Outbreaks Of Diarrheal Disease Research Articles

Outbreak of waterborne acute diarrheal disease in a South District village of Tripura: A public health emergency in the Northeast region of India

Food and waterborne outbreaks are a neglected public health problem in India. However, it is important to identify the source of infection and the causative pathogen to curb the outbreak quickly and minimize mortality and morbidity. A retrospective descriptive study was conducted with a line list of 130 diarrheal cases. Epidemiological investigation and laboratory investigation were done. Data were collected from hospital case report forms as well as interviewed affected cases. A case of acute diarrheal disease was reported among the people in the village with abdominal pain, vomiting, and diarrhea from December 31, 2022 to January 3, 2023. Out of a total of 130 recorded cases, 33 stool samples were collected and were positive for Enteroaggregative Escherichia coli, Shigella flexneri 3a, and Shigella sonnei by cultural and molecular tests. The presumptive fecal pollution indicator assay indicated high coliform counts in the water samples (most probable number [MPN]-05) and the presence of Escherichia coli. The identified pathogens showed susceptibility to gentamicin and meropenem. People who used public drinking water were found to be infected with acute diarrheal disease (ADD). Quick identification of the causative pathogens and their antimicrobial resistance pattern helped correct antibiotic prescriptions and quick recovery of the patients without any deaths. Thus, a timely implementation of food and waterborne outbreak investigation is crucial to saving lives and preventing the spread of infection.

An Epidemiological Investigation of Acute Diarrheal Disease Outbreak at Urban Area in Borsad Taluka of Anand District

Introduction: Acute Diarrheal Disease (ADD) is affecting millions of people around the world especially in second world nations now a days. Major pathogenic organisms that cause diarrhea, are transmitted through feco-oral route. We investigated an outbreak of Acute Diarrheal Disease at urban area of Borsad taluka, Anand District of Gujarat state with Objectives: 1. To confirm the existence of an outbreak, 2. To know the magnitude and distribution of the outbreak with reference to time, place and person, 3. To identify the source of infection, mode of transmission and implement control and preventive measures. Method: A Cross Sectional Epidemiological study was carried out to investigate the outbreak of acute diarrheal disease cases in urban area of Borsad taluka. We obtained required information from Chief District Health Office, Anand &, Community Health Centre, borsad, conducted house to house survey and also inspected the sanitation and water supply of the affected area. Results: There were 72 cases of acute diarrheal disease. The overall Attack Rate was 0.43%. Majority of the affected population used non-chlorinated water for drinking. Conclusion: The underlying cause for the outbreak of acute diarrheal disease can be co-related by consumption of contaminated water and food. Keywords: Acute Diarrheal Disease, Borsad, Chlorination, Epidemic Investigation.

Acute gastroenteritis outbreak associated with multiple and rare norovirus genotypes after storm events in Santa Catarina, Brazil.

Norovirus is a major cause of acute diarrheal disease (ADD) outbreaks worldwide. In the present study, we investigated an ADD outbreak caused by norovirus in several municipalities of Santa Catarina state during the summer season, southern Brazil in 2023. As of the 10th epidemiological week of 2023, approximately 87 000 ADD cases were reported, with the capital, Florianópolis, recording the highest number of cases throughout the weeks. By using RT-qPCR and sequencing, we detected 10 different genotypes, from both genogroups (G) I and II. Some rare genotypes were also identified. Additionally, rotavirus and human adenovirus were sporadically detected among the ADD cases. Several features of the outbreak suggest that sewage-contaminated water could played a role in the surge of ADD cases. Storm events in Santa Catarina state that preceded the outbreak likely increased the discharge of contaminated wastewater and stormwater into water bodies, such as rivers and beaches during a high touristic season in the state. Climate change-induced extreme weather events, including intensified rainfall and frequent floods, can disturb healthcare and sanitation systems. Implementing public policies for effective sanitation, particularly during peak times, is crucial to maintain environmental equilibrium and counter marine pollution.

Participatory Disease Surveillance for the Early Detection of Cholera-Like Diarrheal Disease Outbreaks in Rural Villages in Malawi: Prospective Cohort Study.

Cholera-like diarrheal disease (CLDD) outbreaks are complex and influenced by environmental factors, socioeconomic conditions, and population dynamics, leading to limitations in traditional surveillance methods. In Malawi, cholera is considered an endemic disease. Its epidemiological profile is characterized by seasonal patterns, often coinciding with the rainy season when contamination of water sources is more likely. However, the outbreak that began in March 2022 has extended to the dry season, with deaths reported in all 29 districts. It is considered the worst outbreak in the past 10 years. This study aims to evaluate the feasibility and outcomes of participatory surveillance (PS) using interactive voice response (IVR) technology for the early detection of CLDD outbreaks in Malawi. This longitudinal cohort study followed 740 households in rural settings in Malawi for 24 weeks. The survey tool was designed to have 10 symptom questions collected every week. The proxies' rationale was related to exanthematic, ictero-hemorragica for endemic diseases or events, diarrhea and respiratory/targeting acute diseases or events, and diarrhea and respiratory/targeting seasonal diseases or events. This work will focus only on the CLDD as a proxy for gastroenteritis and cholera. In this study, CLDD was defined as cases where reports indicated diarrhea combined with either fever or vomiting/nausea. During the study period, our data comprised 16,280 observations, with an average weekly participation rate of 35%. Maganga TA had the highest average of completed calls, at 144.83 (SD 10.587), while Ndindi TA had an average of 123.66 (SD 13.176) completed calls. Our findings demonstrate that this method might be effective in identifying CLDD with a notable and consistent signal captured over time (R2=0.681404). Participation rates were slightly higher at the beginning of the study and decreased over time, thanks to the sensitization activities rolled out at the CBCCs level. In terms of the attack rates for CLDD, we observed similar rates between Maganga TA and Ndindi TA, at 16% and 15%, respectively. PS has proven to be valuable for the early detection of epidemics. IVR technology is a promising approach for disease surveillance in rural villages in Africa, where access to health care and traditional disease surveillance methods may be limited. This study highlights the feasibility and potential of IVR technology for the timely and comprehensive reporting of disease incidence, symptoms, and behaviors in resource-limited settings.

Cholera: Analysis and Assessment of Epidemiological Situation around the World and in Russia (2013–2022). Forecast for 2023

The aim of the review was to analyze and assess the epidemiological situation on cholera in the world and Russia in 2013–2022 and to make a forecast for 2023. Over the period of 2013–2022, 500 administrative territories affected by cholera were identified in various regions of 71 countries of Asia, Africa and America (the Caribbean region) with formation of 69 endemic foci in 16, 41 and 12 countries, respectively. In 2022, 1 209 301 cases of cholera were registered in 36 countries of the world. The intensity of epidemic process in Asian countries (Syria, Lebanon) increased. Unfavorable epidemiological situation on the African continent persisted. Epidemics and large outbreaks, which began in 2021–2022 due to emergency situations (ES) of social and natural character, continued. The prediction of the stability of the epidemiological situation on cholera in the territories of constituent entities of the Russian Federation (RF), given for 2022, has been confirmed. In 2022, 43 non-toxigenic strains of Vibrio cholerae О1 were isolated from surface water bodies, 8 V. cholerae nonO1/nonO139 strains – from humans. Similarity of those strains with genetically closely related ones isolated in the course of monitoring in previous years in Russia, Donetsk People’s Republic (DPR) and Zaporozhye Region was demonstrated. In 2023, the risks of importation of the infection into RF are retained. It is associated with the intensification of epidemic processes in Asian, African and Caribbean region countries. The extended border with Ukraine, to where importation of cholera from endemic countries is possible, contributes to increased degree of threat. Bioterrorism is also not excluded. The consequences of a possible cholera epidemic complication in DPR, Lugansk People’s Republic, Zaporozhye and Kherson Regions are exacerbated by social emergencies resulting in disruption of infrastructure, interruptions in water supply, etc. In the absence of implementation of the risks of importation of this infection on the territory of RF, a stable epidemiological situation on cholera will be retained. Detection of non-toxigenic V. cholerae O1 strains (including probability of clonal complexes formation), as well as strains of non-O1/non-O139 serogroups, which can be etiological factors of sporadic cases or outbreaks of diarrheal diseases, in surface water bodies is predicted.

Past, current, and potential treatments for cryptosporidiosis in humans and farm animals: A comprehensive review.

The intracellular protozoan parasite of the genus Cryptosporidium is among the leading causes of waterborne diarrheal disease outbreaks throughout the world. The parasite is transmitted by ingestion of infective oocysts that are highly stable in the environment and resistant to almost all conventional disinfection methods and water treatments. Control of the parasite infection is exceedingly difficult due to the excretion of large numbers of oocysts in the feces of infected individuals that contaminate the environment and serve as a source of infection for susceptible hosts including humans and animals. Drug development against the parasite is challenging owing to its limited genetic tractability, absence of conventional drug targets, unique intracellular location within the host, and the paucity of robust cell culture platforms for continuous parasite propagation. Despite the high prevalence of the parasite, the only US Food and Drug Administration (FDA)-approved treatment of Cryptosporidium infections is nitazoxanide, which has shown moderate efficacy in immunocompetent patients. More importantly, no effective therapeutic drugs are available for treating severe, potentially life-threatening cryptosporidiosis in immunodeficient patients, young children, and neonatal livestock. Thus, safe, inexpensive, and efficacious drugs are urgently required to reduce the ever-increasing global cryptosporidiosis burden especially in low-resource countries. Several compounds have been tested for both in vitro and in vivo efficacy against the disease. However, to date, only a few experimental compounds have been subjected to clinical trials in natural hosts, and among those none have proven efficacious. This review provides an overview of the past and present anti-Cryptosporidium pharmacotherapy in humans and agricultural animals. Herein, we also highlight the progress made in the field over the last few years and discuss the different strategies employed for discovery and development of effective prospective treatments for cryptosporidiosis.

Cholera outbreak investigation report in Mille woreda, Afar region, Ethiopia, 2019

Introduction: Cholera has remained as one of the important public health problems in Asia and Africa causing substantial morbidity and mortality. Although the burden is greatest in low-income populations with poor access to safe water, and sanitation, cholera is also an important health problem globally. Cholera occurs both as a short outbreak and protracted epidemic/pandemic and when uncontrolled; is devastating to communities and to their prospects for development. To respond quickly and control the outbreak, investigation is crucial; identify risk factors that cause the outbreak, and suggest prevention and control measures. Objective: To identify risk factors and etiology of diarrheal disease outbreak and suggest prevention and control measures in Mille woreda, Afar region Ethiopia, May- June, 2018. Method: Descriptive followed by unmatched case-control study with 1:2 ratio were conducted from May-June 2018. A total of 68 patients and 136 controls were enrolled. A structured interviewer-administered questionnaire was used and medical records and line lists review. Simple random sampling was used to select controls and the first 68 cases. Data were analyzed by SPSS and presented using odd ratio, and tables. Environmental and patient samples were collected for culture and rapid diagnostic test. Result: The investigation identified 229 cholera patients, including 22 rapid diagnostic test confirmed patients and seven culture confirmed patients (attack rate: 8.31%, 229/27,562). Index patient were imported from epi-linked woreda. Diglena geraro kebele were the Epicenter of the outbreak. Epicure trend shows common source infection. Using bifurcation of Awash River for drinking, use untreated/ uncoiled water, poor hand washing practices, and close contact with cholera sick person were found to be associated with cholera. Conclusion: This outbreak was caused by vibrio cholera 01 secondary to drinking water from a bifurcation of Awash River and using untreated water. Contact with diseased person, and use untreated/ uncoiled water was associated with being patients. In order to reduce the risk of cholera, safe drinking water or water treatment chemicals needs to be provided to communities.

Targeted next generation sequencing of Cyclospora cayetanensis mitochondrial genomes from seeded fresh produce and other seeded food samples

Cyclospora cayetanensis, a coccidian apicomplexan parasite, causes large outbreaks of foodborne diarrheal disease globally. Tracking the source of C. cayetanensis oocyst contamination in food items is essential to reduce, even prevent outbreaks. We previously showed that a genotyping method based on mitochondrial single nucleotide polymorphism (SNP) profiles had discriminatory power in classifying C. cayetanensis clinical isolates. In food specimens, low level contamination by oocysts and difficulties in DNA extraction present significant challenges in genotyping method development. Here, we report the development of a highly sensitive, custom-designed, targeted sequencing method based on the Illumina AmpliSeq platform; our method was capable of consistently generating near-complete mitochondrial genome sequences of C. cayetanensis from foods with low levels of contamination. To simulate environmentally observed contamination levels in foods, we seeded various food matrices, such as fresh produce and prepared dishes, with known quantities of oocysts, and isolated genomic DNA from washed food samples. Using the Ampliseq Targeted Sequencing method, we obtained near-complete mitochondrial genome sequences of C. cayetanensis from food samples seeded with as low as five to ten oocysts and used the data in downstream analysis. The flexibility of the AmpliSeq platform could potentially allow for more genomic targets to be added to achieve higher discriminatory power. This level of sensitivity in capturing high resolution genome data from contaminated food samples is a critical milestone towards the potential development of a comprehensive genotyping method for C. cayetanensis.

Characterization of Escherichia coli O157:non-H7 isolated from retail food in China and first report of mcr-1/IncI2-carrying colistin-resistant E. coli O157:H26 and E. coli O157:H4

Escherichia coli O157 belongs to a diverse serogroup including different H serotypes. E. coli O157: H7 is the most common serotype that can cause acute gastroenteritis, hemorrhagic colitis (HC), and hemolytic-uremic syndrome (HUS) in humans. In recent years, some E. coli O157:non-H7 strains have been reported to cause sporadic cases and outbreaks of diarrheal diseases. However, the phenotypic and genotypic characteristics of E. coli O157:non-H7 are poorly understood. In this study, E. coli O157:non-H7 strains were isolated from retail food sold on markets in 13 cities in China during 2012–2016 and characterized systematically in terms of their H serotypes, virulence genes, antibiotic resistance, and genotypes. Six H serotypes (H26, H42, H11, H38, H4, and H5) were identified, of which, O157:H42 (31.4 %) and O157:H26 (28.6 %) were the most prevalent. Most of the isolates (82.9 %) carried virulence genes. Ten isolates (28.6 %) carried the eae gene and were identified as atypical enteropathogenic E. coli. Multilocus sequence typing showed that the E. coli O157:non-H7 strains demonstrated diverse sequence types with different evolutionary trends than E. coli O157:H7. All the isolates exhibited multidrug resistance. The isolates showed a high prevalence of resistance to AMC, AMP, CTX, CIP, T/S, TE, and FFC. The predominant antibiotic-resistance genes were TEM-1 (40.0 %), CTX-M-55 (34.3 %), aadA (74.3 %), sul2 (62.9 %), floR (91.4 %), tetA (85.7 %), qnrS (37.1 %), oqxA (62.9 %), and oqxB (62.9 %). For the first time, we identified IncI2 plasmid-mediated colistin-resistant strains (six O157:H26 and one O157:H4). These strains co-harbored plasmid-mediated mcr-1 gene, CTX-M-55, OXA-4, PMQR, and other resistant genes, which is of great concern. Colistin and cefotaxime are generally used as the last defense to treat complicated infections. The emergence of virulent and multidrug resistant strains in food poses a serious threat to human health. The strict monitoring and surveillance of multiple-drug resistant strains in food are needed to prevent their dissemination to humans.

Epidemiological Investigation of an Outbreak of Acute Diarrheal Disease at Talegaon Dabhade, Mawal Block, Pune, Maharashtra

Background: Acute Diarrheal Disease (ADD) affects millions of people across the globe, especially in poor socio-economic regions. Most of the diseases and deaths among children result from diarrhea resulting from contaminated water and food sources. In India, most diarrheal outbreaks can be attributed to contaminated water.These outbreaks can be prevented through the provision of safe drinking water. Outbreak investigation plays a vital role in ascertaining the causes of an outbreak and thereby keeping a check on communicable diseases. This paper explores the investigation that followed an outbreak of diarrhea in one of the interior regions of the Pune district in Maharashtra. Objectives: (i) To confirm the existence of an outbreak at Talegaon Dabhade (ii) To identify the source of infection and mode of transmission (iii) To control and prevent the further spread of the outbreak. Methods: A ground review of the outbreak situation was done along with the local health authority of Talegaon Dabhade and the Primary Health Centre (PHC) Staff. Information regarding water samples collection and testing was obtained from Talegaon Municipal Council officials. An observational cross-sectional study using a mixed-method approach was conducted. Face-to-face interviews of 8 cases were conducted using a semi-structured interview schedule. Result: The frontline workers identified a total of 624 cases during the survey. About 209 patients came to seek treatment at the PHC Outpatient Department (OPD) with three reported hospitalizations. The field workers started reporting cases on 27th December 2021. A total of 217 water samples collected from multiple points were sent for water quality testing. Only one sample from the house of an infected person came out to be positive for coliforms. The source of infection of the outbreak could not be identified. Conclusion: Outbreaks can be prevented through training of local health staff, strengthening labs at the government health facilities, and enhancing Information, Education and Communication (IEC) activities. This ensures early identification andtimely response to epidemic-prone diseases.

Diarrhea outbreak associated with coronavirus infection in adult dairy goats.

BackgroundInfection by coronaviruses cause gastrointestinal disease in many species. Little is known about its prevalence and importance in goats.ObjectiveIdentify the etiology, demographics, and clinical features of an outbreak of diarrhea in adult goats.HypothesisBovine coronavirus (BCoV) PCR would detect viral material in feces of goats in the herds involved in the diarrhea outbreak.AnimalsTwelve herds with 4 to 230 adult goats were affected. Goats sampled for fecal PCR were ≥1‐year‐old: 25 from affected herds and 6 from a control herd.MethodsThis is a cross‐sectional descriptive study of an outbreak of diarrheal disease in adult goats. BCoV PCR primers for the spike (S) or nucleocapsid (N) proteins were used to test fecal material from affected goats. The N protein sequencing and phylogenetic analysis was performed. Herd records and owner surveys were used to characterize morbidity, clinical signs, and treatment.ResultsIn 2 affected herds 18/25 of animals had at least 1 positive BCoV PCR test. Goats from affected herds were significantly more likely to be PCR positive than the control herd (OR 8.75, 95% CI 1.11‐104, P = .05). The most common clinical signs were change in fecal consistency (19/20) and decreased milk production (14/15). Phylogenetic analysis of the N protein showed this virus was closely related to a bovine‐like coronavirus isolated from a giraffe.Conclusions and Clinical ImportanceBovine coronavirus primers detected nucleic acids of the N and S proteins in feces of goats in affected herds. Coronavirus shedding frequency was temporally associated with the outbreak.

Phylogenetic Analysis of Serogroup O5 Vibrio cholerae that Caused Successive Cholera Outbreaks - Guangdong Province, China, 2020-2021.

IntroductionGastroenteritis caused by non-O1/non-O139 Vibrio cholerae exhibited an increasing trend in recent years in China. Whole genome sequence (WGS) data could play an important role both in the identification of the outbreaks and in the determination of the serogroup. Here, we present the employment of WGS data in the investigation of two outbreaks caused by non-O1/non-O139 V. cholerae in Guangdong, China, 2020–2021. MethodsWe obtained the whole genome sequence of 66 V. cholerae strains isolated in two outbreaks with next generation sequencing technology. We retrieved the publicly available WGS data of non-O1/non-O139 V. cholerae from public database. We used a pipeline integrated in China Pathogen Identification Net (PIN) to complete the phylogenetic analysis. ResultsTwo outbreaks caused by non-O1/non-O139 V. cholerae were identified using WGS data. These V. cholerae strains were determined as serogroup O5. Type 3 and 6 secretion systems were detected in these serogroup O5 strains. These serogroup O5 strains belonged to sequence type (ST) 88. ConclusionsOur analysis indicated the risk of non-O1/non-O139 V. cholerae leading to outbreaks of diarrheal diseases. The application of genomic data played an important role in the identification of the serogroup of non-O1/non-O139 V. cholerae in the lack of antiserum, which gave an example of the application of genome data in disease surveillance and public health emergency response.

Cholera outbreak in Kamarhati municipality of West Bengal: Secondary data analysis of a rapid epidemic response

Introduction: In September, 2021, an outbreak of acute diarrhoeal disease affected different wards of Kamarhati municipality of West Bengal. An epidemic investigation was conducted with the objective of identifying the time, place and person distribution of the epidemic. Methods: In this institution based cross-sectional study, an epidemic response team of College of Medicine and Sagore Dutta Hospital (CoMSDH) visited the patients admitted in the infectious diseases ward of the institute and enquired them using a pre-designed proforma. Stools samples were collected and sent for analysis to National Institute of Cholera and Enteric Diseases (NICED), West Bengal. The team also visited the affected wards and collected water samples for laboratory investigations. Collected data were collated in Google sheets and requisite analyses were done in Google sheet, online spreadsheet software. Spatial distributions of cases were shown using QGIS v2.38.Results: 208 patients admitted in infectious diseases ward of CoMSDH, Kamarhati, Kolkata in between 2nd - 13th September, 2021 were interviewed. The epidemic curve showed a rapid rise on 07th September, 2021 (57 cases) followed by a gradual fall over next 5 days. Majority of cases were clustered in Ward 1,2 and 3 of Kamarhati municipality. The attack rate was highest among the geriatric age group (≥60 years) followed by 19-60 years age group. Abdominal Pain (35.71%) and vomiting (28.57%) were commonly associated symptoms. Majority of the respondents (172, 87.76%) used intermittent tap water supply from local municipalities, followed by purchased mineral water (20, 10.20%) and water from Tala tank (4, 2.04%) for their drinking purpose. Stool and water samples revealed the presence of Vibrio Cholerae, O139 ogawa serotype. Conclusion:On the basis of the interim analysis, health education was initiated on the domestic treatment of water by boiling or using chlorine solution. Additionally, steps were taken for water treatment at the water treatment plants. This assisted in controlling the outbreak.

Deltacoronavirus Evolution and Transmission: Current Scenario and Evolutionary Perspectives.

Deltacoronavirus (DCoV)–the only coronavirus that can infect multiple species of mammals and birds–was initially identified in several avian and mammalian species, including pigs, in China in 2009–2011. Porcine DCoV has since spread worldwide and is associated with multiple outbreaks of diarrheal disease of variable severity in farmed pigs. In contrast, avian DCoV is being reported in wild birds in different countries without any evidence of disease. The DCoV transboundary nature and the recent discovery of its remarkably broad reactivity with its cellular receptor–aminopeptidase N (APN)–from different species emphasize its epidemiological relevance and necessitate additional research. Further, the ability of porcine DCoV to infect and cause disease in chicks and turkey poults and gnotobiotic calves is suggestive of its increased potential for interspecies transmission or of its avian origin. Whether, porcine DCoVs were initially acquired by one or several mammalian species from birds and whether avian and porcine DCoVs continue co-evolving with frequent spillover events remain to be major unanswered questions. In this review, we will discuss the current information on the prevalence, genetic diversity, and pathogenic potential of porcine and avian DCoVs. We will also analyze the existing evidence of the ongoing interspecies transmission of DCoVs that may provide novel insights into their complex evolution.

Outbreak of acute diarrhoeal disease attributed to consumption of faecal contaminated water supplied through damaged pipelines in Thiruper, Tiruvallur district, Tamil Nadu, India, 2016

BackgroundOn December 24, 2016, 18 Acute Diarrhoeal Disease (ADD) cases were reported in Thiruper village. We aimed to identify potential exposure and propose recommendations. MethodsWe defined a case of ADD as occurrence loose stools (≥3 episodes), December 14–30, 2016. We did door-to-door case search, calculated attack rate by age and gender, drew epidemic curve and plotted cases by residence. We conducted a matched case-control study and computed Matched Odds ratio (MOR), 95% confidence interval (95% CI) and Population Attributable Risk (PAR). We collected stool and water specimens for laboratory testing. ResultsWe identified 38 (6%) cases among 625 residents. The attack rate of ADD was higher among aged <5 years (16.5%), and female (6.8%). The outbreak lasted between 14–27 December 2016 with multiple peaks. Cases clustered in areas receiving water from damaged pipelines crossing open-defecation area. We compared 38 ADD cases with 76 age, gender and neighbourhood matched controls for different exposures. Consuming water supplied through the damaged subterranean pipeline (MOR = 3.7; 95% CI = 1.1 to 16.4; PAR = 72%) was associated with ADD. The environmental investigation pointed out potential faecal contamination of water through damaged subterranean pipelines near open-air defaecation area of village. The collected stool specimens were negative for pathogens, and water specimens tested positive for Escherichia coli. ConclusionsWe confirmed that the outbreak of ADD in Thiruper village was due to consumption of water contaminated with E. coli supplied through damaged subterranean pipelines post-cyclone. We recommended the replacement of subterranean pipelines and distribution of chlorinated water.

Acute diarrheal disease outbreak in Muzaffarpur Village, Chandauli District, Uttar Pradesh, India.

Acute diarrheal disease (ADD) outbreaks frequently occur in the Gangetic plains of Uttar Pradesh, India. In August 2017, Muzaffarpur village, Uttar Pradesh, reported an ADD outbreak. Outbreak investigation was conducted to find out the epidemiology and to identify the risk factors. A 1:1 area-matched case-control study was conducted. Suspected ADD case was defined as ≥3 loose stools or vomiting within 24 h in a Muzaffarpur resident between August 7 and September 9, 2017. A control was defined as an absence of loose stools and vomiting in a resident between August 7 and September 9, 2017. A matched odds ratio (mOR) with 95% confidence intervals (CIs) was calculated. Drinking water was assessed to test for the presence of any contamination. Stool specimens were tested for Vibrio cholerae, and water samples were also tested for any fecal contamination and residual chlorine. Among 70 cases (female = 60%; median age = 12 years, range = 3 months-70 years), two cases died and 35 cases were hospitalized. Area-A in Muzaffarpur had the highest attack rate (8%). The index case washed soiled clothes at well - A1 1 week before other cases occurred. Among 67 case-control pairs, water consumption from well-A1 (mOR: 43.00; 95% CI: 2.60-709.88) and not washing hands with soap (mOR: 2.87; 95% CI: 1.28-6.42) were associated with illness. All seven stool specimens tested negative for V. cholerae. All six water samples, including one from well-A1, tested positive for fecal contamination with <0.2 ppm of residual chlorine. This outbreak was associated with consumption of contaminated well water and hand hygiene. We recommended safe water provision, covering wells, handwashing with soap, access to toilets, and improved laboratory capacity for testing diarrheal pathogens.

Microbiological status of drinking water sources and its relationship with human health in Solan, India.

In Solan district, the developmental activities associated with chemical based farming, rapid urbanization, and rampant industrialization have led to many diarrhoeal, gastroenteritis, and hepatitis disease outbreaks. This has necessitated for microbiological assessment of indicator organisms, the thermotolerant coliforms, in drinking water sources, and their relationship with diarrhoeal disease. All the 49 Public Health Institutes (PHIs) of the district were categorized into very low, low, moderate, and high disease burden regions by stratification method. For drinking water, 55.5, 16.5, and 17% people preferred springs, borewells, and hand-pump respectively. These sources inventoried by Knowledge, Attitude, and Practice survey in one of very low and seven of high disease burden regions, and were analyzed by multiple tube fermentation technique. A cross-sectional survey of 200 children was undertaken for diarrhoeal disease estimation. Parwanoo, an industrial and Kurgal, a non industrial region witnessed highest (30.20) and lowest (4.40) Most Probable Number (MPN) per 100 ml water of thermotolerant coliforms, respectively. Thermotolerant coliforms were also observed significantly more (16.77 MPN/100 ml water) in monsoon than in post monsoon season (9.04 MPN per 100 ml water). The thermotolerant coliform Escherichia coli was recovered from six and three water sources respectively during monsoon and post monsoon. A strong correlation (r = 0.78) existed between the diarrhoeal disease occurrence and the concentration of thermotolerant coliforms in monsoon whereas it was moderate (r = 0.61) in post monsoon. The study indicated more contamination of water sources due to industrial activities which further got aggravated during the rainy season of the region.

Physico-Chemical and Bacteriological Characteristics of Hand-Dug Wells and Boreholes Water Quality of the Vina Division, Cameroon

Background: Limited access to safe drinking water and lack of information on water quality in the sub-urban and rural regions of Cameroon has contributed to regular outbreaks of diarrheal diseases. Objectives: The aim of this study was to assess the bacteriological quality of drinking water in the Vina division. Methods: A total of 193 water samples were collected from unprotected boreholes, unprotected wells and unprotected clay pots and analyzed physico-chemically including pH, turbidity, total dissolved solid, conductivity and microbiologically such as enumeration of <i>Enterococcus sp.</i>, <i>Escherichia coli</i>, <i>Salmonella sp.</i> and <i>Vibrio</i> sp using standard methods. This study revealed that safe status of the groundwater sources in the Vina division is very poor, considering the high levels of <i>E.coli</i>, <i>Enterococcus</i> sp. and the presence of enter pathogens microorganism such as <i>Vibrio</i> sp., <i>Salmonella</i> sp. and <i>Shigella</i> sp. Representative isolates (26) based on biochemical profile were selected for antibio resistance profile. All selected bacteria exhibited multiple antibiotic resistance at least for five antibiotics including ampicillin, amoxicillin + Clavulanic acid, amoxicillin, penicillin, erythromycin. Conclusion: This study suggests that drinking water available in Vina division of Cameroon lead to a substantial risk to public health. It is therefore necessary to developed strategies for protection of areas around drinking water supplies site. Further studies are therefore needed to assess the prevalence of water borne diseases in Vina division.

Rotavirus cases among Rotarix vaccinated children below five years during the 2018 outbreak in the Kingdom of Eswatini

Background: A large outbreak of diarrhoeal disease in children under 5 years was reported in four surveillance sentinel sites Mbabane Government Hospital, Raleigh Fitkin Memorial Hospital, Hlathikhulu Government Hospital and Good Shepherd Hospital. Rapid increase of number diarrhoeal cases, were reported from week 34 to 41 (August to October 2018). Approximately 1,535 children presented with acute diarrhea, vomiting and dehydration. Methods and materials: Diarrhoeal stool samples were routinely collected for surveillance from children less than 5 years of age to determine the etiology of the diarrhoea. A total of 139 stool samples were tested for rotavirus using enzyme immunoassay kit, Molecular characterization using polyacrylamide gel electrophoresis, semi nested reverse-transcription polymerase chain reaction, sequencing and phylogenetic analysis. Rotavirus negative stool samples were further tested for bacteria and parasites using molecular diagnostic assays. Results: The rotavirus positive samples were positive for group A rotavirus with a prevalence of (117/211) 53% with the age groups mostly affected being;<12 months = (68/117)58.1%, 3-24 months = 23.9% (28/117) and >24 months = 16.2%(19/117). The PAGE patterns observed were long RNA migration pattern. The G3P[8] 59/75(78.6%) rotavirus strain were mainly associated with the outbreak. Phylogenetic analysis of the partial length VP4 P[8] associated G3 clustered together with other P[8] strains detected in Africa and distantly related to vaccine strains (Rotarix™ and RotaTeq™). Pathogens that were observed in Eswatini were Shigella/Enteroinvasive E. coli 18% (11/61) was frequently detected followed by Campylobacter jejuni/coli 13% (8/61) and Giardia lamblia 13% (8/61). Conclusion: Majority of the children affected by the rotavirus received vaccination and the rotavirus genotype G3P[8] was the major cause of these outbreak. It also important to note that the G3P[8] that was circulating was the wild type stains not related to the vaccine strains. As evident from the Maximum likelihood phylogenetic tree generated, G3P[8] study strains clustered in different lineages as compared to the vaccine strains (Rotarix™ and RotaTeq™). Further studies on whole genome sequence analysis are required to determine the evolutionary relationship among the strains and surveillance of rotavirus among the infants should be continued while increasing the rotavirus vaccine coverange and add a booster dose to increase protection.

Laboratory-Based Surveillance of Clostridium difficile Infection in Australian Health Care and Community Settings, 2013 to 2018.

In the early 2000s, a binary toxin (CDT)-producing strain of Clostridium difficile, ribotype 027 (RT027), caused extensive outbreaks of diarrheal disease in North America and Europe. This strain has not become established in Australia, and there is a markedly different repertoire of circulating strains there compared to other regions of the world. The C. difficile Antimicrobial Resistance Surveillance (CDARS) study is a nationwide longitudinal surveillance study of C. difficile infection (CDI) in Australia. Here, we describe the molecular epidemiology of CDI in Australian health care and community settings over the first 5 years of the study, 2013 to 2018. Between 2013 and 2018, 10 diagnostic microbiology laboratories from five states in Australia participated in the CDARS study. From each of five states, one private (representing community) and one public (representing hospitals) laboratory submitted isolates of C. difficile or PCR-positive stool samples during two collection periods per year, February-March (summer/autumn) and August-September (winter/spring). C. difficile was characterized by toxin gene profiling and ribotyping. A total of 1,523 isolates of C. difficile were studied. PCR ribotyping yielded 203 different RTs, the most prevalent being RT014/020 (n = 449; 29.5%). The epidemic CDT+ RT027 (n = 2) and RT078 (n = 6), and the recently described RT251 (n = 10) and RT244 (n = 6) were not common, while RT126 (n = 17) was the most prevalent CDT+ type. A heterogeneous C. difficile population was identified. C. difficile RT014/020 was the most prevalent type found in humans with CDI. Continued surveillance of CDI in Australia remains critical for the detection of emerging strain lineages.