Reports Of Outbreaks Research Articles

Environmental Contamination With SARS-CoV-2 in a Hospital Setting.

Background The coronavirus disease 2019 (COVID-19) pandemic is a global concern and has changed the way we practice medicine in acute hospital settings. This is particularly true with regard to patient triage, patient risk assessment, use of personal protective equipment, and environmental disinfection. Transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is primarily through inhalation of respiratory droplets generated through talking, coughing, or sneezing. There is, however, a potential risk that respiratory droplets settling on inanimate surfaces and objects in the hospital environment could provide a reservoir for nosocomial infections in patients and pose a healthcare risk to medical staff. Indeed, there have been previous reports of healthcare-associated outbreaks in hospitals. Several authors have argued that the risk of transmission via fomites may be insignificant. It is, however, not clear what proportion of SARS-CoV-2 infections are attributable to direct contact with fomites; a few reports have indicated possible transmission via this route. Environmental contamination with SARS-CoV-2 in healthcare institutions has been shown to vary according to the function or service provided by a unit or department. Information that identifies hospital areas that have a propensity for higher environmental burden may improve the practice of infection control and environmental cleaning and decontamination in healthcare institutions. This study aimed to investigate environmental SARS-CoV-2 contamination in the clinical areas of patients with COVID-19 infection. Methodology We conducted a cross-sectional study performing swabbing of frequently touched surfaces, equipment, and ventilation ducts in five specific clinical areas of Peterborough City Hospital which is part of the North West Anglia NHS Foundation Trust. The five clinical areas that were chosen for swabbing were the Emergency Department (ED), Intensive Care Unit (ICU), Isolation Ward, Respiratory Ward, and a Gastroenterology Ward that was serving as a receiving ward at the height of the second COVID-19 infection wave in the United Kingdom. Surfaces to be swabbed were divided into the patient zone, doctor zone, and nursing zone. Swabs from the chosen surfaces were collected on two consecutive days. A total of 158 surface swabs were collected during the second wave of the COVID-19 pandemic. SARS-CoV-2 RNA was detected by reverse transcription polymerase chain reaction. Results The most contaminated clinical areas were the three receiving wards where 12% (11/96) of the swabs were positive. Inside the patient rooms, these surfaces included bed rails and controls, bedside tables, television screens, remote control units, and the room ventilation system. Outside the patient room, these surfaces included mobile computers and computer desk surfaces in the doctors' offices. All swabs taken from the ED and ICU were found to be negative. Conclusions Our study confirms the potential infection risks posed by environmental contamination with the SARS-CoV-2 virus. This highlights the importance of adequate environmental cleaning for proper infection control and prevention in healthcare settings.

What’s New in Prevention of Invasive Fungal Diseases during Hospital Construction and Renovation Work: An Overview

The goal of the overview was to give insight into the recent data of invasive fungal diseases (IFDs) associated with construction and renovation in healthcare settings as well as the recent evidence about available prevention and infection control measures. The number of studies describing IFD outbreaks associated with construction or renovation is on the rise again. Applying adequate prevention measures is still a challenge not just for healthcare workers but also for architects and construction workers as well. The role of multidisciplinary teams in the planning and monitoring of prevention measures cannot be overemphasized. Dust control is an inevitable part of every prevention plan. HEPA filters are helpful in the prevention of fungal outbreaks in hematologic patients, but further studies are needed to clarify the extent in which they contribute as specific control measures. The cut-off value for a "threating" level of fungal spore contamination still remains to be defined. The value of antifungal prophylaxis is difficult to assess because other preventive measures are simultaneously applied. Recommendations are still based on few meta-analyses, a large number of descriptive reports, and the opinion of respective authorities. Outbreak reports in the literature are a valuable resource and should be used for education as well as for preparing outbreak investigations.

Whole-genome sequencing of African swine fever virus from wild boars in the Kaliningrad region reveals unique and distinguishing genomic mutations.

Since the first report of outbreaks of African swine fever (ASF) in Georgia in 2007, the disease has expanded into Europe, Russia, and Asia, spreading rapidly via contact with infected animals including domestic pigs and wild boars. The vast expansion of this Genotype II African swine fever virus (ASFV) across wide-ranging territories and hosts inevitably led to the acquisition of novel mutations. These mutations could be used to track the molecular epidemiology of ASFV, provided that they are unique to strains restricted within a certain area. Whilst whole-genome sequencing remains the gold standard for examining evolutionary changes, sequencing of a single locus with significant variation and resolution power could be used as a rapid and cost-effective alternative to characterize multiple isolates from a single or related outbreak. ASFVs obtained during active ASF outbreaks in the Russian region of Kaliningrad between 2017 and 2019 were examined. Since all of the viruses belonged to Genotype II and no clear differentiation based on central variable region (CVR) sequencing was observed, the whole-genome sequences of nine ASFV isolates from this region were determined. To obtain insights into the molecular evolution of these isolates, their sequences were compared to isolates from Europe, Asia, and Africa. Phylogenetic analysis based on the whole-genome sequences clustered the new isolates as a sister lineage to isolates from Poland and Germany. This suggests a possible shared origin followed by the addition of novel mutations restricted to isolates from this region. This status as a sister lineage was mirrored when analyzing polymorphisms in MGF-505-5R and MGF-110-7L, whilst a polymorphism unique to sequences from Kaliningrad was identified at locus K145R. This newly identified mutation was able to distinguish the isolates obtained from Kaliningrad with sequences of Genotype II ASFVs available on GenBank. The findings of this study suggest that ASFVs circulating in Kaliningrad have recently obtained this mutation providing an additional marker to the mutations previously described.

The Cholera Outbreak in Lebanon: October 2022.

In recent years, Lebanon has been struggling with a socioeconomic crisis exacerbated by population displacement after the Syrian crisis, which put a significant burden on its healthcare system. An additional challenge has been the response to a cholera outbreak- a deadly waterborne disease transmitted through the fecal-oral route that usually manifests as severe watery diarrhea and can rapidly progress to death. After reports of a cholera outbreak in Syria were disclosed in September 2022, the Northern Governorate of Lebanon too began reporting cases immediately after, and the first case was confirmed on October 6, 2022. The outbreak rapidly spread to other parts of the country. As of December 9, 2022, a total of 5105 suspected cholera cases with 23 associated deaths were reported across Lebanon. An estimated 45% of these cases were of children and adolescents below the age of 15 years. With the start of the vaccination campaign, awareness programs emphasizing adequate sanitation and clean water sources have become an urgent need.

Five decades of infectious diseases outbreaks in the African region (1970–2018) a geographic snapshot

This paper is being written at a time when the recent pandemic, namely COVID-19, has shaken the entire world in a manner that has never been seen in modern history. The ecology, socio-economy and weak health systems make Africa an area favorable to the occurrence of various diseases and disease outbreaks. This paper explores forty-eight (48) years of disease outbreaks in the WHO African region of the World Health Organization (WHO). Twenty-five (25) Integrated Disease Surveillance and Response priority diseases were selected, and their outbreaks were described and analyzed. Using inferential spatial statistics, spatial clusters at the health district level, specifically hot spots of those outbreaks, were produced and analyzed. The Population at risk of those hot spots was estimated. Results show a consistent report of outbreaks during the selected period, with 52 outbreaks on average per year. Poliomyelitis, cholera, yellow fever, meningococcal disease and measles were the most reported outbreaks. Democratic Republic of the Congo (DRC) and Nigeria were the countries reporting the highest number of outbreaks (5 on average per year), with high number of people living in hot spots districts (85M). Despite efforts to limit their number, some disease outbreaks, such as cholera, malaria, and measles, continue to have a burden in terms of morbidity and mortality. In contrast, others, such as poliomyelitis, yellow fever and diarrhoeal disease, have shown a declining trend, and wild polio virus transmission has been eliminated in the region. Results suggest that concerted public health action may help reduce outbreaks in the region. Results can be used to inform preparedness and prevention activities. Priority public health actions should target DRC and Nigeria and identified hot spots and areas with existing risk factors within other countries.

Characteristics associated with successful foodborne outbreak investigations involving United States retail food establishments (2014-2016).

This study examined relationships between foodborne outbreak investigation characteristics, such as the epidemiological methods used, and the success of the investigation, as determined by whether the investigation identified an outbreak agent (i.e. pathogen), food item and contributing factor. This study used data from the Centers for Disease Control and Prevention's (CDC) National Outbreak Reporting System and National Environmental Assessment Reporting System to identify outbreak investigation characteristics associated with outbreak investigation success. We identified investigation characteristics that increase the probability of successful outbreak investigations: a rigorous epidemiology investigation method; a thorough environmental assessment, as measured by number of visits to complete the assessment; and the collection of clinical samples. This research highlights the importance of a comprehensive outbreak investigation, which includes epidemiology, environmental health and laboratory personnel working together to solve the outbreak.

Epidemiological Characteristics of Varicella Outbreaks - China, 2006-2022.

Varicella outbreaks significantly disrupt schools and other child-centered institutions. This study aimed to identify patterns and epidemiological features of varicella outbreaks in China from 2006 to 2022. Data were extracted from outbreak reports submitted to the Public Health Emergency Reporting Management Information System within the specified timeframe. Analytical methods included Spearman correlation tests and the Mann-Kendall trend tests, conducted using R software to analyze and summarize reported data. Additionally, statistical analyses of trends and epidemiological characteristics were performed using SPSS software. Between 2006 and 2022, a total of 11,990 varicella outbreaks were reported in China, resulting in 354,082 cases. The attack rates showed a decreasing trend over the years (Z=-4.49, P<0.05). These outbreaks occurred in two peaks annually. The eastern region accounted for the highest number of outbreaks (31.53%), followed by the southwestern (24.22%) and southern (17.93%) regions. Varicella outbreaks were most common in elementary schools. Most of the outbreaks (60.43%) were classified as Grade IV (general) severity, with 86.41% of the outbreaks having 10-49 cases. The median and inter-quartile ranges (IQR) of the duration of outbreaks, response time, and case counts were 21 (10, 39) days, 4 (0, 12) days, and 23 (16, 35) cases, respectively. These variables showed a positive correlation (P<0.001). Varicella outbreaks exhibited fluctuating trends, initially decreasing until 2012, followed by an increase, reaching the highest peak in 2018-2019. Continual monitoring of varicella epidemiology is necessary to assess the burden of the disease and formulate evidence-based strategies and policies for its prevention and control.

672. Report of a Multi-species Outbreak of VIM-producing Carbapenem-resistant Organisms in a Burn Unit and Subsequent Experience Using Novel β-lactam Antibiotics for Treatment

Abstract Background The incidence of carbapenem-resistant organisms (CROs) has increased over the past 3 decades. Carbapenem-resistance due to metallo-β-lactamases (MBLs) such as the Verona integron-encoded metallo-β-lactamase (VIM) are particularly problematic due to the limited treatment options. We describe a multi-species outbreak of VIM-producing CROs (VIM CROs) in a tertiary care hospital along with our experience using novel β-lactam antibiotics for treatment. Methods We performed a retrospective chart review after a cluster of patients in the burn unit of a tertiary care hospital were found to have infections with VIM CROs. Electronic medical records for all patients with a VIM CRO isolated between November 2021 and March 2022 were reviewed. Data regarding patient characteristics, antimicrobial use, culture results, antimicrobial susceptibility testing, and clinical outcomes were recorded for each patient. Results 8 patients were found to have VIM-mediated CRO burn wound infections, 5 of whom were also bacteremic with a VIM CRO. A VIM gene was identified in 5 different species (Pseudomonas aeruginosa and 4 Enterobacterales). None of the patients received carbapenems prior to isolation of a CRO. Among the 5 patients treated with cefiderocol, 2 had cefiderocol-resistant VIM CROs isolated 10-20 days after starting cefiderocol. 3 patients received the combination of ceftazidime/avibactam and aztreonam, and all had subsequent clearing of their CRO infection on follow-up cultures taken from the same site. Only one of the 8 patients died within 30 days of initial CRO isolation, after developing a subsequent fungal infection. The median Pitt bacteremia score at the time of initial CRO isolation was 1 (range 0-4) in the 7 patients who survived versus a score of 6 in the patient who died. Conclusion MBLs such as VIM have the potential for multi-species spread throughout hospital units even in the absence of carbapenem selection pressure. Although over 60% of the patients in this study had bacteremia and cefiderocol-resistance developed in 40% of the patients treated with cefiderocol, mortality was fortunately low in this group. While newer β-lactam antibiotics remain an exciting addition to our armamentarium, we must remain diligent in monitoring for rapid development of resistance. Disclosures Thomas R. Talbot, III, MD, MPH, OmniSolve: Board Member Romney Humphries, PhD, D(ABMM), M(ASCP), Accelerate: Advisor/Consultant|Accelerate: Stocks/Bonds|bioMerieux: Advisor/Consultant|IHMA: Advisor/Consultant|Pattern: Advisor/Consultant|Qiagen: Advisor/Consultant|QPex: Advisor/Consultant|Roche: Advisor/Consultant|Specific Diagnostics: Advisor/Consultant|Specific Diagnostics: Stocks/Bonds|ThermoFisher: Advisor/Consultant|Torus: Advisor/Consultant.

1226. Two consecutive outbreaks of carbapenemase-producing enterobacteriaceae (CPE) in a pediatric hospital

Abstract Background Carbapenemase-producing enterobacteriaceae (CPE) can cause hospital outbreaks with considerable health and economic implications. Intensive infection control measures are implemented to identify CPE carriers and contain outbreaks. Methods We describe a CPE-NDM (New Delhi Metallo-beta-lactamase) hospital wide outbreak, in a tertiary care pediatric hospital, which evolved into a CPE-KPC (Klebsiella pneumoniae carbapenemase) outbreak before subsiding. Results At 10/20/21 rectal screening for CPE was performed in patients in the NICU (neonatal intensive care unit) because of known CPE carriers hospitalized there. Multiple CPE carriers were discovered, and a hospital-wide outbreak of CPE-NDM was identified. All patients who were potential contacts of CPE carriers throughout the hospital were isolated and screened twice a week, as part of intensive infection control measures. Between 10/20/21 and 12/07/21 46 patients carrying CPE-NDM were discovered. Continued screening between 12/15/21 and 04/18/22 identified 81 additional patients carrying CPE, however the carbapenemases identified in 78 of them were KPC. No known CPE-KPC carrier was hospitalized at the beginning of the KPC outbreak. Surprisingly, in 6 of the patients carrying CPE-NDM, repeat screening done months later found the carriage shifted from CPE-NDM to CPE-KPC. The results were validated and analyzed at the National Infection Control Laboratory. No significant morbidity or mortality was observed due to CPE carriage. CPE identification distribution by week and mechanism Conclusion We report an unusual sequence of two CPE outbreaks. We found no previous reports of consecutive outbreaks of CPE. Disclosures All Authors: No reported disclosures.

Leptospirosis: Epidemiological and Clinical Characteristics at the National Reference Hospital in Panama.

Leptospirosis represents a public health problem in Panama, with an incidence rate of 1 in 100,000 inhabitants in 2014. Despite active surveillance and reports of outbreaks in the news, publications about human leptospirosis in Panama are scarce. The objective of this study was to describe the epidemiological and clinical features of leptospirosis in a cohort of patients admitted to the national reference hospital from January 2013 to December 2018. A total of 188 patients with suspected leptospirosis were identified, but only 56.9% (107 of 188) of the medical records could be retrieved. Microagglutination assays were completed in 45% (48 of 107) of the patients, confirming leptospirosis in 29.2% (14 of 48) of the patients. The most prevalent serogroup identified was Leptospira interrogans icterohemorrhagiae (4 of 14, 28.6%). The majority of patients with confirmed disease were middle-aged (36.4 ± 15.7 years), male (11 of 14, 78.6%), and symptomatic for 6.8 ± 0.7 days before admission. The predominant clinical presentation was fever (13 of 14, 92.9%), abdominal pain (7 of 14, 50%), and jaundice (8 of 14, 57.1%). Respiratory failure (8 of 14, 57.1%), elevated creatinine levels on admission (8 of 14, 57.1%), transfusion of blood-derived products (6 of 14, 42.9%), and required use of vasopressors (4 of 14, 28.6%) were common complications. Mortality was 28.6% (4 of 14). Empiric antibiotic therapy was initiated in almost all patients (10 of 12, 83.3%), and was appropriate in 90% (9 of 10) of them. Our study highlights the high prevalence of severe disease and reveals the diagnostic challenges concealing the true burden of leptospirosis in Panama. However, the small number of confirmed patients limits the generalization of these findings.

Detection of West Nile virus isolates in poultry in central Vietnam in 2015-2019

Cases of detection of RNA or ELISA markers of West Nile virus (WNV) have been recorded in many countries of Southeast Asia. At the same time, there were no reports of outbreaks of fevers caused by WNV. Perhaps this is due to the asymptomatic or very mild course of the disease or to the focus of the health systems of these countries on other viral fevers. In this work, for the first time in Vietnam, West Nile virus (WNV) RNA was detected in poultry. WNV RNA was found in three lung samples of chickens from Nghe An province collected in 2017. The isolates belonged to lineages 1a and 2, responsible for many WNV outbreaks in Europe and North America and therefore require close attention.

English

In recent years, Nattrassia mangiferae has received tremendous attention as a destructive plant pathogen that may potentially infect humans and animals. The pathogen was isolated from 61 species belonging to 47 genera and 30 family plants but was most frequently isolated from Cactaceae, Rosaceae, Euphorbiaceae, Anacardiaceae, and Rutaceae hosts. To systematically and comprehensively describe the progress, trends, and hotspots of N. mangiferae research, the 376 related publications from 1966 to 2022 were collected from the Scopus database. The bibliometric characteristics including publication output, countries/region of focus, author&rsquo;s productivity, most proli?c authors, authorship pattern, citation frequency, institutes, most proli?c journals, and research focus were evaluated by using Excel 2013 and VOSviewer. Out of 376 original articles, there are 139 plant and 237 human studies. The leading countries based on the number of publications were the United States, the United Kingdom, and Brazil. A sharp increase in the number of studies related to the pathogenicity of N. mangiferae during 2018 to 2021 was observed, coinciding with an increase in the number of short reports and outbreak reports worldwide. The journal and subject categories with the most significant publications are Plant Disease and Medical Mycology, respectively. The most common document types were article, note, review, and letter. N. mangiferae is a thermophilic fungus, and warming temperatures may weaken trees and affect their susceptibility to this pathogen. The increase in reports of the pathogenicity of this pathogen on various plants and humans from 70 different countries in recent years shows the importance of this pathogen as a sever threat to the world. Our bibliometric analysis reveals the current research hotspots and topic trends on N. mangiferae, thus offering potential clues for further examination. Key words: Neoscytalidium dimidiatum, plant pathogen, Onychomycosis, VOSviewer, Iran.

Isolation of a New Infectious Pancreatic Necrosis Virus (IPNV) Variant from Genetically Resistant Farmed Atlantic Salmon (Salmo salar) during 2021-2022.

Infectious pancreatic necrosis (IPN), caused by IPNV, affects several species of farmed fish, particularly Atlantic salmon, and is responsible for significant economic losses in salmon aquaculture globally. Despite the introduction of genetically resistant farmed Atlantic salmon and vaccination strategies in the Chilean salmon industry since 2019, the number of IPN outbreaks has been increasing in farmed Atlantic salmon in the freshwater phase. This study examined gross and histopathological lesions of IPNV-affected fish, as well as the IPNV nucleotide sequence encoding the VP2 protein in clinical cases. The mortality reached 0.4% per day, and the cumulative mortality was from 0.4 to 3.5%. IPNV was isolated in the CHSE-214 cell line and was confirmed by RT-PCR, and VP2 sequence analysis. The analyzed viruses belong to IPNV genotype 5 and have 11 mutations in their VP2 protein. This is the first report of IPN outbreaks in farmed Atlantic salmon genetically resistant to IPNV in Chile. Similar outbreaks were previously reported in Scotland and Norway during 2018 and 2019, respectively. This study highlights the importance of maintaining a comprehensive surveillance program in conjunction with the use of farmed Atlantic salmon genetically resistant to IPNV.

Oriental theileriosis associated with a new genotype of Theileria orientalis in buffalo (Bubalus bubalis) calves in Uttar Pradesh, India

Theileria orientalis is known to cause a benign infection in cattle and buffalo (Bubalus bubalis). However, the Ikeda and Chitose genotypes of the parasite cause lethal disease in beef and dairy cattle. Recently an outbreak of clinical oriental theileriosis occurred in buffalo calves in a Government Animal Husbandry and Agricultural Farm located in Uttar Pradesh, India. Examination of Giemsa stained thin blood smears revealed typical rod-shaped T. orientalis piroplasms in the erythrocytes. The clinical signs included pyrexia, nasal discharge, lacrimation, lethargy, inappetence and anaemia with varying degrees of paleness of the visible mucous membranes. Vascular congestion in internal organs, pulmonary emphysema and consolidation of lungs, focal areas of necrosis in the heart with mononuclear cell infiltration, focal mononuclear cell aggregation in the cortex and tubular degeneration of the kidney were significant necropsy findings. The T. orientalis major piroplasm surface protein (MPSP) gene was amplified by polymerase chain reaction (PCR) using specific primers. The nucleotide sequence analysis of the PCR product revealed 84.8% identity between the T. orientalis Uttar Pradesh isolate and other reference genotypes available in the public domain. Furthermore, the phylogenetic analysis of the MPSP gene sequence ratified that this is a new genotype of T. orientalis. This is the first report of a clinical outbreak of oriental theileriosis in Indian buffalo calves caused by a novel genotype of T. orientalis.

Measles cases in Split-Dalmatia County (a Croatian tourist region), in May-July 2019: outbreak report and lessons learnt.

Measles elimination was accomplished in Croatia in 2016. Split-Dalmatia County, with population of ca. 425000 inhabitants, is among the most important Croatian tourist areas with numerous seasonal workers coming during summer months. In both 2018 and 2019, more than 3 million tourists visited this county. In 2000-2018, there were no measles cases in this county, or their number was low (1-3 cases per year). After measles was clinically suspected, all contacts were traced and contacted. Detection of specific IgM/IgG antibodies and real-time reverse transcription-polymerase chain reaction detection of viral RNA were used for laboratory confirmation. Sequencing and genotyping were performed for strains' molecular epidemiology analysis. Six epidemiologically unlinked measles virus occurrences happened in Split-Dalmatia County in 15 May-19 July 2019. Causative viral strains belonged to genotypes B3 and D8. Four were single imported cases. Ten patients belonged to two separate clusters within domicile population. Multiple individual and public health measures were implemented. In total, 483 contacts were identified, 64.2% within healthcare system where two persons contracted the disease. Besides the importance of timely vaccination of children, the lessons learned from this outbreak point to the need of stricter implementation of other aspects of Croatian measles prevention programme, such as checking of vaccination status in early adulthood. Despite the fact that measles elimination within domicile population in this tourist region has been accomplished and maintained for years, continuous public health workers' efforts are still necessary for identification and diminishment of populational pockets of susceptibility.

Molecular investigations on outbreaks of ovine theileriosis among sheep and goats in Haryana, India.

During February 2020 to October 2020, four outbreaks of theileriosis in small ruminants were recorded with overall morbidity, mortality and case fatality rates of 27.95%, 17.46% and 62.5%, respectively. The disease was characterized by high fever (up to 106°F), superficial lymphadenopathy, anaemia, anorexia, lethargy, respiratory distress and death. The presence of pleomorphic intra-erythrocytic piroplasms of Theileria species in Giemsa's stained blood smears was a common finding in all the episodes. Significant haematological alterations including high total leucocyte count and low haemoglobin and packed cell volume were characteristic. Necropsy findings of the icteric liver, enlarged spleen, pulmonary oedema and abomasal ulcerations were observed in three flocks. Smear-positive blood samples from all the episodes were screened by PCR using 18S rRNA gene-specific primer sets for T. lestoquardi, T. luwenshuni, T. uilenbergi and T. ovis. T. lestoquardi which was detected in all four flocks, while there was co-infection of T. ovis in two flocks. Phylogenetic analysis revealed that T. ovis and T. lestoquardi identified in this study had 100% and ~ 99.86% homology, respectively, with the published sequences used for comparison. This is the first confirmed report of outbreaks of malignant ovine theileriosis in the Haryana state of India which caused high morbidity, mortality and case fatality among sheep and goats. Further studies on theilerioses in small ruminants are required to understand epidemiology better.

Epidemiology of foot-and-mouth disease outbreaks in Thailand from 2011 to 2018.

Foot-and-mouth disease (FMD) is one of the most important animal diseases hindering livestock production in Thailand. In this study, a temporal and spatial analysis at the subdistrict level was performed on FMD outbreak reports in Thailand from 2011 to 2018. Risk factors associated with FMD outbreaks were furthermore investigated using generalized estimating equations. The results showed that the incidence of FMD outbreaks was the highest in 2016 and was affected by season, with a peak in FMD outbreaks occurring in the rainy-winter season, during October to December. FMDoutbreaks were mostly distributed in small clusters within a few subdistricts. Some high-risk areas with repeated outbreaks were detected in the central regions. Risk factors, including the increase of subdistrict's size of the dairy population, beef population or pig population, the low percentage of forest area, subdistricts in the provinces adjacent to Malaysia, the presence of a livestock market and the occurrence of an FMD outbreak in a neighbouring subdistrict in the previous month significantly increased the odds of having an FMD outbreak. The increase in proximity to the nearest subdistrict with an FMD outbreak in the previous month decreased the odds of having FMD outbreaks. This study helped to identify high-risk areas and periods of FMD outbreaks in Thailand. Together with the identified risk factors, its results can be used to optimize the FMD control programme in Thailand and in other countries having a similar livestock industry and FMD situation.

The first report of Vibrio fluvialis isolated from a clinical sample in Iran.

Vibrio fluvialis is a Gram-negative, bacillus-shaped, curved bacterium known as an emerging pathogen. There are reports of outbreaks caused by this bacterium worldwide. Iran, especially Qom province, is an endemic region for gastrointestinal diseases caused by Vibrio species. So, the aim was to isolate V. fluvialis from clinical and environmental samples. During six months, 363 clinical and surface water samples were evaluated. The samples were cultured on specific media, and all incubated for 24 hours at 37°C. Suspicious colonies were evaluated by Gram staining and biochemical tests. The BD Phoenix automated microbiology system was used for the final confirmation of the isolated bacteria. Evaluation of antibiotic resistance of isolated strains was also performed according to CLSI standard. Eight cases (2.2%) of V. fluvialis, including seven from surface water samples (87.5%) and one from clinical samples (12.5%), were isolated. Based on antimicrobial susceptibility testing, all V. fluvialis isolates were susceptible to amikacin, gentamicin, trimethoprim/sulfamethoxazole, ciprofloxacin, tetracycline, ceftazidime, and chloramphenicol. High-level resistance to ampicillin and amoxicillin/clavulanate was also observed. V. fluvialis-infected patient had a mild fever, watery diarrhea, vomiting, nausea, and abdominal cramps that were manifested after drinking contaminated water or eating contaminated vegetables. The patient's symptoms recovered without antibiotic therapy after four days, resulting in self-limiting disease. The current study is the first human case of V. fluvialis infection isolated in Iran. Therefore, monitoring of water and food samples should be done routinely.

Childcare and School Acute Gastroenteritis Outbreaks: 2009-2020.

Acute gastroenteritis (AGE) outbreaks commonly occur in congregate settings, including schools and childcare facilities. These outbreaks disrupt institutions, causing absences and temporary facility closures. This study analyzed the epidemiology of school and childcare AGE outbreaks in the United States. We analyzed AGE outbreaks occurring in kindergarten to grade 12 schools and childcare facilities reported via the National Outbreak Reporting System in the United States from 2009 to 2019 and compared this information to 2020 data. Outbreak and case characteristics were compared using the Kruskal-Wallis rank sum test, χ2 goodness-of-fit test, and Fisher exact test. From 2009 to 2019, there were 2623 school, 1972 childcare, and 38 school and childcare outbreaks. School outbreaks were larger (median, 29 cases) than childcare outbreaks (median, 10 cases). Childcare outbreaks were longer (median, 15 days) than school outbreaks (median, 9 days). Norovirus (2383 outbreaks; 110 190 illnesses) and Shigella spp. (756 outbreaks; 9123 illnesses) were the most reported etiologies. Norovirus was the leading etiology in schools; norovirus and Shigella spp. were dominant etiologies in childcare centers. Most (85.7%) outbreaks were spread via person-to-person contact. In 2020, 123 outbreaks were reported, 85% in the first quarter. Schools and childcare centers are common AGE outbreak settings in the United States. Most outbreaks were caused by norovirus and Shigella spp. and spread via person-to-person transmission. Fewer outbreaks were reported in 2020 from the COVID-19 pandemic. Prevention and control efforts should focus on interrupting transmission, including environmental disinfection, proper handwashing, safe diapering, and exclusion of ill persons.

Lumpy Skin Disease Outbreaks in Africa, Europe, and Asia (2005-2022): Multiple Change Point Analysis and Time Series Forecast.

LSD is an important transboundary disease affecting the cattle industry worldwide. The objectives of this study were to determine trends and significant change points, and to forecast the number of LSD outbreak reports in Africa, Europe, and Asia. LSD outbreak report data (January 2005 to January 2022) from the World Organization for Animal Health were analyzed. We determined statistically significant change points in the data using binary segmentation, and forecast the number of LSD reports using auto-regressive moving average (ARIMA) and neural network auto-regressive (NNAR) models. Four significant change points were identified for each continent. The year between the third and fourth change points (2016–2019) in the African data was the period with the highest mean of number of LSD reports. All change points of LSD outbreaks in Europe corresponded with massive outbreaks during 2015–2017. Asia had the highest number of LSD reports in 2019 after the third detected change point in 2018. For the next three years (2022–2024), both ARIMA and NNAR forecast a rise in the number of LSD reports in Africa and a steady number in Europe. However, ARIMA predicts a stable number of outbreaks in Asia, whereas NNAR predicts an increase in 2023–2024. This study provides information that contributes to a better understanding of the epidemiology of LSD.