Role In Epidemiology Research Articles

CoVizu: Rapid analysis and visualization of the global diversity of SARS-CoV-2 genomes.

Phylogenetics has played a pivotal role in the genomic epidemiology of severe acute respiratory syndrome coronavirus 2, such as tracking the emergence and global spread of variants and scientific communication. However, the rapid accumulation of genomic data from around the world-with over two million genomes currently available in the Global Initiative on Sharing All Influenza Data database-is testing the limits of standard phylogenetic methods. Here, we describe a new approach to rapidly analyze and visualize large numbers of SARS-CoV-2 genomes. Using Python, genomes are filtered for problematic sites, incomplete coverage, and excessive divergence from a strict molecular clock. All differences from the reference genome, including indels, are extracted using minimap2 and compactly stored as a set of features for each genome. For each Pango lineage (https://cov-lineages.org), we collapse genomes with identical features into 'variants', generate 100 bootstrap samples of the feature set union to generate weights, and compute the symmetric differences between the weighted feature sets for every pair of variants. The resulting distance matrices are used to generate neighbor-joining trees in RapidNJ that are converted into a majority-rule consensus tree for each lineage. Branches with support values below 50 per cent or mean lengths below 0.5 differences are collapsed, and tip labels on affected branches are mapped to internal nodes as directly sampled ancestral variants. Currently, we process about 2 million genomes in approximately 9 h on 52 cores. The resulting trees are visualized using the JavaScript framework D3.js as 'beadplots', in which variants are represented by horizontal line segments, annotated with beads representing samples by collection date. Variants are linked by vertical edges to represent branches in the consensus tree. These visualizations are published at https://filogeneti.ca/CoVizu. All source code was released under an MIT license at https://github.com/PoonLab/covizu.

Insights from Leishmania (Viannia) guyanensis in vitro behavior and intercellular communication

BackgroundPentavalent antimonial-based chemotherapy is the first-line approach for leishmaniasis treatment and disease control. Nevertheless antimony-resistant parasites have been reported in some endemic regions. Treatment refractoriness is complex and is associated with patient- and parasite-related variables. Although amastigotes are the parasite stage in the vertebrate host and, thus, exposed to the drug, the stress caused by trivalent antimony in promastigotes has been shown to promote significant modification in expression of several genes involved in various biological processes, which will ultimately affect parasite behavior. Leishmania (Viannia) guyanensis is one of the main etiological agents in the Amazon Basin region, with a high relapse rate (approximately 25%).MethodsHerein, we conducted several in vitro analyses with L. (V.) guyanensis strains derived from cured and refractory patients after treatment with standardized antimonial therapeutic schemes, in addition to a drug-resistant in vitro-selected strain. Drug sensitivity assessed through Sb(III) half-maximal inhibitory concentration (IC50) assays, growth patterns (with and without drug pressure) and metacyclic-like percentages were determined for all strains and compared to treatment outcomes. Finally, co-cultivation without intercellular contact was followed by parasitic density and Sb(III) IC50 measurements.ResultsPoor treatment response was correlated with increased Sb(III) IC50 values. The decrease in drug sensitivity was associated with a reduced cell replication rate, increased in vitro growth ability, and higher metacyclic-like proportion. Additionally, in vitro co-cultivation assays demonstrated that intercellular communication enabled lower drug sensitivity and enhanced in vitro growth ability, regardless of direct cell contact.ConclusionsData concerning drug sensitivity in the Viannia subgenus are emerging, and L. (V.) guyanensis plays a pivotal epidemiological role in Latin America. Therefore, investigating the parasitic features potentially related to relapses is urgent. Altogether, the data presented here indicate that all tested strains of L. (V.) guyanensis displayed an association between treatment outcome and in vitro parameters, especially the drug sensitivity. Remarkably, sharing enhanced growth ability and decreased drug sensitivity, without intercellular communication, were demonstrated.Graphical

Coronavirus Disease (COVID-19) Pandemic: The Psychological Well-Being in a Cohort of Workers of a Multinational Company

BackgroundThe aim of the present study was to evaluate the psychological well-being (PWB) during the coronavirus disease (COVID-19) pandemic in workers of a multinational company. MethodsEmployees (aged ≥18 years) were recruited from Latin American, North American, New Zealand, and European sites of a multinational company operative during all the pandemic period. The self-reported Psychological General Well-Being Index was used to assess the global PWB and the effects on six subdomains: anxiety, depressed mood, positive well-being, self-control, general health, and vitality. The influencing role of age, gender, geographical location, COVID-19 epidemiology, and restrictive measures adopted to control the pandemic was explored. ResultsA total of 1335 workers completed the survey. The aggregate median PWB global score was in a positive range, with significantly better outcomes detected in the Mexican and Colombian Latin American sites compared with the other worldwide countries (p < 0.001). Among the European locations, a significantly higher PWB score was determined in Spain compared with the German and French sites (p < 0.05). Comparable geographical trends were demonstrated for all the PWB subdomains. Male workers had a significantly better PWB compared with females (p < 0.05), whereas a negative correlation emerged with aging (p = 0.01). COVID-19 epidemiology and pandemic control measures had no clear effects on PWB. ConclusionMonitoring PWB and the impact of individual and pandemic-related variables may be helpful to clarify the mental health effects of pandemic, define targeted psychological-supporting measures, also in the workplace, to face such a complex situation in a more constructive way.

The Rare, the Best: Spread of Antimalarial-Resistant Plasmodium falciparum Parasites by Anopheles Mosquito Vectors.

ABSTRACTThe emergence of resistance to antimalarials has prompted the steady switch to novel therapies for decades. Withdrawal of antimalarials, such as chloroquine in sub-Saharan Africa in the late 1990s, led to rapid declines in the prevalence of resistance markers after a few years, raising the possibility of reintroducing them for malaria treatment. Here, we provide evidence that the mosquito vector plays a crucial role in maintaining parasite genetic diversity. We followed the transmission dynamics of Plasmodium falciparum parasites through its vector in natural infections from gametocytes contained in the blood of asymptomatic volunteers until sporozoites subsequently developed in the mosquito salivary glands. We did not find any selection of the mutant or wild-type pfcrt 76 allele during development in the Anopheles mosquito vector. However, microsatellite genotyping indicated that minority genotypes were favored during transmission through the mosquito. The analysis of changes in the proportions of mutant and wild-type pfcrt 76 alleles showed that, regardless of the genotype, the less-represented allele in the gametocyte population was more abundant in mosquito salivary glands, indicating a selective advantage of the minority allele in the vector. Selection of minority genotypes in the vector would explain the persistence of drug-resistant alleles in the absence of drug pressure in areas with high malaria endemicity and high genetic diversity. Our results may have important epidemiological implications, as they predict the rapid re-emergence and spread of resistant genotypes if antimalarials that had previously selected resistant parasites are reintroduced for malaria prevention or treatment.IMPORTANCE Drug selection pressure in malaria patients is the cause of the emergence of resistant parasites. Resistance imposes a fitness cost for parasites in untreated infections, so withdrawal of the drug leads to the return of susceptible parasites. Little is known about the role of the malaria vector in this phenomenon. In an experimental study conducted in Cameroon, an area of high malaria transmission, we showed that the vector did not favor the parasites based on sensitivity or resistance criteria, but it did favor the selection of minority clones. This finding shows that the vector increases the diversity of plasmodial populations and could play an important role in falciparum malaria epidemiology by maintaining resistant clones despite the absence of therapeutic pressure.

A comparative study of the proximity to nomadic travel routes and environmental factors on the occurrence of cutaneous leishmaniasis in Kohgiluyeh and Boyer-Ahmad province, southwestern Iran.

Cutaneous leishmaniasis (CL) is one of the most important health challenges in hyperendemic countries like Iran. Geospatial information systems-based studies have shown that factors, including land cover, altitude, slope temperature, rainfall and animal livestock, affect CL distribution in Kohgyloyeh and Boyerahmad province, southwestern Iran. However, the question of the influence of nomadic tribes, who travel with their goats and sheep, on CL is unanswered. We, therefore, investigated their role in CL epidemiology from 2008 to 2017 and compare them with geoclimatic factors. CL patient demographic data and their village/city addresses were retrieved from Provincial Health Center and mapped on the geographic information system (GIS) layer of the province's political divisions. Nomadic travel routes (NTRs) with a 2km buffer were generated and their effect on CL was investigated together with the interpolated layers of rainfall, temperatures, humidity, slope, elevation, land covers, by binary regression. CL was significantly more common in villages/cities in the 2km NTR zone (pvalue<.001; OR=1.96; 95% CI=1.4-2.745). Geoclimatic factors, including slope, elevation, rainfall, temperatures, humidity and most of the landcovers, were not significantly different inside and outside the NTR. Areas of irrigated farm were the only effective landcover on CL (p value=.049; OR=2.717; 95% CI=1.003-7.361) within the NTR versus non-NTR. Living within NTRs almost doubled the risk of acquiring CL. Several factors for this include passage through areas of high sand fly activity, increased contact between sandflies and humans, sheep and goats, and feeding on their blood and faeces, and low availability of health facilities that should be more investigated and considered in the future control programs.

Working: The Role of Occupational Epidemiology.

The COVID-19 pandemic redemonstrated the importance of work as a determinant of health. Extant disparities were accentuated, as the workforce was divided into the roughly 50% who could safely work from home and those who could not. With the spotlight on work, one might wonder where all the occupational epidemiologists have gone. To answer, we point to diminished research support and more limited workplace access that have led many to shift away from a focus on workers towards other vulnerable populations. We build on the renewed interest in work as a driver of health and inequality during the pandemic to highlight contributions of occupational epidemiology to public health. Consider: (1) etiologic studies of chronic disease based on employment records to define cohorts and reconstruct long-term exposure; (2) studies of hypothetical interventions particularly appropriate for evaluating potential regulations to reduce workplace exposures; and (3) studies of disparities that take advantage of work as a potential source of social stratification and economic opportunity. As we have learned during COVID-19, workplaces can become venues for public health messaging and delivering interventions to enumerated populations of adults. By starting with COVID-19 prevention policies, we have a chance to protect public health and rethink work.

Methicillin-resistant Staphylococcus aureus isolated from nonhealing wound in a canary bird (Serinus canaria domestica)

Little is known about the presence of methicillin-resistant Staphylococcus aureus (MRSA) in a canary bird (Serinus canaria domestica). Although MRSA in a canary bird was previously reported, to the best of our knowledge, this is the first full description of the isolation and antibiotic resistance pattern of MRSA in this pet bird. A swab was taken from the nonhealing wound on the lateral thigh of a four-year-old, caged, housed alone, male canary bird. After the identification of Staphylococcus aureus, the antibiotic susceptibility profile of the isolate was obtained by the disk diffusion test. According to the resistance to Oxacillin and Cefoxitin, the isolate was identified as MRSA. The mecA gene was confirmed by PCR. The bird was treated by offering drinking water medicated with an injectable enrofloxacin formulation at 200 mg/L over 10 days period. Two weeks after therapy, intensive contraction of the wound was observed with a size reduction. A week later, the complete epithelization of the wound defect was verified. In this study, we could not confirm the source of infection in a canary bird, but we believe that transmission was from wild birds when the cage was putting out in order to allow the bird to sunbathe or more likely via contact with the owner. The results of this study underline the necessity for further investigations on the epidemiological role of canary birds as potential reservoirs of MRSA.

Smart carnivores think twice: Red fox delays scavenging on conspecific carcasses to reduce parasite risk

The recent SARS-CoV-2 epidemic has highlighted the need to prevent emerging and re-emerging diseases, which means that we must approach the study of diseases from a One Health perspective. The study of pathogen transmission in wildlife is challenging, but it is unquestionably key to understand how epidemiological interactions occur at the wildlife-domestic-human interface. In this context, studying parasite avoidance behaviours may provide essential insights on parasite transmission, host-parasite coevolution, and energy flow through food-webs. However, the strategies of avoiding trophically transmitted parasites in mammalian carnivores have received little scientific attention. Here, we explore the behaviour of red foxes (Vulpes vulpes) and other mammalian carnivores at conspecific and heterospecific carnivore carcasses using videos recorded by camera traps. We aim to determine 1) the factors influencing the probability of foxes to practice cannibalism, and 2) whether the scavenging behaviour of foxes differ when facing conspecific vs. heterospecific carcasses. We found that red foxes were generally reluctant to consume mesocarnivore carrion, especially of conspecifics. When recorded, consumption by foxes was delayed several days (heterospecific carcasses) or weeks (conspecific carcasses) after carcass detection. Other mammalian scavengers showed a similar pattern. Also, meat-borne parasite transmission from wild carnivore carcasses to domestic dogs and cats was highly unlikely. Our findings challenge the widespread assumption that cannibalistic or intra-specific scavenging is a major transmission route for Trichinella spp. and other meat-borne parasites, especially for the red fox. Overall, our results suggest that the feeding decisions of scavengers are probably shaped by two main contrasting forces, namely the nutritional reward provided by carrion of phylogenetically similar species and the risk of acquiring meat-borne parasites shared with these species. This study illustrates how the detailed monitoring of carnivore behaviour is essential to assess the epidemiological role of these hosts in the maintenance and dispersion of parasites of public and animal health relevance.

The Presence of Ehrlichia Canis in Rhipicephalus Bursa Ticks Collected from Ungulates in Continental Eastern Europe.

IntroductionRhipicephalus bursa is a common tick parasite of small-to-medium size ungulates, principally in warm, temperate, and subtropical areas. Although common in livestock and showing a wide geographic distribution, its epidemiological role in tick-borne bacterial disease is barely known. This study addressed the knowledge gap and aimed to screen for the presence of Anaplasmataceae and spotted fever group (SFG) Rickettsia species in R. bursa ticks collected from domestic animals in Romania, Eastern Europe.Material and MethodsA total of 64 pools of R. bursa ticks collected from small ungulates were tested by PCR for Anaplasmataceae DNA presence using group-specific primers. Specific testing was performed for Anaplasma marginale/A. centrale/A. ovis, A. platys, A. phagocytophilum, Ehrlichia canis, and SFG Rickettsia. The positive samples were purified and sequenced, and sequences analysis was used to identify the species and to confirm the PCR results.ResultsThe only pathogen identified in this study was E. canis. The obtained sequences confirmed the PCR results. The presence of E. canis in R. bursa in Romania and in ticks from sheep was shown for the first time in this study.ConclusionBased on these findings, it may be presumed that the E. canis DNA originated from ticks; however, the vectorial role of R. bursa (and other arthropod species) in the transmission of E. canis should be proved experimentally.

Molecular Characterization of Imported and Autochthonous Dengue in Northeastern Spain.

Dengue is the most significant arbovirus worldwide and a public health threat to non-endemic areas in which Aedes vectors are present. Autochthonous dengue transmission has been reported in several European countries in the last decade. Infected travelers from endemic regions arriving to areas colonized by Aedes albopictus in Europe need to be monitored in surveillance and control programs. We aimed to perform molecular characterization of RT-PCR-positive dengue cases detected in Catalonia, northeastern Spain, from 2013 to 2018. The basic demographic information and the geographical regions of importation were also analyzed. One-hundred four dengue cases were studied (103 imported infections and the first autochthonous case in our region). The dengue virus strains detected were serotyped and genotyped using molecular methods, and phylogenetic analyses were conducted. All four dengue serotypes were detected in travelers, including up to 10 different genotypes, reflecting the global circulation of dengue in endemic areas. The primary travel-related case of the 2018 autochthonous transmission was not identified, but the molecular analysis revealed dengue serotype 1, genotype I of Asian origin. Our results highlight the diversity of imported dengue virus strains and the role of molecular epidemiology in supporting arbovirus surveillance programs.

Ticks and their epidemiological role in Slovakia: from the past till present.

In Slovakia, 22 tick species have been found to occur to date. Among them, Ixodes ricinus, Dermacentor reticulatus, D. marginatus and marginally Haemaphysalis concinna, H. inermis and H. punctata have been identified as the species of public health relevance. Ticks in Slovakia were found to harbour and transmit zoonotic and/or potentially zoonotic agents such as tick-borne encephalitis virus (TBEV), spirochaetes of the Borrelia burgdorferi sensu lato (s.l.) complex, the relapsing fever sprirochaete Borrelia miyamotoi, bacteria belonging to the orders Rickettsiales (Rickettsia spp., Anaplasma phagocytophilum, Neoehrlichia mikurensis), Legionellales (Coxiella burnetii), and Thiotrichales (Francisella tularensis), and Babesia spp. parasites (order Piroplasmida). Ixodes ricinus is the principal vector of the largest variety of microorganisms including viruses, bacteria and piroplasms. TBEV, B. burgdorferi s.l., rickettsiae of the spotted fever group, C. burnetii and F. tularensis have been found to cause serious diseases in humans, whereas B. miyamotoi, A. phagocytophilum, N. mikurensis, Babesia microti, and B. venatorum pose lower or potential risk to humans. Distribution of TBEV has a focal character. During the last few decades, new tick-borne encephalitis (TBE) foci and their spread to new areas have been registered and TBE incidence rates have increased. Moreover, Slovakia reports the highest rates of alimentary TBE infections among the European countries. Lyme borreliosis (LB) spirochaetes are spread throughout the distribution range of I. ricinus. Incidence rates of LB have shown a slightly increasing trend since 2010. Only a few sporadic cases of human rickettsiosis, anaplasmosis and babesiosis have been confirmed thus far in Slovakia. The latest large outbreaks of Q fever and tularaemia were recorded in 1993 and 1967, respectively. Since then, a few human cases of Q fever have been reported almost each year. Changes in the epidemiological characteristics and clinical forms of tularaemia have been observed during the last few decades. Global changes and development of modern molecular tools led to the discovery and identification of emerging or new tick-borne microorganisms and symbionts with unknown zoonotic potential. In this review, we provide a historical overview of research on ticks and tick-borne pathogens in Slovakia with the most important milestones and recent findings, and outline future directions in the investigation of ticks as ectoparasites and vectors of zoonotic agents and in the study of tick-borne diseases.

Alnus glutinosa and Orientus ishidae (Matsumura, 1902) share phytoplasma genotypes linked to the ‘Flavescence dorée’ epidemics

AbstractFlavescence dorée (FD) is a grapevine disease caused by associated phytoplasmas (FDp) which are epidemically spread by their main vector Scaphoideus titanus. The possible roles of alternative and secondary FDp plant hosts and vectors have gained interest in terms of better understanding of the FDp ecology and epidemiology. The findings of a survey conducted in the surroundings of three vineyards in the southern Swiss Alps aimed at studying the possible epidemiological role of the FDp secondary vector Orientus ishidae and the FDp host plant Alnus glutinosa are reported. This work demonstrates that O. ishidae is able to complete its biological cycle on A. glutinosa and to acquire FDp and 16SrV phytoplasmas very efficiently with an infection rate of 69% for the nymphal instars and 85% for the imagoes. A high prevalence of the map genotype M50 (map type FD1), which is included in the S. titanus—grapevine epidemiological cycle, was found in O. ishidae and A. glutinosa. Additionally, M12 (map type FD3), M44 and M47 were also sporadically detected. Surprisingly, the grapevines tested during this work were all infected by M54 (map type FD2) only, while the few S. titanus caught in the vineyard canopy were all FDp free. In conclusion, the occurrence of infected common alder stands and O. ishidae nearby vineyards do not seem to play a prominent role in FD epidemics in southern Switzerland. Nevertheless, wild vegetation acts as a reservoir of the FDp inoculum, which may locally trigger a FD emergence if S. titanus populations are established inside vineyards.

MERS-CoV in sheep, goats, and cattle, United Arab Emirates, 2019: Virological and serological investigations reveal an accidental spillover from dromedaries.

The recent COVID-19 pandemic has demonstrated again the global threat posed by emerging zoonotic coronaviruses. During the past two decades alone, humans have experienced the emergence of several coronaviruses, such as SARS-CoV in 2003, MERS-CoV in 2012, and SARS-CoV-2 in 2019. To date, MERS-CoV has been detected in 27 countries, with a case fatality ratio of approximately 34.5%. Similar to other coronaviruses, MERS-CoV presumably originated from bats; however, the main reservoir and primary source of human infections are dromedary camels. Other species within the Camelidae family, such as Bactrian camels, alpacas, and llamas, seem to be susceptible to the infection as well, although to a lesser extent. In contrast, susceptibility studies on sheep, goats, cattle, pigs, chickens, and horses obtained divergent results. In the present study, we tested nasal swabs and/or sera from 55 sheep, 45 goats, and 52 cattle, collected at the largest livestock market in the United Arab Emirates, where dromedaries are also traded, for the presence of MERS-CoV nucleic acid by RT-qPCR, and for specific antibodies by immunofluorescence assay. All sera were negative for MERS-CoV-reactive antibodies, but the nasal swab of one sheep (1.8%) repeatedly tested positive for MERS-CoV nucleic acid. Next generation sequencing (NGS) of the complete N gene of the sheep-derived MERS-CoV revealed>99% nucleotide identity to MERS-CoV sequences of five dromedaries in nearby pens and to three reference sequences. The NGS sequence of the sheep-derived MERS-CoV was confirmed by conventional RT-PCR of a part of the N gene and subsequent Sanger sequencing. All MERS-CoV sequences clustered within clade B, lineage 5. In conclusion, our study shows that noncamelid livestock, such as sheep, goats, and cattle do not play a major role in MERS-CoV epidemiology. The one sheep that tested positive most likely reflects an accidental viral spillover event from infected dromedaries in nearby pens.

The High Importance Role of Epidemiology in Health Management

Epidemiology is a scientific discipline, sometimes called “the basic science of public health”. According to what it has done in the last 200 years, epidemiology is the science and practice. One of the areas that are less addressed in the literature is the important role of epidemiology in health management. The authors believed that one of the areas that epidemiologists can work is management debate.

Canine Leishmaniasis in Morocco: A Descriptive Prospective Clinical Study.

Canine leishmaniasis (CanL) is a zoonotic vector-borne disease that is endemic in the Mediterranean Basin including Morocco. Dogs play a major epidemiological role in this zoonosis as reservoir hosts. This study investigated the clinical manifestations of CanL in dogs naturally infected with Leishmania infantum. A total of 96 dogs presented to the Small Animal Clinic of the Hassan II Agronomy and Veterinary Institute (IAV Hassan II) of Rabat, Morocco, and were tested by RT-PCR and/or serology. Among them, 32 (33.3%) were positive to Leishmania infantum infection. The majority of the positive dogs (93.7%) came from urban areas. Most of them were male (62.5%) and purebreds (65.6%), were aged between 3 and 7 years (71.8%), and had outside activities (guarding, hunting, livestock guarding, and service activities) (71.8%) and all of them were living exclusively outdoor or had free access to the outdoor environment. Lymphadenomegaly (81.2%), dermatological disorders (65.6%) (mostly exfoliative dermatitis), weight loss (59.3%), exercise intolerance (56.2%), anorexia (28.1%), hyporexia (15.6%), and ocular lesions (28.1%) were the most frequent clinical signs and complaints recorded. Anemia and hyperproteinemia due to hyperglobulinemia were observed in 68.7% and 72.7% of the cases, respectively. These results suggest that CanL leads to various nonspecific clinical signs as described previously, making the diagnosis challenging. Since CanL is endemic in Morocco, it should be recommended to systematically test dogs displaying clinical signs compatible with this disease and to regularly screen asymptomatic at-risk dogs. It is also crucial to educate dog owners about the zoonotic aspect of the disease and to encourage intersectorial collaboration following the “One Health” concept, in order to contribute to a more effective control/prevention of human and canine leishmaniasis.

Transcatheter approach of concomitant mitral and tricuspid regurgitation

Severe mitral regurgitation represents the second most common indication for valve surgery in Europe. In the last decade, transcatheter mitral valve repair has become an established effective and safe treatment option for patients at high or prohibitive operative risk. A relevant proportion of these patients develop significant tricuspid regurgitation. Once considered a benign and reversible finding, nowadays increasing attention is being paid to the coexistence of this valvular disease, as a growing body of evidence points towards its negative prognostic role. Over the last few years, transcatheter repair has been performed successfully also for the treatment of significant tricuspid regurgitation in patients at high surgical risk. Therefore, combined transcatheter repair is emerging as a treatment strategy for high surgical risk patients with both severe mitral and tricuspid regurgitation. In this review, we provide a comprehensive summary of the epidemiology, pathophysiology, and prognostic role of the coexistence of severe mitral and tricuspid regurgitation. We then discuss the evidence in favor of combined surgical treatment and the emerging data supporting combined transcatheter treatment, with attention to available treatment technologies. The paper is further enriched with three practical case reports and with the suggestion of a decision-making algorithm for the management of this complex subset of patients.

1074The role of epidemiology in improving the health of people with disability

Abstract Focus and outcomes for participants The symposium will focus on the role of epidemiologists in building an evidence base to improve the health of the 15% of the world’s population with disability who currently experience vast health inequalities. Participants will be introduced to new ways of conceptualising disability in epidemiology; state of the art approaches to monitoring disability-related socio-economic and health inequalities; methodological challenges and solutions to address the biases due to misclassification, confounding and reverse causation; and the application of causal mediation analysis and natural experiments in identifying potential policy solutions. Participants will gain a greater understanding of how epidemiological methods can be applied to improve the health of people with disability, as well as insights and ideas for their research. A network of epidemiologists interested in this topic will be generated to foster ongoing communication and collaborative opportunities. Rationale for the symposium, including for its inclusion in the Congress The health of disabled people has largely been ignored by epidemiologists. This is despite emerging evidence that people with disability experience poorer health because of factors unrelated to their impairment, including socio-economic disadvantage, discrimination, and violence. However, turning epidemiologists’ efforts to the health of people with disability presents conceptual and methodological challenges, some of which are unique to the content area. Participants will be shown a suite of approaches that can be deployed to address these problems. Participatory methods and innovative graphical and statistical methods for analysing disability-related health inequalities, approaches rarely used in epidemiology, will be covered. The symposium will also concentrate on the application of methods to optimise causal inference in the presence of multiple potential biases, and methods that simulate randomised controlled trial conditions to model policy interventions. Presentation program The presentations are from researchers from the CRE-DH, funded through Australia’s National Health and Medical Research Council organised four themes. Theme 1: Conceptualisation of disability We will present findings from a scoping review of original articles in epidemiology journals and will argue that, while, disability is usually conceptualised in epidemiology as an outcome, reconceiving of disability as an exposure, mediator and/or effect modifier can provide important insights on the determinants of health of people with disability. Theme 2: Monitoring disability-related inequalities We will demonstrate how the CRE-DH has used participatory methods, where people with disability are ‘experts through lived experience’, to develop indicators to monitor disability-related inequalities and design a National Community Attitudes survey. We will demonstrate innovative ways to graphically illustrate prevalence, absolute and relative inequalities simultaneously, and discuss how hierarchical Bayesian methods can be used to overcome inadequate power due to disaggregation and assess inequalities under uncertainty. Theme 3: Approaches to minimising bias We will talk about how biases can affect estimates of disability prevalence and disability-outcome associations, including reverse causation, confounding and misclassification. We will discuss a range of approaches we have used to address these challenges including modelling incident (rather than prevalent) disability, using fixed effects models and propensity score approaches, and approaches to addressing misclassification bias drawing on examples from our program of research. Theme 4: Identification of policy interventions We will discuss methods that can be used to model the impact of policies on the health of people with disability using examples from our research. We will present the results of a causal mediation analysis modelling the impact of different employment policy interventions on mental health outcomes. We will illustrate the value of natural policy experiments for estimating effects of policy changes on employment and health of people with disability using two examples – the 2014 reassessment of Disability Support Pensioners under stricter impairment tables and the introduction of Australia’s National Disability Insurance Scheme. The symposium will conclude with a facilitated discussion focussed on how epidemiologists can come together internationally to grasp the opportunities and address the challenges in research focussed on the health of people with disabilities. Names of presenters Professor Anne Kavanagh, PhD Dr Nicola Fortune, PhD Dr George Disney, PhD Dr Zoe Aitken Dr Samia Badji, PhD

Temporal Trends in Antimicrobial Resistance of Fecal Escherichia coli from Deer

The changing epidemiologic role of wildlife as reservoirs of antimicrobial-resistant bacteria (ARB) is poorly understood. In this study, we characterize the phenotypic resistance of commensal Escherichia coli from fecal samples of 879 individual white-tailed (Odocoileus virginianus; WTD) over a ten-year period and analyze resistance patterns. Our results show commensal E. coli from WTD had significant linear increases in reduced susceptibility to 5 of 12 antimicrobials, including broad-spectrum cephalosporins and fluoroquinolones, from 2006 to 2016. In addition, the relative frequency distribution of minimal inhibitory concentrations of two additional antimicrobials shifted towards higher values from across the study period. The prevalence of multidrug-resistant commensal E. coli increased over the study period with a prevalence of 0%, 2.2%, and 3.7% in 2006, 2012, and 2016, respectively. WTD may be persistently and increasingly exposed to antibiotics or their residues, ARB, and/or antimicrobial resistance genes via contaminated environments like surface water receiving treated wastewater effluent.

New directions in global environmental health

BACKGROUND AND AIM: The COVID-19 pandemic is challenging the world’s economic and health systems and exemplifies the degree of global interdependencies, the problems in the governance of global crises and the need of preparedness for global health threats. The outbreak of COVID-19 highlighted the links between the occurrence of new infections, the environment and climate at a global scale and the need for a planetary health perspective and trans-disciplinary approaches. The pandemic brought forward considerable health inequities globally METHODS: The new post-pandemic global settings bring forward overarching topics that have not been efficiently addressed: research needs for policy development, locally and globally; development of transdisciplinary research; implementation science for long-standing global problems; global ethics; new approaches in global public health governance. RESULTS:The pandemic has profoundly affected global society in multiple ways, introducing entirely new challenges and accelerating ongoing trends. The pandemic has highlighted the deep interconnections between problems typically studied in isolation or that previously were situated at the periphery of environmental epidemiology. There is a need to develop research and action on multiple levels. For example, air pollution, chemical pollution, or nature-based solutions must be addressed locally in cities. We should also address them at a global level: global air-pollution in relation to decarbonisation, the effects of global pollution and loss of biodiversity on ecosystems and human health. LMICs are disproportionately impacted by environmental pollution because of the lack of environmental policies and export of contaminants from high-income countries. The urgency of responding to the pandemic brought into prominence the need for international collaboration to develop actionable knowledge to emergencies that will require research in understudied populations and understudied thematic areas. CONCLUSIONS:The dramatic changes occurring in a short time will affect research in environmental epidemiology in the long term and the role of environmental epidemiology on a global scale. KEYWORDS: global epidemiology, covid-19, international collaboration

Molecular Detection of a Novel Fowl Adenovirus Serotype-4 (FadV-4) from an Outbreak of Hepatitis Hydropericardium Syndrome in Commercial Broiler Chickens in Egypt.

Hepatitis hydropericardium syndrome (HHS) is an acute infectious disease caused by fowl adenovirus serotype-4 (FAdV-4), which mainly affects broilers aged 4-5 wk. During the winter of January 2021, a 32-day-old broiler flock (Cobb-500) suffered from unusually high mortality (15%) in the Alexandria Governorate, Egypt. The chickens showed depression, ruffled feathers, and greenish diarrhea besides the typical pathologic features of suspected HHS involving flabby hearts, accumulation of a straw-colored fluid in the pericardial sacs, and pale, enlarged hemorrhagic and friable livers with necrotic foci. The kidneys exhibited edema with uric acid depositions. Histopathologic examination of bird livers naturally infected with HHS showed multifocal areas of necrosis, vascular changes, and basophilic intranuclear inclusion bodies (INIB) in the hepatocytes. Molecular identification of the causative agent was accomplished by PCR and sequence analysis of the hyper-variable regions of loop 1 of the hexon gene of fowl aviadenovirus. A pathogenic strain of the novel genotype-4 (FAdV-4) was demonstrated, closely similar to the Israeli strain IS/1905/2019, with an identity of 98%. This is the first report to identify FADV-4 in Egypt, prompting further studies to elucidate its epidemiologic role in all poultry sectors and associated economic losses to provide insights to its control and prevention.