Containment Of Outbreak Research Articles

Exploring the scope and utility of digital proximity tracing in the effective containment of COVID-19 infection: A narrative review.

The ongoing coronavirus disease-2019 (COVID-19) pandemic can be acknowledged as one of the most significant public health emergencies the world has encountered in the last few decades. The purpose of the current review is to understand the significance of contact tracing and explore the pros and cons of digital contact tracing in ensuring better containment of the COVID-19 outbreaks. A widespread search of published articles pertaining to the topic was done in the PubMed search engine and a total of 46 articles matching the objectives of the present review were identified. However, four articles were discarded because of the non-availability of the free full text, and thus 42 research papers were finally included. Digital contact tracing bridges the gap wherein we aim to expedite the process of contact tracing to identify the potential contacts of the confirmed cases. These applications are designed in such a way that they send a notification on the smartphone of a person, once the user is exposed to one or more confirmed cases of COVID-19. To conclude, in the battle against the COVID-19 infection, the international welfare agencies and national policy makers have been looking forward to the employment of digital technologies to support the ongoing public health measures for contact tracing. The approach of digital contact/proximity tracing should be considered as a supplement to conventional manual tracing. The need of the hour is to take specific measures to improve the inherent design of these apps, their implementation and demonstration of their effectiveness, which in turn will play a part in enhancing their acceptance and usability among the general population.

Epidemiologists as Key Partners for Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-COV-2) Outbreak Containment in North Texas Healthcare Facilities

BackgroundSevere acute respiratory syndrome coronavirus 2 (SARS-COV-2) virus has been detected in North Texas healthcare facilities (HCFs) since March 2020. As infection control guidance for this novel virus changes frequently, continued education is essential for HCF administration and staff. The regional health department provides services to 37 counties. One healthcare associated infections (HAI) epidemiologist provided support to the region until January 2021 when an additional HAI epidemiologist joined the team to increase capacity.MethodsBeginning March 2020, a regional epidemiology healthcare team was created to conduct remote and onsite infection control assessments (ICARs) at HCFs in North Texas. The team includes epidemiologists and board-certified infection preventionists. Every team member received remote ICAR training from the senior HAI epidemiologist through ICAR shadowing and return demonstration. Response and proactive ICARs were conducted using templates for the ICAR, infection control guidance, and case tracking. To ensure consistent messaging, weekly conference calls were held to discuss guidance changes or questions from team members. Facilities were monitored until 28 days after the last exposure to a positive COVID-19 case.ResultsFrom March 2020 through September 2021, the region investigated 480 reported SARS-COV-2 outbreaks in HCFs. Of those, 93% (n=445) had at least one case. Of the 445 HCFs with cases, 67% (n=300) had at least one resident positive, and 91% (n=407) had a least one staff positive for SARS-COV-2. The longest monitoring period was 400 days. Hospitalizations occurred in 113 outbreaks. At least one death occurred in 115 outbreaks. ICARs were conducted for 71% (n=314) of the outbreaks.ConclusionsThe addition of epidemiologists and certified infection preventionists on the regional epidemiology healthcare team increased the regional capacity to respond to the 445 HCF outbreaks. A designated trainer and standardized templates allowed for consistent implementation of infection control guidance throughout the region.

Containment of a Multi-facility Outbreak of Candida Auris in a Texas Metropolitan Area During COVID-19 Pandemic

BackgroundDuring the coronavirus disease 2019 (COVID-19) pandemic, healthcare facilities are experiencing shortages of staff, personal protective equipment (PPE), environmental disinfectants, and patient beds. Candida auris, a fungus often resistant to common antifungals, requires staff to wear gown and gloves and use the correct surface disinfectant. A regional epidemiology approach is needed when a multi-facility outbreak occurs.MethodsIn May 2021, an acute care hospital reported a clinical C. auris case to the local health department (LHD). Discussions were initiated between LHD and state partners on the Centers for Disease Control and Prevention (CDC) tiered C. auris approach. Infection Control Assessment Responses (ICARs) were conducted at identified facilities and point prevalence studies were initiated upon identification of infection control gaps. LHD implemented aggressive colonization testing and isolation protocol after discussions with CDC and state partners. Active surveillance was implemented throughout the jurisdiction. An interfacility transfer form helped communicate isolation needs during patient transfers. C. auris isolates confirmed at the state laboratory were sent to the Antibiotic Resistance (AR) Laboratory Network laboratory. Whole genome sequencing (WGS) was performed by the CDC Laboratory.ResultsFrom May through October 2021, the LHD received 149 C. auris case reports. Collection dates ranged from May 1, 2021, to October 15, 2021. Sixteen were clinical cases and 133 were colonized cases. Of the 149 cases, 55% (n=82) were males. Ages ranged from 24 years to 90 years with a mean and median of 65 years. Of the 1725 screening swabs tested, 8% (n=133) were positive for C. auris. Twenty-two ICARs were conducted. WGS was performed on 15 isolates, which showed relatedness between the isolates.ConclusionsAR testing helped epidemiologists identify colonized C. auris cases that would have otherwise not been identified. WGS results supported the epidemiology data showing relatedness between the cases and indicated transmission within and between facilities.

Monkeypox: considerations for the understanding and containment of the current outbreak in non-endemic countries.

The neglected and rare zoonotic disease caused by monkeypox virus (MPV) has recently spread widely, resulting in the largest known monkeypox outbreak outside of Africa, where it is endemic. MPV belongs to the Poxviridae family, genus Orthopoxvirus. At least two different clades have been identified, each having different fatality rates but recent cases are all phylogenetically related to the West African clade. MPV is transmitted directly by either person-to-person, -animal, or virus-contaminated fomite contact. The disease is often self-limited, and clinical symptoms include fever, skin lesions, and lymphadenopathies. At present, no deaths have been associated with the current outbreak. MPV DNA detection using molecular techniques is recommended for diagnosis. At least two approved drugs for antiviral therapy are available in the USA. Two different vaccines, including the vaccine used in the past for smallpox eradication and a new formulation more recently approved based on a live but non-replicating virus, are available that provide immunity to MPV. These and other clinical and public health considerations pertaining to the recent monkeypox outbreaks together with aspects of MPV biology are discussed in this article.

SCoVMod - a spatially explicit mobility and deprivation adjusted model of first wave COVID-19 transmission dynamics.

Background: Mobility restrictions prevent the spread of infections to disease-free areas, and early in the coronavirus disease 2019 (COVID-19) pandemic, most countries imposed severe restrictions on mobility as soon as it was clear that containment of local outbreaks was insufficient to control spread. These restrictions have adverse impacts on the economy and other aspects of human health, and it is important to quantify their impact for evaluating their future value. Methods: Here we develop Scotland Coronavirus transmission Model (SCoVMod), a model for COVID-19 in Scotland, which presents unusual challenges because of its diverse geography and population conditions. Our fitted model captures spatio-temporal patterns of mortality in the first phase of the epidemic to a fine geographical scale. Results: We find that lockdown restrictions reduced transmission rates down to an estimated 12\% of its pre-lockdown rate. We show that, while the timing of COVID-19 restrictions influences the role of the transmission rate on the number of COVID-related deaths, early reduction in long distance movements does not. However, poor health associated with deprivation has a considerable association with mortality; the Council Area (CA) with the greatest health-related deprivation was found to have a mortality rate 2.45 times greater than the CA with the lowest health-related deprivation considering all deaths occurring outside of carehomes. Conclusions: We find that in even an early epidemic with poor case ascertainment, a useful spatially explicit model can be fit with meaningful parameters based on the spatio-temporal distribution of death counts. Our simple approach is useful to strategically examine trade-offs between travel related restrictions and physical distancing, and the effect of deprivation-related factors on outcomes.

BacMam Expressing Highly Glycosylated Porcine Interferon Alpha Induces Robust Antiviral and Adjuvant Effects against Foot-and-Mouth Disease Virus in Pigs.

Foot-and-mouth disease (FMD) is an acute contagious disease that affects cloven-hoofed animals and has severe global economic consequences. FMD is most commonly controlled by vaccination. Currently available commercial FMD vaccines contain chemically inactivated whole viruses, which are thought to be slow acting as they are effective only 4 to 7 days following vaccination. Hence, the development of a novel rapid vaccine or alternative measures, such as antiviral agents or the combination of vaccines and antiviral agents for prompt FMD virus (FMDV) outbreak containment, is desirable. Here, we constructed a recombinant baculovirus (BacMam) expressing consensus porcine interferon alpha (IFN-α) that has three additional N-glycosylation sites driven by a cytomegalovirus immediate early (CMV-IE) promoter (Bac-Con3N IFN-α) for protein expression in mammalian cells. Bac-Con3N IFN-α expressing highly glycosylated porcine IFN-α protein increased the duration of antiviral effects. We evaluated the antiviral effects of Bac-Con3N IFN-α in swine cells and mice and observed sustained antiviral effects in pig serum; additionally, Bac-Con3N IFN-α exhibited sustained antiviral effects in vivo as well as adjuvant effects in combination with an inactivated FMD vaccine. Pigs injected with a combination of Bac-Con3N IFN-α and the inactivated FMD vaccine were protected against FMDV at 1, 3, and 7 days postvaccination. Furthermore, we observed that in combination with the inactivated FMD vaccine, Bac-Con3N IFN-α increased neutralizing antibody levels in mice and pigs. Therefore, we suggest that Bac-Con3N IFN-α is a strong potential antiviral and adjuvant candidate for use in combination with inactivated FMD vaccines to protect pigs against FMDV. IMPORTANCE Early inhibition of foot-and-mouth disease (FMD) virus (FMDV) replication in pigs is highly desirable as FMDV transmission and shedding rates are higher in pigs than in cattle. However, commercial FMD vaccines require at least 4 to 7 days postvaccination (dpv) for protection, and animals are vulnerable to heterologous viruses before acquiring high antibody levels after the second vaccination. Therefore, the development of antiviral agents for use in combination with FMD vaccines is essential. We developed a novel antiviral and immunostimulant, Bac-Con3N IFN-α, which is a modified porcine IFN-α-expressing recombinant baculovirus, to improve IFN stability and allow its direct delivery to animals. We present a promising candidate for use in combination with inactivated FMD vaccines as pigs applied to the strategy had early protection against FMDV at 1 to 7 dpv, and their neutralizing antibody levels were higher than those in pigs administered the vaccine only.

COVID-19 outbreak in a state prison: a case study on the implementation of key public health recommendations for containment and prevention

BackgroundPeople incarcerated in US prisons have been disproportionately harmed by the COVID-19 pandemic. That prisons are such efficient superspreading environments can be attributed to several known factors: small, communal facilities where people are confined for prolonged periods of time; poor ventilation; a lack of non-punitive areas for quarantine/medical isolation; and staggeringly high numbers of people experiencing incarceration, among others. While health organizations have issued guidance on preventing and mitigating COVID-19 infection in carceral settings, little is known about if, when, and how recommendations have been implemented. We examined factors contributing to containment of one of the first California prison COVID-19 outbreaks and remaining vulnerabilities using an adapted multi-level determinants framework to systematically assess infectious disease risk in carceral settings.MethodsCase study employing administrative data; observation; and informal discussions with: people incarcerated at the prison, staff, and county public health officials.ResultsOutbreak mitigation efforts were characterized by pre-planning (e.g., designation of ventilated, single-occupancy quarantine) and a quickly mobilized inter-institutional response that facilitated systematic, voluntary rapid testing. However, several systemic- and institutional-level vulnerabilities were unaddressed hindering efforts and posing significant risk for future outbreaks, including insufficient decarceration, continued inter-facility transfers, incomplete staff cohorting, and incompatibility between built environment features (e.g., dense living conditions) and public health recommendations.ConclusionsOur adapted framework facilitates systematically assessing prison-based infectious disease outbreaks and multi-level interventions. We find implementing some recommended public health strategies may have contributed to outbreak containment. However, even with a rapidly mobilized, inter-institutional response, failure to decarcerate created an overreliance on chance conditions. This left the facility vulnerable to future catastrophic outbreaks and may render standard public health strategies - including the introduction of effective vaccines - insufficient to prevent or contain those outbreaks.

Regional opening strategies with commuter testing and containment of new SARS-CoV-2 variants in Germany

BackgroundDespite the vaccination process in Germany, a large share of the population is still susceptible to SARS-CoV-2. In addition, we face the spread of novel variants. Until we overcome the pandemic, reasonable mitigation and opening strategies are crucial to balance public health and economic interests.MethodsWe model the spread of SARS-CoV-2 over the German counties by a graph-SIR-type, metapopulation model with particular focus on commuter testing. We account for political interventions by varying contact reduction values in private and public locations such as homes, schools, workplaces, and other. We consider different levels of lockdown strictness, commuter testing strategies, or the delay of intervention implementation. We conduct numerical simulations to assess the effectiveness of the different intervention strategies after one month. The virus dynamics in the regions (German counties) are initialized randomly with incidences between 75 and 150 weekly new cases per 100,000 inhabitants (red zones) or below (green zones) and consider 25 different initial scenarios of randomly distributed red zones (between 2 and 20% of all counties). To account for uncertainty, we consider an ensemble set of 500 Monte Carlo runs for each scenario.ResultsWe find that the strength of the lockdown in regions with out of control virus dynamics is most important to avoid the spread into neighboring regions. With very strict lockdowns in red zones, commuter testing rates of twice a week can substantially contribute to the safety of adjacent regions. In contrast, the negative effect of less strict interventions can be overcome by high commuter testing rates. A further key contributor is the potential delay of the intervention implementation. In order to keep the spread of the virus under control, strict regional lockdowns with minimum delay and commuter testing of at least twice a week are advisable. If less strict interventions are in favor, substantially increased testing rates are needed to avoid overall higher infection dynamics.ConclusionsOur results indicate that local containment of outbreaks and maintenance of low overall incidence is possible even in densely populated and highly connected regions such as Germany or Western Europe. While we demonstrate this on data from Germany, similar patterns of mobility likely exist in many countries and our results are, hence, generalizable to a certain extent.

Identification of novel Ebola virus inhibitors using biologically contained virus

Despite recent advancements in the development of vaccines and monoclonal antibody therapies for Ebola virus disease, treatment options remain limited. Moreover, management and containment of Ebola virus outbreaks is often hindered by the remote nature of the locations in which the outbreaks originate. Small-molecule compounds offer the advantage of being relatively cheap and easy to produce, transport and store, making them an interesting modality for the development of novel therapeutics against Ebola virus disease. Furthermore, the repurposing of small-molecule compounds, previously developed for alternative applications, can aid in reducing the time needed to bring potential therapeutics from bench to bedside. For this purpose, the Medicines for Malaria Venture provides collections of previously developed small-molecule compounds for screening against other infectious diseases. In this study, we used biologically contained Ebola virus to screen over 4,200 small-molecule drugs and drug-like compounds provided by the Medicines for Malaria Venture (i.e., the Pandemic Response Box and the COVID Box) and the Centre for Drug Design and Discovery (CD3, KU Leuven, Belgium). In addition to confirming known Ebola virus inhibitors, illustrating the validity of our screening assays, we identified eight novel selective Ebola virus inhibitors. Although the inhibitory potential of these compounds remains to be validated in vivo, they represent interesting compounds for the study of potential interventions against Ebola virus disease and might serve as a basis for the development of new therapeutics.

Containment of a carbapenem-resistant Acinetobacter baumannii complex outbreak in a COVID-19 intensive care unit

BackgroundA carbapenem-resistant Acinetobacter baumannii outbreak in the COVID intensive care unit of a community hospital was contained using multidrug resistant organism guidelines. The purpose of this study is to report on an outbreak investigation and containment strategy that was used, and to discuss prevention strategy.MethodsA multidisciplinary approach contained the spread of infection. Strategies implemented included consultation with experts, screening, and reversal of personal protective equipment conservation. Ensuring infection control best practices are maintained remain important efforts to reduce the spread of multidrug resistant organisms.ResultsFive patients with carbapenem-resistant Acinetobacter baumannii were identified from routine clinical cultures within one week and one patient was identified from active surveillance cultures.DiscussionPersonal protective equipment conservation, strategies to prevent health care personnel exposure, and patient surge staffing protocols may have increased the likelihood of multidrug resistant organism transmission. Environmental and behavioral infection control regulations with effective administrative guidance, active surveillance cultures, and antimicrobial stewardship are critical to prevent future outbreaks.ConclusionsAfter outbreak containment strategies were implemented, no additional patients were identified with carbapenem-resistant Acinetobacter baumannii. Conventional infection prevention and control strategies were re-instituted. A multidisciplinary approach with continued focus on hand hygiene, environmental cleaning, and correct use of personal protective equipment needs to be put in place to successfully contain and prevent the spread of carbapenem resistant infections.

Inference is bliss: Simulation for power estimation for an observational study of a cholera outbreak intervention.

The evaluation of ring vaccination and other outbreak-containment interventions during severe and rapidly-evolving epidemics presents a challenge for the choice of a feasible study design, and subsequently, for the estimation of statistical power. To support a future evaluation of a case-area targeted intervention against cholera, we have proposed a prospective observational study design to estimate the association between the strength of implementation of this intervention across several small outbreaks (occurring within geographically delineated clusters around primary and secondary cases named 'rings') and its effectiveness (defined as a reduction in cholera incidence). We describe here a strategy combining mathematical modelling and simulation to estimate power for a prospective observational study. The strategy combines stochastic modelling of transmission and the direct and indirect effects of the intervention in a set of rings, with a simulation of the study analysis on the model results. We found that targeting 80 to 100 rings was required to achieve power ≥80%, using a basic reproduction number of 2.0 and a dispersion coefficient of 1.0-1.5. This power estimation strategy is feasible to implement for observational study designs which aim to evaluate outbreak containment for other pathogens in geographically or socially defined rings.

How Taiwan Succeeded in Containing Its 2021 COVID-19 Outbreak

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), or coronavirus disease-2019 (COVID-19), emerged in December 2019 and has since then progressed into a global pandemic (Lai et al., 2020). However, the Taiwan model helped Taiwan contain the COVID-19 epidemic successfully for more than one year (Wu, 2020). Unexpectedly, sporadic cases began to emerge late April 2021, causing a large-scale COVID-19 outbreak in Taiwan (Kao, Shuhua, et al., 2021).
 
 With the help of technology and reinforced border control, level 3 alert, accessible healthcare system, contact tracing, and quarantines, Taiwan’s Central Epidemic Command Center contained the outbreak successfully within two months with the cooperation of the citizens. After the swift containment of the COVID-19 outbreak in Taiwan, there were significantly fewer locally transmitted COVID-19 cases, and the government and medical care units had become less weary. These measures to contain the outbreak helped Taiwan substantially by buying time to deploy against COVID-19, which is still a worldwide pandemic. Through analyzing Taiwan’s actions taken in containing an ongoing outbreak of COVID-19, better frameworks can be designed for other countries to decelerate the spread of COVID-19 or future emerging respiratory infectious diseases.

Utilization of Artificial Intelligence in Meeting the Challenges of COVID-19 Pandemic: A Quick Literature Review

The world is facing several challenges due to the COVID-19 pandemic, which is causing severe social and economic disruption. The disruption has resulted in recession, unemployment, and social isolation and has caused an extreme burden on health care services. Artificial intelligence (AI) has a promising role in the healthcare sector by bringing many advantages to practicing clinicians, patients, and society. This article aims to determine the role of artificial intelligence in the ongoing COVID-19 pandemic. A quantitative methodology is used, and a literature review is done by using electronic databases such as PubMed, Google Scholar, and Scopus. The keywords used for this data research are "artificial intelligence" and "COVID 19"; "COVID 19" and "artificial intelligence". The results have shown that artificial intelligence has been extensively used in seven major domains during the current ongoing COVID-19 pandemic. These include screening and detection of COVID-19 transmission dynamics, diagnostics, disease monitoring and forecasting, disease outbreak containment, disease recovery and mortality, treatment and vaccination, and protection of healthcare workers. Artificial intelligence is a transformational force in the medical field. It assists in early detection of disease, real-time surveillance, diagnosis, treatment, disease containment, development of treatment and vaccinations, and reducing morbidity and mortality. Artificial intelligence will help us in the future to meet many challenges in a timely fashion through the prediction of pandemics, making stakeholders worldwide well prepared to deal with epidemics and pandemics in a systematic and organized manner, avoiding economic turmoil and unnecessary morbidity and mortality.

The How Matters: Simulation-Based Assessment of the Potential Contributions of Lateral Flow Device Tests for Keeping Schools Open and COVID-Safe in England

Environments where exact contact tracing is infeasible pose a challenge to ‘test and trace’ approaches for containing infectious diseases like COVID-19 that rely on following up on the close contacts of an index case. This is particularly problematic in primary schools and some workplaces. The additional benefit of using rapid screening tests over mere isolation restrictions of contacts has repeatedly been put forward for schools in the United Kingdom as potentially leading to improved containment and less absence from school for the pupils, but setting up randomized comparisons in primary schools is particularly challenging. Investigating this issue continues to be relevant as many countries take similar steps and more infectious mutations of the virus emerge while pupils, especially young ones, remain largely unvaccinated. We use a customized agent-based simulation to assess the impact of different test and isolation schemes on containment of outbreaks and school days missed in a primary school setting. The simulation links the screening test sensitivity and the infection risk to each individual’s latent viral load. Robustness with respect to a number of criticisms of previous models is assessed by extensive sensitivity analyses. We made the core functionality of our simulation tool available as an interactive web app allowing investigators to explore parameter ranges relevant to their scenario of interest. Reactive use of repeated lateral flow device (LFD) screening tests (‘test for release’) is less effective than regular whole school cross-sectional testing in primary schools and comparable settings and the influence of screening test sensitivity is secondary to that of other key parameters that impact transmission. Results are stable with respect to a wide range of previously debated additional factors like test-retest autocorrelation, imperfect test compliance, and assumptions on the dynamics of viral loads in infected individuals. Our findings support the adoption of regular (e.g, once- or twice-weekly) cross-sectional testing to contain COVID-19 in primary school settings.

Outbreak caused by the SARS-CoV-2 Omicron variant in the psychiatric ward of a general hospital in Brazil.

ABSTRACTBackground: An outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Omicron variant was detected in the psychiatric ward of a general hospital in Brasília, Brazil. Methods: We report the investigation, clinical outcomes, viral sequencing, and control measures applied to outbreak containment. Results: The overall attack rate was 95% (23/24) in a period of 13 days. Among the cases, 78% (18/23) were vaccinated and 17% (4/23) required intensive care. The Omicron variant was isolated from the 19 sequenced samples. Conclusions: The findings highlight the potential harm that highly transmissible variants may generate among hospitalized populations, particularly those with comorbidities.

Requirements for the containment of COVID-19 disease outbreaks through periodic testing, isolation, and quarantine

We employ individual-based Monte Carlo computer simulations of a stochastic SEIR model variant on a two-dimensional Newman–Watts small-world network to investigate the control of epidemic outbreaks through periodic testing and isolation of infectious individuals, and subsequent quarantine of their immediate contacts. Using disease parameters informed by the COVID-19 pandemic, we investigate the effects of various crucial mitigation features on the epidemic spreading: fraction of the infectious population that is identifiable through the tests; testing frequency; time delay between testing and isolation of positively tested individuals; and the further time delay until quarantining their contacts as well as the quarantine duration. We thus determine the required ranges for these intervention parameters to yield effective control of the disease through both considerable delaying the epidemic peak and massively reducing the total number of sustained infections.

The epidemic volatility index, a novel early warning tool for identifying new waves in an epidemic

Early warning tools are crucial for the timely application of intervention strategies and the mitigation of the adverse health, social and economic effects associated with outbreaks of epidemic potential such as COVID-19. This paper introduces, the Epidemic Volatility Index (EVI), a new, conceptually simple, early warning tool for oncoming epidemic waves. EVI is based on the volatility of newly reported cases per unit of time, ideally per day, and issues an early warning when the volatility change rate exceeds a threshold. Data on the daily confirmed cases of COVID-19 are used to demonstrate the use of EVI. Results from the COVID-19 epidemic in Italy and New York State are presented here, based on the number of confirmed cases of COVID-19, from January 22, 2020, until April 13, 2021. Live daily updated predictions for all world countries and each of the United States of America are publicly available online. For Italy, the overall sensitivity for EVI was 0.82 (95% Confidence Intervals: 0.75; 0.89) and the specificity was 0.91 (0.88; 0.94). For New York, the corresponding values were 0.55 (0.47; 0.64) and 0.88 (0.84; 0.91). Consecutive issuance of early warnings is a strong indicator of main epidemic waves in any country or state. EVI’s application to data from the current COVID-19 pandemic revealed a consistent and stable performance in terms of detecting new waves. The application of EVI to other epidemics and syndromic surveillance tasks in combination with existing early warning systems will enhance our ability to act swiftly and thereby enhance containment of outbreaks.

"Swab Team" in the SARS-CoV-2 outbreak containment among healthcare workers.

To analyze the virus spread among Sassari Hospital staff in the first Covid-19 wave and the impact of the Swab Team, a multidisciplinary task force entitled of nasopharyngeal swab collection and testing. Nasopharyngeal swabs from HCWs between March 6 and May 28 2020 are evaluated. 4919 SARS-CoV-2 tests were performed on 3521 operators. Nurses and doctors are the categories at highest risk. After the Swab Team institution, the average number of swabs raised from 47/day to 86/day (p = 0.007). Positive samples decreased from 18.6% to 1.7% (p < 0.0001). The Swab Team is effective in increasing the cases tested and in reducing the reporting time. Procedure standardization reduces the risk for all the subjects involved (no transmission among swab team members, nor during the sample collection).

Genomic Investigation and Successful Containment of an Intermittent Common Source Outbreak of OXA-48-Producing Enterobacter cloacae Related to Hospital Shower Drains.

ABSTRACTThe hospital environment has been reported as a source of transmission events and outbreaks of carbapenemase-producing Enterobacterales. Interconnected plumbing systems and the microbial diversity in these reservoirs pose a challenge for outbreak investigation and control. A total of 133 clinical and environmental OXA-48-producing Enterobacter cloacae isolates collected between 2015 and 2021 were characterized by whole-genome sequencing (WGS) to investigate a prolonged intermittent outbreak involving 41 patients in the hematological unit. A mock-shower experiment was performed to investigate the possible acquisition route. WGS indicated the hospital water environmental reservoir as the most likely source of the outbreak. The lack of diversity of the blaOXA-48-like harbouring plasmids was a challenge for data interpretation. The detection of blaOXA-48-like-harboring E. cloacae strains in the shower area after the mock-shower experiment provided strong evidence that showering is the most likely route of acquisition. Initially, in 20 out of 38 patient rooms, wastewater traps and drains were contaminated with OXA-48-positive E. cloacae. Continuous decontamination using 25% acetic acid three times weekly was effective in reducing the trap/drain positivity in monthly environmental screening but not in reducing new acquisitions. However, the installation of removable custom-made shower tubs did prevent new acquisitions over a subsequent 12-month observation period. In the present study, continuous decontamination was effective in reducing the bacterial burden in the nosocomial reservoirs but was not sufficient to prevent environment-to-patient transmission in the long term. Construction interventions may be necessary for successful infection prevention and control.IMPORTANCE The hospital water environment can be a reservoir for a multiward outbreak, leading to acquisitions or transmissions of multidrug-resistant organisms in a hospital setting. The majority of Gram-negative bacteria are able to build biofilms and persist in the hospital plumbing system over a long period of time. The elimination of the reservoir is essential to prevent further transmission and spread, but proposed decontamination regimens, e.g., using acetic acid, can only suppress but not fully eliminate the environmental reservoir. In this study, we demonstrated that colonization with multidrug-resistant organisms can be acquired by showering in showers with contaminated water traps and drains. A construction intervention by installing removable and autoclavable shower inserts to avoid sink contact during showering was effective in containing this outbreak and may be a viable alternative infection prevention and control measure in outbreak situations involving contaminated shower drains and water traps.

Genetic support of carbapenemases: a One Health systematic review and meta-analysis of current trends in Africa.

Antimicrobial resistance (AMR) is a public health threat globally. Carbapenems are β-lactam antibiotics used as last-resort agents for treating antibiotic-resistant infections. Mobile genetic elements (MGEs) play an important role in the dissemination and expression of antimicrobial resistance genes (ARGs), including the mobilization of ARGs within and between species. The presence of MGEs around carbapenem-hydrolyzing enzymes, called carbapenemases, in bacterial isolates in Africa is concerning. The association between MGEs and carbapenemases is described herein. Specific plasmid replicons, integrons, transposons, and insertion sequences were found flanking specific and different carbapenemases across the same and different clones and species isolated from humans, animals, and the environment. Notably, similar genetic contexts have been reported in non-African countries, supporting the importance of MGEs in driving the intra- and interclonal and species transmission of carbapenemases in Africa and globally. Technical and budgetary limitations remain challenges for epidemiological analysis of carbapenemases in Africa, as studies undertaken with whole-genome sequencing remained relatively few. Characterization of MGEs in antibiotic-resistant infections can deepen our understanding of carbapenemase epidemiology and facilitate the control of AMR in Africa. Investment in genomic epidemiology will facilitate faster clinical interventions and containment of outbreaks.