Waterborne Outbreaks Research Articles

An assessment of groundwater quality in Zimbabwe's urban areas: case of Mkoba 19 suburb, Gweru.

Groundwater quality assessment in urban areas is one of significant endeavours to ensure safety of urban residents who use groundwater especially in areas with erratic tap water supply. The study assessed groundwater quality and vulnerability of residents to water contamination-related diseases in Mkoba 19 suburb in Gweru, Zimbabwe. The research employed a mixed methods research design using both quantitative and qualitative research methods. Laboratory tests, questionnaires, interviews, focus group discussions and observations were used to solicit data. Statistical package for social scientist (SPSS) version 20.0 and Microsoft excel package were adopted for data analysis in this study. The study revealed that Mkoba 19 suburb has more wells than boreholes. Boreholes were evenly distributed over the residential area than wells which were clustered to the southern and northern edges of the suburb. All boreholes in Mkoba 19 were drilled to the depth of 40m, but wells were dug to varying depths. The study confirmed that borehole water in Mkoba 19 was acidic and thus unsafe for human consumption. Water from wells in Mkoba 19 was confirmed positive of Escherichia coli which shows contamination from sewage and waste dump leachates. The findings of this research indicated that both borehole and well water sources in Mkoba suburb had permissible levels of dissolved oxygen and turbidity. Chi-square tests conducted confirmed that there was an association between water source depth and level of E. coli contamination in water whereas there is no association between water source depth and water pH level. The research confirmed that residents of Mkoba 19 were highly vulnerable to water borne illnesses as they were using contaminated water for domestic purposes without treating it. Basing on similar studies conducted in the past 3years, it was shown that groundwater quality in Mkoba 19 mimics that of other countries of the developing world, especially in sub-Saharan Africa, which shows that vulnerability to ground water contamination in urban areas is an issue that requires critical attention and almost similar solution. The research recommends that Gweru City Council should upgrade its water supply system especially the pumping system to improve water supply in Mkoba suburb. To minimize water-borne disease outbreaks in the future, urban residents who rely on secondary or tertiary sources of water for domestic purposes should treat water using chlorine, water guards and other water cleansing measures on a regular basis.

Hepatitis E Virus RNA Presence in Wild Boar Carcasses at Slaughterhouses in Italy.

Simple SummaryHepatitis E virus (HEV) is a worldwide diffused pathogen responsible for acute hepatitis of humans. Transmission of the pathogen is mostly related to the consumption of contaminated food and water. Although initially the disease was contained in developing countries, in recent years autochthonous infections have been reported in several industrialised countries. A different epidemiological pattern of transmission has been highlighted; while in Africa and Asia transmission is mainly due to waterborne outbreaks caused by low sanitation standards, in Europe and other industrialised countries, the disease has mainly spread due to consumption of raw or undercooked meat and seafood. Although HEV has been identified in several domestic and wild animal species, pigs and wild boar, appear to play a distinct role mainly acting as a reservoir of the pathogen. In this study, we monitored the presence of HEV in carcasses and livers of wild boar sampled in Tuscany at the slaughterhouse following hunting activities. Our data indicate the presence of the pathogen in the liver and the carcasses, suggesting cross-contamination. This evidence highlights the importance of maintaining safety control measures to avoid the spreading of HEV infection.Hepatitis E virus (HEV) is a waterborne and foodborne pathogen largely spread around the world. HEV is responsible for acute hepatitis in humans and it is also diffused in domestic and wild animals. In particular, domestic pigs represent the main reservoir of the infection and particular attention should be paid to the consumption of raw and undercooked meat as a possible zoonotic vehicle of the pathogen. Several studies have reported the presence of HEV in wild boar circulating in European countries with similar prevalence rates. In this study, we evaluated the occurrence of HEV in wild boar hunted in specific areas of Tuscany. Sampling was performed by collecting liver samples and also by swabbing the carcasses at the slaughterhouses following hunting activities. Our data indicated that 8/67 (12%) of liver samples and 4/67 (6%) of swabs were positive for HEV RNA. The presence of HEV genome on swabs indicates the possible cross-contamination of carcass surfaces during slaughtering procedures. Altogether, our data indicated that it is essential to promote health education programmes for hunters and consumers to limit the diffusion of the pathogen to humans.

Universal Bacterial Detection Utilizing PEDOT:PSS-Based Organic Electrochemical Transistors

Bacteria are one of the most common sources of illness, responsible for a wide range of infections. Bacterial infections can be caused from a variety of sources, with thousands of deaths attributed to waterborne outbreaks alone [1]. Detection of both infectious and non-infectious bacteria is important to ensure commercial goods and water are safe for consumers. Current detection of bacterial contamination typically uses cell culture plates to measure the number of colony forming bacteria (CFU/ml) in a liquid media. This technique is widely used due to its high sensitivity and easy visual readout. Unfortunately, culture counting technique is time consuming (1-3 days), requires skilled lab technicians, can be contaminated during preparation, and cannot be integrated into the desired testing media directly.To overcome these limitations, many bacterial sensors and detection techniques have been developed over the last few decades [2]. A recent sensor for bacteria detection is utilizing the organic electrochemical transistor (OECT). OECTs are polymer-based transistors that utilize ionic solutions to de-dope and re-dope a conducting channel. These devices are known for the high transconductance, bio-compatibility, low operating voltage, low cost, small size, ease of integration into measurement systems, and ability to function in aqueous environments [3]. Detection of a single bacteria is typically desired and achieved through the capture of bacteria cells onto the OECT channel area [4]. This approach allows for rapid detection of a specific pathogen with high sensitivity. However, for detecting contamination from a variety of bacteria a different approach must be used.We have investigated the OECT response to the presence of non-captured bacteria present within the OECT operating media. In this approach cells are detected both in solution and on the surface of the source-drain channel and on the gate electrode. Presence of bacteria between the gate and channel region will cause a shift in effective gate voltage, leading to a change in source-drain current. Detection and characterization of (non-bacteria) whole cells has previously been reported utilizing this approach [5, 6]. In our work we have focused on the bacteria pseudomonas fluorescens (p. fluorescens) due to its size (~1µm) and potential as a water borne pathogen. P. fluorescens was cultured in Luria-Bertani (LB) and Dey-Engley (D/E) media, diluted to different concentrations in broth, and used as the operating media for OECT. Concentrations of 1.9e5 to 6.8e8 CFU/ml were found to cause a shift in effective gate voltage between 36.8 to 97.5mV. Craun, G.F., Statistics of waterborne outbreaks in the US (1920–1980). Waterborne diseases in the United States, 2018: p. 73-159.Ahmed, A., et al., Biosensors for whole-cell bacterial detection. Clinical microbiology reviews, 2014. 27(3): p. 631-646.Strakosas, X., M. Bongo, and R.M. Owens, The organic electrochemical transistor for biological applications. Journal of Applied Polymer Science, 2015. 132(15).Demuru, S., et al. Flexible Organic Electrochemical Transistor with Functionalized Inkjet-Printed Gold Gate for Bacteria Sensing. 20th International Conference on Solid-State Sensors, Actuators and Microsystems & Eurosensors, 2019.Liao, J., et al., Organic electrochemical transistor based biosensor for detecting marine diatoms in seawater medium. Sensors and Actuators B: Chemical, 2014. 203: p. 677-682.Ramuz, M., et al., Monitoring of cell layer coverage and differentiation with the organic electrochemical transistor. Journal of Materials Chemistry B, 2015. 3(29): p. 5971-5977. Figure 1

Cryptosporidium spp. infections in livestock and wild animals in Azerbaijan territory

Cryptosporidium is an intracellular protozoan parasite, globally distributed and capable of infecting various vertebrate species, including humans as well as domestic and wild animals. Cryptosporidium is increasingly gaining attention as a human and an animal pathogen mainly due to its dominant involvement in worldwide waterborne outbreaks. The present paper reviews the current knowledge and understanding of Cryptosporidium spp. in terrestrial and water animals in Azerbaijan.

Hepatitis E: An update on One Health and clinical medicine.

The hepatitis E virus (HEV) is one of the main causes of acute hepatitis and the de facto global burden is underestimated. HEV-related clinical complications are often undetected and are not considered in the differential diagnosis. Convincing findings from studies suggest that HEV is clinically relevant not only in developing countries but also in industrialized countries. Eight HEV genotypes (HEV-1 to HEV-8) with different human and animal hosts and other HEV-related viruses are in circulation. Transmission routes vary by genotype and location, with large waterborne outbreaks in developing countries and zoonotic food-borne infections in developed countries. An acute infection can be aggravated in pregnant women, organ transplant recipients, patients with pre-existing liver disease and immunosuppressed patients. HEV during pregnancy affects the fetus and newborn with an increased risk of vertical transmission, preterm and stillbirth, neonatal jaundice and miscarriage. Hepatitis E is associated with extrahepatic manifestations that include neurological disorders such as neuralgic amyotrophy, Guillain-Barré syndrome and encephalitis, renal injury and haematological disorders. The risk of transfusion-transmitted HEV is increasingly recognized in Western countries where the risk may be because of a zoonosis. RNA testing of blood components is essential to determine the risk of transfusion-transmitted HEV. There are currently no approved drugs or vaccines for HEV infections. This review focuses on updating the latest developments in zoonoses, screening and diagnostics, drugs in use and under development, and vaccines.

Neurological manifestations of hepatitis E virus infection: An overview.

Hepatitis E virus (HEV) is an important cause of repeated waterborne outbreaks of acute hepatitis. Recently, several extrahepatic manifestations (EHMs) have been described in patients with HEV infection. Of these, neurological disorders are the most common EHM associated with HEV. The involvement of both the peripheral nervous system and central nervous system can occur together or in isolation. Patients can present with normal liver function tests, which can often be misleading for physicians. There is a paucity of data on HEV-related neurological manifestations; and these data are mostly described as case reports and case series. In this review, we analyzed data of 163 reported cases of HEV-related neurological disorders. The mechanisms of pathogenesis, clinico-demographic profile, and outcomes of the HEV-related neurological disorders are described in this article. Nerve root and plexus disorder were found to be the most commonly reported disease, followed by meningoencephalitis.

Comparison of Skimmed Milk and Lanthanum Flocculation for Concentration of Pathogenic Viruses in Water

Concentration of viruses in water is necessary for detection and quantification of the viruses present, in order to evaluate microbiological barriers in water treatment plants and detect pathogenic viruses during waterborne outbreaks, but there is currently no standardised procedure. In this study, we implemented a previously described fast and simple lanthanum-based protocol for concentration of norovirus genogroup I (GI), genogroup II (GII) and hepatitis A virus (HAV) in drinking and surface water. We compared the results with those of a widely used skimmed milk flocculation method, followed by nucleic acid extraction and RT-qPCR detection. Three seeding levels, with intended concentrations 5 × 103, 5 × 104 and 5 × 105 genome copies/10 L, were added to drinking water or surface water. All seed levels were detected with both flocculation methods. Samples extracted with skimmed milk flocculation had on average 1.82, 1.86 and 1.38 times higher measured concentration of norovirus GI, GII and HAV, respectively, than those extracted with lanthanum flocculation, across all seeding levels and water types tested. Mengovirus was used as a positive process control. Mengovirus recovery was higher for skimmed milk (40.7% in drinking water, 26.0% in surface water) than for lanthanum flocculation (24.4% in drinking water, 9.7% in surface water). Together, this indicates that skimmed milk flocculation provides higher viral recovery than lanthanum flocculation. However, lanthanum-based flocculation can be performed much faster than skimmed milk flocculation (1.5 h versus 16 h flocculation time) and thus could be a good alternative for rapid monitoring of viruses in water.

Trends in recent waterborne and foodborne disease outbreaks in South Korea, 2015-2019.

ObjectivesThis study analyzed trends in foodborne and waterborne diseases in South Korea between 2015 and 2019.MethodsThe data consisted of information on outbreaks of waterborne and foodborne infectious diseases reported through the Korea Centers for Disease Control and Prevention (KCDC) system. We analyzed the trends and epidemiological aspects of outbreaks by month, place of occurrence, and causative pathogens in this observational study.ResultsThe number of outbreaks has steadily increased over the last 5 years, but the number of cases per outbreak has followed a decreasing trend. Incidence at daycare centers and preschools has been steadily increasing over consecutive years.ConclusionThe steady number of patients and decreasing number of cases per outbreak, even as the number of outbreaks has been increasing, suggest that the KCDC’s professional management system is operating effectively. It is necessary to continue improving the objectivity and efficiency of the management system and to carefully examine the increasing number of outbreaks in smaller-scale group catering facilities, such as daycare centers and preschools. Outbreaks can be prevented by closely examining those caused by unidentified pathogens and group outbreaks caused by other diseases, identifying problems, and supplementing the management system.

Storied experiences of the Havelock North drinking water crisis: A case for a ‘narrative green victimology’

The number of victims from environmental harm far exceeds that from everyday property and interpersonal crime, yet little is known about the experience of environmental victimisation. This paper makes a case for a narrative green victimology to advance scholarship about environmental victims, drawing on data from interviews with persons affected by a waterborne outbreak of campylobacter in the small town of Havelock North, New Zealand, in August 2016. Findings demonstrate that understandings of environmental harm are developed in narratives, with narratives. In particular, participants’ stories of harm and victimisation revealed fragments of larger, cultural narratives about sacrifice, nation-building, motherhood, and environmental purity, each of which affected their understanding of the impact of the outbreak on their autonomy as agentive persons. It is proposed that a narrative green victimology offers environmental victimology a platform upon which it can foot its frameworks.

Population structure, case clusters, and genetic lesions associated with Canadian Salmonella 4,[5],12:i:- isolates.

Monophasic Salmonella 4,[5]:12:i:- are a major public health problem because they are one of the top five Salmonella serotypes isolated from clinical cases globally and because they can carry resistance to multiple antibiotics. A total of 811 Salmonella 4,[5]:12:i:- and S. Typhimurium whole genome sequences (WGS) were generated. The various genetic lesions causing the Salmonella 4,[5]:12:i:- genotype were identified and assessed with regards to their distribution in the population of 811 Salmonella 4,[5]:12:i:- and S. Typhimurium isolates, their geographical and temporal distribution, and their association with non-human sources. Several clades were identified in the population structure, and the largest two were associated almost exclusively with a short prophage insertion and insertion of a mobile element carrying loci encoding antibiotic and mercury resistance. IS26-mediated deletions and fljB point mutants appeared to spread clonally. 'Inconsistent' Salmonella 4,[5]:12:i:- isolates associated with specific, single amino acid changes in fljA and hin were found in a single clade composed of water, shellfish, and avian isolates. Inclusion of isolates from different case clusters identified previously by PFGE validated some of the clusters and invalidated others. Some wgMLST clusters of clinical isolates composed of very closely related isolates contained an isolate(s) with a different genetic lesion, suggesting continuing mobility of the implicated element responsible. Such cases may need to be left out of epidemiological investigations until sufficient numbers of isolates are included that statistical significance of association with sources is not impaired. Non-human sources were frequently found in or near clinical case clusters. Prospective surveillance and WGS of non-human sources and retrospective analysis by WGS of isolates from existing culture collections provides data critical for epidemiological investigations of food- and waterborne outbreaks.

Evolving Patterns of Cryptosporidiosis: Issues and Implications in the Context of Public Health in India

Cryptosporidiosis is one of the major causes of diarrhea in immune-compromised individuals and children besides causing sporadic water-borne, food-borne, and zoonotic outbreaks. In 2016, Cryptosporidium species infection was the fifth leading cause of diarrhea and acute infection causing more than 4.2 million disability-adjusted life years lost besides a decrease in childhood growth. Human cryptosporidiosis is primarily caused by two species/genotype: Cryptosporidium hominis (anthroponotic) and Cryptosporidium parvum (zoonotic) besides other six rare species/genotypes. Transmission intensity, genetic diversity, and occurrence of genetic recombination have shaped the genus Cryptosporidium population structures into palmitic, clonal, and epidemic. Genetic recombination is more in C. parvum compared with C. hominis. Furthermore, parasite–host co-evolution, host adaptation, and geographic segregation have led to the formation of “subtype- families.” Host-adapted subtype-families have distinct geographical distribution and host preferences. Genetic exchanges between subtypes played an important role throughout the evolution of the genus leading to “adaptation introgression” that led to emergence of virulent and hyper-transmissible subtypes. The population structure of C. hominis in India appears to be more complex where both transmission intensity and genetic diversity are much higher. Further, study based on “molecular strain surveillance” has resulted newer insights into the epidemiology and transmission of cryptosporidiosis in India. The identification at the species and genotype levels is essential for the assessment of infection sources in humans and the public health potential of the parasite at large. The results of the study over three decades on cryptosporidiosis in India, in the absence of a national surveillance data, were analyzed highlighting current situation on epidemiology, genetic diversity, and distribution particularly among vulnerable population. Despite creditable efforts, there are still many areas need to be explored; therefore, the intent of this article is to facilitate future research approaches for mitigating the burden associated with this disease.

FLOW CYTOMETRIC AND MOLECULAR ANALYSIS OF POSSIBLE PROTOZOAL CONTAMINATION OF DRINKING WATER IN TANTA, EGYPT

Protozoal water contamination is an alarming cause of countless waterborne outbreaks. The mosteminent causal protozoa are Cryptosporidium and Giardia species (spp.) as they can endure aquaticenvironment even with chlorine disinfectants. The currently used traditional techniques cannot permitan easy detection of the waterborne protozoa concerning their count, viability, and pathogenicity. Thepresent work detected protozoal contamination of the drinking water in Egypt with the determinationof their load, viability and potential pathogenicity. Four techniques were compared including conventionalstaining techniques, immunofluorescence (IF) staining, flow cytometry (FC) and molecularstudy. Also, viability was assessed by conventional trypan blue stain and nucleic acid stain. Along ayear, 64 water samples were collected and concentrated from water tanks and tap water of differentdistricts, significant differences (P < 0.001) was between the different techniques in each season regardingthe detection of Giardia cysts and Cryptosporidium oocysts. Number of total positive sampleswas significantly higher in tank water than tap water (P < 0.001) especially at summer. Flow cytometryand nested polymerase chain reaction (nPCR) proved to be much more sensitive than IF assay, andconventional staining techniques. Regarding viability, nucleic acid stain was more sensitive than trypanblue stain (P < 0.001). Also, C. parvum predominate other Cryptosporidium genotypes.

Characteristics of hospitalized patients during a large waterborne outbreak of Campylobacter jejuni in Norway

Very few reports describe all hospitalized patients with campylobacteriosis in the setting of a single waterborne outbreak. This study describes the demographics, comorbidities, clinical features, microbiology, treatment and complications of 67 hospitalized children and adults during a large waterborne outbreak of Campylobacter jejuni in Askoy, Norway in 2019, where more than 2000 people in a community became ill. We investigated factors that contributed to hospitalization and treatment choices. Data were collected from electronic patient records during and after the outbreak. Fifty adults and seventeen children were included with a biphasic age distribution peaking in toddlers and middle-aged adults. Most children, 14 out of 17, were below 4 years of age. Diarrhea was the most commonly reported symptom (99%), whereas few patients (9%) reported bloody stools. Comorbidities were frequent in adults (63%) and included cardiovascular disease, pre-existing gastrointestinal disease or chronic renal failure. Comorbidities in children (47%) were dominated by pulmonary and gastrointestinal diseases. Adult patients appeared more severely ill than children with longer duration of stay, higher levels of serum creatinine and CRP and rehydration therapy. Ninety-two percent of adult patients were treated with intravenous fluid as compared with 12% of children. Almost half of the admitted children received antibiotics. Two patients died, including a toddler. Both had significant complicating factors. The demographic and clinical findings presented may be useful for health care planning and patient management in Campylobacter outbreaks both in primary health care and in hospitals.

Zoonotic Giardia duodenalis sub-assemblage BIV in wild raccoons (Procyon lotor) from Germany and Luxembourg.

Giardia duodenalis is a cosmopolitan flagellate that causes giardiasis, one of the most significant gastrointestinal diseases in humans. This parasite can be a serious threat to public health because it can cause waterborne outbreaks as well as sporadic infections in humans. Invasive raccoons (Procyon lotor) may play a role in disseminating Giardia into the environment and transmitting it to humans and domestic animals because they live in high densities and deposit their faces in latrines near areas used by humans. While Giardia infections have been reported from raccoons in North America, it is unknown whether they carry G. duodenalis with zoonotic assemblage A and B, which have the potential to cause illness in humans. We collected faecal samples from 66 legally harvested raccoons in Germany and Luxembourg and examined for Giardia using molecular techniques. Using a quantitative PCR based on primers specific to Giardia genetic assemblages A and B, we detected the presence of zoonotic assemblage B in 27% (95% CI, 17.0-39.6) of all examined faecal samples from raccoons, including animals sampled in buildings. We did not detect genetic assemblage A in any of the samples. Sequences obtained from the glutamate dehydrogenase and beta-giardin gene fragments from a selection of three of the positive samples showed that raccoons carried a zoonotic G. duodenalis genotype belonging to sub-assemblage BIV, which is commonly found in humans and animals worldwide. Our results suggest that free-ranging raccoons have the potential to play an increasingly important role in the epidemiology of Giardia and pose a threat to public health in Europe and other regions where this species is common and lives in close association with humans.

Ferric sulphate flocculation as a concentration method for Giardia and Cryptosporidium in filter backwash water

Abstract Filter backwash water (FBW) is a prominent residue from water treatment plants (WTPs) that is often disposed into water bodies or recycled within the WTP without due disinfection. FBW usually contains particles within a size range that includes pathogenic protozoa, as the infective forms of Giardia and Cryptosporidium, parasites responsible for waterborne diseases outbreaks. Quantifying (oo)cysts is essential for addressing this matter, as it might assist research on giardiasis and cryptosporidiosis epidemiology, as well as shed light onto disinfection technologies for FBW. However, (oo)cyst recovery from FBW and other complex matrices still lacks a standard protocol and entails specialized professionals and expensive material. Seeking to provide insight in a reduced-cost recovery method, this study analysed the recovery efficiency (RE) obtained by acid flocculation with ferric sulphate, a common coagulant, on bench-scale simulated FBW. Steps included concentration by flocculation, centrifugation, and quantification by immunofluorescence. Although recovery was sufficient for Cryptosporidium parvum (40.59%), Method 1623.1 recommendations were not reached for Giardia muris (1.76%). Coefficients of variation obtained for both organisms were not satisfactory, highlighting the variability to which environmental matrices are subjected and why defining a methodology for (oo)cyst recovery in WTP residues is important.

Community waterborne outbreak linked to a firefighting response during the COVID-19 emergency.

On 6 March 2020, a big fire in a village forced the firefighters to draw water simultaneously from many sources, including the Adige river. From 9 March, an increasing number of inhabitants reported gastrointestinal symptoms. We describe the outbreak and the challenges linked to the concurrent COVID-19 spread. Residents with enteric symptoms and their relatives were interviewed and samples from some of the patients and public water pipelines were tested for enteric pathogens with microbiological and molecular methods. By 20 March, 182 people reported symptoms and 131 met the case definition. Norovirus GI/GII and other pathogens were found in human and water samples. Contamination of the public water network with sewage-contaminated river water through the firefighters pressurized water tank was the suspected source of the outbreak. The investigation was partly hampered due to the SARS-CoV-2 emergency. Control measures included avoiding tap water, alternative water supplies and chlorination of public water.

Türkiye'nin Batı Kesiminde Tularemi Salgını; İda Dağı'nın İntikamı

Objective: Tularemia is a zoonotic disease. Sporadic cases and outbreaks occur in humans. Here, we report a waterborne outbreak, its clinical presentation, and the results of treatment. Material and Methods: An increase in the frequency of patients presenting with lymphadenopathy from the same region was detected. Patients with serological diagnosis of tularemia were included in the study between December 2018 and April 2019. This case series were evaluated as an outbreak, clinical and laboratory parameters, demographic characteristics, clinical forms of tularemia and laboratory findings such as immunoglobulin M antibody titer for F. tularemia, inflammatory markers (C-reactive protein, leukocytosis, erythrocyte sedimentation rate), choice of first antibiotic treatment, total duration of treatment, initial clinical/laboratory response day, relapse and reinfection ratios have been investigated. The bacteria was investigated from drinking water fountains by polymerase chain reaction (PCR) (16sRNA Nanobiz® F. tularemia). Results: Tularemia was diagnosed serologically in 35 patients. Distribution of clinical forms was glandular (21 cases-60%); ulceroglandular (11 cases-31.4%); oropharyngeal (2 cases-5.7%) and oculoglandular (1 case-2.8%), respectively. First serologic test positivity was 80%. Inflammatory markers such as C-reactive protein, leukocytes, erythrocyte sedimentation rate were high. Antibiotic choice for treatment was streptomycin in 19 cases (54.3%), ciprofloxacin in nine cases (25.7%), gentamicin in four cases (11.4%); doxycycline in three cases (8.6%) respectively. The common suspicious contact was the use of drinking water from street fountains. F.tularemia PCR (16sRNA) was positive in 35 of these fountains (35/80, 43.75%). Conclusion: Tularemia should always be considered in head and neck lymphandenopathies that do not heal or show late recovery. We should keep in mind tularemia in a water-borne outbreak, were high it is rare.

Hepatitis E virus genotype 1f outbreak in Bangladesh, 2018.

Hepatitis E virus (HEV) infection is a significant public health issue in many developing countries, causing waterborne outbreaks as well as sporadic hepatitis. We report here an outbreak of HEV genotype 1f infection during April-May 2018 among peopleliving at Halisohor, a low land in thesouthern part of Chottogram District of Bangladesh. A total of 933 patients were admitted toCombined Military Hospital (CMH), Chottogram, with symptoms of acute hepatitis. Among them, 550 patients were tested by ELISA for HEV-specific (IgM) and all were positive. Genotyping, sequencing, and phylogenetic analysis based on ORF2 region revealed that the outbreak was caused by genotype 1f and the strains were closely related to the previously reported HEV strains that caused the outbreak in Bangladesh in 2010. The current outbreak was most likely linked with water supplyas fecal contamination in water was evident and could be prevented by ensuring access to safe drinking water.

'Evidence for waterborne origin of an extended mixed gastroenteritis outbreak in a town in Northern Greece, 2019'.

We investigated a large gastroenteritis outbreak that occurred in Northern Greece in 2019. A case was defined as anyone presenting with diarrhoea and/or vomiting from 24 January 2019 to 04 February 2019. We conducted a case-control study (CCS) using random selection of participants >16 years of age, residents of town X, who visited the health care centre between 25 and 28 January 2019. Moreover, we conducted a retrospective cohort study (CS) at the four elementary schools of the town. We collected clinical and water samples and the water supply system was inspected. In total, we recorded 638 cases (53% female; median age was 44 years (range 0-93)). Forty-eight cases and 52 controls participated in the CCS and 236 students in the CS. Both CCS and CS indicated tap water as the most likely source (OR 10, 95% CI 2.09-93.4, explaining 95.7% of cases; RR = 2.22, 95% CI 1.42-3.46, respectively). More than one pathogen was detected from stool samples of 6 of the 11 cases tested (norovirus, Campylobacter jejuni, Enterohemorrhagic E. coli (EHEC) and Enteropathogenic E. coli (EPEC)). Water samples, collected after ad-hoc chlorination, tested negative. Technical failures of the water tanks' status were identified. Our results suggested a waterborne outbreak. We recommended regular monitoring of the water supply system and immediate repair of technical failures.

Genomic and Phenotypic Characterisation of Campylobacter jejuni Isolates From a Waterborne Outbreak.

Campylobacter infections are the leading cause of bacterial gastroenteritis. In Europe, over 246,000 cases are confirmed annually. Infections are often transmitted via contaminated food, such as poultry products, but water may be the source of infection as well. The aim of this study was to characterise a selection of Campylobacter jejuni human isolates, together with a water isolate, from a waterborne outbreak in Norway in 2019, including human isolates from early, mid-, and late epidemic. The isolates were characterised with whole-genome sequencing, analysing the expression of putative virulence genes and demonstrating the pathogenic potential in an in vitro adhesion model using HT-29 cells. All isolates belonged to the multilocus sequence type 1701 and ST45 clonal complex. In the genomic analysis, the water isolate clustered somewhat separately from the human isolates. There was some variation between the human isolates, but the water isolate seemed to display the greatest pathogenic potential, demonstrated by the highest levels of virulence gene expression, adhesion to epithelial cells and IL-8 induction. These results suggest that the water isolate of the study has potential to cause human infections, and that some bacterial changes due to host or environmental adaptation, may occur during a waterborne Campylobacter epidemic. This is, to the best of our knowledge, the first study on C. jejuni isolates from a waterborne outbreak, including both human isolates and a water isolate, characterised with genomic and phenotypic approaches.