discrepancies). Discrepancies were reduced when an MCN-AM upper-limit value of 4 µg/mL for fluconazole-susceptible C. auris and an Etest upper-limit value of 8 µg/mL for the wild type for AMB were used. Our data show that resistance to fluconazole was underestimated by MCN-AM, while resistance to AMB was overestimated by Etest when using the CDC's tentative resistance breakpoints of ≥32 µg/mL for fluconazole and ≥2 µg/mL for AMB. Method-specific resistance breakpoints should be devised for accurate AST of clinical C. auris isolates for proper patient management.

Epidemiology and molecular evolution of GI.1 sapovirus in the recent era.

Sapovirus (SaV) infection is increasing worldwide. Herein, we provided evidence of a significant increase in SaV infection in Japan during 2010-2022, primarily due to the considerable (p = 0.0003) rise of the GI.1 genotype. Furthermore, we found that all major and minor SaV outbreaks in Japan, including the largest SaV outbreak in 2021-2022, were caused by the GI.1 genotype. Therefore, to get insight into the underlying molecular mechanism behind this rising trend of the SaV GI.1 type, we selected 15 SaV GI.1 outbreak strains for complete genome analysis through next-generation sequencing. Phylogenetically, our strains remained clustered in different branches in lineages I and II among the GI.1 genotype. We showed all amino acid (aa) substitutions in different open reading frames (ORFs) in these strains. Importantly, we have demonstrated that the strains involved in the largest SaV outbreak in Japan in 2021-2022 belonged to lineage II and possessed the third ORF. We have identified some unique aa mutations in these major outbreak strains in the NS1 and NS6-NS7 regions that are thought to be associated with viral pathogenicity, cell tropism, and epidemiological competence. Thus, in addition to enriching the database of SaV's complete sequences, this study provides insights into its important mutations.

Molecular Epidemiology of Western Equine Encephalitis Virus, South America, 2023-2024.

Western equine encephalitis virus (WEEV) is a mosquitoborne virus that reemerged in December 2023 in Argentina and Uruguay, causing a major outbreak. We investigated the outbreak using epidemiologic, entomological, and genomic analyses, focusing on WEEV circulation near the Argentina‒Uruguay border in Rio Grande do Sul state, Brazil. During November 2023‒April 2024, the outbreak in Argentina and Uruguay resulted in 217 human cases, 12 of which were fatal, and 2,548 equine cases. We determined cases on the basis of laboratory and clinical epidemiologic criteria. We characterized 3 fatal equine cases caused by a novel WEEV lineage identified through a nearly complete coding sequence analysis, which we propose as lineage C. Our findings highlight the importance of continued surveillance and equine vaccination to control future WEEV outbreaks in South America.

Diarrhea and cholera surveillance for early warning and preparedness to prevent epidemics among Rohingya Myanmar nationals in Cox's Bazar, Bangladesh

Diarrheal diseases, especially cholera, can be a serious threat to Rohingya refugees in Cox's Bazar due to overcrowding and inadequate hygiene infrastructure. Assessing the risk, cholera surveillance network was established with the aim to identify the outbreak of diarrhea and cholera and help to take appropriate preventive measures including a vaccination campaign. The surveillance network has been ongoing for 6 years (2017–2023) in 17 health facilities. Diarrhea patients from Rohingya Myanmar nationals matched with case definition were enrolled and stool samples were tested by Rapid diagnostic test (RDT) for early cholera detection Multiple Logistic regression models were fitted to examine the associations of risk factors among cholera cases. A total of 17,252 stool samples were collected through surveillance. Among the tested samples, 588 (3.5 %) were detected positive by RDT, and 239 (1.4 %) Vibrio cholerae were isolated by microbiological culture. Between 2021 and 2023, the number of culture-confirmed cases exceeded that in the period from 2017 to 2020. In addition to V. cholerae; high positivity was identified for ETEC (11.8 %) followed by Salmonella (3.9 %) and Shigella (2.7 %). Most of the cholera cases were presented with vomiting, dehydration and loose watery and rice watery nature of stool (p value = <0.001). Major risk factors for cholera were 2–4 years age group (OR = 5.72; 95 % CI, 3.84–8.53.14; P = .001), process of water treatment (OR = 1.54; 95 % CI, 1.01–2.37; P = .046) and hand washing with soap before taking meals (OR = 0.6; 95 % CI, 0.39–0.92; P = .020. This study highlights the epidemiology of cholera among the Rohingya population and underscores the effectiveness of integrating surveillance data with early warning, alert, and response systems (EWARS) system, along with oral cholera vaccine (OCV) campaigns, in preventing major cholera outbreak.

Unraveling flavivirus pathogenesis: from bulk to single-cell RNA-sequencing strategies.

The global spread of flaviviruses has triggered major outbreaks worldwide, significantly impacting public health, society, and economies. This has intensified research efforts to understand how flaviviruses interact with their hosts and manipulate the immune system, underscoring the need for advanced research tools. RNA-sequencing (RNA-seq) technologies have revolutionized our understanding of flavivirus infections by offering transcriptome analysis to dissect the intricate dynamics of virus-host interactions. Bulk RNA-seq provides a macroscopic overview of gene expression changes in virus-infected cells, offering insights into infection mechanisms and host responses at the molecular level. Single-cell RNA sequencing (scRNAseq) provides unprecedented resolution by analyzing individual infected cells, revealing remarkable cellular heterogeneity within the host response. A particularly innovative advancement, virus-inclusive single-cell RNA sequencing (viscRNA-seq), addresses the challenges posed by non-polyadenylated flavivirus genomes, unveiling intricate details of virus-host interactions. In this review, we discuss the contributions of bulk RNA-seq, scRNA-seq, and viscRNA-seq to the field, exploring their implications in cell line experiments and studies on patients infected with various flavivirus species. Comprehensive transcriptome analyses from RNA-seq technologies are pivotal in accelerating the development of effective diagnostics and therapeutics, paving the way for innovative treatments and enhancing our preparedness for future outbreaks.

Cryptic transmission and novel introduction of Dengue 1 and 2 genotypes in Colombia.

Dengue fever remains as a public health challenge in Colombia, standing as the most prevalent infectious disease in the country. The cyclic nature of dengue epidemics, occurring approximately every 3years, is intricately linked to meteorological events like El Niño Southern Oscillation (ENSO). Therefore, the Colombian system faces challenges in genomic surveillance. This study aimed to evaluate local dengue virus (DENV) transmission and genetic diversity in four Colombian departments with heterogeneous incidence patterns (department is first-level territorial units in Colombia). For this study, we processed 266 serum samples to identify DENV. Subsequently, we obtained 118 genome sequences by sequencing DENV genomes from serum samples of 134 patients infected with DENV-1 and DENV-2 serotypes. The predominant serotype was DENV-2 (108/143), with the Asian-American (AA) genotype (91/118) being the most prevalent one. Phylogenetic analysis revealed concurrent circulation of two lineages of both DENV-2 AA and DENV-1 V, suggesting ongoing genetic exchange with sequences from Venezuela and Cuba. The continuous migration of Venezuelan citizens into Colombia can contribute to this exchange, emphasizing the need for strengthened prevention measures in border areas. Notably, the time to most recent common ancestor analysis identified cryptic transmission of DENV-2 AA since approximately 2015, leading to the recent epidemic. This challenges the notion that major outbreaks are solely triggered by recent virus introductions, emphasizing the importance of active genomic surveillance. The study also highlighted the contrasting selection pressures on DENV-1 V and DENV-2 AA, with the latter experiencing positive selection, possibly influencing its transmissibility. The presence of a cosmopolitan genotype in Colombia, previously reported in Brazil and Peru, raises concerns about transmission routes, emphasizing the necessity for thorough DENV evolution studies. Despite limitations, the study underscores genomic epidemiology's crucial role in early detection and comprehension of DENV genotypes, recommending the use of advanced sequencing techniques as an early warning system to help prevent and control dengue outbreaks in Colombia and worldwide.

Resurgence of Clinical Malaria in Ethiopia and Its Link to Anopheles stephensi Invasion.

The invasion of Anopheles stephensi into Africa poses a potential threat to malaria control and elimination on the continent. However, it is not clear if the recent malaria resurgence in Ethiopia has linked to the expansion of An. stephensi. We obtained the clinical malaria case reports and malaria intervention data from the Ethiopian Ministry of Health (MoH) for the period 2001-2022. We analyzed clinical malaria hotspots and investigated the potential role of An. stephensi in the 2022 malaria outbreaks. Clinical malaria cases in Ethiopia decreased by 80%, from 5.2 million cases in 2004 to 1.0 million cases in 2018; however, cases increased steadily to 2.6 million confirmed cases in 2022. Plasmodium vivax cases and proportion have increased significantly in the past 5 years. Clinical malaria hotspots are concentrated along the western Ethiopian border areas and have grown significantly from 2017 to 2022. Major malaria outbreaks in 2022/2023 were detected in multiple sites across Ethiopia, and An. stephensi was the predominant vector in some of these sites, however, it was absence from many of the outbreak sites. The causes of recent upsurge in malaria in Ethiopia may be multi-factorial and it is a subject of further investigation.

Application of spatial scan statistics on retrospective data to detect outbreaks of dengue hemorrhagic fever in Hai An and Duong Kinh districts, Hai Phong, 2020 - 2023

Dengue fever is an endemic disease that can lead to major outbreaks in Vietnam. This study aims to describe application of spatial scan statistics on retrospective data to detect outbreaks of dengue hemorrhagic fever in Hai An and Duong Kinh districts, Hai Phong, 2020 - 2023. The study analyzed aggregate dengue data covering 177 weeks (from Week 1/2020 to Week 20/2023). During the retrospective data period, 360 cases were reported from 14 wards of Hai An and Duong Kinh districts, of which 74 cases formed 5 clusters, with the remaining cases being sporadic. The clusters mainly occurred in November each year. Scan statistics should be systematically applied in monitoring dengue fever outbreaks, as the study results demonstrate that scan techniques can effectively detect clusters in the community.

Challenges Facing Two Outbreaks of Carbapenem-Resistant Acinetobacter baumannii: From Cefiderocol Susceptibility Testing to the Emergence of Cefiderocol-Resistant Mutants.

Carbapenem-resistant Acinetobacter baumannii (CRAB) infections are associated with poor outcomes depending on patient's conditions, clinical severity and type of infection, and treatment is challenging given the limited therapeutic options available. The aim of this study was to describe the clinical and microbiological characteristics of two outbreaks caused by CRAB in an intensive care unit (ICU). In addition, the mechanisms of resistance detected in these strains and the treatment chosen according to the available therapeutic options were analyzed. Overall, 28 patients were included. Ten patients (35.71%) had ventilator-associated pneumonia (VAP), ten (35.71%) had a bloodstream infection (BSI), and eight (28.57%) were only colonized. Recurrent infection occurred in 25% (5/20) of infected patients. Two different strains of A. baumannii were isolated from the index patient of the first outbreak. The first strain belonged to the ST85 and carried the blaNDM-1 carbapenemase gene, while the second belonged to the ST2 and carried blaOXA-23, and blaOXA-66 carbapenemase genes. The phylogenetic analysis revealed that the ST2 strain was the cause of the major outbreak, and mutations in the AmpC gene were related to progressive increasing minimum inhibitory concentration (MIC) and finally, cefiderocol-resistance in one strain. The CRAB isolates from the second outbreak were also identified as ST2. Cefiderocol-resistant strains tests identified by the disc diffusion method were involved in 24% (6/25) of nosocomial infections. Using broth microdilution (BMD) ComASP® only, 33.3% (2/6) of these strains were cefiderocol-resistant. All-cause ICU mortality was 21.4%. Conclusions: Cefiderocol is the first approved siderophore cephalosporin for the treatment of CRAB infections. Cefiderocol-resistant strains were related with blaNDM-1 carbapenemase and mutations in the AmpC gene. Cefiderocol-resistant strains or that cannot be properly interpreted by disk diffusion, should be retested using BMD for definitive categorization.

A Synoptic Review of Plant Disease Epidemics and Outbreaks Published in 2022.

This scientometric study reviews the scientific literature and CABI distribution records published in 2022 to find evidence of major disease outbreaks and first reports of pathogens in new locations or on new hosts. This is the second time we have done this, and this study builds on our work documenting and analyzing reports from 2021. Pathogens with three or more articles identified in 2022 literature were Xylella fastidiosa, Bursaphelenchus xylophilus, Meloidogyne species complexes, 'Candidatus Liberibacter asiaticus', Raffaelea lauricola, Fusarium oxysporum formae specialis, and Puccinia graminis f. sp. tritici. Our review of CABI distribution records found 29 pathogens with confirmed first reports in 2022. Pathogens with four or more first reports were Meloidogyne species complexes, Pantoea ananatis, grapevine red globe virus, and Thekopsora minima. Analysis of the proportion of new distribution records from 2022 indicated that grapevine red globe virus, sweet potato chlorotic stunt virus, and 'Ca. Phytoplasma vitis' may have been actively spreading. As we saw last year, there was little overlap between the pathogens identified by reviewing scientific literature versus distribution records. We hypothesize that this lack of concordance is because of the unavoidable lag between first reports of the type reported in the CABI database of a pathogen in a new location and any subsequent major disease outbreaks being reported in the scientific literature, particularly because the latter depends on the journal policy on types of papers to be considered, whether the affected crop is major or minor, and whether the pathogen is of current scientific interest. Strikingly, too, there was also no overlap between species assessed to be actively spreading in this year's study and those identified last year. We hypothesize that this is because of inconsistencies in sampling coverage and effort over time and delays between the first arrival of a pathogen in a new location and its first report, particularly for certain classes of pathogens causing only minor or non-economically damaging symptoms, which may have been endemic for some time before being reported. In general, introduction of new pathogens and outbreaks of extant pathogens threaten food security and ecosystem services. Continued monitoring of these threats is essential to support phytosanitary measures intended to prevent pathogen introductions and management of threats within a country.

What Triggers Change in Antimicrobial Use?

SummaryThis article considers how different ‘triggers' contribute to changes in the use of antimicrobials. Drawing on the Triggering Change model, the article suggests that the use of antimicrobials is path dependent: economically, socially and culturally invested in maintaining a steady trajectory, with incremental changes. Triggering events – such as farm succession, financial crisis, or disease outbreak – are required to break these dependencies and stimulate transitions to new farming trajectories. The article investigates which triggering events are significant in the context of responsible antimicrobial usage, in three European countries, spanning the beef, dairy, poultry and pig sectors. Results demonstrated that major reductions in antimicrobial use are often part of larger transition processes. Triggers led to major changes on farm which included reduction in antimicrobial use amongst other changes. When antimicrobial change occurred in isolation, it was typically in response to legislation, and progressed incrementally over time. To achieve major changes in antimicrobial use thus requires policies which work with trigger events such as supporting training of successors, and enabling farmers who have experienced major disease outbreaks to ‘build back better’. Working to shape what farmers understand as ‘good farming’ through education, regulations and benchmarking, are also important options.