Using prospective syndromic surveillance, we detected statistically significant increases in the presentation of cases of gastroenteritis and diarrhea to general practitioner services and related calls to the national health telephone advice service in those areas affected by the BWN.
In the affected areas, average in-hours general practitioner consultations for gastroenteritis increased by 24.8% (from 13.49 to 16.84) during the BWN period; average diarrhea consultations increased by 28.5% (from 8.33 to 10.71). Local public health investigations revealed no laboratory reported cases confirmed as being associated with the water supply. These findings suggest that the increases reported by syndromic surveillance of cases of gastroenteritis and diarrhea likely resulted from changes in healthcare seeking behaviour driven by the intense local and national media coverage of the potential health risks during the event.
This study has further highlighted the potential for media-driven bias in syndromic surveillance, and the challenges in disentangling true increases in community infection from those driven by media reporting.
The potential impact of media reporting in syndromic surveillance: An example using a possible Cryptosporidium exposure in north west England, August to September 2015
Euro Surveill. 2016;21(41):pii=30368. DOI: http://dx.doi.org/10.2807/1560-7917.ES.2016.21.41.30368
AJ Elliot, HE Hughes, J Astbury, G Nixon, K Brierley, R Vivancos, T Inns, V Decraene, K Platt, I Lake, SJ O’Brien, GE Smith
The average annual number of foodborne disease outbreaks reported to CDC increased in 1998 in comparison to previous years, coinciding with the transition to an electronic reporting system, and decreased in 2009 in comparison to 1998–2008 coinciding with the transition to reporting through NORS (FDOSS and WBDOSS share an enhanced reporting platform, the National Outbreak Reporting System (NORS) (http://www.cdc.gov/nors). NORS also collects information on disease outbreaks with modes of transmission other than food and water, including person-to-person contact, animal contact, and environmental contamination.)
In 2013, a total of 792 single-state exposure outbreaks were reported with 11,786 illnesses by 47 states and Puerto Rico (Table) (Figure 2); an additional 26 multistate outbreaks (i.e., exposure to the implicated food occurred in more than one state) with 1,530 associated illnesses also were reported. CDC periodically publishes more detailed annual summaries describing the implicated foods, etiologic agents, settings, and points of contamination associated with foodborne disease outbreaks (http://www.cdc.gov/foodsafety/fdoss/data/annual-summaries/index.html).
Waterborne Disease Outbreaks
During 1971–2013, CDC received reports of 1,957 waterborne disease outbreaks with 642,782 outbreak-associated illnesses from 50 states and six freely associated states/territories. An average of 46 waterborne outbreaks was reported each year (Figure 1). In 2013, a total of 55 outbreaks causing at least 2,824 illnesses occurred in 21 states. No multistate outbreaks were reported; waterborne disease outbreak data for 2013 are preliminary (Table) (Figure 3). CDC periodically publishes more detailed summaries of waterborne disease outbreaks associated with recreational water and of waterborne disease outbreaks associated with drinking water (http://www.cdc.gov/healthywater/surveillance/surveillance-reports.html).
Reported outbreaks represent only a small fraction of all foodborne and waterborne illnesses that occur each year and the outbreak data reported here are subject to limitations. Outbreaks caused by certain pathogens or vehicles might be more likely to be recognized, investigated, or reported. Some illnesses reported as sporadic (i.e., not outbreak-associated) are likely not recognized as being part of a reported outbreak or might be part of an undetected outbreak. In addition, all outbreak-related illnesses might not be identified during an investigation, smaller outbreaks might not come to the attention of public health authorities, and some outbreaks might not be investigated or reported to CDC.
Reporting practices for foodborne and waterborne disease outbreaks vary among states and territories, which might have differing definitions or interpretations of which events are reportable and unique laws related to disease outbreak reporting. Thus, variations in reporting rates by state or territory might reflect variations in levels of effort and funding for foodborne and waterborne disease outbreak investigation, rather than true differences in outbreak incidence rates by state. NORS maintains a dynamic database; this report includes data available on May 1, 2015, for foodborne disease outbreaks and May 4, 2015, for waterborne disease outbreaks; data published in this Summary might differ from those published earlier or later.
Foodborne disease outbreaks are defined as two or more cases of a similar illness resulting from ingestion of a common food. Waterborne disease outbreaks are defined as two or more cases of a similar illness linked epidemiologically by time and location to exposure to water or water-associated chemicals volatized into the air.
We installed 130 electronic hand hygiene counting devices in our redesigned outpatient department. We remotely monitored physicians’ hand hygiene practices during outpatient examinations and calculated the adherence rate as follows: number of hand hygiene counts divided by the number of outpatients examined multiplied by 100. Physician individual adherence rates were also classified into 4 categories.
Two hundred and eighty physicians from 28 clinical departments were monitored for 3 months. The overall hand hygiene adherence rate was 10.7% at baseline, which improved significantly after feedback to 18.2% in the third month. Of the clinical departments, 78.6% demonstrated significant improvement in hand hygiene compliance. The change in the percentage of physicians in each category before and after feedback were as follows: very low (84.3% to 72.1%), low (8.6% to 14.3%), moderate (2.9% to 8.9%), and high (4.3% to 4.6%), from the first to third month, respectively. Based on category assessment, 17.1% of physicians were classified as responders.
Physicians’ adherence to hand hygiene practices during outpatient examinations was successfully monitored remotely using electronic counting devices. Audit and feedback of adherence data may have a positive impact on physicians’ hand hygiene compliance.
Utility of electronic hand hygiene counting devices for measuring physicians’ handwashing
American Journal of Infection Control, DOI: http://dx.doi.org/10.1016/j.ajic.2016.08.002
A Arai, M Tanabe, A Nakamura, D Yamasaki, Y Muraki, T Kaneko, A Kadowaki, M Ito
High-throughput whole-genome sequencing (WGS) is a revolutionary tool in public health microbiology and is gradually substituting classical typing methods in surveillance of infectious diseases. In combination with epidemiological methods, WGS is able to identify both sources and transmission-pathways during disease outbreak investigations.
This review provides the current state of knowledge on the application of WGS in the epidemiology of Campylobacter jejuni, the leading cause of bacterial gastroenteritis in the European Union.
We describe how WGS has improved surveillance and outbreak detection of C. jejuni infections and how WGS has increased our understanding of the evolutionary and epidemiological dynamics of this pathogen. However, the full implementation of this methodology in real-time is still hampered by a few hurdles. The limited insight into the genetic diversity of different lineages of C. jejuni impedes the validity of assumed genetic relationships. Furthermore, efforts are needed to reach a consensus on which analytic pipeline to use and how to define the strains cut-off value for epidemiological association while taking the needs and realities of public health microbiology in consideration.
Even so, we claim that ample evidence is available to support the benefit of integrating WGS in the monitoring of C. jejuni infections and outbreak investigations.
Use of whole-genome sequencing in the epidemiology of Campylobacter jejuni infections: state-of-knowledge
Ahead of print, doi: http://dx.doi.org/10.1101/078550
During the screening process, the researchers collected as many as 150 fresh seafood samples including popular varieties like sardine, mackerel, prawns and crabs from the markets in and around Kochi.
The study was conducted by a team of scientists including S.S. Greeshma, M.M. Prasad, K.V. Lalitha, Toms C. Joseph, and V. Murugadas.
The presence of salmonella in seafood indicates contamination with human and animal excreta. Fishes and shellfish normally do not harbour micro-organisms like salmonella but can get contaminated with through the use of contaminated ice, water, containers and poor hygienic handling practices, explained Dr. Greeshma.
Samples were collected over a period of nine months. Once salmonella reaches soil and aquatic environments, it can survive there for long periods.
While cooking kills the micro-organism, there exists the risk of cross-contamination with other food items that are consumed raw when handled along with seafood contaminated with salmonella.
Humans who come into direct contact with salmonella-contaminated seafoods face health risk, she explained.
The study underscores the need to hygienic handling of fish in the markets, said C.N. Ravishankar, Director of the Institute in a communication.
The researchers are planning a source study to identify the routes and points of possible contamination of the fish.
Materials and Methods: Sixty blood samples were collected from finished pigs at slaughter and their sera was evaluated by an indirect-IgG ELISA. Matched muscle samples were obtained from the tongue and loin. Whole blood and tissue samples were evaluated to search for T. gondii DNA using a nested-polymerase chain reaction.
Results: Seroprevalence of T. gondii was 96.6% (58/60) of sampled pigs. Meanwhile, T. gondii DNA was present in 23.21% of tongue tissue samples (13/56), 7% of loin tissues (4/57), and 0% in blood samples (0/44), respectively. Two pigs were serologically indeterminate.
Conclusion: This is the first report of the presence of T. gondii DNA in tissue samples obtained from finalized pigs. Results from the present study suggest a high exposure to T. gondii in pigs intended for human consumption from the tropical region of Mexico. Thus, the consumption of some undercooked pork meat meals typical from the southern region of Mexico could represent a significant risk for acquiring infection for the human population.
Presence of Toxoplasma gondii in pork intended for human consumption in tropical southern of Mexico
Foodborne Pathogens and Disease. September 2016, ahead of print. doi:10.1089/fpd.2016.2165.
IB Hernández-Cortazar, KY Acosta-Viana, E Guzmán-Marin, A Ortega-Pacheco, JF de Jesus Torres-Acosta, M Jimenez-Coello
And kissing kittens increases the risk of being infected.
“The scope and impact of the disease is a little bit larger than we thought,” says Dr. Christina Nelson, a medical epidemiologist with the Centers for Disease Control and Prevention and lead author on the study. It’s the first large-scale evaluation of the illness in the United States in over 15 years.
While the total number of people infected with the disease has gone down, the number of people becoming seriously ill has increased. Symptoms typically involve fatigue, fever and swollen lymph nodes. But in a small number of cases, cat-scratch disease can cause the brain to swell or infect the heart. Infections like those can be fatal if they aren’t properly treated.
“Most of the people who get seriously sick from cat-scratch are immunocompromised. The classic example is patients with HIV,” says Dr. Aaron Glatt, chairman of medicine and hospital epidemiology of South Nassau Community Hospital in New York. Glatt was not involved in the study
The fact that there are more people with suppressed immune systems today may be why a larger number of patients are getting dangerously ill, Glatt says. But Nelson thinks that severe cases of cat-scratch disease may have been misdiagnosed in the past. Either way, she says, this study, which was published Wednesday in Emerging Infectious Diseases, is a good first step.
“Cat-scratch is preventable,” Nelson says. “If we can identify the populations at risk and the patterns of disease, we can focus the prevention efforts.”
It’s preventable because you need direct contact with a cat to get it. The disease is caused by bacteria, usually Bartonella henselae, and passed between cats by fleas. The bacteria are also present in flea dirt — the official name for flea feces — which build up in the cats’ fur. It gets on their paws and in their mouths when they groom themselves. If a person is scratched by contaminated claws, they’re at risk of getting the disease.
The study combed health insurance claims from 2005 to 2013, and charted when and where cat-scratch disease is most likely to strike. It found that about 12,000 people will be diagnosed with cat-scratch disease each year, and 500 of them will be sick enough to be hospitalized.
Many of those infected will be children, probably because of the ways kids play with cats. And most of the infections will occur in the South, where heat-and-moisture-loving fleas are more common.
If you want to avoid cat-scratch disease altogether, says Nelson, go somewhere arid —like Colorado or Utah.
But moving to the Rockies isn’t an option for everyone. If you’re stuck in the South, how can you skip cat-scratch?
“Stay away from cats,” says Glass, although he acknowledges that in a country full of cat-lovers, this isn’t really realistic.
“Use adequate flea control and keep your cats indoors,” suggests Nelson. The bacteria can also enter your body through your nose, eyes or mouth, so the CDC recommends washing your hands after touching a cat. Kissing their flea dirt-filled fur probably isn’t a good idea, either. Neither is letting them lick you if you have any scrapes, scabs or open wounds.
Oh. And avoid kittens.
“Younger cats are more likely to have bacteria in their blood,” explains Nelson. Kittens aren’t immune to cat-scratch, so they’re an easy target for the bacteria.
So try to keep from kissing Felix … at least until he’s flea-free.
In a newly published study, researchers artificially contaminated food with salmonella. They then tested the food samples using Salmonella-specific antibodies combined with a unique signal amplification technique. Their test found salmonella present after 15 hours and removed other microorganisms that sometimes clutter laboratory results. This is shorter than the two to three days it takes to detect salmonella in a culture, the study shows.
“The test has great potential as a simple monitoring system for foodborne pathogens in food samples, which can improve food safety and public health,” said Soohyoun Ahn, a UF/IFAS assistant professor of food science and human nutrition and lead author of the study. “Even with all the strategies used to minimize contamination of beef and poultry, they are still one of the major food vehicles for salmonella.”
The test would be suitable for any government research laboratory or industry that routinely tests for Salmonella, Ahn said.
Ahn sees the salmonella test showing similar potential for faster detection of other pathogens you can get from eating certain contaminated foods. A similar test has been developed for E. coli in milk and ground beef, and it performed well, she said.
The study is published in the Journal of Food Safety.
Attempts to reduce the human risk for acquiring EHEC infections should include strategies to control such STEC strains persisting in cattle. We therefore aimed to identify genetic patterns associated with the STEC colonization type in the bovine host. We included 88 persistent colonizing STEC (STECper) (shedding for ≥4 months) and 74 sporadically colonizing STEC (STECspo) (shedding for ≤2 months) isolates from cattle and 16 bovine STEC isolates with unknown colonization types. Genoserotypes and multilocus sequence types (MLSTs) were determined, and the isolates were probed with a DNA microarray for virulence-associated genes (VAGs). All STECper isolates belonged to only four genoserotypes (O26:H11, O156:H25, O165:H25, O182:H25), which formed three genetic clusters (ST21/396/1705, ST300/688, ST119). In contrast, STECspo isolates were scattered among 28 genoserotypes and 30 MLSTs, with O157:H7 (ST11) and O6:H49 (ST1079) being the most prevalent. The microarray analysis identified 139 unique gene patterns that clustered with the genoserotypes and MLSTs of the strains. While the STECper isolates possessed heterogeneous phylogenetic backgrounds, the accessory genome clustered these isolates together, separating them from the STECspo isolates.
Given the vast genetic heterogeneity of bovine STEC strains, defining the genetic patterns distinguishing STECper from STECspo isolates will facilitate the targeted design of new intervention strategies to counteract these zoonotic pathogens at the farm level.
The accessory genome of Shiga toxin-producing Escherichia coli defines a persistent colonization type in cattle
Appl Environ Microbiol 82:5455–5464. doi:10.1128/AEM.00909-16.
SA Barth, C Menge, I Eichhorn, T Semmier, LH Wieler, D Pickard, A Belka, C Berens, L Geue