Quality Surveillance Research Articles

Epidemiology of Pertussis After the COVID-19 Pandemic: Analysis of the Factors Involved in the Resurgence of the Disease in High-, Middle-, and Low-Income Countries

Pertussis is a highly contagious bacterial disease of the respiratory tract that can be prevented by vaccination. Before the COVID-19 pandemic, the vaccine coverage rate for the third dose of a DPT-containing vaccine was 86%, with large disparities among countries. Since 2022, many high-income countries have reported a resurgence of pertussis, especially in the European region, but the disease has also caused outbreaks in middle- and low-income countries, despite their less extensive disease surveillance capacities. This paper aims to review the incidence rates (IRs) of pertussis in high-, middle-, and low-income countries following the COVID-19 pandemic and to discuss the most relevant factors associated with the resurgence of the disease. The epidemiology of pertussis is highly variable and is influenced not only by the type of vaccine used but also by the specific characteristics of the disease, vaccine coverage rates, vaccination schedules, and the quality of surveillance. Since the cessation of COVID-19 measures, there have been significant pertussis outbreaks that could have been partially mitigated with higher coverage rates and more comprehensive pertussis vaccination throughout life.

Enhanced and Sustainable Indoor Carbon Dioxide Monitoring by Using Ambient Light to Power Advanced Biological Sensors

Enhancing carbon dioxide (CO2) detection is crucial for improving indoor air quality and environmental surveillance. Traditional CO2 sensors face drawbacks like high costs, large sizes, environmental impact, and reliance on external power, limiting their practicality for continuous indoor monitoring. In this research, an innovative indoor CO2‐sensing system using a self‐powered bio‐solar cell (BSC) platform is introduced. Utilizing cyanobacteria as a sensitive biocatalyst and sustainable power source, the system offers a cost‐effective, eco‐friendly, and maintenance‐free alternative to conventional sensors. It operates by monitoring electron‐transfer processes in cyanobacteria during photosynthesis, converting CO2 and water into oxygen and chemical energy, enabling accurate CO2 level monitoring. The system responds to CO2 fluctuations and issues alerts when levels are outside the recommended range of 500–1000 ppm for human health and productivity. A self‐sustaining configuration of eight BSCs—one for sensing and others for power generation—ensures continuous operation without external power. An integrated energy‐harvesting board efficiently manages power distribution to a microcontroller and display system for real‐time data visualization, with the array producing up to 400 μW. Additionally, a machine‐learning model interprets BSC outputs to accurately quantify CO2 levels, enhancing the sensor's adaptive performance.

Assessment of the quality of malaria surveillance and laboratory services for diagnosis in three districts of Gujarat state, India.

Surveillance is the backbone for the control of malaria and its elimination. In the state of Gujarat, situated in the western region of India, some of the districts reported a high annual blood examination rate (ABER) for malaria. Therefore, a study was conducted to identify the underlying reasons for the increase in the ABER for malaria. Planned investigations were carried out in three of the state districts, scrutinizing records of malaria forms and other epidemiological data collected during health worker surveillance, assessment of laboratory services, and rapid fever surveys. The rate of fever ranged from 8 to 57% in the primary health centers that were surveyed. Analysis of epidemiological data revealed that malaria parasite positivity was more from passive than active surveillance. Increased ABER was accounted for by multiple factors, including blood slides collected during the mass survey and contact smears, which were included in the ABER and not mentioned separately. Blood slides prepared for the migrant population were included in the ABER, but the migrant population was not counted while calculating the ABER. The ABER in villages surveyed varied from 1.6 to 78%, which is mainly due to indiscriminate preparation of blood slides, i.e., without fever symptoms. Addressing the key gaps identified in data recording may aid in channeling the limited resources efficiently, thereby progressing toward malaria elimination. Adequate surveillance activities, along with systematic data recording, will enable timely, informed decision-making for the effective allocation of resources, ultimately supporting malaria elimination efforts in the state.

Effective Surveillance of Water Quality in Recirculating Aquaculture Systems through the Application of Intelligent Biosensors

Water quality (WQ) is the paramount element influencing fish well-being and productivity in aquaculture farming systems. The survival of fish is mostly reliant on the aquatic environment that sustains them. Consequently, it is vital to possess a comprehensive awareness of the WQ prerequisites for the fish. Optimal WQ in Recirculating Aquaculture Systems (RAS) is essential for cultivating species' effective development and survival. Currently, no laws dictate the parameters to be monitored in RAS, leaving each farmer to choose which parameters to monitor. Historically, WQ measurements have been assessed at certain intervals using portable sensors and laboratory tests, which may be labor-intensive. This study proposes an Effective Surveillance of Water Quality (ESWQ) in RAS using Intelligent Biosensors (IBS). This study examines essential water characteristics (temperature, pH, calcium, magnesium, and Dissolved Oxygen (DO)) for RAS and evaluates the IBS for monitoring these factors. This research provides a potential solution for RAS using IBS, which would enhance ESWQ aspects, facilitate data-driven decision-making, and enable more rapid adaptation to evolving RAS situations.

Sanitary Surveillance Program for pools in Matosinhos, Portugal

Abstract The use of pools for sports, recreational, and therapeutic activities has increased over time. It is important to ensure and control the quality of the water and surrounding areas, as well as the hygienic-sanitary conditions of these spaces. The ‘2018 Pool Sanitary Surveillance Program’ of the Portuguese Northern Regional Health Administration proposes the surveillance of water quality, teaching accessories, and surfaces. The aim of this investigation is to conduct microbiological analysis of the teaching accessories and surfaces in public pools in the municipality of Matosinhos and assess if this program has improved the results for water quality, teaching accessories, and surfaces from 2018 to 2023. The environmental health team of our Public Health Unit performed swabs of the teaching accessories and surfaces of all seven public pools in Matosinhos for microbiological analysis. The swabs were performed in 2018 (21), 2019 (48) and 2023 (42). During each visit, three random points were selected for analysis. In 2019, 31 rugs (64,6%) were analysed, but in 2023 only 10 (23,8%) were rugs. It was found that rugs had the highest contamination by P. aeruginosa (94,4%), fungi (60,8%), and the only sample with coagulase-positive Staphylococci. There was a decrease in samples from twelve to six with P. aeruginosa and an increase from 22 (46.8%) to 29 (69.0%) with fungi from 2019 to 2023. Bacterial colonies grew in 20 samples (95.2%) in 2018, 44 (91,6%) in 2019, and 42 (100%) in 2023. All water samples collected for the evaluation of microbiological parameters outlined obtained compliant results. Fungal and P. aeruginosa detection indicate a potential risk to the health of pool users. A quality report with corrective measures was produce for each pool in each visit. Surveillance of pool water, teaching materials and surrounding surfaces, is crucial to ensure water quality and safety. By doing so, we may lower the risk of disease transmission and protect the population’s health. Key messages • To ensure the safety of pool users is a public health challenge. It would be relevant to have legislation that addresses this issue. • To survey pools and its surroundings and accessories must be a continuous task, allied with literacy to management and users.

Rubella epidemiology in Lesotho after vaccine introduction: a five-year review, 2018–2022

BackgroundThe rubella virus is a major contributor to birth defects globally and is preventable by vaccination. In 2020, the world was supposed to be free of both rubella and Congenital Rubella Syndrome (CRS) however this goal has yet to be realized with only 93 out of 194 WHO member states confirmed rubella-free in 2020.MethodsA retrospective measles and rubella case-based surveillance data record review was conducted from 2018 to 2022 to document rubella epidemiology after the introduction of rubella vaccination in Lesotho and progress toward elimination. All samples submitted for surveillance purposes and tested for rubella were considered but only filtered according to inclusion and exclusion criteria. Descriptive statistics were used to analyse the data.ResultsOf the 1041 samples that were tested for rubella between 2018 and 2022, 10 (1%) were confirmed measles positive and were excluded from further analysis. The median age of the respondents was 6.0 (IQR 4.0–8.0.) years. About 643 (62.4%) of respondents were in the age category of 5 - <13 years. Rubella prevalence was 1% (95% CI; 0.5 -1.8%). The non-measles, non-rubella rash illness rate of 2 per 100 000 population was obtained at the national level each year of the study period but by only 2 of the country’s 10 districts in 2021.ConclusionsThe study showed low rubella prevalence. Rubella infection was predominant in those aged 5 - < 13 years. Failure to meet surveillance targets at certain time points during the study period may have led to an underestimation of rubella cases. There is a need to improve the quality of measles and rubella surveillance in Lesotho. Supplementary immunization activities would also be useful in closing immunity gaps, limiting outbreaks, and advancing rubella and CRS elimination in Lesotho.

Prediction and Visualization of Total Volatile Basic Nitrogen in Yellow Croaker (Larimichthys polyactis) Using Shortwave Infrared Hyperspectral Imaging.

In the present investigation, we have devised a hyperspectral imaging (HSI) apparatus to assess the chemical characteristics and freshness of the yellow croaker (Larimichthys polyactis) throughout its storage period. This system operates within the shortwave infrared spectrum, specifically ranging from 900 to 1700 nm. A variety of spectral pre-processing techniques, including standard normal variate (SNV), multiple scatter correction, and Savitzky-Golay (SG) derivatives, were employed to augment the predictive accuracy of total volatile basic nitrogen (TVB-N)-which serves as a critical freshness parameter. Among the assessed methodologies, SG-1 pre-processing demonstrated superior predictive accuracy (Rp2 = 0.8166). Furthermore, this investigation visualized freshness indicators as concentration images to elucidate the spatial distribution of TVB-N across the samples. These results indicate that HSI, in conjunction with chemometric analysis, constitutes an efficacious instrument for the surveillance of quality and safety in yellow croakers during its storage phase. Moreover, this methodology guarantees the freshness and safety of seafood products within the aquatic food sector.

Environmental Enteropathy (EE): A Critical Challenge in Indian Public Health

There is strong causal relationship between stunting and Environmental Enteropathy, a subclinical condition of the small intestines. The biological plausibility for Environmental Enteropathy being a strong causal pathway for stunting has important policy implication in improving WASH in India, which has the highest incidence of stunting in the world. Four states of India namely, Uttar Pradesh, Jharkhand, Bihar and Assam have high incidence of stunting. This paper focuses on the association of WASH with stunting in these states. Review of literature and statistical analysis of data from IMIS of the MDWS, GOI provide certain critical findings in this respect. It was observed that all these states have low sanitation facilities and low coverage of piped water supply. Also, there is little surveillance of bacteriological quality of water in these states. Further, sanitary survey of the water sources to assess the risk of contamination of the sources have also been very poor. It is likely that children in these states face higher incidence of Environmental Enteropathy, which being asymptotic makes it difficult to identify the children living in such condition for child specific interventions.

Assessing measles risk transmission in Iran: a utilization of the World Health Organization’s programmatic risk assessment tool,2022

BackgroundDespite successful efforts to eliminate measles in Iran, imported measles cases continue to be reported. Because measles is endemic in neighboring countries. This research aims to evaluate the risk of measles transmission in different regions of Iran.MethodsMeasles case-based surveillance data of the Expanded Program of Immunization containing 31 provinces and 463 districts from 2019 to 2021 were assessed. The WHO Measles Programmatic Risk Assessment tool was used to evaluate the risk of disease transmission in four domains: population immunity, surveillance quality, program delivery performance, and threat assessment. scores were categorized as low, medium, high, or very high risk.ResultsDuring 2019–2021, the average incidence of measles was 1.9 per 1 million. Chabahar and Mashhad with 76 and ./6per million reported the highest and lowest incidence respectively. All 463 districts were categorized as low risk in risk assessment. Andimeshk, Chabahar, and Bojnurd obtained the highest risk scores with 27, 24, and 25 respectively. All districts were classified as low risk for population immunity. The average coverage of (MMR1) and (MMR2) was 95% or higher. All districts received the minimum points for surveillance quality.ConclusionAll regions are placed at a low level of disease transmission risk. However, the tool is not able to assess the risk at the rural or peripheral sectors level. The indicators used in this tool are the same for all countries with different epidemiological features (elimination, endemic). Sensitivity analysis can optimize the use of this tool for countries with different disease conditions.

Exploring the Birthday Week Effect on Hand, Foot, and Mouth Disease in Yunnan Province, China, From 2008 to 2022: Surveillance Data Analysis.

Hand, foot, and mouth disease (HFMD) is a notable infectious disease predominantly affecting infants and children worldwide. Previous studies on HFMD have primarily focused on natural patterns, such as seasonality, but research on the influence of important social time points is lacking. Several studies have indicated correlations between birthdays and certain disease outcomes. This study aimed to explore the association between birthdays and HFMD. Surveillance data on HFMD from 2008 to 2022 in Yunnan Province, China, were collected. We defined the period from 6 days before the birthday to the exact birthday as the "birthday week." The effect of the birthday week was measured by the proportion of cases occurring during this period, termed the "birthday week proportion." We conducted subgroup analyses to present the birthday week proportions across sexes, age groups, months of birth, and reporting years. Additionally, we used a modified Poisson regression model to identify conditional subgroups more likely to contract HFMD during the birthday week. Among the 973,410 cases in total, 116,976 (12.02%) occurred during the birthday week, which is 6.27 times the average weekly proportion (7/365, 1.92%). While the birthday week proportions were similar between male and female individuals (68,849/564,725, 12.19% vs 48,127/408,685, 11.78%; χ21=153.25, P<.001), significant differences were observed among different age groups (χ23=47,145, P<.001) and months of birth (χ211=16,942, P<.001). Compared to other age groups, infants aged 0-1 year had the highest birthday week proportion (30,539/90,709, 33.67%), which is 17.57 times the average weekly proportion. Compared to other months, patients born from April to July and from October to December, the peak months of the HFMD epidemic, had higher birthday week proportions. Additionally, a decreasing trend in birthday week proportions from 2008 to 2022 was observed, dropping from 33.74% (3914/11,600) to 2.77% (2254/81,372; Cochran-Armitage trend test: Z=-102.53, P<.001). The results of the modified Poisson regression model further supported the subgroup analyses findings. Compared with children aged >7 years, infants aged 0-1 year were more likely to contract HFMD during the birthday week (relative risk 1.182, 95% CI 1.177-1.185; P<.001). Those born during peak epidemic months exhibited a higher propensity for contracting HFMD during their birthday week. Compared with January, the highest relative risk was observed in May (1.087, 95% CI 1.084-1.090; P<.001). This study identified a novel "birthday week effect" of HFMD, particularly notable for infants approaching their first birthday and those born during peak epidemic months. Improvements in surveillance quality may explain the declining trend of the birthday week effect over the years. Higher exposure risk during the birthday period and potential biological mechanisms might also account for this phenomenon. Raising public awareness of the heightened risk during the birthday week could benefit HFMD prevention and control.

Ultra-sensitive CuAl2O4 Nanoflakes for ppb level detection of Isopropanol

Trace-level detection of isopropanol is important for human health monitoring and air quality surveillance. In this work, we report synthesis of high surface area two-dimensional (2D) nanoflakes of CuAl2O4 using surfactant-assisted hydrothermal process and its application in ppb level detection of isopropanol. X-ray diffraction revealed the polycrystalline nature of the spinel and a nano crystallite size of 42 nm. The 2D morphology of CuAl2O4 was confirmed using field emission scanning electron microscope whereas BET revealed the mesoporous nature and a high surface area of 41.8 m2g-1. The surface oxidation states of the material were found through X-ray photoelectron spectroscopy. The 2D CuAl2O4 demonstrated excellent sensing towards isopropanol with its response varying from 11.8 to 84.5 % (500 ppb–10 ppm) at 300 °C. The limit of detection of the spinel was found to be 56 ppb at its optimum operating temperature of 300 °C. In addition, the sensing layer was found to have response times in range 1101 s for 500 ppb to 168 s for 10 ppm and recovery times in the range 300 s for 500 ppb to 570 s for 10 ppm.

Value for money of medicine sampling and quality testing: evidence from Indonesia

BackgroundSubstandard and falsified medicines (SFMs) are a public health concern of global importance. Postmarket surveillance in the form of medicine sampling and quality testing can prevent and detect SFM, however,...

Characterization of Clonal Groups of Antibiotic-Resistant Biofilm-Forming Staphylococcus aureus Strains Isolated from Patients with Urinary Tract Infections in Isfahan, Iran

Background: Over the past decades, the role of biofilm-forming Staphylococcus aureus strains in urinary tract infections (UTIs) has garnered significant attention. Objectives: This study aimed to determine the epidemiological characteristics and diversity of S. aureus strains isolated from patients with UTIs in Isfahan, Iran, in 2017, with regard to their antimicrobial resistance, biofilm formation, and phylogenetic profiles. Additionally, the study investigated potential relationships among these factors statistically to develop efficient control and treatment approaches. Methods: All patients with symptomatic UTIs who had positive urine cultures for S. aureus during the study period at the laboratory of a referral hospital in Isfahan were included. All isolates were identified using specific primers for the nucA gene. Their biofilm formation capacity was evaluated using a combination of the microtiter plate and Congo-red agar methods. Antibiotic susceptibility testing was performed using the disk diffusion method. The presence of genes involved in biofilm formation and resistance to cefoxitin, aminoglycosides, and fluoroquinolones was detected using polymerase chain reaction (PCR). Staphylococcal cassette chromosome mec (SCCmec) typing, agr typing, and phene plate (PhP) typing were employed to investigate the diversity of collected strains. Results: Results showed that 19%, 57%, and 24% of confirmed S. aureus strains were strong, intermediate, and non-biofilm formers, respectively. The highest rate of resistance was against nalidixic acid (77%), followed by streptomycin (73%). The icaD and icaA genes had the highest frequency among biofilm-producing strains. gyrA (44%) and grlA (35%) were the most frequent genes among fluoroquinolone-resistant strains, while aph(3′)-IIIa was the most prevalent aminoglycoside-modifying enzyme gene. The majority of bacterial strains harbored SCCmec type III and agr type I. PhP typing of strains revealed the presence of 8 common types (CTs) and 14 single types (STs), with CT2 being the dominant type. Conclusions: The present investigation revealed various biofilm production capacities, antimicrobial resistance profiles, and clonal lineages in S. aureus isolated from patients with UTIs. These findings provide further insights into the epidemiology and pathogenicity of S. aureus strains in Iran, thereby improving the quality of surveillance and therapeutic protocols.

Inflammatory Pseudotumor of the Liver or Intrahepatic Cholangiocarcinoma, That's the Question: A Review of the Literature.

An inflammatory pseudotumor of the liver is a rare tumor-like lesion composed of polymorphous inflammatory cell infiltrates and variable amounts of fibrosis that can often mimic a malignant liver neoplasm. The etiology of inflammatory pseudotumors of the liver is unknown; symptoms are faint and imaging non-specific. Thus, it is often hard to make a diagnosis preoperatively and it is not so rare to over-treat patients with this disease or vice versa. Thus, more profound knowledge is necessary to plan appropriate disease management. We reported our two cases and systematically searched the literature regarding IPTL. We selected articles published in English from four databases, PubMed, Scopus, Web of Science and Google Scholar, and we included only articles with consistent data. Twenty nine papers fulfilling criteria for the review were selected. The analysis of 69 cases published from 1953 confirmed that the risk factors are unclear, the imaging data is not specific, and biopsy is crucial but not so widely used in clinical practice due to the procedure's related risks, and relatively low effectiveness and improvement in imaging analysis. Regarding treatment, surgeons have moved towards a more conservative attitude over the years due to better imaging quality and patient surveillance. However, surgery remains the modality of choice for most cases with an indeterminate diagnosis. Even if an inflammatory pseudotumor of the liver is a benign tumor with a good prognosis, not requiring any treatment in most cases, sometimes it remains challenging to differentiate it from ICC; therefore, there is a solid recommendation to manage this condition with a multidisciplinary team.

Overview of the pesticide contamination provided by the last Brazilian water quality surveillance information system for human consumption (SISÁGUA 2022) report

The Water Quality Surveillance Information System for Human Consumption (SISÁGUA) is designed to manage the risks of water contamination for human consumption. This short communication focuses on data from the 2022 Report regarding pesticide analysis. The data centers on 27 active pesticide ingredients found in drinking water samples exceeding the maximum residual limits (MRLs) established by Brazilian legislation. Results indicate that 1609 municipalities (60 %) found at least one pesticide in their water. Two hundred ten municipalities detected all 27 pesticides tested, with 11 of these pesticides reported to have some carcinogenic potential. Nearly one and a half million people were exposed to levels above the Brazilian MRL, with the sum of maximum detected residues exceeding 80,000 ppb. Additionally, the report highlights that 53 % of Brazilian municipalities did not submit water monitoring data for human consumption. Thus, improving and expanding the scope of water analysis within the SISÁGUA framework is essential.

Role of frontline healthcare professionals in improving air quality and climate health surveillance in India

Role of frontline healthcare professionals in improving air quality and climate health surveillance in India

Post-marketing quality surveillance of selected antibacterial agents marketed in porous borders; the case of Ethiopia-Sudan-Eritrea border.

The presence of poor-quality medicines is becoming a public health threat in many parts of the world, particularly in developing countries. Antibiotics are among the most common anti-infective medicines that are highly prone to this problem. The purpose of this study was to assess the quality of selected antibacterials that are marketed in Setit Humera and West Gondar Zones, North West Ethiopia, which are located on the Ethiopian side of the Ethiopia-Sudan-Eritrea border. Seventy-one samples of the four antibacterial medicines (Ciprofloxacin, Norfloxacin, Amoxycillin, and Amoxycillin clavullanate combination) were collected from six sites in Setit Humera and West Gondar Zones, North West Ethiopia. A mystery shopping system was used for sample collection. Visual inspections and confirmation of the registration status were carried out using the joint WHO/FIP/USP checklist and the Ethiopian Food and Drug Authority's (EFDA's) Electronic Regulatory Information System (eRIS), respectively. Then Pharmacopeial methods (USP, BP) were employed to assess the physicochemical quality parameters. During the period of our data collection, the application status for registration in the eRIS system was checked. From 71 samples, 25.35% (18/71) were not registered, and 15.49% (11/71) were registered, but the license period had expired. Some samples (12.06% (17/71)) did not meet the visual inspection criteria. The physicochemical evaluation showed that all the samples studied met the quality specifications for the identification and hardness tests. However, concerning assay, dissolution, uniformity of dosage units, disintegration, and friability test parameters, 27.49% (23/71), 16.9% (12/71), and 14.08% (10/71), 2.82% (2/71) and 8.57% (3/35) of samples were found to be substandard, respectively. Overall, 56.33% (40/71) of the samples tested were of poor quality, failing to meet any one or more of the assessed parameters in this study. The study indicated that poor-quality antibacterial medicines are circulating in the study sites. Therefore, even if the area was affected by conflict at the time of the study, the regulatory bodies should focus on enforcing the necessary measures by collaborating with the regional and national regulatory medicine agencies to ensure that the antibacterial medicines available meet the required mandatory minimum standards.

Improving Coordination to Strengthen Operationalization of Malaria Surveillance and Routine Data Quality: Landscape Analysis of Current Surveillance-Related Initiatives.

Improving the visibility and global coordination of malaria surveillance and data quality improvement initiatives is required to optimize sharing of best practices, tools, and approaches and to promote efficient, effective, and equitable distribution of resources. With these aims in mind, Rollback Malaria's Surveillance, Monitoring and Evaluation Working Group established the Surveillance Practice and Data Quality Committee in May 2021. As a priority initiative, the committee conducted a landscape analysis of implementing partners' (IPs') malaria surveillance-related projects. A questionnaire that included questions on current project objectives, activities, geographic scope, and lessons learned was distributed among committee members and other IPs. Three years since its inception, information has been submitted regarding 49 projects by 25 IPs and funded by 17 donors. To present and share the landscaping results, an interactive dashboard was published to the Rollback Malaria's Global Malaria Dashboard website (endmalaria.org) in March 2021. It is the first time that multiple stakeholders have shared such information regarding surveillance projects.

Public Health Significance of Verocytotoxigenic Escherichia coli: An Overview

Meat is a global vital protein source catering to diverse diets. By 2050, world’s population may rise to 9 billion and the demand for meat will exceed supply, necessitating a doubling of meat production. Nutritionally rich composition makes meat, a fertile ground for numerous microbes, leading to spoilage and foodborne illnesses, impacting human health. External factors like poor hygiene, inadequate post-production storage, mishandling and more contribute to meat contamination. The zoonotic strains of E. coli can cause severe food poisoning, with over 700 identified serotypes, hence it is crucial to identify, monitor and control E. coli to ensure food safety. Among E. coli pathotypes, Verocytotoxigenic E. coli (VTEC) stands out as major cause of food poisoning. The VTEC toxin (Shiga toxin), can induce mild diarrhea to severe form of illness like Hemorrhagic Uremic Syndrome and Hemorrhagic Colitis, posing a severe public health risk. The Cattle is a primary reservoir for VTEC, which, by faecal shedding, can pollute food, water and the environment. Furthermore, E. coli can spread through contaminated meat, raw milk and milk products. This bacterium is commonly found in the immediate surroundings of animal reservoir, including soil, grass and manure, leading to potential contamination of milk. E. coli infections not only impact humans but also animals, with cattle, sheep and poultry acting as reservoirs for different E. coli strains. Cattle populations frequently harbor E. coli O157:H7 asymptomatic carriers, contributing to faecal contamination of food and water sources. Educating the public about the risks associated with improper meat handling and contamination is essential to reduce foodborne illnesses. Monitoring and surveillance of meat quality in local markets, as are crucial steps towards ensuring food safety. This underscores the importance of understanding and managing E. coli contamination in meat to safeguard public health and ensure the safety of meat products in the global food supply chain.

Quality of endoscopic surveillance of Lynch syndrome patients in a Swedish cohort.

Background and study aims Risk factors for colorectal cancer (CRC) in Lynch syndrome (LS) include sex, age, smoking, high body mass index (BMI), surveillance interval length, and risk genotype. The Boston Bowel Preparation Scale (BBPS) produces a standardized bowel cleanliness rating. A low BBPS score might be a risk factor for missed early lesions. The aim of this study was to investigate the correlation between BBPS score and adenoma detection (with known risk factors for CRC) and surveillance interval with CRC detection in LS patients. Methods A retrospective cohort study including 366 LS patients with 1,887 colonoscopies under surveillance in Stockholm, Sweden from 1989 to 2021 was conducted. Associations were tested using linear and logistic regression. Results We found no association between BBPS score and number of adenomas detected. A low BBPS score was found to be associated with older age (regression coefficient (coeff) -0.015; 95% confidence interval [CI] -0.026 to -0.004; P = 0.007) and obesity (coeff = -0.48; 95% CI: -0.89 to -0.062; P = 0.024). A higher number of detected adenomas was associated with older age (coeff = 0.008; 95% CI 0.004 to 0.012; P < 0.001), male sex (coeff = 0.097; 95% CI 0.008 to 0.19; P = 0.033) and CRC (coeff = 0.28; 95% CI 0.061 to 0.50; P = 0.012). Surveillance interval length was not significant in CRC detection. Conclusions Bowel cleanliness was not associated with adenoma detection and was less likely achieved in patients who were older and had higher BMI. Adenoma detection was associated with older age and male sex. The results indicate the need for better adherence to guidelines and attention to older age groups, men, and patients with obesity.