Multiple Outbreaks Research Articles

Phenotypic Differences Between the Epidemic Strains of Vesicular Stomatitis Virus Serotype Indiana 98COE and IN0919WYB2 Using an In-Vivo Pig (Sus scrofa) Model

During the past 25 years, vesicular stomatitis virus (VSV) has produced multiple outbreaks in the US, resulting in the emergence of different viral lineages. Currently, very little is known about the pathogenesis of many of these lineages, thus limiting our understanding of the potential biological factors favoring each lineage in these outbreaks. In this study, we aimed to determine the potential phenotypic differences between two VSV Indiana (VSIV) serotype epidemic strains using a pig model. These strains are representative of the epidemic lineages that affected the US between 1997 and 1998 (IN98COE) and between 2019 and 2020 (IN0919WYB2), the latter responsible for one of the most extensive outbreaks in the US. Our initial genome analysis revealed the existence of 121 distinct mutations between both strains, including the presence of a 14-nucleotide insertion in the intergenic region between the G and L genes observed in IN0919WYB2. The levels of viral RNA in clinical samples between pigs infected with IN98COE or IN0919WYB2 were compared. Overall, higher and prolonged expression of viral RNA in pigs infected with IN98COE was observed. However, clinically, IN0919WYB2 was slightly more virulent than IN98COE, as well as more efficient at producing infection through contact transmission. Additionally, infectious virus was recovered from more samples when the pigs were infected with IN0919WYB2, as revealed by virus isolation in cell culture, indicating the increased ability of this virus to replicate in pigs. Sequence analyses conducted from isolates recovered from both experimental groups showed that IN0919WYB2 produced more variability during the infection, denoting the potential of this strain to evolve rapidly after a single infection–contact transmission event in pigs. Collectively, the results showed that epidemic strains of VSIV may represent disparate phenotypes in terms of virulence/transmissibility for livestock, a situation that may impact the intensity of an epidemic outbreak. This study also highlights the relevance of pathogenesis studies in pigs to characterize phenotypic differences in VSV strains affecting livestock in the field.

Comparative study of two Rift Valley fever virus field strains originating from Mauritania.

Rift Valley fever (RVF) is one of the major viral arthropod-borne diseases in Africa. In recent decades, RVF virus (RVFV), the causative agent of RVF, has been responsible for multiple outbreaks in West Africa with important consequences on human and animal health. In particular, an outbreak occurred in 2010 after heavy rains in the desertic region of Adrar, Mauritania. It was characterized by the appearance of severe clinical signs among dromedary camels. Another one occurred in 2013-2014 across Senegal and the southern part of Mauritania. In this study, we characterized two RVFV field strains isolated during these two outbreaks. The first strain, MRU25010-30, was isolated from a camel (2010) while the second, MRU2687-3, was isolated from a goat (2013). By deep-sequencing and rapid amplification of cDNA-ends by polymerase chain reaction, we successfully sequenced the complete genome of these two RVFV strains as well as the reference laboratory strain ZH548. Phylogenetic analysis showed that the two field viruses belong to two different RVFV genetic lineages. Moreover, we showed that MRU25010-30 replicates more efficiently in various in vitro cell culture models than MRU2687-3 and ZH548. In vivo, MRU25010-30 caused rapid death of BALB/c mice and proved to be more virulent than MRU2687-3, regardless of the route of inoculation (subcutaneous or intranasal). The virulence of MRU25010-30 is associated with a high viral load in the liver and serum of infected mice, while the death of mice infected with MRU2687-3 and ZH548 correlated with a high viral load in the brain. Altogether, the data presented in this study provide new avenues to unveil the molecular viral determinants that modulate RVFV virulence and replication capacity.

Horizontal transfers between fungal Fusarium species contributed to successive outbreaks of coffee wilt disease.

Outbreaks of fungal diseases have devastated plants and animals throughout history. Over the past century, the repeated emergence of coffee wilt disease caused by the fungal pathogen Fusarium xylarioides severely impacted coffee production across sub-Saharan Africa. To improve the disease management of such pathogens, it is crucial to understand their genetic structure and evolutionary potential. We compared the genomes of 13 historic strains spanning 6 decades and multiple disease outbreaks to investigate population structure and host specialisation. We found that F. xylarioides comprised at least 4 distinct lineages: 1 host-specific to Coffea arabica, 1 to C. canephora var. robusta, and 2 historic lineages isolated from various Coffea species. The presence/absence of large genomic regions across populations, the higher genetic similarities of these regions between species than expected based on genome-wide divergence and their locations in different loci in genomes across populations showed that horizontal transfers of effector genes from members of the F. oxysporum species complex contributed to host specificity. Multiple transfers into F. xylarioides populations matched different parts of the F. oxysporum mobile pathogenicity chromosome and were enriched in effector genes and transposons. Effector genes in this region and other carbohydrate-active enzymes important in the breakdown of plant cell walls were shown by transcriptomics to be highly expressed during infection of C. arabica by the fungal arabica strains. Widespread sharing of specific transposons between F. xylarioides and F. oxysporum, and the correspondence of a putative horizontally transferred regions to a Starship (large mobile element involved in horizontal gene transfers in fungi), reinforce the inference of horizontal transfers and suggest that mobile elements were involved. Our results support the hypothesis that horizontal gene transfers contributed to the repeated emergence of coffee wilt disease.

Prevalence of immunity to hepatitis B in NCAA athletes.

Hepatitis B is a viral infection spread by contact with infected blood, semen, or other bodily fluids. The availability of a safe and effective vaccine has played a tremendous role in decreasing the prevalence of the disease since 1981. However, according to the Center for Disease Control, when adjusting for under-ascertainment and under-reporting, there were approximately 14,000 acute hepatitis B cases in the USA in 2020. There have been multiple outbreaks of vaccine-preventable disease in sports leagues including mumps and measles. However, there is limited literature available assessing hepatitis B prevalence of immunity in NCAA athletes. Hepatitis B immunization data from local NCAA Division I and III athletes were analyzed from the years 2016-2023 through Epic chart review. The age range of the cohort was set at 18-24, upon time of evaluation. An Epic Reportwriter ran a SlicerDicer query searching for athletes who presented to our healthcare system clinic and/or training room facilities meeting the appropriate criteria outlined above. All NCAA sports were included. Data obtained included gender, race, country of birth, hepatitis B vaccination records, and hepatitis B surface antibodies if available. We had a total of 379 athletes. The median age for the cohort was 20 years. Overall, 64.6% of the athletes had received the hepatitis B vaccine. Only 4 athletes (1.06%) had hepatitis B surface antibody results available in their chart. All 4 of those athletes had a negative titer. A majority of the athletes in this study had completed their hepatitis B vaccination. While 64.6% of athletes were vaccinated, the healthcare system needs to do a better job addressing vaccine adherence and hesitancy to prevent future outbreaks.

Assessing the ecological patterns of Aedes aegypti in areas with high arboviral risks in the large city of Abidjan, Côte d’Ivoire

Background The city of Abidjan, Côte d’Ivoire has increasingly faced multiple outbreaks of Aedes mosquito-borne arboviral diseases (e.g., dengue (DEN) and yellow fever (YF)) during the recent years, 2017–2023. Thus, we assessed and compared Aedes aegypti larval and adult population dynamics and Stegomyia indices in four urbanized areas with differential arboviral incidences in Abidjan, Côte d’Ivoire. Methods From August 2019 to July 2020, we sampled Aedes mosquito immatures (larvae and pupae), adults and breeding habitats in Anono and Gbagba with high arboviral incidences and Ayakro and Entente with low arboviral incidences in the Abidjan city, using standardized methods. Sampling was conducted in the peridomestic and domestic (indoors and outdoors) premises during short dry season (SDS), short rainy season (SRS), long dry season (LDS) and long rainy season (LRS). The abdomens and ovaries of Ae. aegypti females were examined to determine their blood-meal and parity statuses. Stegomyia indices (container index: CI, house index: HI and Breteau index: BI), blood-meal status and parity rates were compared by study sites and seasons and with the World Health Organization (WHO)-established epidemic thresholds. Results Overall, Aedes and arboviral risk indices were high and similar between the four study areas. In total, 86,796 mosquitoes were identified and dominated by Ae. aegypti species (97.14%, 84,317/86,796). The most productive larval breeding habitats were tires, discarded containers and water storage containers. CI, HI, and BI in Anono (22.4%, 33.5% and 89.5), Ayakro (23.1%, 43.8% and 91.0), Entente (15.9%, 24.8% and 48.5) and Gbagba (23.3%, 43.0% and 102.0) were high in the respective study sites. Stegomyia indices were higher than the WHO-established epidemic thresholds during any seasons for DEN, and LRS and SRS for YF. The numbers of Ae. aegypti-positive breeding sites were higher in the domestic premises (68.0%, 900/1,324) than in the peridomestic premises (32.0%, 424/1,324). In the domestic premises, Ae. aegypti-positive breeding sites (94.6%, 851/4,360) and adult individuals (93.4%, 856/916) were mostly found outdoors of houses. Aedes aegypti adult females were mostly unfed (51.3%, 203/396), followed by blood-fed (22.2%, 88/396), gravid (13.9%, 55/396) and half-gravid (12.6%, 50/396), and had parity rate of 49.7% (197/396) that was comparable between the study sites. Conclusions The city of Abidjan, Côte d’Ivoire is highly infested with Ae. aegypti which showed comparable ecological patterns across study sites and seasons. Thus, the local communities are exposed to high and permanent risks of transmission of DEN and YF viruses that were above the WHO-established epidemic thresholds throughout. The results provide a baseline for future vector studies needed to further characterize the observed patterns of local Ae. aegypti abundances and behaviors, and risks of transmission of these arboviruses. Community-based larval source management of identified productive containers might reduce Ae. aegypti numbers and risks of transmission of Aedes-borne arboviruses in Abidjan, and other sub-Saharan African cities.

Therapeutics for Nipah virus disease: a systematic review to support prioritisation of drug candidates for clinical trials.

Nipah virus disease is a bat-borne zoonosis with person-to-person transmission, a case-fatality rate of 38-75%, and well recognised potential to cause a pandemic. The first reported outbreak of Nipah virus disease occurred in Malaysia and Singapore in 1998, which has since been followed by multiple outbreaks in Bangladesh and India. Todate, no therapeutics or vaccines have been approved to treat Nipah virus disease, and only few such candidates are in development. In this Review, we aim to assess the safety and efficacy of the therapeutic options (monoclonal antibodies and small molecules) for Nipah virus disease and other henipaviral diseases to support prioritisation of drug candidates for further evaluation in clinical trials. At present, sufficient evidence exists to suggest trialling 1F5, m102.4, and remdesivir (alone or in combination) for prophylaxis and early treatment of Nipah virus disease. In addition to well designed clinical efficacy trials, in-vivo pharmacokinetic-pharmacodynamic studies are needed to optimise the selection and dosing of therapeutic candidates in animal challenge and natural human infection.

Dengue virus transmission during non-outbreak period in Dar Es Salaam, Tanzania: a cross-sectional survey

BackgroundTanzania has experienced multiple dengue outbreaks between 2010 and 2019, caused by various dengue virus (DENV) strains. In 2019, there were 6917 confirmed dengue cases and 13 deaths in Tanzania. Routine diagnosis of dengue fever is unfortunately excluded, particularly during non-outbreak periods, resulting in delayed outbreak detection and control. The aim of this study was to improve early detection and control measures for DENV by investigating its circulation in human and Aedes aegypti (A.aegypti) mosquitoes during the non-outbreak periods in Dar es Salaam, Tanzania, which is an area frequently affected by dengue outbreaks.MethodsFour hundred and fifteen (415) blood samples were collected from patients attending randomly selected health facilities in five wards; Azimio, Keko, Mtoni, Mbagala and Chamazi within Temeke district. The samples were tested for DENV NS1 antigen and anti-dengue IgM and IgG antibodies by rapid test. Then, 150 out of 415 blood samples were tested for the DENV by conventional Reverse Transcriptase Polymerase Chain Reaction (RT-PCR). Two thousand two hundred and fifty (2,250) adult female A.aegypti mosquitoes were collected using a Prokopack aspirator and BG sentinel trap or obtained after rearing immature stages and tested, in pools of 15 for DENV by RT-PCR. Statistical Software, SPSS version 23, was used for data analysis.ResultsOf the tested blood samples, 17% (71/415) were positive by NS1 antigen, 0.5% (2/415) by IgM, 0.5% (2/415) by IgG antibodies, and 0.5% (2/415) by IgM and IgG. None of the samples tested positive by DENV RT-PCR. Moreover, 3.3% (5/150) of tested mosquito pools had DENV by RT-PCR. Individuals aged between 21 and 40 years of age had increased risk of testing positive for DENV NS1 antigen, followed by those aged 5–20 years old, particularly those residing from Azimio ward, Keko ward, Mtoni ward and Mbagala ward, p-value ≤ 0.05.ConclusionFindings from this study revealed evidence of DENV circulation during non-outbreak periods in Dar es Salaam, Tanzania. These findings underscore the importance of including testing for dengue infection in routine differential diagnoses of febrile cases, and also frequent dengue surveillance in mosquitos. This proactive approach will help early DENV outbreak detection and control in the country.

Investigating Transmission Patterns and Genome Sequencing of SARS-CoV-2 in University College Dublin

Abstract Background This study describes the investigation and management of multiple outbreaks of SARS-Cov2 during the second and third wave of the pandemic at University College Dublin, Ireland from September 2020 to September 2021. Methods Relevant data were gathered as part of the public health outbreak investigations led by the UCD Internal Covid Control Team (ICCT) in collaboration with the public health teams of the Health Service Executive (HSE). Results are presented for PCR (polymerase chain reaction) confirmed cases and their close contacts, reported to the UCD ICCT between September 2020 to September 2021. Results There were 214 cases notified to ICCT. Among these, 153 cases were in residence on-campus cases. 73 epidemiologically linked clusters identified, where the number of cases linked with each cluster varied between 1 to 27. Additional cases during this period had no obvious epidemiological link to the identified clusters. Of 902 close contacts with PCR test results, 31.5% (n = 284) tested positive. 77% (n = 219) self-reported with mild to moderately symptoms while 23% (n = 65) self-reported as asymptomatic. Retrospective Whole Genome Sequence (WGS) analysis was undertaken after the outbreaks had subsided. The test positive cases were grouped into 6 clusters, and it was shown that many of the apparent sporadic cases were included in these clusters. Conclusions The proportion of close contacts testing positive varied significantly throughout the pandemic, with testing policy and type of exposure having the greatest impact. Whole genome sequencing can give a better understanding of webs of transmission to complement epidemiological investigations. It is now possible to undertake sequencing in real time where it can make a contribution to outbreak control and resolution. Public Health professionals should become familiar with WGS and bioinformatics as useful tools in their armory for the control of all communicable diseases not only SARS-CoV-2. Key messages • Combined epidemiological investigations and Whole Genome Sequencing (WGS) provide crucial insights into campus COVID-19 outbreaks, guiding effective control measures. • WGS integration enhances understanding of transmission patterns, identifies clusters, and equips public health professionals with data-driven approaches for outbreak management beyond SARS-CoV-2.

Readiness to manage Ebola Virus Disease among emergency healthcare workers in Uganda: a nationwide multicenter survey

BackgroundEmerging infectious diseases like the Ebola Virus Disease (EVD) pose significant global public health threats. Uganda has experienced multiple EVD outbreaks, the latest occurring in 2022. Frontline healthcare workers (HCWs) are at increased risk, yet there is insufficient evidence of existing knowledge of EVD of these HCWs. We aimed to assess the readiness of Uganda’s emergency HCWs to manage EVD and identify their training needs to inform targeted capacity-building interventions for future outbreaks.MethodsThis multicentre nationwide cross-sectional study was conducted from July to September 2023 among HCWs providing emergency care in 14 secondary and tertiary hospitals across Uganda. Participants were consecutively recruited using the probability-proportional-to-size sampling technique, and data was collected using a self-reported questionnaire. Factors associated with EVD knowledge were identified through a mixed-effect linear model.ResultsData from 691 eligible HCWs with a median age of 32 (IQR: 28–38) was analyzed (response rate: 92%). Only one-third (34.4%, n = 238) had received EVD training in the past year. The median EVD knowledge score was 77.4% (IQR: 71.2 − 83.4%). EVD knowledge was associated with longer professional experience in years (β: 0.21, 95% CI: 0.03 to 0.39, p = 0.024) and higher level of education: diploma (β: 3.37, 95% CI: 1.49 to 5.25, p < 0.001), undergraduate degree (β: 6.45, 95% CI: 4.11 to 8.79) and postgraduate degree (β: 7.13, 95% CI: 4.01 to 10.25, p < 0.001). Being a doctor (β: 2.55, 95% CI: 0.35 to 4.74, p = 0.023), providing care in the obstetrics/gynecology department (β: −1.90, 95% CI: −3.47 to − 0.32, p = 0.018), previous EVD training (β: 2.27, 95% CI: 0.96 to 3.59, p = 0.001) and accessing EVD information through social media (β: 2.52, 95% CI: 1.17 to 3.88, p < 0.001) were also significantly associated with EVD knowledge. HCWs were mostly interested in training on management (92.9%), infection prevention and control (87.1%), and clinical presentation (84.1%), and preferred physical (51.5%) and hybrid (38.2%) training modes.ConclusionOur study shows that the readiness of HCWs in Uganda to respond to EVD outbreaks varies by individual factors and information sources. We recommend targeted training and suggest future research on educational innovations and social media’s potential to fill knowledge gaps.

Yellow fever in Ghana: Predicting emergence and ecology from historical outbreaks.

Understanding the epidemiology and ecology of yellow fever in endemic regions is critical for preventing future outbreaks. Ghana is a high-risk country for yellow fever. In this study we estimate the disease burden, ecological cycles, and areas at risk for yellow fever in Ghana based on historical outbreaks. We identify 2387 cases and 888 deaths (case fatality rate 37.7%) from yellow fever reported in Ghana from 1910 to 2022. During the approximately 30-year periods before and after implementation of routine childhood vaccination in 1992, the reported mean annual number of cases decreased by 80%. The geographic distribution of yellow fever cases has also changed over the past century. While there have been multiple large historical outbreaks of yellow fever in regions throughout Ghana, recent outbreaks have originated in northern regions. Comparing the locations where yellow fever outbreaks have emerged, we find patterns with seasons and different ecological transmission cycles. Using an ecological niche modeling framework, we predict areas in Ghana that are similar to where prior yellow fever outbreaks have originated based on temperature, precipitation, vegetation, and human population density. We find that these predictions differ depending on the ecological cycles of outbreaks. Ultimately, these findings and methods could be used to inform further subnational risk assessments for yellow fever in Ghana and other high-risk countries.

Genomic Analysis of Aeromonas salmonicida ssp. salmonicida Isolates Collected During Multiple Clinical Outbreaks Supports Association with a Single Epidemiological Unit.

Outbreaks of furunculosis cause significant losses in salmonid aquaculture worldwide. With a recent rise in antimicrobial resistance, regulatory measures to minimize the use of antibiotics in animal husbandry, including aquaculture, have increased scrutiny and availability of veterinary medical products to control this disease in production facilities. In such a regulatory environment, the utility of autogenous vaccines to assist with disease prevention and control as a veterinary-guided prophylactic measure is of high interest to the producers and veterinary services alike. However, evolving concepts of epidemiological units and epidemiological links need to be considered during approval and acceptance procedures for the application of autogenous vaccines in multiple aquaculture facilities. Here, we present the results of solid-state nanopore sequencing (Oxford Nanopore Technologies, ONT) performed on 54 isolates of Aeromonas salmonicida ssp. salmonicida sampled during clinical outbreaks of furunculosis in different aquaculture facilities from Bavaria, Germany, from 2017 to 2020. All of the performed analyses (phylogeny, single nucleotide polymorphism and 3D protein modeling for major immunogenic proteins) support a high probability that all studied isolates belong to the same epidemiological unit. Simultaneously, we describe a cost/effective method of whole genome analysis with the usage of ONT as a viable strategy to study outbreaks of other pathogens in the field of aquatic veterinary medicine for the purpose of developing the best autogenous vaccine candidates applicable to multiple aquaculture establishments.

Identifying Candida auris transmission in a hospital outbreak investigation using whole-genome sequencing and SNP phylogenetic analysis.

Candida auris poses a global public health challenge, causing multiple outbreaks within healthcare facilities. Despite advancements in strain typing for various infectious diseases, a consensus on the genetic relatedness threshold for identifying C. auris transmission in local hospital outbreaks remains elusive. We investigated genetic variations within our local isolate collection using whole-genome-based single nucleotide polymorphism (SNP) phylogenetic analysis. A total of 74 C. auris isolates were subjected to whole-genome sequencing (WGS) and SNP phylogenetic analysis via the QIAGEN CLC Genomics Workbench. Isolates included known related strains from the same patient, strains from different hospitals, strains from our hospital patients with no epidemiological link, and 19 patient isolates from a recent C. auris outbreak. All but three isolates were identified to be Clade IV. By examining the genetic diversities of C. auris within patients and between patients, we identified a SNP variation range of 0-13 for identifying related isolates. During an outbreak investigation, utilizing this range, maximum likelihood phylogenetic analysis revealed two distinct clusters that aligned with the epidemiological links. Determining a SNP variation range to delineate genetic relatedness among isolates is crucial for the application of WGS and SNP phylogenetic analysis in identifying C. auris transmission during hospital outbreak investigations. The use of WGS SNP phylogenetic analysis via the CLC Genomics Workbench has emerged as a valuable method for typing C. auris in clinical microbiology laboratories.

Hot topic: Influenza A H5N1 virus exhibits a broad host range, including dairy cows

The widespread circulation of highly pathogenic avian influenza (HPAI) H5N1 clade 2.3.4.4b in wild birds in North America since late 2021 has resulted in multiple outbreaks in commercial and backyard poultry leading to major economic losses. Since the emergence of the virus in North America, multiple reassortment events have led to the emergence of many new variant genotypes that have been isolated from wild birds, with several viruses spilling over into poultry and other terrestrial and aquatic mammalian hosts. Notably, the most recent emerging HPAI H5N1 reassortant genotype B3.13 spilled over into dairy cattle (Bos taurus), resulting in unprecedented efficient transmission of the virus in this species, the first case of sustained transmission in a mammalian species. The transmission pathways involved in the spread of the virus from its first detection in Texas to several other states are complex. However, movement of subclinically infected cattle likely played a major role in virus spread. Infection in dairy cattle is characterized by the virus's tropism for milk-secreting cells in the mammary gland, leading to high viral load and shedding in milk. Replication of the virus in milk-secreting cells results in destruction of infected cells leading to severe viral mastitis, which is characterized by marked changes in milk quality (altered consistency and color) and pronounced decline in milk production by clinically affected animals. Here, we provide an overview of the HPAI H5N1 panzootic virus and discuss its host range and the current knowledge of its pathogenesis in the new bovine host.

Ontology-Based Data Collection for a Hybrid Outbreak Detection Method Using Social Media.

Given the persistent global challenge presented by rapidly spreading diseases, as evidenced notably by the widespread impact of the COVID-19 pandemic on both human health and economies worldwide, the necessity of developing effective infectious disease prediction models has become of utmost importance. In this context, the utilization of online social media platforms as valuable tools in healthcare settings has gained prominence, offering direct avenues for disseminating critical health information to the public in a timely and accessible manner. Propelled by the ubiquitous accessibility of the internet through computers and mobile devices, these platforms promise to revolutionize traditional detection methods, providing more immediate and reliable epidemiological insights. Leveraging this paradigm shift, our proposed framework harnesses Twitter data associated with infectious disease symptoms, employing ontology to identify and curate relevant tweets. Central to our methodology is a hybrid model that integrates XGBoost and Bidirectional Long Short-Term Memory (BiLSTM) architectures. The integration of XGBoost addresses the challenge of handling small dataset sizes, inherent during outbreaks due to limited time series data. XGBoost serves as a cornerstone for minimizing the loss function and identifying optimal features from our multivariate time series data. Subsequently, the combined dataset, comprising original features and predicted values by XGBoost, is channeled into the BiLSTM for further processing. Through extensive experimentation with a dataset spanning multiple infectious disease outbreaks, our hybrid model demonstrates superior predictive performance compared to state-of-the-art and baseline models. By enhancing forecasting accuracy and outbreak tracking capabilities, our model offers promising prospects for assisting health authorities in mitigating fatalities and proactively preparing for potential outbreaks.

A far ultraviolet-C light technology is effective for decontamination of items in proximity to sinks and is enhanced by a far UV-C reflective surface.

Dispersal of gram-negative bacilli from sink drains has been implicated as a source of transmission in multiple outbreaks. In an acute care hospital, we assessed how often patient care supplies and other frequently touched items were within 1 meter of sink drains. We tested the efficacy of a ceiling-mounted far ultraviolet-C (UV-C) light technology for decontamination of sink bowls and surfaces near sinks with and without a wall-mounted film that reflects far UV-C light. Of 190 sinks assessed, 55 (29%) had patient care supplies or other frequently touched items within 1 meter of the drain. The far UV-C technology reduced Pseudomonas aeruginosa, Enterobacter cloacae and Candida auris on steel disk carriers by ≥1.5 log10 colony-forming units (CFU) in 45 minutes. On inoculated real-world items, ≥1.9 log10 CFU reductions in P. aeruginosa were achieved on sites in line with the light source versus 0.4-1.8 log10 CFU reductions on shaded surfaces. The addition of the reflective surface significantly enhanced efficacy in shaded sites (P < 0.01). In a hospital setting, patient care supplies and other frequently touched items were often in proximity to sinks. The far UV-C light technology could potentially be useful for sink decontamination in high-risk areas.

Environmental contamination with carbapenem resistant Acinetobacter baumannii in healthcare settings in Fiji: a potential source of infection.

There are multiple ongoing outbreaks of carbapenem resistant Acinetobacter baumannii (CRAb) infection in Fiji's hospitals. CRAb is able to colonize and persist on various hospital surfaces for extended periods. We conducted a study to understand the extent of hospital environmental contamination and phylogenetic links with clinical isolates. Swabs were collected from high-touch surfaces at Colonial War Memorial Hospital (CWMH) September 2021 and December 2022; Lautoka Hospital (LTKH) August 2022; and Labasa Hospital (LBSH) November 2022. All bacterial isolates were identified, and antimicrobial susceptibility testing (AST) performed; isolates resistant to carbapenems and producing a carbapenemase underwent whole genome sequencing. Comparison was made to clinical isolates obtained from CWMH in 2016-2017 and 2019-2021 and from LTKH and LBSH from 2020-2021. From the 180 environmental samples collected, ten (5.6%) CRAb were isolated; no other carbapenem-resistant gram-negative organisms were isolated. Seven (70%) of the CRAb were isolated from CWMH and three (30%) from LTKH; no CRAb were isolated from LBSH. Of the seven CWMH CRAb, two were sequence type 2 (ST2), three ST25, and two ST499. All LTKH isolates were ST499. The two environmental CRAb ST2 isolates were closely genetically linked to isolates obtained from patients in CWMH, LTKH, and LBSH 2020-2021. Similarly, the three environmental CRAb ST25 isolates were closely genetically linked to isolates obtained from patients admitted to CWMH in 2019-2021 and LBSH in 2020. The environmental CRAb ST499 isolates represented two distinct clones, with clone 1 comprising two genetically identical isolates from CWMH and clone 2 the three isolates from LTKH. Although no genetic linkages were observed when comparing environmental ST499 isolates to those from CWMH patients in 2020-2021, both clone 1 isolates were genetically identical to an isolate obtained from a patient admitted during the sampling period. Our study highlights the contamination of high-touch surfaces within Fiji hospitals with CRAb, suggesting that these may serve as important sources for CRAb. Phylogenetic linkages to CRAb isolated from patients since 2019 underscores the persistence of this resistant pathogen in hospital settings and the ongoing risk for hospital-acquired infections.

Re-emerging Chandipura vesiculovirus: A cause of concern for global health.

Chandipura vesiculovirus(CHPV) is an emerging neurotropic virus primarily affecting children and causing acute encephalitis syndrome (AES) in India. The virus, transmitted mainly by sand flies, has led to multiple outbreaks with high mortality rates, particularly in rural and resource-limited settings. CHPV infection is characterized by rapid disease progression, with symptoms ranging from fever and seizures to coma and death, often within 24 to 48h of onset. The current management of CHPV is limited to supportive care due to the lack of specific antiviral therapies. Diagnosis relies on laboratory methods such as RT-PCR, serology, and immunofluorescence, though these face challenges due to the rapid progression of the disease and the need for timely sample collection and analysis. Prevention strategies are focused on vector control through insecticide use and public health interventions, including community education and early detection programs. Despite some progress in understanding CHPV, significant research gaps remain, particularly in developing effective antiviral treatments and vaccines, understanding transmission dynamics, and improving diagnostic capabilities. The potential for the virus to spread globally due to factors like climate change and increased human movement underscores the need for international collaboration in surveillance and response efforts. Strengthening public health infrastructure, enhancing vector control measures, and fostering global partnerships are crucial steps toward mitigating the impact of CHPV and preventing future outbreaks. Continued research and proactive public health strategies are essential to protect vulnerable populations and control the spread of this potentially deadly virus.

Jardin Royal Garden Retirement Home: Success Amid Burnout in Canadian Retirement Homes During the COVID-19 Pandemic

The COVID-19 pandemic has had many long-term effects on various sectors, but its impact was particularly devastating in retirement homes. Jardin Royal Garden is a retirement home in Ottawa, Canada, and was among the few homes not to have experienced a single case of COVID-19 during the peak of the pandemic while other retirement homes in the region battled multiple outbreaks. The success of their strategy is largely a result of a proactive approach and the trust and relationships between management, employees, residents, and residents’ families.

Opioid Overdose Patients in Central Missouri, United States, Have High Rates of Hepatitis C Infection and Limited Testing History.

Cases of newly identified hepatitis C virus (HCV) infection increased 3.8-fold between 2010 and 2017 due to increasing injection drug use. Furthermore, multiple HIV outbreaks have been attributed to injection drug use. This retrospective cohort study assessed the prevalence of and testing history for HIV and HCV among opioid overdose patients in the emergency department. Each encounter including an opioid overdose at three emergency departments between January 2021 and May 2022 was reviewed. Emergency department note, most recent primary care note, and laboratory results from January 2000 to May 2022 were reviewed for the history of HIV and HCV testing. Fisher's exact test was used to identify associations of HIV and HCV status with age or gender. There were 134 encounters for 120 patients. A total of 72 were male and 48 were female. A total of 48 had a history of HCV testing. A total of 54 had a history of HIV testing. A total of 20 tested positive for HCV antibodies. One tested positive for HIV. Eight had detectable HCV viral loads, six had undetectable HCV viral loads, and six had no quantitative testing. One had a detectable HIV viral load. A total of 16.7% of both males and females had a history of a positive HCV test. Females were more likely to have ever received an HCV test compared to males (p=0.013, odds ratio (OR)=.68 (confidence interval (CI): 1.293-5.836)). Patients aged 55-64 were more likely to test positive than any other age group (p=0.018, OR=3.889 (CI: 1.391-11.81)), and were the least likely to be untested (p=0.037, OR=0.1905 (CI: 0.03914-0.9334)). There is a substantial burden of HCV among opioid overdose patients in central Missouri, United States, emergency departments, particularly among male patients and those aged 55-64. Universal HCV screening for individuals being observed following an overdose could detect many undiagnosed HCV infections.

Reemergence of a Big Brown Bat Lyssavirus rabies Variant in Striped Skunks in Flagstaff, Arizona, USA, 2021-2023.

Background: Throughout the Americas, Lyssavirus rabies (RV) perpetuates as multiple variants among bat and mesocarnivore species. Interspecific RV spillover occurs on occasion, but clusters and viral host shifts are rare. The spillover and host shift of a big brown bat (Eptesicus fuscus) RV variant Ef-W1 into mesocarnivores was reported previously on several occasions during 2001-2009 in Flagstaff, Arizona, USA, and controlled through rabies vaccination of target wildlife. During autumn 2021, a new cluster of Ef-W1 RV cases infecting striped skunks (Mephitis mephitis) was detected from United States Department of Agriculture enhanced rabies surveillance in Flagstaff. The number of Ef-W1 RV spillover cases within a short timeframe suggested the potential for transmission between skunks and an emerging host shift. Materials and Methods: Whole and partial RV genomic sequencing was performed to evaluate the phylogenetic relationships of the 2021-2023 Ef-W1 cases infecting striped skunks with earlier outbreaks. Additionally, real-time reverse-transcriptase PCR (rtRT-PCR) was used to opportunistically compare viral RNA loads in brain and salivary gland tissues of naturally infected skunks. Results: Genomic RV sequencing revealed that the origin of the 2021-2023 epizootic of Ef-W1 RV was distinct from the multiple outbreaks detected from 2001-2009. Naturally infected skunks with the Ef-W1 RV showed greater viral RNA loads in the brain, but equivalent viral RNA loads in the mandibular salivary glands, compared to an opportunistic sample of skunks naturally infected with a South-Central skunk RV from northern Colorado, USA. Conclusion: Considering a high risk for onward transmission and spread of the Ef-W1 RV in Flagstaff, public outreach, enhanced rabies surveillance, and control efforts, focused on education, sample characterization, and vaccination, have been ongoing since 2021 to mitigate and prevent the spread and establishment of Ef-W1 RV in mesocarnivores.