Reports Of Outbreaks Research Articles

Microbial indicators for water quality in recirculating shower technology.

Recirculating showers save up to 70-80% of the water and energy use of conventional showers, but water quality in these systems are not studied very well due to the technology's early stages. The aim of this study was to provide an overview of information available on which microorganisms were investigated and at which densities. Based on this platform we further aimed at identifying key microbial indicators and pathogens for monitoring water quality in these systems by integrating data from the top five waterborne outbreaks with findings from studies on (1) microbial investigations in reuse projects involving shower effluents or combined bathroom streams, (2) shower water effluents, and (3) biofilms in conventional showers. Outbreak data were extracted from the National Outbreak Reporting System (NORS) and a systematic literature review, supplemented with additional references found within the papers. Escherichia coli, Total Coliforms, enterococci as faecal indicator bacteria and the heterotrophic plate count were reported in shower effluents at variable, but generally high concentrations, indicating these organisms to be relevant as indication of faecal bacterial contamination and as general microbial densities in recirculating showers. Pseudomonas aeruginosa was abundant in conventional shower biofilms, detectable in shower effluents at concentrations in the range of 2-4 logs CFU/100mL and ranked among the top five etiological agents of waterborne outbreaks. Consequently, P. aeruginosa is considered as a significant reference pathogen for assessing water quality in recirculating shower systems. A diverse range of Legionella species, particularly Legionella pneumophila, are the primary cause of waterborne outbreaks, and persist in conventional shower biofilms. Therefore, we consider it to be significant as an indicator species in monitoring water quality. Staphylococcus aureus, Mycobacterium spp., and fungi such as Candida albicans could serve as supplementary microbial parameters. Trace organisms such as protozoa (Cryptosporidium spp. and Giardia spp.) and model viruses are also recommended for assessing treatment efficacy. In conclusion, while further research is required to validate these findings, this review critically evaluates relevant pathogens, creating the basis for future microbial water quality assessments in recirculating showers.

Comparison of Illumina and Oxford Nanopore sequencing data quality for Clostridioides difficile genome analysis and their application for epidemiological surveillance

BackgroundThe burden of Clostridioides difficile as a nosocomial- and community-acquired pathogen has been increasing over the recent decades, including reports of severe outbreaks. Molecular and virulence genotyping are central for the epidemiological surveillance of this pathogen, but need to balance accuracy and rapid turnaround time of the results. While Illumina short-read sequencing has been adopted as the gold standard to investigate C. difficile virulence and transmission routes, little is known about the potential of Nanopore long-read sequencing in this field. The goal of our study was to compare sequencing and assembly quality of 37 C. difficile isolates using Illumina (SPAdes assembled) and Nanopore (Flye and Unicycler assembled) data alone, along with hybrid assemblies obtained with short-read polishing of long reads.ResultsIllumina sequencing produced reads with an average quality of 99.68% (Q25), while Nanopore sequencing produced reads reaching an average quality of 96.84% (Q15), showing a tenfold difference in quality. Sequence type (ST) designation from Nanopore assemblies failed to detect ST5, ST7, ST8, ST13 and ST49, while ST designation based on unpolished Nanopore reads using Krocus was successful for all STs. Nanopore sequences exhibited an average of 640 base errors per genome (~ 0.015% substitution rate), which was reflected by the incorrect assignment of over 180 alleles in core genome multilocus sequence typing (cgMLST) analysis. As a result, Nanopore-derived phylogenies were not as accurate as the Illumina reference, and therefore inadequate for precise investigation of transmission events. Both sequencing platforms provided comparable, satisfactory results for the detection of virulence genes tcdA, tcdB, cdtAB and in-frame deletions in tcdC.ConclusionCompared to Illumina, Nanopore has higher error rate, which limits its application for high-resolution epidemiological surveillance. However, the short analysis time, lower cost and more simple procedure combined with correctly identified STs and virulence genes, makes it an alternative when fast and less detailed analyses are preferred.

Burkholderia cepacia complex nosocomial outbreaks in India: A scoping review.

Burkholderia cepacia complex (Bcc) is an opportunistic pathogen that causes severe infections in immunocompromised individuals. It is a common contaminant of medical drugs, solutions and devices used in healthcare setups. This scoping review aimed to assess Bcc outbreaks in Indian hospital settings and address a wide range of sources to improve outbreak management. As per PRISMA-ScR guidelines, electronic databases 'Embase', 'PubMed' and 'Web of Science' were searched from 1993 to September 2024 to identify studies reporting Burkholderia cepacia complex outbreaks across India. The search identified 22 outbreak reports meeting the inclusion criteria. Bacteremia was the most common presentation in twenty studies, followed by acute-onset post-operative endophthalmitis in two studies. In 14 outbreak studies, B. cepacia was the identified species, whereas five studies had Bcc; one study each had B. cenocepacia, B. multivorans and B. contaminans isolated. Most outbreaks were associated with contaminated pharmaceuticals (45.4%) and medical (18.1%) products in contrast to the environment as a source (13.6%). Multi-locus sequence typing (MLST) was employed to study clonality among isolates in six outbreaks. This review highlights that varied medical products and environmental surfaces/objects can harbour Bcc and act as potential sources of Bcc outbreaks in hospitals. Ensuring immediate identification of Bcc from clinical samples, regular sterility checks, thorough epidemiological investigations, and timely infection control and prevention measures are critical to help manage and prevent these outbreaks and the subsequent mortality.

Suspected fenugreek (Trigonella foenum-graecum L.) toxicosis in a herd of Saskatchewan beef cattle.

An apparent outbreak of fenugreek forage toxicosis occurred in a beef cattle herd near Moose Jaw, Saskatchewan in February-May 2022. The herd had consumed fenugreek hay from late fall to early winter. Clinical signs included various degrees of weakness, ataxia, knuckling, walking on hocks, and recumbency. All adult cattle in the herd eventually died or were euthanized. Feed analysis did not reveal nutritional deficiencies or mycotoxin contamination. Liver mineral and vitamin status of affected animals did not indicate any consistent abnormality. The last live cow in the herd was presented to a veterinary teaching hospital for evaluation and subsequent postmortem examination. Major postmortem findings included emaciation, and sciatic nerve and spinal cord axonal degeneration. Histologic examination of the sciatic nerve showed Wallerian-like axonal degeneration, increased Schwann cell nuclei, and endoneurial fibrosis. Histologic examination of the spinal cord showed infrequent myelin sheath dilation and digestion chambers within white matter. These results are consistent with other reports of natural and experimental outbreaks of fenugreek poisoning in livestock. To our knowledge, fenugreek toxicosis has not been reported previously in Canada. We conclude that caution should be taken when feeding fenugreek hay to cattle.

Lexicalisation in Media Reports of Recurrent Diphtheria Outbreak in Nigeria: Implications for Health Communication

Linguistic studies on media coverage of pandemics and outbreaks in Nigeria, including the COVID-19 pandemic, Ebola, and Lassa fever, have been extensive. However, the linguistic analysis of media reports on the diphtheria outbreak remains underexplored. This study addresses this gap by examining the lexical choices employed in framing the diphtheria outbreak in Nigeria. Twenty articles from four popular Nigerian newspapers – The Punch, The Guardian, The Vanguard, and The Premium Times – were examined to discover the prevalent frames and associated lexical choices. The articles were collected between January and August 2023, a significant period marked by the resurgence of the disease and extensive reporting on its impact on victims. Using frame theory and lexical priming theory as analytical frameworks, the study identified frames such as health crisis, victim, government response, global aid and response, vaccination shortfall/hesitancy, public health awareness, past antecedent, and collaborative effort. Common lexical choices included terms like “deadly,” “surge,” and “critical situation,” which emphasize fear and urgency. This emotive tone is used purposefully to attract readers’ attention and prime them to interpret the outbreak as an urgent public health issue. Frames like Public Health Awareness and Government Response are concerned with informing the public. Several other frames, most notably Vaccination Shortfall/Hesitancy and Collaborative Effort, serve as a rallying cry. They highlight the need for increased vaccination coverage, collaboration among stakeholders, and public participation in health measures. Through framing and lexical choices, the media shapes public opinion, influences perceptions, and guides individual and collective responses to health issues like the diphtheria outbreak. The relevance of this study lies in its contribution to understanding how media framing and lexical choices impact public health communication, ultimately aiding in more effective health crisis management and public engagement strategies.

A model-based approach to evaluate the effect of vaccination of the herd on transmission of equine herpesvirus 1 in naturally occurring outbreaks.

Equine herpesvirus 1 (EHV-1) infection is the cause of high impact disease syndromes, affecting the global horse industry. The effect of vaccination on transmission dynamics of EHV-1 in naturally occurring outbreaks is not quantified. Our aims were to estimate R0 for EHV-1 in equine populations from outbreak data, and evaluate the effect of vaccination status of the herd on R through a systematic review, model-based estimations and meta-analysis. A literature search for outbreak reports was carried out. Depending on available data, the early epidemic growth rate (GR) or final attack rate (AR) approach was used to estimate the basic reproduction number for that outbreak. Herd vaccination status, as well as virus genotype and use of antivirals were recorded. Only outbreaks in herds where either none or all of the horses had been vaccinated were included. An overall estimate for R0 (non-vaccinated herds) and Rv (vaccinated herds) was computed by meta-analysis and the two groups were compared using a random effects model. Twelve outbreaks, in herds of 16-135 horses, met the inclusion criteria, of which six occurred in non-vaccinated herds and six in vaccinated herds. One R0 calculation from a report describing empirical determination of a herd immunity threshold was also included. We found no evidence for a significant difference between estimates of R0 and RV in outbreaks: Rˆ0=3.3(2.6-4.0) and RˆV=2.7(2.1-3.2), p=0.15. Our main limitations were our inability to investigate the influence of genotype or antivirals on results. Sensitivity analyses gave volatile p-values. In conclusion, we found no robust evidence for a significant reduction on transmission of EHV-1 in herds where all horses were vaccinated vs non-vaccinated herds. Rˆ in herds where all horses were vaccinated was substantially >1 and vaccination as a sole mitigating measure may have limited effect on transmission of EHV-1.

Causal Mediation Analysis of Foodborne Salmonella Outbreaks in the United States: Serotypes and Food Vehicles.

Various Salmonella serotypes have caused numerous foodborne outbreaks associated with food vehicles in different categories. This study provides evidence on the occurrence and inter-relations between Salmonella serotypes and the number of deaths mediated by the number of illnesses and hospitalizations. Confirmed foodborne outbreaks of Salmonella serotypes (n = 2868) that occurred between 1998 and 2021 were obtained from the Centers for Disease Control and Prevention National Outbreak Reporting System. Causal mediation analysis was performed based on 500 bootstrap samples. The serotypes and the Interagency Food Safety Analytics Collaboration (IFSAC) food categories as confounding effects were considered as categorical variables. A total of 106 single Salmonella serotypes were associated with foodborne outbreaks. Foodborne outbreaks caused by Salmonella serotypes resulted in 81,996 illnesses, 11,018 hospitalizations, and 115 deaths between 1998 and 2021 in the United States. The serotypes Enteritidis (815 outbreaks, 28.42%), Typhimurium (359 outbreaks, 12.52%), and Newport (220 outbreaks, 7.67%) accounted for almost half of Salmonella-linked outbreaks. Poultry products, "chickens", "eggs", and "turkey", were the leading IFSAC food categories, accounting for 14.02% of total outbreaks and 10.44% of total deaths. Certain serotypes had a significant effect on illness, hospitalization, and death counts. Two serotypes, Heidelberg and Saintpaul, and "fruits" as the food vehicle in IFSAC categories had a significant direct effect on the number of illnesses, hospitalizations, and deaths as outcomes of Salmonella outbreaks (p ≤ 0.05). There was strong evidence that illness and hospitalization counts played a key role in the pathway from serotype to death counts on foodborne outbreaks caused by Salmonella based on causal mediation analysis. The findings of this study can help outbreak investigations and lead to prevention and control measures by providing insightful information about the frequencies of Salmonella serotypes and the associated food vehicles causing foodborne diseases.

Epidemiological and Molecular Surveillance of Leishmania Species among Humans, Vectors, and Dogs in a Wildland-Urban Interface of Cartagena, Colombia.

In Colombia, human leishmaniasis is endemic in rural areas, with increasing reports of outbreaks and cases in urban areas. Cartagena, an urban city in the Colombian Caribbean with a wildland-urban interface, faced its first local cases between 2011 and 2015. Despite reports, visceral leishmaniasis (VL) remains neglected and understudied and almost devoid of active surveillance. Here we report the epidemiological and molecular surveillance of Leishmania species in humans, domestic dogs, and sandflies at the wildland interface in two poverty-stricken neighborhoods of Cartagena. In October 2021, we conducted a surveillance study in the El Toril and La Quinta neighborhoods. Blood samples were collected from 150 healthy humans and 77 domestic dogs for Leishmania species testing by using molecular tools. Five human samples (3.3%) tested positive for Leishmania, one case in El Toril and four cases in La Quinta. The Leishmania donovani complex was detected in three human samples, and all dog samples tested negative for Leishmania. CDC light traps placed for three consecutive days in peridomiciliary areas of the Leishmania-positive case in El Toril allowed the capture of seven females of Lutzomyia dubitans, but none tested positive for Leishmania. Multiple attempts to conduct entomological surveillance in La Quinta were unsuccessful because of non-study-related issues. Our findings contribute to the characterization of the epidemiology of VL in Cartagena, revealing possible neglected cryptic infections in two neighborhoods with an urban-wildland interface.

The Burden of Bacteria Pathogens Associated with Cage-cultured Nile Tilapia, (Oreochromis niloticus) along the Mwanza Gulf of Lake Victoria, Tanzania

The recently intensified aquaculture projects in Mwanza Gulf of Lake Victoria, Tanzania, have brought about incidences of increased pathogenic bacteria in the lake waters. In some instances, there have been reports of disease outbreaks in cage-farmed fish. This study aimed to identify the prevalence of selected pathogenic bacteria in Nile tilapia, (Oreochromis niloticus) cage-cultured along the gulf. A total of 250 fish from the cage farms and control site were sampled. Bacteria were isolated and identified from the samples through standard bacterial techniques. A total of 10 bacteria genera were identified, where, staphylococcus spp. had the highest prevalence with 34.5%, pseudomonas spp. at 25.9%, Streptococcus spp. at 10.5%, then Lactococuss spp. 15.5%. These results suggest intensive cage farming is likely the main risk factor for increased bacterial prevalence in the gulf. Henceforth, biosecurity measures must be intensified for sustainable healthy fish farming in cages along the Mwanza Gulf.

Waterborne Disease Outbreaks Associated with Splash Pads - United States, 1997-2022.

Splash pads are recreational interactive water venues that spray or jet water on users. Splash pads are intended for children aged <5 years and designed so that water typically does not collect in areas accessible to users, thereby minimizing the risk for drowning. Splash pads were first found to be associated with waterborne disease outbreaks in 1997. 1997-2022. Since 1971, waterborne disease outbreaks have been voluntarily reported to CDC by state, local, and territorial health departments using a standard paper form via the Waterborne Disease and Outbreak Surveillance System (WBDOSS). Beginning in 2009, WBDOSS reporting was made available exclusively through the National Outbreak Reporting System, a web-based platform. This report characterizes waterborne disease outbreaks associated with splash pads reported to CDC that occurred during 1997-2022. During 1997-2022, public health officials from 23 states and Puerto Rico reported 60 waterborne disease outbreaks associated with splash pads. These reported outbreaks resulted in 10,611 cases, 152 hospitalizations, 99 emergency department visits, and no reported deaths. The 40 (67%) outbreaks confirmed to be caused, in part, by Cryptosporidium resulted in 9,622 (91%) cases and 123 (81%) hospitalizations. Two outbreaks suspected to be caused by norovirus resulted in 72 (73%) emergency department visits. Waterborne pathogens that cause acute gastrointestinal illness can be transmitted by ingesting water contaminated with feces from infected persons. Chlorine is the primary barrier to pathogen transmission in splash pad water. However, Cryptosporidium is tolerant to chlorine and is the most common cause of reported waterborne disease outbreaks associated with splash pads. Public health officials and the aquatics sector can use the findings in this report to promote the prevention of splash pad-associated outbreaks (e.g., recommended user behaviors) and guide the construction, operation, and management of splash pads. Public health practitioners and the aquatics sector also can collaborate to voluntarily adopt CDC's Model Aquatic Health Code recommendations to prevent waterborne illness associated with splash pads.

Streptococcus agalactiae Infection in Wild Trahira (Hoplias malabaricus) and Farmed Arapaima (Arapaima gigas) in Brazil: An Interspecies Transmission in Aquatic Environments Shared with Nile Tilapia (Oreochromis niloticus).

Streptococcus agalactiae is an important pathogen responsible for cases of high mortality in farmed and wild fish worldwide. In Brazil, this bacterium has been commonly associated with outbreaks in Nile tilapia farms, but other native fish species are also susceptible. Since floating cages are one of the most common culture systems used in the country, the close contact between farmed tilapia and native fish species presents a risk concerning the transmission of this pathogen. In this study, we characterized a mortality outbreak in free-living trahira and in farmed arapaima, as well as the genetic and antimicrobial susceptibility patterns of the isolates obtained. During the outbreaks, moribund fish were sampled and subjected to bacterial examination, after which the isolates were identified via MALDI-ToF analysis. Genotyping was evaluated using repetitive sequence-based PCR (REP-PCR) and multilocus sequence typing (MLST). Antimicrobial susceptibility was evaluated using disc diffusion assays. In addition, whole-genome analysis also was performed. S. agalactiae was identified in all diseased fish, all of which belonged to serotype Ib; however, trahira strains were classified as non-typeable lineages in the MLST assay, while arapaima strains were classified as ST260. These isolates were shown to be similar to the main genotype found in Nile tilapia in Brazil, using REP-PCR, MLST and phylogenomic analysis. The pathogenicity of the bacterium was confirmed by Koch's postulates for both fish species. The antimicrobial susceptibility assay showed variable results to the same antibiotics among the isolates, prompting four of the isolates to be classified as multidrug-resistant. This study represents the first report of a natural outbreak of Streptococcus agalactiae infection in wild trahira and farmed arapaima inhabiting the same aquatic environment as Nile tilapia.

Measles secondary vaccine failure in a childcare setting: an outbreak report.

The Sunshine Coast Public Health Unit (SCPHU) identified a measles case in a childcare educator (CE) with secondary vaccine failure (SVF). The CE had been exposed to a confirmed measles case in a hospital emergency department and later developed symptoms including fever, cough, malaise, and a rash. Diagnostic tests confirmed measles virus infection. Sunshine Coast Public Health Unit (SCPHU) implemented control measures including contact tracing, vaccination, post-exposure prophylaxis, and quarantine for susceptible contacts. Out of 372 identified contacts, 72 were identified as susceptible, all of whom were infants and children. Despite the CE having close contact to all susceptible infants and children, no onward transmission occurred. This suggests that SVF cases pose a lower risk of spreading measles compared to immunologically naïve individuals. This report highlights the importance of prioritising immunologically naïve cases in outbreak responses.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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