Reports Of Outbreaks Research Articles

Neonatal Colonization With Antibiotic-Resistant Pathogens in Low- and Middle-Income Countries

In low- and middle-income countries (LMICs), neonatal bacterial infections are mainly caused by Enterobacterales species and Staphylococcus aureus, which are also the leading causes of mortality directly attributable to antimicrobial resistance. As bacterial colonization often precedes infection, better knowledge of colonization is crucial to prevent antibiotic-resistant neonatal sepsis. To synthesize current evidence on the prevalence of and factors associated with colonization with third-generation cephalosporin-resistant Enterobacterales (3GCRE), carbapenem-resistant Enterobacterales (CRE), and methicillin-resistant S aureus (MRSA) during the first 3 months of life in LMICs. PubMed, Scopus, Web of Science, and the World Health Organization Global Index Medicus were searched for articles published from January 1, 2000, through July 29, 2024. Included studies were conducted in LMICs and reported prevalence rates or factors associated with colonization with 3GCRE, CRE, or MRSA in neonates and infants up to 3 months of age. Outbreak reports were excluded. Data extraction and risk-of-bias assessment using a Joanna Briggs Institute tool were performed by 2 independent reviewers. Pooled prevalence for each pathogen was computed using a random-effects model. Reporting followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline. Prevalence of and factors associated with 3GCRE, CRE, and MRSA colonization. Of the 3147 articles identified in the search, 67 studies (51 for 3GCRE and CRE and 16 for MRSA) including 17 152 individuals were eligible. The pooled prevalence of 3GCRE colonization was 30.2% (95% CI, 21.4%-40.7%; τ2 = 1.48; I2 = 95.1%), varying from 18.2% (95% CI, 10.8%-29.1%) in nonhospitalized individuals to 48.2% (95% CI, 36.4%-60.2%) in hospitalized individuals. The prevalence of CRE colonization was 2.6% (95% CI, 0.7%-8.8%; τ2 = 7.79; I2 = 95.6%), while it was 2.7% (95% CI, 1.0%-6.7%; τ2 = 2.58; I2 = 93.5%) for MRSA. Increased risk of colonization with 3GCRE was associated with hospital birth (odds ratio [OR], 1.87; 95% CI, 1.33-2.64), neonatal antibiotic use (OR, 2.96; 95% CI, 1.43-6.11), and prolonged rupture of membranes (OR, 3.86; 95% CI, 2.19-6.84). In this systematic review and meta-analysis of antibiotic-resistant pathogen carriage in individuals aged 0 to 3 months, the pooled prevalence was substantial despite a limited exposure period. Although high heterogeneity between studies limited extrapolation of results, the findings highlight the need for further investigation to identify transmission routes and to design targeted and effective preventive measures.

Fresh produce-associated foodborne disease outbreaks in Australia, 2001 to 2017.

Fresh produce is an important source of foodborne outbreaks in Australia. Using descriptive analysis, we examined confirmed and suspected foodborne outbreaks associated with fresh produce in Australia recorded in the OzFoodNet outbreak register from 2001 to 2017. The outbreak register contains reports of foodborne disease outbreaks collected by OzFoodNet epidemiologists and public health officials. A fresh produce outbreak was defined as the occurrence of two or more cases of the same illness in which the investigation had implicated a common food and this food contained fresh produce. A total of 92 fresh produce outbreaks were reported, encompassing 3,422 reported illnesses, 446 hospitalisations and four deaths. Of these outbreaks, 76.1% (70/92) were caused by a known pathogen, with the majority caused by either Salmonella enterica (n = 30) or Norovirus (n = 29). Most outbreaks (77.2%; 71/92) were associated with consumption of foods containing multiple ingredients, some of which were not fresh produce. The largest outbreaks associated with a single fresh produce item included bean sprouts contaminated with S. enterica serovar Saintpaul (419 illnesses and 76 hospitalisations) and semi-dried tomatoes contaminated with Hepatitis A (372 illnesses and 169 hospitalisations). Restaurants (45.7%; n = 42/92) and commercial catering (15.2%: n = 14/92) were common settings for fresh produce outbreaks. Outbreaks occurred in all states and territories of Australia and in all seasons, with an increased frequency in the warmer months (September-May). Although the number of fresh produce-associated outbreaks did not seem to be increasing in Australia, integrated surveillance is needed to rapidly identify sources of infection due to the propensity of these outbreaks to be large and widespread.

Association between delayed outbreak identification and SARS-CoV-2 infection and mortality among long-term care home residents, Ontario, Canada, March to November 2020: a cohort study.

BackgroundLate outbreak identification is a common risk factor mentioned in case reports of large respiratory infection outbreaks in long-term care (LTC) homes.AimTo systematically measure the association between late SARS-CoV-2 outbreak identification and secondary SARS-CoV-2 infection and mortality in residents of LTC homes.MethodsWe studied SARS-CoV-2 outbreaks across LTC homes in Ontario, Canada from March to November 2020, before the COVID-19 vaccine rollout. Our exposure (late outbreak identification) was based on cumulative infection pressure (the number of infectious resident-days) on the outbreak identification date (early: ≤ 2 infectious resident-days, late: ≥ 3 infectious resident-days), where the infectious window was -2 to +8 days around onset. Our outcome consisted of 30-day incidence of secondary infection and mortality, based on the proportion of at-risk residents with a laboratory-confirmed SARS-CoV-2 infection with onset within 30 days of the outbreak identification date.ResultsWe identified 632 SARS-CoV-2 outbreaks across 623 LTC homes. Of these, 36.4% (230/632) outbreaks were identified late. Outbreaks identified late had more secondary infections (10.3%; 4,437/42,953) and higher mortality (3.2%; 1,374/42,953) compared with outbreaks identified early (infections: 3.3%; 2,015/61,714; p < 0.001, mortality: 0.9%; 579/61,714; p < 0.001). After adjustment for 12 LTC home covariates, the incidence of secondary infections in outbreaks identified late was 2.90-fold larger than that of outbreaks identified early (OR: 2.90; 95% CI: 2.04-4.13).ConclusionsThe timeliness of outbreak identification could be used to predict the trajectory of an outbreak, plan outbreak measures and retrospectively provide feedback for quality improvement, with the objective of reducing the impacts of respiratory infections in LTC home residents.

Epidemiology of Ciguatoxin Poisoning Outbreaks in the United States Between 2001 and 2021.

This study examined data from the Centers for Disease Control and Prevention's National Outbreak Reporting System between 2001 and 2021 for confirmed outbreaks of foodborne illness due to Ciguatoxin in the United States. Previous research into Ciguatoxin illness in the United States has focused on specific states or territories-namely Hawaii, Florida, Puerto Rico, and the Virgin Islands-meaning the national distribution of outbreaks remains unclear. In addition, while specific categories of seafood (e.g., reef fish) are known to carry elevated risk of illness due to Ciguatoxin poisoning, it remains unclear the extent to which specific seafood items are associated with the odds of being hospitalized in an outbreak. This study calculated descriptive statistics for the distribution of outbreaks by state, season, site of exposure, and implicated seafood item. Then, binomial regression was used to assess the relationship between the implicated seafood item in an outbreak and hospitalization. Results provided evidence that knowing the implicated seafood item in an outbreak is associated with the odds of hospitalization (χ25 = 33.023, p < 0.0001). Even when a seafood item was found to be associated with elevated odds of hospitalization, not all cases involved hospitalization. This finding aligns with Ciguatoxin poisoning case reports, noting that key epidemiological factors include not just the seafood item consumed but also the quantity and the part consumed (e.g., the head). In conclusion, public health officials should consider Ciguatoxin poisoning outbreaks as multidimensional and utilize information about the seafood consumed as well as the quantity and parts of the seafood consumed.

Serratia marcescens outbreak at a neonatal intensive care unit in an acute care tertiary hospital in Singapore

To report the epidemiological, diagnostic, and genetic investigation of an outbreak of neonatal patients infected or colonized with Serratia marcescens (S. marcescens) including the infection control interventions. Outbreak investigation report. 28-bedded neonatal unit in an acute care tertiary hospital in Singapore divided into three areas: two negative-pressure airborne infection isolation rooms with a shared anteroom, 10 neonatal intensive care unit (NICU) beds, and 16 high dependency beds. A total of five neonates were involved in this outbreak. Screening of in-flight patients and their immediate environment for S. marcescens to determine probable environmental sources, whole genome sequencing (WGS) analysis of resulting isolates to determine clone-relatedness and possible transmission patterns. Implementation of infection control interventions included prompt isolation of cases, enhanced equipment and environmental disinfection, use of alcohol-based hand rub as the preferred hand hygiene mode, enhanced infection prevention orientation for parents, review of practices, audits, and immediate feedback on non-compliance. Five neonates infected or colonized with S. marcescens were involved in this outbreak. Four were infection cases whilst one identified through contact tracing. Three NICU sinks and the milk preparation room sink were tested positive for S. marcescens. WGS confirmed clonality of strains from two NICU sinks, and milk preparation room sink with that of the five neonates. Multiprong strategy was required to contain this outbreak. WGS analysis showed association of biofilms in sinks with the outbreak.

Epidemiological Analysis of Foot and Mouth Disease (FMD) Outbreak in 2014 in Sri Lanka

Sri Lanka faced a massive Foot and Mouth Disease (FMD) outbreak in 2014, which was initiated in Jaffna district in December 2013, and lasted for a period of more than a year, until January 2015. The disease spread throughout the country, affecting 68895 domestic animals, and causing 2007 deaths. The aim of this study was to epidemiologically analyze the data of 2014 FMD outbreak in order to understand the pattern and determinants of the massive disease distribution. Data were collected regarding the number of cases and deaths in relation to the time and location. Data in Disease Outbreak Reports, Follow-up Reports, Disease Investigation Reports and Laboratory Investigation Reports were reviewed, and descriptive and simple statistical analyses were carried out concerning the 57 epidemiological week study period. Disease Incidence, Period Prevalence, Mortality Rate, and Case Fatality Ratio of the disease were determined to be 68895, 6.11%, 0.18% and 2.91%, respectively. Seasonal animal movements and unauthorized livestock transportation appeared to be the main causes for the extensive spreading of the disease, while inadequate vaccination and poor awareness seemingly facilitated the development of three epidemic curves during the outbreak period. Newly identified causative agent, the sub-lineage O/ME-SA/Ind-2001d has led to a more severe FMD outbreak in 2014 compared to the previous outbreaks occurred in Sri Lanka.

Classical biological control of the western grape leaf skeletonizer in California, a review 1941–2022

ABSTRACT Western grape leaf skeletonizer was first reported in southern California in 1941 and soon became a serious pest of commercially produced grapes in that region. Their gregarious larvae can easily defoliate vineyards and they remained a major problem for production of grapes until this pest was reunited with its host-specific natural enemies. Efforts to import into southern California effective natural enemies during the 1950s from southern Arizona succeeded in reducing populations of this moth to economically tolerable levels. We report for the first time on releases of natural enemies into central and northern California for control of western grape leaf skeletonizer. Over 600,000 parasitoids new to this region were released during late 1970s–1980s by the state’s Biological Control Program. Foreign exploration by the California Department of Food and Agriculture (CDFA) into Mexico in 1978 resulted in additional parasitoids new to California: a new biotype of Ametadoria harrisinae and a new species of Chetogena sp. (Tachinidae). The high numbers of tachinids released throughout California is credited with aiding in the spread of a highly virulent strain of granulosis virus which in turn caused high levels of mortality to western grape leaf skeletonizer larvae. Reports of WGLS outbreaks in vineyards over the last 15 years are rare, in contrast to previous years.

Analysis of Cholera Risk in India: Insights from 2017-18 Serosurvey Data Integrated with Epidemiologic data and Societal Determinants from 2015-2019.

Indian subcontinent being an important region in the fight to eliminate cholera needs better cholera surveillance. Current methods miss most infections, skewing disease burden estimates. Triangulating serosurvey data, clinical cases, and risk factors could reveal India's true cholera risk. We synthesized data from a nationally representative serosurvey, outbreak reports and risk factors like water, sanitation and the Multidimensional Poverty Index, to create a composite vulnerability index for assessing state-wise cholera risk in India. We tested 7,882 stored sera samples collected during 2017-18 from individuals aged 9-45 years, for vibriocidal antibodies to Vibrio cholerae O1 using a cut-off titre ≥320 defining as elevated titre. We also extracted data from the 2015-19 Integrated Disease Surveillance Programme and published cholera reports. Overall, 11.7% (CI: 10.4-13.3%) of the sampled population had an elevated titre of cholera vibriocidal antibodies (≥320). The Southern region experienced the highest incidence (16.8%, CI: 12.1-22.8), followed by the West (13.2%, CI: 10.0-17.3) and North (10.7%, CI: 9.3-12.3). Proportion of samples with an elevated vibriocidal titre (≥320) was significantly higher among individuals aged 18-45 years (13.0% CI: 11.2-15.1) compared to children 9-17 years (8.6%, CI 7.3-10.0, p<0.05); we found no differences between sex or urbanicity. Between 2015-2019, the Integrated Disease Surveillance Program (IDSP) reported 29,400 cases of cholera across the country. Using the composite vulnerability index, we found Karnataka, Madhya Pradesh, and West Bengal were the most vulnerable states in India in terms of risk of cholera. The present study showed that cholera infection is present in all five regions across India. The states with high cholera vulnerability could be prioritized for targeted prevention interventions.

Ralstonia mannitolilytica infection in a tertiary care centre: an outbreak report

BackgroundIn this paper we describe an outbreak of Ralstonia mannitolilytica infection declared in our facility between January 2021 and January 2022. MethodsIn order to identify the source of the outbreak, we applied widespread epidemiological investigation and infection control measures, including device isolation, environmental sampling, and PFGE typing. ResultsThirty-six cases of R. mannitolilytica infection were identified, mostly adults (78%) and males (75%). Initially, neurological procedures were a common risk factor among cases, leading to sampling of related environmental settings. Cases with other medical procedures started to be reported. The PFGE results showed most R. mannitolilytica isolates were indistinguishable which expanded our investigation to all hospital areas. The infection source was discovered later as a single lot number of sodium chloride solution that had been used in practice. The contaminated solution was recalled from all hospital units and the findings were reported to the Saudi FDA to communicate with the manufacturer and other healthcare organizations involved. No new cases of R. mannitolilytica were identified thereafter. ConclusionOur findings indicate that identifying the source of an outbreak could be challenging. An extended incubation period might be considered to improve and accelerate the identification of R. mannitolilytica. In order to minimize similar incidents, it is essential to regularly monitor the compliance of manufacturers and suppliers with regulations related to the safety of solutions administered in medical practice.

First Trial of a Novel Caseous Lymphadenitis Inactivated Vaccine in South Korea: Experimental Evaluation across Various Animal Models.

Caseous lymphadenitis (CLA) is a chronic and subclinical bacterial disease of ruminants caused by Corynebacterium pseudotuberculosis (C. pseudotuberculosis) infection. Until 2014, there were no reports of CLA outbreaks in South Korea; however, the prevalence of CLA cases has steadily increased. In this study, we used recently obtained field isolates to develop the first inactivated CLA vaccine in South Korea and evaluated it in various animal models. The inactivated vaccine was evaluated for virulence and effectiveness. Mice were tested for virulence and immunization challenges, and guinea pigs and Korean Native Black Goats (KNBGs) evaluated various vaccine concentrations to determine the optimal dose and effectiveness. In the case of KNBGs, clinical symptoms were not observed after vaccination. In addition, CLA-specific IgG was detected at a significantly (p < 0.05) high level and was maintained. In histopathological evaluations, inflammation was predominantly observed in the prefemoral lymph nodes in the non-vaccinated+CHAL group. The genetic diversity of C. pseudotuberculosis, which has become widespread in South Korea, is less than 0.5% our vaccine is expected to prevent infection by a wide range of strains effectively. In summary, our CLA vaccine can potentially prevent CLA and foster the growth of South Korea's domestic KNBG industry.

An outbreak of ischaemic teat necrosis in a dairy herd in Taranaki, New Zealand

ABSTRACT Case History In spring 2021, on a seasonally calving, pastorally based, Taranaki dairy farm, 12 first-calving heifers (≤ 30 days post-calving) developed similar dry, red to black, crusting lesions on the medial aspect of the teat udder junction extending down the medial teat. Some cows had multiple teats affected. Treatment was initially unrewarding and did not slow the progression of the disease. Overall, 8/12 cows recovered, and 4/12 cows were culled, with three of the cows culled after a teat sloughed and the fourth after surgical amputation of a teat. Outbreaks of the same condition, on the same farm but affecting fewer animals, occurred in spring 2022 (n = 6) and spring 2023 (n = 3). Clinical Findings An initial scab-like or crusting lesion progressed to resemble a thick eschar consisting of very dry and hard dead tissue. The unaffected areas of the teat felt normal but immediately under the dead tissue, there was a warm, firmer area consistent with an inflammatory reaction. Removing the scab led to profuse bleeding, with no visible bed of granulation underneath the scab. There was no leaking of milk in those cows that lost a teat, and no smell to the lesions themselves. Serology and virology ruled out the involvement of bovine alphaherpesvirus (BoHV-2) bovine gammaherpesvirus (BoHV-4), orthopoxviruses (cowpox) and parapoxviruses (pseudocowpox). Histopathology of an affected and surgically amputated teat showed multifocal erosion and ulceration of the epidermis, covered by a thick serocellular crust. In areas of ulceration, there were numerous neutrophils, and the dermis was expanded by granulation tissue with variable numbers of neutrophils, eosinophils, and lymphocytes around small blood vessels. Diagnosis Based on the similarity of the history, presentation, and histopathological changes to those described for a novel disease reported in the UK, a diagnosis of ischaemic teat necrosis (ITN) was made. Clinical Relevance If ITN is an emerging condition in New Zealand and becomes as prevalent as it has in the UK, clinicians will be confronted with a significant new welfare problem in dairy cows. Anecdotally, there have been reports of other ITN outbreaks in New Zealand, and the Ministry for Primary Industries would be interested in collating reports from other New Zealand veterinarians.

Using EPIWATCH® open-source surveillance to describe the epidemiology of lumpy skin disease outbreaks in South and Southeast Asia (2022-2023).

Lumpy skin disease (LSD) poses a significant threat to animal welfare and leads to economic losses in affected countries. LSD outbreaks may also impact trade and regional relationships. South and Southeast Asia, with its dense livestock population and intricate trade networks, are susceptible to LSD outbreaks. Indonesia confirmed its first LSD cases in March 2022, leading to substantial livestock losses by August 2023. Australia, an important player in the global beef industry, faced trade disruptions due to LSD concerns raised by Indonesia and Malaysia, claims that were refuted by Australian authorities. The dispute highlights the need for good surveillance. EPIWATCH®, employing artificial intelligence, provides real-time outbreak signals, and spatial analysis can identify LSD hotspots, leading to timely interventions. This study uses data collected by the EPIWATCH® open-source disease surveillance system at the University of New South Wales in 2022 and 2023 and compares it for timeliness and completeness with data available on the World Animal Health Information System (WAHIS). We found more timely reports of LSD outbreaks in EPIWATCH® compared to WAHIS. In conclusion, open-source surveillance tools like EPIWATCH® can provide timely alerts of disease emergence, such as LSD outbreaks in South and Southeast Asia, which can supplement formal reporting systems.

Measles resurgence in Armenia: unmasking health system vulnerabilities and crafting comprehensive eradication strategies - a review.

Measles is an acute febrile illness associated with rashes, fever and life-threatening complications. It is a vaccine-preventable disease with the Measles Mumps Rubella(MMR) vaccine but a recent global trend unveils a resurgence of measles in various parts of the world including Armenia. Measles was declared eliminated from Armenia in 2021 before reports of local outbreaks surfaced in 2023. The WHO identified discrepancies in the vaccination coverage during COVID-19. Measles also poses a great financial burden as a public health issue worldwide. Sociocultural factors impacting measles transmission are maternal education, healthcare access, migration, vaccine hesitancy, and socioeconomic status (Table 3). Efforts to control and eradicate measles from Armenia are run by a collaborative approach of national and international health bodies such as United Nations Children's Fund (UNICEF), WHO, Global Vaccine Alliance (GAVI), and the Ministry of Health. Thus, the resurgence of measles can be managed through widespread patient education, innovative approaches, strengthening the healthcare system and addressing vaccine hesitancy, sociocultural barriers, and humanitarian emergencies. This review investigates the complicated dynamics of measles inside Armenia's health system in depth. A thorough examination of measles incidence and immunization patterns highlights the shift from few cases and high vaccination rates to a comeback caused by imported viruses. The causes of its recurrence have been thoroughly investigated, including reduced immunization programs and vaccine hesitancy. The research delves further into the 'One Health' idea, assessing the possibility of interspecies transmission among nonhuman primates and examining the environmental factors that influence measles transmission. Among the challenges are weaknesses within Armenia's health system as well as the possibility of interruptions from the COVID-19 outbreak. In measles vaccination status, the combination of maternal education, postnatal care, and socioeconomic variables exposes the larger drivers at work. The study concludes with a comprehensive set of public health policy recommendations covering vaccination promotion, surveillance, healthcare provider education, public awareness, international collaboration, data analysis, law enforcement, emergency preparedness, research, and coordination. The research sheds light on the tangled web of measles dynamics, health system resilience, and contextual subtleties via this multifaceted approach, inviting readers to investigate the multiple strategies required for eliminating measles in Armenia.

An outbreak of SARS-CoV-2 omicron variant and deaths of three lions in a zoo

There have been reports of the transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) from humans to various mammalian species. Some infected animals show clinical signs and may even die in rare cases. Outbreaks of SARS-CoV-2 have been reported in zoos where susceptible animals are bred in high population densities. However, there have been few reports of omicron variant outbreaks in zoo animals. From late 2022 to 2023, an outbreak of the SARS-CoV-2 omicron variant occurred in one Japanese zoo. A total of 24 lions were housed in the zoo; 13 of them showed respiratory symptoms, and the three oldest lions died. Molecular and histopathological analyses revealed that the deceased lions were infected with SARS-CoV-2 omicron BF.7.15. Virus-neutralization tests showed that all 21 lions were positive for antibodies against the omicron variant, but not against the delta variant. In addition, three tigers and one bear in the same or neighboring building as the lions possessed antibodies against the omicron variant. This is a very rare report on the outbreak of a SARS-CoV-2 omicron variant infection that resulted in the death of animals. This finding demonstrates the importance of continuous countermeasures to protect non-vaccinated animals from SARS-CoV-2 infection.

Effectiveness of preventive treatment among different age groups and Mycobacterium tuberculosis infection status: a systematic review and individual-participant data meta-analysis of contact tracing studies.

Tuberculosis is a preventable disease. However, there is debate regarding which individuals would benefit most from tuberculosis preventive treatment and whether these benefits vary in settings with a high burden and low burden of tuberculosis. We aimed to compare the effectiveness of tuberculosis preventive treatment in exposed individuals of differing ages and Mycobacterium tuberculosis infection status while considering tuberculosis burden of the settings. In this systematic review and individual-participant meta-analysis, we investigated the development of incident tuberculosis in people closely exposed to individuals with tuberculosis. We searched for studies published between Jan 1, 1998, and April 6, 2018, in MEDLINE, Web of Science, BIOSIS, and Embase. We restricted our search to cohort studies; case-control studies and outbreak reports were excluded. Two reviewers evaluated titles, abstracts, and full text articles for eligibility. At each stage, two reviewers discussed discrepancies and re-evaluated articles until a consensus was reached. Individual-participant data and a pre-specified list of variables, including characteristics of the exposed contact, the index patient, and environmental characteristics, were requested from authors of all eligible studies; contacts exposed to a drug-resistant tuberculosis index patient were excluded. The primary study outcome was incident tuberculosis. We estimated adjusted hazard ratios (aHRs) for incident tuberculosis with mixed-effects Cox regression models with a study-level random effect. We estimated the number-needed-to-treat (NNT) to prevent one person developing tuberculosis. Propensity score matching procedures were used in all analyses. This study is registered with PROSPERO (CRD42018087022). After screening 25 358 records for eligibility, 439 644 participants from 32 cohort studies were included in the individual-participant data meta-analysis. Participants were followed for 1 396 413 person-years (median of 2·7 years [IQR 1·3-4.4]), during which 2496 people were diagnosed with incident tuberculosis. Overall, effectiveness of preventive treatment was 49% (aHR 0·51 [95% CI 0·44-0·60]). Participants with a positive tuberculin-skin-test (TST) or IFNγ release assay (IGRA) result at baseline benefitted from greater protection, regardless of age (0·09 [0·05-0·17] in children younger than 5 years, 0·20 [0·15-0·28] in individuals aged 5-17 years, and 0·17 [0·13-0·22] in adults aged 18 years and older). The effectiveness of preventive treatment was greater in high-burden (0·31 [0·23-0·40]) versus low-burden (0·58 [0·47-0·72]) settings. The NNT ranged from 9 to 34 depending on age among participants with a positive TST or IGRA in both high-burden and low-burden settings; among all contacts (regardless of TST or IGRA test result), the NNT ranged from 29 to 43 in high-burden settings and 213 to 455 in low-burden settings. Our findings suggest that a risk-targeted strategy prioritising contacts with evidence of M tuberculosis infection might be indicated in low-burden settings, and a broad approach including all contacts should be considered in high-burden settings. Preventive treatment was similarly effective among contacts of all ages. None.

How feasible or useful are timeliness metrics as a tool to optimise One Health outbreak responses?

IntroductionAs timeliness metrics gain traction to assess and optimise outbreak detection and response performance, implementation and scale-up require insight into the perspectives of stakeholders adopting these tools. This study sought...

Investigation of landscape risk factors for the recent spread of varroa mite (Varroa destructor) in European honeybee (Apis mellifera) colonies in New South Wales, Australia.

In June 2022, an exotic pest of the European honeybee (Apis mellifera), the varroa mite (Varroa destructor), was detected in surveillance hives at the Port of Newcastle, New South Wales (NSW). Previously, Australia remained the only continent free of the varroa mite. In September 2023, the National Management Group decided to shift the focus of the response from eradication to management. It is estimated that the establishment of varroa mite in Australia could lead to more than $70 million in losses each year due to greatly reduced pollination services. Currently, there are no reported studies on the epidemiology of varroa mite in NSW because it is such a recent outbreak, and there is little knowledge of the factors associated with the presence of V. destructor in the Australian context. We sourced publicly available varroa mite outbreak reports from June 22 to December 19, 2022, to determine if urbanization, land use, and distance from the incursion site are associated with the detection of varroa mite infestation in European honeybee colonies in NSW. The outcome investigated was epidemic day, relative to the first detected premises (June 22, 2022). The study population was comprised of 107 premises, which were declared varroa-infested. The median epidemic day was day 37 (July 29, 2022), and a bimodal distribution was observed from the epidemic curve, which was reflective of an intermittent source pattern of spread. We found that premises were detected to be infected with varroa mite earlier in urban areas [median epidemic day 25 (July 17, 2022)] compared to rural areas [median epidemic day 37.5 (July 29, 2022)]. Infected premises located in areas without cropping, forests, and irrigation were detected earlier in the outbreak [median epidemic days 23.5 (July 15, 2022), 30 (July 22, 2022), and 15 (July 7, 2022), respectively] compared to areas with cropping, forests, and irrigation [median epidemic days 50 (August 11, 2022), 43 (August 4, 2022), and 47 (August 8, 2022), respectively]. We also found that distance from the incursion site was not significantly correlated with epidemic day. Urbanization and land use are potential factors for the recent spread of varroa mite in European honeybee colonies in NSW. This knowledge is essential to managing the current varroa mite outbreak and preventing future mass varroa mite spread events.

Salmonella in Chicken and Pork Meat as a Likely Major Contributor to Foodborne Illness in Peru.

Nontyphoidal Salmonella is one of the major causes of self-limiting diarrheal disease and the most common foodborne pathogen worldwide. It is an important contributor to the burden of foodborne illness in South America, including Peru, where chicken and pork are important vehicles for Salmonella infection. Salmonella infections are underreported, particularly in low- and middle-income countries where concerted action tackling Salmonella along the chicken and pork chains, from primary production to retail, is urgently needed. To support and inform the implementation of new strategies to reduce Salmonella contamination of chicken and pork, this study describes the frequency and distribution of foodborne outbreaks attributed to Salmonella in Peru and evaluates the level of Salmonella in chicken and pork meat sold in markets of three regions of Peru. To that end, we analyzed historical reports of foodborne outbreaks, levels of Salmonella in chicken and pork sold in markets, and the number of mesophiles in the collected meat samples. As a result, the microbiological analysis reveals a widespread contamination of chicken (77.1%) and pork (26.8%) with Salmonella. It also pinpoints Salmonella as the causative agent in nearly half of the outbreaks (47.0%) where the potential origin is identified over a 11-year period with chicken, mayonnaise, and pork being the most likely food vehicles. These results suggest that Salmonella is a major contributor to foodborne illness in Peru and that the monitoring of mesophiles could be a good strategy for surveillance, generating data to support source attribution studies and ultimately evidence-informed policies.

Rabies in rural northeast India: A case report emphasising the urgency of the One Health approach

Dog-mediated rabies is endemic in India. The country records the highest mortality due to dog-bite-related rabies despite the availability of interventions to prevent deaths. We present a case study of the death of a 59-year-old man in a suburban town of Northeast India after a dog bite from an owned pup. Through this case study, we investigate various omissions and commissions in communities and health professionals that make rabies rampant in India. The circumstances surrounding the death were investigated by interviewing the wife, relatives, neighbour, the hospital/nursing home where the bite case was reported, the district Rapid Response Team (RRT), and the Veterinary and Animal Health Department Officer and through the information recorded in the disease outbreak report. While the biting animal was not vaccinated and had no restriction over its movement imposed by the owners, the response of the hospital staff and public authorities was delayed and inadequate. A poignant reminder of the complexities surrounding dog-mediated rabies in India, this case study calls for a holistic protocol to address dog bites through ensuring the One Health approach encompassing education, provision of post-exposure prophylaxis (PEP) and canine rabies vaccines for dogs, promotion of responsible dog ownership, and intersectoral collaboration. Moreover, strengthening communication channels through effective data exchange and encouraging synergy among healthcare, veterinary, and public health sectors is indispensable to maximize the impact of rabies prevention and control interventions.

Marked increase in cryptosporidiosis cases, Spain, 2023.

BackgroundBy mid-September 2023, several event notifications related to cryptosporidiosis had been identified from different regions in Spain. Therefore, a request for urgent notification of cryptosporidiosis cases to the National Surveillance Network was launched.AimWe aimed at assessing the extent of the increase in cases, the epidemiological characteristics and the transmission modes and compared to previous years.MethodsWe analysed data on case notifications, outbreak reports and genotypes focusing on June-October 2023 and compared the results to 2016-2022.ResultsIn 2023, 4,061 cryptosporidiosis cases were notified in Spain, which is an increase compared to 2016-2022. The cumulative incidence was 8.3 cases per 100,000 inhabitants in 2023, sixfold higher than the median of 1.4 cases per 100,000 inhabitants 2016-2022. Almost 80% of the cases were notified between June and October. The largest outbreaks were related to contaminated drinking water or swimming pools. Cryptosporidium hominis was the most common species in the characterised samples (115/122), and the C. hominis IfA12G1R5 subtype, previously unusual in Spain, was detected from 76 (62.3%) of the 122 characterised samples.ConclusionsA substantial increase in cryptosporidiosis cases was observed in 2023. Strengthening surveillance of Cryptosporidium is essential for prevention of cases, to better understand trends and subtypes circulating and the impact of adverse meteorological events.