Potential Source Of Transmission Research Articles

Campylobacter occurrence and antimicrobial resistance profile in under five-year-old diarrheal children, backyard farm animals, and companion pets.

Campylobacteriosis disproportionately affects children under five in low-income countries. However, epidemiological and antimicrobial resistance (AMR) information at the children-animal interface is lacking. We hypothesized that Campylobacter is a major cause of enteritis in children in Ethiopia, and contact with animals is a potential source of transmission. The objective of the study was to determine Campylobacter occurrence and its AMR in children under five with diarrhea, backyard farm animals, and companion pets. Stool from 303 children and feces from 711 animals were sampled. Campylobacter was isolated through membrane filtration on modified charcoal cefoperazone deoxycholate agar plates under microaerobic incubation, and the technique showed to be feasible for use in regions lacking organized laboratories. Typical isolates were characterized with MALDI-TOF MS and multiplex PCR. Of 303 children, 20% (n = 59) were infected, with a higher proportion in the 6 to 11-month age group. Campylobacter occurred in 64% (n = 14) of dogs and 44% (n = 112) of poultry. Campylobacter jejuni was present in both a child and animal species in 15% (n = 23) of 149 households positive for Campylobacter. MICs using the gradient strip diffusion test of 128 isolates displayed resistance rates of 20% to ciprofloxacin and 11% to doxycycline. MICs of ciprofloxacin and doxycycline varied between C. coli and C. jejuni, with higher resistance in C. coli and poultry isolates. Campylobacter infection in children and its prevalent excretion from backyard poultry and dogs is a understudied concern. The co-occurrence of C. jejuni in animals and children suggest household-level transmission As resistance to ciprofloxacin and doxycycline was observed, therapy of severe campylobacteriosis should consider susceptibility testing. Findings from this study can support evidence-based diagnosis, antimicrobial treatment, and further investigations on the spread of AMR mechanisms for informed One Health intervention.

Prevalence and associated risk factors of anti-Coxiella burnetii antibodies in dairy cattle herds using bulk tank milk analysis in Kabylia area, north Algeria.

Coxiella burnetii, or Q fever agent, has notable implications for human and livestock health. Infections in cattle primarily manifest through reproductive issues where infected animals shed the bacterium in birth fluids, placental tissues, and milk, serving as potential sources of transmission. Bovine herds become reservoirs, contributing to the environmental contamination of farming areas. Comprehensive studies on the prevalence, transmission routes, and associated risk factors among cattle contribute to the development of effective control strategies, ultimately safeguarding both livestock and public health.Here we determine the prevalence of Coxiella burnetii antibodies against in dairy cattle farms from Kabylia (northern Algeria) and identify the associated risk factors. Bulk tank milk samples from 184 farms were analyzed by indirect ELISA technique, 49 of them were tested positive which corresponds to a prevalence rate of 26.63% (95% CI 20.25-33.01%). Multivariate analysis by logistic regression showed that the risk factors associated with detection of anti-Coxiella burnetii antibodies are: cohabitation of cattle with small ruminants(OR = 3.74 95% CI [1.41-8.92]), exposure to prevailing winds (OR = 5.12 95% CI [2.11-13.45]), and the veterinarian visits frequency(OR = 5.67 95% CI [2.55-13.60]). These findings underscore the susceptibility of dairy cattle to Q fever in the Kabylia region, highlighting practices that pose risks. We recommend the implementation of hygienic measures and adherence to proper farming conditions to mitigate the transmission of Q fever and reduce the associated zoonotic risk.

Factors Associated with Utilization of COVID-19 Preventive Measures by Patients Attending Private Healthcare Facilities in Southwest Nigeria

Background: Understanding disease risk is important for prevention. Identifying high-risk COVID-19 patients helps healthcare professionals implement precautions. This study examined factors related to COVID-19 prevention in patients at private healthcare facilities in Southwest Nigeria, during the early stages of the pandemic. Methods: A descriptive cross-sectional survey was conducted in two hospitals using multi-stage sampling. 400 respondents were selected two out of 78 private healthcare facilities in in Southwest Nigeria. Trained interviewers administered a questionnaire to collect information on risk profile, symptoms, perception of COVID-19 risk, and preventive practices. Data was analyzed using descriptive statistics, chi-square test, and binary logistic regression at a significance level of 0.05. Results: The average age of participants was 27.83 + 10.46 years. 52.8% of respondents were female. 70.5% were single, 75.8% belonged to the Yoruba ethnic group, and 72% identified as Christians. None had a history of international travel or contact with a confirmed COVID-19 case in the past 14 days, but 12.75% had been in contact with suspected cases. 47% reported having a fever. The majority had a low risk score for COVID-19. Most did not smoke (98.5%), consume alcohol (83.75%), or visit club houses (85.75%). Only 9.5% underwent COVID-19 testing, and 16.0% of those tested were positive. The main reason for test refusal was a lack of perception of susceptibility to COVID-19. Adherence to preventive practices was poor in all investigated circumstances. Conclusion: Patients presenting in hospitals during the early phase of the COVID-19 pandemic had a low risk of COVID-19. However, their poor compliance with preventive protocols and low testing uptake make them a potential source of transmission. Strategies to promote adoption of preventive measures are needed, especially among patients at private healthcare facilities.

Seroepidemiology of Asymptomatic Plasmodium falciparum CoInfections with Hepatitis B And C Virus among Blood Donors in Modakeke Area Office, Ile Ife, Osun State, Nigeria

Despite the remarkable achievements in the reduction of malaria mortality, the disease had remained the most common cause of morbidity and mortality. Infection with hepatitis B virus (HBV) and hepatitis C virus (HCV) might associate with increased mortality rate as the infections may predisposes to the development of serious liver diseases such as liver cirrhosis, liver failure and hepatocellular carcinoma (HCC). The aim of the present study was to determine the Asymptomatic Plasmodium falciparum co-infections with hepatitis B and C viruses among blood donors in Modakeke Area Office, Ile Ife, Osun State, Nigeria. The study was conducted in Modakeke Area Office, Ile Ife, Osun State. The study was conducted in Modakeke health facility, Ile Ife, Osun State. Five (5) ml of venous blood was obtained from each of 400 blood donors into plain bottles and labeled accordingly. Thick and thin films of the donor’s blood samples were made on slides dried for five minutes at 37°C then stained using Giemsa stain. The slides were then examined microscopically for presence and densities of malaria parasites. Species identification and determination of the Hematological parameters were also conducted on the slides. Sera were separated from the remaining aliquots of the blood and screened for hepatitis-B and C surface antigens (HBsAg and anti-HCV). The overall mean parasitaemia of malarious blood donors was 786.20µl/blood while that of blood donors with hepatitis virus infection was 53 representing 13.3% of the total donor examined. Donors infected with HBV, HCV and co-infection of HBV and HCV had viraemia of 25 (6.3%), 21 (5.3%) and 7(1.8%) respectively. Among the age groups, high prevalence of Hepatitis viral infection rate of 57.9% was recorded among aged group 18-26 years. The infection rate of 15.8%, 13.6% and 10.5% of HBV, HCV was recorded from age group 18-26years respectively. The highest co-infection rate of HBV and HCV of 18.8% was recorded from age group 54-62years, while high mean malaria parasitaemia of 1,882.78 (µl of blood) was also recorded among donors aged 18-26 years. High hepatitis viral infection rate of 22.2% with 16.7% of HCV were recorded among females, while 6.3% of HBV and 1.9% of co-infection was observed among males and the mean malaria parasitaemia of 2,382.80 µl of blood was observed among females. High prevalence of Hepatitis infection rate of 17.1%, 8.6% of HCV, (6.3%) of HBV and 2.3% of co-infection were recorded among single donors. The mean malaria parasitaemia of 786.89 (µl of blood) was observed among married donors, there was significant difference between marital status and hepatitis infection (p= 0.0043) and between HCV (p=0.009). High prevalence of hepatitis viraemia of 21.4% and co-infection 5.6% was recorded among artisans, while 14.6% HBV infection rate was recorded among civil servants and 14.3% of HCV was recorded among donors who are farmers. The mean malaria parasitaemia of 1,150.15 µl/blood was recorded among donors who are traders. Donors that have acquired primary education have high prevalence of hepatitis infection rate of 38.5%, with 15.4% of HBV and (23.1%) co-infection (HBVand HCV). HCV (6.7%) was high among donors with secondary education; high mean malaria parasitaemia of 2,096.84 µl of blood was recorded among donors with primary education. Blood B+ve had high hepatitis viral infection rate of 21.7%, HCV 13.0% and co-infection of 5.8% while 7.8% of HBV was recorded among O+ve donors. The mean malaria parasitaemia of 1,378.50 (µl of blood) was recorded among B-ve donors. The total mean PCV in the study was 42.63, White blood cell count was 5,281.25, lymphocytes count was 42.88, eosinophils was 1.53 and neutrophil count was 55.72. The total percentage of elevated AST was 5.0%, ALT was 6.0% and ALB was 10.5%. There was significant difference between malaria and ALT (p=0.000) also, there was significant difference between HCV and ALB (p=0.000). There was significant difference between HBV and AST (p=0.001), ALT (p=0.028) and ALB (p=0.028).The hepatitis viral infection had significant difference with ALB (p=0.000). The logistic regression shows that there was an association between hepatitis viral infection and aged group 27-35years (p=0.022), female (p=0.006), trading (p=0.001), tertiary (p=0.003) A+ve (p=0.018) and B+ve (p=0.001). In conclusion, Although, the prevalence of malaria was low, while that of hepatitis viral infection was high in the local government area, critical screening of blood donors is of prime importance because they serve as an asymptomatic reservoirs and a potential source of transmission of these infections. The strengthening of creating awareness on the general public regarding Malaria, HBV and HCV transmission and prevention should be embarked on.

Evaluation of Alanine Aminotransferase (Alt), Aspatate Aminotransferase (Ast) and Albumin (Alb) Among Blood Donors Infected with Hepatitis B and C Virus and Malaria in Ife Central Local Government Area, Ile Ife, Osun State, Nigeria

Liver diseases are responsible for over one and half million deaths annually and are characterized by permanent inflammatory processes that predispose to liver cancer.Liver function biomarkers are important indices that help in assessment of disease severity. Several studies reveal changes in activity level of liver enzymes and protein in the serum due to Plasmodium infection and Hepatitis infection. Liver enzymes play an important role in the assessment of liver function because of liver injury resulting in cytolysis or necrosis that causes release of enzymes into circulation. Infection with hepatitis B virus (HBV) and hepatitis C virus (HCV) are major global health problems. Moreover, infection with these viruses might associate with increased mortality rate as the infection may predisposes to the development of serious liver diseases such as liver cirrhosis, liver failure and hepatocellular carcinoma (HCC). The objectives of the study are to determine the prevalence Hepatitis B and C infections among blood donors, analyze the relationship between socio- demographic variables and Alanine aminotransferase (ALT), Aspatate aminotransferase (AST) and Albumin (ALB), analyze the relationship between malarial and ALT and AST and evaluate the effect of hepatitis infections on the liver cells. The study was conducted in Ife Central Local Government .Area, Ile Ife, Osun State. Five (5) ml of venous blood was obtained from each of 400 blood donors into plain bottles and labeled accordingly. Sera were separated from aliquots of the blood and screened for hepatitis-B and C surface antigens (HBsAg and HCV), and enzymes such as aspatate aminotransferase (AST) and alanine aminotransferase (ALT). The total percentage of elevated AST was 14(3.5%), ALT 15 (3.8%) and ALB 32(8.0%), while that the least AST 24 (6.0%), ALT 23 (4.8%) and ALB 6 (1.5%). There was significant difference between Occupation and ALT (p= 0.040) and ALB (p= 0.030), Marital status and AST (p=0.014), ALT (p= 0.012), ALB (p=0.014), there was no significant difference between HCV and AST (p=0.532), ALT (p=0.532), but with ALB (p=0.000). There was no significant difference between HBV and AST ( p=0.285), ALT (p=0.593) and ALB (p=0.033), the general hepatitis viral infection had no significant difference with AST ( p=0.516), ALT (p=0.516), but with ALB (p= 0.000), There was no significant difference between malaria infection and AST (p= 0.906), ALT (p= 0.999) and ALB (p= 0.718). in conclusion, although the prevalence hepatitis B and C viral infections was low and there was no significant relationship between the Alanine aminotransferase (ALT), Aspatate aminotransferase,(AST) and Hepatitis infection in the local government, critical screening of blood donors is of prime importance because they serve as an asymptomatic reservoirs and a potential source of transmission of these infections. The strengthening of creating awareness on the general public regarding HBsAg and HCV transmission and prevention should be of paramount important.

Antimicrobial sensitivity pattern of aerobic bacteria isolated from hunting dogs in Maiduguri, Nigeria

Hunting dogs may be a potential source of transmission of pathogenic, zoonotic, or drug-resistant bacteria to people since they may carry the pathogenic bacteria in their oral cavities. As a result of clinic-based cross-sectional study conducted to evaluate the level of multidrug resistant bacteria, colonization of the bacteria in the oral cavities of hunting dogs that appeared apparently healthy were found in Maiduguri. Oral swab samples were taken from one hundred and ninety-three (193) apparently healthy hunting dogs. Using colony morphology and oxidase, catalase, starch hydrolysis, casein hydrolysis, indole, methyl-red and Voges-Proskauer test (MR-VP) the bacteria were isolated and identified. The isolates were tested for antibiotic susceptibility to ten (10) different antibiotics using the Kirby-Bauer disk diffusion method in accordance with standard procedure. Escherichia coli (E. coli) accounted for the greater proportion of 100 (51.8%) of the isolates. Others were Staphylococcus spp. 19 (18.8%), Klebsiella spp. 13 (6.7%), and Streptococcus spp. 7 (3.6%). Escherichia coli isolates were highly resistant to Penicillin 100 (100%), Ceftriaxone (100%) and Tetracycline (80%) while Klebsiella spp. was found resistant to Amikacin (100%), Gentamicin (100%) and Ceftriaxone (100 %). Similarly, Staphylococcus spp. obtained in the current study was found to be resistant to Ciprofloxacin (100%), Gentamicin (100%) and Amikacin (100%) while Streptococcus isolates were resistant to Tetracycline (100%), Penicillin (100%) and Chloramphenicol (100%). Susceptibility of the isolates were E. coli 100 (100%) for Chloramphenicol. Owners of dogs should refrain from using antibiotics indiscriminately. In conclusion, the study revealed the presence of dissimilar bacteria in the oral cavities of hunting dogs using cultural isolation, biochemical and antibiotics sensitivity tests in the study area.

Parents' willingness to pay for COVID-19 vaccination for children in Malaysia using the contingent valuation method.

Children are susceptible and a potential source of transmission for coronavirus disease 2019 (COVID-19). However compulsory COVID-19 vaccination programs among children have not been a focus in Malaysia. The aim of this study was to measure parents' willingness to pay (WTP) for the COVID-19 vaccine and analyze the effects of socioeconomic variables on parents' WTP. An online cross-sectional study was conducted in Malaysia with two waves of surveys (i.e., different samples for each wave), March and June 2021. The study participants were Malaysian parents above 18 years old. Parents were randomized between two vaccine effectiveness profiles (95% and 50% effectiveness) and two risk levels of an adverse event (5% and 20% risk of fever). The WTP was estimated using a double-bounded dichotomous choice. Socioeconomic variables such as age of parent, gender, insurance, income, and education were examined. A total of 292 parents in March 2021 and 271 in June 2021 were included in the study. The vaccine safety and effectiveness profile did not significantly impact the WTP. In March 2021, the estimated WTP ranged from RM344.74 to RM399.64 (US$82.5 to US$95.6) across vaccine profiles and between RM377.55 and RM444.33 (US$90.3 to US$106.3) in June. Insurance status was associated with the parents' WTP, and during the June wave, the age of parents influenced the WTP. Implementing subsidies or free vaccinations is considerable to increase herd immunity and prevent transmission of COVID-19 in Malaysia.

Environmental sampling for typhoidal Salmonellas in household and surface waters in Nepal identifies potential transmission pathways.

Salmonella Typhi and Salmonella Paratyphi, fecal-oral transmitted bacterium, have temporally and geographically heterogeneous pathways of transmission. Previous work in Kathmandu, Nepal implicated stone waterspouts as a dominant transmission pathway after 77% of samples tested positive for Salmonella Typhi and 70% for Salmonella Paratyphi. Due to a falling water table, these spouts no longer provide drinking water, but typhoid fever persists, and the question of the disease's dominant pathway of transmission remains unanswered. We used environmental surveillance to detect Salmonella Typhi and Salmonella Paratyphi A DNA from potential sources of transmission. We collected 370, 1L drinking water samples from a population-based random sample of households in the Kathmandu and Kavre Districts of Nepal between February and October 2019. Between November 2019 and July 2021, we collected 380, 50mL river water samples from 19 sentinel sites on a monthly interval along the rivers leading through the Kathmandu and Kavre Districts. We processed drinking water samples using a single qPCR and processed river water samples using differential centrifugation and qPCR at 0 and after 16 hours of liquid culture enrichment. A 3-cycle threshold (Ct) decrease of Salmonella Typhi or Salmonella Paratyphi, pre- and post-enrichment, was used as evidence of growth. We also performed structured observations of human-environment interactions to understand pathways of potential exposure. Among 370 drinking water samples, Salmonella Typhi was detected in 7 samples (1.8%) and Salmonella Paratyphi A was detected in 4 (1.0%) samples. Among 380 river water samples, Salmonella Typhi was detected in 171 (45%) and Salmonella Paratyphi A was detected in 152 (42%) samples. Samples located upstream of the Kathmandu city center were positive for Salmonella Typhi 12% of the time while samples from locations in and downstream were positive 58% and 67% of the time respectively. Individuals were observed bathing, washing clothes, and washing vegetables in the rivers. These results suggest that drinking water was not the dominant pathway of transmission of Salmonella Typhi and Salmonella Paratyphi A in the Kathmandu Valley in 2019. The high degree of river water contamination and its use for washing vegetables raises the possibility that river systems represent an important source of typhoid exposure in Kathmandu.

Searching for Strep A in the clinical environment during a human challenge trial: a sub-study protocol.

Streptococcus pyogenes (also known as group A Streptococcus , Strep A) is an obligate human pathogen with significant global morbidity and mortality. Transmission is believed to occur primarily between individuals via respiratory droplets, but knowledge about other potential sources of transmission via aerosols or the environment is limited. Such knowledge is required to design optimal interventions to control transmission, particularly in endemic settings. We aim to detail an experimental methodology to assess the transmission potential of Strep A in a clinical environment. We will examine potential sources of transmission in up to 20 participants recruited to the Controlled human infection for penicillin against Streptococcus pyogenes (CHIPS) Trial. Three approaches to understanding transmission will be used: the use of selective agar settle plates to capture possible droplet or airborne spread of Strep A; measurement of the possible distance of Strep A droplet spread during conversation; and environmental swabbing of personal and common high-touch items to detect the presence of Strep A on hard and soft surfaces. All methods are designed to allow for an assessment of transmission potential by symptomatic, asymptomatic and non-cases. Ethical approval has been obtained through Bellberry Human Research Ethics Committee (approval 2021-03-295). Trial registration number: ACTRN12621000751875. Any results elicited from these experiments will be of benefit to the scientific literature in improving our knowledge of opportunities to prevent Strep A transmission as a direct component of the primordial prevention of rheumatic fever. Findings will be reported at local, national and international conferences and in peer-reviewed journals.

Intensive Care Unit Sluice Room Sinks as Reservoirs and Sources of Potential Transmission of Carbapenem-Resistant Bacteria in a South African Tertiary Care Hospital.

Carbapenem-resistant bacteria (CRB) pose a major health risk to patients in intensive care units (ICU) across African hospitals. There are hardly any data about the role of hospital sinks as reservoirs of CRB in resource-poor African settings. Furthermore, the specific within-sink location of the highest concentration of pathogens and the role of splash back as a transmission mechanism remains poorly clarified. We swabbed ICU sluice room sinks in a tertiary hospital in Cape Town, South Africa. Swabs were taken from four different parts of the sluice room sinks (tap-opening, trap, below the trap, and u-bend). Dilutions were prepared and plated on carbapenem-infused agar. Colonies were identified and drug resistance profiles were determined using a biochemical analyser. To evaluate the potential transmission from the sink, similar plates were placed at fixed distances from the sink when the tap was turned on and off. CRB were isolated from the trap, water interface below the trap, and the u-bend (the latter harboured the highest density of CRB species). Five CRB, resistant to at least 7 antibiotic classes, were isolated including Pseudomonas, Klebsiella, Citrobacter, Serratia, and Providencia. CRB could be cultured from droplets that fell on agar-containing plates placed at a varying distance from the trap. There is a higher density of CRB in the u-bend of ICU sluice room sinks which can act as a potential source of transmission. The data inform targeted CRB transmission-interruption strategies in resource-poor settings.

PARASITIC CONTAMINATION OF VEGETABLES IN SELECTED LOCAL MARKETS IN ADEN GOVERNORATE, YEMEN

Fresh and raw vegetables may play a significant role in transmission of intestinal parasitic infections to humans. Therefore, this study was conducted to estimate the level of parasitic contamination in vegetables which are consumed raw in Aden governorate, Yemen. This is a descriptive analytic cross-sectional study in which six local markets were randomly selected. A total of 216 fresh vegetable samples including parsley (Petroselinum sativum), watercress (Nasturtium officinale), lettuce (Lactuca sativa), leek (Allium porrum), green onion (Allium cepa), and tomatoes (Solanum Lycopersicum) were purchased from the selected markets and analysed using direct and iodine wet mount smear preparation. Modified Ziehl–Neelsen staining and Zinc sulphate flotation method were also used. Smears were examined by under the light microscope. Out of 216 vegetable samples, 166 (76.9%) were contaminated with one or more parasites. Parsley was the most contaminated (97.2%), followed by watercress (94.4%), lettuce (88.9%), leek (80.6%), green onion (77.8%), whereas the least contamination rate was in tomato (22.2%). Statistically significant difference in parasitic contamination rate was found between different types of vegetables (P < 0.05). The most common parasite was Ascaris lumbricoides 75 (24.4%), followed by cyst of Entamoeba histolytica/dispar 64 (20.9%), and Entamoeba coli 52 (16.8%). Significant difference was reported in prevalence rate between different parasitic species (????< 0.05). Vegetable samples collected from Dar Saad market, show the highest contamination rate (94.4%) while vegetables collected from Al Mansura market showed the lowest contamination rate(50.0%). However, the parasitic contamination rates were not significantly different for samples collected from different markets. This study highlighted the importance of raw vegetables as the potential source of transmission for intestinal parasites to humans. Prevention methods such as proper washing or cooking of vegetables before consumption should be conveyed to consumers. In addition, comprehensive health education and hygienic practices, including washing hands after handling vegetables, should be provided to sellers and consumers.

Outbreak of Burkholderia multivorans among patients at two acute-care hospitals in California, August 2021–July 2022

Background:Burkholderia multivorans are gram-negative bacteria typically found in water and soil. B. multivorans outbreaks among patients without cystic fibrosis have been associated with exposure to contaminated medical devices or nonsterile aqueous products. Acquisition can also occur from exposure to environmental reservoirs like sinks or other hospital water sources. We describe an outbreak of B. multivorans among hospitalized patients without cystic fibrosis at 2 hospitals within the same healthcare system in California (hospitals A and B) between August 2021 and July 2022. Methods: We defined confirmed case patients as patients without cystic fibrosis hospitalized at hospital A or hospital B between January 2020 to July 2022 with B. multivorans isolated from any body site matching the outbreak strain. We reviewed medical records to describe case patients and to identify common exposures. We evaluated infection control practices and interviewed staff to detect exposures to nonsterile water. Select samples from water, ice, drains, and sink splash zone surfaces were collected and cultured for B. multivorans in March 2022 and July 2022 from both hospitals. Common aqueous products used among case patients were tested for B. multivorans. Genetic relatedness between clinical and environmental samples was determined using random amplified polymorphic DNA (RAPD) and repetitive extragenic palindromic polymerase chain reaction (Rep-PCR). Results: We identified 23 confirmed case patients; 20 (87%) of these were identified at an intensive care unit (ICU) in hospital A. B. multivorans was isolated from respiratory sources in 18 cases (78%). We observed medication preparation items, gloves, and patient care items stored within sink splash zones in ICU medication preparation rooms and patient rooms. Nonsterile water and ice were used for bed baths, swallow evaluations, and ice packs. B. multivorans was cultured from ice and water dispensed from an 11-year-old ice machine in the ICU at hospital A in March 2022 but no other water sources. Additional testing in July 2022 yielded B. multivorans from ice and a drain pan from a new ice machine in the same ICU location at hospital A. All products were negative. Clinical and environmental isolates were the same strain by RAPD and Rep-PCR. Conclusions: The use of nonsterile water and ice from a contaminated ice machine contributed to this outbreak. Water-related fixtures can serve as reservoirs for Burkholderia, posing infection risk to hospitalized and immunocompromised patients. During outbreaks of water-related organisms, such as B. multivorans , nonsterile water and ice use should be investigated as potential sources of transmission and other options should be considered, especially for critically ill patients.Disclosures: None

Multidrug-resistant Acinetobacter outbreak in spinal cord unit identified and stemmed through infection prevention epidemiologic efforts

Background: Drug-resistant pathogens are a significant source of increased cost and patient complications in long-term and/or congregate care settings. Once introduced, depending on the environmental niche in which they establish and the mechanisms they employ for survival, they can be difficult to eradicate. We report the details of an epidemiologic investigation of a multidrug-resistant Acinetobacter baumannii (MDR-A) outbreak in a spinal cord intervention (SCI) unit within a Veterans Affairs facility in San Antonio, Texas, that was identified after back tracing a positive wound culture from a long-term resident. Methods: All MDR-A isolates were matched to the patients harboring them. Their clinical, epidemiologic, and geographic histories within our facility were traced. All potentially shared characteristics between cases were evaluated closely. Results: In total, 5 cases were determined to be likely connected over a period of ~18 months starting December 2020. The extant isolates underwent molecular evaluation and were genetically related. Patient activity was traced by the infection prevention team to identify potential sources of transmission. Environmental sampling after standard cleaning found a common strain on a shower trolley shared by these patients. Following focused cleaning of this and other shared locations, no new related isolates have been identified from patient or environmental samples. Conclusions: In this case, investigation by the infection prevention team of a single multidrug-resistant organism led to identification and eradication of a potential pathogen. Despite standard cleaning processes, a likely shared fomite was identified and decontaminated, thereby preventing future infections. This case exemplifies the value of thorough epidemiologic study paired with modern molecular methods of identification.Disclosures: None

Factors associated with high influenza vaccination among healthcare workers in Tennessee acute-care hospitals, 2014–2022

Background: Healthcare workers (HCWs) are at increased risk of influenza exposure and represent a potential transmission source. The Department of Health and Human Services (HHS) set a goal for 2020 to have 90% of all HCWs in acute-care hospitals (ACHs) vaccinated. Vaccination against influenza decreases symptomatic illness and absenteeism and protects HCWs and their contacts. We assessed characteristics of facility intervention programs based on their success in meeting this benchmark. Methods: Data from the NHSN were utilized, including answers to the Annual Flu Survey for 2014–2022 and the rate of vaccine compliance by facility. Flu surveys detail facility-specific programs implemented for each influenza season, from October to March. We used SAS version 9.4 software for univariate analyses to determine factors significantly associated with meeting the HHS benchmark target of ≥90% vaccination among all HCWs, split into categories for employees, students or volunteers, and licensed independent practitioners. Facilities were excluded if they were not ACHs or Critical Access Hospitals (CAH), did not complete the Annual Flu Survey for at least 1 year, or required vaccination as a condition of employment. Results: From 2014 to 2022, 745 surveys were completed. Overall, 48.58% of respondents succeeded in meeting the HHS benchmark. Also, 306 surveys completed noted that their facility did not require influenza vaccination. Among those, only 19.93% respondents succeeded. Moreover, 80.33% of successful respondents for all HCWs required personal protective equipment (PPE) upon vaccination refusal compared to 34.29% of unsuccessful respondents (P < .0001). Furthermore, 98.36% successful respondents required documentation of offsite vaccination, compared to 89.39% of unsuccessful respondents (P = .027). For employees, 64.56% of successful respondents tracked vaccination rates in some or all units compared to 45.81% of unsuccessful respondents (P = .004). Also, 63.29% successful respondents had visible vaccination of leadership, compared to 43.61% of unsuccessful respondents (P = .003). Furthermore, 86.08% of successful respondents had mobile vaccination carts, compared to 73.57% unsuccessful respondents (P = .023). For the student- or volunteer-specific benchmark, 24.59% of successful respondents provided vaccination incentives compared to 14.63% of unsuccessful respondents (P = .035). Conclusions: Facilities with ≥90% vaccination among HCWs were more likely to require PPE after vaccination refusal and documentation for offsite vaccination. Other strategies for vaccination were differentially associated by employee type for Tennessee facilities. For future outreach, a multipronged approach is more likely to be successful in addressing vaccine uptake among employees with lagging rates. Strategies for influenza vaccine uptake could also improve other occupational vaccinations. More research is needed on the barriers to vaccination among HCWs specifically.Disclosures: None

Reptarenavirus S Segment RNA Levels Correlate with the Presence of Inclusion Bodies and the Number of L Segments in Snakes with Reptarenavirus Infection-Lessons Learned from a Large Breeding Colony.

Reptarenaviruses cause boid inclusion body disease (BIBD), a fatal disease particularly impacting captive boa constrictor collections. The development of cytoplasmic inclusion bodies (IBs) comprising reptarenavirus nucleoprotein (NP) in many cell types of affected snakes is characteristic of BIBD. However, snakes can harbor reptarenaviruses without showing IBs, hence representing carriers and a potential source of transmission. The RNA genome of reptarenaviruses comprises a small (S) and a large (L) segment, and the snakes with BIBD commonly carry a swarm of reptarenavirus segments. To design sensitive and reliable tools for the diagnosis of reptarenavirus infection in snake colonies, we used metatranscriptomics to determine the reptarenavirus segments present in a large boa constrictor breeding colony. The analysis identified one reptarenavirus S segment and three L segments in the colony. The sequence data served to design real-time reverse transcription-PCR (RT-PCR) targeting the found S segment. This allowed us to identify all infected animals and to quantify the S segment RNA levels, which we found to correlate with the presence of IBs. We further found a positive correlation between the number of L segments and the S segment RNA level, which could suggest that L segment excess also contributes to the IB formation. Information on cohousing of the snakes showed a clear association of reptarenavirus infection with cohousing in general and cohousing with infected animals. Information on breeding and offspring confirmed that vertical transmission occurred. Furthermore, our data suggest that some animals might be able to clear the infection or at least exhibit transient or intermittent viremia. IMPORTANCE Boid inclusion body disease (BIBD) is caused by reptarenavirus infection, and while reptarenavirus nucleoprotein is the main component of the inclusion bodies (IBs) characteristic of BIBD, not all reptarenavirus-infected snakes demonstrate IBs in their cells. Identification of infected individuals is critical for controlling the spread of the disease; however, the genetic divergence of reptarenaviruses complicates reverse transcription-PCR (RT-PCR)-based diagnostics. Here, we tested a next-generation-sequencing-based approach to establish a tailored "colony-specific" set of diagnostic tools for the detection of reptarenavirus small (S) and large (L) genome segments. With this approach, we could demonstrate that an S-segment-specific RT-PCR is highly effective in identifying the infected individuals. We further found the S segment RNA level to positively correlate with the presence of IBs and the number of L segments, which could direct future studies to identify the BIBD pathogenetic mechanisms.

Detection of Parasites Contaminating Raw Consumable Vegetables in Kalar City, Kurdistan Region, Iraq

Intestinal parasitic infections are one of the most important health problems. Although freshvegetables are considered as a vital element of a healthy diet, they are a potential source ofhuman intestinal parasitic infections during production, collection, transportation, preparationand consumption. The present study was carried out to determine and detect the parasitecontaminants of fresh vegetables that are sold at different open-aired markets in Kalar city,Kurdistan Region, Iraq. A total of 240 raw vegetable samples were examined by sedimentationtechnique after washing the samples with normal saline. Of the 240 samples, 124 (51.7%) weremicroscopically positive for intestinal parasites. Particularly, a high rate of contamination wasrecorded in cress (Lepidium sativum) with 70%. However, the least contaminated sample waslettuce (Lactuca sativa) with 36.7%. The most encountered parasite was Taenia spp. (egg12.9%), whereas Trichuris trichiura (0.83%) was the least detected parasite. Since, the resultsemphasize the fresh vegetables are potential sources of transmission for intestinal parasites incentral markets of Kalar city, strict hygienic measures should always be adopted to avoidparasitic contamination. Untreated sewage and the manure used by greengrocer as fertilizer canbe implicated in vegetable contamination.

How big of an impact do asymptomatic people have on the dynamics of an epidemic?

Asymptomatic carriers serve as a potential source of transmission of epidemic diseases. Exposed people who develop symptoms only get tested and remain isolated in their homes or sometimes in hospitals when needed. In contrast, the asymptomatic individuals go untested and spread the disease silently as they roam freely throughout their entire infectious lifetime. The work intends to explore the role of asymptomatic carriers in the transmission of epidemic diseases and investigate suitable optimal control strategies. We propose a SEIAQR compartmental model subdividing the total population into six different compartments. To illustrate the model’s implication, we estimate the number of asymptomatic individuals using COVID-19 data during June 9–July 18, 2021 from Bangladesh. We then analyze the model to explore whether the epidemic subsides if the asymptomatic individuals are tested randomly and isolated. Finally, to gain a better understanding of the potential of this unidentified transmission route, we propose an optimal control model considering two different control strategies: personal protective measures and isolation of asymptomatic carriers through random testing. Our results show that simultaneous implementation of both control strategies can reduce the epidemic early. Most importantly, sustained effort in identifying and isolation of asymptotic individuals allows relaxation in personal protective measures.

Ecology and epidemiology of Salmonella spp. isolated from the environment and the roles played by wild animals in their maintenance

Salmonella is a ubiquitous organism of public health importance that causes diarrhea and other systemic disease syndromes. The ecology and epidemiology of the organism in addition to the roles played by wild animals are important in understanding its disease. Relevant published peer-reviewed literature was obtained after imputing the study's keywords into the Google search engine. The publications were thereafter saved for the study. The study revealed the ecology of Salmonella is directly related to its epidemiology. These were found to be either positively or negatively influenced by the living and non-living parts of the environment. Free-ranging and captive wild animals can serve as asymptomatic carriers of Salmonella, therefore, help to maintain the cycle of the disease since wildlife serves as reservoir hosts to over 70% of emerging zoonotic diseases. Cockroaches transmit Salmonella through their feces, and body parts and when ingested by birds and animals. The statistically significant over 83% of Salmonella isolation in lizards suggests the reptile could be a source of Salmonella distribution. Snakes, foxes, badgers, rodents, and raccoons have been reported to have Salmonella as a natural component of their gut with the ability to shed the organism often. The high occurrence (>45%) of diverse Salmonella serovars coupled with the fact that some of these animals were handled, kept as pets and consumed by man portends these animals as potential sources of transmission of the organism and the disease. The etiology and epidemiology of Salmonella are overtly affected by several environmental factors which also determine their survival and maintenance. The roles played by wild animals in the relationship, transmission, growth or interaction within and between Salmonella spp., the occurrence, prevalence, and distribution of the organism help maintain the organism in the environment. An understanding of the roles played by the different parts of the environment and wild animals in the ecology and epidemiology of Salmonella can help make informed decisions on the prevention and control of the diseases it causes. This review aimed to investigate the relationship between ecology, epidemiology, and environment, including the roles played by wild animals in the maintenance of the organism and its disease.

Comparative molecular profiling of antimicrobial resistance and phylogenetic characterization of multidrug-resistant Escherichia coli isolated from meat sources in 2009 and 2021 in Japan

The global spread of antimicrobial resistance (AMR) is alarming. Escherichia coli is a Gram-negative bacterium that causes healthcare-associated infections and is a major threat to public health. Currently, no comprehensive antimicrobial surveillance of multidrug-resistant E. coli of diverse phylogroups along the meat value chain has been implemented in Higashihiroshima, Japan. Therefore, by employing the One Health approach, 1183 bacterial isolates, including 303 recovered from meat samples in 2009, were screened for the presence of antimicrobial resistance determinants using multiplex PCR and DNA sequencing techniques. Seventy-seven non-duplicate E. coli isolates that harbored AMR genes were subjected to antimicrobial susceptibility testing and the detection of integrons. Phylogenetic characterization, which has not been previously investigated, was used to assign E. coli to one of the eight phylogroups.Twenty-six out of 33 (78.8%) and 34 out of 44 (77.3%) E. coli isolates from 2009 and 2021 exhibited multidrug resistance (MDR) phenotypes, respectively. The most common clinical resistance was observed against ampicillin, tetracycline, kanamycin, sulfamethoxazole/trimethoprim, cefotaxime, and chloramphenicol. Overall, 22.1% (17/77) of the E. coli isolates carried extended-spectrum β-lactamase (ESBL)-encoding genes and showed the ESBL-resistant phenotypes. For the two isolation years, AmpC/ESBL prevalence decreased from 42.4% in 2009 to 20.5% in 2021. The identified AMR genes included blaCTX-M-1, blaCTX-M-2, blaCTX-M-14, blaCTX-M-15, and blaSHV-12 (ESBL-types); blaSHV-1, blaTEM-1, blaTEM-135, and blaTEM-176 (narrow-spectrum types); blaCMY-4, blaADC-32, blaADC-216, blaACT-48, and blaACT-51 (AmpC types); and integrons. All E. coli isolates were negative for carbapenemase-encoding genes, whereas one isolate from 2009 carried mcr-5.1 allele. Approximately 52% of E. coli isolates identified in 2009 were assigned to phylogroup A compared to the 20.5% in 2021. Notably, the highest proportions of E. coli phylogroups exhibiting MDR were groups A, B1, and F, suggesting that members of these groups are mostly associated with drug resistance. This study highlights the role of meat as a significant reservoir of MDR E. coli and potential source for transmission of AMR genes. Our findings emphasize the importance of continuous monitoring to track the changes in the spread of antimicrobial resistance in the food chain.

Molecular detection of Toxoplasma gondii, Neospora caninum and Sarcocystis spp in tissues of Sus scrofa slaughtered in southern Brazil.

The aim of this study was to determine the presence of deoxyribonucleic acid (DNA) from Toxoplasma gondii, Sarcocystis spp. and Neospora caninum, in tissues of wild boars slaughtered in southern Brazil. A total of 156 samples were collected from different organs of 25 wild boars, and DNA from at least one of the protozoa investigated was detected in 79 samples. To differentiate between infectious agents, restriction fragment length polymorphism was performed using the restriction enzymes DdeI and HpaII. For N. caninum, conventional PCR was performed with specific primers. The DNA of at least one of the studied pathogens was detected in each animal: 26.58% for T. gondii, 68.36% for Sarcocystis spp. and 5.06% for N. caninum. Coinfection between T. gondii and Sarcocystis spp. occurred in 14 animals, between T. gondii and N. caninum in only one male animal, between Sarcocystis spp. and N. caninum in a female, while co-infection with the three agents was equally observed in only one male animal. Considering the high frequency of detection and its zoonotic risk, especially T. gondii, it appears that wild boars can be potential sources of transmission of infectious agents and the adoption of monitoring measures in these populations should be prioritized.