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Publisher: Cambridge University Press   (Total: 387 journals)

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Showing 1 - 200 of 387 Journals sorted alphabetically
Acta Neuropsychiatrica     Hybrid Journal   (Followers: 6, SJR: 0.733, CiteScore: 2)
Acta Numerica     Hybrid Journal   (Followers: 5, SJR: 6.709, CiteScore: 10)
Advances in Animal Biosciences     Full-text available via subscription   (Followers: 14)
Advances in Applied Mathematics and Mechanics     Full-text available via subscription   (Followers: 2, SJR: 0.441, CiteScore: 1)
Aeronautical J., The     Hybrid Journal   (Followers: 7)
Africa     Hybrid Journal   (Followers: 20, SJR: 0.582, CiteScore: 1)
African Studies Review     Full-text available via subscription   (Followers: 20, SJR: 0.437, CiteScore: 1)
Ageing & Society     Hybrid Journal   (Followers: 44, SJR: 0.756, CiteScore: 2)
Agricultural and Resource Economics Review     Open Access   (Followers: 6, SJR: 0.414, CiteScore: 1)
AI EDAM     Hybrid Journal   (Followers: 2, SJR: 0.375, CiteScore: 1)
AJIL Unbound     Open Access  
AJS Review     Full-text available via subscription   (Followers: 4, SJR: 0.128, CiteScore: 0)
American Political Science Review     Hybrid Journal   (Followers: 319, SJR: 5.587, CiteScore: 4)
Anatolian Studies     Full-text available via subscription   (Followers: 5, SJR: 0.528, CiteScore: 1)
Ancient Mesoamerica     Hybrid Journal   (Followers: 12, SJR: 0.478, CiteScore: 1)
Anglo-Saxon England     Hybrid Journal   (Followers: 36, SJR: 0.1, CiteScore: 0)
animal     Hybrid Journal   (Followers: 3, SJR: 0.842, CiteScore: 2)
Animal Health Research Reviews     Hybrid Journal   (Followers: 3, SJR: 0.69, CiteScore: 2)
Animal Science     Full-text available via subscription   (Followers: 11)
Annals of Actuarial Science     Full-text available via subscription   (Followers: 1)
Annual of the British School at Athens     Full-text available via subscription   (Followers: 17, SJR: 0.177, CiteScore: 0)
Annual Review of Applied Linguistics     Hybrid Journal   (Followers: 43, SJR: 3.223, CiteScore: 4)
Antarctic Science     Hybrid Journal   (Followers: 1, SJR: 0.643, CiteScore: 1)
Antichthon     Full-text available via subscription   (Followers: 3, SJR: 0.101, CiteScore: 0)
Antiquaries J., The     Full-text available via subscription   (Followers: 12, SJR: 0.106, CiteScore: 0)
Antiquity     Hybrid Journal   (Followers: 33)
ANZIAM J.     Open Access   (Followers: 1, SJR: 0.216, CiteScore: 0)
Applied Psycholinguistics     Hybrid Journal   (Followers: 25, SJR: 0.945, CiteScore: 2)
APSIPA Transactions on Signal and Information Processing     Open Access   (Followers: 9, SJR: 0.404, CiteScore: 2)
Arabic Sciences and Philosophy     Hybrid Journal   (Followers: 9, SJR: 0.101, CiteScore: 0)
Arbor Clinical Nutrition Updates     Full-text available via subscription   (Followers: 5)
Archaeological Dialogues     Hybrid Journal   (Followers: 38, SJR: 0.898, CiteScore: 1)
Archaeological Reports     Full-text available via subscription   (Followers: 5, SJR: 0.128, CiteScore: 0)
Architectural History     Full-text available via subscription  
arq: Architectural Research Quarterly     Hybrid Journal   (Followers: 7, SJR: 0.123, CiteScore: 0)
Art Libraries J.     Full-text available via subscription  
Asian J. of Comparative Law     Hybrid Journal   (Followers: 11, SJR: 0.129, CiteScore: 0)
Asian J. of Intl. Law     Hybrid Journal   (Followers: 18, SJR: 0.135, CiteScore: 0)
Asian J. of Law and Society     Hybrid Journal   (Followers: 7, SJR: 0.195, CiteScore: 0)
Astin Bulletin     Full-text available via subscription   (Followers: 1, SJR: 0.878, CiteScore: 1)
Australasian J. of Organisational Psychology     Hybrid Journal   (Followers: 9, SJR: 0.154, CiteScore: 1)
Australian J. of Environmental Education     Full-text available via subscription   (Followers: 9, SJR: 0.403, CiteScore: 1)
Australian J. of Indigenous Education, The     Full-text available via subscription   (Followers: 10, SJR: 0.26, CiteScore: 1)
Australian J. of Rehabilitation Counseling     Full-text available via subscription   (Followers: 6, SJR: 0.144, CiteScore: 0)
Austrian History Yearbook     Full-text available via subscription   (Followers: 11, SJR: 0.161, CiteScore: 0)
Behavioral and Brain Sciences     Hybrid Journal   (Followers: 39, SJR: 0.595, CiteScore: 1)
Behaviour Change     Full-text available via subscription   (Followers: 13, SJR: 0.508, CiteScore: 1)
Behavioural and Cognitive Psychotherapy     Hybrid Journal   (Followers: 180, SJR: 0.976, CiteScore: 2)
Bilingualism: Language and Cognition     Hybrid Journal   (Followers: 42, SJR: 1.446, CiteScore: 2)
Biofilms     Full-text available via subscription   (Followers: 1)
Bird Conservation Intl.     Hybrid Journal   (Followers: 25, SJR: 0.581, CiteScore: 1)
BJPsych Advances     Full-text available via subscription   (Followers: 57, SJR: 0.275, CiteScore: 0)
BJPsych Intl.     Open Access   (Followers: 2)
BJPsych Open     Open Access   (Followers: 3)
Brain Impairment     Full-text available via subscription   (Followers: 2, SJR: 0.321, CiteScore: 1)
Breast Cancer Online     Full-text available via subscription   (Followers: 4)
Britannia     Full-text available via subscription   (Followers: 11, SJR: 0.111, CiteScore: 0)
British Actuarial J.     Full-text available via subscription  
British Catholic History     Hybrid Journal   (Followers: 2, SJR: 0.133, CiteScore: 1)
British J. for the History of Science     Hybrid Journal   (Followers: 24, SJR: 0.235, CiteScore: 0)
British J. of Anaesthetic and Recovery Nursing     Full-text available via subscription   (Followers: 8)
British J. of Music Education     Hybrid Journal   (Followers: 24, SJR: 0.564, CiteScore: 1)
British J. Of Nutrition     Hybrid Journal   (Followers: 90, SJR: 1.612, CiteScore: 4)
British J. of Political Science     Hybrid Journal   (Followers: 216, SJR: 4.661, CiteScore: 4)
British J. of Psychiatry     Hybrid Journal   (Followers: 221, SJR: 2.844, CiteScore: 3)
Bulletin of Entomological Research     Hybrid Journal   (Followers: 13, SJR: 0.805, CiteScore: 2)
Bulletin of Symbolic Logic     Full-text available via subscription   (Followers: 2, SJR: 0.555, CiteScore: 1)
Bulletin of the Australian Mathematical Society     Full-text available via subscription   (Followers: 2, SJR: 0.44, CiteScore: 0)
Bulletin of the School of Oriental and African Studies     Hybrid Journal   (Followers: 21, SJR: 0.146, CiteScore: 0)
Business and Human Rights J.     Full-text available via subscription   (Followers: 4, SJR: 0.536, CiteScore: 1)
Business Ethics Quarterly     Full-text available via subscription   (Followers: 18, SJR: 1.098, CiteScore: 2)
Business History Review     Hybrid Journal   (Followers: 16, SJR: 0.347, CiteScore: 1)
Cambridge Archaeological J.     Hybrid Journal   (Followers: 150, SJR: 1.121, CiteScore: 1)
Cambridge Classical J.     Full-text available via subscription   (Followers: 24, SJR: 0.101, CiteScore: 0)
Cambridge J. of Postcolonial Literary Inquiry     Hybrid Journal   (Followers: 7)
Cambridge Law J.     Hybrid Journal   (Followers: 199, SJR: 0.213, CiteScore: 0)
Cambridge Opera J.     Hybrid Journal   (Followers: 4, SJR: 0.14, CiteScore: 0)
Cambridge Quarterly of Healthcare Ethics     Hybrid Journal   (Followers: 11, SJR: 0.299, CiteScore: 1)
Cambridge Yearbook of European Legal Studies     Full-text available via subscription  
Camden Fifth Series     Full-text available via subscription   (Followers: 3)
Canadian Entomologist     Hybrid Journal   (Followers: 5, SJR: 0.482, CiteScore: 1)
Canadian J. of Emergency Medicine     Hybrid Journal   (Followers: 13, SJR: 0.624, CiteScore: 1)
Canadian J. of Law & Jurisprudence     Full-text available via subscription   (Followers: 11, SJR: 0.237, CiteScore: 0)
Canadian J. of Law and Society     Hybrid Journal   (Followers: 20, SJR: 0.259, CiteScore: 1)
Canadian J. of Mathematics / J. canadien de mathématiques     Hybrid Journal  
Canadian J. of Neurological Sciences     Full-text available via subscription   (SJR: 0.549, CiteScore: 1)
Canadian J. of Political Science/Revue canadienne de science politique     Full-text available via subscription   (Followers: 25, SJR: 0.385, CiteScore: 1)
Canadian J. on Aging     Hybrid Journal   (Followers: 13, SJR: 0.426, CiteScore: 1)
Canadian Mathematical Bulletin     Hybrid Journal  
Canadian Yearbook of Intl. Law / Annuaire canadien de droit international     Full-text available via subscription   (Followers: 3)
Cardiology in the Young     Hybrid Journal   (Followers: 34, SJR: 0.372, CiteScore: 1)
Central European History     Full-text available via subscription   (Followers: 32, SJR: 0.159, CiteScore: 0)
Children Australia     Partially Free   (Followers: 2, SJR: 0.255, CiteScore: 0)
China Quarterly     Hybrid Journal   (Followers: 52, SJR: 2.289, CiteScore: 3)
Chinese J. of Agricultural Biotechnology     Full-text available via subscription   (Followers: 4)
Church History : Studies in Christianity and Culture     Full-text available via subscription   (Followers: 75, SJR: 0.106, CiteScore: 0)
Classical Quarterly     Full-text available via subscription   (Followers: 35, SJR: 0.204, CiteScore: 0)
Classical Review     Full-text available via subscription   (Followers: 29)
CNS Spectrums     Hybrid Journal   (Followers: 3, SJR: 1.391, CiteScore: 3)
Cognitive Behaviour Therapist     Hybrid Journal   (Followers: 14)
Combinatorics, Probability and Computing     Hybrid Journal   (Followers: 4, SJR: 0.839, CiteScore: 1)
Communications in Computational Physics     Full-text available via subscription   (Followers: 3, SJR: 1.048, CiteScore: 2)
Comparative Studies in Society and History     Full-text available via subscription   (Followers: 49, SJR: 0.585, CiteScore: 1)
Compositio Mathematica     Full-text available via subscription   (SJR: 3.139, CiteScore: 1)
Contemporary European History     Hybrid Journal   (Followers: 34, SJR: 0.263, CiteScore: 1)
Continuity and Change     Hybrid Journal   (Followers: 12, SJR: 0.107, CiteScore: 0)
Dance Research J.     Full-text available via subscription   (Followers: 15, SJR: 0.211, CiteScore: 0)
Development and Psychopathology     Hybrid Journal   (Followers: 9, SJR: 2.068, CiteScore: 4)
Dialogue Canadian Philosophical Review/Revue canadienne de philosophie     Full-text available via subscription   (Followers: 5, SJR: 0.156, CiteScore: 0)
Diamond Light Source Proceedings     Full-text available via subscription   (Followers: 1)
Disaster Medicine and Public Health Preparedness     Hybrid Journal   (Followers: 14, SJR: 0.471, CiteScore: 1)
Du Bois Review: Social Science Research on Race     Full-text available via subscription   (Followers: 10, SJR: 0.561, CiteScore: 1)
Early China     Hybrid Journal   (Followers: 3)
Early Music History     Hybrid Journal   (Followers: 9, SJR: 0.101, CiteScore: 0)
Earth and Environmental Science Transactions of the Royal Society of Edinburgh     Hybrid Journal   (Followers: 5)
East Asian J. on Applied Mathematics     Full-text available via subscription   (SJR: 0.418, CiteScore: 1)
Ecclesiastical Law J.     Full-text available via subscription   (Followers: 6, SJR: 0.114, CiteScore: 0)
Econometric Theory     Hybrid Journal   (Followers: 18, SJR: 2.915, CiteScore: 1)
Economics and Philosophy     Hybrid Journal   (Followers: 18, SJR: 0.622, CiteScore: 1)
Edinburgh J. of Botany     Hybrid Journal   (SJR: 0.283, CiteScore: 1)
Educational and Developmental Psychologist     Full-text available via subscription   (Followers: 10, SJR: 0.146, CiteScore: 0)
Eighteenth-Century Music     Hybrid Journal   (Followers: 13, SJR: 0.113, CiteScore: 0)
English Language and Linguistics     Hybrid Journal   (Followers: 24, SJR: 0.52, CiteScore: 1)
English Profile J.     Hybrid Journal   (Followers: 2)
English Today     Hybrid Journal   (Followers: 13, SJR: 0.279, CiteScore: 0)
Enterprise & Society : The Intl. J. of Business History     Hybrid Journal   (Followers: 18, SJR: 0.245, CiteScore: 1)
Environment and Development Economics     Hybrid Journal   (Followers: 40, SJR: 0.617, CiteScore: 1)
Environmental Conservation     Hybrid Journal   (Followers: 60, SJR: 1.028, CiteScore: 2)
Environmental Practice     Full-text available via subscription   (Followers: 3, SJR: 0.145, CiteScore: 0)
Epidemiology & Infection     Hybrid Journal   (Followers: 18, SJR: 1.128, CiteScore: 2)
Epidemiology and Psychiatric Sciences     Hybrid Journal   (Followers: 3, SJR: 1.494, CiteScore: 2)
Episteme     Hybrid Journal   (Followers: 12, SJR: 0.756, CiteScore: 1)
Ergodic Theory and Dynamical Systems     Hybrid Journal   (Followers: 2, SJR: 1.193, CiteScore: 1)
Ethics & Intl. Affairs     Full-text available via subscription   (Followers: 17, SJR: 0.557, CiteScore: 1)
European Constitutional Law Review (EuConst)     Full-text available via subscription   (Followers: 35, SJR: 1.009, CiteScore: 1)
European J. of Applied Mathematics     Hybrid Journal   (SJR: 0.52, CiteScore: 1)
European J. of Intl. Security     Hybrid Journal   (Followers: 1)
European J. of Sociology     Hybrid Journal   (Followers: 36, SJR: 0.643, CiteScore: 1)
European Political Science Review     Hybrid Journal   (Followers: 27, SJR: 1.816, CiteScore: 2)
European Review     Hybrid Journal   (Followers: 19, SJR: 0.131, CiteScore: 0)
Evolutionary Human Sciences     Open Access  
Experimental Agriculture     Hybrid Journal   (Followers: 14, SJR: 0.542, CiteScore: 1)
Expert Reviews in Molecular Medicine     Hybrid Journal   (Followers: 1, SJR: 1.647, CiteScore: 4)
Fetal and Maternal Medicine Review     Hybrid Journal   (Followers: 6)
Financial History Review     Full-text available via subscription   (Followers: 15, SJR: 0.238, CiteScore: 1)
Foreign Policy Bulletin     Hybrid Journal   (Followers: 6)
Forum of Mathematics, Pi     Open Access   (Followers: 1)
Forum of Mathematics, Sigma     Open Access   (Followers: 1)
Genetics Research     Hybrid Journal   (Followers: 4, SJR: 0.483, CiteScore: 1)
Geological Magazine     Hybrid Journal   (Followers: 16, SJR: 0.966, CiteScore: 2)
Glasgow Mathematical J.     Full-text available via subscription   (SJR: 0.604, CiteScore: 0)
Global Constitutionalism     Hybrid Journal   (Followers: 17)
Global Mental Health     Open Access   (Followers: 9)
Global Sustainability     Open Access  
Government and Opposition     Full-text available via subscription   (Followers: 24, SJR: 0.965, CiteScore: 2)
Greece & Rome     Partially Free   (Followers: 30, SJR: 0.113, CiteScore: 0)
Hague J. on the Rule of Law     Full-text available via subscription   (Followers: 15, SJR: 0.271, CiteScore: 1)
Harvard Theological Review     Full-text available via subscription   (Followers: 80, SJR: 0.165, CiteScore: 0)
Health Economics, Policy and Law     Hybrid Journal   (Followers: 29, SJR: 0.745, CiteScore: 1)
Hegel Bulletin     Full-text available via subscription   (Followers: 2)
High Power Laser Science and Engineering     Open Access   (Followers: 3, SJR: 0.901, CiteScore: 3)
Historical J.     Hybrid Journal   (Followers: 39, SJR: 0.247, CiteScore: 1)
History in Africa     Full-text available via subscription   (Followers: 9)
Horizons     Partially Free   (Followers: 1, SJR: 0.129, CiteScore: 0)
Industrial and Organizational Psychology     Hybrid Journal   (Followers: 27, SJR: 0.916, CiteScore: 1)
Infection Control and Hospital Epidemiology     Full-text available via subscription   (Followers: 41, SJR: 1.97, CiteScore: 3)
Intl. & Comparative Law Quarterly     Full-text available via subscription   (Followers: 251, SJR: 0.369, CiteScore: 1)
Intl. Annals of Criminology     Full-text available via subscription  
Intl. J. of Asian Studies     Hybrid Journal   (Followers: 13, SJR: 0.143, CiteScore: 0)
Intl. J. of Astrobiology     Hybrid Journal   (Followers: 4, SJR: 0.548, CiteScore: 1)
Intl. J. of Cultural Property     Full-text available via subscription   (Followers: 13, SJR: 0.253, CiteScore: 1)
Intl. J. of Disability Management Research     Full-text available via subscription   (Followers: 9, SJR: 0.105, CiteScore: 0)
Intl. J. of Law in Context     Hybrid Journal   (Followers: 17, SJR: 0.275, CiteScore: 1)
Intl. J. of Legal Information     Full-text available via subscription   (Followers: 343)
Intl. J. of Microwave and Wireless Technologies     Hybrid Journal   (Followers: 10, SJR: 0.184, CiteScore: 1)
Intl. J. of Middle East Studies     Hybrid Journal   (Followers: 72, SJR: 0.434, CiteScore: 0)
Intl. J. of Technology Assessment in Health Care     Hybrid Journal   (Followers: 14, SJR: 0.714, CiteScore: 1)
Intl. Labor and Working-Class History     Full-text available via subscription   (Followers: 14, SJR: 0.182, CiteScore: 0)
Intl. Organization     Full-text available via subscription   (Followers: 106, SJR: 8.527, CiteScore: 5)
Intl. Psychogeriatrics     Hybrid Journal   (Followers: 13, SJR: 1.048, CiteScore: 2)
Intl. Review of Social History     Full-text available via subscription   (Followers: 27, SJR: 0.315, CiteScore: 1)
Intl. Review of the Red Cross     Full-text available via subscription   (Followers: 13, SJR: 0.214, CiteScore: 0)
Intl. Theory: A J. of Intl. Politics, Law and Philosophy     Hybrid Journal   (Followers: 19, SJR: 2.293, CiteScore: 2)
Iraq     Full-text available via subscription   (Followers: 4)
Irish Historical Studies     Hybrid Journal   (Followers: 6, SJR: 0.103, CiteScore: 0)
Irish J. of Psychological Medicine     Hybrid Journal   (Followers: 2, SJR: 0.221, CiteScore: 0)
Israel Law Review     Hybrid Journal   (Followers: 2, SJR: 0.165, CiteScore: 0)
Italian Political Science Review / Rivista Italiana di Scienza Politica     Hybrid Journal  
Itinerario     Full-text available via subscription   (Followers: 11, SJR: 0.158, CiteScore: 0)
J. of African History     Hybrid Journal   (Followers: 21, SJR: 0.348, CiteScore: 1)
J. of African Law     Full-text available via subscription   (Followers: 3, SJR: 0.113, CiteScore: 0)
J. of Agricultural and Applied Economics     Open Access   (Followers: 2, SJR: 0.263, CiteScore: 1)
J. of Agricultural Science     Full-text available via subscription   (Followers: 8, SJR: 0.563, CiteScore: 1)
J. of American Studies     Hybrid Journal   (Followers: 20, SJR: 0.164, CiteScore: 0)
J. of Anglican Studies     Hybrid Journal   (Followers: 6, SJR: 0.101, CiteScore: 0)
J. of Applied Animal Nutrition     Hybrid Journal   (Followers: 4)
J. of Asian Studies     Full-text available via subscription   (Followers: 41, SJR: 0.591, CiteScore: 1)
J. of Benefit-Cost Analysis     Hybrid Journal   (Followers: 4)
J. of Biosocial Science     Hybrid Journal   (Followers: 4, SJR: 0.48, CiteScore: 1)
J. of British Studies     Full-text available via subscription   (Followers: 32, SJR: 0.246, CiteScore: 0)

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Similar Journals
Journal Cover
Epidemiology & Infection
Journal Prestige (SJR): 1.128
Citation Impact (citeScore): 2
Number of Followers: 18  
  Hybrid Journal Hybrid journal (It can contain Open Access articles)
ISSN (Print) 0950-2688 - ISSN (Online) 1469-4409
Published by Cambridge University Press Homepage  [387 journals]
  • Infectious disease outbreaks in the African region: overview of events
           reported to the World Health Organization in 2018
    • Authors: F. Mboussou; P. Ndumbi, R. Ngom, Z. Kamassali, O. Ogundiran, J. Van Beek, G. Williams, C. Okot, E. L. Hamblion, B. Impouma
      Abstract: The WHO African region is characterised by the largest infectious disease burden in the world. We conducted a retrospective descriptive analysis using records of all infectious disease outbreaks formally reported to the WHO in 2018 by Member States of the African region. We analysed the spatio-temporal distribution, the notification delay as well as the morbidity and mortality associated with these outbreaks. In 2018, 96 new disease outbreaks were reported across 36 of the 47 Member States. The most commonly reported disease outbreak was cholera which accounted for 20.8% (n = 20) of all events, followed by measles (n = 11, 11.5%) and Yellow fever (n = 7, 7.3%). About a quarter of the outbreaks (n = 23) were reported following signals detected through media monitoring conducted at the WHO regional office for Africa. The median delay between the disease onset and WHO notification was 16 days (range: 0–184). A total of 107 167 people were directly affected including 1221 deaths (mean case fatality ratio (CFR): 1.14% (95% confidence interval (CI) 1.07%–1.20%)). The highest CFR was observed for diseases targeted for eradication or elimination: 3.45% (95% CI 0.89%–10.45%). The African region remains prone to outbreaks of infectious diseases. It is therefore critical that Member States improve their capacities to rapidly detect, report and respond to public health events.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268819001912
      Issue No: Vol. 147 (2019)
  • Persistent socioeconomic and racial and ethnic disparities in pathogen
           burden in the United States, 1999–2014
    • Authors: R. C. Stebbins; G. A. Noppert, A. E. Aiello, E. Cordoba, J. B. Ward, L. Feinstein
      Abstract: The disproportionate burden of prevalent, persistent pathogens among disadvantaged groups may contribute to socioeconomic and racial/ethnic disparities in long-term health. We assessed if the social patterning of pathogen burden changed over 16 years in a U.S.-representative sample. Data came from 17 660 National Health and Nutrition Examination Survey participants. Pathogen burden was quantified by summing the number of positive serologies for cytomegalovirus, herpes simplex virus-1, HSV-2, human papillomavirus and Toxoplasma gondii and dividing by the number of pathogens tested, giving a percent-seropositive for each participant. We examined sex- and age-adjusted mean pathogen burdens from 1999–2014, stratified by race/ethnicity and SES (poverty-to-income ratio (PIR); educational attainment). Those with a PIR < 1.3 had a mean pathogen burden 1.4–1.8 times those with a PIR > 3.5, with no change over time. Educational disparities were even greater and showed some evidence of increasing over time, with the mean pathogen burden among those with less than a high school education approximately twice that of those who completed more than high school. Non-Hispanic Black, Mexican American and other Hispanic participants had a mean pathogen burden 1.3–1.9 times non-Hispanic Whites. We demonstrate that socioeconomic and racial/ethnic disparities in pathogen burden have persisted across 16 years, with little evidence that the gap is closing.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268819001894
      Issue No: Vol. 147 (2019)
  • Comparison of epidemiological, clinical and microbiological
           characteristics of bloodstream infection in children with solid tumours
           and haematological malignancies
    • Authors: M. M. Garrido; R. Q. Garrido, T. N. Cunha, S. Ehrlich, I. S. Martins
      Abstract: Bloodstream infection (BSI) is a serious complication in immunocompromised hosts. This study compares epidemiological, clinical and microbiological characteristics of BSI among children with haematological malignancies (HM) and solid tumours (ST). The study was conducted from October 2012 through to November 2015 at a referral hospital for cancer care and included the first BSI episode detected in 210 patients aged 18 years or less. BSI cases were prospectively detected by daily laboratory-based surveillance. The Centers for Disease Control and Prevention definitions for primary or secondary BSI were used. A higher proportion of use of corticosteroids (P = 0.02), chemotherapy (P = 0.01) and antibiotics (P = 0.05) before the BSI diagnosis; as well as of neutropenia (P < 0.001) and mucositis (P < 0.001) at the time of BSI diagnosis was observed in patients with HM than with ST. Previous surgical procedures (P = 0.03), mechanical ventilation (P = 0.01) and bed confinement (P < 0.001) were more frequent among children with ST. The frequency of use of temporary (P = 0.01) and implanted vascular lines (P < 0.01) was significantly higher in children with ST than with HM while the tunnelled line (P = 0.01) use was more frequent in children with HM as compared to ST. Most (n = 181) BSI cases were primary BSI. BSI associated with a tunnelled catheter was more frequent in children with HM (P < 0.01), whereas BSI associated with an implanted (P < 0.01) or temporary central line (P < 0.02) was more common in patients with ST. BSI associated with mucosal barrier injury was more frequent (P = 0.01) in children with HM. Indication for intensive care was more frequent in children (P = 0.05) with ST. Mortality ratio was similar in children with ST and HM, and length of hospital stay after BSI was higher in patients with HM than with ST (median of 19 vs. 13 days; P = 0.02). Infection caused by Gram-negative bacteria (P = 0.04) and polymicrobial infections (P = 0.05) due to Gram-positive cocci plus fungus was more common in patients with HM. These findings suggest that the characteristics of BSI acquisition and mortality can be cancer-specific.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268819001845
      Issue No: Vol. 147 (2019)
  • Salmonella+enterica+serovar+Heidelberg+of+poultry+origin+–+a+risk+profile+using+the+Codex+framework&rft.title=Epidemiology+&+Infection&rft.issn=0950-2688&,+Agnes+Agunos,+Daleen+Loest,+Brennan+Chapman,+Rita+Finley,+Manisha+Mehrotra,+Lauren+M.+Sherk,+Réjean+Gaumond,+Rebecca+Irwin&rft_id=info:doi/10.1017/S0950268819001778">Ceftiofur-resistant Salmonella enterica serovar Heidelberg of poultry
           origin – a risk profile using the Codex framework
    • Authors: Carolee Carson; Xian-Zhi Li, Agnes Agunos, Daleen Loest, Brennan Chapman, Rita Finley, Manisha Mehrotra, Lauren M. Sherk, Réjean Gaumond, Rebecca Irwin
      Abstract: Codex published the ‘Guidelines for Risk Analysis of Foodborne Antimicrobial Resistance’ to standardise the approach for evaluating risk posed by foodborne antimicrobial-resistant bacteria. One of the first steps in the guidelines is to compile a risk profile, which provides the current state of knowledge regarding a food safety issue, describes risk management options and recommends next steps. In Canada, ceftiofur/ceftriaxone-resistant Salmonella enterica subsp. enterica serovar Heidelberg from poultry was identified as an antimicrobial resistance (AMR) food safety issue. The first objective of this article was to contextualise this food safety issue, using the risk profile format of the Codex Guidelines. A second objective was to evaluate the applicability of the Codex Guidelines. This risk profile indicated that ceftiofur/ceftriaxone-resistant S. Heidelberg (CSH) was commonly isolated from poultry and was associated with severe disease in humans. Ceftiofur use in poultry hatcheries temporally mirrored the prevalence of CSH from poultry meat at retail and from people with salmonellosis. The evidence was sufficient to indicate the need for risk management options, such as restricting the use of ceftiofur in poultry. The Codex Guidelines provided a useful approach to summarise data for decision-makers to evaluate an AMR food safety issue.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268819001778
      Issue No: Vol. 147 (2019)
  • High expression levels of influenza virus receptors in airway of the
           HBV-transgenic mice
    • Authors: Jiajun Yang; Hao Li, Liyuan Jia, Xianchun Lan, Yuhui Zhao, Huijie Bian, Zheng Li
      Abstract: In the human population, influenza A viruses are associated with acute respiratory illness and are responsible for millions of deaths annually. Avian and human influenza viruses typically have a different α2-3- and α2-6-linked sialic acid (SA) binding preference. Only a few amino acid changes in the haemagglutinin on the surface of avian influenza viruses (AIV) can cause a switch from avian to human receptor specificity, and the individuals with pathognostic chronic diseases might be more susceptible to AIV due to the decreased expression level of terminal α2-3-linked SA in their saliva. Here, using lectin and virus histochemical staining, we observed the higher expression levels of α2-3/6-linked SA influenza virus receptors in the airway of HBV-transgenic mice compared with that of control mice due to the significant decrease in control mice during ageing, which imply that this is also a risk factor for individuals with pathognostic chronic diseases susceptible to influenza viruses. Our findings will help understand the impact on influenza virus pathogenesis and transmission.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268819001833
      Issue No: Vol. 147 (2019)
  • Updated modelling of the prevalence of immunodeficiency-associated
           long-term vaccine-derived poliovirus (iVDPV) excreters
    • Authors: D. A. Kalkowska; M. A. Pallansch, K. M. Thompson
      Abstract: Conditions and evidence continue to evolve related to the prediction of the prevalence of immunodeficiency-associated long-term vaccine-derived poliovirus (iVDPV) excreters, which affect assumptions related to forecasting risks and evaluating potential risk management options. Multiple recent reviews provided information about individual iVDPV excreters, but inconsistencies among the reviews raise some challenges. This analysis revisits the available evidence related to iVDPV excreters and provides updated model estimates that can support future risk management decisions. The results suggest that the prevalence of iVDPV excreters remains highly uncertain and variable, but generally confirms the importance of managing the risks associated with iVDPV excreters throughout the polio endgame in the context of successful cessation of all oral poliovirus vaccine use.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S095026881900181X
      Issue No: Vol. 147 (2019)
  • Helicobacter+pylori+and+drinking+habits+in+women:+collaborative+research+between+a+pharmacy+and+a+clinic&rft.title=Epidemiology+&+Infection&rft.issn=0950-2688&,+Takahisa+Furuta,+Toshiyuki+Ojima&rft_id=info:doi/10.1017/S0950268819001730">Relationship between primary eradication of Helicobacter pylori and
           drinking habits in women: collaborative research between a pharmacy and a
    • Authors: Kayoko Ozeki; Michio Asano, Takahisa Furuta, Toshiyuki Ojima
      Abstract: Helicobacter pylori is a cause of stomach cancer and peptic ulcer. For prevention, improving the eradication rate of H. pylori is crucial. However, the association between eradication and lifestyle of infected patients, including alcohol consumption, remains unclear. We explored associations between failed primary eradication therapy and drinking status by sex. This study involved 356 patients who visited a pharmacy with prescriptions for primary H. pylori eradication therapy. We assessed drinking habits using a questionnaire. Data on patients with failed primary eradication were provided by the nearby local clinic. We performed logistic regression analysis to examine the effect of drinking habit and frequency of drinking on failed primary eradication by sex. The odds ratio of primary eradication failure in female patients with a drinking habit was 3.75 (P = 0.001), but that in male patients was not significant. The odds ratio tended to increase in relation to drinking frequency in women. Frequent consumption of alcohol is not only likely to affect eradication, but also has a large impact on the bodies of women, who are more susceptible than men to the effects of alcohol. Thus, women should take greater care in alcohol consumption.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268819001730
      Issue No: Vol. 147 (2019)
  • Francisella+tularensis+in+Swedish+predators+and+scavengers&rft.title=Epidemiology+&+Infection&rft.issn=0950-2688&,+M.+Koene,+S.+Åkerström,+A.+Malmsten,+F.+Dahl,+P-A.+Åhlén,+A-M.+Dalin,+D.+Gavier-Widén&rft_id=info:doi/10.1017/S0950268819001808">Francisella tularensis in Swedish predators
           and scavengers
    • Authors: G. Hestvik; H. Uhlhorn, M. Koene, S. Åkerström, A. Malmsten, F. Dahl, P-A. Åhlén, A-M. Dalin, D. Gavier-Widén
      Abstract: Tularaemia is a zoonotic disease, in Europe caused by Francisella tularensis subsp. holarctica. Many lagomorphs and a variety of small rodents are wildlife species prone to develop clinical disease, while predators and scavengers are relatively resistant and may serve as sentinels. Blood samples from 656 Swedish wild predators and scavengers were serologically investigated using slide agglutination and microagglutination. In the slide agglutination test, 34 seropositive animals were detected, and they were found among all species investigated: brown bear (Ursus arctos), Eurasian lynx (Lynx lynx), raccoon dog (Nyctereutes procyonoides), red fox (Vulpes vulpes), wild boar (Sus scrofa), wolf (Canis lupus) and wolverine (Gulo gulo). Due to haemolysis the microagglutination test was more difficult to read at low titres, and only 12 animals were classified as seropositive. F. tularensis subsp. holarctica was detected by a polymerase chain reaction in lymphatic tissues of the head in one brown bear, one red fox and one wolf. The significance of this finding regarding possible latency of infection is not clear. In conclusion, the results of this study indicate that all predator and scavenger species included in this study may serve as sentinels for tularaemia in Sweden. Their role as reservoirs is unclear.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268819001808
      Issue No: Vol. 147 (2019)
  • Epidemiological profile and spectrum of neglected tropical disease
           eumycetoma from Delhi, North India
    • Authors: N. Dubey; M. R. Capoor, A. S. Hasan, A. Gupta, V. Ramesh, S. Sharma, A. Singh, S. M. Rudramurthy, A. Chakrabarti
      Abstract: Mycetoma is a chronic granulomatous, suppurative and progressive inflammatory disease that usually involves the subcutaneous tissue and bones after traumatic inoculation of the causative organism. In India, actinomycotic mycetoma is prevalent in south India, south-east Rajasthan and Chandigarh, while eumycetoma, which constitutes one third of the total cases, is mainly reported from north India and central Rajasthan. The objective was to determine the epidemiological profile and spectrum of eumycetoma from a tertiary care hospital in Delhi, North India. Thirty cases of eumycetoma were diagnosed by conventional methods of direct microscopy, culture and species-specific sequencing as per standard protocol. The spectrum of fungal pathogens included Exophiala jeanselmei, Madurella mycetomatis, Fusarium solani, Sarocladium kiliense, Acremonium blochii, Aspergillus nidulans, Fusarium incarnatum, Scedosporium apiospermum complex, Curvularia lunata and Medicopsis romeroi. Eumycetoma can be treated with antifungal therapy and needs to be combined with surgery. It has good prognosis if it is timely diagnosed and the correct species identified by culture for targeted therapy of these patients. Black moulds required prolonged therapy. Its low reporting and lack of familiarity may predispose patients to misdiagnosis and consequently delayed treatment. Hence health education and awareness campaign on the national and international level in the mycetoma belt is crucial.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268819001766
      Issue No: Vol. 147 (2019)
  • Escherichia+coli+O157:H7+infections+–+ERRATUM&rft.title=Epidemiology+&+Infection&rft.issn=0950-2688&,+H.+N.+Oltean,+J.+Mayer,+P.+Rabinowitz,+J.+Wakefield,+P.+I.+Tarr,+T.+E.+Besser,+A.+I.+Phipps&rft_id=info:doi/10.1017/S095026881900178X">Importance of case age in the purported association between phylogenetics
           and hemolytic uremic syndrome in Escherichia coli O157:H7 infections –
    • Authors: G. A. M. Tarr; S. Shringi, H. N. Oltean, J. Mayer, P. Rabinowitz, J. Wakefield, P. I. Tarr, T. E. Besser, A. I. Phipps
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S095026881900178X
      Issue No: Vol. 147 (2019)
  • Foodborne viral outbreaks associated with frozen produce
    • Authors: Neda Nasheri; Adrian Vester, Nicholas Petronella
      Abstract: Over the past decade, frozen fruits have been a major vehicle of foodborne illnesses mainly attributed to norovirus (NoV) and hepatitis A virus (HAV) infections. Fresh produce may acquire viral contamination by direct contact with contaminated surface, water or hands, and is then frozen without undergoing proper decontamination. Due to their structural integrity, foodborne viruses are able to withstand hostile conditions such as desiccation and freezing, and endure for a long period of time without losing their infectivity. Additionally, these foods are often consumed raw or undercooked, which increases the risk of infection. Herein, we searched published literature and databases of reported outbreaks as well as the databases of news articles for the viral outbreaks associated with the consumption of frozen produce between January 2008 and December 2018; recorded the worldwide distribution of these outbreaks; and analysed the implication of consumption of different types of contaminated frozen food. In addition, we have briefly discussed the factors that contribute to an increased risk of foodborne viral infection following the consumption of frozen produce. Our results revealed that frozen fruits, especially berries and pomegranate arils, contributed to the majority of the outbreaks, and that most outbreaks were reported in industrialised countries.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268819001791
      Issue No: Vol. 147 (2019)
  • Risk factors and patterns of household clusters of respiratory viruses in
           rural Nepal
    • Authors: E. M. Scott; A. Magaret, J. Kuypers, J. M. Tielsch, J. Katz, S. K. Khatry, L. Stewart, L. Shrestha, S. C. LeClerq, J. A. Englund, H. Y. Chu
      Abstract: Viral pneumonia is an important cause of death and morbidity among infants worldwide. Transmission of non-influenza respiratory viruses in households can inform preventative interventions and has not been well-characterised in South Asia. From April 2011 to April 2012, household members of pregnant women enrolled in a randomised trial of influenza vaccine in rural Nepal were surveyed weekly for respiratory illness until 180 days after birth. Nasal swabs were tested by polymerase chain reaction for respiratory viruses in symptomatic individuals. A transmission event was defined as a secondary case of the same virus within 14 days of initial infection within a household. From 555 households, 825 initial viral illness episodes occurred, resulting in 79 transmission events. The overall incidence of transmission was 1.14 events per 100 person-weeks. Risk of transmission incidence was associated with an index case age 1–4 years (incidence rate ratio (IRR) 2.35; 95% confidence interval (CI) 1.40–3.96), coinfection as initial infection (IRR 1.94; 95% CI 1.05–3.61) and no electricity in household (IRR 2.70; 95% CI 1.41–5.00). Preventive interventions targeting preschool-age children in households in resource-limited settings may decrease the risk of transmission to vulnerable household members, such as young infants.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268819001754
      Issue No: Vol. 147 (2019)
  • Clostridium+difficile+infection+in+patients+with+chronic+kidney+disease+in+Korea&rft.title=Epidemiology+&+Infection&rft.issn=0950-2688&,+Yu-Ji+Lee&rft_id=info:doi/10.1017/S0950268819001742">Metronidazole therapy as initial treatment of Clostridium difficile
           infection in patients with chronic kidney disease in Korea
    • Authors: Jaeuk Shin; Yu Mi Wi, Yu-Ji Lee
      Abstract: The risk of metronidazole treatment failure in Clostridium difficile infection (CDI) patients with chronic kidney disease (CKD) or end-stage renal disease in Korea has not been established. We evaluated 481 patients who had been admitted to two secondary hospitals with a diagnosis of, and treatment for, CDI during 2010–2016. CDI patients were divided into three groups according to CKD status: non-CKD (n = 363), CKD (n = 55) and those requiring dialysis (n = 63). Logistic regression analyses were performed to examine the association of CKD status with treatment failure. CDI patients receiving dialysis tended to have increased odds of metronidazole and overall treatment failure compared to non-CKD patients; adjusted odds ratios and 95% confidence intervals were 2.09 (1.03–4.21) and 2.18 (1.11–4.32) for metronidazole and overall treatment failure, respectively. However, CKD patients did not have increased odds of metronidazole or overall treatment failure compared to non-CKD patients, even where severe CDI was more prevalent in CKD patients. The incidence of symptomatic ileus or toxic megacolon did not differ among groups. Our results suggest that initial metronidazole therapy may be considered in CDI patients with non-dialysis CKD, but should not be considered in CDI patients undergoing dialysis.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268819001742
      Issue No: Vol. 147 (2019)
  • Surgical site infection following cesarean section in a general hospital
           in Kuwait: trends and risk factors
    • Authors: W. Alfouzan; M. Al Fadhli, N. Abdo, W. Alali, R. Dhar
      Abstract: Surgical site infections (SSI) are a significant cause of post-surgical morbidity and mortality. The objectives of this study were to determine the prevalence of SSI and identify risk factors for infections following cesarean section (CS). A prospective study of SSI after CS was carried out from January 2014 to December 2016 using the methodology of the American National Nosocomial Infection Surveillance System. Suspected SSIs were confirmed clinically by the surgeon, and or, by culture. Seven thousand two hundred thirty five CS were performed with an overall SSI prevalence of 2.1%, increasing from 1.7% in 2014 to 2.95% in 2016 (P = 0.010). Of 152 cases of SSI, the prevalence of infection was 46.7% in women ⩽30 years and 53.3% in women >30 years (P = 0.119). Of 148 culture samples from as many women, 112 (75.7%) yielded growth of microorganisms with 42 (37.5%) of isolates being multi-drug resistant (MDR). Women who did not receive prophylactic antibiotics (35.5%) developed SSI more often than those who did (P < 0.0001). These findings suggest that emergency CS and inappropriate antibiotic prophylaxis are risk factors for developing SSI. In the light of the emergence of MDR bacteria there is a need to implement revised prophylactic antibiotic policy as part of antimicrobial stewardship to decrease SSI rates.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268819001675
      Issue No: Vol. 147 (2019)
  • Clustering of hepatitis C virus antibody positivity within households and
           communities in Punjab, India
    • Authors: A. Trickey; A. Sood, V. Midha, W. Thompson, C. Vellozzi, S. Shadaker, V. Surlikar, S. Kanchi, P. Vickerman, M. T. May, F. Averhoff
      Abstract: To better understand hepatitis C virus (HCV) epidemiology in Punjab state, India, we estimated the distribution of HCV antibody positivity (anti-HCV+) using a 2013–2014 HCV household seroprevalence survey. Household anti-HCV+ clustering was investigated (a) by individual-level multivariable logistic regression, and (b) comparing the observed frequency of households with multiple anti-HCV+ persons against the expected, simulated frequency assuming anti-HCV+ persons are randomly distributed. Village/ward-level clustering was investigated similarly. We estimated household-level associations between exposures and the number of anti-HCV+ members in a household (N = 1593 households) using multivariable ordered logistic regression. Anti-HCV+ prevalence was 3.6% (95% confidence interval 3.0–4.2%). Individual-level regression (N = 5543 participants) found an odds ratio of 3.19 (2.25–4.50) for someone being anti-HCV+ if another household member was anti-HCV+. Thirty households surveyed had ⩾2 anti-HCV+ members, whereas 0/1000 (P < 0.001) simulations had ⩾30 such households. Excess village-level clustering was evident: 10 villages had ⩾6 anti-HCV+ members, occurring in 31/1000 simulations (P = 0.031). The household-level model indicated the number of household members, living in southern Punjab, lower socio-economic score, and a higher proportion having ever used opium/bhuki were associated with a household's number of anti-HCV+ members. Anti-HCV+ clusters within households and villages in Punjab, India. These data should be used to inform screening efforts.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268819001705
      Issue No: Vol. 147 (2019)
  • Relative transmissibility of hand, foot and mouth disease from male to
           female individuals
    • Authors: Yuxue Liao; Yaqing He, Yan Lu, Hong Yang, Yanhua Su, Yi-Chen Chiang, Benhua Zhao, Huawei Xiong, Tianmu Chen
      Abstract: Hand, foot and mouth disease (HFMD) has spread widely and leads to high disease burden in many countries. However, relative transmissibility from male to female individuals remains unclear. HFMD surveillance database was built in Shenzhen City from 2013 to 2017. An intersex transmission susceptible–infectious–recovered model was developed to calculate the transmission relative rate among male individuals, among female individuals, from male to female and from female to male. Two indicators, ratio of transmission relative rate (Rβ) and relative transmissibility index (RTI), were developed to assess the relative transmissibility of male vs. female. During the study period, 270 347 HFMD cases were reported in the city, among which 16 were death cases with a fatality of 0.0059%. Reported incidence of total cases, male cases and female cases was 0.0057 (range: 0.0036–0.0058), 0.0052 (range: 0.0032–0.0053) and 0.0044 (range: 0.0026–0.0047), respectively. The difference was statistically significant between male and female (t = 3.046, P = 0.002). Rβ of male vs. female, female vs. female, from female to male vs. female and from male to female vs. female was 7.69, 1.00, 1.74 and 7.13, respectively. RTI of male vs. female, female vs. female, from female to male vs. female and from male to female vs. female was 3.08, 1.00, 1.88 and 1.43, respectively. Transmissibility of HFMD is different between male and female individuals. Male cases seem to be more transmissible than female.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268819001729
      Issue No: Vol. 147 (2019)
  • Incubation periods of enteric illnesses in foodborne outbreaks, United
           States, 1998–2013
    • Authors: S. J. Chai; W. Gu, K. A. O'Connor, L. C. Richardson, R. V. Tauxe
      Abstract: Early in a foodborne disease outbreak investigation, illness incubation periods can help focus case interviews, case definitions, clinical and environmental evaluations and predict an aetiology. Data describing incubation periods are limited. We examined foodborne disease outbreaks from laboratory-confirmed, single aetiology, enteric bacterial and viral pathogens reported to United States foodborne disease outbreak surveillance from 1998–2013. We grouped pathogens by clinical presentation and analysed the reported median incubation period among all illnesses from the implicated pathogen for each outbreak as the outbreak incubation period. Outbreaks from preformed bacterial toxins (Staphylococcus aureus, Bacillus cereus and Clostridium perfringens) had the shortest outbreak incubation periods (4–10 h medians), distinct from that of Vibrio parahaemolyticus (17 h median). Norovirus, salmonella and shigella had longer but similar outbreak incubation periods (32–45 h medians); campylobacter and Shiga toxin-producing Escherichia coli had the longest among bacteria (62–87 h medians); hepatitis A had the longest overall (672 h median). Our results can help guide diagnostic and investigative strategies early in an outbreak investigation to suggest or rule out specific etiologies or, when the pathogen is known, the likely timeframe for exposure. They also point to possible differences in pathogenesis among pathogens causing broadly similar syndromes.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268819001651
      Issue No: Vol. 147 (2019)
  • Rickettsia+infections:+the+Asian+perspective&rft.title=Epidemiology+&+Infection&rft.issn=0950-2688&,+Tom+Hughes,+John+Stenos,+Stuart+D.+Blacksell&rft_id=info:doi/10.1017/S0950268819001390">Diagnosis of spotted fever group Rickettsia infections: the Asian
    • Authors: Matthew T. Robinson; Jaruwan Satjanadumrong, Tom Hughes, John Stenos, Stuart D. Blacksell
      Abstract: Spotted fever group rickettsiae (SFG) are a neglected group of bacteria, belonging to the genus Rickettsia, that represent a large number of new and emerging infectious diseases with a worldwide distribution. The diseases are zoonotic and are transmitted by arthropod vectors, mainly ticks, fleas and mites, to hosts such as wild animals. Domesticated animals and humans are accidental hosts. In Asia, local people in endemic areas as well as travellers to these regions are at high risk of infection. In this review we compare SFG molecular and serological diagnostic methods and discuss their limitations. While there is a large range of molecular diagnostics and serological assays, both approaches have limitations and a positive result is dependent on the timing of sample collection. There is an increasing need for less expensive and easy-to-use diagnostic tests. However, despite many tests being available, their lack of suitability for use in resource-limited regions is of concern, as many require technical expertise, expensive equipment and reagents. In addition, many existing diagnostic tests still require rigorous validation in the regions and populations where these tests may be used, in particular to establish coherent and worthwhile cut-offs. It is likely that the best strategy is to use a real-time quantitative polymerase chain reaction (qPCR) and immunofluorescence assay in tandem. If the specimen is collected early enough in the infection there will be no antibodies but there will be a greater chance of a PCR positive result. Conversely, when there are detectable antibodies it is less likely that there will be a positive PCR result. It is therefore extremely important that a complete medical history is provided especially the number of days of fever prior to sample collection. More effort is required to develop and validate SFG diagnostics and those of other rickettsial infections.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268819001390
      Issue No: Vol. 147 (2019)
  • Dirofilaria+immitis+in+Northern+Portugal&rft.title=Epidemiology+&+Infection&rft.issn=0950-2688&,+E.+Carretón,+J.+Esteves-Guimarães,+C.+Maia-Rocha,+P.+Oliveira,+L.+Lobo,+R.+Morchón,+F.+Araújo,+F.+Simón,+J.+A.+Montoya-Alonso&rft_id=info:doi/10.1017/S0950268819001687">Exposure of humans to the zoonotic nematode Dirofilaria immitis in
           Northern Portugal
    • Authors: A. P. Fontes-Sousa; A. C. Silvestre-Ferreira, E. Carretón, J. Esteves-Guimarães, C. Maia-Rocha, P. Oliveira, L. Lobo, R. Morchón, F. Araújo, F. Simón, J. A. Montoya-Alonso
      Abstract: Dirofilariosis caused by Dirofilaria immitis (heartworm) is a zoonosis, considered an endemic disease of dogs and cats in several countries of Western Europe, including Portugal. This study assesses the levels of D. immitis exposure in humans from Northern Portugal, to which end, 668 inhabitants of several districts belonging to two different climate areas (Csa: Bragança, Vila Real and Csb: Aveiro, Braga, Porto, Viseu) were tested for anti-D. immitis and anti-Wolbachia surface proteins (WSP) antibodies. The overall prevalence of seropositivity to both anti-D. immitis and WSP antibodies was 6.1%, which demonstrated the risk of infection with D. immitis in humans living in Northern Portugal. This study, carried out in a Western European country, contributes to the characterisation of the risk of infection with D. immitis among human population in this region of the continent. From a One Health point of view, the results of the current work also support the close relationship between dogs and people as a risk factor for human infection
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268819001687
      Issue No: Vol. 147 (2019)
  • Methods for generating hypotheses in human enteric illness outbreak
           investigations: a scoping review of the evidence
    • Authors: C. Ickert; J. Cheng, D. Reimer, J. Greig, A. Hexemer, T. Kershaw, L. Waddell, M. Mascarenhas
      Abstract: Enteric illness outbreaks are complex events, therefore, outbreak investigators use many different hypothesis generation methods depending on the situation. This scoping review was conducted to describe methods used to generate a hypothesis during enteric illness outbreak investigations. The search included five databases and grey literature for articles published between 1 January 2000 and 2 May 2015. Relevance screening and article characterisation were conducted by two independent reviewers using pretested forms. There were 903 outbreaks that described hypothesis generation methods and 33 papers which focused on the evaluation of hypothesis generation methods. Common hypothesis generation methods described are analytic studies (64.8%), descriptive epidemiology (33.7%), food or environmental sampling (32.8%) and facility inspections (27.9%). The least common methods included the use of a single interviewer (0.4%) and investigation of outliers (0.4%). Most studies reported using two or more methods to generate hypotheses (81.2%), with 29.2% of studies reporting using four or more. The use of multiple different hypothesis generation methods both within and between outbreaks highlights the complexity of enteric illness outbreak investigations. Future research should examine the effectiveness of each method and the contexts for which each is most effective in efficiently leading to source identification.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268819001699
      Issue No: Vol. 147 (2019)
  • Gastrointestinal infections caused by consumption of raw drinking milk in
           England & Wales, 1992–2017
    • Authors: N. Adams; L. Byrne, J. Edge, A. Hoban, C. Jenkins, L. Larkin
      Abstract: Systematic, national surveillance of outbreaks of intestinal infectious disease has been undertaken by Public Health England (PHE) since 1992. Between 1992 and 2002, there were 19 outbreaks linked to raw drinking milk (RDM) or products made using raw milk, involving 229 people; 36 of these were hospitalised. There followed an eleven-year period (2003–2013) where no outbreaks linked to RDM were reported. However, since 2014 seven outbreaks of Escherichia coli O157:H7 (n = 3) or Campylobacter jejuni (n = 4) caused by contaminated RDM were investigated and reported. Between 2014 and 2017, there were 114 cases, five reported hospitalisations and one death. The data presented within this review indicated that the risk of RDM has increased since 2014. Despite the labelling requirements and recommendations that children should not consume RDM, almost a third of outbreak cases were children. In addition, there has been an increase in consumer popularity and in registered RDM producers in the UK. The Food Standards Agency (FSA) continue to provide advice on RDM to consumers and have recently made additional recommendations to enhance existing controls around registration and hygiene of RDM producers.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S095026881900164X
      Issue No: Vol. 147 (2019)
  • Assessment of population susceptibility to upcoming seasonal influenza
           epidemic strain using interepidemic emerging influenza virus strains
    • Authors: Lin-Lei Chen; Wai-Lan Wu, Wan-Mui Chan, Carol H. Y. Fong, Anthony C. K. Ng, Jonathan D. Ip, Lu Lu, Thrimendra K. Dissanayake, Xixia Ding, Jian-Piao Cai, Anna J. X. Zhang, Sidney Tam, Ivan F. N. Hung, Kwok-Hung Chan, Kwok-Yung Yuen, Kelvin K. W. To
      Abstract: Seasonal influenza virus epidemics have a major impact on healthcare systems. Data on population susceptibility to emerging influenza virus strains during the interepidemic period can guide planning for resource allocation of an upcoming influenza season. This study sought to assess the population susceptibility to representative emerging influenza virus strains collected during the interepidemic period. The microneutralisation antibody titers (MN titers) of a human serum panel against representative emerging influenza strains collected during the interepidemic period before the 2018/2019 winter influenza season (H1N1-inter and H3N2-inter) were compared with those against influenza strains representative of previous epidemics (H1N1-pre and H3N2-pre). A multifaceted approach, incorporating both genetic and antigenic data, was used in selecting these representative influenza virus strains for the MN assay. A significantly higher proportion of individuals had a ⩾four-fold reduction in MN titers between H1N1-inter and H1N1-pre than that between H3N2-inter and H3N2-pre (28.5% (127/445) vs. 4.9% (22/445), P < 0.001). The geometric mean titer (GMT) of H1N1-inter was significantly lower than that of H1N1-pre (381 (95% CI 339–428) vs. 713 (95% CI 641–792), P < 0.001), while there was no significant difference in the GMT between H3N2-inter and H3N2-pre. Since A(H1N1) predominated the 2018–2019 winter influenza epidemic, our results corroborated the epidemic subtype.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268819001717
      Issue No: Vol. 147 (2019)
  • Characteristics of hospitalised patients with influenza in 2015–2016 in
           northern Israel: three circulating strains and continued fear of 2009
    • Authors: Tomer Kalish; Dan Miron, Maya Azrad, Hagai Rechnitzer, Hila Ben-Amram, Daniel Glikman, Avi Peretz
      Abstract: This study aimed to characterise children and adults diagnosed with influenza who were admitted to three medical centres in northern Israel in the winter of 2015–2016, a unique season due to infection with three types of influenza strains: A/H1N1, A/non-H1N1 and B. Data were collected retrospectively from medical records. Influenza A/H1N1 infected mainly adults (61% vs. 16% in children, P < 0.001) while influenza B was the common type in children (54% vs. 28% in adults, P < 0.001). Adults (36% vs. 5% in children, P < 0.001) and patients infected with A/H1N1 had higher rates of pneumonia (34% vs. 16% and 14% in influenza B and A/non-H1N1, respectively, P = 0.002). Treatment with oseltamivir was prescribed to 90% of patients; adults had higher rates of treatment (96% vs. 84% in children, P = 0.002) as well as patients infected with A/H1N1 (96% vs. 86% in influenza B and A/non-H1N1, respectively, P = 0.04). Oseltamivir was given after a mean of 3.6 days of symptoms. Preferential infection of adults by A/H1N1 was evident in Israel in 2015–2016; pneumonia rates were higher in adults and in A/H1N1-infected patients. Oseltamivir was prescribed to most patients but especially to those infected with A/H1N1, and was given relatively late in the course of the disease.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268819001407
      Issue No: Vol. 147 (2019)
  • Helicobacter+pylori+positive+and+negative+cytotoxin-associated+gene+A+phenotypes+among+Arab+and+Jewish+residents+of+Jerusalem&rft.title=Epidemiology+&+Infection&rft.issn=0950-2688&,+G.+Beer-Davidson,+H.+Nassar,+W.+Abu+Ahmed,+D.+Cohen,+J.+D.+Kark&rft_id=info:doi/10.1017/S0950268819001456">Correlates of infection with Helicobacter pylori positive and negative
           cytotoxin-associated gene A phenotypes among Arab and Jewish residents of
    • Authors: K. Muhsen; R. Sinnereich, G. Beer-Davidson, H. Nassar, W. Abu Ahmed, D. Cohen, J. D. Kark
      Abstract: We examined the prevalence and correlates of Helicobacter pylori (H. pylori) infection according to cytotoxin-associated gene A (CagA) phenotype, a main virulence antigen, among the ethnically diverse population groups of Jerusalem. A cross-sectional study was undertaken in Arab (N = 959) and Jewish (N = 692) adults, randomly selected from Israel's national population registry in age-sex and population strata. Sera were tested for H. pylori immunoglobulin G (IgG) antibodies. Positive samples were tested for virulence IgG antibodies to recombinant CagA protein, by enzyme-linked immunosorbent assay. Multinomial regression models were fitted to examine associations of sociodemographic factors with H. pylori phenotypes. H. pylori IgG antibody sero-prevalence was 83.3% (95% confidence interval (CI) 80.0%–85.5%) and 61.4% (95% CI 57.7%–65.0%) among Arabs and Jews, respectively. Among H. pylori positives, the respective CagA IgG antibody sero-positivity was 42.3% (95% CI 38.9%–45.8%) and 32.5% (95% CI 28.2%–37.1%). Among Jews, being born in the Former Soviet Union, the Middle East and North Africa, vs. Israel and the Americas, was positively associated with CagA sero-positivity. In both populations, sibship size was positively associated with both CagA positive and negative phenotypes; and education was inversely associated. In conclusion, CagA positive and negative infection had similar correlates, suggesting shared sources of these two H. pylori phenotypes.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268819001456
      Issue No: Vol. 147 (2019)
  • Candida+albicans+vs.+non-albicans+candidaemia+in+adult+patients+in+Northeast+China&rft.title=Epidemiology+&+Infection&rft.issn=0950-2688&,+Hao+Wu,+Rui+Zheng&rft_id=info:doi/10.1017/S0950268819001638">Epidemiology, risk factors and outcomes of Candida albicans vs.
           non-albicans candidaemia in adult patients in Northeast China
    • Authors: Wei Zhang; Xingpeng Song, Hao Wu, Rui Zheng
      Abstract: This study aimed to evaluate the clinical characteristics, risk factors and outcomes of adult patients with candidaemia caused by C. albicans vs. non-albicans Candida spp. (NAC). All adult hospitalised cases of candidaemia (2012–2017) at a tertiary hospital in Shenyang were included in the retrospective study, and a total of 180 episodes were analysed. C. parapsilosis was the most frequently isolated species (38.3%), followed by C. albicans (35.6%), C. glabrata (13.9%), C. tropicalis (10%) and others (2.2%). As initial antifungal therapy, 75.0%, 3.9%, 5.6% and 2.2% of patients received fluconazole, caspofungin, micafungin and voriconazole, respectively. Multivariate analyses revealed that total parenteral nutrition was associated with an increased risk of NAC bloodstream infections (BSI) (OR 2.535, 95% CI (1.066–6.026)) vs. C. albicans BSI. Additionally, the presence of a urinary catheter was associated with an increased risk of C. albicans BSI (OR 2.295 (1.129–4.666)) vs. NAC BSI. Moreover, ICU stay (OR 4.013 (1.476–10.906)), renal failure (OR 3.24 (1.084–9.683)), thrombocytopaenia (OR 7.171 (2.152–23.892)) and C. albicans (OR 3.629 (1.352–9.743)) were independent risk factors for candidaemia-related 30-day mortality, while recent cancer surgery was associated with reduced mortality risk (OR 26.479 (2.550–274.918)). All these factors may provide useful information to select initial empirical antifungal agents.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268819001638
      Issue No: Vol. 147 (2019)
  • Neisseria+gonorrhoeae+isolates+in+Madrid,+Spain,+in+2016&rft.title=Epidemiology+&+Infection&rft.issn=0950-2688&éndez,+C.+S.+Guerras,+E.+Tello,+J.+Ballesteros,+P.+Clavo,+T.+Puerta,+M.+Vera,+O.+Ayerdi,+J.+C.+Carrio,+I.+Mozo,+J.+Del+Romero,+J.+A.+Vázquez,+R.+Abad&rft_id=info:doi/10.1017/S095026881900150X">Epidemiology, molecular characterisation and antimicrobial susceptibility
           of Neisseria gonorrhoeae isolates in Madrid, Spain, in 2016
    • Authors: M. D. Guerrero-Torres; M. B. Menéndez, C. S. Guerras, E. Tello, J. Ballesteros, P. Clavo, T. Puerta, M. Vera, O. Ayerdi, J. C. Carrio, I. Mozo, J. Del Romero, J. A. Vázquez, R. Abad
      Abstract: With the aim to elucidate gonococcal antimicrobial resistance (AMR)–risk factors, we undertook a retrospective analysis of the molecular epidemiology and AMR of 104 Neisseria gonorrhoeae isolates from clinical samples (urethra, rectum, pharynx and cervix) of 94 individuals attending a sexually transmitted infection clinic in Madrid (Spain) from July to October 2016, and explored potential links with socio-demographic, behavioural and clinical factors of patients. Antimicrobial susceptibility was determined by E-tests, and isolates were characterised by N. gonorrhoeae multi-antigen sequence typing. Penicillin resistance was recorded for 15.4% of isolates, and most were susceptible to tetracycline, cefixime and azithromycin; a high incidence of ciprofloxacin resistance (~40%) was found. Isolates were grouped into 51 different sequence types (STs) and 10 genogroups (G), with G2400, ST5441, ST2318, ST12547 and G2992 being the most prevalent. A significant association (P = 0.015) was evident between HIV-positive MSM individuals and having a ciprofloxacin-resistant strain. Likewise, a strong association (P = 0.047) was found between patient age of MSM and carriage of isolates expressing decreased susceptibility to azithromycin. A decrease in the incidence of AMR gonococcal strains and a change in the strain populations previously reported from other parts of Spain were observed. Of note, the prevalent multi-drug resistant genogroup G1407 was represented by only three strains in our study, while the pan-susceptible clones such as ST5441, and ST2318, associated with extragenital body sites were the most prevalent.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S095026881900150X
      Issue No: Vol. 147 (2019)
  • Force of infection of Middle East respiratory syndrome in dromedary camels
           in Kenya
    • Authors: E. G. Gardner; S. Kiambi, R. Sitawa, D. Kelton, J. Kimutai, Z. Poljak, Z. Tadesse, S. Von Dobschuetz, L. Wiersma, A. L. Greer
      Abstract: Middle East respiratory syndrome coronavirus (MERS-CoV) is a zoonotic disease transmitted from dromedary camels to people, which can result in outbreaks with human-to-human transmission. Because it is a subclinical infection in camels, epidemiological measures other than prevalence are challenging to assess. This study estimated the force of infection (FOI) of MERS-CoV in camel populations from age-stratified serological data. A cross-sectional study of MERS-CoV was conducted in Kenya from July 2016 to July 2017. Seroprevalence was stratified into four age groups: 3 years old. Age-independent and age-dependent linear and quadratic generalised linear models were used to estimate FOI in pastoral and ranching camel herds. Models were compared based on computed AIC values. Among pastoral herds, the age-dependent quadratic FOI was the best fit model, while the age-independent FOI was the best fit for the ranching herd data. FOI provides an indirect estimate of infection risk, which is especially valuable where direct estimates of incidence and other measures of infection are challenging to obtain. The FOIs estimated in this study provide important insight about MERS-CoV dynamics in the reservoir species, and contribute to our understanding of the zoonotic risks of this important public health threat.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268819001663
      Issue No: Vol. 147 (2019)
  • Chlamydia+trachomatis+prevalence+in+young+women+in+England,+Scotland+and+Wales+changed'+Evidence+from+national+probability+surveys&rft.title=Epidemiology+&+Infection&rft.issn=0950-2688&">Letter to editor in response to Has Chlamydia trachomatis prevalence in
           young women in England, Scotland and Wales changed' Evidence from
           national probability surveys
    • Authors: P. J. White; J. Lewis
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268819001572
      Issue No: Vol. 147 (2019)
  • Chlamydia+trachomatis+prevalence+in+young+women+in+England,+Scotland+and+Wales+changed'+Evidence+from+national+probability+surveys.+Epidemiology+and+Infection.+2019&rft.title=Epidemiology+&+Infection&rft.issn=0950-2688&,+K.+Soldan,+P.+Horner&rft_id=info:doi/10.1017/S0950268819001560">Response to White and Lewis: Letter to editor in response to Has Chlamydia
           trachomatis prevalence in young women in England, Scotland and Wales
           changed' Evidence from national probability surveys. Epidemiology and
           Infection. 2019
    • Authors: D. Z. Kounali; A. E. Ades, K. Soldan, P. Horner
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268819001560
      Issue No: Vol. 147 (2019)
  • et+al.'s+letter+of+response&rft.title=Epidemiology+&+Infection&rft.issn=0950-2688&">Response to Kounali et al.'s letter of
    • Authors: P. J. White; J. Lewis
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268819001584
      Issue No: Vol. 147 (2019)
  • Salmonella+Poona+infections+associated+with+imported+cucumbers,+2015–2016&rft.title=Epidemiology+&+Infection&rft.issn=0950-2688&,+J.+Weiss,+J.+Higa,+E.+McDonald,+R.+Sowadsky,+D.+Fejes,+A.+Saupe,+G.+Provo,+S.+Seelman,+J.+Concepción-Acevedo,+L.+Gieraltowski&rft_id=info:doi/10.1017/S0950268819001596">Multistate outbreak of Salmonella Poona infections associated with
           imported cucumbers, 2015–2016
    • Authors: M. Laughlin; L. Bottichio, J. Weiss, J. Higa, E. McDonald, R. Sowadsky, D. Fejes, A. Saupe, G. Provo, S. Seelman, J. Concepción-Acevedo, L. Gieraltowski
      Abstract: We investigated a large multistate outbreak that occurred in the United States in 2015–2016. Epidemiologic, laboratory, and traceback studies were conducted to determine the source of the infections. We identified 907 case-patients from 40 states with illness onset dates ranging from July 3, 2015 to March 2, 2016. Sixty-three percent of case-patients reported consuming cucumbers in the week before illness onset. Ten illness sub-clusters linked to events or purchase locations were identified. All sub-clusters investigated received cucumbers from a single distributor which were sourced from a single grower in Mexico. Seventy-five cucumber samples were collected, 19 of which yielded the outbreak strain. Whole genome sequencing performed on 154 clinical isolates and 19 cucumber samples indicated that the sequenced isolates were closely related genetically to one another. This was the largest US foodborne disease outbreak in the last ten years and the third largest in the past 20 years. This was at least the fifth multistate outbreak caused by contaminated cucumbers since 2010. The outbreak is noteworthy because a recall was issued only 17 days after the outbreak was identified, which allowed for the removal of the contaminated cucumbers still available in commerce, unlike previous cucumber associated outbreaks. The rapid identification and response of multiple public health agencies resulted in preventing this from becoming an even larger outbreak.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268819001596
      Issue No: Vol. 147 (2019)
  • Incorporating calendar effects to predict influenza seasonality in
           Milwaukee, Wisconsin
    • Authors: Ryan B. Simpson; Tania M. Alarcon Falconi, Aishwarya Venkat, Kenneth H. H. Chui, Jose Navidad, Yuri N. Naumov, Jack Gorski, Sanjib Bhattacharyya, Elena N. Naumova
      Abstract: Social outings can trigger influenza transmission, especially in children and elderly. In contrast, school closures are associated with reduced influenza incidence in school-aged children. While influenza surveillance modelling studies typically account for holidays and mass gatherings, age-specific effects of school breaks, sporting events and commonly celebrated observances are not fully explored. We examined the impact of school holidays, social events and religious observances for six age groups (all ages, ⩽4, 5–24, 25–44, 45–64, ⩾65 years) on four influenza outcomes (tests, positives, influenza A and influenza B) as reported by the City of Milwaukee Health Department Laboratory, Milwaukee, Wisconsin from 2004 to 2009. We characterised holiday effects by analysing average weekly counts in negative binomial regression models controlling for weather and seasonal incidence fluctuations. We estimated age-specific annual peak timing and compared influenza outcomes before, during and after school breaks. During the 118 university holiday weeks, average weekly tests were lower than in 140 school term weeks (5.93 vs. 11.99 cases/week, P < 0.005). The dampening of tests during Winter Break was evident in all ages and in those 5–24 years (RR = 0.31; 95% CI 0.22–0.41 vs. RR = 0.14; 95% CI 0.09–0.22, respectively). A significant increase in tests was observed during Spring Break in 45–64 years old adults (RR = 2.12; 95% CI 1.14–3.96). Milwaukee Public Schools holiday breaks showed similar amplification and dampening effects. Overall, calendar effects depend on the proximity and alignment of an individual holiday to age-specific and influenza outcome-specific peak timing. Better quantification of individual holiday effects, tailored to specific age groups, should improve influenza prevention measures.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268819001511
      Issue No: Vol. 147 (2019)
  • Prevalence and risk factors of pulmonary nontuberculous mycobacterial
           infections in the Zhejiang Province of China
    • Authors: Jintian Xu; Ping Li, Shengchao Zheng, Wei Shu, Yu Pang
      Abstract: Risk factors and prevalence of pulmonary nontuberculous mycobacterial (NTM) diseases were retrospectively evaluated in 1208 suspected pulmonary TB patients seeking care at the Affiliated Hospital of Hangzhou Normal University between July 2018 and December 2018. Further analysis of 390 culture-positive cases demonstrated that 358 (358/390, 91.8%) were infected with Mycobacterium tuberculosis (MTB), 24 (24/390, 6.2%) with NTM and eight (8/390, 2.0%) with both MTB and NTM. M. intracellulare was the most prevalent NTM isolated (16/24, 66.7%), followed by M. abscessus (3/24), M. kansasii (2/24), M. avium (1/24), M. szulgai (1/24) and M. fortuitum (1/24). The difference between NTM and TB case rates for the ⩾65-year-old age group significantly exceeded the difference for the reference group (patients aged 25–44 years) (OR (95% CI): 4.63 (1.03–20.90)). Pulmonary NTM diseases incidence positively correlated with prior TB history (OR (95% CI): 12.92 (3.24–31.82)). Moreover, pulmonary NTM patients were significantly more likely to exhibit underlying bronchiectasis than pulmonary TB patients (OR (95% CI): 18.89 (7.54–47.88)). In conclusion, approximately one-tenth of culture-positive suspected pulmonary TB patients are infected with NTM (most frequently M. intracellulare) in Zhejiang Province, China. The elderly and those with bronchiectasis or a history of TB are at the greatest risk of contracting pulmonary NTM disease.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268819001626
      Issue No: Vol. 147 (2019)
  • Salmonella+infections+linked+to+imported+Maradol+papayas+–+United+States,+December+2016–September+2017&rft.title=Epidemiology+&+Infection&rft.issn=0950-2688&,+D.+L.+Williams,+K.+Holloman,+D.+Grady,+D.+Thomas,+E.+Omoregie,+K.+Lamba,+M.+Leeper,+L.+Gieraltowski&rft_id=info:doi/10.1017/S0950268819001547">Multistate outbreaks of Salmonella infections linked to imported Maradol
           papayas – United States, December 2016–September 2017
    • Authors: R. Hassan; B. Whitney, D. L. Williams, K. Holloman, D. Grady, D. Thomas, E. Omoregie, K. Lamba, M. Leeper, L. Gieraltowski
      Abstract: Foodborne salmonellosis causes approximately 1 million illnesses annually in the United States. In the summer of 2017, we investigated four multistate outbreaks of Salmonella infections associated with Maradol papayas imported from four Mexican farms. PulseNet initially identified a cluster of Salmonella Kiambu infections in June 2017, and early interviews identified papayas as an exposure of interest. Investigators from Maryland, Virginia and Food and Drug Administration (FDA) collected papayas for testing. Several strains of Salmonella were isolated from papayas sourced from Mexican Farm A, including Salmonella Agona, Gaminara, Kiambu, Thompson and Senftenberg. Traceback from two points of service associated with illness sub-clusters in two states identified Farm A as a common source of papayas, and three voluntary recalls of Farm A papayas were issued. FDA sampling isolated four additional Salmonella strains from papayas sourced from Mexican Farms B, C and D. In total, four outbreaks were identified, resulting in 244 cases with illness onset dates from 20 December 2016 to 20 September 2017. The sampling of papayas and the collaborative work of investigative partners were instrumental in identifying the source of these outbreaks and preventing additional illnesses. Evaluating epidemiological, laboratory and traceback evidence together during investigations is critical to solving and stopping outbreaks.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268819001547
      Issue No: Vol. 147 (2019)
  • Pneumonia incidence trends in UK primary care from 2002 to 2017:
           population-based cohort study
    • Authors: Xiaohui Sun; Abdel Douiri, Martin Gulliford
      Abstract: Increasing hospital admissions for pneumonia have been reported recently but it is not known whether pneumonia incidence rates have increased in the community. To determine whether incidence rates of pneumonia increased in primary care in the United Kingdom from 2002 to 2017, an open cohort study was conducted using electronic health records from the UK Clinical Practice Research Datalink. Clinically diagnosed pneumonia, influenza pneumonia, pleural infection and clinically suspected pneumonia, defined as chest infection treated with antibiotics, were evaluated. Age-standardised and age-specific rates were estimated. Joinpoint regression models were fitted and annual percentage changes (APC) were estimated. There were 70.7 million person-years of follow-up with 120 662 episodes of clinically diagnosed pneumonia, 1 831 005 of clinically suspected pneumonia, 23 814 episodes of influenza pneumonia and 2644 pleural infections over 16 years. The incidence of clinically diagnosed pneumonia increased from 1.50 per 1000 person-years in 2002 to 2.22 per 1000 in 2017. From 2010 to 2017, the APC in age-standardised incidence was 5.1% (95% confidence interval 3.4–6.9) compared with 0.3% (−0.6 to 1.2%) before 2010. Clinically suspected pneumonia incidence rates increased from 2002 to 2008 with an APC 3.8% (0.8–6.9) but decreased with an APC −4.9% (−6.7 to −3.1) from 2009 to 2017. Influenza pneumonia increased in the epidemic year of 2009. There was no overall trend in pleural infection. The results show that clinically diagnosed pneumonia has increased in primary care but there was a contemporaneous decline in recording of clinically suspected pneumonia or ‘chest infection’. Changes in disease labelling practice might partly account for these trends.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268819001559
      Issue No: Vol. 147 (2019)
  • E.+coli+infection&rft.title=Epidemiology+&+Infection&rft.issn=0950-2688&">The importance of integrating genetic strain information for managing
           cases of Shiga toxin-producing E. coli infection
    • Authors: Dirk Werber; Flemming Scheutz
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268819001602
      Issue No: Vol. 147 (2019)
  • Surveillance of infections in long-term care facilities (LTCFs): The
           impact of participation during multiple years on health care-associated
           infection incidence
    • Authors: A. P. J. Haenen; L. P. Verhoef, A. Beckers, E. F. Gijsbers, J. Alblas, A. Huis, M. Hulscher, S. C. de Greeff
      Abstract: We studied trends in the incidence of health care-associated infections (HAIs) in LTCFs between 2009 and 2015 and determined the effect of participation in our network. Elder-care physicians reported weekly the number of cases of influenza-like illness, gastroenteritis, (probable) pneumonia, urinary tract infections (UTIs) and all-cause mortality. Trends in the incidence of infection and mortality in relation to LTCF characteristics were calculated using multilevel univariate and multivariate logistic regression. Thirty LTCF participated for 3 years or more, 16 for 2 years and the remaining 12 LTCF for 1 year. During the study period, the median number of beds decreased from 158 to 139, whereas the percentage of residents with private bedrooms increased from 14% to 87%. UTIs were the most frequently reported infections, followed by (probable) pneumonia and gastroenteritis. Adjusted for calendar year and season, we observed a statistically significant decrease in the incidence of influenza-like illness (odds ratio (OR) = 0.8, P < 0.01) and (probable) pneumonia (OR = 0.8, P < 0.01) for each extra year an LTCF participated. Although there are other likely contributors, such as more private rooms and enhanced infection control measures, the decreasing trend of HAI in LTCFs participating in surveillance implies that surveillance is a valuable addition to current strategies to optimise infection control.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268819001328
      Issue No: Vol. 147 (2019)
  • Mapping of control measures to prevent secondary transmission of STEC
           infections in Europe during 2016 and revision of the national guidelines
           in Norway
    • Authors: L. Veneti; H. Lange, L. Brandal, K. Danis, L. Vold
      Abstract: In 2016, we reviewed preventive control measures for secondary transmission of Shiga-toxin producing Escherichia coli (STEC) in humans in European Union (EU)/European Free Trade Association (EEA) countries to inform the revision of the respective Norwegian guidelines which at that time did not accommodate for the varying pathogenic potential of STEC. We interviewed public health experts from EU/EEA institutes, using a semi-structured questionnaire. We revised the Norwegian guidelines using a risk-based approach informed by the new scientific evidence on risk factors for HUS and the survey results. All 13 (42%) participating countries tested STEC for Shiga toxin (stx) 1, stx2 and eae (encoding intimin). Five countries differentiated their control measures based on clinical and/or microbiological case characteristics, but only Denmark based their measures on routinely conducted stx subtyping. In all countries, but Norway, clearance was obtained with ⩽3 negative STEC specimens. After this review, Norway revised the STEC guidelines and recommended only follow-up of cases infected with high-virulent STEC (determined by microbiological and clinical information); clearance is obtained with three negative specimens. Implementation of the revised Norwegian guidelines will lead to a decrease of STEC cases needing follow-up and clearance, and will reduce the burden of unnecessary public health measures and the socioeconomic impact on cases. This review of guidelines could assist other countries in adapting their STEC control measures.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268819001614
      Issue No: Vol. 147 (2019)
  • Surveillance of congenital Zika syndrome in England and Wales: methods and
           results of laboratory, obstetric and paediatric surveillance
    • Authors: C. Oeser; E. Aarons, P.T. Heath, K. Johnson, A. Khalil, M Knight, R. M. Lynn, D. Morgan, R. Pebody
      Abstract: The spread of the Zika virus (ZIKV) in the Americas led to large outbreaks across the region and most of the Southern hemisphere. Of greatest concern were complications following acute infection during pregnancy. At the beginning of the outbreak, the risk to unborn babies and their clinical presentation was unclear. This report describes the methods and results of the UK surveillance response to assess the risk of ZIKV to children born to returning travellers. Established surveillance systems operating within the UK – the paediatric and obstetric surveillance units for rare diseases, and national laboratory monitoring – enabled rapid assessment of this emerging public health threat. A combined total of 11 women experiencing adverse pregnancy outcomes after possible ZIKV exposure were reported by the three surveillance systems; five miscarriages, two intrauterine deaths and four children with clinical presentations potentially associated with ZIKV infection. Sixteen women were diagnosed with ZIKV during pregnancy in the UK. Amongst the offspring of these women, there was unequivocal laboratory evidence of infection in only one child. In the UK, the number and risk of congenital ZIKV infection for travellers returning from ZIKV-affected countries is very small.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268819001535
      Issue No: Vol. 147 (2019)
  • Applications of machine learning techniques to predict filariasis using
           socio-economic factors
    • Authors: Phani Krishna Kondeti; Kumar Ravi, Srinivasa Rao Mutheneni, Madhusudhan Rao Kadiri, Sriram Kumaraswamy, Ravi Vadlamani, Suryanaryana Murty Upadhyayula
      Abstract: Filariasis is one of the major public health concerns in India. Approximately 600 million people spread across 250 districts of India are at risk of filariasis. To predict this disease, a pilot scale study was carried out in 30 villages of Karimnagar district of Telangana from 2004 to 2007 to collect epidemiological and socio-economic data. The collected data are analysed by employing various machine learning techniques such as Naïve Bayes (NB), logistic model tree, probabilistic neural network, J48 (C4.5), classification and regression tree, JRip and gradient boosting machine. The performances of these algorithms are reported using sensitivity, specificity, accuracy and area under ROC curve (AUC). Among all employed classification methods, NB yielded the best AUC of 64% and was equally statistically significant with the rest of the classifiers. Similarly, the J48 algorithm generated 23 decision rules that help in developing an early warning system to implement better prevention and control efforts in the management of filariasis.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268819001481
      Issue No: Vol. 147 (2019)
  • The distinct epidemic characteristics of HCV co-infection among
           HIV-1-infected population caused by drug injection and sexual transmission
           in Yunnan, China
    • Authors: A-Mei Zhang; Ming Yang, Li Gao, Mi Zhang, Lingshuai Jiao, Yue Feng, Xingqi Dong, Xueshan Xia
      Abstract: Hepatitis C virus (HCV) infection was frequent in human immunodeficiency virus (HIV) patients in Yunnan province. We studied the epidemic characteristics of HCV in HIV/HCV co-infected patients. Serum from 894 HIV-1 patients was collected, together with basic information and biochemical features. All samples were infected with HIV through injecting drug users (IDUs) and sexual transmission (ST). The NS5B gene was amplified and sequenced to affirm HCV genotype. In total, 202 HIV patients were co-infected with HCV, and most (81.19%) of co-infected patients were IDUs. Genotype 3b was predominant (37.62%) in these samples, and its frequency was similar in patients with IDU and ST. The frequencies of genotypes 1a, 1b, 3a, 6a, 6n, 2a and 6u were 3.96%, 16.34%, 23.76%, 6.93%, 10.40%, 0.50% and 0.50%, respectively. However, genotype 3a showed significantly different frequency in HCV patients with IDU and ST (P = 0.019). When HCV patients were divided into subgroups, the haemoglobin (HGB) level was significantly higher in patients with genotype 3a than in patients with 3b (P = 0.033), 6a (P = 0.006) and 6n (P = 0.007), respectively. Although no difference existed among HCV subgroups, HIV-viral load was identified to be positively correlated with the HGB level and CD4+ cells when dividing HCV/HIV co-infected persons into male and female groups. In conclusion, genotype 3b was the predominant HCV genotype in Yunnan HIV/HCV co-infected persons. The HGB level was higher in patients with genotype 3a than others. HIV-viral load was positively correlated with the HGB level and CD4+ cells in the male or female HCV-infected group.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268819001365
      Issue No: Vol. 147 (2019)
  • Seroprevalence of HPV serotypes 6, 11, 16 and 18 in unvaccinated children
           from Mexico City
    • Authors: Reyna Lizette Pacheco-Domínguez; Ramón A. Durazo-Arvizu, Angélica López-Hernández, Jesica Figueroa-Padilla, Julia Berenice Ramírez-González, Malaquías López-Cervantes
      Abstract: Data regarding humoral immunity against HPV infection are scarce. Most analyses focus on the identification of viruses on mucous membranes and primarily refer to women of reproductive age. The aim of this work was to estimate the seroprevalence of antibodies against HPV serotypes 6, 11, 16 and 18 among unvaccinated boys living in Mexico City. A cross-sectional study of 257 male students from 48 public primary schools in Mexico City, whose ages fluctuated between 9 and 14 years, was carried out. Immunological status was assessed by applying the competitive Luminex Immunoassay of HPV (cLIA). Among the study population, we initially found that 38.52% (n = 99) of the children tested positive against one or more of the HPV 6, 11, 16 and/or 18 serotypes. The most commonly found serotype was isolated HPV 18 or in combination with other serotypes (22% and 31%, respectively), followed by HPV 6 with frequencies of 4.7% and 11%, respectively; however, lower frequencies were estimated for HPV 16 (2%; 6%) and isolated HPV 11, 4%. If a second set of cut-off points for seropositivity is applied, the overall prevalence for any serotype is reduced to 15.2%. As it appears that a significant sector of the study population has had basal contact with an HPV serotype, we recommend considering the possibility of vaccination against HPV at earlier ages.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268819001341
      Issue No: Vol. 147 (2019)
  • Antibiotic-resistant pathogens in different patient settings and
           identification of surveillance gaps in Switzerland – a systematic review
    • Authors: R. Fulchini; W. C. Albrich, A. Kronenberg, A. Egli, C. R. Kahlert, M. Schlegel, P. Kohler
      Abstract: The prevalence of antimicrobial resistance (AMR) varies significantly among different patient populations. We aimed to summarise AMR prevalence data from screening studies in different patient settings in Switzerland and to identify surveillance gaps. We performed a systematic review, searching Pubmed, MEDLINE, Embase (01/2000–05/2017) and conference proceedings for Swiss studies reporting on carbapenemase-producing Enterobacteriaceae (CPE), extended-spectrum beta-lactamases (ESBL), mobilised colistin-resistance, methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococci (VRE) within different patient settings. We identified 2345 references and included 46 studies. For acute care patients, most screening data come from admission screenings, whereas AMR prevalence among hospitalised patients is largely unknown. Universal admission screenings showed ESBL-prevalences of 5–8% and MRSA-prevalences of 2–5%. For targeted screening, ESBL-prevalence ranged from 14–21%; MRSA-prevalence from 1–4%. For refugees, high ESBL (9–24%) and MRSA (16–24%) carriage rates were reported; returning travellers were frequently (68–80%) colonised with ESBL. Screening data for other pathogens, long-term care facility (LTCF) residents and pediatric populations were scarce. This review confirms high ESBL- and MRSA-carriage rates for risk populations in Switzerland. Emerging pathogens (CPE and VRE) and certain populations (inpatients, LTCF residents and children) are understudied. We encourage epidemiologists and public health authorities to consider these findings in the planning of future surveillance studies.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268819001523
      Issue No: Vol. 147 (2019)
  • Inflammation throughout pregnancy and fetal growth restriction in rural
    • Authors: Michael W. Sauder; Sun Eun Lee, Kerry J. Schulze, Parul Christian, Lee S. F. Wu, Subarna K. Khatry, Steven C. LeClerq, Ramesh K. Adhikari, John D. Groopman, Keith P. West
      Abstract: Maternal systemic inflammation during pregnancy may restrict embryo−fetal growth, but the extent of this effect remains poorly established in undernourished populations. In a cohort of 653 maternal−newborn dyads participating in a multi-armed, micronutrient supplementation trial in southern Nepal, we investigated associations between maternal inflammation, assessed by serum α1-acid glycoprotein and C-reactive protein, in the first and third trimesters of pregnancy, and newborn weight, length and head and chest circumferences. Median (IQR) maternal concentrations in α1-acid glycoprotein and C-reactive protein in the first and third trimesters were 0.65 (0.53–0.76) and 0.40 (0.33–0.50) g/l, and 0.56 (0.25–1.54) and 1.07 (0.43–2.32) mg/l, respectively. α1-acid glycoprotein was inversely associated with birth size: weight, length, head circumference and chest circumference were lower by 116 g (P = 2.3 × 10−6), and 0.45 (P = 3.1 × 10−5), 0.18 (P = 0.0191) and 0.48 (P = 1.7 × 10−7) cm, respectively, per 50% increase in α1-acid glycoprotein averaged across both trimesters. Adjustment for maternal age, parity, gestational age, nutritional and socio-economic status and daily micronutrient supplementation failed to alter any association. Serum C-reactive protein concentration was largely unassociated with newborn size. In rural Nepal, birth size was inversely associated with low-grade, chronic inflammation during pregnancy as indicated by serum α1-acid glycoprotein.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268819001493
      Issue No: Vol. 147 (2019)
  • Hospitalisation by tick-borne diseases in the last 10 years in two
           hospitals in South Spain: analysis of tick exposure data collected in the
           Emergency Department
    • Authors: M. Rivera-Izquierdo; L. M. Martín-delosReyes, A. J. Láinez-Ramos-Bossini, P. Ruiz-Díaz, E Casado-Fernández, A. Bueno-Cavanillas, V. Martínez-Ruiz
      Abstract: Tick-borne diseases (TBDs) can sometimes cause severe symptoms and lead to hospitalisation, but they often go unnoticed in the Emergency Department (ED). The aim of this study was twofold: (i) to describe the profile of patients hospitalised by TBDs; and (ii) to evaluate the data collected in the medical records from the ED in order to analyse their potential clinical consequences. A total of 84 cases that included all TBD diagnoses registered in the ED records were identified and analysed. These corresponded to all the hospitalisations by TBDs in the last 10 years (2009–2019) in two tertiary hospitals in Granada, Spain. Statistical analyses were made using RStudio. Coinciding with the absence of patient's report of exposure to ticks, 64.3% of TBDs were not suspected in the ED. Intensive care unit admission was required in 8.3% of cases, and the mortality rate was 2.4%. Non-suspected cases showed longer hospital stay (P < 0.001), treatment duration (P = 0.02) and delay in the initiation of antibiotic treatment (P < 0.001). Our findings indicate that symptoms associated with TBDs are highly non-specific. In the absence of explicit information related to potential tick exposure, TBDs are not initially suspected. As a consequence, elective treatment administration is delayed and hospitalisation time is prolonged. In conclusion, our results highlight the importance of addressing potential exposure to ticks during the ED contact with patients presenting with febrile syndrome.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S095026881900147X
      Issue No: Vol. 147 (2019)
  • Staphylococcus+aureus+isolated+from+rabbits+in+Fujian,+China&rft.title=Epidemiology+&+Infection&rft.issn=0950-2688&,+S.+Sun,+Y.+Chen,+D.+Chen,+X.+Xie&rft_id=info:doi/10.1017/S0950268819001468">Characterisation of Staphylococcus aureus isolated from rabbits in Fujian,
    • Authors: J. Wang; L. Sang, S. Sun, Y. Chen, D. Chen, X. Xie
      Abstract: Staphylococcus aureus has been recognised as one of the important zoonotic pathogens. However, knowledge about the epidemiology and genetic characteristics of S. aureus in rabbits was limited. The aim of this study was to determine the characteristics of 281 S. aureus isolated from dead rabbits of nine rabbit farms in Fujian Province, China. All the isolates were characterised by multi-locus sequencing typing, detection of virulence factors and antimicrobial susceptibility test. The results showed that the 281 isolates were grouped into two sequence types, ST121 (13.52%, 38/281) and ST398 (86.48%, 243/281). Surprisingly, the ST121 strains were only recovered from the lung samples from one of the nine rabbit farms studied. In the 281 isolates, the virulence genes of nuc, hla, hlb, clfA, clfB and fnbpA were positive, whereas the sea, seb, tsst, eta and etb genes were negative. Notably, the 38 ST121 isolates carried the pvl gene. All the 281 isolates were methicillin-susceptible S. aureus, and the isolates were susceptible to most of the used antibiotics, except for streptomycin, kanamycin, azithromycin and penicillin, and the resistance rates of which were 23.84%, 19.57%, 16.01% and 11.03%, respectively. This study first described the epidemiology and characteristics of S. aureus in rabbits in Fujian Province, which will help in tracking the evolution of epidemic strains and preventing the rabbit–human transmission events.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268819001468
      Issue No: Vol. 147 (2019)
  • Salmonella+illness+associated+with+frozen+raw+breaded+chicken+products+in+Canada,+2015–2019&rft.title=Epidemiology+&+Infection&rft.issn=0950-2688&,+S.+Coleman,+M.+Viswanathan,+K.+Chau,+A.+Orr,+A.+Hexemer&rft_id=info:doi/10.1017/S0950268819001432">Outbreaks of Salmonella illness associated with frozen raw breaded chicken
           products in Canada, 2015–2019
    • Authors: V. K. Morton; A. Kearney, S. Coleman, M. Viswanathan, K. Chau, A. Orr, A. Hexemer
      Abstract: Frozen raw breaded chicken products (FRBCP) have been identified as a risk factor for Salmonella infection in Canada. In 2017, Canada implemented whole genome sequencing (WGS) for clinical and non-clinical Salmonella isolates, which increased understanding of the relatedness of Salmonella isolates, resulting in an increased number of Salmonella outbreak investigations. A total of 18 outbreaks and 584 laboratory-confirmed cases have been associated with FRBCP or chicken since 2017. The introduction of WGS provided the evidence needed to support a new requirement to control the risk of Salmonella in FRBCP produced for retail sale.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268819001432
      Issue No: Vol. 147 (2019)
  • Proper pertussis vaccination will probably not increase vaccination
           coverage: a case–control study
    • Authors: R. Solano; A. V. Sanchez-Callejas, M. I. Alvarez-Ibañez, M. Sandiumenge-Durán, M. I. Fernández-San-Martín
      Abstract: Vaccination coverage (VC) against pertussis can increase when management practices and policies at primary care centres (PCCs) are reinforced. From 2011 to 2015, we performed a case–control study to evaluate VC among pertussis patients treated at PCCs in Barcelona, Spain. We recorded pertussis in patients from 8- to 16-year-olds at 52 PCCs. Pertussis cases had laboratory diagnostic and controls were healthy outpatients visiting the same facility for reasons other than cough. DTaP/dTap VC was recorded as either proper vaccination status (five doses recorded) or improper vaccination status (
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268819001444
      Issue No: Vol. 147 (2019)
  • Indirect costs associated with deaths of children aged 0–14 years from
           measles in a weak health system and conflict and fragile zone: the case of
    • Authors: Omar B. Da'ar
      Abstract: This study recognises periodic outbreaks of measles continue to affect conflict and fragile zones in the least developed countries. This study set out to provide evidence for the indirect costs or economic loss associated with measles-related deaths among children aged 0–14 years in Somalia. Using epidemiologic and economic data, the indirect cost was calculated based on the framework of the World Health Organisation guide of identifying the economic consequences of disease and injury. The baseline indirect cost was computed as the product of discounted future productive years of life lost (PYLL), non-health gross domestic product per capita (NHGDPPC) and the estimated total measles deaths (ETMD). The model was adjusted for conflict and fragility conditions and further extension considered a finite and stable upper limit growth of the instability-adjusted NHGDPPC. To discount future costs, a rate of 3% was applied. Using a ±20% variability assumption of the epidemiologic and economic factor inputs, a sensitivity analysis was conducted to account for uncertainty. In 2015 values, the ETMD of 3723 measles deaths of children aged 0–14 years could decrease non-health GDP of the country by $23.46 million, a potential loss of $6303 per death over the discounted PYLL. The loss would increase by 5.3% when adjusted for conflict and fragility conditions. Assuming growth, the future adjusted loss is expected to be $35.91 million in 2015 values. Girl-child deaths accounted for 51.2% of the burden. Results are robust to the variations in the model inputs, although sensitivity analyses suggest the proportion of total measles deaths and the discount rate accounted for greater uncertainty of the loss than do the proportion of growth and instability assumption. Conflict and fragility accounted for the least uncertainty, perhaps confirming their relative perpetuity in Somalia. Results show significant indirect cost related to measles deaths of children, exacerbated by conflict and fragility. This is an economic burden, but one which the health system, policy-makers, government and other stakeholders should be prepared to colossally discount by collectively taking measles surveillance and security measures now to reduce further deaths in the future.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268819001420
      Issue No: Vol. 147 (2019)
  • Beyond morbidity and mortality: the burden of infectious diseases on
           healthcare services
    • Authors: Edoardo Colzani
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268819001298
      Issue No: Vol. 147 (2019)
  • Do we know how scabies outbreaks in residential and nursing care homes for
           the elderly should be managed' A systematic review of interventions
           using a novel approach to assess evidence quality
    • Authors: E. J. Morrison; J. Middleton, S. Lanza, J. E. Cowen, K. Hewitt, S. L. Walker, M. Nicholls, J. Rajan-Iyer, J. Fletcher, J. A. Cassell
      Abstract: Currently no national guidelines exist for the management of scabies outbreaks in residential or nursing care homes for the elderly in the United Kingdom. In this setting, diagnosis and treatment of scabies outbreaks is often delayed and optimal drug treatment, environmental control measures and even outcome measures are unclear. We undertook a systematic review to establish the efficacy of outbreak management interventions and determine evidence-based recommendations. Four electronic databases were searched for relevant studies, which were assessed using a quality assessment tool drawing on STROBE guidelines to describe the quality of observational data. Nineteen outbreak reports were identified, describing both drug treatment and environmental management measures. The quality of data was poor; none reported all outcome measures and only four described symptom relief measures. We were unable to make definitive evidence-based recommendations. We draw on the results to propose a framework for data collection in future observational studies of scabies outbreaks. While high-quality randomised controlled trials are needed to determine optimal drug treatment, evidence on environmental measures will need augmentation through other literature studies. The quality assessment tool designed is a useful resource for reporting of outcome measures including patient-reported measures in future outbreaks.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268819001249
      Issue No: Vol. 147 (2019)
  • Temporal and spatial distribution of anthrax outbreaks among Kenyan
           wildlife, 1999–2017
    • Authors: J. M. Gachohi; F. Gakuya, I. Lekolool, E. Osoro, L. Nderitu, P. Munyua, I. Ngere, N. Kemunto, B. Bett, F. Otieno, M. Muturi, A. Mwatondo, M. A. Widdowson, M. Kariuki Njenga
      Abstract: The burden of anthrax in wildlife is demonstrated through high numbers of sudden mortalities among herbivore species, including endangered animal species. East Africa is home of multiple species of faunal wildlife numbering in the millions but there are limited disease surveillance programmes, resulting in a paucity of information on the role of anthrax and other infectious diseases on declining wildlife populations in the region. We reviewed historical data on anthrax outbreaks from Kenya Wildlife Service (KWS) spanning from 1999 to 2017 in Kenya to determine the burden, characteristics and spatial distribution of anthrax outbreaks. A total of 51 anthrax outbreaks associated with 1014 animal deaths were reported across 20 of 60 wildlife conservation areas located in six of the seven agro-ecological zones. Overall, 67% of the outbreaks were reported during the dry seasons, affecting 24 different wildlife species. Over 90% (22 of 24) of the affected species were herbivore, including 12 grazers, five browsers and five mixed grazers and browsers. Buffaloes (23.5%), black rhinos (21.6%) and elephants (17.6%) were the most frequently affected species. Our findings demonstrate the extensive geographic distribution of wildlife anthrax in the country, making it one of the important infectious diseases that threaten wildlife conservation.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268819001304
      Issue No: Vol. 147 (2019)
  • Acceptability of community quarantine in contexts of communicable disease
           epidemics: perspectives of literate lay people living in Conakry, Guinea
    • Authors: Lonzozou Kpanake; Jean-Pierre Leno, Paul Clay Sorum, Etienne Mullet
      Abstract: During the 2014–2016 Ebola epidemic in West Africa, some communities reacted hostilely to the implementation of quarantine measures. This study's aim was to examine the views of lay people in Guinea on the acceptability of community quarantine. From June to August 2016, 302 adults indicated the acceptability of quarantine in 36 scenarios varying as a function of four factors: the infectious disease's level of contagiousness, its level of lethality, the number of cases in the community and whether persons in quarantine are provided with support services. Five clusters were identified: (1) for 18% of the participants, quarantine is never acceptable; (2) 16% considered, in contrast, that quarantine is always acceptable; (3) for 14%, it depends on the disease's level of contagiousness and lethality; (4) 36% based their judgement not only on the levels of contagiousness and lethality, but also on whether those in quarantine are provided with support services; and (5) 16% had no opinion. Interventions to increase voluntary compliance with community quarantine in Guinea must not be ‘one size fits all’, but must be multifaceted and tailored in design and implementation to match the diversity of people's concerns and needs.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268819001419
      Issue No: Vol. 147 (2019)
  • Respiratory syncytial virus hospitalisations among young children: a data
           linkage study
    • Authors: Namrata Prasad; E. Claire Newbern, Adrian A. Trenholme, Tim Wood, Mark G. Thompson, Nayyereh Aminisani, Q. Sue Huang, Cameron C. Grant
      Abstract: We aimed to provide comprehensive estimates of laboratory-confirmed respiratory syncytial virus (RSV)-associated hospitalisations. Between 2012 and 2015, active surveillance of acute respiratory infection (ARI) hospitalisations during winter seasons was used to estimate the seasonal incidence of laboratory-confirmed RSV hospitalisations in children aged
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268819001377
      Issue No: Vol. 147 (2019)
  • Estimating the effectiveness of vaccine programs in dog populations
    • Authors: R.M. Wallace; E.A. Undurraga, A. Gibson, J. Boone, E.G. Pieracci, L. Gamble, J.D. Blanton
      Abstract: Dogs harbor numerous zoonotic pathogens, many of which are controlled through vaccination programs. The delivery of these programs can be difficult where resources are limited. We developed a dynamic model to estimate vaccination coverage and cost-per-dog vaccinated. The model considers the main factors that affect vaccination programs: dog demographics, effectiveness of strategies, efficacy of interventions and cost. The model was evaluated on data from 18 vaccination programs representing eight countries. Sensitivity analysis was performed for dog confinement and vaccination strategies. The average difference between modelled vaccination coverage and field data was 3.8% (2.3%–5.3%). Central point vaccination was the most cost-effective vaccination strategy when >88% of the dog population was confined. More active methods of vaccination, such as door-to-door or capture-vaccinate-release, achieved higher vaccination coverage in free-roaming dog populations but were more costly. This open-access tool can aid in planning more efficient vaccination campaigns in countries with limited resources.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268819001158
      Issue No: Vol. 147 (2019)
  • Increasing varicella incidence rates among children in the Republic of
           Korea: an age–period–cohort analysis
    • Authors: Young Hwa Lee; Young June Choe, Sung-Il Cho, Ji Hwan Bang, Myoung-don Oh, Jong-Koo Lee
      Abstract: In the Republic of Korea, despite the introduction of one-dose universal varicella vaccination in 2005 and achieving a high coverage rate of 98.9% in 2012, the incidence rate has been increased sevenfold. This study aimed to investigate time trends of varicella incidence rate, assessing the age, period and birth cohort effects. We used national data on the annual number of reported cases from 2006 to 2017. A log-linear Poisson regression model was used to estimate age–period–cohort effects on varicella incidence rate. From 2006 to 2017, the incidence of varicella increased from 22.5 cases to more than 154.8 cases per 100 000. Peak incidence has shifted from 4 to 6 years old. The estimated period and cohort effects showed significant upward patterns, with a linear increasing trend by net drift. There has been an increase in the incidence among the Korean population regarding period and cohort despite the universal vaccination of varicella vaccine. Our data suggest the need for additional studies to address the current gap in herd immunity.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268819001389
      Issue No: Vol. 147 (2019)
  • Are there missed opportunities for vaccinating against hepatitis B among
           people who inject drugs in the UK'
    • Authors: J. Njoroge; V.D. Hope, C. O'Halloran, C. Edmundson, R Glass, J.V. Parry, F. Ncube
      Abstract: Sustaining the impact of hepatitis B virus (HBV) vaccination on incidence and prevalence of HBV infection requires increasing and maintaining the uptake of vaccine among those at risk. In recent years, the level of vaccine uptake among people who inject drugs (PWID) in the UK has levelled-off. Data (2015–2016) from the national unlinked-anonymous monitoring survey of PWID, an annual survey that collects data from PWID across England, Wales and Northern Ireland, were used to examine HBV vaccine uptake. Data from participants who had injected drugs during the previous year were used to investigate sources of hepatitis B vaccine doses as well as factors associated with vaccine uptake. Among the 3175 anti-HBc-negative participants, 3138 (99%) reported their vaccination status; 23% (714) reported no vaccine uptake. Among those not vaccinated, 447 (63%) reported being sexually active and 116 (16%) reported sharing needles and syringes. Majority of those not vaccinated reported accessing services in the previous year that could have provided hepatitis B vaccine doses. These missed opportunities for vaccinating of PWID indicate a need for additional targeted interventions.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268819001353
      Issue No: Vol. 147 (2019)
  • Effects of large-scale oceanic phenomena on non-cholera vibriosis
           incidence in the United States: implications for climate change
    • Authors: Chloë Logar-Henderson; Rebecca Ling, Ashleigh R. Tuite, David N. Fisman
      Abstract: Non-cholera Vibrio (NCV) species are important causes of disease. These pathogens are thermophilic and climate change could increase the risk of NCV infection. The El Niño Southern Oscillation (ENSO) is a ‘natural experiment’ that may presage ocean warming effects on disease incidence. In order to evaluate possible climatic contributions to observed increases in NCV infection, we obtained NCV case counts for the United States from publicly available surveillance data. Trends and impacts of large-scale oceanic phenomena, including ENSO, were evaluated using negative binomial and distributed non-linear lag models (DNLM). Associations between latitude and changing risk were evaluated with meta-regression. Trend models demonstrated expected seasonality (P < 0.001) and a 7% (6.1%–8.1%) annual increase in incidence from 1999 to 2014. DNLM demonstrated increased vibriosis risk following ENSO conditions over the subsequent 12 months (relative risk 1.940, 95% confidence interval (CI) 1.298–2.901). The ‘relative–relative risk’ (RRR) of annual disease incidence increased with latitude (RRR per 10° increase 1.066, 95% CI 1.027–1.107). We conclude that NCV risk in the United States is impacted by ocean warming, which is likely to intensify with climate change, increasing NCV risk in vulnerable populations.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268819001316
      Issue No: Vol. 147 (2019)
  • peste+des+petits+ruminants+seroprevalence+in+northern+Tanzania+across+sheep,+goats+and+cattle&rft.title=Epidemiology+&+Infection&rft.issn=0950-2688&,+B.+J.+Willett,+T.+J.+Kibona,+I.+M.+Cattadori,+V.+Kapur,+P.+J.+Hudson,+J.+Buza,+S.+Cleaveland,+O.+N.+Bjørnstad&rft_id=info:doi/10.1017/S0950268819001262">Pastoral production is associated with increased peste des petits
           ruminants seroprevalence in northern Tanzania across sheep, goats and
    • Authors: C. M. Herzog; W. A. de Glanville, B. J. Willett, T. J. Kibona, I. M. Cattadori, V. Kapur, P. J. Hudson, J. Buza, S. Cleaveland, O. N. Bjørnstad
      Abstract: Peste des petits ruminants virus (PPRV) causes a contagious disease of high morbidity and mortality in small ruminant populations globally. Using cross-sectional serosurvey data collected in 2016, our study investigated PPRV seroprevalence and risk factors among sheep, goats and cattle in 20 agropastoral (AP) and pastoral (P) villages in northern Tanzania. Overall observed seroprevalence was 21.1% (95% exact confidence interval (CI) 20.1–22.0) with 5.8% seroprevalence among agropastoral (95% CI 5.0–6.7) and 30.7% among pastoral villages (95% CI 29.3–32.0). Seropositivity varied significantly by management (production) system. Our study applied the catalytic framework to estimate the force of infection. The associated reproductive numbers (R0) were estimated at 1.36 (95% CI 1.32–1.39), 1.40 (95% CI 1.37–1.44) and 1.13 (95% CI 1.11–1.14) for sheep, goats and cattle, respectively. For sheep and goats, these R0 values are likely underestimates due to infection-associated mortality. Spatial heterogeneity in risk among pairs of species across 20 villages was significantly positively correlated (R2: 0.59–0.69), suggesting either cross-species transmission or common, external risk factors affecting all species. The non-negligible seroconversion in cattle may represent spillover or cattle-to-cattle transmission and must be investigated further to understand the role of cattle in PPRV transmission ahead of upcoming eradication efforts.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268819001262
      Issue No: Vol. 147 (2019)
  • Syndemic effects of HIV risk behaviours: results from the NHANES study
    • Authors: L. Smith; C. Cao, X. Zong, D. T. McDermott, S. Stefanac, S. Haider, S. E. Jackson, N. Veronese, G. F. López-Sánchez, A. Koyanagi, L. Yang, I. Grabovac
      Abstract: The aim of the present study is to use the syndemic framework to investigate the risk of contracting HIV in the US population. Cross-sectional analyses are from The National Health and Nutrition Examination Survey. We extracted and aggregated data on HIV antibody test, socio-demographic characteristics, alcohol use, drug use, depression, sexual behaviours and sexually transmitted diseases from cycle 2009–2010 to 2015–2016. We carried out weighted regression among young adults (20–39 years) and adults (40–59 years) separately. In total, 5230 men and 5794 women aged 20–59 years were included in the present analyses. In total, 0.8% men and 0.2% women were tested HIV-positive. Each increasing HIV risk behaviour was associated with elevated odds of being tested HIV-positive (1.15, 95% CI 1.15–1.15) among young adults and adults (1.61, 95% CI 1.61–1.61). Multi-faceted, community-based interventions are urgently required to reduce the incidence of HIV in the USA.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S095026881900133X
      Issue No: Vol. 147 (2019)
  • Hepatitis C subtype distribution in chronically infected patients with
           mild liver fibrosis in France: the GEMHEP study
    • Authors: T. Semenova; B. Nemoz, V. Thibault, G. Lagathu, G. Duverlie, E. Brochot, P. Trimoulet, C. Payan, S. Vallet, C. Henquell, S. Chevaliez, M. Bouvier-Alias, S. Maylin, A-M. Roque-Afonso, L. Izquierdo, F. Lunel-Fabiani, P. Marcellin, P. Morand, V. Leroy, S. Larrat
      Abstract: Treatment options for Hepatitis C infection have greatly improved with direct-acting antiviral (DAA) combinations achieving high cure rates. Nevertheless, the cost of this treatment is still high and access to treatment in many countries has been preferentially reserved for patients with more severe fibrosis (F3 and F4). In this French nationwide study, we investigated the epidemiological characteristics and genotype distribution of hepatitis C virus (HCV) in treatment-naive patients with METAVIR fibrosis stages between F0 and F2 in order to identify patient profiles that became eligible for unrestricted treatment in a second period. Between 2015 and 2016 we collected data from nine French university hospitals on a total of 584 HCV positive patients with absent, mild or moderate liver fibrosis. The most represented genotypes were genotype 1b (159/584; 27.2%), followed by genotype 1a (150/584; 25.7%); genotype 3 (87/584: 14.9%); genotype 4 (80/584; 13.7%). Among genotype 4: 4a was predominantly encountered with 22 patients (27.5% of genotype 4). Genotypes 1b and 1a are currently the most frequent virus types present in treatment-naive patients with mild fibrosis in France. They can be readily cured using the available DAA. Nevertheless, non-a/non-d genotype 4 is also frequent in this population and clinical data on the efficacy of DAA on these subtypes is missing. The GEMHEP is the French group for study and evaluation of viral hepatitis on a national scale. Data collection on epidemiological and molecular aspects of viral hepatitis is performed on a regular basis in all main French teaching hospitals and serves as a basis for surveillance of these infections. Analysis and trends are regularly published on behalf of the GEMHEP group. Data collection was performed retrospectively over the 2015–2016 period, covering nine main university hospitals in France. A total of 584 hepatitis C positive patients were included in this study. Genotyping of the circulating viruses showed a high prevalence of genotypes 1b and 1a in our population. The epidemiology of hepatitis C is slowly changing in France, particularly as a consequence of the rise of ‘non-a non-d’ genotype 4 viruses mainly originating from African populations. More data concerning treatment efficacy of these genotypes is needed in order to guide clinical care.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268819001225
      Issue No: Vol. 147 (2019)
  • Aedes+albopictus+bites+in+mainland+France+using+an+immunological+biomarker&rft.title=Epidemiology+&+Infection&rft.issn=0950-2688&,+F.+Binetruy,+E.+Elguero,+F.+Darriet,+P.+Gallian,+X.+De+Lamballerie,+R.+N.+Charrel,+F.+Remoue&rft_id=info:doi/10.1017/S0950268819001286">Risk factors of exposure to Aedes albopictus bites in mainland France
           using an immunological biomarker
    • Authors: A. Poinsignon; D. Boulanger, F. Binetruy, E. Elguero, F. Darriet, P. Gallian, X. De Lamballerie, R. N. Charrel, F. Remoue
      Abstract: In recent decades, the invasive Aedes albopictus vector has spread across Europe and is responsible for numerous outbreaks of autochthonous arboviral disease. The aim of this study was to identify epidemiological and sociological risk factors related to individual levels of exposure to Aedes albopictus bites. A multidisciplinary survey was conducted with volunteer blood donors living in areas either colonised or not by Aedes albopictus in mainland France. Individual levels of exposure were evaluated by measuring the IgG level specific to Aedes albopictus saliva. The most striking risk factors concerned the localisation and characteristics of the dwelling. Individuals living in areas colonised prior to 2009 or recently colonised (between 2010 and 2012) had higher anti-salivary gland extract IgG levels compared with those who were living in areas not yet colonised by Ae. albopictus. The type of dwelling did not seem to impact the level of exposure to Aedes bites. People living in apartments had a higher anti-salivary gland extract IgG level than those living in individual houses but the difference was not statistically significant. Interestingly, the presence of air conditioning or window nets was associated with a noticeable reduction in bite intensity.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268819001286
      Issue No: Vol. 147 (2019)
  • The public health importance of scabies in community domiciliary care
           settings: an exploratory cross-sectional survey of Health Protection Teams
           in England
    • Authors: Emily Phipps; Maaike. E. Pietzsch, Jackie A. Cassell, Clare Humphreys
      Abstract: Scabies is a contagious skin infection commonly occurring in institutions such as care homes. However, a large proportion of vulnerable people in England receive domiciliary care in the community and their experience of scabies has not been described. We undertook a pragmatic cross-sectional survey of Health Protection Teams (HPTs) in England to determine the burden of scabies related to domiciliary care. Fifteen cases or outbreaks were notified to HPTs between January 2013 and December 2017. Although a relatively uncommon event for individual HPTs, they were complex to manage and required the co-ordination of multiple stakeholders. Diagnosis was often delayed and required several clinical consultations. A lack of guidance led to difficulties establishing stakeholder roles and responsibilities and sources of funding for treatment. The stigmatisation of scabies sometimes affected the quality of care provided to patients, such as use of excessive personal protective equipment. Our study demonstrates that scabies is an issue of public health importance for domiciliary care service providers and users, and research is required to better understand the impacts of the disease and to develop evidence-based guidance. More generally, there is a need for simpler treatment regimens and methods of diagnosing scabies.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268819001274
      Issue No: Vol. 147 (2019)
  • Pteropus+alecto)&rft.title=Epidemiology+&+Infection&rft.issn=0950-2688&,+L.+Huth,+D.+G.+Mayer,+M.+E.+Vidgen,+L.+McMichael,+A.+Broos,+D.+Melville,+J.+Kristoffersen,+C.+de+Jong,+A.+McLaughlin,+H.+E.+Field&rft_id=info:doi/10.1017/S0950268819001237">Time of year, age class and body condition predict Hendra virus infection
           in Australian black flying foxes (Pteropus alecto)
    • Authors: D. Edson; A. J. Peel, L. Huth, D. G. Mayer, M. E. Vidgen, L. McMichael, A. Broos, D. Melville, J. Kristoffersen, C. de Jong, A. McLaughlin, H. E. Field
      Abstract: Hendra virus (HeV) continues to cause fatal infection in horses and threaten infection in close-contact humans in eastern Australia. Species of Pteropus bats (flying-foxes) are the natural reservoir of the virus. We caught and sampled flying-foxes from a multispecies roost in southeast Queensland, Australia on eight occasions between June 2013 and June 2014. The effects of sample date, species, sex, age class, body condition score (BCS), pregnancy and lactation on HeV antibody prevalence, log-transformed median fluorescent intensity (lnMFI) values and HeV RNA status were assessed using unbalanced generalised linear models. A total of 1968 flying-foxes were sampled, comprising 1012 Pteropus alecto, 742 P. poliocephalus and 214 P. scapulatus. Sample date, species and age class were each statistically associated with HeV RNA status, antibody status and lnMFI values; BCS was statistically associated with HeV RNA status and antibody status. The findings support immunologically naïve sub-adult P. alecto playing an important role in maintaining HeV infection at a population level. The biological significance of the association between BCS and HeV RNA status, and BCS and HeV antibody status, is less clear and warrants further investigation. Contrary to previous studies, we found no direct association between HeV infection and pregnancy or lactation. The findings in P. poliocephalus suggest that HeV exposure in this species may not result in systemic infection and virus excretion, or alternatively, may reflect assay cross-reactivity with another (unidentified) henipavirus.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268819001237
      Issue No: Vol. 147 (2019)
  • Spatial diffusion of the 2015–2016 Zika, dengue and chikungunya
           epidemics in Rio de Janeiro Municipality, Brazil
    • Authors: A. P. R. Dalvi; J. U. Braga
      Abstract: Different countries, especially Brazil, that have faced recurrent dengue epidemics for decades and chikungunya epidemics since 2014, have had to restructure their health services to combat a triple epidemic of arboviruses – Zika, dengue and Chikungunya – transmitted by the same vector, mainly Aedes aegypti, in 2015–2016. Several efforts have been made to better understand these three arboviruses. Spatial analysis plays an important role in the knowledge of disease dynamics. The knowledge of the patterns of spatial diffusion of these three arboviruses during an epidemic can contribute to the planning of surveillance actions and control of these diseases. This study aimed to identify the spatial diffusion processes of these viruses in the context of the triple epidemic in 2015–2016 in Rio de Janeiro, Brazil. Two study designs were used: cross-sectional and ecological. Sequential Kernel maps, nearest-neighbour ratios calculated cumulatively over time, Moran global autocorrelation correlograms, and local autocorrelation changes over time were used to identify spatial diffusion patterns. The results suggested an expansion diffusion pattern for the three arboviruses during 2015–2016 in Rio de Janeiro. These findings can be considered for more effective control measures and for new studies on the dynamics of these three arboviruses.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268819001250
      Issue No: Vol. 147 (2019)
  • Escherichia+coli+with+specific+foods:+a+systematic+review+and+meta-analysis+of+case-control+studies&rft.title=Epidemiology+&+Infection&rft.issn=0950-2688&,+I.+Young,+A.+Gill,+S.+E.+Majowicz&rft_id=info:doi/10.1017/S0950268819001183">Associating sporadic, foodborne illness caused by Shiga toxin-producing
           Escherichia coli with specific foods: a systematic review and
           meta-analysis of case-control studies
    • Authors: B. Devleesschauwer; S. M. Pires, I. Young, A. Gill, S. E. Majowicz
      Abstract: Shiga toxin-producing Escherichia coli (STEC) infections are a significant public health issue, with foodborne transmission causing >1 million illnesses worldwide each year. We conducted a systematic review and meta-analysis (PROSPERO registry # CRD42017074239), to determine the relative association of different food types with sporadic illnesses caused by STEC. Searches were conducted from 01 August to 30 September 2017, using bibliographic and grey literature databases, websites and expert consultation. We identified 22 case-control studies of sporadic STEC infection in humans, from 10 countries within four World Health Organization subregions, from 1985 to 2012. We extracted data from 21 studies, for 237 individual measures in 11 food categories and across three status types (raw or undercooked, not raw and unknown). Beef was the most significant food item associated with STEC illness in the Americas and Europe, but in the Western Pacific region, chicken was most significant. These findings were not significantly moderated by the raw or cooked status of the food item, nor the publication year of the study. Data from the African, South-East Asian and Eastern Mediterranean subregions were lacking and it is unclear whether our results are relevant to these regions.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268819001183
      Issue No: Vol. 147 (2019)
  • Escherichia+coli+infections+using+analysis+of+outbreak+surveillance+data&rft.title=Epidemiology+&+Infection&rft.issn=0950-2688&,+Alexander+Gill,+Brecht+Devleesschauwer&rft_id=info:doi/10.1017/S095026881900116X">Global and regional source attribution of Shiga toxin-producing
           Escherichia coli infections using analysis of outbreak surveillance data
    • Authors: Sara M. Pires; Shannon Majowicz, Alexander Gill, Brecht Devleesschauwer
      Abstract: Shiga toxin-producing Escherichia coli (STEC) infections pose a substantial health and economic burden worldwide. To target interventions to prevent foodborne infections, it is important to determine the types of foods leading to illness. Our objective was to determine the food sources of STEC globally and for the six World Health Organization regions. We used data from STEC outbreaks that have occurred globally to estimate source attribution fractions. We categorised foods according to their ingredients and applied a probabilistic model that used information on implicated foods for source attribution. Data were received from 27 countries covering the period between 1998 and 2017 and three regions: the Americas (AMR), Europe (EUR) and Western-Pacific (WPR). Results showed that the top foods varied across regions. The most important sources in AMR were beef (40%; 95% Uncertainty Interval 39–41%) and produce (35%; 95% UI 34–36%). In EUR, the ranking was similar though with less marked differences between sources (beef 31%; 95% UI 28–34% and produce 30%; 95% UI 27–33%). In contrast, the most common source of STEC in WPR was produce (43%; 95% UI 36–46%), followed by dairy (27%; 95% UI 27–27%). Possible explanations for regional variability include differences in food consumption and preparation, frequency of STEC contamination, the potential of regionally predominant STEC strains to cause severe illness and differences in outbreak investigation and reporting. Despite data gaps, these results provide important information to inform the development of strategies for lowering the global burden of STEC infections.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S095026881900116X
      Issue No: Vol. 147 (2019)
  • Usutu virus: A new threat'
    • Authors: M. Clé; C. Beck, S. Salinas, S. Lecollinet, S. Gutierrez, P. Van de Perre, T. Baldet, V. Foulongne, Y. Simonin
      Abstract: Usutu virus (USUV) is an emerging arbovirus that was first isolated in South Africa in 1959. This Flavivirus is maintained in the environment through a typical enzootic cycle involving mosquitoes and birds. USUV has spread to a large part of the European continent over the two decades mainly leading to substantial avian mortalities with a significant recrudescence of bird infections recorded throughout Europe within the few last years. USUV infection in humans is considered to be most often asymptomatic or to cause mild clinical signs. Nonetheless, a few cases of neurological complications such as encephalitis or meningoencephalitis have been reported. USUV and West Nile virus (WNV) share many features, like a close phylogenetic relatedness and a similar ecology, with co-circulation frequently observed in nature. However, USUV has been much less studied and in-depth comparisons of the biology of these viruses are yet rare. In this review, we discuss the main body of knowledge regarding USUV and compare it with the literature on WNV, addressing in particular virological and clinical aspects, and pointing data gaps.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268819001213
      Issue No: Vol. 147 (2019)
  • Baseline incidence of adverse birth outcomes and infant influenza and
           pertussis hospitalisations prior to the introduction of influenza and
           pertussis vaccination in pregnancy: a data linkage study of 78 382
           mother–infant pairs, Northern Territory, Australia, 1994–2015
    • Authors: L. McHugh; R.M. Andrews, B. Leckning, T. Snelling, M.J. Binks
      Abstract: We conducted probabilistic data linkage of three population datasets for the Northern Territory (NT), Australia, to describe the incidence of preterm births, stillbirths, low birthweight and small for gestational age (SGA) per 1000 NT births; and influenza and pertussis hospitalisations per 1 00 000 NT births in infants
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268819001171
      Issue No: Vol. 147 (2019)
  • Clostridioides+difficile+infection&rft.title=Epidemiology+&+Infection&rft.issn=0950-2688&,+F.+Bella,+J.+Pérez,+A.+Hornero,+E.+Limon,+F.+Gudiol,+M.+Pujol&rft_id=info:doi/10.1017/S0950268819001080">Impact of a training program on the surveillance of Clostridioides
           difficile infection
    • Authors: N. Sopena; N. Freixas, F. Bella, J. Pérez, A. Hornero, E. Limon, F. Gudiol, M. Pujol
      Abstract: A high degree of vigilance and appropriate diagnostic methods are required to detect Clostridioides difficile infection (CDI). We studied the effectiveness of a multimodal training program for improving CDI surveillance and prevention. Between 2011 and 2016, this program was made available to healthcare staff of acute care hospitals in Catalonia. The program included an online course, two face-to-face workshops and dissemination of recommendations on prevention and diagnosis. Adherence to the recommendations was evaluated through surveys administered to the infection control teams at the 38 participating hospitals. The incidence of CDI increased from 2.20 cases/10 000 patient-days in 2011 to 3.41 in 2016 (P < 0.001). The number of hospitals that applied an optimal diagnostic algorithm rose from 32.0% to 71.1% (P = 0.002). Hospitals that applied an optimal diagnostic algorithm reported a higher overall incidence of CDI (3.62 vs. 1.92, P < 0.001), and hospitals that were more active in searching for cases reported higher rates of hospital-acquired CDI (1.76 vs. 0.84, P < 0.001). The results suggest that the application of a multimodal training strategy was associated with a significant rise in the reporting of CDI, as well as with an increase in the application of the optimal diagnostic algorithm.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268819001080
      Issue No: Vol. 147 (2019)
  • Symptom profiling for infectious intestinal disease (IID): a secondary
           data analysis of the IID2 study
    • Authors: A. L. Donaldson; H. E. Clough, S. J. O'Brien, J. P. Harris
      Abstract: Less than half of stool samples from people symptomatic with infectious intestinal disease (IID) will identify a causative organism. A secondary data analysis was undertaken to explore whether symptomology alone could be used to make inferences about causative organisms. Data were utilised from the Second Study of Infectious Intestinal Disease in the Community. A total of 844 cases were analysed. Few symptoms differentiated individual pathogens, but grouping pathogens together showed that viral IID was more likely when symptom onset was in winter (odds ratio (OR) 2.08, 95% confidence interval (CI) 1.16–3.75) or spring (OR 1.92, 95% CI 1.11–3.33), the patient was aged under 5 years (OR 3.63, 95% CI 2.24–6.03) and there was loss of appetite (OR 2.19, 95% CI 1.29–3.72). The odds of bacterial IID were higher with diarrhoea in the absence of vomiting (OR 3.54, 95% CI 2.37–5.32), diarrhoea which persisted for >3 days (OR 2.69, 95% CI 1.82–3.99), bloody diarrhoea (OR 4.17, 95% CI 1.63–11.83) and fever (OR 1.67, 95% CI 1.11–2.53). Symptom profiles could be of value to help guide clinicians and public health professionals in the management of IID, in the absence of microbiological confirmation.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268819001201
      Issue No: Vol. 147 (2019)
  • Comparison of the epidemiological aspects of acute infectious diseases
           between foreign and native imported cases in the border counties of
           Southwest China, 2008–2017
    • Authors: Li Jiang; Tian Huang
      Abstract: This study analysed the epidemiological characteristics of imported cases of acute infectious diseases and compared these features by nationality in 25 border counties of Yunnan Province from 2008 to 2017 to inform prevention strategies. Surveillance data for the imported cases collected in the border counties were analysed to determine disease variety, seasonal patterns, infection site and personal demographics and these features were compared by patient nationality. A total of 12 820 imported cases were reported in the 25 border counties, with 5610 foreign cases and 7210 native cases. The disease spectrum was more diverse among foreign cases than among native cases. Both foreign and native cases were mostly imported from Myanmar. The shift in the number of foreign cases was greater than that of native cases after 2016. Ruili, a city, that shares a border with Myanmar, exhibited the greatest number of imported infections. Farmers, businessmen, women and preschool children were frequently diagnosed with infections. Multiple prevention strategies including disease screening at the border, health education before departure and health service provision to foreigners should be carried out to reduce the risk of autochthonous spreading and to avoid potential outbreaks. Furthermore, international collaboration in terms of sharing infectious disease data should be improved between China and neighbouring countries.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268819001195
      Issue No: Vol. 147 (2019)
  • Norovirus waterborne outbreak in Chalkidiki, Greece, 2015: detection of
           GI.P2_GI.2 and GII.P16_GII.13 unusual strains
    • Authors: K. Tryfinopoulou; M. Kyritsi, K. Mellou, F. Kolokythopoulou, V.A. Mouchtouri, M. Potamiti-Komi, A. Lamprou, Th. Georgakopoulou, C. Hadjichristodoulou
      Abstract: Noroviruses, along with rotaviruses, are among the leading causes of gastroenteritis worldwide and novel strains are periodically emerging. In August 2015, an unusual increase of gastroenteritis cases occurred in a touristic district in Kassandra peninsula, Chalkidiki, Northern Greece. Seven stool specimens from cases were tested positive for norovirus. Molecular investigation and phylogenetic analysis identified that there was co-circulation of norovirus GI.P2_GI.2 and the recombinant strain GII.P16_GII.13. A 1:1 case–control study conducted and showed that tap water consumption significantly associated with developing symptoms of gastroenteritis (odds ratio = 36.9, P = 0.018). The results of the epidemiological investigation, the co-circulation of two different norovirus strains, the information of a pipeline breakage at the water supply system before the onset of cases, and reports on flooded wells and sewage overflow, indicated the possibility of water contamination by sewage during the pipeline breakage leading to a large outbreak with a peak at 10 August and a possible secondary person-to-person transmission after the 16th of August. Norovirus GI.P2_GI.2 strains are rarely reported in Europe, while it is the first time that infection from the recombinant strain GII.P16_GII.13 is recorded in Greece.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268819000852
      Issue No: Vol. 147 (2019)
  • Meningococcal carriage by age in the African meningitis belt: a systematic
           review and meta-analysis
    • Authors: L. V. Cooper; P. A. Kristiansen, H. Christensen, A. Karachaliou, C. L. Trotter
      Abstract: Meningococcal carriage dynamics drive patterns of invasive disease. The distribution of carriage by age has been well described in Europe, but not in the African meningitis belt, a region characterised by frequent epidemics of meningitis. We aimed to estimate the age-specific prevalence of meningococcal carriage by season in the African meningitis belt. We searched PubMed, Web of Science, the Cochrane Library and grey literature for papers reporting carriage of Neisseria meningitidis in defined age groups in the African meningitis belt. We used a mixed-effects logistic regression to model meningococcal carriage prevalence as a function of age, adjusting for season, location and year. Carriage prevalence increased from low prevalence in infants (0.595% in the rainy season, 95% CI 0.482–0.852%) to a broad peak at age 10 (1.94%, 95% CI 1.87–2.47%), then decreased in adolescence. The odds of carriage were significantly increased during the dry season (OR 1.5 95% CI 1.4–1.7) and during outbreaks (OR 6.7 95% CI 1.6–29). Meningococcal carriage in the African meningitis belt peaks at a younger age compared to Europe. This is consistent with contact studies in Africa, which show that children 10–14 years have the highest frequency of contacts. Targeting older children in Africa for conjugate vaccination may be effective in reducing meningococcal transmission.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268819001134
      Issue No: Vol. 147 (2019)
  • A foodborne norovirus outbreak in a nursing home and spread to staff and
           their household contacts
    • Authors: I. Parrón; J. Álvarez, M. Jané, T. Cornejo Sánchez, E. Razquin, S. Guix, G. Camps, C. Pérez, À. Domínguez
      Abstract: On 16 March 2018, a nursing home notified a possible acute gastroenteritis outbreak that affected 11 people. Descriptive and case–control studies and analysis of clinical and environmental samples were carried out to determine the characteristics of the outbreak, its aetiology, the transmission mechanism and the causal food. The extent of the outbreak in and outside the nursing home was determined and the staff factors influencing propagation were studied by multivariate analysis. A turkey dinner on March 14 was associated with the outbreak (OR 4.22, 95% CI 1.11–16.01). Norovirus genogroups I and II were identified in stool samples. The attack rates in residents, staff and household contacts of staff were 23.49%, 46.22% and 22.87%, respectively. Care assistants and cleaning staff were the staff most frequently affected. Cohabitation with an affected care assistant was the most important factor in the occurrence of cases in the home (adjusted OR 6.37, 95% CI 1.13–36.02). Our results show that staff in close contact with residents and their household contacts had a higher risk of infection during the norovirus outbreak.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268819001146
      Issue No: Vol. 147 (2019)
  • Bayesian modelling of a hepatitis A outbreak in men who have sex with men
           in Sydney, Australia, 1991/1992
    • Authors: X.-S. Zhang; A. Charlett
      Abstract: To control hepatitis A spread by vaccination, accurate estimation of transmissibility is vital. Regan et al. (2016) proposed a model of hepatitis A virus (HAV) transmission and used least squares to calibrate model to the 1991/1992 HAV outbreak in men who have sex with men (MSM) in Sydney, Australia. Based on the estimate of R0, they obtained the critical immunity of 70% and showed that when the proportion immune
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268819001109
      Issue No: Vol. 147 (2019)
  • Subtype-specific differences in the risk of hospitalisation among patients
           infected with hepatitis E virus genotype 3 in Belgium, 2010–2018
    • Authors: Lorenzo Subissi; Michael Peeters, Sophie Lamoral, Sofieke Klamer, Vanessa Suin, Steven Van Gucht
      Abstract: Some European countries recently reported an increase in hepatitis E virus genotype 3 (HEV-3) of the subtype 3c. No link between HEV-3 subtypes and severity is established to date. Here, we report that patients infected with HEV-3c were at lower risk of hospitalisation, compared to those infected with HEV-3f, the other main subtype circulating in Belgium.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268819001122
      Issue No: Vol. 147 (2019)
  • Length of stay and odds of MRSA acquisition: a dose–response
    • Authors: H. Y. Loke; W. M. Kyaw, M. I. C. Chen, J. W. Lim, B. Ang, A. Chow
      Abstract: The association between methicillin-resistant Staphylococcus aureus (MRSA) colonisation and/or infection with increased morbidity and mortality among hospital patients has long been recognised. We sought to build on previous studies to identify modifiable risk factors associated with the acquisition of MRSA colonisation and infection by conducting a retrospective cohort study on patients admitted through the Emergency Department of an acute tertiary-care general hospital in Singapore which implemented universal on-admission MRSA screening. Patients were assigned to the acquisition or non-acquisition group depending on whether they acquired MRSA during their admission. We used logistic regression models with a patient being in the acquisition group as the binary outcome to identify factors associated with MRSA acquisition. A total of 1302 acquisition and 37 949 non-acquisition group patients were analysed. Fifteen variables were included in the multivariate model. A dose–response relationship between length of stay and odds of MRSA acquisition was observed, with a length of stay 3 weeks or more (Adj OR 11.78–57.36, all P < 0.001) being the single biggest predictor of MRSA acquisition. Other variables significantly associated with MRSA acquisition were: male gender, age 65 or greater, previous MRSA colonisation or infection, exposure to certain antibiotics and surgery, and history of diabetes.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268819001110
      Issue No: Vol. 147 (2019)
  • A tuberculosis outbreak at an insecure, temporary housing facility, manga
           café, Tokyo, Japan, 2016–2017
    • Authors: M. Endo; M. Ota, A. Kayebeta, I. Takahashi, Y. Nagata
      Abstract: In November 2016, a woman in her 30s who stayed at an insecure, temporary housing facility, a manga café in Tokyo, Japan, for a year was diagnosed with sputum smear-positive tuberculosis (TB). Since the café had 31 staff members and provided with accommodation to many people, the local health office initiated a contact investigation. This study aims to characterise the cases found in the outbreak. A TB case was defined as a person tested bacteriologically positive for TB, or was determined to have TB by a physician. A latent TB infection case was defined as a person tested positive by interferon-γ release assay. From January 2016 through November 2017, there were 31 staff members at the manga café, of which, six developed TB disease (one smear-negative, culture-positive and five smear- and culture-negative) in addition to seven LTBI. Another long-term customer was found having sputum smear-positive TB. Variable numbers tandem repeat (VNTR) test revealed that the index patient and the long-term customer had the identical type of VNTR; however, one staff member had a different VNTR. Local health authorities should intensify screening long-term customers of such facilities for TB regularly as well as once a TB outbreak occurs.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268819001092
      Issue No: Vol. 147 (2019)
  • Patients with laboratory evidence of West Nile virus disease without
           reported fever
    • Authors: K. Landry; I. B. Rabe, S. L. Messenger, J. K. Hacker, M. L. Salas, C. Scott-Waldron, D. Haydel, E. Rider, S. Simonson, C. M. Brown, S. C. Smole, D. F. Neitzel, E. K. Schiffman, A. K. Strain, S. Vetter, M. Fischer, N. P. Lindsey
      Abstract: In 2013, the national surveillance case definition for West Nile virus (WNV) disease was revised to remove fever as a criterion for neuroinvasive disease and require at most subjective fever for non-neuroinvasive disease. The aims of this project were to determine how often afebrile WNV disease occurs and assess differences among patients with and without fever. We included cases with laboratory evidence of WNV disease reported from four states in 2014. We compared demographics, clinical symptoms and laboratory evidence for patients with and without fever and stratified the analysis by neuroinvasive and non-neuroinvasive presentations. Among 956 included patients, 39 (4%) had no fever; this proportion was similar among patients with and without neuroinvasive disease symptoms. For neuroinvasive and non-neuroinvasive patients, there were no differences in age, sex, or laboratory evidence between febrile and afebrile patients, but hospitalisations were more common among patients with fever (P < 0.01). The only significant difference in symptoms was for ataxia, which was more common in neuroinvasive patients without fever (P = 0.04). Only 5% of non-neuroinvasive patients did not meet the WNV case definition due to lack of fever. The evidence presented here supports the changes made to the national case definition in 2013.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268819001079
      Issue No: Vol. 147 (2019)
  • Estimating prevalence from dried blood spots without using biological
           cut-offs: application of a novel approach to hepatitis C virus in drug
           users in France (ANRS-Coquelicot survey)
    • Authors: L. Léon; J. Pillonel, M. Jauffret-Roustide, F. Barin, Y. Le Strat
      Abstract: Seroprevalence estimation using cross-sectional serosurveys can be challenging due to inadequate or unknown biological cut-off limits of detection. In recent years, diagnostic assay cut-offs, fixed assay cut-offs and more flexible approaches as mixture modelling have been proposed to classify biological quantitative measurements into a positive or negative status. Our objective was to estimate the prevalence of anti-HCV antibodies among drug users (DU) in France in 2011 using a biological test performed on dried blood spots (DBS) collected during a cross-sectional serosurvey. However, in 2011, we did not have a cut-off value for DBS. We could not use the values for serum or plasma, knowing that the DBS value was not necessarily the same. Accordingly, we used a method which consisted of applying a two-component mixture model with age-dependent mixing proportions using penalised splines. The component densities were assumed to be log-normally distributed and were estimated in a Bayesian framework. Anti-HCV prevalence among DU was estimated at 43.3% in France and increased with age. Our method allowed us to provide estimates of age-dependent prevalence using DBS without having a specified biological cut-off value.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268819001043
      Issue No: Vol. 147 (2019)
  • Using routine testing data to understand circulation patterns of influenza
           A, respiratory syncytial virus and other respiratory viruses in Victoria,
    • Authors: O. H. Price; S. G. Sullivan, C. Sutterby, J. Druce, K. S. Carville
      Abstract: Several studies have reported evidence of interference between respiratory viruses: respiratory viruses rarely reach their epidemic peak concurrently and there appears to be a negative association between infection with one respiratory virus and co-infection with another. We used results spanning 16 years (2002–2017) of a routine diagnostic multiplex panel that tests for nine respiratory viruses to further investigate these interactions in Victoria, Australia. Time series analyses were used to plot the proportion positive for each virus. The seasonality of all viruses included was compared with respiratory syncytial virus (RSV) and influenza A virus using cross-correlations. Logistic regression was used to explore the likelihood of co-infection with one virus given infection with another. Seasonal peaks were observed each year for influenza A and RSV and less frequently for influenza B, coronavirus and parainfluenza virus. RSV circulated an average of 6 weeks before influenza A. Co-infection with another respiratory virus was less common with picornavirus, RSV or influenza A infection. Our findings provide further evidence of a temporal relationship in the circulation of respiratory viruses. A greater understanding of the interaction between respiratory viruses may enable better prediction of the timing and magnitude of respiratory virus epidemics.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268819001055
      Issue No: Vol. 147 (2019)
  • Prior exposure to immunogenic peptides found in human influenza A viruses
           may influence the age distribution of cases with avian influenza H5N1 and
           H7N9 virus infections
    • Authors: N. Komadina; S. G. Sullivan, K. Kedzierska, S. M. Quiñones-Parra, K. Leder, J. McVernon
      Abstract: The epidemiology of H5N1 and H7N9 avian viruses of humans infected in China differs despite both viruses being avian reassortants that have inherited six internal genes from a common ancestor, H9N2. The median age of infected populations is substantially younger for H5N1 virus (26 years) compared with H7N9 virus (63 years). Population susceptibility to infection with seasonal influenza is understood to be influenced by cross-reactive CD8+ T cells directed towards immunogenic peptides derived from internal viral proteins which may provide some level of protection against further influenza infection. Prior exposure to seasonal influenza peptides may influence the age-related infection patterns observed for H5N1 and H7N9 viruses. A comparison of relatedness of immunogenic peptides between historical human strains and the two avian emerged viruses was undertaken for a possible explanation in the differences in age incidence observed. There appeared to be some relationship between past exposure to related peptides and the lower number of H5N1 virus cases in older populations, however the relationship between prior exposure and older populations among H7N9 virus patients was less clear.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S095026881900102X
      Issue No: Vol. 147 (2019)
  • Chlamydia+trachomatis+infection+as+a+risk+factor+for+subsequent+anorectal+infection+in+men+who+have+sex+with+men+(MSM)+and+women+visiting+STI+clinics+in+the+Netherlands&rft.title=Epidemiology+&+Infection&rft.issn=0950-2688&,+C.J.P.A.+Hoebe,+A.A.+Hogewoning,+H.J.C.+de+Vries,+N.H.T.M.+Dukers-Muijrers&rft_id=info:doi/10.1017/S0950268819001018">A longitudinal study to investigate previous Chlamydia trachomatis
           infection as a risk factor for subsequent anorectal infection in men who
    • Authors: J. Leenen; G.A.F.S. van Liere, C.J.P.A. Hoebe, A.A. Hogewoning, H.J.C. de Vries, N.H.T.M. Dukers-Muijrers
      Abstract: Although anorectal Chlamydia trachomatis (CT) infections are frequently diagnosed in men who have sex with men (MSM) and women, the reason for this infection often remains unexplained, as anal sex is not always reported. Oropharyngeal infections inoculating the gastrointestinal (GI) tract may contribute to anorectal-CT infections, as evidence in animals suggests that chlamydia bacteria undergo GI passage; however, no evidence exists in humans. Longitudinal patient clinic-registry data from MSM (n = 17 125) and women (n = 4120) from two Dutch sexually transmitted infection clinics were analysed. When adjusting for confounding socio-demographics, co-infections and risk behaviour, previous (from 3 weeks up to 24 months) oropharyngeal CT was not a risk factor for subsequent anorectal CT in women (odds ratio (OR) 0.46; 95% confidence interval (CI) 0.18–1.18; P = 0.11) and MSM (OR 1.33; 95% CI 0.86–2.07; P = 0.204). Despite the large dataset, the numbers did not allow for the estimation of risk in specific subgroups of interest. The role of the GI tract cannot be excluded with this epidemiological study, but the impact of preceding oropharyngeal CT on anorectal-CT infection is likely limited.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268819001018
      Issue No: Vol. 147 (2019)
  • Escherichia+coli+(STEC)+infection+incidence,+risk+factors+and+clinical+features&rft.title=Epidemiology+&+Infection&rft.issn=0950-2688&,+T.+C.+Rose,+G.+K.+Adak,+C.+Jenkins,+A.+Charlett,+M.+Violato,+S.J.+O'Brien,+M.+M.+Whitehead,+B.+Barr,+D.+C.+Taylor-Robinson,+J.+I.+Hawker&rft_id=info:doi/10.1017/S0950268819000864">Influence of socio-economic status on Shiga toxin-producing Escherichia
           coli (STEC) infection incidence, risk factors and clinical features
    • Authors: N. L. Adams; L. Byrne, T. C. Rose, G. K. Adak, C. Jenkins, A. Charlett, M. Violato, S.J. O'Brien, M. M. Whitehead, B. Barr, D. C. Taylor-Robinson, J. I. Hawker
      Abstract: Shiga toxin-producing Escherichia coli (STEC) infection can cause serious illness including haemolytic uraemic syndrome. The role of socio-economic status (SES) in differential clinical presentation and exposure to potential risk factors amongst STEC cases has not previously been reported in England. We conducted an observational study using a dataset of all STEC cases identified in England, 2010–2015. Odds ratios for clinical characteristics of cases and foodborne, waterborne and environmental risk factors were estimated using logistic regression, stratified by SES, adjusting for baseline demographic factors. Incidence was higher in the highest SES group compared to the lowest (RR 1.54, 95% CI 1.19–2.00). Odds of Accident and Emergency attendance (OR 1.35, 95% CI 1.10–1.75) and hospitalisation (OR 1.71, 95% CI 1.36–2.15) because of illness were higher in the most disadvantaged compared to the least, suggesting potential lower ascertainment of milder cases or delayed care-seeking behaviour in disadvantaged groups. Advantaged individuals were significantly more likely to report salad/fruit/vegetable/herb consumption (OR 1.59, 95% CI 1.16–2.17), non-UK or UK travel (OR 1.76, 95% CI 1.40–2.27; OR 1.85, 95% CI 1.35–2.56) and environmental exposures (walking in a paddock, OR 1.82, 95% CI 1.22–2.70; soil contact, OR 1.52, 95% CI 2.13–1.09) suggesting other unmeasured risks, such as person-to-person transmission, could be more important in the most disadvantaged group.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268819000864
      Issue No: Vol. 147 (2019)
  • Mycobacterium+tuberculosis+isolates+from+a+high-burden+tuberculosis+state+in+Brazil&rft.title=Epidemiology+&+Infection&rft.issn=0950-2688&,+R.+B.+Barcellos,+B.+M.+Praetzel,+I.+S.+Anusca,+L.+S.+Esteves,+M.+L.+Halon,+G.+Unis,+C.F.+Dias,+S.+S.+Miranda,+I.+N.+de+Almeida,+L.+J.+de+Assis+Figueredo,+E.+C.+Silva,+A.+L.+Kritski,+E.+R.+Dalla+Costa,+M.+L.+R.+Rossetti&rft_id=info:doi/10.1017/S0950268819001006">Molecular characterisation of multidrug-resistant Mycobacterium
           tuberculosis isolates from a high-burden tuberculosis state in Brazil
    • Authors: R. S. Salvato; S. Schiefelbein, R. B. Barcellos, B. M. Praetzel, I. S. Anusca, L. S. Esteves, M. L. Halon, G. Unis, C.F. Dias, S. S. Miranda, I. N. de Almeida, L. J. de Assis Figueredo, E. C. Silva, A. L. Kritski, E. R. Dalla Costa, M. L. R. Rossetti
      Abstract: Tuberculosis (TB) is the leading cause of death among infectious diseases worldwide. Among the estimated cases of drug-resistant TB, approximately 60% occur in the BRICS countries (Brazil, Russia, India, China and South Africa). Among Brazilian states, primary and acquired multidrug-resistant TB (MDR-TB) rates were the highest in Rio Grande do Sul (RS). This study aimed to perform molecular characterisation of MDR-TB in the State of RS, a high-burden Brazilian state. We performed molecular characterisation of MDR-TB cases in RS, defined by drug susceptibility testing, using 131 Mycobacterium tuberculosis (M.tb) DNA samples from the Central Laboratory. We carried out MIRU-VNTR 24loci, spoligotyping, sequencing of the katG, inhA and rpoB genes and RDRio sublineage identification. The most frequent families found were LAM (65.6%) and Haarlem (22.1%). RDRio deletion was observed in 42 (32%) of the M.tb isolates. Among MDR-TB cases, eight (6.1%) did not present mutations in the studied genes. In 116 (88.5%) M.tb isolates, we found mutations associated with rifampicin (RIF) resistance in rpoB gene, and in 112 isolates (85.5%), we observed mutations related to isoniazid resistance in katG and inhA genes. An insertion of 12 nucleotides (CCAGAACAACCC) at the 516 codon in the rpoB gene, possibly responsible for a decreased interaction of RIF and RNA polymerase, was found in 19/131 of the isolates, belonging mostly to LAM and Haarlem families. These results enable a better understanding of the dynamics of transmission and evolution of MDR-TB in the region.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268819001006
      Issue No: Vol. 147 (2019)
  • Real-time estimation of the influenza-associated excess mortality in Hong
    • Authors: Jessica Y. Wong; Edward Goldstein, Vicky J. Fang, Benjamin J. Cowling, Peng Wu
      Abstract: Statistical models are commonly employed in the estimation of influenza-associated excess mortality that, due to various reasons, is often underestimated by laboratory-confirmed influenza deaths reported by healthcare facilities. However, methodology for timely and reliable estimation of that impact remains limited because of the delay in mortality data reporting. We explored real-time estimation of influenza-associated excess mortality by types/subtypes in each year between 2012 and 2018 in Hong Kong using linear regression models fitted to historical mortality and influenza surveillance data. We could predict that during the winter of 2017/2018, there were ~634 (95% confidence interval (CI): (190, 1033)) influenza-associated excess all-cause deaths in Hong Kong in population ⩾18 years, compared to 259 reported laboratory-confirmed deaths. We estimated that influenza was associated with substantial excess deaths in older adults, suggesting the implementation of control measures, such as administration of antivirals and vaccination, in that age group. The approach that we developed appears to provide robust real-time estimates of the impact of influenza circulation and complement surveillance data on laboratory-confirmed deaths. These results improve our understanding of the impact of influenza epidemics and provide a practical approach for a timely estimation of the mortality burden of influenza circulation during an ongoing epidemic.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268819001067
      Issue No: Vol. 147 (2019)
  • Molecular detection and characterisation of sapoviruses and noroviruses in
           outpatient children with diarrhoea in Northwest Ethiopia
    • Authors: A. Gelaw; C. Pietsch, P. Mann, U.G. Liebert
      Abstract: Childhood morbidity and mortality of diarrhoeal diseases are high, particularly in low-income countries and noroviruses and sapoviruses are among the most frequent causes worldwide. Their epidemiology and diversity remain not well studied in many African countries. To assess the positivity rate and the diversity of sapoviruses and noroviruses in Northwest Ethiopia, during November 2015 and April 2016, a total of 450 faecal samples were collected from outpatient children aged
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268819001031
      Issue No: Vol. 147 (2019)
  • Influenza vaccine effectiveness against hospitalisation due to
           laboratory-confirmed influenza in children in England in the 2015–2016
           influenza season – a test-negative case–control study
    • Authors: N. L. Boddington; F. Warburton, H. Zhao, N. Andrews, J. Ellis, M. Donati, R. G. Pebody
      Abstract: England has recently started a new paediatric influenza vaccine programme using a live-attenuated influenza vaccine (LAIV). There is uncertainty over how well the vaccine protects against more severe end-points. A test-negative case–control study was used to estimate vaccine effectiveness (VE) in vaccine-eligible children aged 2–16 years of age in preventing laboratory-confirmed influenza hospitalisation in England in the 2015–2016 season using a national sentinel laboratory surveillance system. Logistic regression was used to estimate the VE with adjustment for sex, risk-group, age group, region, ethnicity, deprivation and month of sample collection. A total of 977 individuals were included in the study (348 cases and 629 controls). The overall adjusted VE for all study ages and vaccine types was 33.4% (95% confidence interval (CI) 2.3–54.6) after adjusting for age group, sex, index of multiple deprivation, ethnicity, region, sample month and risk group. Risk group was shown to be an important confounder. The adjusted VE for all influenza types for the live-attenuated vaccine was 41.9% (95% CI 7.3–63.6) and 28.8% (95% CI −31.1 to 61.3) for the inactivated vaccine. The study provides evidence of the effectiveness of influenza vaccination in preventing hospitalisation due to laboratory-confirmed influenza in children in 2015–2016 and continues to support the rollout of the LAIV childhood programme.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268819000876
      Issue No: Vol. 147 (2019)
  • Sex and age distributions of persons in foodborne disease outbreaks and
           associations with food categories
    • Authors: P. D. Strassle; W. Gu, B. B. Bruce, L. H. Gould
      Abstract: Sex and age differences in food preferences may be reflected in the demographics of outbreaks. Outbreaks from 1998–2015 with a single confirmed implicated food source in the Centers for Disease Control and Prevention Foodborne Disease Outbreak Surveillance System were analysed using logistic regression to assess associations between a food category, sex and age. Males were more likely to be involved in outbreaks attributed to beef, pork, game, dairy and shellfish; females were more likely to be involved in grains-beans, nuts-seeds, fruits, sprouts and vegetable row crops outbreaks. Children
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268818003126
      Issue No: Vol. 147 (2019)
  • The+Eradication+of+Dracunculiasis+(Guinea+Worm+Disease)+in+Nigeria:+An+Eyewitness+Account.+By+Luke+Ekundayo+Edungbola.+Academic+Press,+Elsevier,+2019.+€101.33+(print+version)+and+€115.25+(ebook).+142+pp.&rft.title=Epidemiology+&+Infection&rft.issn=0950-2688&">The Eradication of Dracunculiasis (Guinea Worm Disease) in Nigeria: An
           Eyewitness Account. By Luke Ekundayo Edungbola. Academic Press, Elsevier,
           2019. €101.33 (print version) and €115.25 (ebook). 142 pp.
    • Authors: Lucy J. Robertson
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268819000918
      Issue No: Vol. 147 (2019)
  • HIV transmission between spouses living in Lu'an city, Anhui province,
           China: a longitudinal study
    • Authors: Gongyan Ma; Haiyan Chen, Jin Chen, Zhenghao Jiang, Tai Ma
      Abstract: This study aims to investigate the human immunodeficiency virus (HIV) transmission rate in HIV serodiscordant couples, in addition to the relevant influencing factors. From January 1999 to August 2016, patients with HIV/AIDS (index cases) along with their fixed partners were registered and monitored to determine the rate of HIV transmission between couples, as well as relevant influencing factors. A total of 231 HIV-positive couples were investigated, of these, 45-negative (19.48%) partners were infected with HIV via sexual transmission prior to diagnosis of the first case detected in couples. After diagnosis, the transmission rate between spouses was 0.39 per 100 person-years (2/507.7), and the cumulative transmission rate was 1.08% (2/186), which was significantly lower than the transmission rate before diagnosis (χ2 = 35.714, P < 0.001). Among the 119 HIV/AIDS patients who received antiretroviral therapy (ART), the transmission rate was 0 (0/119), whereas the transmission rate was 2.99% (2/67) in HIV/AIDS patients who did not receive ART. In addition, HIV transmission rate in serodiscordant couples was high prior to diagnosis of the index case. However, following diagnosis, the transmission rate was reduced, and the risk of transmission in the index case with antiviral treatment was null. Therefore, a prompt intervention in HIV discordant couples with ART of index case is vital to reduce the risk of HIV transmission.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S095026881900089X
      Issue No: Vol. 147 (2019)
  • Complete sequence analysis of human norovirus GII.17 detected in South
    • Authors: H. Kim; Y. J. Won, L. H. Kang, A. R. Lee, J. I. Han, C. I. Suh, S. Y. Paik
      Abstract: Norovirus, a major cause of gastroenteritis in people of all ages worldwide, was first reported in South Korea in 1999. The most common causal agents of pediatric acute gastroenteritis are norovirus and rotavirus. While vaccination has reduced the pediatric rotavirus infection rate, norovirus vaccines have not been developed. Therefore, prediction and prevention of norovirus are very important. Norovirus is divided into genogroups GI–GVII, with GII.4 being the most prevalent. However, in 2012–2013, GII.17 showed a higher incidence than GII.4 and a novel variant, GII.P17-GII.17, appeared. In this study, 204 stool samples collected in 2013–2014 were screened by reverse transcriptase-polymerase chain reaction; 11 GI (5.39%) and 45 GII (22.06%) noroviruses were identified. GI.4, GI.5, GII.4, GII.6 and GII.17 were detected. The whole genomes of the three norovirus GII.17 were sequenced. The whole genome of GII.17 consists of three open reading frames of 5109, 1623 and 780 bp. Compared with 20 GII.17 strains isolated in other countries, we observed numerous changes in the protruding P2 domain of VP1 in the Korean GII.17 viruses. Our study provided genome information that might aid in epidemic prevention, epidemiology studies and vaccine development.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268819000943
      Issue No: Vol. 147 (2019)
  • Histoplasma+capsulatum+clinical+isolates+from+Mexico,+Guatemala,+Colombia+and+Argentina,+using+a+randomly+amplified+polymorphic+DNA-PCR+assay&rft.title=Epidemiology+&+Infection&rft.issn=0950-2688&,+C.+Canteros,+G.+Rodríguez-Arellanes,+M.+R.+Reyes-Montes,+M.+L.+Taylor&rft_id=info:doi/10.1017/S0950268819000931">Analyses of the genetic diversity and population structures of Histoplasma
           capsulatum clinical isolates from Mexico, Guatemala, Colombia and
           Argentina, using a randomly amplified polymorphic DNA-PCR assay
    • Authors: J. H. Sahaza; E. Duarte-Escalante, C. Canteros, G. Rodríguez-Arellanes, M. R. Reyes-Montes, M. L. Taylor
      Abstract: We studied the genetic diversity and the population structure of human isolates of Histoplasma capsulatum, the causative agent of histoplasmosis, using a randomly amplified polymorphic DNA-polymerase chain reaction (RAPD-PCR) assay to identify associations with the geographic distribution of isolates from Mexico, Guatemala, Colombia and Argentina. The RAPD-PCR pattern analyses revealed the genetic diversity by estimating the percentage of polymorphic loci, effective number of alleles, Shannon's index and heterozygosity. Population structure was identified by the index of association (IA) test. Thirty-seven isolates were studied and clustered into three groups by the unweighted pair-group method with arithmetic mean (UPGMA). Group I contained five subgroups based on geographic origin. The consistency of the UPGMA dendrogram was estimated by the cophenetic correlation coefficient (CCCr = 0.94, P = 0.001). Isolates from Mexico and Colombia presented higher genetic diversity than isolates from Argentina. Isolates from Guatemala grouped together with the reference strains from the United States of America and Panama. The IA values suggest the presence of a clonal population structure in the Argentinian H. capsulatum isolates and also validate the presence of recombining populations in the Colombian and Mexican isolates. These data contribute to the knowledge on the molecular epidemiology of histoplasmosis in Latin America.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268819000931
      Issue No: Vol. 147 (2019)
  • Attrition during pre-ART and ART time periods among adolescents enrolled
           in Integrated HIV Care Programme in Myanmar, 2005–2017
    • Authors: T. Htun; K. W. Y. Kyaw, T. K. Aung, J. Moe, A. A. Mon, C. L. Tun, O. Mon, S. Satyanarayana, H. N. Oo
      Abstract: Retaining adolescents (aged 10–19 years), living with HIV (ALHIV) on antiretroviral therapy (ART) is challenging. In Myanmar, 1269 ALHIV were under an Integrated HIV Care (IHC) Programme by June 2017 and their attrition (death and lost to follow-up) rates were not assessed before. We undertook a cohort study using routinely collected data of ALHIV enrolled into HIV care from July 2005 to June 2017 and assessed their attrition rates in June 2018 by time-to-event analysis. Of 1269 enrolled, 197(16%) and of 1054 initiated ART, 224 (21%) had an attrition defining event. The pre-ART and ART attrition rates were 21.8 (95% CI 19.0–25.1) and 6.4 (95% CI 5.6–7.3) per 100 person-years follow-up, respectively. The factors ‘at enrolment’ that were associated with higher hazards of attrition were: (1) WHO stage 3 or 4; (2) haemoglobin
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268819000906
      Issue No: Vol. 147 (2019)
  • Test characteristics of the tuberculin skin test and post-mortem
           examination for bovine tuberculosis diagnosis in cattle in Northern
           Ireland estimated by Bayesian latent class analysis with adjustments for
    • Authors: M. J. H. O'Hagan; H. Ni, F. D. Menzies, A. V. Pascual-Linaza, A. Georgaki, J. A. Stegeman
      Abstract: The single intradermal comparative cervical tuberculin (SICCT) test and post-mortem examination are the main diagnostic tools for bovine tuberculosis (bTB) in cattle in the British Isles. Latent class modelling is often used to estimate the bTB test characteristics due to the absence of a gold standard. However, the reported sensitivity of especially the SICCT test has shown a lot of variation. We applied both the Hui–Walter latent class model under the Bayesian framework and the Bayesian model specified at the animal level, including various risk factors as predictors, to estimate the SICCT test and post-mortem test characteristics. Data were collected from all cattle slaughtered in abattoirs in Northern Ireland in 2015. Both models showed comparable posterior median estimation for the sensitivity of the SICCT test (88.61% and 90.56%, respectively) using standard interpretation and for post-mortem examination (53.65% and 53.79%, respectively). Both models showed almost identical posterior median estimates for the specificity (99.99% vs. 99.80% for SICCT test at standard interpretation and 99.66% vs. 99.86% for post-mortem examination). The animal-level model showed slightly narrower posterior 95% credible intervals. Notably, this study was carried out in slaughtered cattle which may not be representative for the general cattle population.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268819000888
      Issue No: Vol. 147 (2019)
  • Epidemiologic characteristics of outbreaks of three norovirus genotypes
           (GII.2, GII.17 and GII.4 Sydney) in Guangzhou, China, from 2012 to 2018
    • Authors: H. Wang; D. H. Wang, C. Chen, Y. Lu, M. X. Li, T. G. Li, Z. B. Zhang, Z. C. Yang
      Abstract: To compare the epidemiologic features (e.g. settings and transmission mode) and patient clinical characteristics associated with outbreaks of different norovirus (Nov) strains, we retrospectively analysed data of Nov outbreaks occurring in Guangzhou, China from 2012 to 2018. The results suggested that outbreaks of Nov GII.2, GII.17 and GII.4 Sydney exhibited different outbreak settings, transmission modes and symptoms. GII.2 outbreaks mainly occurred in kindergartens, elementary and high schools and were transmitted mainly through person-to-person contact. By contrast, GII.4 Sydney outbreaks frequently occurred in colleges and were primarily associated with foodborne transmission. Cases from GII.2 and GII.17 outbreaks reported vomiting more frequently than those from outbreaks associated with GII.4 Sydney.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268819000992
      Issue No: Vol. 147 (2019)
  • Late-onset sepsis and mortality among neonates in a Brazilian Intensive
           Care Unit: a cohort study and survival analysis
    • Authors: F. T. M. Freitas; A. F. O. L. Araujo, M. I. S. Melo, G. A. S. Romero
      Abstract: A cohort study was performed from January 2014 to December 2016 in a Brazilian neonatal intensive care unit, including neonates with high risk for infection and death. We estimated bloodstream infection (BSI) incidence and conducted a survival analysis, considering the time to death and to the first episode of BSI as outcomes, comparing very low birth weight (VLBW) neonates with the remaining neonates. An extended Cox model was performed and the hazard ratio (HR) was calculated for different time periods. The study had 1560 neonates included, the incidence and the incidence density of BSI was 22% and 18.6 per 1000 central venous catheter-days, respectively. Considering VLBW neonates as the reference group, the HR for time to death was 4.06 (95% CI 2.75–6.00, P < 0.01) from day 0 to 60 and for time to the first episode of BSI was 1.76 (95% CI 1.31–2.36, P < 0.01) from day 0 to 36. Having the heavier neonates group as reference, the HR for time to the first episode of BSI was 2.94 (95% CI 1.92–4.34, P < 0.01) from day 37 to 90. Late-onset neonatal sepsis prevention measures should consider the differences in risk during time, according to neonates' birth weight.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S095026881900092X
      Issue No: Vol. 147 (2019)
  • Suspected spread of hepatitis A virus from a restaurant among adults in
           rural area of the Kerala state, India
    • Authors: Y. K. Gurav; G. Retheesh Babu, K. P. Vinu, K. S. Lole
      Abstract: India is experiencing a substantial decrease in early childhood exposure to hepatitis A virus (HAV). Kerala has experienced several hepatitis A outbreaks in young adults/adults in the recent past. The current hepatitis outbreak occurred in Nellikuzhi, Kerala state, India in December 2016. Investigation was carried by preparing a line list of suspected hepatitis cases. The blood and stool samples collected from patients were tested for anti-HAV/anti-Hepatitis E virus (HEV) immunoglobulin (IgM) antibodies and RNA respectively. A total of 562 suspected hepatitis cases were reported during the outbreak. Along with the first case (35 years, male), 86.1% (484/562) of the cases gave history of consuming food/water/cold drinks from one restaurant. Anti-HAV IgM positivity was 74.5% (73/98) in tested samples and amongst the positives, 81% were adults/young adults and adolescents. None of the samples tested positive for anti-HEV IgM. There were three HAV associated deaths without any co-morbidity. Sequence analysis of HAV RNA positive stool samples showed the presence of genotype IIIA HAV. The suspected source of the infection was a private well situated in the premise of a restaurant. Considering increasing HAV naive population in Kerala, there is a need to introduce hepatitis A vaccine in high-risk age groups.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268819000967
      Issue No: Vol. 147 (2019)
  • Strongyloides+stercoralis+infection+in+San+Marino+Republic:+first+epidemiological+data+from+an+observational+study&rft.title=Epidemiology+&+Infection&rft.issn=0950-2688&,+A.+Cadioli,+S.+Manoni,+R.+Silva,+D.+Buonfrate&rft_id=info:doi/10.1017/S0950268819000980">Strongyloides stercoralis infection in San Marino Republic: first
           epidemiological data from an observational study
    • Authors: E. D. Cappella; A. C. Piscaglia, A. Cadioli, S. Manoni, R. Silva, D. Buonfrate
      Abstract: Strongyloides stercoralis is a neglected parasite that can cause death in immunocompromised individuals. There were no data on the epidemiology of S. stercoralis infection in San Marino Republic until two patients (one of whom died) were diagnosed with severe strongyloidiasis (hyperinfection) between September 2016 and March 2017. A serology test for Strongyloides spp. was introduced in routine practice in the laboratory of the State Hospital to test patients considered to be at risk for strongyloidiasis. Between August 2017 and August 2018, of 42 patients tested with serology, two (4.8%) were positive. An additional case was found by gastric biopsy. Two of the positive cases were presumably autochthonous infections (elderly people with no significant travel history), while the other was a probable imported case (young man born in Nigeria and settled in Europe since 2003). Epidemiology of strongyloidiasis in San Marino might be similar to Northern Italy, where a relevant proportion of cases was diagnosed in immigrants (mainly from sub-Saharan Africa) and in elderly Italians with eosinophilia. Screening for strongyloidiasis might be worthwhile in inhabitants of San Marino in the same categories of individuals, particularly those at risk of immune suppression.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268819000980
      Issue No: Vol. 147 (2019)
  • Healthcare utilisation and cost expenditures for pneumonia in individuals
           with diabetes mellitus in the USA
    • Authors: K. Liu; G. C. Lee
      Abstract: Pneumonia is one of the leading causes of hospitalisations among adults in the USA. Individuals with diabetes mellitus (DM) have been associated with increased risk for pneumonia and complications including death. The objectives of this study were to (1) compare the prevalence and healthcare utilisation patterns for pneumonia in individuals with and without DM, and (2) identify risk factors for pneumonia in those with DM. We performed a retrospective, cross-sectional analysis of the US adult population using Medical Expenditure Panel Surveys (MEPS) data from 2014. Overall, the data represented 24 million individuals with DM and 218 million without DM in the USA. The population-based rate for a pneumonia event was 34 per 1000 persons for individuals with DM and 19 per 1000 persons without DM. Compared to the non-DM group, individuals with DM were treated 1.8x, 2.6x and 1.4x more in the ED, hospital and outpatient, respectively. Furthermore, the average cost per pneumonia event was significantly higher among individuals with DM compared to non-DM in the inpatient setting ($11 931 vs. $7751; P < 0.001). Among individuals with DM, female sex, DM complications, smokers and administration of pneumococcal vaccines were significant factors associated with a pneumonia event.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268819000979
      Issue No: Vol. 147 (2019)
  • A retrospective descriptive analysis of rabies post-exposure prophylaxis
           cases in Dalian from 2016 to 2017
    • Authors: Yi Song; Xiaoguang Lu, Xue Jiang, Weitong Zhao, Zhiwei Fan, Xin Kang, Yu Wang
      Abstract: Dalian, China, is a city free of rabies in recent 20 years, but the annual cost for rabies vaccination still brings an economic burden on society and individuals. We did a retrospective descriptive analysis to analyse the reason for this and try to find some ways to resolve it. A total of 10 028 post-exposure prophylaxis (PEP) cases were recorded from January 2016 to December 2017. According to the exposure grades, 32 cases were grade I; 7712 cases were grade II; 2284 cases were grade III. All the patients in the cases were injured by pet dogs without abnormal clinical signs, and 80% of them were home pet dogs. Fifty-two per cent of the pet dogs were vaccinated. All the dogs survived during the PEP vaccination period. The data showed that a considerable proportion of people who did not have exposure risk for rabies had received vaccination. The underlying reasons included social, medical and personal factors. So here we proposed to replace the current ‘five-course’ intramuscular injection with intradermal injection method in the cities free of rabies in China, this can not only achieve effective vaccination but also save resources and eliminate the fear of rabies from victims. Meanwhile we should strengthen communication on rabies knowledge and make a routine evaluation of rabies surveillance system to improve understanding of the risk for rabies from biting animals.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268819000785
      Issue No: Vol. 147 (2019)
  • Global status of Middle East respiratory syndrome coronavirus in dromedary
           camels: a systematic review – CORRIGENDUM
    • Authors: R. S. Sikkema; E. A. B. A. Farag, Mazharul Islam, Muzzamil Atta, C. B. E. M. Reusken, Mohd M. Al-Hajri, M. P. G. Koopmans
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268819000669
      Issue No: Vol. 147 (2019)
  • Bordetella+pertussis+toxin+antibodies+in+children+and+adolescents+in+Tunis,+Tunisia&rft.title=Epidemiology+&+Infection&rft.issn=0950-2688&,+M.+Hsairi,+A.+Kechrid,+H.+Smaoui&rft_id=info:doi/10.1017/S0950268819000840">Seroprevalence of Bordetella pertussis toxin antibodies in children and
           adolescents in Tunis, Tunisia
    • Authors: I. Ben Fraj; M. Zghal, M. Hsairi, A. Kechrid, H. Smaoui
      Abstract: Pertussis remains a public health concern in most countries. This cross-sectional study aims to investigate the distribution of pertussis toxin antibodies (anti-PT IgG) in Tunisian children and adolescents aged 3–18 years, to define optimal age for booster vaccination. Anti-PT IgG concentrations of enrolled participants were measured using commercial enzyme-linked immunosorbent assay. Concentrations were classified as: indicative of current/recent infection if ⩾100 IU/ml, indicative of recent exposure to Bordetella pertussis within the last year if 40–100 IU/ml and less likely revealing a recent exposure to B. pertussis if
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268819000840
      Issue No: Vol. 147 (2019)
  • Modelling an optimum vaccination strategy against ZIKA virus for outbreak
    • Authors: Eduardo Massad; Francisco Antonio Bezerra Coutinho, Annelies Wilder-Smith
      Abstract: We present a model to optimise a vaccination campaign aiming to prevent or to curb a Zika virus outbreak. We show that the optimum vaccination strategy to reduce the number of cases by a mass vaccination campaign should start when the Aedes mosquitoes' density reaches the threshold of 1.5 mosquitoes per humans, the moment the reproduction number crosses one. The maximum time it is advisable to wait for the introduction of a vaccination campaign is when the first ZIKV case is identified, although this would not be as effective to minimise the number of infections as when the mosquitoes' density crosses the critical threshold. This suboptimum strategy, however, would still curb the outbreak. In both cases, the catch up strategy should aim to vaccinate at least 25% of the target population during a concentrated effort of 1 month immediately after identifying the threshold. This is the time taken to accumulate the herd immunity threshold of 56.5%. These calculations were done based on theoretical assumptions that vaccine implementation would be feasible within a very short time frame.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268819000712
      Issue No: Vol. 147 (2019)
  • Mycobacterium+tuberculosis+transmission+in+a+remote+circumpolar+region&rft.title=Epidemiology+&+Infection&rft.issn=0950-2688&,+B.+Roberts,+M.+Allen,+J.+McFadzen,+D.+Roth,+D.+Jorgensen,+M.+Rodrigues,+P.+Tang,+B.+Hanley,+J.+Johnston,+V.+J.+Cook,+J.+L.+Gardy&rft_id=info:doi/10.1017/S0950268819000670">Whole genome sequencing for improved understanding of Mycobacterium
           tuberculosis transmission in a remote circumpolar region
    • Authors: J. L. Guthrie; L. Strudwick, B. Roberts, M. Allen, J. McFadzen, D. Roth, D. Jorgensen, M. Rodrigues, P. Tang, B. Hanley, J. Johnston, V. J. Cook, J. L. Gardy
      Abstract: Few studies have used genomic epidemiology to understand tuberculosis (TB) transmission in rural and remote settings – regions often unique in history, geography and demographics. To improve our understanding of TB transmission dynamics in Yukon Territory (YT), a circumpolar Canadian territory, we conducted a retrospective analysis in which we combined epidemiological data collected through routine contact investigations with clinical and laboratory results. Mycobacterium tuberculosis isolates from all culture-confirmed TB cases in YT (2005–2014) were genotyped using 24-locus Mycobacterial Interspersed Repetitive Units-Variable Number of Tandem Repeats (MIRU-VNTR) and compared to each other and to those from the neighbouring province of British Columbia (BC). Whole genome sequencing (WGS) of genotypically clustered isolates revealed three sustained transmission networks within YT, two of which also involved BC isolates. While each network had distinct characteristics, all had at least one individual acting as the probable source of three or more culture-positive cases. Overall, WGS revealed that TB transmission dynamics in YT are distinct from patterns of spread in other, more remote Northern Canadian regions, and that the combination of WGS and epidemiological data can provide actionable information to local public health teams.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268819000670
      Issue No: Vol. 147 (2019)
  • Transmission dynamics of foot and mouth disease in selected outbreak areas
           of northwest Ethiopia
    • Authors: B. Tadesse; W. Molla, A. Mengsitu, W. T. Jemberu
      Abstract: Foot and mouth disease (FMD) is a highly contagious and economically important disease of cloven-hoofed animals, which is endemic in Ethiopia. An outbreak follow-up study was undertaken to quantify the transmission parameters of FMD in the crop–livestock mixed (CLM) system and commercial dairy farms in selected areas of northwest Ethiopia. The transmission parameters were quantified using a generalised linear model (GLM) based on a susceptible–infectious–recovered (SIR) epidemic model. The per day average transmission rate between animals was 0.26 (95% CI 0.22–0.32) and 0.33 (95% CI 0.21–0.57) in the CLM system and in the commercial dairy farms, respectively. The average basic reproduction ratio of FMD was 1.68 (95% CI 1.42–2.07) in the CLM system and 1.98 (95% CI 1.26–3.42) in the commercial dairy farms. The medium per day transmission rate and moderate basic reproduction ratio observed in this study indicated that a vaccination coverage needed to stop transmission of the disease in these populations might not be very high.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268819000803
      Issue No: Vol. 147 (2019)
  • Campylobacter,+E.+coli+and+Salmonella+in+meat+products&rft.title=Epidemiology+&+Infection&rft.issn=0950-2688&,+R.+Meyers,+E.+J.+Parmley,+A.+Fazil&rft_id=info:doi/10.1017/S0950268819000797">Seasonality and zoonotic foodborne pathogens in Canada: relationships
           between climate and Campylobacter, E. coli and Salmonella in meat products
    • Authors: B. A. Smith; S. Meadows, R. Meyers, E. J. Parmley, A. Fazil
      Abstract: Infections due to Campylobacter, Escherichia coli and Salmonella pose a significant health burden in Canada, resulting in major costs to the health care system and economic impacts due to lost productivity resulting from illness. Recent literature suggests that climate may play a role in the prevalence of these pathogens along the food chain. This study used integrated surveillance data to examine associations between weather variables, serving as a proxy for climate, in agricultural areas and Campylobacter, generic E. coli and Salmonella contamination on samples of beef, poultry and swine meat products in Canada. Various temperature metrics (average, maximum and variability) were correlated with Campylobacter prevalence along the food chain. The prevalence of E. coli and Salmonella was correlated with both precipitation and temperatures metrics; however, analysis for E. coli was limited to beef and swine meats at retail settings, because prevalence in other combinations approached 100%, which obviated further analysis. Campylobacter contamination in poultry and swine at abattoir and retail settings demonstrated a seasonal trend, with increased prevalence generally from June or July through November, compared to the baseline month of December. Based on these analyses, Campylobacter is the most likely foodborne bacteria studied whose occurrence in meat products is affected by climatic changes in Canada. An exploratory analysis of data at the provincial scale, using Ontario as an example, revealed similar directional relationships between climate and bacterial prevalence.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268819000797
      Issue No: Vol. 147 (2019)
  • Notification data and criteria during a large Q-fever epidemic reassessed
    • Authors: D. A. T. Hanssen; G. Morroy, M. M. A. de Lange, C. C. H. Wielders, W. van der Hoek, F. Dijkstra, P. M. Schneeberger
      Abstract: From 2007 to 2010, the largest reported Q-fever epidemic occurred in the Netherlands with 4026 notified laboratory-confirmed cases. During the course of the epidemic, health-seeking behaviour changed and awareness among health professionals increased. Changes in laboratory workflows were implemented. The aim of this study was to analyse how these changes instigated adjustments of notification criteria and how these adjustments affected the monitoring and interpretation of the epidemic. We used the articles on laboratory procedures related to the epidemic and a description of the changes that were made to the notification criteria. We compared the output of a regional laboratory with notifications to the regional Public Health Service and the national register of infectious diseases. We compared the international notification criteria for acute Q-fever. Screening with ELISA IgM phase II and PCR was added to the diagnostic workflow. In the course of the epidemic, serology often revealed a positive IgG/IgM result although cases were not infected recently. With increasing background seroprevalence, the presence of IgM antibodies can only be suggestive for acute Q-fever and has to be confirmed either by seroconversion of IgG or a positive PCR result. Differences in sero-epidemiology make it unlikely that full harmonisation of notification criteria between countries is feasible.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268819000736
      Issue No: Vol. 147 (2019)
  • Mycoplasma+pneumoniae+pneumonia+in+North+China:+2006+to+2016&rft.title=Epidemiology+&+Infection&rft.issn=0950-2688&,+Ying-hui+Hu,+Xiu-yun+Liu,+Xue-li+Feng,+Jian-Xin+He,+Jun+Liu,+Yan+Guo,+Bao-Ping+Xu,+Kun-Ling+Shen&rft_id=info:doi/10.1017/S0950268819000839">The epidemiology of paediatric Mycoplasma pneumoniae pneumonia in North
           China: 2006 to 2016
    • Authors: Li-Wei Gao; Ju Yin, Ying-hui Hu, Xiu-yun Liu, Xue-li Feng, Jian-Xin He, Jun Liu, Yan Guo, Bao-Ping Xu, Kun-Ling Shen
      Abstract: Paediatric Mycoplasma pneumoniae pneumonia (MPP) is a major cause of community-acquired pneumonia in China. Data on epidemiology of paediatric MPP from China are little known. This study retrospectively collected data from June 2006 to June 2016 in Beijing Children's Hospital, Capital Medical University of North China and aims to explore the epidemiological features of paediatric MPP and severe MPP (SMPP) in North China during the past 10 years. A total of 27 498 paediatric patients with pneumonia were enrolled. Among them, 37.5% of paediatric patients had MPP. In this area, an epidemic took place every 2–3 years at the peak, and the positive rate of MPP increased during these peak years over time. The peak age of MPP was between the ages of 6 and 10 years, accounting for 75.2%, significantly more compared with other age groups (χ2 = 1384.1, P < 0.0001). The epidemics peaked in September, October and November (χ2 = 904.9, P < 0.0001). Additionally, 13.0% of MPP paediatric patients were SMPP, but over time, the rate of SMPP increased, reaching 42.6% in 2016. The mean age of paediatric patients with SMPP (6.7 ± 3.0 years old) was younger than that of patients with non-SMPP (7.4 ± 3.2 years old) (t = 3.60, P = 0.0001). The prevalence of MPP and SMPP is common in China, especially in children from 6 to 10 years old. Paediatric patients with SMPP tend to be younger than those with non-SMPP. MPP outbreaks occur every 2–3 years in North China. September, October and November are the peak months, unlike in South China. Understanding the epidemiological characteristics of paediatric MPP can contribute to timely treatment and diagnosis, and may improve the prognosis of children with SMPP.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268819000839
      Issue No: Vol. 147 (2019)
  • Real-world study on clinical outcomes of nucleos(t)ide analogues antiviral
           therapy in patients with chronic hepatitis B
    • Authors: Y. Sun; Y. Zhang, Y. Xu, M. Shu, K. Bonroy, H. Qiu, W. Cai
      Abstract: Nucleos(t)ide analogues (NAs) are widely used for antiviral therapy in patients with chronic hepatitis B (CHB), but real-world data on treatment patterns and long-term clinical outcomes are not always available. Using data from electronic medical records between January 2011 and December 2016 in Shanghai, China, we evaluated patient characteristics, treatment patterns and clinical outcomes in patients with CHB. There were 6688 patients in the study cohort. The incidences of cirrhosis and hepatocellular carcinoma (HCC) were 41.0‰ and 6.8‰ person-years, respectively. There were more cirrhosis and HCC cases among patients who had shorter NA treatment duration (
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268819000815
      Issue No: Vol. 147 (2019)
  • Application of a long short-term memory neural network: a burgeoning
           method of deep learning in forecasting HIV incidence in Guangxi, China
    • Authors: G. Wang; W. Wei, J. Jiang, C. Ning, H. Chen, J. Huang, B. Liang, N. Zang, Y. Liao, R. Chen, J. Lai, O. Zhou, J. Han, H. Liang, L. Ye
      Abstract: Guangxi, a province in southwestern China, has the second highest reported number of HIV/AIDS cases in China. This study aimed to develop an accurate and effective model to describe the tendency of HIV and to predict its incidence in Guangxi. HIV incidence data of Guangxi from 2005 to 2016 were obtained from the database of the Chinese Center for Disease Control and Prevention. Long short-term memory (LSTM) neural network models, autoregressive integrated moving average (ARIMA) models, generalised regression neural network (GRNN) models and exponential smoothing (ES) were used to fit the incidence data. Data from 2015 and 2016 were used to validate the most suitable models. The model performances were evaluated by evaluating metrics, including mean square error (MSE), root mean square error, mean absolute error and mean absolute percentage error. The LSTM model had the lowest MSE when the N value (time step) was 12. The most appropriate ARIMA models for incidence in 2015 and 2016 were ARIMA (1, 1, 2) (0, 1, 2)12 and ARIMA (2, 1, 0) (1, 1, 2)12, respectively. The accuracy of GRNN and ES models in forecasting HIV incidence in Guangxi was relatively poor. Four performance metrics of the LSTM model were all lower than the ARIMA, GRNN and ES models. The LSTM model was more effective than other time-series models and is important for the monitoring and control of local HIV epidemics.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S095026881900075X
      Issue No: Vol. 147 (2019)
  • Genetic variants in RIG-I-like receptor influences HCV clearance in
           Chinese Han population
    • Authors: Xinyu Wu; Feng Zang, Mei Liu, Lingyun Zhuo, Jingjing Wu, Xueshan Xia, Yue Feng, Rongbin Yu, Peng Huang, Sheng Yang
      Abstract: Human innate immune plays an essential role in the spontaneous clearance of acute infection and therapy of HCV. We investigated whether the SNPs in retinoic acid-inducible gene I-like receptor family were associated with HCV spontaneous clearance and response to treatment. To evaluate the clinical value of DDX58 rs3824456, rs10813831 and rs10738889 genotypes on HCV spontaneous clearance and treatment response in Chinese Han population, we genotyped 1001 HCV persistent infectors, 599 participants with HCV natural clearance and 354 patients with PEGylated interferon-α and ribavirin (PEG IFN-α/RBV) treatment. People carrying rs10813831-G allele genotype were more liable to achieve spontaneous clearance than the carriage of the T allele (dominant model: adjusted OR 1.35, 95% CI 1.08–1.71, P = 0.008). In rs10738889, the rate of persistent infection was significantly lower in patients with the TC genotype compared to those with TT genotype (dominant model: adjusted OR 1.36, 95% CI 1.06–1.74, P = 0.015). Multivariate stepwise analysis indicated that rs10738889, age, alanine aminotransferase (ALT) and aspartate aminotransferase (AST) were independent predictors for HCV spontaneous clearance. However, there were no significant differences in the three selection SNPs between the non-SVR group and the SVR group. These results suggest the DDX58 rs10813831 and rs10738889 are associated with spontaneous clearance of HCV, which may be identified as a predictive marker in the Chinese Han population of HCV.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268819000827
      Issue No: Vol. 147 (2019)
  • Yersinia+enterocolitica+to+support+outbreak+investigations+in+New+Zealand&rft.title=Epidemiology+&+Infection&rft.issn=0950-2688&,+S.+Paine,+K.+Dyet,+K.+Cullen,+J.+Wright&rft_id=info:doi/10.1017/S0950268819000773">Evaluating sub-typing methods for pathogenic Yersinia enterocolitica to
           support outbreak investigations in New Zealand
    • Authors: H. Strydom; J. Wang, S. Paine, K. Dyet, K. Cullen, J. Wright
      Abstract: Incidence of human yersiniosis in New Zealand has increased between 2013 and 2017. For surveillance and outbreak investigations it is essential that an appropriate level of discrimination between pathogenic Yersinia enterocolitica isolates is provided, in order to support epidemiological linking of connected cases. Subtyping of 227 Y. enterocolitica isolates was performed using a range of different typing methods, including biotyping, serotyping and seven loci multiple-locus variable-number tandem-repeat analysis (MLVA). In addition, core genome single-nucleotide polymorphism (core SNP) analysis and multi-locus sequence typing were performed on a subset of 69 isolates. Sixty-seven different MLVA types were identified. One MLVA profile was associated with an outbreak in the Bay of Plenty region, supported by epidemiological data. Core SNP analysis showed that all the outbreak-related isolates clustered together. The subtyping and epidemiological evidence suggests that the outbreak of yersiniosis in the Bay of Plenty region between October and December 2016 could be attributed to a point source. However, subtyping results further suggest that the same clone was isolated from several regions between August 2016 and March 2017. Core SNP analysis and MLVA typing failed to differentiate between Y. enterocolitica biotype 2 and biotype 3. For this reason, we propose that these biotypes should be reported as a single type namely: Y. enterocolitica biotype 2/3 and that the serotype should be prioritised as an indicator of prevalence.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268819000773
      Issue No: Vol. 147 (2019)
  • Analysis of influenza data generated by four epidemiological surveillance
           laboratories in Mexico, 2010–2016
    • Authors: L. Fernandes-Matano; I. E. Monroy-Muñoz, M. Bermúdez de León, Y. A. Leal-Herrera, I. D. Palomec-Nava, J. A. Ruíz-Pacheco, B. L. Escobedo-Guajardo, C. Marín-Budip, C. E. Santacruz-Tinoco, J. González-Ibarra, C. R. González-Bonilla, J. E. Muñoz-Medina
      Abstract: The disease caused by the influenza virus is a global public health problem due to its high rates of morbidity and mortality. Thus, analysis of the information generated by epidemiological surveillance systems has vital importance for health decision making. A retrospective analysis was performed using data generated by the four molecular diagnostic laboratories of the Mexican Social Security Institute between 2010 and 2016. Demographics, influenza positivity, seasonality, treatment choices and vaccination status analyses were performed for the vaccine according to its composition for each season. In all cases, both the different influenza subtypes and different age groups were considered separately. The circulation of A/H1N1pdm09 (48.7%), influenza A/H3N2 (21.1%), influenza B (12.6%), influenza A not subtyped (11%) and influenza A/H1N1 (6.6%) exhibited well-defined annual seasonality between November and March, and there were significant increases in the number of cases every 2 years. An inadequate use of oseltamivir was determined in 38% of cases, and the vaccination status in general varied between 12.1 and 18.5% depending on the season. Our results provide current information about influenza in Mexico and demonstrate the need to update both operational case definitions and medical practice guidelines to reduce the inappropriate use of antibiotics and antivirals.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268819000694
      Issue No: Vol. 147 (2019)
  • On the role of different age groups during pertussis epidemics in
           California, 2010 and 2014
    • Authors: A. S. Mahmud; M. Lipsitch, E. Goldstein
      Abstract: There is limited information on the roles of different age groups in propagating pertussis outbreaks, and the temporal changes in those roles since the introduction of acellular pertussis vaccines. The relative roles of different age groups in propagating the 2010 and the 2014 pertussis epidemics in California were evaluated using the relative risk (RR) statistic that measures the change in the group's proportion among all detected cases before vs. after the epidemic peak. For the 2010–11 epidemic, evidence for a predominant transmission age group was weak, with the largest RR estimates being 1.26 (95% CI 1.08–1.46) (aged 11–13 years); 1.19 (1.01–1.4) (aged 9–10 years); 1.17 (0.86–1.59) (aged 14–15 years); 1.12 (0.86–1.46) (aged 16–19 years) and 1.1 (0.89–1.36) (aged 7–8 years). The 2014 epidemic showed a strong signal of the role of older adolescents, with the highest RR estimate being in those aged 14–15 years (RR = 1.83, 1.61–2.07), followed by adolescents aged 16–19 years (RR = 1.41, 1.24–1.61) and 11–13 years (RR = 1.26, 1.12–1.41), with lower RR estimates in other age groups. As the time following introduction of acellular pertussis vaccines in California progressed, older adolescents played an increasing role in transmission during the major pertussis outbreaks. Booster pertussis vaccination for older adolescents with vaccines effective against pertussis transmission should be considered with the aim of mitigating future pertussis epidemics in the community.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268819000761
      Issue No: Vol. 147 (2019)
  • Social patterning of acute respiratory illnesses in the Household
           Influenza Vaccine Evaluation (HIVE) Study 2014–2015
    • Authors: Ryan E. Malosh; Grace A. Noppert, Jon Zelner, Emily T. Martin, Arnold S. Monto
      Abstract: Social patterning of infectious diseases is increasingly recognised. Previous studies of social determinants of acute respiratory illness (ARI) have found that highly educated and lower income families experience more illnesses. Subjective social status (SSS) has also been linked to symptomatic ARI, but the association may be confounded by household composition. We examined SSS and ARI in the Household Influenza Vaccine Evaluation (HIVE) Study in 2014–2015. We used SSS as a marker of social disadvantage and created a workplace disadvantage score for working adults. We examined the association between these measures and ARI incidence using mixed-effects Poisson regression models with random intercepts to account for household clustering. In univariate analyses, mean ARI was higher among children
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268819000748
      Issue No: Vol. 147 (2019)
  • Salmonella+serotype+diversity+in+the+USA,+1996–2016&rft.title=Epidemiology+&+Infection&rft.issn=0950-2688&,+B.+E.+Mahon,+P.+I.+Fields,+K.+K.+Wong&rft_id=info:doi/10.1017/S0950268819000724">Epidemiologic patterns of human Salmonella serotype diversity in the USA,
    • Authors: M. C. Judd; R. M. Hoekstra, B. E. Mahon, P. I. Fields, K. K. Wong
      Abstract: Although researchers have described numerous risk factors for salmonellosis and for infection with specific common serotypes, the drivers of Salmonella serotype diversity among human populations remain poorly understood. In this retrospective observational study, we partition records of serotyped non-typhoidal Salmonella isolates from human clinical specimens reported to CDC national surveillance by demographic, geographic and seasonal characteristics and adapt sample-based rarefaction methods from the field of community ecology to study how Salmonella serotype diversity varied within and among these populations in the USA during 1996–2016. We observed substantially higher serotype richness in children
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268819000724
      Issue No: Vol. 147 (2019)
  • Co-receptor tropism and genetic characteristics of the V3 regions in
           variants of antiretroviral-naive HIV-1 infected subjects
    • Authors: J. L. Guo; Y. Yan, J. F. Zhang, J. M. Ji, Z. J. Ge, R. Ge, X. F. Zhang, H. H. Wang, Z. W. Chen, J. Y. Luo
      Abstract: Co-receptor tropism has been identified to correlate with HIV-1 transmission and the disease progression in patients. A molecular epidemiology investigation of co-receptor tropism is important for clinical practice and effective control of HIV-1. In this study, we investigated the co-receptor tropism on HIV-1 variants of 85 antiretroviral-naive patients with Geno2pheno algorithm at a false-positive rate of 10%. Our data showed that a majority of the subjects harboured the CCR5-tropic virus (81.2%, 69/85). No significant differences in gender, age, baseline CD4+ T-cell counts and transmission routes were observed between subjects infected with CXCR4-tropic or CCR5-tropic virus. The co-receptor tropism appeared to be associated with the virus genotype; a significantly more CXCR4-use was predicted in CRF01_AE infections whereas all CRF07_BC and CRF08_BC were predicted to use CCR5 co-receptor. Sequences analysis of V3 revealed a higher median net charge in the CXCR4 viruses over CCR5 viruses (4.0 vs. 3.0, P < 0.05). The predicted N-linked glycosylation site between amino acids 6 and 8 in the V3 region was conserved in CCR5 viruses, but not in CXCR4 viruses. Besides, variable crown motifs were observed in both CCR5 and CXCR4 viruses, of which the most prevalent motif GPGQ existed in both viral tropism and almost all genotypes identified in this study except subtype B. These findings may offer important implications for clinical practice and enhance our understanding of HIV-1 biology.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268819000700
      Issue No: Vol. 147 (2019)
  • Disgust as an emotional driver of vaccine attitudes and uptake' A
           mediation analysis
    • Authors: P. M. Luz; H. E. Brown, C. J. Struchiner
      Abstract: Research on the drivers of vaccine acceptance has expanded but most interventions fall short of coverage targets. We explored whether vaccine uptake is driven directly or indirectly by disgust with attitudes towards vaccines acting as a possible mediator. An online cross-sectional study of 1007 adults of the USA via Amazon's Mechanical Turk was conducted in January 2017. The questionnaire consisted of four sections: (1) items assessing attitudes towards vaccines and vaccine uptake, (2) revised Disgust Scale (DS-R) to measure Disgust Sensitivity, (3) Perceived Vulnerability to Disease scale (PVD) to measure Germ Aversion and Perceived Susceptibility, and (4) socio-demographic information. Using mediation analysis, we assess the direct, the indirect (through Vaccine Attitudes) and the total effect of Disgust Sensitivity, Germ Aversion and Perceived Susceptibility on 2016 self-reported flu vaccine uptake. Mediation analysis showed the effect of Disgust Sensitivity and Germ Aversion on vaccine uptake to be twofold: a direct positive effect on vaccine uptake and an indirect negative effect through Vaccine Attitudes. In contrast, Perceived Susceptibility was found to have only a direct positive effect on vaccine uptake. Nonetheless, these effects were attenuated and small compared to economic, logistic and psychological determinants of vaccine uptake.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268819000517
      Issue No: Vol. 147 (2019)
  • Case–case analyses of cryptosporidiosis and giardiasis using routine
           national surveillance data in the United States – 2005–2015
    • Authors: K. M. Benedict; S. A. Collier, E. P. Marder, M. C. Hlavsa, K. E. Fullerton, J. S. Yoder
      Abstract: Understanding endemic infectious disease risk factors through traditional epidemiological tools is challenging. Population-based case–control studies are costly and time-consuming. A case–case analyses using surveillance data addresses these limitations by using resources more efficiently. We conducted a case–case analyses using routine surveillance data reported by 16 U.S. states (2005–2015), wherein reported cases of salmonellosis were used as a comparison group to identify exposure associations with reported cases of cryptosporidiosis and giardiasis. Odds ratios adjusted for age and reporting state (aOR) and 95% confidence intervals (95% CI) were calculated. A total of 10 704 cryptosporidiosis cases, 17 544 giardiasis cases, and 106 351 salmonellosis cases were included in this analyses. When compared with cases of salmonellosis, exposure to treated recreational water (aOR 4.7, 95% CI 4.3–5.0) and livestock (aOR: 3.2; 95% CI: 2.9–3.5) were significantly associated with cryptosporidiosis and exposure to untreated drinking (aOR 4.1, 95% CI 3.6–4.7) and recreational water (aOR 4.1, 95% CI 3.7–4.5) were associated with giardiasis. Our analyses shows that routine surveillance data with standardised exposure information can be used to identify associations of interest for cryptosporidiosis and giardiasis.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268819000645
      Issue No: Vol. 147 (2019)
  • Estimating within-flock transmission rate parameter for H5N2 highly
           pathogenic avian influenza virus in Minnesota turkey flocks during the
           2015 epizootic
    • Authors: A. Ssematimba; S. Malladi, T. J. Hagenaars, P. J. Bonney, J. T. Weaver, K. A. Patyk, E. Spackman, D. A. Halvorson, C. J. Cardona
      Abstract: Better control of highly pathogenic avian influenza (HPAI) outbreaks requires deeper understanding of within-flock virus transmission dynamics. For such fatal diseases, daily mortality provides a proxy for disease incidence. We used the daily mortality data collected during the 2015 H5N2 HPAI outbreak in Minnesota turkey flocks to estimate the within-flock transmission rate parameter (β). The number of birds in Susceptible, Exposed, Infectious and Recovered compartments was inferred from the data and used in a generalised linear mixed model (GLMM) to estimate the parameters. Novel here was the correction of these data for normal mortality before use in the fitting process. We also used mortality threshold to determine HPAI-like mortality to improve the accuracy of estimates from the back-calculation approach. The estimated β was 3.2 (95% confidence interval (CI) 2.3–4.3) per day with a basic reproduction number of 12.8 (95% CI 9.2–17.2). Although flock-level estimates varied, the overall estimate was comparable to those from other studies. Sensitivity analyses demonstrated that the estimated β was highly sensitive to the bird-level latent period, emphasizing the need for its precise estimation. In all, for fatal poultry diseases, the back-calculation approach provides a computationally efficient means to obtain reasonable transmission parameter estimates from mortality data.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268819000633
      Issue No: Vol. 147 (2019)
  • The emergence of vampire bat rabies in Uruguay within a historical context
    • Authors: G. Botto Nuñez; D. J. Becker, R. K. Plowright
      Abstract: Pathogen spillover from wildlife to humans or domestic animals requires a series of conditions to align with space and time. Comparing these conditions between times and locations where spillover does and does not occur presents opportunities to understand the factors that shape spillover risk. Bovine rabies transmitted by vampire bats was first confirmed in 1911 and has since been detected across the distribution of vampire bats. However, Uruguay is an exception. Uruguay was free of bovine rabies until 2007, despite high-cattle densities, the presence of vampire bats and a strong surveillance system. To explore why Uruguay was free of bovine rabies until recently, we review the historic literature and reconstruct the conditions that would allow rabies invasion into Uruguay. We used available historical records on the abundance of livestock and wildlife, the vampire bat distribution and occurrence of rabies outbreaks, as well as environmental modifications, to propose four alternative hypotheses to explain rabies virus emergence and spillover: bat movement, viral invasion, surveillance failure and environmental changes. While future statistical modelling efforts will be required to disentangle these hypotheses, we here show how a detailed historical analysis can be used to generate testable predictions for the conditions leading to pathogen spillover.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268819000682
      Issue No: Vol. 147 (2019)
  • Decreasing case fatality rate following invasive pneumococcal disease,
           North East England, 2006–2016
    • Authors: C. Houseman; K. E. Chapman, P. Manley, R. Gorton, D. Wilson, G. J. Hughes
      Abstract: Declining mortality following invasive pneumococcal disease (IPD) has been observed concurrent with a reduced incidence due to effective pneumococcal conjugate vaccines. However, with IPD now increasing due to serotype replacement, we undertook a statistical analysis to estimate the trend in all-cause 30-day case fatality rate (CFR) in the North East of England (NEE) following IPD. Clinical, microbiological and demographic data were obtained for all laboratory-confirmed IPD cases (April 2006–March 2016) and the adjusted association between CFR and epidemiological year estimated using logistic regression. Of the 2510 episodes of IPD included in the analysis, 486 died within 30 days of IPD (CFR 19%). Increasing age, male sex, a diagnosis of septicaemia, being in ⩾1 clinical risk groups, alcohol abuse and individual serotypes were independently associated with increased CFR. A significant decline in CFR over time was observed following adjustment for these significant predictors (adjusted odds ratio 0.93, 95% confidence interval 0.89–0.98; P = 0.003). A small but significant decline in 30-day all-cause CFR following IPD has been observed in the NEE. Nonetheless, certain population groups remain at increased risk of dying following IPD. Despite the introduction of effective vaccines, further strategies to reduce the ongoing burden of mortality from IPD are needed.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268819000657
      Issue No: Vol. 147 (2019)
  • Rates of asymptomatic respiratory virus infection across age groups
    • Authors: M. Galanti; R. Birger, M. Ud-Dean, I. Filip, H. Morita, D. Comito, S. Anthony, G. A. Freyer, S. Ibrahim, B. Lane, N. Matienzo, C. Ligon, R. Rabadan, A. Shittu, E. Tagne, J. Shaman
      Abstract: Respiratory viral infections are a leading cause of disease worldwide. A variety of respiratory viruses produce infections in humans with effects ranging from asymptomatic to life-treathening. Standard surveillance systems typically only target severe infections (ED outpatients, hospitalisations, deaths) and fail to track asymptomatic or mild infections. Here we performed a large-scale community study across multiple age groups to assess the pathogenicity of 18 respiratory viruses. We enrolled 214 individuals at multiple New York City locations and tested weekly for respiratory viral pathogens, irrespective of symptom status, from fall 2016 to spring 2018. We combined these test results with participant-provided daily records of cold and flu symptoms and used this information to characterise symptom severity by virus and age category. Asymptomatic infection rates exceeded 70% for most viruses, excepting influenza and human metapneumovirus, which produced significantly more severe outcomes. Symptoms were negatively associated with infection frequency, with children displaying the lowest score among age groups. Upper respiratory manifestations were most common for all viruses, whereas systemic effects were less typical. These findings indicate a high burden of asymptomatic respiratory virus infection exists in the general population.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268819000505
      Issue No: Vol. 147 (2019)
  • HPV infection in semen: results from a new molecular approach
    • Authors: G. Capra; R. Schillaci, L. Bosco, M. C. Roccheri, A. Perino, M. A. Ragusa
      Abstract: Human papillomavirus (HPV) is the agent of the most common sexually transmitted diseases causing a variety of clinical manifestations ranging from warts to cancer. Oncogenic HPV infection is the major cause of cervical cancer and less frequently of penile cancers. Its presence in semen is widely known, but the effects on fertility are still controversial. We developed a new approach to evaluate virus localisation in the different semen components. We analysed also the specific genotype localisation and viral DNA quantity by qPCR. Results show that HPV DNA can be identified in every fraction of semen: spermatozoa, somatic cells and seminal plasma. Different samples can contain the HPV DNA in different fractions and several HPV genotypes can be found in the same fraction. Additionally, different fractions may contain multiple HPV genotypes in different relative quantity. We analysed the wholeness of HPV DNA in sperm cells by qPCR. In one sample more than half of viral genomes were defective, suggesting a possible recombination event. The new method allows to easily distinguish different sperm infections and to observe the possible effects on semen. The data support the proposed role of HPV in decreased fertility and prompt new possible consequences of the infection in semen.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268819000621
      Issue No: Vol. 147 (2019)
  • Escherichia+coli+associated+with+pre-+and+post-weaning+piglet+diarrhoea+in+organised+farms,+India&rft.title=Epidemiology+&+Infection&rft.issn=0950-2688&,+D.+K.+Sinha,+B.+S.+Pruthvishree,+Shika+Tamta,+Z.+B.+Dubal,+R.+Karthikeyan,+Ramkumar+N.+Rupner,+Y.+S.+Malik&rft_id=info:doi/10.1017/S0950268819000591">Risk factor analysis, antimicrobial resistance and pathotyping of
           Escherichia coli associated with pre- and post-weaning piglet diarrhoea in
           organised farms, India
    • Authors: O. R. VinodhKumar; B. R. Singh, D. K. Sinha, B. S. Pruthvishree, Shika Tamta, Z. B. Dubal, R. Karthikeyan, Ramkumar N. Rupner, Y. S. Malik
      Abstract: A cross-sectional study was conducted from 2014 to 2017 in 13 organised pig farms located in eight states of India (Northern, North-Eastern and Southern regions) to identify the risk factors, pathotype and antimicrobial resistance of Escherichia coli associated with pre- and post-weaning piglet diarrhoea. The data collected through questionnaire survey were used to identify the risk factors by univariable analysis, in which weaning status, season, altitude, ventilation in the shed, use of heater/cooler for temperature control in the sheds, feed type, water source, and use of disinfectant, were the potential risk factors. In logistic regression model, weaning and source of water were the significant risk factors. The piglet diarrhoea prevalence was almost similar across the regions. Of the 909 faecal samples collected (North – 310, North-East – 194 and South – 405) for isolation of E. coli, pathotyping and antibiotic screening, 531 E. coli were isolated in MacConkey agar added with cefotaxime, where 345 isolates were extended spectrum β-lactamase (ESBL) producers and were positive for blaCTX-M-1 (n = 147), bla TEM (n = 151), qnrA (n = 98), qnrB (n = 116), qnrS (n = 53), tetA (n = 46), tetB (n = 48) and sul1 (n = 54) genes. Multiple antibiotic resistance (MAR) index revealed that 14 (2.64%) isolates had MAR index of 1. On the virulence screening of E. coli, 174 isolates harboured alone or combination of Stx1, Stx2, eaeA, hlyA genes. The isolates from diarrhoeic and post-weaning samples harboured higher number of virulence genes than non-diarrhoeic and pre-weaning. Alleviating the risk factors might reduce the piglet diarrhoea cases. The presence of multidrug-resistant and ESBL-producing pathogenic E. coli in piglets appears a public health concern.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268819000591
      Issue No: Vol. 147 (2019)
  • Evidence of a care home effect on antibiotic prescribing for those that
           transition into a care home: a national data linkage study
    • Authors: L. Patterson; A. Maguire, C. Cardwell, F. Kee, C. Hughes, L. Geoghegan, L. Doherty, M. Dolan, N. Q. Verlander, D. O'Reilly
      Abstract: We compared antibiotic prescribing to older people in different settings to inform antibiotic stewardship interventions. We used data linkage to stratify individuals aged 65 years and over in Northern Ireland, 1st January 2012–31st December 2013, by residence: community dwelling, care home dwelling or ‘transitioned’ if admitted to a care home. The odds of being prescribed an antibiotic by residence were analysed using logistic regression, adjusting for patient demographics and selected medication use (proxy for co-morbidities). Trends in monthly antibiotic prescribing were examined in the 6 months pre- and post-admission to the care home. The odds of being prescribed at least one antibiotic were twofold higher in care homes compared with community dwellers (adjusted odds ratio 2.05, 95% CI 1.93–2.17). There was a proportionate increase of 51.5% in the percentage prescribed an antibiotic on admission, with a monthly average of 23% receiving an antibiotic in the 6 months post admission. While clinical need likely accounts for some of the observed antibiotic prescribing in care homes we cannot rule out more liberal prescribing, given the twofold difference between care home residents and their community dwelling peers having accounted for co-morbidities. The appropriateness of antibiotic prescribing in the care home setting should be examined.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268818003382
      Issue No: Vol. 147 (2019)
  • Clostridioides+difficile+infection+in+young+children&rft.title=Epidemiology+&+Infection&rft.issn=0950-2688&,+W.+Bamberg,+M.+M.+Farley,+C.+C.+Espinosa,+L.+Wilson,+R.+Perlmutter,+S.+Holzbauer,+T.+Whitten,+E.+C.+Phipps,+E.+B.+Hancock,+G.+Dumyati,+D.+S.+Nelson,+Z.+G.+Beldavs,+V.+Ocampo,+C.+M.+Davis,+B.+Rue,+L.+Korhonen,+L.+C.+McDonald,+A.+Y.+Guh&rft_id=info:doi/10.1017/S0950268819000372">Risk factors for community-associated Clostridioides difficile infection
           in young children
    • Authors: M. K. Weng; S. H. Adkins, W. Bamberg, M. M. Farley, C. C. Espinosa, L. Wilson, R. Perlmutter, S. Holzbauer, T. Whitten, E. C. Phipps, E. B. Hancock, G. Dumyati, D. S. Nelson, Z. G. Beldavs, V. Ocampo, C. M. Davis, B. Rue, L. Korhonen, L. C. McDonald, A. Y. Guh
      Abstract: The majority of paediatric Clostridioides difficile infections (CDI) are community-associated (CA), but few data exist regarding associated risk factors. We conducted a case–control study to evaluate CA-CDI risk factors in young children. Participants were enrolled from eight US sites during October 2014–February 2016. Case-patients were defined as children aged 1–5 years with a positive C. difficile specimen collected as an outpatient or ⩽3 days of hospital admission, who had no healthcare facility admission in the prior 12 weeks and no history of CDI. Each case-patient was matched to one control. Caregivers were interviewed regarding relevant exposures. Multivariable conditional logistic regression was performed. Of 68 pairs, 44.1% were female. More case-patients than controls had a comorbidity (33.3% vs. 12.1%; P = 0.01); recent higher-risk outpatient exposures (34.9% vs. 17.7%; P = 0.03); recent antibiotic use (54.4% vs. 19.4%; P < 0.0001); or recent exposure to a household member with diarrhoea (41.3% vs. 21.5%; P = 0.04). In multivariable analysis, antibiotic exposure in the preceding 12 weeks was significantly associated with CA-CDI (adjusted matched odds ratio, 6.25; 95% CI 2.18–17.96). Improved antibiotic prescribing might reduce CA-CDI in this population. Further evaluation of the potential role of outpatient healthcare and household exposures in C. difficile transmission is needed.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268819000372
      Issue No: Vol. 147 (2019)
  • Injection drug network characteristics as a predictor of injection
    • Authors: Tim Spelman; Rachel Sacks-Davis, Paul Dietze, Peter Higgs, Margaret Hellard
      Abstract: Social network characteristics of people who inject drugs (PWID) have previously been flagged as potential risk factors for HCV transmission such as increased injection frequency. To understand the role of the injecting network on injection frequency, we investigated how changes in an injecting network over time can modulate injecting risk behaviour. PWID were sourced from the Networks 2 Study, a longitudinal cohort study of PWID recruited from illicit drug street markets across Melbourne, Australia. Network-related correlates of injection frequency and the change in frequency over time were analysed using adjusted Cox Proportional Hazards and Generalised Estimating Equations modelling. Two-hundred and eighteen PWID followed up for a mean (s.d.) of 2.8 (1.7) years were included in the analysis. A greater number of injecting partners, network closeness centrality and eigenvector centrality over time were associated with an increased rate of infection frequency. Every additional injection drug partner was associated with an increase in monthly injection frequency. Similarly, increased network connectivity and centrality over time was also associated with an increase in injection frequency. This study observed that baseline network measures of connectivity and centrality may be associated with changes in injection frequency and, by extension, may predict subsequent HCV transmission risk. Longitudinal changes in network position were observed to correlate with changes in injection frequency, with PWID who migrate from the densely-connected network centre out to the less-connected periphery were associated with a decreased rate of injection frequency.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S095026881900061X
      Issue No: Vol. 147 (2019)
  • A history of FMD research and control programmes in Southeast Asia:
           lessons from the past informing the future
    • Authors: Stuart D. Blacksell; Jarunee Siengsanan-Lamont, Somjai Kamolsiripichaiporn, Laurence J. Gleeson, Peter A. Windsor
      Abstract: Foot and mouth disease (FMD) is a major animal health problem within Southeast Asia (SEA). Although Indonesia and more recently the Philippines have achieved freedom from FMD, the disease remains endemic on continental SEA. Control of FMD within SEA would increase access to markets in more developed economies and reduce lost productivity in smallholder and emerging commercial farmer settings. However, despite many years of vaccination by individual countries, numerous factors have prevented the successful control of FMD within the region, including unregulated ‘informal’ transboundary movement of livestock and their products, difficulties implementing vaccination programmes, emergence of new virus topotypes and lineages, low-level technical capacity and biosecurity at national levels, limited farmer knowledge on FMD disease recognition, failure of timely outbreak reporting and response, and limitations in national and international FMD control programmes. This paper examines the published research of FMD in the SEA region, reviewing the history, virology, epidemiology and control programmes and identifies future opportunities for FMD research aimed at the eventual eradication of FMD from the region.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268819000578
      Issue No: Vol. 147 (2019)
  • Bending the epidemic curve: advancements and opportunities to reduce the
           threat of emerging pathogens
    • Authors: Angel N. Desai; Lawrence C. Madoff
      Abstract: This invited editorial introduces a special issue of Epidemiology & Infection while also discussing advances in emerging infectious diseases.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S095026881900058X
      Issue No: Vol. 147 (2019)
  • Lag effect of climatic variables on dengue burden in India
    • Authors: Satya Ganesh Kakarla; Cyril Caminade, Srinivasa Rao Mutheneni, Andrew P Morse, Suryanaryana Murty Upadhyayula, Madhusudhan Rao Kadiri, Sriram Kumaraswamy
      Abstract: Dengue is a widespread vector-borne disease believed to affect between 100 and 390 million people every year. The interaction between vector, host and pathogen is influenced by various climatic factors and the relationship between dengue and climatic conditions has been poorly explored in India. This study explores the relationship between El Niño Southern Oscillation (ENSO), the Indian Ocean Dipole (IOD) and dengue cases in India. Additionally, distributed lag non-linear model was used to assess the delayed effects of climatic factors on dengue cases. The weekly dengue cases reported by the Integrated Disease Surveillance Program (IDSP) over India during the period 2010–2017 were analysed. The study shows that dengue cases usually follow a seasonal pattern, with most cases reported in August and September. Both temperature and rainfall were positively associated with the number of dengue cases. The precipitation shows the higher transmission risk of dengue was observed between 8 and 15 weeks of lag. The highest relative risk (RR) of dengue was observed at 60 mm rainfall with a 12-week lag period when compared with 40 and 80 mm rainfall. The RR of dengue tends to increase with increasing mean temperature above 24 °C. The largest transmission risk of dengue was observed at 30 °C with a 0–3 weeks of lag. Similarly, the transmission risk increases more than twofold when the minimum temperature reaches 26 °C with a 2-week lag period. The dengue cases and El Niño were positively correlated with a 3–6 months lag period. The significant correlation observed between the IOD and dengue cases was shown for a 0–2 months lag period.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268819000608
      Issue No: Vol. 147 (2019)
  • Extension of the known distribution of a novel clade C betacoronavirus in
           a wildlife host
    • Authors: I. F. Saldanha; B. Lawson, H. Goharriz, J. Rodriguez-Ramos Fernandez, S. K. John, A. R. Fooks, A. A. Cunningham, N. Johnson, D. L. Horton
      Abstract: Disease surveillance in wildlife populations presents a logistical challenge, yet is critical in gaining a deeper understanding of the presence and impact of wildlife pathogens. Erinaceus coronavirus (EriCoV), a clade C Betacoronavirus, was first described in Western European hedgehogs (Erinaceus europaeus) in Germany. Here, our objective was to determine whether EriCoV is present, and if it is associated with disease, in Great Britain (GB). An EriCoV-specific BRYT-Green® real-time reverse transcription PCR assay was used to test 351 samples of faeces or distal large intestinal tract contents collected from casualty or dead hedgehogs from a wide area across GB. Viral RNA was detected in 10.8% (38) samples; however, the virus was not detected in any of the 61 samples tested from Scotland. The full genome sequence of the British EriCoV strain was determined using next generation sequencing; it shared 94% identity with a German EriCoV sequence. Multivariate statistical models using hedgehog case history data, faecal specimen descriptions and post-mortem examination findings found no significant associations indicative of disease associated with EriCoV in hedgehogs. These findings indicate that the Western European hedgehog is a reservoir host of EriCoV in the absence of apparent disease.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268819000207
      Issue No: Vol. 147 (2019)
  • Post-monsoon waterlogging-associated upsurge of cholera cases in and
           around Kolkata metropolis, 2015
    • Authors: Asish K. Mukhopadhyay; Alok K. Deb, Goutam Chowdhury, Falguni Debnath, Prosenjit Samanta, Rudra Narayan Saha, Byomkesh Manna, Mihir K. Bhattacharya, Dharitri Datta, Keinosuke Okamoto, Uchhal K. Bhadra, Shanta Dutta
      Abstract: The Infectious Diseases and Beliaghata General Hospital, Kolkata, India witnessed a sudden increase in admissions of diarrhoea cases during the first 2 weeks of August 2015 following heavy rainfall. This prompted us to investigate the event. Cases were recruited through hospital-based surveillance along with the collection of socio-demographic characteristics and clinical profile using a structured questionnaire. Stool specimens were tested at bacteriological laboratory of the National Institute of Cholera and Enteric Diseases (NICED), Kolkata. Admission of 3003 diarrhoea cases, clearly indicated occurrence of outbreak in Kolkata municipal area as it was more than two standard deviation of the mean number (911; s.d. = 111) of diarrhoea admissions during the same period in previous 7 years. Out of 164 recruited cases, 25% were under-5 children. Organisms were isolated from 80 (49%) stool specimens. Vibrio cholerae O1 was isolated from 50 patients. Twenty-eight patients had this organism as the sole pathogen. Among 14 infants, five had cholera. All V. cholerae O1 isolates were resistant to nalidixic acid, followed by co-trimoxazole (96%), streptomycin (92%), but sensitive to fluroquinolones. We confirmed the occurrence of a cholera outbreak in Kolkata during August 2015 due to V. cholerae O1 infection, where infants were affected.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268819000529
      Issue No: Vol. 147 (2019)
  • Yersinia+enterocolitica&rft.title=Epidemiology+&+Infection&rft.issn=0950-2688&,+W.+van+Pelt,+K.A.+Krogfelt&rft_id=info:doi/10.1017/S0950268819000530">Kinetics of serum antibodies in response to infection with Yersinia
    • Authors: I. Vaitkeviciute; P.F.M. Teunis, W. van Pelt, K.A. Krogfelt
      Abstract: Information on the kinetics of the serum antibody response to infection with Yersinia enterocolitica is essential to allow the estimation and comparison of seroconversion rates in a diversity of pools of cross-sectional serum antibody measurements. Data from 94 patients with acute enteritis caused by Yersinia infection were used. The follow-up period for the longitudinal study was 36 months, addressed by questionnaire. An indirect enzyme-linked immunosorbent assay method was adapted to determine the concentration of antibodies against Y. enterocolitica in human sera. A mathematical within-host model was used to describe the interaction between pathogen and immune system and the waning of immunity after clearing of the pathogen. All observed antibodies (IgG, IgM, IgA) reached peak levels shortly after infection and then decayed slowly indicating that the median levels decreased only little during the observation period. Estimated maximum peak antibody levels were highest in IgG. Seroresponse curves of all antibodies showed large individual variation between patients. There was no apparent pattern of variation with age, nor any notable difference between genders. Estimated half-times were very long for all antibodies, and their posterior distributions were highly skewed. IgA appeared to have the most persistent antibody response, compared with IgG and IgM. Median peak levels of all three antibodies were similar. There was no significance found between peak antibody levels and severity of symptoms of gastrointestinal infection and severity of joint pain. Our findings allow the use of cross-sectional serum antibody measurements as biomarkers, to estimate seroconversion rates. Such seroincidence estimates include asymptomatic seroconversions, thereby avoiding under-reporting, and allows the comparison of infection pressures among countries, independent of their healthcare and surveillance systems.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268819000530
      Issue No: Vol. 147 (2019)
  • Clostridium+difficile+in+hepatic+cirrhosis+patients&rft.title=Epidemiology+&+Infection&rft.issn=0950-2688&,+Tao+lv,+Dong+Yan,+Qiaomai+Xu,+Silan+Gu,+Ping+Shen,+Jiazheng+Quan,+Yunhui+Fang,+Lifeng+Chen,+Guangyong+Ye,+Lanjuan+Li&rft_id=info:doi/10.1017/S0950268819000554">Longitudinal investigation of carriage rates and genotypes of toxigenic
           Clostridium difficile in hepatic cirrhosis patients
    • Authors: Yunbo Chen; Hongqin Gu, Tao lv, Dong Yan, Qiaomai Xu, Silan Gu, Ping Shen, Jiazheng Quan, Yunhui Fang, Lifeng Chen, Guangyong Ye, Lanjuan Li
      Abstract: Toxigenic Clostridium difficile (C. difficile) carriers represent an important source in the transmission of C. difficile infection (CDI) during hospitalisation, but its prevalence and mode in patients with hepatic cirrhosis are not well established. We investigated longitudinal changes in carriage rates and strain types of toxigenic C. difficile from admission to discharge among hepatic cirrhosis patients. Toxigenic C. difficile was detected in 104 (19.8%) of 526 hepatic cirrhosis patients on admission, and the carriage status changed in a portion of patients during hospitalisation. Approximately 56% (58/104) of patients lost the colonisation during their hospital stay. Among the remaining 48 patients who remained positive for toxigenic C. difficile, the numbers of patients who were positive at one, two, three and four isolations were 10 (55.6%), three (16.7%), two (11.1%) and three (16.7%), respectively. Twenty-eight patients retained a particular monophyletic strain at multiple isolations. The genotype most frequently identified was the same as that frequently identified in symptomatic CDI patients. A total of 25% (26/104) of patients were diagnosed with CDI during their hospital stay. Conclusions: Colonisation with toxigenic C. difficile strains occurs frequently in cirrhosis patients and is a risk factor for CDI.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268819000554
      Issue No: Vol. 147 (2019)
  • Escherichia+coli&rft.title=Epidemiology+&+Infection&rft.issn=0950-2688&,+E.+Arnold,+L.+Byrne,+N.+McCarthy&rft_id=info:doi/10.1017/S0950268819000451">Analysis of individual patient data to describe the incubation period
           distribution of Shiga-toxin producing Escherichia coli
    • Authors: A. Awofisayo-Okuyelu; I. Hall, E. Arnold, L. Byrne, N. McCarthy
      Abstract: Shiga-toxin producing Escherichia coli (STEC) is a pathogen that can cause bloody diarrhoea and severe complications. Cases occur sporadically but outbreaks are also common. Understanding the incubation period distribution and factors influencing it will help in the investigation of exposures and consequent disease control. We extracted individual patient data for STEC cases associated with outbreaks with a known source of exposure in England and Wales. The incubation period was derived and cases were described according to patient and outbreak characteristics. We tested for heterogeneity in reported incubation period between outbreaks and described the pattern of heterogeneity. We employed a multi-level regression model to examine the relationship between patient characteristics such as age, gender and reported symptoms; and outbreak characteristics such as mode of transmission with the incubation period. A total of 205 cases from 41 outbreaks were included in the study, of which 64 cases (31%) were from a single outbreak. The median incubation period was 4 days. Cases reporting bloody diarrhoea reported shorter incubation periods compared with cases without bloody diarrhoea, and likewise, cases aged between 40 and 59 years reported shorter incubation period compared with other age groups. It is recommended that public health officials consider the characteristics of cases involved in an outbreak in order to inform the outbreak investigation and the period of exposure to be investigated.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268819000451
      Issue No: Vol. 147 (2019)
  • Developing influenza and respiratory syncytial virus activity thresholds
           for syndromic surveillance in England
    • Authors: S. E. Harcourt; R. A. Morbey, G. E. Smith, P. Loveridge, H. K. Green, R. Pebody, J. Rutter, F. A. Yeates, G. Stuttard, A. J. Elliot
      Abstract: Influenza and respiratory syncytial virus (RSV) are common causes of respiratory tract infections and place a burden on health services each winter. Systems to describe the timing and intensity of such activity will improve the public health response and deployment of interventions to these pressures. Here we develop early warning and activity intensity thresholds for monitoring influenza and RSV using two novel data sources: general practitioner out-of-hours consultations (GP OOH) and telehealth calls (NHS 111). Moving Epidemic Method (MEM) thresholds were developed for winter 2017–2018. The NHS 111 cold/flu threshold was breached several weeks in advance of other systems. The NHS 111 RSV epidemic threshold was breached in week 41, in advance of RSV laboratory reporting. Combining the use of MEM thresholds with daily monitoring of NHS 111 and GP OOH syndromic surveillance systems provides the potential to alert to threshold breaches in real-time. An advantage of using thresholds across different health systems is the ability to capture a range of healthcare-seeking behaviour, which may reflect differences in disease severity. This study also provides a quantifiable measure of seasonal RSV activity, which contributes to our understanding of RSV activity in advance of the potential introduction of new RSV vaccines.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268819000542
      Issue No: Vol. 147 (2019)
  • Escherichia+coli:+integrated+analysis+of+virulence+and+antimicrobial+resistance+in+ruminants+and+humans&rft.title=Epidemiology+&+Infection&rft.issn=0950-2688&,+M.+Alkorta,+J.+M.+Marimón,+M.+Montes,+A.+Hurtado&rft_id=info:doi/10.1017/S0950268819000566">Zoonotic approach to Shiga toxin-producing Escherichia coli: integrated
           analysis of virulence and antimicrobial resistance in ruminants and humans
    • Authors: B. Oporto; M. Ocejo, M. Alkorta, J. M. Marimón, M. Montes, A. Hurtado
      Abstract: In 2014–2016, we conducted a cross-sectional survey in 115 sheep, 104 beef and 82 dairy cattle herds to estimate Shiga toxin-producing Escherichia coli (STEC) prevalence, and collected data on human clinical cases of infection. Isolates were characterised (stx1, stx2, eae, ehxA) and serogroups O157 and O111 identified by PCR, and their antimicrobial resistance (AMR) profiles were determined by broth microdilution. STEC were more frequently isolated from beef cattle herds (63.5%) and sheep flocks (56.5%) than from dairy cattle herds (30.5%) (P < 0.001). A similar but non-significant trend was observed for O157:H7 STEC. In humans, mean annual incidence rate was 1.7 cases/100 000 inhabitants for O157 STEC and 4.7 for non-O157 STEC, but cases concentrated among younger patients. Distribution of virulence genes in STEC strains from ruminants differed from those from human clinical cases. Thus, stx2 was significantly associated with animal STEC isolates (O157 and non-O157), ehxA to ruminant O157 STEC (P = 0.004) and eae to human non-O157 STEC isolates (P < 0.001). Resistance was detected in 21.9% of human and 5.2% of animal O157 STEC isolates, whereas all non-O157 isolates were fully susceptible. In conclusion, STEC were widespread in ruminants, but only some carried virulence genes associated with severe disease in humans; AMR in ruminants was low but profiles were similar to those found in human isolates.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268819000566
      Issue No: Vol. 147 (2019)
  • Incidence and characteristics of Lyme neuroborreliosis in adult patients
           with facial palsy in an endemic area in the Netherlands
    • Authors: S.M. Bierman; B. van Kooten, Y.M. Vermeeren, T.D. Bruintjes, B.C. van Hees, R.A. Bruinsma, G.W. Landman, T. van Bemmel, T.P. Zomer
      Abstract: Making a distinction between facial palsy due to Lyme neuroborreliosis (LNB) and idiopathic facial palsy (IFP) is of importance to ensure timely and adequate treatment. The study objective was to assess incidence and patient characteristics of facial palsy due to LNB. Hospital records were reviewed of adult patients with facial palsy visiting the departments of neurology and/or otorhinolaryngology of Gelre hospitals between June 2007 and December 2017. Gelre hospitals are located in an area endemic for Lyme borreliosis. Patients with LNB had pleocytosis and intrathecal antibody production or pleocytosis with positive IgG serology. Patients with IFP had negative serology. Clinical characteristics were compared between patients with LNB and patients with IFP. Five hundred and fifty-nine patients presented with facial palsy, 4.7% (26) had LNB and 39.4% (220) IFP. The incidence of facial palsy due to LNB was 0.9/100 000 inhabitants/year. Over 70% of patients with facial palsy due to LNB did not report a recent tick bite and/or erythema migrans (EM). Patients with facial palsy due to LNB presented more often in July to September (69.2% vs. 21.9%, P < 0.001), and had more often headache (42.3% vs. 15.5%, P < 0.01). To reduce the risk of underdiagnosing LNB in an endemic area, we recommend testing for LNB in patients with facial palsy in summer months especially when presenting with headache, irrespective of a recent tick bite and/or EM.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268819000438
      Issue No: Vol. 147 (2019)
  • Estimate of the annual burden of foodborne illness in nondeployed active
           duty US Army Service Members: five major pathogens, 2010–2015
    • Authors: S. B. Mullaney; D. R. Hyatt, M. D. Salman, S. Rao, B. J. McCluskey
      Abstract: In this study, we estimate the burden of foodborne illness (FBI) caused by five major pathogens among nondeployed US Army service members. The US Army is a unique population that is globally distributed, has its own food procurement system and a food protection system dedicated to the prevention of both unintentional and intentional contamination of food. To our knowledge, the burden of FBI caused by specific pathogens among the US Army population has not been determined. We used data from a 2015 US Army population survey, a 2015 US Army laboratory survey and data from FoodNet to create inputs for two model structures. Model type 1 scaled up case counts of Campylobacter jejuni, Shigella spp., Salmonella enterica non-typhoidal and STEC non-O157 ascertained from the Disease Reporting System internet database from 2010 to 2015. Model type 2 scaled down cases of self-reported acute gastrointestinal illness (AGI) to estimate the annual burden of Norovirus illness. We estimate that these five pathogens caused 45 600 (5%–95% range, 30 300–64 000) annual illnesses among nondeployed active duty US Army Service members. Of these pathogens, Norovirus, Campylobacter jejuni and Salmonella enterica non-typhoidal were responsible for the most illness. There is a tremendous burden of AGI and FBI caused by five major pathogens among US Army Soldiers, which can have a tremendous impact on readiness of the force. The US Army has a robust food protection program in place, but without a specific active FBI surveillance system across the Department of Defence, we will never have the ability to measure the effectiveness of modern, targeted, interventions aimed at the reduction of specific foodborne pathogens.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268818003199
      Issue No: Vol. 147 (2019)
  • Escherichia+coli+and+first+report+of+blaVIM+carbapenemases+gene+in+calves+from+India&rft.title=Epidemiology+&+Infection&rft.issn=0950-2688&,+O.+R.+Vinodh+Kumar,+Ajay+Kumar+Yadav,+B.+S.+Pruthvishree,+Prasanna+Vadhana,+K.+R.+Nirupama,+Monika+Bhardwaj,+B.+R.+Singh&rft_id=info:doi/10.1017/S0950268819000463">Epidemiology of carbapenem-resistant Escherichia coli and first report of
           blaVIM carbapenemases gene in calves from India
    • Authors: M. Senthil Murugan; D. K. Sinha, O. R. Vinodh Kumar, Ajay Kumar Yadav, B. S. Pruthvishree, Prasanna Vadhana, K. R. Nirupama, Monika Bhardwaj, B. R. Singh
      Abstract: A cross-sectional study on six dairy farms was conducted to ascertain the occurrence of carbapenem-resistant Escherichia coli in calves. Two-hundred and seventy-nine isolates of E. coli were recovered from 90 faecal samples from apparently healthy (45) and diarrhoeal (45) calves. The isolates were screened for phenotypic susceptibility to carbapenems and production of metallo β-lactamase, as well as five carbapenemase resistance genes by PCR, and overexpression of efflux pumps. Eighty-one isolates (29.03%) were resistant to at least one of three carbapenem antibiotics [meropenem (23.30%), imipenem (2.15%) and ertapenem (1.43%)], and one isolate was positive for the blaVIM gene which was located on an Incl1 plasmid of a novel sequence type (ST 297) by multilocus sequence typing. The majority (83.95%) of isolates had an active efflux pump. Calves housed on concrete floors were approximately seven times more likely to acquire meropenem-resistant isolates than those housed on earthen floors (95% CI 1.27–41.54). In India, carbapenem drugs are not used in food animal treatment, hence carbapenem-resistant strains in calves possibly originate from the natural environment or human contact and is of public health importance. To our knowledge, this is the first report of blaVIM carbapenemases gene in calves from India.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268819000463
      Issue No: Vol. 147 (2019)
  • The effectiveness of vaccination to prevent the papillomavirus infection:
           a systematic review and meta-analysis
    • Authors: Herney Andrés García-Perdomo; Julio Cesar Osorio, Adrian Fernandez, James Alejandro Zapata-Copete, Andrés Castillo
      Abstract: Our purpose was to determine the effectiveness and harms of vaccination in patients with any sexual history to prevent the prevalence of papillomavirus infection. A search strategy was conducted in the MEDLINE, CENTRAL, EMBASE and LILACS databases. Searches were also conducted in other databases and unpublished literature. The risk of bias was evaluated with the Cochrane Collaboration's tool. Analysis of fixed effects was conducted. The primary outcome was the infection by any and each human papillomavirus (HPV) genotype, serious adverse effects and short-term adverse effects. The measure of the effect was the risk difference (RD) with a 95% confidence interval (CI). The planned interventions were bivalent vaccine/tetravalent/nonavalent vs. placebo/no intervention/other vaccines. We included 29 studies described in 35 publications. Bivalent HPV vaccine offers protection against HPV16 (RD −0.05, 95% CI −0.098 to −0.0032), HPV18 (RD −0.03, 95% CI −0.062 to −0.0004) and HPV16/18 genotypes (RD of −0.1, 95% CI −0.16 to −0.04). On the other side, tetravalent HPV vaccine offered protection against HPV6 (RD of −0.0500, 95% CI −0.0963 to −0.0230), HPV11 (RD −0.0198, 95% CI −0.0310 to −0.0085). Also, against HPV16 (RD of −0.0608, 95% CI −0.1126 to −0.0091) and HPV18 (RD of −0.0200, 95% CI −0.0408 to −0.0123). There was a reduction in the prevalence of HPV16, 18 and 16/18 genotypes when applying the bivalent vaccine, with no increase in adverse effects. Regarding the tetravalent vaccine, we found a reduction in the prevalence of HPV6, 11, 16 and 18 genotypes, with no increase in adverse effects.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268818003679
      Issue No: Vol. 147 (2019)
  • Estimating seasonal variation in Australian pertussis notifications from
           1991 to 2016: evidence of spring to summer peaks
    • Authors: R. N. F. Leong; J. G. Wood, R. M. Turner, A. T. Newall
      Abstract: Unlike for many other respiratory infections, the seasonality of pertussis is not well understood. While evidence of seasonal fluctuations in pertussis incidence has been noted in some countries, there have been conflicting findings including in the context of Australia. We investigated this issue by analysing the seasonality of pertussis notifications in Australia using monthly data from January 1991 to December 2016. Data were made available for all states and territories in Australia except for the Australian Capital Territory and were stratified into age groups. Using a time-series decomposition approach, we formulated a generalised additive model where seasonality is expressed using cosinor terms to estimate the amplitude and peak timing of pertussis notifications in Australia. We also compared these characteristics across different jurisdictions and age groups. We found evidence that pertussis notifications exhibit seasonality, with peaks observed during the spring and summer months (November–January) in Australia and across different states and territories. During peak months, notifications are expected to increase by about 15% compared with the yearly average. Peak notifications for children
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268818003680
      Issue No: Vol. 147 (2019)
  • Development of predictive nomograms for clinical use to quantify the risk
           of isolating resistance prone organisms in patients with infected foot
    • Authors: A. Farkas; F. Lin, K. Bui, F. Liu, G. L. An, A. Pakholskiy, C. F. Stavropoulos, J. C. Lantis, A. Yassin
      Abstract: Pseudomonas aeruginosa and methicillin-resistant Staphylococcus aureus (MRSA) have been considered prevalent pathogens in foot infections. However, whether empiric therapy directed against these organisms is necessary, and in whom to consider treatment, is rather unclear. The aim of this study was to develop predictive algorithms for forecasting the probability of isolating these organisms in the infected wounds of patients in a population where the prevalence of resistant pathogens is low. This was a retrospective study of regression model-based risk factor analysis that included 140 patients who presented with infected, culture positive foot ulcers to two urban hospitals. A total of 307 bacteria were identified, most frequently MRSA (11.1%). P. aeruginosa prevalence was 6.5%. In the multivariable analysis, amputation (odds ratio (OR) 5.75, 95% confidence interval (CI) 1.48–27.63), renal disease (OR 5.46, 95% CI 1.43–25.16) and gangrene (OR 2.78, 95% CI 0.82–9.59) were identified as risk factors associated with higher while diabetes (OR 0.07, 95% CI 0.01–0.34) and Infectious Diseases Society of America infection severity >3 (OR 0.18, 95% CI 0.03–0.65) were associated with lower odds of P. aeruginosa isolation (C statistic 0.81). Similar analysis for MRSA showed that amputation was associated with significantly lower (OR 0.29, 95% CI 0.09–0.79) risk, while history of MRSA infection (OR 5.63, 95% CI 1.56–20.63) and osteomyelitis (OR 2.523, 95% CI 1.00–6.79) was associated with higher odds of isolation (C statistic 0.69). We developed two predictive nomograms with reasonable to strong ability to discriminate between patients who were likely of being infected with P. aeruginosa or MRSA and those who were not. These analyses confirm the association of some, but also question the significance of other frequently described risk factors in predicting the isolation of these organisms.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268818003667
      Issue No: Vol. 147 (2019)
  • Factors associated with acquisition of glycopeptide-resistant enterococci
           during a single-strain outbreak
    • Authors: S. Deboscker; P. Schneider, F. Séverac, C. Ménard, J. Gaudart, T. Lavigne, N. Meyer
      Abstract: The aim of our study was to describe and to investigate the factors associated with glycopeptide-resistant enterococci (GRE) acquisition during a single-strain outbreak which occurred in several wards of hospital from September 2013 to January 2014. We designed a case–control study. Analyses were performed using Bayesian methods. Univariate logistic regressions with informative priors from published studies were conducted. A multivariate model was build including variables with a probability of odd-ratio exceeding one (Pr) >85% or
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268818003655
      Issue No: Vol. 147 (2019)
  • Corrigendum: Influence of IL28B and MxA gene polymorphisms on HCV
           clearance in Han Chinese population
    • Authors: Feng Zang; Ming Yue, Yinan Yao, Mei Liu, Haozhi Fan, Yue Feng, Xueshan Xia, Peng Huang, Rongbin Yu
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268818003321
      Issue No: Vol. 147 (2019)
  • Clostridium+difficile+in+the+community:+importance+of+animals,+infants+and+asymptomatic+carriers&rft.title=Epidemiology+&+Infection&rft.issn=0950-2688&,+M.+Kirk,+K.+Glass&rft_id=info:doi/10.1017/S0950268819000384">Modelling diverse sources of Clostridium difficile in the community:
           importance of animals, infants and asymptomatic carriers
    • Authors: A. McLure; A. C. A. Clements, M. Kirk, K. Glass
      Abstract: Clostridium difficile infections (CDIs) affect patients in hospitals and in the community, but the relative importance of transmission in each setting is unknown. We developed a mathematical model of C. difficile transmission in a hospital and surrounding community that included infants, adults and transmission from animal reservoirs. We assessed the role of these transmission routes in maintaining disease and evaluated the recommended classification system for hospital- and community-acquired CDIs. The reproduction number in the hospital was 1 for nearly all scenarios without transmission from animal reservoirs (range: 1.0–1.34). However, the reproduction number for the human population was 3.5–26.0%) of human exposures originated from animal reservoirs. Symptomatic adults accounted for
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268819000384
      Issue No: Vol. 147 (2019)
  • Clostridium+difficile+infection+in+the+Western+Australian+population&rft.title=Epidemiology+&+Infection&rft.issn=0950-2688&,+S.+Tempone,+R.+McCann,+P.+K.+Armstrong,+T.+V.+Riley,+A.+Cook&rft_id=info:doi/10.1017/S0950268819000499">Recurrence of Clostridium difficile infection in the Western Australian
    • Authors: M. Alfayyadh; D. A. Collins, S. Tempone, R. McCann, P. K. Armstrong, T. V. Riley, A. Cook
      Abstract: Clostridium difficile, the most common cause of hospital-associated diarrhoea in developed countries, presents major public health challenges. The high clinical and economic burden from C. difficile infection (CDI) relates to the high frequency of recurrent infections caused by either the same or different strains of C. difficile. An interval of 8 weeks after index infection is commonly used to classify recurrent CDI episodes. We assessed strains of C. difficile in a sample of patients with recurrent CDI in Western Australia from October 2011 to July 2017. The performance of different intervals between initial and subsequent episodes of CDI was investigated. Of 4612 patients with CDI, 1471 (32%) were identified with recurrence. PCR ribotyping data were available for initial and recurrent episodes for 551 patients. Relapse (recurrence with same ribotype (RT) as index episode) was found in 350 (64%) patients and reinfection (recurrence with new RT) in 201 (36%) patients. Our analysis indicates that 8- and 20-week intervals failed to adequately distinguish reinfection from relapse. In addition, living in a non-metropolitan area modified the effect of age on the risk of relapse. Where molecular epidemiological data are not available, we suggest that applying an 8-week interval to define recurrent CDI requires more consideration.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268819000499
      Issue No: Vol. 147 (2019)
  • The seroprevalence of cytomegalovirus infection in Belgium anno 2002 and
           2006: a comparative analysis with hepatitis A virus seroprevalence
    • Authors: G. S. A. Smit; S. Abrams, P. Dorny, N. Speybroeck, B. Devleesschauwer, V. Hutse, H. Jansens, H. Theeten, P. Beutels, N. Hens
      Abstract: Cytomegalovirus (CMV) infection is endemic worldwide but its seroprevalence varies widely. The goal of this study was to estimate the age-specific seroprevalence of CMV infection in Belgium based on two cross-sectional serological datasets from 2002 and 2006. The seroprevalence was estimated relying on diagnostic test results based on cut-off values pre-specified by the manufacturers of the tests as well as relying on mixture models applied to continuous pathogen-specific immunoglobulin G antibody titre concentrations. The age-specific seroprevalence of hepatitis A virus (HAV), based on three Belgian cross-sectional serological datasets from 1993, 2002 and 2006, was used as a comparator since individuals acquire lifelong immunity upon recovery, implying an increasing seroprevalence with age. The age group weighted overall CMV seroprevalence derived from the mixture model was 32% (95% confidence interval (CI) 31–34%) in 2002 and 31% (95% CI 30–32%) in 2006. We demonstrated that CMV epidemiology differs from the immunizing infection HAV. This was the first large-scale study of CMV and HAV serial datasets in Belgium, estimating seroprevalence specified by age and birth cohort.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268819000487
      Issue No: Vol. 147 (2019)
  • Chronic hepatitis B and C infections in the Netherlands: estimated
           prevalence in risk groups and the general population
    • Authors: J. Koopsen; J. E. van Steenbergen, J. H. Richardus, M. Prins, E. L. M. Op de Coul, E. A. Croes, J. Heil, F. R. Zuure, I. K. Veldhuijzen
      Abstract: Chronic hepatitis B virus (HBV) and hepatitis C virus (HCV) infections are usually asymptomatic for decades, thus targeted screening can prevent liver disease by timely diagnosis and linkage to care. More robust estimates of chronic HBV and HCV infections in the general population and risk groups are needed. Using a modified workbook method, the total number of ever chronically infected individuals in the Netherlands in 2016 was determined using population size and prevalence estimates from studies in the general and high-risk population. The estimated 2016 chronic HBV infection prevalence is 0.34% (low 0.22%, high 0.47%), corresponding to approximately 49 000 (low 31 000, high 66 000) HBV-infected individuals aged 15 years and older. The estimated ever-chronic HCV infection prevalence is 0.16% (low 0.06%, high 0.27%), corresponding to approximately 23 000 (low 8000, high 38 000) ever-chronic HCV-infected individuals. The prevalence of chronic HBV and HCV infections in the Netherlands is low. First-generation migrants account for most infections with 81% and 60% of chronic HBV and HCV infections, respectively. However, about one-fifth of HCV infections is found in the general population at low risk. This method can serve as an example for countries in need of more accurate prevalence estimates, to help the design and evaluation of prevention and control policies.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268819000359
      Issue No: Vol. 147 (2019)
  • Clostridium+difficile+infections+in+Northern+Ireland,+2012–2016:+a+population+data+linkage+and+case–case+study&rft.title=Epidemiology+&+Infection&rft.issn=0950-2688&,+N.Q.+Verlander,+D.+Fairley,+D.T.+Bradley,+L.+Patterson&rft_id=info:doi/10.1017/S0950268819000414">Comparing the epidemiology of community- and hospital-associated
           Clostridium difficile infections in Northern Ireland, 2012–2016: a
           population data linkage and case–case study
    • Authors: A. Maisa; G. Ross, N.Q. Verlander, D. Fairley, D.T. Bradley, L. Patterson
      Abstract: The burden of community-associated Clostridium difficile infection (CA-CDI) has increased. We aimed to describe the epidemiology of CA-CDI to inform future interventions. We used population-based linked surveillance data from 2012 to 2016 to describe socio-demographic factors, ribotype and mortality for all CA (n = 1303) and hospital-associated (HA, n = 1356) CDI. For 483 community-onset (CO) CA-CDI and 287 COHA-CDI cases, a questionnaire on risk factors was completed and we conducted a case–case study using logistic regression models for univariate and multivariable analysis. CA-CDI cases had lower odds of being male (adjusted odds ratio (AOR) 0.71, 95% confidence interval (CI) 0.58–0.87; P < 0.001), and higher odds of living in rural rather than urban settlement (AOR 1.5, 95% CI 1.1–2.1; P = 0.05) compared with HA-CDI cases. The distribution of ribotypes was similar in both groups with RT078 being most prevalent. CDI-specific death was lower in CA-CDI than HA-CDI (7% vs. 11%, P < 0.001). COCA-CDI had lower odds of having had an outpatient appointment in the previous 4 weeks compared with COHA-CDI (AOR 0.61; 95% CI 0.41–0.9, P = 0.01) and lower odds of being in a care home or hospice when compared with their own home, than COHA-CDI (AOR 0.66; 95% CI 0.45–0.98 and AOR 0.35; 95% CI 0.13–0.92, P = 0.02). Exposure to gastric acid suppressants (50% in COCA-CDI and 55% in COHA-CDI) and antimicrobial therapy (18% in COCA-CDI and 20% in COHA-CDI) prior to CDI was similar. Our analysis of community-onset cases suggests that other risk factors for COHA-CDI may be equally important for COCA-CDI. Opportunities to safely reduce antibiotic and gastric acid suppressants use should be investigated in all healthcare settings.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268819000414
      Issue No: Vol. 147 (2019)
  • The resurgence of syphilis in high-income countries in the 2000s: a focus
           on Europe
    • Authors: G. Spiteri; M. Unemo, O. Mårdh, A. J. Amato-Gauci
      Abstract: Syphilis can cause severe complications and sequelae. Following a decrease in reported cases in European Union/European Economic Area (EU/EEA) and other high-income countries in the 1980s and 1990s as a result of the HIV epidemic and ensuing changes in sexual behaviour, trends started to increase in the 2000s in a number of EU/EEA Member States with higher rates among men and a large proportion of cases reported among men who have sex with men (MSM), particularly HIV-positive MSM. Trends in EU/EEA Member States vary however with some countries continuing to report decreases in the number of reported cases (mostly in the Eastern part of EU/EEA) whereas many Western European countries report increasing numbers of cases. Increasing rates among women, although still relatively low, have been observed in a number of countries leading to concerns around mother-to-child transmission of syphilis and congenital syphilis. Similar overall trends are observed in other high-income countries with the exception of Japan where rates among heterosexual men and women have been rising at alarming levels. Control of syphilis requires use of comprehensive, evidence-based strategies which take into account lessons learned from previous control efforts as well as consideration of biomedical interventions.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268819000281
      Issue No: Vol. 147 (2019)
  • Campylobacter+jejuni+capsule+types+in+a+Peruvian+birth+cohort+and+associations+with+diarrhoeal+disease+severity&rft.title=Epidemiology+&+Infection&rft.issn=0950-2688&édéric+Poly,+Janelle+Kuroiwa,+Rosa+Burga,+Maribel+Paredes+Olortegui,+Patricia+Guerry,+Margaret+Kosek,+Chad+K.+Porter&rft_id=info:doi/10.1017/S0950268818002960">Campylobacter jejuni capsule types in a Peruvian birth cohort and
           associations with diarrhoeal disease severity
    • Authors: Britney Neitenbach; Frédéric Poly, Janelle Kuroiwa, Rosa Burga, Maribel Paredes Olortegui, Patricia Guerry, Margaret Kosek, Chad K. Porter
      Abstract: Campylobacter jejuni is a leading cause of bacterial diarrhoea worldwide. The objective of this study was to examine the association between C. jejuni capsule types and clinical signs and symptoms of diarrhoeal disease in a well-defined birth cohort in Peru. Children were enrolled in the study at birth and followed until 2 years of age as part of the Malnutrition and Enteric Infections birth cohort. Associations between capsule type and clinical outcomes were assessed using the Pearson's χ2 and the Kruskal–Wallis test statistics. A total of 318 C. jejuni samples (30% from symptomatic cases) were included in this analysis. There were 22 different C. jejuni capsule types identified with five accounting for 49.1% of all isolates. The most common capsule types among the total number of isolates were HS4 complex (n = 52, 14.8%), HS5/31 complex (n = 42, 11.9%), HS15 (n = 29, 8.2%), HS2 (n = 26, 7.4%) and HS10 (n = 24, 6.8%). These five capsule types accounted for the majority of C. jejuni infections; however, there was no significant difference in prevalence between symptomatic and asymptomatic infection (all p > 0.05). The majority of isolates (n = 291, 82.7%) were predicted to express a heptose-containing capsule. The predicted presence of methyl phosphoramidate, heptose or deoxyheptose on the capsule was common.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268818002960
      Issue No: Vol. 147 (2019)
  • Magnitude, distribution, risk factors and care-seeking behaviour of acute,
           self-reported gastrointestinal illness among US Army Soldiers: 2015
    • Authors: S. B. Mullaney; S. Rao, M. D. Salman, B. J. McCluskey, D. R. Hyatt
      Abstract: Throughout history, acute gastrointestinal illness (AGI) has been a significant cause of morbidity and mortality among US service members. We estimated the magnitude, distribution, risk factors and care seeking behaviour of AGI among the active duty US Army service members using a web-based survey. The survey asked about sociodemographic characteristics, dining and food procurement history and any experience of diarrhoea in the past 30 days. If respondents reported diarrhoea, additional questions about concurrent symptoms, duration of illness, medical care seeking and stool sample submission were asked. Univariable and multivariable logistic regression were used to identify the factors associated with AGI and factors associated with seeking care and submitting a stool sample. The 30-day prevalence of AGI was 18.5% (95% CI 16.66–20.25), the incidence rate was 2.24 AGI episodes per person-year (95% CI 2.04–2.49). Risk factors included a region of residence, eating at the dining facility and eating at other on-post establishments. Individuals with AGI missed 2.7–3.7 days of work, which costs approximately $ 847 451 629 in paid wages. Results indicate there are more than 1 million cases of AGI per year among US Army Soldiers, which can have a major impact on readiness. We found that care-seeking behaviours for AGI are different among US Army Service Members than the general population. Army Service Members with AGI report seeking care and having a stool sample submitted less often, especially for severe (bloody) diarrhoea. Factors associated with seeking care included rank, experiencing respiratory symptoms (sore throat, cough), experiencing vomiting and missing work for their illness. Factors associated with submitting a stool sample including experiencing more than five loose stools in 24 h and not experiencing respiratory symptoms. US Army laboratory-based surveillance under-estimates service members with both bloody and non-bloody diarrhoea. To our knowledge, this is the first study to estimate the magnitude, distribution, risk factors and care-seeking behaviour of AGI among Army members. We determined Army service members care-seeking behaviours, AGI risk factors and stool sample submission rates are different than the general population, so when estimating burden of AGI caused by specific foodborne pathogens using methods like Scallan et al. (2011), unique multipliers must be used for this subset of the population. The study legitimises not only the importance of AGI in the active duty Army population but also highlights opportunities for public health leaders to engage in simple strategies to better capture AGI impact so more modern intervention strategies can be implemented to reduce burden and indirectly improve operational readiness across the Enterprise.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268818003187
      Issue No: Vol. 147 (2019)
  • Seroprevalence of HCV, HBV and HIV in two inner-city London emergency
    • Authors: L. Cieply; R. Simmons, S. Ijaz, E. Kara, A. Rodger, W. Rosenberg, A. McGuinness, J. L. Mbisa, J. Ledesma, N. Ohemeng-Kumi, S. Dicks, H. Potts, S. Lattimore, S. Mandal
      Abstract: Summary: In this paper we build on work investigating the feasibility of human immunodeficiency virus (HIV) testing in emergency departments (EDs), estimating the prevalence of hepatitis B, C and HIV infections among persons attending two inner-London EDs, identifying factors associated with testing positive in an ED. We also undertook molecular characterisation to look at the diversity of the viruses circulating in these individuals, and the presence of clinically significant mutations which impact on treatment and control.Blood-borne virus (BBV) testing in non-traditional settings is feasible, with emergency departments (ED) potentially effective at reaching vulnerable and underserved populations. We investigated the feasibility of BBV testing within two inner-London EDs. Residual samples from biochemistry for adults (⩾18 years) attending The Royal Free London Hospital (RFLH) or the University College London Hospital (UCLH) ED between January and June 2015 were tested for human immunodeficiency virus (HIV)Ag/Ab, anti-hepatitis C (HCV) and HBsAg. PCR and sequence analysis were conducted on reactive samples. Sero-prevalence among persons attending RFH and UCLH with residual samples (1287 and 1546), respectively, were 1.1% and 1.0% for HBsAg, 1.6% and 2.3% for anti-HCV, 0.9% and 1.6% for HCV RNA, and 1.3% and 2.2% for HIV. For RFH, HBsAg positivity was more likely among persons of black vs. white ethnicity (odds ratio 9.08; 95% confidence interval 2.72–30), with anti-HCV positivity less likely among females (0.15, 95% CI 0.04–0.50). For UCLH, HBsAg positivity was more likely among non-white ethnicity (13.34, 95% CI 2.20–80.86 (Asian); 8.03, 95% CI 1.12–57.61 (black); and 8.11, 95% CI 1.13–58.18 (other/mixed)). Anti-HCV positivity was more likely among 36–55 year olds vs. ⩾56 years (7.69, 95% CI 2.24–26.41), and less likely among females (0.24, 95% CI 0.09–0.65). Persons positive for HIV-markers were more likely to be of black vs. white ethnicity (4.51, 95% CI 1.63–12.45), and less likely to have one ED attendance (0.39, 95% CI 0.17–0.88), or female (0.12, 95% CI 0.04–0.42). These results indicate that BBV-testing in EDs is feasible, providing a basis for further studies to explore provider and patient acceptability, referral into care and cost-effectiveness.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268819000360
      Issue No: Vol. 147 (2019)
  • Epidemiology of two decades of invasive meningococcal disease in the
           Republic of Ireland: an analysis of national surveillance data on
           laboratory-confirmed cases from 1996 to 2016
    • Authors: D. Bennett; P. O'Lorcain, S. Morgan, S. Cotter, M. Cafferkey, R. Cunney
      Abstract: We examined the epidemiology of invasive meningococcal disease (IMD) in the Republic of Ireland (ROI) between epidemiological year (EY) 1996/1997 and EY2015/2016. Over the 20 EYs, 3707 cases were reported with annual incidence rates per 100 000 peaking at 11.6 in EY1999/2000, decreasing significantly to 1.5 in EY2015/2016. The highest disease burden was in infants and children
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268819000396
      Issue No: Vol. 147 (2019)
  • Hospitalisations with infections related to antimicrobial-resistant
           bacteria from the French nationwide hospital discharge database, 2016
    • Authors: M. Opatowski; P. Tuppin, K. Cosker, M. Touat, G. De Lagasnerie, D. Guillemot, J. Salomon, C. Brun-Buisson, L. Watier
      Abstract: Massive use of antibiotics has led to increased bacterial resistance to these drugs, making infections more difficult to treat. Few studies have assessed the overall antimicrobial resistance (AMR) burden, and there is a paucity of comprehensive data to inform health policies. This study aims to assess the overall annual incident number of hospitalised patients with AMR infection in France, using the National Hospital Discharge database. All incident hospitalisations with acute infections in 2016 were extracted. Infections which could be linked with an infecting microorganism were first analysed. Then, an extrapolation of bacterial species and resistance status was performed, according to age class, gender and infection site to estimate the total number of AMR cases. Resistant bacteria caused 139 105 (95% CI 127 920–150 289) infections, resulting in a 12.3% (95% CI 11.3–13.2) resistance rate. ESBL-producing Enterobacteriaceae and methicillin-resistant Staphylococcus aureus were the most common resistant bacteria (>50%), causing respectively 49 692 (95% CI 47 223–52 142) and 19 493 (95% CI 15 237–23 747) infections. Although assumptions are needed to provide national estimates, information from PMSI is comprehensive, covering all acute bacterial infections and a wide variety of microorganisms.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268819000402
      Issue No: Vol. 147 (2019)
  • The health and economic impact of acute gastroenteritis in Belgium,
    • Authors: Theofilos Papadopoulos; Sofieke Klamer, Stephanie Jacquinet, Boudewijn Catry, Amber Litzroth, Laure Mortgat, Pavlos Mamouris, Javiera Rebolledo, Bert Vaes, Dieter Van Cauteren, Johan Van der Heyden, Philippe Beutels, Brecht Devleesschauwer
      Abstract: Acute gastroenteritis (AGE) remains a common condition in both low- and high-income countries. In Belgium, however, there is currently a lack of information on the societal health and economic impact of AGE. We conducted a retrospective study using mortality and cause-of-death data, hospital data, primary care data, health interview survey data and other published data. We estimated the burden of illness during a 5-year period (2010–2014) in Belgium in terms of deaths, patients admitted to hospitals, patients consulting their general practitioner (GP) and cases occurring in the community. We further quantified the health impact in terms of disability-adjusted life years (DALYs) and the economic impact in terms of cost-of-illness estimates. We estimated 343 deaths, 27 707 hospitalised patients, 464 222 GP consultations and 10 058 741 episodes occurring in the community (0.91 cases/person) on average per year. AGE was associated with 11 855 DALYs per year (107 DALY per 100 000 persons). The economic burden was estimated to represent direct costs of €112 million, indirect costs of €927 million (90% of the total costs) and an average total cost of €103 per case and €94 per person. AGE results in a substantial health and economic impact in Belgium, justifying continued mitigation efforts.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S095026881900044X
      Issue No: Vol. 147 (2019)
  • Escherichia+coli+in+a+community&rft.title=Epidemiology+&+Infection&rft.issn=0950-2688&,+H.+Watanabe,+L.+Qin,+M.+Ohnishi,+J.+Terajima,+S.+Iyoda,+T.+Morita-Ishihara,+K.+Tateda,+Y.+Ishii,+T.+Saga,+K.+Aoki,+R.+A.+Bonomo&rft_id=info:doi/10.1017/S0950268819000426">Epidemiology and genotypic characterisation of dissemination patterns of
           uropathogenic Escherichia coli in a community
    • Authors: M. Matsukawa; M. Igarashi, H. Watanabe, L. Qin, M. Ohnishi, J. Terajima, S. Iyoda, T. Morita-Ishihara, K. Tateda, Y. Ishii, T. Saga, K. Aoki, R. A. Bonomo
      Abstract: To characterise the dissemination patterns of uropathogenic Escherichia coli (UPEC) in a community, we conducted a study utilising molecular and fundamental descriptive epidemiology. The subjects, consisted of women having community-acquired acute urinary tract infection (UTI), were enrolled in the study from 2011 to 2012. UPEC isolates were subjected to antibacterial-susceptibility testing, O serogrouping, phylotyping, multilocus-sequence typing with phylogenetic-tree analysis and pulsed-field-gel electrophoresis (PFGE). From the 209 unique positive urinary samples 166 UPEC were isolated, of which 129 were fully susceptible to the tested antibiotics. Of the 53 sequence types (STs), the four most prevalent STs (ST95, ST131, ST73 and ST357) accounted for 60% of all UPEC strains. Antimicrobial resistance was less frequently observed for ST95 and ST73 than for the others. A majority of rare STs and a few common STs constituted the diversity pattern within the population structure, which was composed of the two phylogenetically distinct clades. Eleven genetically closely related groups were determined by PFGE, which accounted for 42 of the 166 UPEC isolates, without overt geo-temporal clustering. Our results indicate that a few major lineages of UPEC, selected by unidentified factors, are disseminated in this community and contribute to a large fraction of acute UTIs.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268819000426
      Issue No: Vol. 147 (2019)
  • Salmonella+enterica+serovar+Wangata+in+north-eastern+New+South+Wales,+Australia,+2016–2017&rft.title=Epidemiology+&+Infection&rft.issn=0950-2688&,+G.+Bell,+D.+N.+Durrheim,+G.+A.+Hill-Cawthorne,+K.+Hope,+P.+Howard,+T.+Kohlenberg,+K.+Lawrence,+K.+Lilly,+P.+Porigneaux,+V.+Sintchenko,+Q.+Wang,+M.+P.+Ward,+A.+Wiethoelter,+S.+M.+Mor,+J.+Flint&rft_id=info:doi/10.1017/S0950268819000475">A One Health investigation of Salmonella enterica serovar Wangata in
           north-eastern New South Wales, Australia, 2016–2017
    • Authors: J. Collins; K. M. J. Simpson, G. Bell, D. N. Durrheim, G. A. Hill-Cawthorne, K. Hope, P. Howard, T. Kohlenberg, K. Lawrence, K. Lilly, P. Porigneaux, V. Sintchenko, Q. Wang, M. P. Ward, A. Wiethoelter, S. M. Mor, J. Flint
      Abstract: Salmonella enterica serovar Wangata (S. Wangata) is an important cause of endemic salmonellosis in Australia, with human infections occurring from undefined sources. This investigation sought to examine possible environmental and zoonotic sources for human infections with S. Wangata in north-eastern New South Wales (NSW), Australia. The investigation adopted a One Health approach and was comprised of three complimentary components: a case–control study examining human risk factors; environmental and animal sampling; and genomic analysis of human, animal and environmental isolates. Forty-eight human S. Wangata cases were interviewed during a 6-month period from November 2016 to April 2017, together with 55 Salmonella Typhimurium (S. Typhimurium) controls and 130 neighbourhood controls. Indirect contact with bats/flying foxes (S. Typhimurium controls (adjusted odds ratio (aOR) 2.63, 95% confidence interval (CI) 1.06–6.48)) (neighbourhood controls (aOR 8.33, 95% CI 2.58–26.83)), wild frogs (aOR 3.65, 95% CI 1.32–10.07) and wild birds (aOR 6.93, 95% CI 2.29–21.00) were statistically associated with illness in multivariable analyses. S. Wangata was detected in dog faeces, wildlife scats and a compost specimen collected from the outdoor environments of cases’ residences. In addition, S. Wangata was detected in the faeces of wild birds and sea turtles in the investigation area. Genomic analysis revealed that S. Wangata isolates were relatively clonal. Our findings suggest that S. Wangata is present in the environment and may have a reservoir in wildlife populations in north-eastern NSW. Further investigation is required to better understand the occurrence of Salmonella in wildlife groups and to identify possible transmission pathways for human infections.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268819000475
      Issue No: Vol. 147 (2019)
  • TB+among+health+care+workers+in+China&rft.title=Epidemiology+&+Infection&rft.issn=0950-2688&,+Yan+Li,+Hui+Jing,+Yan+Wang,+Xuezheng+Li,+Lingzhong+Xu&rft_id=info:doi/10.1017/S0950268818002777">Isolation measures and protection awareness are significant for latent
           tuberculosis infection: a cross-sectional study based on T-SPOT.TB among
           health care workers in China
    • Authors: Yunfeng Deng; Yun Liu, Yan Li, Hui Jing, Yan Wang, Xuezheng Li, Lingzhong Xu
      Abstract: This study aimed to reveal the associated risk factors for latent tuberculosis infection (LTBI) detected by T-SPOT.TB assay among health care workers (HCWs) at different working locations or job categories in China. This cross-sectional study included 934 HCWs who underwent the T-SPOT.TB assay. Demographic and social characteristics of the participants, including age, sex, job categories, department/ward and duration of healthcare service, were recorded. Among 934 HCWs, 267 (28.5867%) were diagnosed as having LTBI with positive T-SPOT.TB assay. HCWs working in inpatient tuberculosis (TB) (odds ratio (OR) 2.917; 95% confidence interval (CI) 1.852–4.596; P < 0.001) and respiratory wards (OR 1.840; 95% CI 1.124–3.011; P = 0.015), and with longer duration of healthcare service (OR 1.048; 95% CI 1.016–1.080; P = 0.003) were risk factors for positive T-SPOT.TB result. Furthermore, longer working duration increased the positive rate of T-SPOT.TB results for physicians and nurses, and physicians had higher risks than nurses for the same working duration. Inpatient TB and respiratory wards were high-risk working locations for HCWs with LTBI, and longer duration of healthcare service also increased the risk of LTBI among HCWs. A complete strategy for TB infection control and protection awareness among HCWs should be enhanced.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268818002777
      Issue No: Vol. 147 (2019)
  • The association of cellulitis incidence and meteorological factors in
    • Authors: Ren-Jun Hsu; Chia-Cheng Chou, Jui-Ming Liu, See-Tong Pang, Chien-Yu Lin, Heng-Chang Chuang, Cheng-Keng Chuang, Hsiao-Wei Wang, Ying-Hsu Chang, Po-Hung Lin
      Abstract: Cellulitis is a common infection of the skin and soft tissue. Susceptibility to cellulitis is related to microorganism virulence, the host immunity status and environmental factors. This retrospective study from 2001 to 2013 investigated relationships between the monthly incidence rate of cellulitis and meteorological factors using data from the Taiwanese Health Insurance Dataset and the Taiwanese Central Weather Bureau. Meteorological data included temperature, hours of sunshine, relative humidity, total rainfall and total number of rainy days. In otal, 195 841 patients were diagnosed with cellulitis and the incidence rate was strongly correlated with temperature (γS = 0.84, P < 0.001), total sunshine hours (γS = 0.65, P < 0.001) and total rainfall (γS = 0.53, P < 0.001). The incidence rate of cellulitis increased by 3.47/100 000 cases for every 1° elevation in environmental temperature. Our results may assist clinicians in educating the public of the increased risk of cellulitis during warm seasons and possible predisposing environmental factors for infection.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268819000323
      Issue No: Vol. 147 (2019)
  • An apple a day: an outbreak of cryptosporidiosis in Norway associated with
           self-pressed apple juice
    • Authors: L. J. Robertson; T. T. Temesgen, K. R. Tysnes, J. E. Eikås
      Abstract: In the autumn of 2018, an outbreak of cryptosporidiosis affected adult employees from the same company in Western Norway. The organism was Cryptosporidium parvum, GP60 subtype IIaA14G1R1. All those infected had drunk from the same container of self-pressed apple juice. Incubation period (1 week) and clinical signs were similar among those infected, although some experienced a more prolonged duration of symptoms (up to 2–3 weeks) than others. The infections resulted after consumption from only one of 40 containers of juice and not from any of the other containers. It seems that although Cryptosporidium oocysts were detected in a sample from another container, the contamination did not affect the whole batch. This is perhaps indicative of a restricted contamination event, either from contaminated ground in the orchard, or during collection of the fruit, or during processing. Although outbreaks of food-borne cryptosporidiosis have previously been associated with consumption of contaminated apple juice, most of the more recent outbreaks of food-borne cryptosporidiosis have been associated with salad vegetables or herbs. This outbreak, the first outside USA reported to be associated with apple juice, is a timely reminder that such juice is a suitable transmission vehicle for Cryptosporidium oocysts, and that appropriate hygienic measures are essential in the production of such juice, including artisanal (non-commercial) production.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268819000232
      Issue No: Vol. 147 (2019)
  • Determinants of antibiotic prescribing for upper respiratory tract
           infections in an emergency department with good primary care access: a
           qualitative analysis
    • Authors: Y. Y. Chan; M. A. Bin Ibrahim, C. M. Wong, C. K. Ooi, A. Chow
      Abstract: Upper respiratory tract infections (URTIs) account for substantial attendances at emergency departments (EDs). There is a need to elucidate determinants of antibiotic prescribing in time-strapped EDs – popular choices for primary care despite highly accessible primary care clinics. Semi-structured in-depth interviews were conducted with purposively sampled physicians (n = 9) in an adult ED in Singapore. All interviews were analysed using thematic analysis and further interpreted using the Social Ecological Model to explain prescribing determinants. Themes included: (1) reliance on clinical knowledge and judgement, (2) patient-related factors, (3) patient–physician relationship factors, (4) perceived practice norms, (5) policies and treatment guidelines and (6) patient education and awareness. The physicians relied strongly on their clinical knowledge and judgement in managing URTI cases and seldom interfered with their peers’ clinical decisions. Despite departmental norms of not prescribing antibiotics for URTIs, physicians would prescribe antibiotics when faced with uncertainty in patients’ diagnoses, treating immunocompromised or older patients with comorbidities, and for patients demanding antibiotics, especially under time constraints. Participants had a preference for antibiotic prescribing guidelines based on local epidemiology, but viewed hospital policies on prescribing as a hindrance to clinical judgement. Participants highlighted the need for more public education and awareness on the appropriate use of antibiotics and management of URTIs. Organisational practice norms strongly influenced antibiotic prescribing decisions by physicians, who can be swayed by time pressures and patient demands. Clinical decision support tools, hospital guidelines and patient education targeting at individual, interpersonal and community levels could reduce unnecessary antibiotic use.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S095026881800331X
      Issue No: Vol. 147 (2019)
  • Monitoring telehealth vomiting calls as a potential public health early
           warning system for seasonal norovirus activity in Ontario, Canada
    • Authors: S. L. Hughes; R. A. Morbey, A. J. Elliot, S. A. McEwen, A. L. Greer, I. Young, A. Papadopoulos
      Abstract: Norovirus is a predominant cause of infectious gastroenteritis in countries worldwide [1–5]. It accounts for approximately 50% of acute gastroenteritis (AGE) and >90% of viral gastroenteritis outbreaks [6, 7]. The incubation period ranges between 10 and 48 h and illness duration is generally 1–3 days with self-limiting symptoms; however, this duration is often longer (e.g. 4–6 days) in vulnerable populations such as hospital patients or young children [2, 8]. Symptomatic infection of norovirus presents as acute vomiting, diarrhoea, abdominal cramps and nausea, with severe vomiting and diarrhoea (non-bloody) being most common [2, 5, 9].
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268818003357
      Issue No: Vol. 147 (2019)
  • vs.+HIV-negative+men+in+Taizhou,+China&rft.title=Epidemiology+&+Infection&rft.issn=0950-2688&,+X.+Chen,+W.+Shen,+X.+Ye,+Y.+Lin,+Z.+Lin,+S.+Zhou,+M.+Gao,+Y.+Ding,+N.+He&rft_id=info:doi/10.1017/S0950268818003205">Prevalence and genotypes of anal human papillomavirus infection among
           HIV-positive vs. HIV-negative men in Taizhou, China
    • Authors: X. Liu; H. Lin, X. Chen, W. Shen, X. Ye, Y. Lin, Z. Lin, S. Zhou, M. Gao, Y. Ding, N. He
      Abstract: This study aims to investigate the prevalence and genotype distribution of anal human papillomavirus (HPV) infection among men with different sexual orientations with or without human immunodeficiency virus (HIV) in China. A cross-sectional study was conducted during 2016–2017 in Taizhou City, Zhejiang Province. Convenient sampling was used to recruit male participants from HIV voluntary counselling and testing clinics and Center for Disease Control and Prevention. A face-to-face questionnaire interview was administered and an anal-canal swab was collected for HPV genotyping. A total of 160 HIV-positive and 113 HIV-negative men participated in the study. The prevalence of any type HPV was 30.6% for heterosexual men, 74.1% for homosexual and 63.6% for bisexual men among HIV-positive participants, while the prevalence was 8.3%, 29.2% and 23.8% respectively among HIV-negatives. The most prevalent genotypes were HPV-58 (16.9%), HPV-6 (15.6%) and HPV-11 (15.0%) among HIV-positive men, and were HPV-16 (4.4%), HPV-52 (4.4%) and HPV-6 (3.5%) among HIV-negative men. Having ever had haemorrhoids and having ever seen blood on tissue after defaecation was associated with HPV infection. One-fourth of the HPV infections in this study population can be covered by the quadrivalent vaccine in market. The highly prevalent anal HPV infection among men especially HIV-infected men calls for close observation and further investigation for anal cancer prevention.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268818003205
      Issue No: Vol. 147 (2019)
  • Antimicrobial resistance patterns of bacteria isolated from dogs with
    • Authors: C. Bourély; G. Cazeau, N. Jarrige, A. Leblond, J.Y. Madec, M. Haenni, E. Gay
      Abstract: Antimicrobial-resistant bacteria in dogs can be transmitted to humans and close contact between dogs and people might foster dissemination of resistance determinants. The aim of our study was to describe the antimicrobial resistance (AMR) pattern of the major causative agents of canine otitis – one of the most common diseases in dogs – isolated in France. Data collected between 2012 and 2016 by the French national surveillance network for AMR, referred to as RESAPATH, were analysed. Resistance trends were investigated using non-linear analysis (generalised additive models). A total of 7021 antibiograms were analysed. The four major causative agents of canine otitis in France were coagulase-positive staphylococci, Pseudomonas aeruginosa, Proteus mirabilis and streptococci. Since 2013, resistance to fluoroquinolones has been on the decrease in both P. aeruginosa and Staphylococcus pseudintermedius isolates. For P. aeruginosa, 19.4% of isolates were resistant to both enrofloxacin and gentamicin. The levels of multidrug resistance (acquired resistance to at least one antibiotic in three or more antibiotic classes) ranged between 11.9% for P. mirabilis and 16.0% for S. pseudintermedius. These results are essential to guide prudent use of antibiotics in veterinary medicine. They will also help in designing efficient control strategies and in measuring their effectiveness.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268818003278
      Issue No: Vol. 147 (2019)
  • Spatiotemporal distribution of a non-haematophagous bat community and
           rabies virus circulation: a proposal for urban rabies surveillance in
    • Authors: R. A. Dias; F. Rocha, F. M. Ulloa-Stanojlovic, A. Nitsche, C. Castagna, T. de Lucca, R. C. A. Rodrigues
      Abstract: In Brazil, rabies surveillance is based on monitoring domestic and wild animals, although the most prevalent lineage of the rabies virus (RABV) currently diagnosed in Brazil is associated with bats, particularly non-haematophagous bats. Disease control is based on the mass vaccination of dogs and cats. We used data collected by the passive surveillance system of the city of Campinas from 2011 to 2015, to describe the temporal and geographic distributions of the bat specimens and RABV and discuss the current rabies surveillance with the advent of the declaration of canine and feline rabies-free areas in Brazil. We described the species, locations and health statuses of the collected bat specimens. Moreover, all samples were submitted for RABV diagnosis. Then, we performed a time series decomposition for each bat family. Additionally, we determined the spatiotemporal relative risk for RABV infection using the ratio of the kernel-smoothed estimates of spatiotemporal densities of RABV-positive and RABV-negative bats. From the 2537 bat specimens, the most numerous family was Molossidae (72%), followed by Vespertilionidae (14%) and Phyllostomidae (13%). The bat families behaved differently in terms of seasonal and spatial patterns. The distribution of bats varied geographically in the urban environment, with Molossidae and Phyllostomidae being observed downtown and Vespertilionidae being observed in peripheral zones. Concurrently, a significant relative risk of RABV infection was observed downtown for Vespertilionidae and in peripheral zones for Molossidae. No RABV-positive sample clusters were observed. As a result of the official declaration of RABV-free areas in southern Brazil, mass dog and cat vaccinations are expected to halt in the near future. This stoppage would make most dog and cat populations susceptible to other RABV lineages, such as those maintained by non-haematophagous bats. In this scenario, all information available on bats and RABV distribution in urban areas is essential. Currently, few studies have been conducted. Some local health authorities, such as that in Campinas, are spontaneously basing their surveillance efforts on bat rabies, which is the alternative in reality scenario of increased susceptibility to bat-associated RABV that is developing in Brazil.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268818003229
      Issue No: Vol. 147 (2019)
  • Associations between antibiotic prescriptions and recurrent urinary tract
           infections in female college students
    • Authors: S. N. Rich; E. M. Klann, C. R. Almond, E. M. Larkin, G. Nicolette, J. D. Ball
      Abstract: Urinary tract infections (UTIs) are common among college-aged women and often recur. Some antibiotics recommended to treat UTIs trigger dysbiosis of intestinal and vaginal microbiomes – where uropathogens originate, though few studies have investigated associations between these therapies with recurrent infections. We retrospectively analysed the electronic medical records of 6651 college-aged women diagnosed with a UTI at a US university student health centre between 2006 and 2014. Women were followed for 6 months for incidence of a recurrent infection. In a secondary analysis, associations in women whose experienced UTI recurrence within 2 weeks were also considered for potential infection relapse. Logistic regression was used to assess associations between infection recurrence or relapse and antibiotics prescribed, in addition to baseline patient characteristics including age, race/ethnicity, region of origin, year of encounter, presence of symptomology, pyelonephritis, vaginal coinfection and birth control consultation. There were 1051 instances of infection recurrence among the 6620 patients, indicating a prevalence of 16%. In the analysis of patient characteristics, Asian women were statistically more likely to experience infection recurrence whereas African American were less likely. No significant associations were identified between the antibiotic administered at the initial infection and the risk of infection recurrence after multivariable adjustment. Treatment with trimethoprim-sulphamethoxazole and being born outside of the USA were significantly associated with increased odds of infection relapse in the multivariate analysis. The results of the analyses suggest that treatment with trimethoprim-sulphamethoxazole may lead to an increased risk of UTI relapse, warranting further study.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268818003369
      Issue No: Vol. 147 (2019)
  • Impact of maternal HIV infection on pregnancy outcomes in southwestern
           China – a hospital registry based study
    • Authors: M. Yang; Y. Wang, Y. Chen, Y. Zhou, Q. Jiang
      Abstract: Globally, human immune deficiency virus (HIV)/acquired immune deficiency syndrome (AIDS) continues to be a major public health issue. With improved survival, the number of people living with HIV/AIDS is increasing, with over 2 million among pregnant women. Investigating adverse pregnant outcomes of HIV-infected population and associated factors are of great importance to maternal and infant health. A cross-sectional data collected from hospital delivery records of 4397 mother–infant pairs in southwestern China were analysed. Adverse pregnant outcomes (including low birthweight/preterm delivery/low Apgar score) and maternal HIV status and other characteristics were measured. Two hundred thirteen (4.9%) mothers were HIV positive; maternal HIV infection, rural residence and pregnancy history were associated with all three indicators of adverse pregnancy outcomes. This research suggested that maternal population have high prevalence in HIV infection in this region. HIV-infected women had higher risks of experiencing adverse pregnancy outcomes. Rural residence predisposes adverse pregnancy outcomes. Findings of this study suggest social and medical support for maternal-infant care needed in this region, selectively towards rural areas and HIV-positive mothers.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268818003345
      Issue No: Vol. 147 (2019)
  • Seasonality and trends in incidence of human ehrlichiosis in two Missouri
    • Authors: K. E. Andrews; K. K. Eversman, S. A. Foré, H. J. Kim
      Abstract: Ehrlichiosis is a zoonotic illness caused by Ehrlichia pathogens transmitted by ticks. Case data from 1999 to 2015, provided by the Missouri Department of Health and Senior Services (DHSS), were used to compare the seasonality and the change in incidence over time of ehrlichiosis infection in two Missouri ecoregions, Eastern Temperate Forest (ETF) and Great Plains (GP). Although the number of cases has increased over time in both ecoregions, the rate of change was significantly faster in ETF region. There was no significant difference in seasonality of ehrlichiosis between ecoregions. In Missouri, the estimated ehrlichiosis season begins, on average, in mid-March, peaks in June, and concludes in mid-October. Our results show that the exposure and risk season for ehrlichiosis in Missouri is at least 7 months long.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268818003448
      Issue No: Vol. 147 (2019)
  • Campylobacter+jejuni+among+broilers+in+semi-commercial+farms+in+Jordan&rft.title=Epidemiology+&+Infection&rft.issn=0950-2688&,+M.+Walker,+A.+Alaboudi,+E.+Abu-Basha,+D.+P.+Blake,+J.+Guitian,+M.+Crotta&rft_id=info:doi/10.1017/S0950268818003308">The transmission dynamics of Campylobacter jejuni among broilers in
           semi-commercial farms in Jordan
    • Authors: M. I. Neves; I. Malkawi, M. Walker, A. Alaboudi, E. Abu-Basha, D. P. Blake, J. Guitian, M. Crotta
      Abstract: Campylobacter is the leading cause of foodborne bacterial gastroenteritis in humans worldwide, often associated with the consumption of undercooked poultry. In Jordan, the majority of broiler chicken production occurs in semi-commercial farms, where poor housing conditions and low bio-security are likely to promote campylobacter colonisation. While several studies provided estimates of the key parameters describing the within-flock transmission dynamics of campylobacter in typical high-income countries settings, these data are not available for Jordan and Middle-East in general. A Bayesian model framework was applied to a longitudinal dataset on Campylobacter jejuni infection in a Jordan flock to quantify the transmission rate of C. jejuni in broilers within the farm, the day when the flock first became infected, and the within-flock prevalence (WFP) at clearance. Infection with C. jejuni is most likely to have occurred during the first 8 days of the production cycle, followed by a transmission rate value of 0.13 new infections caused by one infected bird/day (95% CI 0.11–0.17), and a WFP at clearance of 34% (95% CI 0.24–0.47). Our results differ from published studies conducted in intensive poultry production systems in high-income countries but are well aligned with the expectations obtained by means of structured questionnaires submitted to academics with expertise on campylobacter in Jordan. This study provides for the first time the most likely estimates and credible intervals of key epidemiological parameters driving the dynamics of C. jejuni infection in broiler production systems commonly found in Jordan and the Middle-East and could be used to inform Quantitative Microbial Risk Assessment models aimed to assess the risk of human exposure/infection to campylobacter through consumption of poultry meat.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268818003308
      Issue No: Vol. 147 (2019)
  • Enterovirus+in+Brazil:+four+decades+since+the+first+report&rft.title=Epidemiology+&+Infection&rft.issn=0950-2688&,+M.+G.+Buzinaro,+M.+C.+Livonesi,+A.+M.+Fernandes,+R.+L.+M.+Sousa&rft_id=info:doi/10.1017/S0950268818003394">Detection and molecular characterisation of bovine Enterovirus in Brazil:
           four decades since the first report
    • Authors: M. Candido; S. R. Almeida-Queiroz, M. G. Buzinaro, M. C. Livonesi, A. M. Fernandes, R. L. M. Sousa
      Abstract: It is suggested that bovine enteroviruses (BEV) are involved in the aetiology of enteric infections, respiratory disease, reproductive disorders and infertility. In this study, bovine faecal samples collected in different Brazilian states were subjected to RNA extraction, reverse transcription-polymerase chain reaction analysis and partial sequencing of the 5′-terminal portion of BEV. One hundred and three samples were tested with an overall positivity of 14.5%. Phylogenetic analysis clustered these BEV Brazilian samples into the Enterovirus F clade. Our results bring an important update of the virus presence in Brazil and contribute to a better understanding of the distribution and characterisation of BEV in cattle.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268818003394
      Issue No: Vol. 147 (2019)
  • School sessions are correlated with seasonal outbreaks of medically
           attended respiratory infections: electronic health record time series
           analysis, Wisconsin 2004–2011
    • Authors: J. L. Temte; J. G. Meiman, R. E. Gangnon
      Abstract: Increased social contact within school settings is thought to be an important factor in seasonal outbreaks of acute respiratory infection (ARI). To better understand the degree of impact, we analysed electronic health records and compared risks of respiratory infections within communities while schools were in session and out-of-session. A time series analysis of weekly respiratory infection diagnoses from 28 family medicine clinics in Wisconsin showed that people under the age of 65 experienced an increased risk of ARI when schools were in session. For children aged 5–17 years, the risk ratio for the first week of a school session was 1.12 (95% confidence interval (CI) 0.93–1.34), the second week of a session was 1.39 (95% CI 1.15–1.68) and more than 2 weeks into a session was 1.43 (95% CI 1.20–1.71). Less significant increased risk ratios were also observed in young children (0–4 years) and adults (18–64 years). These results were obtained after modelling for baseline seasonal variations in disease prevalence and controlling for short-term changes in ambient temperature and relative humidity. Understanding the mechanisms of seasonality make it easier to predict outbreaks and launch timely public health interventions.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268818003424
      Issue No: Vol. 147 (2019)
  • Comparison of 3-day and 7-day recall periods for food consumption
           reference values in foodborne disease outbreak investigations
    • Authors: V. K. Morton; M. K. Thomas, N. Ciampa, J. Cutler, M. Hurst, A. Currie
      Abstract: Investigations into an outbreak of foodborne disease attempt to identify the source of illness as quickly as possible. Population-based reference values for food consumption can assist in investigation by providing comparison data for hypothesis generation and also strengthening the evidence associated with a food product through hypothesis testing. In 2014–2015 a national phone survey was conducted in Canada to collect data on food consumption patterns using a 3- or 7-day recall period. The resulting food consumption values over the two recall periods were compared. The majority of food products did not show a significant difference in the consumption over 3 days and 7 days. However, comparison of reference values from the 3-day recall period to data from an investigation into a Salmonella Infantis outbreak was shown to support the conclusion that chicken was the source of the outbreak whereas the reference values from a 7-day recall did not support this finding. Reference values from multiple recall periods can assist in the hypothesis generation and hypothesis testing phase of foodborne outbreak investigations.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268818003370
      Issue No: Vol. 147 (2019)
  • Annual relative increased in inpatient mortality from antimicrobial
           resistant nosocomial infections in Thailand
    • Authors: T. Phodha; A. Riewpaiboon, K. Malathum, P. C. Coyte
      Abstract: Antimicrobial resistance is a major health threat worldwide as it brings about poorer treatment outcome and places economic burden to the society. This study aims to estimate the annual relative increased in inpatient mortality from antimicrobial resistant (AMR) nosocomial infections (NI) in Thailand. A retrospective cohort study was conducted at Ramathibodi Hospital, Bangkok, Thailand, over 2008–2012. Survival model was used to estimate the hazard ratio of mortality of AMR relative to those patients without resistance (non-AMR) after controlling for nine potential confounders. The majority of NI (73.80%) were caused by AMR bacteria over the study period. Patients in the AMR and non-AMR groups had similar baseline clinical characteristics. Relative to patients in the non-AMR group, the expected hazard ratios of mortality for patients in the AMR group with Acinetobacter baumannii, Escherichia coli, Pseudomonas aeruginosa and Staphylococcus aureus were 1.92 (95% CI 0.10–35.52), 1.25 (95% CI 0.08–20.29), 1.60 (95% CI 0.13–19.10) and 1.84 (95% CI 0.04–95.58), respectively. In the complete absence of AMR bacteria, this study estimated that annually, in Thailand, there would be 111 295 fewer AMR cases and 48 258 fewer deaths.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268818003436
      Issue No: Vol. 147 (2019)
  • Screening for Epstein–Barr virus (EBV) infection status in university
           freshmen: acceptability of a gingival swab method
    • Authors: J. M. Grimm-Geris; S. K. Dunmire, L. M. Duval, E. A. Filtz, H. J. Leuschen, D. O. Schmeling, S. L. Kulasingam, H. H. Balfour
      Abstract: Prophylactic vaccines against Epstein–Barr virus (EBV) are under development. EBV-naïve college freshmen are ideal candidates for an efficacy trial, because their incidence of infectious mononucleosis (mono) during freshman year is as high as 20%. To assess perceptions about mono and a mono vaccine, and to learn if EBV immune status could be determined using a gingival swab rather than phlebotomy, we performed a cross-sectional study of 235 healthy students at the beginning of their freshman year. Subjects completed questionnaires and donated oral washes, gingival swabs and venous blood. Overall, 90% of students found the swab easy to use and 80% preferred the swab over venepuncture. Of the 193 students with sufficient samples, 108 (56%) had EBV antibodies in blood vs. 87 (45.1%) in the gingival swab. The sensitivity and specificity of the swab compared with blood for detecting EBV antibodies was 75.9% and 94.1%, respectively, with an accuracy of 89.3%. EBV DNA was detected in the oral wash and swab of 39.2% and 30.4% of blood-antibody-positive individuals, respectively. In conclusion, 44% of our freshmen were EBV-naïve and thus vaccine candidates, the gingival swab was an acceptable alternative to phlebotomy for detecting EBV antibody but needs improved sensitivity, and the perceived value of EBV vaccine was high (72% believed they would benefit).
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268819000335
      Issue No: Vol. 147 (2019)
  • Salmonella+isolated+from+dog+treats+in+Japan&rft.title=Epidemiology+&+Infection&rft.issn=0950-2688&,+Y.+Tamura,+S.+Ohshima,+T.+Hasegawa&rft_id=info:doi/10.1017/S0950268819000153">Characterisation of antibiotic resistance of Salmonella isolated from dog
           treats in Japan
    • Authors: S. Yukawa; I. Uchida, Y. Tamura, S. Ohshima, T. Hasegawa
      Abstract: Dog treats might be contaminated with Salmonella. In Canada and the USA, outbreaks of human salmonellosis related to exposure to animal-derived dog treats were reported. Consequently, surveillance data on Salmonella contamination of dog treats have been gathered in many countries, but not in Japan. In the current study, we investigated whether dog treats in Japan were contaminated with Salmonella. Overall, 303 dog treats (of which 255 were domestically produced) were randomly collected and the presence of Salmonella investigated. Seven samples were positive for Salmonella enterica subsp. enterica. Among these isolates, three were identified as serovar 4,5,12:i:–; two were serovar Rissen; and two were serovar Thompson. All serovar 4,5,12:i:– and Thompson isolates were resistant to one or more drugs. Two serovar Rissen isolates were fully susceptible to all tested antimicrobial agents. All Salmonella isolates were susceptible to cefotaxime, ciprofloxacin and nalidixic acid. The gene blaTEM was detected in two serovar 4,5,12:i:– isolates. The blaCTX−M and blaCMY genes were not detected in any isolates. This study demonstrated that dog treats in Japan could constitute a potential source of dog and human Salmonella infections, including multidrug-resistant Salmonella isolates.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268819000153
      Issue No: Vol. 147 (2019)
  • Enterobacteriaceae&rft.title=Epidemiology+&+Infection&rft.issn=0950-2688&,+S.+Anandan,+A.+G.+Madabhushi,+A.+K.+Pragasam,+V.+P.+Verghese,+V.+Balaji,+E.+A.+F.+Simões&rft_id=info:doi/10.1017/S0950268819000256">Risk factors and epidemiologic predictors of blood stream infections with
           New Delhi Metallo-b-lactamase (NDM-1) producing Enterobacteriaceae
    • Authors: B. M. Snyder; B. T. Montague, S. Anandan, A. G. Madabhushi, A. K. Pragasam, V. P. Verghese, V. Balaji, E. A. F. Simões
      Abstract: Carbapenem-resistant Enterobacteriaceae conferred by New Delhi metallo-b-lactamase (NDM-1) resistance mechanism are endemic in India and Southeast Asia. An understanding of risk factors for NDM-1 infections is necessary to guide prevention strategies. We performed a retrospective case-control study of patients admitted at Christian Medical College Hospital, Vellore, India between May 2010 and August 2014 with Klebsiella pneumoniae blood stream infection (BSI). We compared patients with BSI caused by NDM-1 producing strains to two control groups: BSI with other multidrug resistant (MDR) strains and BSI with pan-susceptible strains. The study groups were assessed for risk factors for the outcomes: (1) infection with any MDR strain compared to pan-susceptible; and, (2) infection with NDM-1 strain as compared with other MDR and (3) Mortality. A total of 101 patients with BSI with NDM-1 producing Klebsiella pneumoniae were matched to two groups of controls: 112 with non-NDM-1 MDR strains and 101 with pan-susceptible strains. Medical (OR 10.4) and neonatal (OR 0.7) ICU admission, central venous catheter placement (CVC, OR 7.4) predicted MDR BSI. Prior carbapenem use (OR 8.4) and CVC (OR 4.8) predicted acquisition of an NDM-1 strain. Significant predictors for mortality included ICU stay (OR 3.0), mechanical ventilation (OR 3.2), female gender (OR 2.2), diabetes (OR 0.4). CVC placement, prior carbapenem use and ICU admission were significantly associated with BSI with NDM-1 producing and other MDR strains.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268819000256
      Issue No: Vol. 147 (2019)
  • Spatiotemporal patterns and risk factors concerning hepatitis B virus
           infections in the Beijing–Tianjin–Hebei area of China
    • Authors: C. D. Xu; G. X. Xiao, J. M. Li, H. X. Cao
      Abstract: Beijing–Tianjin–Hebei is the largest urban agglomeration in northern China, but the spatiotemporal patterns and risk factors concerning hepatitis B virus (HBV) incidence in this area have been unclear. The present study aimed to reveal the spatiotemporal epidemiological features of HBV infection and quantify the association between HBV infection and socio-economic risk factors. The data on HBV cases in Beijing–Tianjin–Hebei from 2007 to 2012 was collected for each county. The Bayesian space–time hierarchy model and the GeoDetector method were used to reveal spatiotemporal patterns and detect risk factors. High-risk regions were mainly distributed in the underdeveloped rural areas in the north and mid-south of the study region, while low-risk regions were mainly distributed in the urban and western areas. The HBV annual incidence rate decreased substantially over the 6-year period, dropping from 7.34/105 to 5.51/105. Compared with this overall trend, 38.5% of high-risk counties showed a faster decrease, and 35.9% of high-risk counties exhibited a slower decrease. Meanwhile, 29.7% of low-risk counties had a faster decrease, and 44.6% of low-risk counties exhibited a slower decrease. Socio-economic factors were strongly associated with the spatiotemporal patterns and variation. The population density and gross domestic product per capita were negatively associated with HBV transmission, with determinant powers of 0.17 and 0.12, respectively. The proportion of primary industry and the number of healthcare workers were positively associated with the disease incidence, with determinant powers of 0.11 and 0.8, respectively. The interactive effect between population density and the other factors exerted a greater influence on HBV transmission than that of these factors measured independently.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268818003412
      Issue No: Vol. 147 (2019)
  • Using roaming behaviours of dogs to estimate contact rates: the predicted
           effect on rabies spread
    • Authors: Emily G. Hudson; Victoria J. Brookes, Michael P. Ward, Salome Dürr
      Abstract: Domestic dogs display complex roaming behaviours, which need to be captured to more realistically model the spread of rabies. We have previously shown that roaming behaviours of domestic dogs can be categorised as stay-at-home, roamer and explorer in the Northern Peninsular Area (NPA), Queensland, Australia. These roaming behaviours are likely to cause heterogeneous contact rates that influence the speed or pattern of rabies spread in a dog population. The aim of this study was to define contact spatial kernels using the overlap of individual dog utilisation distributions to describe the daily probability of contact between pairs of dogs exhibiting these three a priori roaming behaviours. We further aimed to determine if the kernels lead to different predicted rabies outbreaks (outbreak duration and number of rabid dogs) by incorporating the spatial kernels into a previously developed rabies spread model for the NPA. Spatial kernels created with both dogs in a pair being explorers or one dog explorer and one dog roamer (who roamed away from their residence) produced short but large outbreaks compared with spatial kernels with at least one stay-at-home dog. Outputs from this model incorporating heterogeneous contacts demonstrate how roaming behaviours influence disease spread in domestic dog populations.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268819000189
      Issue No: Vol. 147 (2019)
  • Association of meteorological factors with seasonal activity of influenza
           A subtypes and B lineages in subtropical western China
    • Authors: M. Pan; H. P. Yang, J. Jian, Y. Kuang, J. N. Xu, T. S. Li, X. Zhou, W. L. Wu, Z. Zhao, C. Wang, W. Y. Li, M. Y. Li, S. S. He, L.L. Zhou
      Abstract: The seasonality of individual influenza subtypes/lineages and the association of influenza epidemics with meteorological factors in the tropics/subtropics have not been well understood. The impact of the 2009 H1N1 pandemic on the prevalence of seasonal influenza virus remains to be explored. Using wavelet analysis, the periodicities of A/H3N2, seasonal A/H1N1, A/H1N1pdm09, Victoria and Yamagata were identified, respectively, in Panzhihua during 2006–2015. As a subtropical city in southwestern China, Panzhihua is the first industrial city in the upper reaches of the Yangtze River. The relationship between influenza epidemics and local climatic variables was examined based on regression models. The temporal distribution of influenza subtypes/lineages during the pre-pandemic (2006–2009), pandemic (2009) and post-pandemic (2010–2015) years was described and compared. A total of 6892 respiratory specimens were collected and 737 influenza viruses were isolated. A/H3N2 showed an annual cycle with a peak in summer–autumn, while A/H1N1pdm09, Victoria and Yamagata exhibited an annual cycle with a peak in winter–spring. Regression analyses demonstrated that relative humidity was positively associated with A/H3N2 activity while negatively associated with Victoria activity. Higher prevalence of A/H1N1pdm09 and Yamagata was driven by lower absolute humidity. The role of weather conditions in regulating influenza epidemics could be complicated since the diverse viral transmission modes and mechanism. Differences in seasonality and different associations with meteorological factors by influenza subtypes/lineages should be considered in epidemiological studies in the tropics/subtropics. The development of subtype- and lineage-specific prevention and control measures is of significant importance.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268818003485
      Issue No: Vol. 147 (2019)
  • Online symptom checker diagnostic and triage accuracy for HIV and
           hepatitis C
    • Authors: A.C. Berry; B.D. Cash, B. Wang, M.S. Mulekar, A.B. Van Haneghan, K. Yuquimpo, A. Swaney, M. C. Marshall, W.K. Green
      Abstract: We sought to address the prior limitations of symptom checker accuracy by analysing the diagnostic and triage feasibility of online symptom checkers using a consecutive series of real-life emergency department (ED) patient encounters, and addressing a complex patient population – those with hepatitis C or HIV. We aimed to study the diagnostic and triage accuracy of these symptom checkers in relation to an emergency room physician-determined diagnosis. An ED retrospective analysis was performed on 8363 consecutive adult patients. Eligible patients included: 90 HIV, 67 hepatitis C, 11 both HIV and hepatitis C. Five online symptom checkers were utilised for diagnosis (Mayo Clinic, WebMD, Symptomate, Symcat, Isabel), three with triage capabilities. Symptom checker output was compared with ED physician-determined diagnosis data in regards to diagnostic accuracy and differential diagnosis listing, along with triage advice. All symptom checkers, whether for combined HIV and hepatitis C, HIV alone or hepatitis C alone had poor diagnostic accuracy in regards to Top1 (
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268819000268
      Issue No: Vol. 147 (2019)
  • Chlamydia+trachomatis+prevalence+in+young+women+in+England,+Scotland+and+Wales+changed'+Evidence+from+national+probability+surveys&rft.title=Epidemiology+&+Infection&rft.issn=0950-2688&,+K.+Soldan,+S.+C.+Woodhall,+J.+Kevin+Dunbar,+S.+J.+Migchelsen,+C.+H.+Mercer,+P.+Horner,+A.+E.+Ades&rft_id=info:doi/10.1017/S0950268819000347">Has Chlamydia trachomatis prevalence in young women in England, Scotland
           and Wales changed' Evidence from national probability surveys
    • Authors: D. Z. Kounali; N. J Welton, K. Soldan, S. C. Woodhall, J. Kevin Dunbar, S. J. Migchelsen, C. H. Mercer, P. Horner, A. E. Ades
      Abstract: We evaluate the utility of the National Surveys of Attitudes and Sexual Lifestyles (Natsal) undertaken in 2000 and 2010, before and after the introduction of the National Chlamydia Screening Programme, as an evidence source for estimating the change in prevalence of Chlamydia trachomatis (CT) in England, Scotland and Wales. Both the 2000 and 2010 surveys tested urine samples for CT by Nucleic Acid Amplification Tests (NAATs). We examined the sources of uncertainty in estimates of CT prevalence change, including sample size and adjustments for test sensitivity and specificity, survey non-response and informative non-response. In 2000, the unadjusted CT prevalence was 4.22% in women aged 18–24 years; in 2010, CT prevalence was 3.92%, a non-significant absolute difference of 0.30 percentage points (95% credible interval −2.8 to 2.0). In addition to uncertainty due to small sample size, estimates were sensitive to specificity, survey non-response or informative non-response, such that plausible changes in any one of these would be enough to either reverse or double any likely change in prevalence. Alternative ways of monitoring changes in CT incidence and prevalence over time are discussed.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268819000347
      Issue No: Vol. 147 (2019)
  • Integration of a recent infection testing algorithm into HIV surveillance
           in Ireland: improving HIV knowledge to target prevention
    • Authors: E. Robinson; J. Moran, K. O'Donnell, J. Hassan, H. Tuite, O. Ennis, F. Cooney, E. Nugent, L. Preston, S. O'Dea, S. Doyle, S. Keating, J. Connell, C. De Gascun, D. Igoe
      Abstract: Recent infection testing algorithms (RITA) for HIV combine serological assays with epidemiological data to determine likely recent infections, indicators of ongoing transmission. In 2016, we integrated RITA into national HIV surveillance in Ireland to better inform HIV prevention interventions. We determined the avidity index (AI) of new HIV diagnoses and linked the results with data captured in the national infectious disease reporting system. RITA classified a diagnosis as recent based on an AI < 1.5, unless epidemiological criteria (CD4 count
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268819000244
      Issue No: Vol. 147 (2019)
  • Oral fluid testing facilitates understanding of hepatitis A virus
           household transmission
    • Authors: Becky Haywood; Richard S. Tedder, Kazim Beebeejaun, Koye Balogun, Sema Mandal, Nick Andrews, Siew Lin Ngui
      Abstract: The public health response to sporadic hepatitis A virus (HAV) infection, hepatitis A, can be complex especially when the index case is a child and no obvious source is identified. Identifying an infection source may avoid mass immunisation within schools when transmission is found to have occurred within the household. Screening of asymptomatic contacts via venepuncture can be challenging and unacceptable, as a result non-invasive methods may facilitate public health intervention. Enzyme-linked immunoassays were developed to detect HAV immunoglobulin M (IgM) and immunoglobulin G (IgG) in oral fluid (ORF). A validation panel of ORF samples from 30 confirmed acute HAV infections were all reactive for HAV IgM and IgG when tested. A panel of 40 ORF samples from persons known to have been uninfected were all unreactive. Two hundred and eighty household contacts of 72 index cases were screened by ORF to identify HAV transmission within the family and factors associated with household transmission. Almost half of households (35/72) revealed evidence of recent infection, which was significantly associated with the presence of children ⩽11 years of age (odds ratio 9.84, 95% confidence interval: 2.74–35.37). These HAV IgM and IgG immunoassays are easy to perform, rapid and sensitive and have been integrated into national guidance on the management of hepatitis A cases.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S095026881900027X
      Issue No: Vol. 147 (2019)
  • Borrelia+recurrentis+infection)&rft.title=Epidemiology+&+Infection&rft.issn=0950-2688&">Louse-borne relapsing fever (Borrelia
    • Authors: David A. Warrell
      Abstract: Louse-borne relapsing fever (LBRF) is an epidemic disease with a fascinating history from Hippocrates’ times, through the 6th century ‘Yellow Plague’, to epidemics in Ireland, Scotland and England in the 19th century and two large Afro-Middle Eastern pandemics in the 20th century. An endemic focus persists in Ethiopia and adjacent territories in the Horn of Africa. Since 2015, awareness of LBRF in Europe, as a re-emerging disease, has been increased dramatically by the discovery of this infection in dozens of refugees arriving from Africa.The causative spirochaete, Borrelia recurrentis, has a genome so similar to B. duttonii and B. crocidurae (causes of East and West African tick-borne relapsing fever), that they are now regarded as merely ecotypes of a single genomospecies. Transmission is confined to the human body louse Pediculus humanus corporis, and, perhaps, the head louse P. humanus capitis, although the latter has not been proved. Infection is by inoculation of louse coelomic fluid or faeces by scratching. Nosocomial infections are possible from contamination by infected blood. Between blood meals, body lice live in clothing until the host's body temperature rises or falls, when they seek a new abode.The most distinctive feature of LBRF, the relapse phenomenon, is attributable to antigenic variation of borrelial outer-membrane lipoprotein. High fever, rigors, headache, pain and prostration start abruptly, 2–18 days after infection. Petechial rash, epistaxis, jaundice, hepatosplenomegaly and liver dysfunction are common. Severe features include hyperpyrexia, shock, myocarditis causing acute pulmonary oedema, acute respiratory distress syndrome, cerebral or gastrointestinal bleeding, ruptured spleen, hepatic failure, Jarisch–Herxheimer reactions (J-HR) and opportunistic typhoid or other complicating bacterial infections. Pregnant women are at high risk of aborting and perinatal mortality is high.Rapid diagnosis is by microscopy of blood films, but polymerase chain reaction is used increasingly for species diagnosis. Severe falciparum malaria and leptospirosis are urgent differential diagnoses in residents and travellers from appropriate geographical regions.High untreated case-fatality, exceeding 40% in some historic epidemics, can be reduced to less than 5% by antibiotic treatment, but elimination of spirochaetaemia is often accompanied by a severe J-HR.Epidemics are controlled by sterilising clothing to eliminate lice, using pediculicides and by improving personal hygiene.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268819000116
      Issue No: Vol. 147 (2019)
  • Mycobacterium+avium+complex+disease+by+gender&rft.title=Epidemiology+&+Infection&rft.issn=0950-2688&,+J.+Akahane,+M.+Kosaka,+Y.+Kitaguchi,+K.+Urushihata,+M.+Yasuo,+H.+Yamamoto,+M.+Hanaoka&rft_id=info:doi/10.1017/S0950268819000293">Comparison of clinical characteristics of patients with Mycobacterium
           avium complex disease by gender
    • Authors: Y. Ikuyama; A. Ushiki, J. Akahane, M. Kosaka, Y. Kitaguchi, K. Urushihata, M. Yasuo, H. Yamamoto, M. Hanaoka
      Abstract: The clinical characteristics of male patients with pulmonary Mycobacterium avium complex disease have not been clearly defined. We aimed to clarify the clinical characteristics of male patients with pulmonary Mycobacterium avium complex disease compared with female patients.We retrospectively reviewed the medical records of patients with pulmonary Mycobacterium avium complex disease who visited the outpatient clinic of the Shinshu University Hospital between 2003 and 2016 and compared the clinical characteristics of male and female patients.A total of 234 patients with pulmonary Mycobacterium avium complex disease were identified (68 men and 166 women). Male patients were significantly older than female patients. Blood examination results showed that the lymphocyte count, total protein level and albumin level were significantly lower in men than in women. Chest imaging findings were broadly categorised into the fibrocavitary and nodular bronchiectasis types. There were no significant differences in chest imaging findings and the time from diagnosis to disease exacerbation between men and women.During the study period, the incidence of the nodular bronchiectasis type of pulmonary Mycobacterium avium complex disease in male patients increased compared with previous reports. Men had no difference in time to exacerbation compared with women.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268819000293
      Issue No: Vol. 147 (2019)
  • Dengue outbreaks: unpredictable incidence time series
    • Authors: A.F.B. Gabriel; A.P. Alencar, S.G.E.K. Miraglia
      Abstract: Dengue fever is a disease with increasing incidence, now occurring in some regions which were not previously affected. Ribeirão Preto and São Paulo, municipalities in São Paulo state, Brazil, have been highlighted due to the high dengue incidences especially after 2009 and 2013. Therefore, the current study aims to analyse the temporal behaviour of dengue cases in the both municipalities and forecast the number of disease cases in the out-of-sample period, using time series models, especially SARIMA model. We fitted SARIMA models, which satisfactorily meet the dengue incidence data collected in the municipalities of Ribeirão Preto and São Paulo. However, the out-of-sample forecast confidence intervals are very wide and this fact is usually omitted in several papers. Despite the high variability, health services can use these models in order to anticipate disease scenarios, however, one should interpret with prudence since the magnitude of the epidemic may be underestimated.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268819000311
      Issue No: Vol. 147 (2019)
  • Development of a mechanistic dengue simulation model for Guangzhou
    • Authors: G. Mincham; K. L. Baldock, H. Rozilawati, C. R. Williams
      Abstract: Dengue infection in China has increased dramatically in recent years. Guangdong province (main city Guangzhou) accounted for more than 94% of all dengue cases in the 2014 outbreak. Currently, there is no existing effective vaccine and most efforts of control are focused on the vector itself. This study aimed to evaluate different dengue management strategies in a region where this disease is emerging. This work was done by establishing a dengue simulation model for Guangzhou to enable the testing of control strategies aimed at vector control and vaccination. For that purpose, the computer-based dengue simulation model (DENSiM) together with the Container-Inhabiting Mosquito Simulation Model (CIMSiM) has been used to create a working dengue simulation model for the city of Guangzhou. In order to achieve the best model fit against historical surveillance data, virus introduction scenarios were run and then matched against the actual dengue surveillance data. The simulation model was able to predict retrospective outbreaks with a sensitivity of 0.18 and a specificity of 0.98. This new parameterisation can now be used to evaluate the potential impact of different control strategies on dengue transmission in Guangzhou. The knowledge generated from this research would provide useful information for authorities regarding the historic patterns of dengue outbreaks, as well as the effectiveness of different disease management strategies.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S095026881900030X
      Issue No: Vol. 147 (2019)
  • Measles and rubella seroprevalence in a population of young adult blood
           donors, France 2013
    • Authors: D. Antona; P. Morel, C. Jacquot, L. Fonteneau, J. Dina, C. Vauloup-Fellous, L. Gimeno, A. Degeorges, P. Gallian, D. Lévy-Bruhl
      Abstract: As part of the evaluation of the French plan for the elimination of measles and rubella, we conducted a seroprevalence survey in 2013, aimed at updating seroprevalence data for people 18–32 years old. A secondary objective was to estimate measles incidence in this population during the 2009–2011 outbreak, and thus estimate the exhaustiveness of measles mandatory reporting. We used a cross-sectional survey design, targeting blood donors 18–32 years old, living in France since 2009, who came to give blood in a blood collecting site. We included 4647 people in metropolitan France, 806 people in Réunion Island and 496 in the French Caribbean. A further 3942 individuals were interviewed in the south-east region of metropolitan France to estimate the exhaustiveness of measles mandatory reporting. One of the main findings of this survey is that the proportion of people 18–32 years old susceptible to both measles and rubella infections remained high in France in 2013, 9.2% and 5.4%, respectively, in metropolitan France, even after the promotion campaigns about vaccination catch-up during and following the major measles epidemic in 2009–2011. Applying our results to French census data would suggest that around 1 million people aged 18–32 years old are currently susceptible to measles in France, despite this age group being one of the vaccination targets of the national measles elimination plan. Another important finding is that only an estimated 45% of the true number of cases in this age group was actually notified, despite notification being mandatory.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268819000050
      Issue No: Vol. 147 (2019)
  • Understanding of HIV/AIDS in the international border area, Manipur:
           Northeast India
    • Authors: A. L. Sharma; T. R. Singh, L. S. Singh
      Abstract: Manipur, an international border region has the highest incidence of human immunodeficiency virus (HIV)-1 infection in India. Nevertheless, there have been no analytical reviews of research article published within this region. In this review, the authors aim to draw the attention of policy makers, medical practitioners and researchers in adopting new strategies to limit the expansion of HIV/acquired immunodeficiency syndrome (AIDS) not only in Manipur but also in other international border areas. A systematic search for published literature in last decade was performed based on the keywords ‘Manipur’ and ‘HIV’ using the PubMed. Twenty-six articles were selected and reviewed. There were high incidence of drug resistance (53%), emergence of recombinant virus (32%) and increased incidence of co-infection with hepatitis C virus. The prime cause of the HIV is due to the uses of ‘heroin’ smuggled from the ‘South Asia Golden Triangle’ and complex patterns of cross-border movement for trade and commerce. The drug abuse, social stigma, geographical location and resource limitation and socio-political problem of the region have contributed strongly on spreading and failure of preventively programme of HIV/AIDS. This review will provide vital knowledge for the policy makers and clinicians for sentinel surveillance of AIDS pandemic in Manipur and other international border regions.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268818003564
      Issue No: Vol. 147 (2019)
  • Does scientific effort reflect global need' A review of infectious
           disease publications over 100 years
    • Authors: D. T. S. Hayman; M. G. Baker
      Abstract: In a rational world, scientific effort would reflect society's needs. We tested this hypothesis using the area of infectious diseases, where the research response to emerging threats has obvious potential to save lives through informing interventions such as vaccination and prevention policies. Pathogens continue to evolve, emerge and re-emerge and infectious diseases that were once common become less so or their global distribution changes. A question remains as to whether scientific endeavours can adapt. Here, we identified papers on infectious diseases published in the four highest ranking, health-related journals over the 118 years from 1900. Focussing on outbreak-related and burden of disease-related metrics over the two time periods, 1990 to 2017 and 1900 to 2017, our analyses suggest that there is little underrepresentation of important infectious diseases among top ranked journals. Encouragingly our results suggest the scientific process is largely self-correcting.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268818003552
      Issue No: Vol. 147 (2019)
  • Pneumonia hospitalisation and case-fatality rates in older Australians
           with and without risk factors for pneumococcal disease: implications for
           vaccine policy
    • Authors: S. Dirmesropian; B. Liu, J. G. Wood, C. R. MacIntyre, P. McIntyre, S. Karki, S. Jayasinghe, A. T. Newall
      Abstract: Community-acquired pneumonia (CAP) results in substantial numbers of hospitalisations and deaths in older adults. There are known lifestyle and medical risk factors for pneumococcal disease but the magnitude of the additional risk is not well quantified in Australia. We used a large population-based prospective cohort study of older adults in the state of New South Wales (45 and Up Study) linked to cause-specific hospitalisations, disease notifications and death registrations from 2006 to 2015. We estimated the age-specific incidence of CAP hospitalisation (ICD-10 J12-18), invasive pneumococcal disease (IPD) notification and presumptive non-invasive pneumococcal CAP hospitalisation (J13 + J18.1, excluding IPD), comparing those with at least one risk factor to those with no risk factors. The hospitalised case-fatality rate (CFR) included deaths in a 30-day window after hospitalisation. Among 266 951 participants followed for 1 850 000 person-years there were 8747 first hospitalisations for CAP, 157 IPD notifications and 305 non-invasive pneumococcal CAP hospitalisations. In persons 65–84 years, 54.7% had at least one identified risk factor, increasing to 57.0% in those ⩾85 years. The incidence of CAP hospitalisation in those ⩾65 years with at least one risk factor was twofold higher than in those without risk factors, 1091/100 000 (95% confidence interval (CI) 1060–1122) compared with 522/100 000 (95% CI 501–545) and IPD in equivalent groups was almost threefold higher (18.40/100 000 (95% CI 14.61–22.87) vs. 6.82/100 000 (95% CI 4.56–9.79)). The CFR increased with age but there were limited difference by risk status, except in those aged 45 to 64 years. Adults ⩾65 years with at least one risk factor have much higher rates of CAP and IPD suggesting that additional risk factor-based vaccination strategies may be cost-effective.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268818003473
      Issue No: Vol. 147 (2019)
  • Modelling the epidemiologic impact of achieving UNAIDS fast-track 90-90-90
           and 95-95-95 targets in South Africa
    • Authors: N. N. Abuelezam; A. W. McCormick, E. D. Surface, T. Fussell, K. A. Freedberg, M. Lipsitch, G. R. Seage
      Abstract: UNAIDS established fast-track targets of 73% and 86% viral suppression among human immunodeficiency virus (HIV)-positive individuals by 2020 and 2030, respectively. The epidemiologic impact of achieving these goals is unknown. The HIV-Calibrated Dynamic Model, a calibrated agent-based model of HIV transmission, is used to examine scenarios of incremental improvements to the testing and antiretroviral therapy (ART) continuum in South Africa in 2015. The speed of intervention availability is explored, comparing policies for their predicted effects on incidence, prevalence and achievement of fast-track targets in 2020 and 2030. Moderate (30%) improvements in the continuum will not achieve 2020 or 2030 targets and have modest impacts on incidence and prevalence. Improving the continuum by 80% and increasing availability reduces incidence from 2.54 to 0.80 per 100 person-years (−1.73, interquartile range (IQR): −1.42, −2.13) and prevalence from 26.0 to 24.6% (−1.4 percentage points, IQR: −0.88, −1.92) from 2015 to 2030 and achieves fast track targets in 2020 and 2030. Achieving 90-90-90 in South Africa is possible with large improvements to the testing and treatment continuum. The epidemiologic impact of these improvements depends on the balance between survival and transmission benefits of ART with the potential for incidence to remain high.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268818003497
      Issue No: Vol. 147 (2019)
  • Epidemiological, clinical and laboratory characteristics of acute Q fever
           in an endemic area in Israel, 2006–2016
    • Authors: S. Reisfeld; S. Hasadia Mhamed, M. Stein, M. Chowers
      Abstract: Our purpose was to describe the clinical, epidemiological and laboratory characteristics of patients hospitalised with acute Q fever in an endemic area of Israel. We conducted a historical cohort study of all patients hospitalised with a definite diagnosis of acute Q fever, and compared them to patients suspected to have acute Q fever, but diagnosis was ruled out. A total of 38 patients had a definitive diagnosis, 47% occurred during the autumn and winter seasons, only 18% lived in rural regions. Leucopaenia and thrombocytopaenia were uncommon (16% and 18%, respectively), but mild hepatitis was common (mean aspartate aminotransferase 76 U/l, mean alanine aminotransferase 81 U/l). We compared them with 74 patients in which acute Q fever was ruled out, and found that these parameters were not significantly different. Patients with acute Q fever had a shorter hospitalisation and they were treated more often with doxycycline than those without acute Q fever (6.4 vs. 14 days, P = 0.007, 71% vs. 38%, P = 0.001, respectively). In conclusion, acute Q fever can manifest as an unspecified febrile illness, with no seasonality. We suggest that in endemic areas, Q fever should be considered in the differential diagnosis in any febrile patient with risk factors for a persistent infection.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268818003576
      Issue No: Vol. 147 (2019)
  • Epidemiological evaluation of human papillomavirus genotypes and their
           associations in multiple infections
    • Authors: Raffaele Del Prete; Luigi Ronga, Raffaella Magrone, Grazia Addati, Angela Abbasciano, Domenico Di Carlo, Giuseppe Miragliotta
      Abstract: The aim of this study was to determine the frequency of multiple type human papillomavirus (HPV) infections, and whether any types are involved in multiple HPV-type infections (mHPV) more or less frequently than expected. From January 2012 to February 2018, 2848 cervico-vaginal swabs were analysed in the UOC Microbiology and Virology of Policlinico of Bari, Italy. HPV DNA detection was performed using initially nested-polymerase chain reaction (PCR) and subsequently multiplex real-time PCR assay. 1357/2848 samples (47.65%) were HPV DNA positive and 694/1357 (51.14%) showed mHPVs. The median number of mHPVs was 2 (interquartile range: 2–3). HPV-types more frequently detected were 42 (9.97%), 16 (8.92%), 53 (7.23%) and 31 (7.16%). Each detected HPV-type was involved in mHPVs in more than 50% of cases. Statistical analysis showed significant associations for all HPV-types except for 33, 43, 51, 58 and 82 HPV-types. The major number of significant pairwise associations were detected for the types 42 and 70. Only positive associations were detected. Further data are necessary to evaluate the clinical impact of the single combinations.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268818003539
      Issue No: Vol. 147 (2019)
  • A system dynamics modelling simulation based on a cohort of hepatitis B
           epidemic research in east China community
    • Authors: Zhixin Yu; Min Deng, Chunting Peng, Xue Song, Yi Chen, Xue Zhang, Qiuxia Liu, Yuchuan Li, Haiyin Jiang, Xiaolan Xu, Liya Pan, Jing Yuan, Bing Ruan
      Abstract: Hepatitis B constitutes a severe public health challenge in China. The Community-based Collaborative Innovation hepatitis B (CCI-HBV) project is a national epidemiological study of hepatitis B and has been conducting a comprehensive intervention in southern Zhejiang since 2009.The comprehensive intervention in CCI-HBV areas includes the dynamic hepatitis B screening in local residents, the normalised treatment for hepatitis B infections and the upcoming full-aged hepatitis B vaccination. After two rounds of screening (each round taking for 4 years), the initial epidemiological baseline of hepatitis B in Qinggang was obtained, a coastal community in east China. By combining key data and system dynamics modelling, the regional hepatitis B epidemic in 20 years was predicted.There were 1041 HBsAg positive cases out of 12 228 people in Round 1 indicating HBV prevalence of 8.5%. Of the 13 146 people tested in Round 2, 1171 people were HBsAg positive, with a prevalence of 8.9%. By comparing the two rounds of screening, the HBV incidence rate of 0.192 per 100 person-years was observed. By consulting electronic medical records, the HBV onset rate of 0.533 per 100 person-years was obtained. We generated a simulated model to replicate the real-world situation for the next two decades. To evaluate the effect of interventions on regional HBV prevalence, three comparative experiments were conducted.In this study, the regional hepatitis B epidemic in 20 years was predicted and compared with HBV prevalence under different interventions. Owing to the existing challenges in research methodology, this study combined HBV field research and simulation to provide a system dynamics model with close-to-real key data to improve prediction accuracy. The simulation also provided a prompt guidance for the field implementation.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268819000220
      Issue No: Vol. 147 (2019)
  • The Ebola virus disease outbreak in Tonkolili district, Sierra Leone: a
           retrospective analysis of the Viral Haemorrhagic Fever surveillance
           system, July 2014–June 2015
    • Authors: Alessandro Miglietta; Angelo Solimini, Ghyslaine Bruna Djeunang Dongho, Carla Montesano, Giovanni Rezza, Vincenzo Vullo, Vittorio Colizzi, Gianluca Russo
      Abstract: In Sierra Leone, the Ebola virus disease (EVD) outbreak occurred with substantial differences between districts with someone even not affected. To monitor the epidemic, a community event-based surveillance system was set up, collecting data into the Viral Haemorrhagic Fever (VHF) database. We analysed the VHF database of Tonkolili district to describe the epidemiology of the EVD outbreak during July 2014–June 2015 (data availability). Multivariable analysis was used to identify risk factors for EVD, fatal EVD and barriers to healthcare access, by comparing EVD-positive vs. EVD-negative cases. Key-performance indicators for EVD response were also measured. Overall, 454 EVD-positive cases were reported. At multivariable analysis, the odds of EVD was higher among those reporting contacts with an EVD-positive/suspected case (odds ratio (OR) 2.47; 95% confidence interval (CI) 2.44–2.50; P < 0.01) and those attending funeral (OR 1.02; 95% CI 1.01–1.04; P < 0.01). EVD cases from Kunike chiefdom had a lower odds of death (OR 0.22; 95% CI 0.08–0.44; P < 0.01) and were also more likely to be hospitalised (OR 2.34; 95% CI 1.23–4.57; P < 0.05). Only 25.1% of alerts were generated within 1 day from symptom onset. EVD preparedness and response plans for Tonkolili should include social-mobilisation activities targeting Ebola/knowledge-attitudes-practice during funeral attendance, to avoid contact with suspected cases and to increase awareness on EVD symptoms, in order to reduce delays between symptom onset to alert generation and consequently improve the outbreak-response promptness.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268819000177
      Issue No: Vol. 147 (2019)
  • Skin and soft tissue infections and current antimicrobial prescribing
           practices in Australian aged care residents
    • Authors: N. J. Bennett; N. Imam, R. J. Ingram, R. S. James, K. L. Buising, A. L. Bull, C. S. Chen, K. A. Thursky, L. J. Worth
      Abstract: To determine the burden of skin and soft tissue infections (SSTI), the nature of antimicrobial prescribing and factors contributing to inappropriate prescribing for SSTIs in Australian aged care facilities, SSTI and antimicrobial prescribing data were collected via a standardised national survey. The proportion of residents prescribed ⩾1 antimicrobial for presumed SSTI and the proportion whose infections met McGeer et al. surveillance definitions were determined. Antimicrobial choice was compared to national prescribing guidelines and prescription duration analysed using a negative binomial mixed-effects regression model. Of 12 319 surveyed residents, 452 (3.7%) were prescribed an antimicrobial for a SSTI and 29% of these residents had confirmed infection. Topical clotrimazole was most frequently prescribed, often for unspecified indications. Where an indication was documented, antimicrobial choice was generally aligned with recommendations. Duration of prescribing (in days) was associated with use of an agent for prophylaxis (rate ratio (RR) 1.63, 95% confidence interval (CI) 1.08–2.52), PRN orders (RR 2.10, 95% CI 1.42–3.11) and prescription of a topical agent (RR 1.47, 95% CI 1.08–2.02), while documentation of a review or stop date was associated with reduced duration of prescribing (RR 0.33, 95% CI 0.25–0.43). Antimicrobial prescribing for SSTI is frequent in aged care facilities in Australia. Methods to enhance appropriate prescribing, including clinician documentation, are required.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268819000128
      Issue No: Vol. 147 (2019)
  • Introduction of Ebola virus into a remote border district of Sierra Leone,
           2014: use of field epidemiology and RNA sequencing to describe chains of
    • Authors: M. B. DeSilva; T. Styles, C. Basler, F. L. Moses, F. Husain, M. Reichler, S. Whitmer, J. McAuley, E. Belay, M. Friedman, I. S. Muoghalu, P. Swaray, U. Ströher, J. T. Redd
      Abstract: In early October 2014, 7 months after the 2014–2015 Ebola epidemic in West Africa began, a cluster of reported deaths in Koinadugu, a remote district of Sierra Leone, was the first evidence of Ebola virus disease (Ebola) in the district. Prior to this event, geographic isolation was thought to have prevented the introduction of Ebola to this area. We describe our initial investigation of this cluster of deaths and subsequent public health actions after Ebola was confirmed, and present challenges to our investigation and methods of overcoming them. We present a transmission tree and results of whole genome sequencing of selected isolates to identify the source of infection in Koinadugu and demonstrate transmission between its villages. Koinadugu's experience highlights the danger of assuming that remote location and geographic isolation can prevent the spread of Ebola, but also demonstrates how deployment of rapid field response teams can help limit spread once Ebola is detected.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268819000104
      Issue No: Vol. 147 (2019)
  • Trends of hospitalisations rates in a cohort of HIV-infected persons
           followed in an Italian hospital from 1998 to 2016
    • Authors: S. Bellino; A. Borghetti, F. Lombardi, L. Camoni, A. Ciccullo, G. Baldin, S. Belmonti, D. Moschese, S. Lamonica, R. Cauda, P. Pezzotti, S. Di Giambenedetto
      Abstract: Here we evaluated hospitalisation rates and associated risk factors of human immunodeficiency virus (HIV)-infected individuals who were followed up in an Italian reference hospital from 1998 to 2016. Incidence rates (IR) of hospitalisations were calculated for five study periods from 1998 to 2016. The random-effects Poisson regression model was used to assess risk factors for hospitalisation including demographic and clinical characteristics. To consider that more events may occur for the same subject, multiple failure-time data analysis was also performed for selected causes using the Cox proportional hazards model. We evaluated 2031 patients. During 13 173 person-years (py) of follow-up, 3356 hospital admissions were carried out for 756 patients (IR: 255 per 1000 py). IR decreased significantly over the study period, from 634 in 1998–2000 to 126 per 1000 py in 2013–2016. Major declines were detected for AIDS-defining events, non-HIV/AIDS-related infections and neurological diseases. Older age, female sex, longer HIV duration and HCV coinfection were associated with a higher hospitalisation risk, whereas higher CD4 nadir and antiretroviral therapy were associated with a reduced risk. Influence of advanced HIV disease markers declined over time. Hospitalisation rates decreased during the study period in most causes. The relative weight of hospitalisations for non-AIDS-related tumours, cardiovascular, respiratory and kidney diseases increased during the study period, whereas those for AIDS-defining events declined.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268819000098
      Issue No: Vol. 147 (2019)
  • High prevalence of selected viruses and parasites and their predictors in
           Malawian children
    • Authors: Y.-M. Fan; S. Oikarinen, K.-M. Lehto, N. Nurminen, R. Juuti, C. Mangani, K. Maleta, H. Hyöty, P. Ashorn
      Abstract: Enteric pathogens have been related to child undernutrition. Whereas there are lots of data on enteric bacterial microbiota and infections, much less is known about the incidence of prevalence of intestinal colonisation with viruses or important parasitic species. This study assessed the presence of selected viruses and parasites in stools of 469, 354, 468 Malawian children at 6, 12 and 18 months. We also assessed environmental predictors of the presence of viruses and parasites among 6-month infants. Microbial presence was documented using real-time polymerase chain reaction (PCR). Enteroviruses were identified in 68%, 80% and 81% of the stool samples at 6, 12 and 18 months children, rhinovirus in 28%, 18% and 31%, norovirus in 24%, 22% and 16%, parechovirus in 23%, 17% and 17%, rotavirus in 3%, 1% and 0.6%, Giardia lamblia in 9.6%, 23.5% and 26%, and Cryptosporidium (spp.) in 6%, 8% and 2% of the 6, 12 and 18 months stool samples. Dry season (May–October) was associated with a low infection rate of enterovirus, norovirus and Cryptosporidium (spp.). Higher father's education level, less number of person in the household and higher sanitation were associated with a low infection rate of enterovirus, norovirus and rotavirus, respectively. The results suggest that the prevalence of asymptomatic viral and parasitic infections is high among Malawian children and that the family's living conditions and seasonality influence the rate of infections.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268819000025
      Issue No: Vol. 147 (2019)
  • Seroprevalence of hepatitis E virus in dromedary camels, Bedouins, Muslim
           Arabs and Jews in Israel, 2009–2017
    • Authors: R. Bassal; M. Wax, R. Shirazi, T. Shohat, D. Cohen, D. David, S. Abu-Mouch, Y. Abu-Ghanem, E. Mendelson, Z. Ben-Ari, O. Mor
      Abstract: Hepatitis E virus (HEV) is an emerging cause of viral hepatitis worldwide. Recently, HEV-7 has been shown to infect camels and humans. We studied HEV seroprevalence in dromedary camels and among Bedouins, Arabs (Muslims, none-Bedouins) and Jews and assessed factors associated with anti-HEV seropositivity. Serum samples from dromedary camels (n = 86) were used to determine camel anti-HEV IgG and HEV RNA positivity. Human samples collected between 2009 and 2016 from >20 years old Bedouins (n = 305), non-Bedouin Arabs (n = 320) and Jews (n = 195), were randomly selected using an age-stratified sampling design. Human HEV IgG levels were determined using Wantai IgG ELISA assay. Of the samples obtained from camels, 68.6% were anti-HEV positive. Among the human populations, Bedouins and non-Bedouin Arabs had a significantly higher prevalence of HEV antibodies (21.6% and 15.0%, respectively) compared with the Jewish population (3.1%). Seropositivity increased significantly with age in all human populations, reaching 47.6% and 34.8% among ⩾40 years old, in Bedouins and non-Bedouin Arabs, respectively. The high seropositivity in camels and in ⩾40 years old Bedouins and non-Bedouin Arabs suggests that HEV is endemic in Israel. The low HEV seroprevalence in Jews could be attributed to higher socio-economic status.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268819000062
      Issue No: Vol. 147 (2019)
  • Invasive pneumococcal disease in hospitalised children from Lima, Peru
           before and after introduction of the 7-valent conjugated vaccine
    • Authors: A. Luna-Muschi; F. Castillo-Tokumori, M. P. Deza, E. H. Mercado, M. Egoavil, K. Sedano, M. E. Castillo, I. Reyes, E. Chaparro, R. Hernández, W. Silva, O. Del Aguila, F. Campos, A. Saenz, T. J. Ochoa
      Abstract: The objective of this study was to determine the serotype distribution and antibiotic resistance of invasive pneumococcal disease (IPD) strains in children from Lima, Peru, before and after the introduction of the 7-valent pneumococcal conjugate vaccine (PCV7), which was introduced in the national immunisation program on 2009. We conducted a prospective, multicentre, passive surveillance IPD study during 2006–2008 and 2009–2011, before and right after the introduction of PCV7 in Peru. The study was performed in 11 hospitals and five private laboratories in Lima, Peru, in patients
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268819000037
      Issue No: Vol. 147 (2019)
  • Streptococcus+pneumoniae+after+PCV10+associated+with+a+ST320+in+adult+population,+in+Porto+Alegre,+Brazil&rft.title=Epidemiology+&+Infection&rft.issn=0950-2688&ão,+G.R.+Cunha,+M.M.+Del+Maschi,+K.+Pizzutti,+P.+d'Azevedo,+C.A.G.+Dias&rft_id=info:doi/10.1017/S0950268819000013">Emergence of serotype 19A Streptococcus pneumoniae after PCV10 associated
           with a ST320 in adult population, in Porto Alegre, Brazil
    • Authors: M.P. Mott; J. Caierão, G.R. Cunha, M.M. Del Maschi, K. Pizzutti, P. d'Azevedo, C.A.G. Dias
      Abstract: Use of pneumococcal conjugate vaccines has caused emergence of non-vaccine serotypes. No Brazilian data specifically about serotype 19A are available. We aimed to evaluate the frequency of occurrence, susceptibility profile and molecular epidemiology of serotype 19A before and after vaccine introduction in Brazil. Pneumococcal identification was performed by the conventional method. Strain serotype was determined by multiplex polymerase chain reaction (PCR) and/or Quellung reaction. Resistance was determined by Etest® and PCR was performed to determine the presence of macrolide resistance genes, ermB and/or mefA. Pneumococci were typed by Multilocus Sequence Typing. Thirty-eight serotype 19A Streptococcus pneumoniae were recovered, mostly from invasive diseases. Prevalence of serotype 19A increased following vaccination (from 3.5% before vaccination to 8.1% after, p = 0.04196). Non-susceptibility increased to most antimicrobials after vaccine introduction and was associated with clonal complex (CC)320. MLST showed nine different STs, which were grouped in one main CC: CC320 (63.9%). During the post-vaccination era, the frequency of this serotype increased significantly from 1.2% in 2011 to 18.5% in 2014 (p = 0.00001), with a concomitant decrease in the genetic variability: ST320 consistently predominated after vaccine-introduction (61.1%). Overall, our results showed a post-PCV10 increase in the frequency of serotype 19A. This was accompanied by a selection of CC320 and antimicrobial resistance.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268819000013
      Issue No: Vol. 147 (2019)
  • Gender and time delays in diagnosis of pulmonary tuberculosis: a
           cross-sectional study from China
    • Authors: H. G. Chen; T. W. Wang, Q. X. Cheng
      Abstract: Gender inequality has severe consequences on public health in terms of delay in diagnosis of pulmonary tuberculosis (PTB). In order to explore gender-related differences in diagnosis delay, a cross-sectional study of 10 686 patients diagnosed with PTB in Yulin from 1 January 2009 to 31 December 2014 was conducted. Diagnosis delay was categorised into ‘short delay’ and ‘long delay’ by four commonly used cut-off points of 14, 30, 60 and 90 days. Logistic regression analysis was used to analyse gender differences in diagnostic delay. Stratified analyses by smear results, age, urban/rural were performed to examine whether the effect persisted across the strata. The median delay was 31 days (interquartile range 13–65). Diagnostic delay in females at cut-off points of 14, 30, 60 and 90 days had odds ratios (OR) of 0.99 (95% CI 0.91–1.09), 1.09 (95% CI 1.01–1.18), 1.15 (95% CI 1.05–1.26) and 1.18 (95% CI 1.06–1.31), respectively, compared with males. Stratified analysis showed that females were associated with increased risk of longer delay among those aged 30–60 years, smear positive and living in the rural areas (P < 0.05). The female-to-male OR increased along with increased delay time. Further inquiry into the underlying reasons for gender differences should be urgently addressed to improve the current situation.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268819000049
      Issue No: Vol. 147 (2019)
  • Nipah virus infection: A review
    • Authors: Aditi; M. Shariff
      Abstract: Nipah virus (NiV) is an emerging bat-borne pathogen. It was first identified 20 years ago in Malaysia and has since caused outbreaks in other parts of South and Southeast Asia. It causes severe neurological and respiratory disease which is highly lethal. It is highly infectious and spreads in the community through infected animals or other infected people. Different strains of the virus show differing clinical and epidemiological features. Rapid diagnosis and implementation of infection control measures are essential to contain outbreaks. A number of serological and molecular diagnostic techniques have been developed for diagnosis and surveillance. Difficulties in diagnosis and management arise when a new area is affected. The high mortality associated with infection and the possibility of spread to new areas has underscored the need for effective management and control. However, no effective treatment or prophylaxis is readily available, though several approaches show promise. Given the common chains of transmission from bats to humans, a One Health approach is necessary for the prevention and control of NiV infection.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268819000086
      Issue No: Vol. 147 (2019)
  • Entamoeba+histolytica,+Entamoeba+dispar+and+Entamoeba+moshkovskii+in+faecal+samples+using+nested+multiplex+PCR+in+west+of+Iran&rft.title=Epidemiology+&+Infection&rft.issn=0950-2688&,+Ghasem+Zamini,+Mohammadbagher+Khademerfan&rft_id=info:doi/10.1017/S0950268819000141">Differential detection of Entamoeba histolytica, Entamoeba dispar and
           Entamoeba moshkovskii in faecal samples using nested multiplex PCR in west
           of Iran
    • Authors: Fares Bahrami; Ali Haghighi, Ghasem Zamini, Mohammadbagher Khademerfan
      Abstract: This study aimed to determine the prevalence of Entamoeba histolytica, Entamoeba dispar and Entamoeba moshkovskii (collectively referred to as Entamoeba complex), using microscopic and molecular methods in Kurdistan Province, northwest of Iran. The relationship between positive Entamoeba species and clinical symptoms was also investigated. Eight positive Entamoeba complex, as well as four Entamoeba complex-like isolates, were detected by microscopic stool examination. DNA was extracted from all positive and from 55 randomly selected negative stool samples. PCR was performed using species-specific 18S rRNA primers for the Entamoeba complex. All positive PCR samples were sequenced. In total, 14 (1.01%) out of 1383 isolates, i.e. 12 microscopy-positive and Entamoeba complex-like isolates and two out of 55 microscopy-negative isolates, were identified via PCR and sequencing. Overall, 0.58% (8/1383) of the isolates were E. dispar, 0.14% (2/1383) E. histolytica, 0.07% (1/1383) E. moshkovskii and 0.22% (3/1383) were mixed of E. histolytica and E. dispar. Based on our findings, the prevalence of E. dispar is greater than that of E. histoltyica. On the other hand, a case of E. moshkovskii was reported for the first time in this region. It seems that some gastrointestinal symptoms may be attributed to Entamoeba species.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268819000141
      Issue No: Vol. 147 (2019)
  • Feral cats do not play a major role in leptospirosis epidemiology on
           Reunion Island
    • Authors: Y. Gomard; E. Lagadec, L. Humeau, P. Pinet, S. Bureau, D. Da Silva, M. Turpin, Y. Soulaimana Mattoir, S. Georger, P. Mavingui, P. Tortosa
      Abstract: Although previous studies have reported Leptospira carriage in kidneys and urine of cats, the role of these animals in leptospirosis epidemiology remains poorly understood. Using molecular methods, we investigated Leptospira renal carriage in 172 feral cats from Reunion Island, an oceanic geographically isolated island located in the South West Indian Ocean. Only one out of the 172 analysed specimens tested positive for Leptospira DNA through quantitative real-time polymerase chain reaction. Using this positive sample, we could obtain sequences at three Leptospira loci (rrs2, lipL32 and lipL41) allowing to report for the first time Leptospira borgpetersenii naturally infecting cats. Comparisons with bacterial sequences from both acute human cases and animal reservoirs revealed similarities with Leptospira sequences previously reported on Reunion Island. However, the low prevalence (0.6%) reported herein does not support any major role of feral cats in leptospirosis epidemiology on Reunion Island, contrasting with results recently reported on another Indian Ocean Island, Christmas Island. The significance of these discrepancies is discussed.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268819000190
      Issue No: Vol. 147 (2019)
  • Letter to the editor in response to ‘Reconstruction and prediction of
           viral disease epidemics’
    • Authors: T. Alex Perkins
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S095026881900013X
      Issue No: Vol. 147 (2019)
  • Are food exposures obtained through commercial market panels
           representative of the general population' Implications for outbreak
    • Authors: T. Inns; D. Curtis, P. Crook, R. Vivancos, D. Gardiner, N. McCarthy, P. Mook
      Abstract: Current methods of control recruitment for case-control studies can be slow (a particular issue for outbreak investigations), resource-intensive and subject to a range of biases. Commercial market panels are a potential source of rapidly recruited controls. Our study evaluated food exposure data from these panel controls, compared with an established reference dataset. Market panel data were collected from two companies using retrospective internet-based surveys; these were compared with reference data from the National Diet and Nutrition Survey (NDNS). We used logistic regression to calculate adjusted odds ratios to compare exposure to each of the 71 food items between the market panel and NDNS participants. We compared 2103 panel controls with 2696 reference participants. Adjusted for socio-demographic factors, exposure to 90% of foods was statistically different between both panels and the reference data. However, these differences were likely to be of limited practical importance for 89% of Panel A foods and 79% of Panel B foods. Market panel food exposures were comparable with reference data for common food exposures but more likely to be different for uncommon exposures. This approach should be considered for outbreak investigation, in conjunction with other considerations such as population at risk, timeliness of response and study resources.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268819000219
      Issue No: Vol. 147 (2019)
  • Syndromic surveillance: two decades experience of sustainable systems –
           its people not just data!
    • Authors: Gillian E. Smith; Alex J. Elliot, Iain Lake, Obaghe Edeghere, Roger Morbey, Mike Catchpole, David L. Heymann, Jeremy Hawker, Sue Ibbotson, Brian McCloskey, Richard Pebody
      Abstract: Syndromic surveillance is a form of surveillance that generates information for public health action by collecting, analysing and interpreting routine health-related data on symptoms and clinical signs reported by patients and clinicians rather than being based on microbiologically or clinically confirmed cases. In England, a suite of national real-time syndromic surveillance systems (SSS) have been developed over the last 20 years, utilising data from a variety of health care settings (a telehealth triage system, general practice and emergency departments). The real-time systems in England have been used for early detection (e.g. seasonal influenza), for situational awareness (e.g. describing the size and demographics of the impact of a heatwave) and for reassurance of lack of impact on population health of mass gatherings (e.g. the London 2012 Olympic and Paralympic Games).We highlight the lessons learnt from running SSS, for nearly two decades, and propose questions and issues still to be addressed. We feel that syndromic surveillance is an example of the use of ‘big data’, but contend that the focus for sustainable and useful systems should be on the added value of such systems and the importance of people working together to maximise the value for the public health of syndromic surveillance services.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268819000074
      Issue No: Vol. 147 (2019)
  • A hospital qPCR-based survey of 10 gastrointestinal parasites in routine
           diagnostic screening, Marseille, France
    • Authors: E. Menu; C. Mary, I. Toga, D. Raoult, S. Ranque, F. Bittar
      Abstract: There is a scarcity of recent epidemiological data on intestinal parasitic infections in France. We conducted a prospective study aimed at estimating the prevalence of 10 enteric parasites in Marseille, France, using real-time polymerase chain reaction (PCR)-based diagnosis. A total of 643 faeces from 488 patients referred to the Parasitology-Mycology Laboratory of the University Hospital of Marseille over a 6 months period were included. DNA was extracted using a semi-automated method. Parasites of interest were detected using singleplex quantitative PCRs (qPCRs). For positive samples, the Blastocystis subtype was determined by sequence analysis. During the study, the overall prevalence of enteric parasites was 17%. Blastocystis sp. was the most frequent species (10.5%), followed by Dientamoeba fragilis (2.3%) and Giardia intestinalis (2.3%). The prevalence of other parasites was
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268819000165
      Issue No: Vol. 147 (2019)
  • Global status of Middle East respiratory syndrome coronavirus in dromedary
           camels: a systematic review
    • Authors: R. S. Sikkema; E. A. B. A. Farag, Mazharul Islam, Muzzamil Atta, C. B. E. M. Reusken, Mohd M. Al-Hajri, M. P. G. Koopmans
      Abstract: Dromedary camels have been shown to be the main reservoir for human Middle East respiratory syndrome (MERS) infections. This systematic review aims to compile and analyse all published data on MERS-coronavirus (CoV) in the global camel population to provide an overview of current knowledge on the distribution, spread and risk factors of infections in dromedary camels. We included original research articles containing laboratory evidence of MERS-CoV infections in dromedary camels in the field from 2013 to April 2018. In general, camels only show minor clinical signs of disease after being infected with MERS-CoV. Serological evidence of MERS-CoV in camels has been found in 20 countries, with molecular evidence for virus circulation in 13 countries. The seroprevalence of MERS-CoV antibodies increases with age in camels, while the prevalence of viral shedding as determined by MERS-CoV RNA detection in nasal swabs decreases. In several studies, camels that were sampled at animal markets or quarantine facilities were seropositive more often than camels at farms as well as imported camels vs. locally bred camels. Some studies show a relatively higher seroprevalence and viral detection during the cooler winter months. Knowledge of the animal reservoir of MERS-CoV is essential to develop intervention and control measures to prevent human infections.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S095026881800345X
      Issue No: Vol. 147 (2019)
  • The prevalence, temporal trends, and geographical distribution of HIV-1
           subtypes among men who have sex with men in China: A systematic review and
    • Authors: Yueqi Yin; Yuxiang Liu, Jing Zhu, Xiang Hong, Rui Yuan, Gengfeng Fu, Ying Zhou, Bei Wang
      Abstract: The aim of this meta-analysis was to provide a comprehensive overview of human immunodeficiency virus (HIV)-1 subtypes and to investigate temporal and geographical trends of the HIV-1 epidemic among men who have sex with men (MSM) in China. Chinese and English articles published between January 2007 and December 2017 were systematically searched. Pooled HIV-1 prevalence was calculated, and its stability was analysed using sensitivity analysis. Subgroups were based on study time period, sampling area and prevalence. Publication bias was measured using Funnel plot and Egger's test. A total of 68 independent studies that included HIV-1 molecular investigations were eligible for meta-analysis. Circulating recombinant form (CRF) 01_AE (57.36%, 95% confidence interval (CI) 53.76–60.92) was confirmed as the most prevalent HIV-1 subtype among MSM in China. Subgroup analysis for time period found that CRF01_AE steadily increased prior to 2012 but decreased during 2012–2016. Further whereas CRF07_BC increased over time, B/B′ decreased over time. CRF55_01B has increased in recent years, with higher pooled estimated rate in Guangdong (12.22%, 95% CI 10.34–13.17) and Fujian (8.65%, 95% CI 4.98–13.17) provinces. The distribution of HIV-1 subtypes among MSM in China has changed across different regions and periods. HIV-1 strains in MSM are becoming more complex. Long-term molecular monitoring in this population remains necessary for HIV-1 epidemic control and prevention.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268818003400
      Issue No: Vol. 147 (2019)
  • Molecular detection of rabies virus strain with N-gene that clustered with
           China lineage 2 co-circulating with Africa lineages in Monrovia, Liberia:
           first reported case in Africa
    • Authors: A. O. Olarinmoye; V. Kamara, N. D. Jomah, B. O. Olugasa, O. O. Ishola, A. Kamara, P. D. Luka
      Abstract: Despite a long history of dog-transmitted human rabies outbreaks in Liberia, West Africa, no reports exist of molecular characterisation of the causative lyssaviruses. This study investigated Rabies lyssavirus (RABV) strains isolated at the dog–human interface in Monrovia, Liberia 2016 and 2017, by reverse transcription polymerase chain reaction, using primers specific for the nucleoprotein (N) gene. Out of 20 specimens (19 dog brain samples and one human saliva) tested as suspected rabies cases, three (15%) were positive. Purified amplicons from all three positive specimens were sequenced in both forward and reverse directions. Phylogenetic analysis was conducted in MEGA7 and PhyML3 to determine their relationship with RABV sequences accessioned in NCBI GenBank. The first of three RABV strains detected clustered with China lineage 2 RABVs of dogs (99% homology to KU963489 and DQ666322). The second strain segregated with Africa lineage 2 RABVs also of dog origin, and the third strain segregated with Africa lineage 3 RABVs of Southern Africa viverrids. Our results show a transcontinental strain of rabies virus co-circulating with Africa lineages in post-conflict Liberia. This finding should stimulate more effective sub-regional planning and execution of one-health actions, towards stepwise surveillance and elimination of rabies in West Africa by 2030.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268818003333
      Issue No: Vol. 147 (2019)
  • The study on the early warning period of varicella outbreaks based on
           logistic differential equation model
    • Authors: Feng-Rui Pang; Qing-Hong Luo, Xiu-Qin Hong, Bin Wu, Jun-Hua Zhou, Wen-Ting Zha, Yuan Lv
      Abstract: Chickenpox is a common acute and highly contagious disease in childhood; moreover, there is currently no targeted treatment. Carrying out an early warning on chickenpox plays an important role in taking targeted measures in advance as well as preventing the outbreak of the disease. In recent years, the infectious disease dynamic model has been widely used in the research of various infectious diseases. The logistic differential equation model can well demonstrate the epidemic characteristics of epidemic outbreaks, gives the point at which the early epidemic rate changes from slow to fast. Therefore, our study aims to use the logistic differential equation model to explore the epidemic characteristics and early-warning time of varicella. Meanwhile, the data of varicella cases were collected from first week of 2008 to 52nd week of 2017 in Changsha. Finally, our study found that the logistic model can be well fitted with varicella data, besides the model illustrated that there are two peaks of varicella at each year in Changsha City. One is the peak in summer–autumn corresponding to the 8th–38th week; the other is in winter–spring corresponding to the time from the 38th to the seventh week next year. The ‘epidemic acceleration week’ average value of summer–autumn and winter–spring are about the 16th week (ranging from the 15th to 17th week) and 45th week (ranging from the 44th to 47th week), respectively. What is more, taking warning measures during the acceleration week, the preventive effect will be delayed; thus, we recommend intervene during recommended warning weeks which are the 15th and 44th weeks instead.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268818002868
      Issue No: Vol. 147 (2019)
  • Prevalence and risk factors of anaemia in hospitalised HIV-infected
           patients in southeast China: a retrospective study
    • Authors: J. L. Lai; Y. H. Chen, Y. M. Liu, J. J. Yuan, J. Lin, A. Q. Huang, H. H. Ye
      Abstract: The association between opportunistic infection (OI) and anaemia among HIV-infected patients remains to be studied. We investigated the prevalence and risk factors of anaemia in hospitalised HIV-infected patients to reveal the association between OI and anaemia. We conducted a retrospective study of HIV-positive hospitalised patients from June 2016 to December 2017 in Mengchao Hepatobiliary Hospital of Fujian Medical University. Patients’ information on socio-demographic and clinical characteristics were carefully collected. The comparison of anaemia prevalence between groups was conducted with χ2 test. A logistic regression model was carried out to analyse the predictors of anaemia. The total prevalence of anaemia in hospitalised HIV-infected patients was 55.15%. The prevalence of mild, moderate and severe anaemia was 41.42%, 11.08% and 2.64%, respectively. Predictors independently associated with anaemia were: CD4 counts
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268818003618
      Issue No: Vol. 147 (2019)
  • Time-series modelling and forecasting of hand, foot and mouth disease
           cases in China from 2008 to 2018
    • Authors: C. W. Tian; H. Wang, X. M. Luo
      Abstract: Seasonal autoregressive-integrated moving average (SARIMA) has been widely used to model and forecast incidence of infectious diseases in time-series analysis. This study aimed to model and forecast monthly cases of hand, foot and mouth disease (HFMD) in China. Monthly incidence HFMD cases in China from May 2008 to August 2018 were analysed with the SARIMA model. A seasonal variation of HFMD incidence was found from May 2008 to August 2018 in China, with a predominant peak from April to July and a trough from January to March. In addition, the annual peak occurred periodically with a large annual peak followed by a relatively small annual peak. A SARIMA model of SARIMA (1, 1, 2) (0, 1, 1)12 was identified, and the mean error rate and determination coefficient were 16.86% and 94.27%, respectively. There was an annual periodicity and seasonal variation of HFMD incidence in China, which could be predicted well by a SARIMA (1, 1, 2) (0, 1, 1)12 model.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S095026881800362X
      Issue No: Vol. 147 (2019)
  • Dengue, chikungunya and zika virus coinfection: results of the national
           surveillance during the zika epidemic in Colombia
    • Authors: Marcela Mercado-Reyes; Jorge Acosta-Reyes, Edgar Navarro-Lechuga, Sherill Corchuelo, Angélica Rico, Edgar Parra, Natalia Tolosa, Lissethe Pardo, Maritza González, Jorge Martìn-Rodriguez-Hernández, Luz Karime-Osorio, Martha Ospina-Martinez, Helena Rodriguez-Perea, Gaspar Del Rio-Pertuz, Diego Viasus
      Abstract: Our objective was to determine the frequency of zika (ZIKV), chikungunya (CHIKV) and dengue (DENV) virus coinfection and describe the mortality cases that occurred during the epidemiologic surveillance of the ZIKV epidemic in Colombia. We analysed all cases of suspected ZIKV infection that were reported to the National Institute of Health (October 2015–December 2016). DENV, CHIKV and ZIKV RNA were detected in serum or tissue samples using polymerase chain reaction assay. Medical records of the fatal cases were reviewed. We identified that 23 871 samples were processed. The frequency of viral agents was 439 (1.84%) for DENV, 257 (1.07%) for CHIKV and 10118 (42.38%) for ZIKV. Thirty-four (0.14%) cases of coinfection were identified. The CHIKV–ZIKV coinfection was present in 28 cases (82.3%), DENV–CHIKV in three (8.8%) and DENV–ZIKV in three (8.8%). Seven (20.6%) coinfection cases were fatal (two DENV–CHIKV cases and five CHIKV–ZIKV cases). Two cases were foetal deaths and the others were related to neurological syndrome and sepsis. In conclusion, the frequency of arbovirus coinfection during epidemic of ZIKV was low, and CHIKV–ZIKV coinfection was the most common. Mortality was high among coinfection patients. The role of each virus in the mortality cases of coinfection warrants further studies.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S095026881800359X
      Issue No: Vol. 147 (2019)
  • Persistence and gender differences in protection against severe fever with
           thrombocytopaenia syndrome virus with natural infection: a 4-year
           follow-up and mathematical prediction study
    • Authors: R. Qi; Y.T. Huang, X.J. Yu
      Abstract: Severe fever with thrombocytopaenia syndrome (SFTS) is an emerging infectious disease discovered in 2010 and has a case fatality as high as 30%. We intended to study the immune protection conferred by SFTS with natural infection. We collected and analysed 4-year follow-up data to study the characteristics of neutralising antibodies against SFTS virus (SFTSV). The 50% plaque reduction neutralisation test was used for the detection of neutralising antibodies against SFTSV. Geometric mean titres (GMTs) and proportions of patients with a protective titre were analysed, and the persistence of protection was predicted. The titre of antibodies declined yearly in the 4-year study period. Approximately 3 months after infection, the GMT was 143 (95% confidence interval (CI): 89–231), and 100% of patients had a protective titre. In the fourth year, the GMT declined to 53 (95% CI: 37–76), and 95% of patients had a protective titre. The titre was higher in females than in males. On average, the protection offered by neutralising antibodies against SFTSV could last as long as 9 years. The durations of protection were different for different initial titres. The characteristics of neutralising antibodies can be used as a reference for the vaccination doses and schedules of forthcoming vaccines.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S1469440918003643
      Issue No: Vol. 147 (2019)
  • Genetic characterisation of Measles virus variants identified during a
           large epidemic in Milan, Italy, March–December 2017
    • Authors: S. Bianchi; E.R. Frati, A. Lai, D. Colzani, G. Ciceri, M. Baggieri, A. Lamberti, S. Senatore, M. Faccini, F. Mazzilli, M. Gramegna, G. Zehender, F. Magurano, E. Tanzi, A. Amendola
      Abstract: In 2017, Italy experienced a large measles epidemic with 5408 cases and four deaths. As Subnational Reference Laboratory of the Measles and Rubella surveillance NETwork (MoRoNET), the EpiSoMI (Epidemiology and Molecular Surveillance of Infections) Laboratory (University of Milan) set up rapid and active surveillance for the complete characterisation of the Measles virus (Mv) responsible for the large measles outbreak in Milan and surrounding areas (Lombardy, Northern Italy). The aims of this study were to describe the genetic profile of circulating viruses and to track the pathway of measles transmission. Molecular analysis was performed by sequencing the highly variable 450 nucleotides region of the N gene (N-450) of Mv genome. Two-hundred and ninety-nine strains of Mv were analysed. The phylogenetic analysis showed five different variants, two not previously described in the studied area, belonging to D8 and B3 genotypes. Three events of continuous transmission of autochthonous variants (D8-Osaka, D8-London and B3-Milan variants) and two events of continuous transmission of imported variants (B3-Dublin and D8-Hulu Langat) tracked five different transmission pathways. These pathways outlined two epidemic peaks: the first in April and the second in July 2017. The correlation between Mv variant and the epidemiological data may enable us to identify the sources of virus importation and recognise long-lasting virus transmission pathways.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268818003606
      Issue No: Vol. 147 (2019)
  • Environmental and social determinants of acute rheumatic fever: a
           longitudinal cohort study
    • Authors: J. W. Cannon; M. Abouzeid, N. de Klerk, C. Dibben, J. R. Carapetis, J. M. Katzenellenbogen
      Abstract: Acute rheumatic fever (ARF), an auto-immune response to a group A Streptococcus infection and precursor to rheumatic heart disease (RHD), remains endemic in many socio-economically disadvantaged settings. A Global Resolution on ARF and RHD was recently adopted at the 71st World Health Assembly where governments committed to improving efforts to prevent and control ARF and RHD. To inform these efforts, the objectives of this study were to examine associations between childhood ARF in the UK between 1958 and 1969 and a range of environmental and social factors. Of 17 416 children from the nationally representative birth cohort of the National Child Development Study, ARF was reported in 23 children during early childhood (between birth and the 7-year follow-up) and in 29 additional children during middle childhood (between the 7- and 11-year follow-ups). Risk factors associated with ARF in both early and middle childhood were: a large family size; attendance at a private nursery or class; a history of nephritis, kidney or urinary tract infections; and a history of throat or ear infections. Risk factors for ARF in early childhood alone were families with fathers in a professional or semi-professional occupation and families who moved out of their local neighbourhood. Risk factors in late childhood alone included overcrowding and free school meals. These data suggest that prevention strategies in ARF endemic settings may be enhanced by targeting, for example, new members entering a community and children in environments of close contact, such as a nursery or shared bedrooms.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268818003527
      Issue No: Vol. 147 (2019)
  • Diabetes, undernutrition, migration and indigenous communities:
           tuberculosis in Chiapas, Mexico
    • Authors: H. A. Rashak; H. J. Sánchez-Pérez, B. E. Abdelbary, A. Bencomo-Alerm, N. Enriquez-Ríos, A. Gómez-Velasco, A. Colorado, M. Castellanos-Joya, M. H. Rahbar, B. I. Restrepo
      Abstract: We investigated the distribution of comorbidities among adult tuberculosis (TB) patients in Chiapas, the poorest Mexican state, with a high presence of indigenous population, and a corridor for migrants from Latin America. Secondary analysis on 5508 new adult TB patients diagnosed between 2010 and 2014 revealed that the most prevalent comorbidities were diabetes mellitus (DM; 19.1%) and undernutrition (14.4%). The prevalence of DM in these TB patients was significantly higher among middle aged (41–64 years) compared with older adults (⩾65 years) (38.6% vs. 23.2%; P < 0.0001). The prevalence of undernutrition was lower among those with DM, and higher in communities with high indigenous presence. Immigrants only comprised 2% of all TB cases, but were more likely to have unfavourable TB treatment outcomes (treatment failure, death and default) when compared with those born in Chiapas (29.5% vs. 11.1%; P < 0.05). Unfavourable TB outcomes were also more prevalent among the TB patients with undernutrition, HIV or older age, but not DM (P < 0.05). Our study in Chiapas illustrates the challenges of other regions worldwide where social (e.g. indigenous origin, poverty, migration) and host factors (DM, undernutrition, HIV, older age) are associated with TB. Further understanding of these critical factors will guide local policy makers and health providers to improve TB management.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268818003461
      Issue No: Vol. 147 (2019)
  • Bayesian evaluation of three serological tests for the diagnosis of bovine
           brucellosis in Bangladesh
    • Authors: A. K. M. A. Rahman; S. Smit, B. Devleesschauwer, P. Kostoulas, E. Abatih, C. Saegerman, M. Shamsuddin, D. Berkvens, N. K. Dhand, M. P. Ward
      Abstract: We evaluated the performance of three serological tests – an immunoglobulin G indirect enzyme linked immunosorbent assay (iELISA), a Rose Bengal test and a slow agglutination test (SAT) – for the diagnosis of bovine brucellosis in Bangladesh. Cattle sera (n = 1360) sourced from Mymensingh district (MD) and a Government owned dairy farm (GF) were tested in parallel. We used a Bayesian latent class model that adjusted for the conditional dependence among the three tests and assumed constant diagnostic accuracy of the three tests in both populations. The sensitivity and specificity of the three tests varied from 84.6% to 93.7%, respectively. The true prevalences of bovine brucellosis in MD and the GF were 0.6% and 20.4%, respectively. Parallel interpretation of iELISA and SAT yielded the highest negative predictive values: 99.9% in MD and 99.6% in the GF; whereas serial interpretation of both iELISA and SAT produced the highest positive predictive value (PPV): 99.9% in the GF and also high PPV (98.9%) in MD. We recommend the use of both iELISA and SAT together and serial interpretation for culling and parallel interpretation for import decisions. Removal of brucellosis positive cattle will contribute to the control of brucellosis as a public health risk in Bangladesh.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268818003503
      Issue No: Vol. 147 (2019)
  • Outbreak of hepatitis A genotype IB in Australia associated with imported
           frozen pomegranate arils
    • Authors: N. Franklin; H. Camphor, R. Wright, R. Stafford, K. Glasgow, V. Sheppeard
      Abstract: Locally acquired hepatitis A infection is re-emerging in Australia owing to person-to-person outbreaks among men who have sex with men and imported frozen produce. This paper describes a multi-state foodborne outbreak in the first half of 2018. Enhanced human epidemiological investigation including a case–control study, as well as microbial surveillance and trace-back investigations concluded that the outbreak was caused by consumption of imported frozen pomegranate arils. A total of 30 cases of hepatitis A infection, genotype IB with identical sequences met the outbreak case definition, including 27 primary cases and three secondary cases. Twenty-five (83%) of the cases were hospitalised for their illness and there was one death. Imported frozen pomegranate arils from Egypt were strongly implicated as the source of infection through case interviews (19 of 26 primary cases) as well as from a case–control study (adjusted odds ratio 43.4, 95% confidence interval 4.2–448.8, P = 0.002). Hepatitis A virus (HAV) was subsequently detected by polymerase chain reaction in two food samples of the frozen pomegranate aril product. This outbreak was detected and responded to promptly owing to routine genetic characterisation of HAVs from all hepatitis A infections in Australia as part of a national hepatitis A enhanced surveillance project. This is now the third outbreak of hepatitis A in Australia from imported frozen fruits. A re-assessment of the risk of these types of imported foods is strongly recommended.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268818003515
      Issue No: Vol. 147 (2019)
  • Risk of influenza infection with low vaccine effectiveness: the role of
           avoidance behaviour
    • Authors: Thomas N. Vilches; Majid Jaberi-Douraki, Seyed M. Moghadas
      Abstract: Low vaccine-effectiveness has been recognised as a key factor undermining efforts to improve strategies and uptake of seasonal influenza vaccination. Aiming to prevent disease transmission, vaccination may influence the perceived risk-of-infection and, therefore, alter the individual-level behavioural responses, such as the avoidance of contact with infectious cases. We asked how the avoidance behaviour of vaccinated individuals changes disease dynamics, and specifically the epidemic size, in the context of imperfect vaccination. For this purpose, we developed an agent-based simulation model, and parameterised it with published estimates and relevant databases for population demographics and agent characteristics. Encapsulating an age-stratified structure, we evaluated the per-contact risk-of-infection and estimated the epidemic size. Our results show that vaccination could lead to a larger epidemic size if the level of avoidance behaviour in vaccinated individuals reduces below that of susceptible individuals. Furthermore, the risk-of-infection in vaccinated individuals, which follows the pattern of age-dependent frailty index of the population, increases for older age groups, and may reach, or even exceed, the risk-of-infection in susceptible individuals. Our findings indicate that low engagement in avoidance behaviour can potentially offset the benefits of vaccination even for vaccines with high effectiveness. While highlighting the protective effects of vaccination, seasonal influenza immunisation programmes should enhance strategies to promote avoidance behaviour despite being vaccinated.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268818003540
      Issue No: Vol. 147 (2019)
  • Predominance of influenza B/Yamagata lineage viruses in Bulgaria during
           the 2017/2018 season
    • Authors: N. S. Korsun; S. G. Angelova, I. T. Trifonova, I. L. Georgieva, I. S. Tzotcheva, S. D. Mileva, S. E. Voleva, A. M. Kurchatova, P. I. Perenovska
      Abstract: In this study, we investigated the antigenic and genetic characteristics of influenza viruses circulating in Bulgaria during the 2017/2018 season. The detection and typing/subtyping of influenza viruses were performed using real-time RT-PCR. Results of antigenic characterisation, phylogenetic and amino acid sequence analyses of representative influenza strains are presented. The season was characterised by the predominance of B/Yamagata viruses, accounting for 77% of detected influenza viruses, followed by A(H1N1)pdm09 (17%), B/Victoria (3.7%) and A(H3N2) (2.4%). The sequenced B/Yamagata, B/Victoria, A(H1N1)pdm09 and A(H3N2) viruses belonged to the genetic groups 3, 1A, 6B.1 and 3C.2a1, respectively. Amino acid analysis of B/Yamagata isolates revealed the presence of three changes in haemagglutinin (HA), eight changes in neuraminidase (NA) and a number of substitutions in internal proteins compared with the B/Phucket/3073/2013 vaccine virus. Despite the amino acid changes, B/Yamagata viruses remained antigenically related to the vaccine strain. B/Victoria isolates fell into a group of viruses with double deletion (Δ162–163) in HA1. Substitutions in HA and NA sequences of B/Victoria, A(H1N1)pdm09 and A(H3N2) viruses were also identified compared with the vaccine strains, including in antigenic sites. The results of this study confirm the genetic variability of circulating influenza viruses and the need for continual antigenic and molecular surveillance.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268818003588
      Issue No: Vol. 147 (2019)
  • Bovine tuberculosis in working foxhounds: lessons learned from a complex
           public health investigation
    • Authors: Emily Phipps; Kate McPhedran, David Edwards, Katherine Russell, Catherine M. O'Connor, Danielle A. Gunn-Moore, Conor O'Halloran, Tony Roberts, Jill Morris
      Abstract: In 2017, Public Health England South East Health Protection Team (HPT) were involved in the management of an outbreak of Mycobacterium bovis (the causative agent of bovine tuberculosis) in a pack of working foxhounds. This paper summarises the actions taken by the team in managing the public health aspects of the outbreak, and lessons learned to improve the management of future potential outbreaks. A literature search was conducted to identify relevant publications on M. bovis. Clinical notes from the Public Health England (PHE) health protection database were reviewed and key points extracted. Animal and public health stakeholders involved in the management of the situation provided further evidence through unstructured interviews and personal communications. The PHE South East team initially provided ‘inform and advise’ letters to human contacts whilst awaiting laboratory confirmation to identify the infectious agent. Once M. bovis had been confirmed in the hounds, an in-depth risk assessment was conducted, and contacts were stratified in to risk pools. Eleven out of 20 exposed persons with the greatest risk of exposure were recommended to attend TB screening and one tested positive, but had no evidence of active TB infection. The number of human contacts working with foxhound packs can be large and varied. HPTs should undertake a comprehensive risk assessment of all potential routes of exposure, involve all other relevant stakeholders from an early stage and undertake regular risk assessments. Current guidance should be revised to account for the unique risks to human health posed by exposure to infected working dogs.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268818002753
      Issue No: Vol. 147 (2019)
  • Analysis of spatial-temporal distribution and influencing factors of
           pulmonary tuberculosis in China, during 2008–2015
    • Authors: Y. Zhang; X. L. Wang, T. Feng, C. Z. Fang
      Abstract: At present, the number of people with tuberculosis in China is second only to India and ranks second in the world. Under such a severe case of tuberculosis in China, prevention and control of pulmonary tuberculosis are urgently needed. This study aimed to study the temporal and geographical relevance of the pathogenesis of pulmonary tuberculosis and the factors affecting the incidence of tuberculosis. Spatial autocorrelation model was used to study the spatial distribution characteristics of pulmonary tuberculosis from a quantitative level. The research results showed that the overall incidence of pulmonary tuberculosis (IPT) in China was low in the east, high in the west and had certain seasonal characteristics. We use Spatial Lag Model to explore influencing factors of pulmonary tuberculosis. It indicates that the IPT is high in areas with underdeveloped economics, poor social services and low average smoking ages. Additionally, the IPT is high in areas with high AIDS prevalence. Also, compared with Classical Regression Model and Spatial Error Model, our model has smaller values of Akaike information criterion and Schwarz criterion. Besides, our model has bigger values of coefficient of determination (R2) and log-likelihood (log L) than the other two models. Apart from that, it is more significant than Spatial Error Models in the spatial dependence test for the IPT.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268818002765
      Issue No: Vol. 147 (2019)
  • Parasitic infections in relation to practices and knowledge in a rural
           village in Northern Thailand with emphasis on fish-borne trematode
    • Authors: K. Chaisiri; C. Jollivet, P. Della Rossa, S. Sanguankiat, D. Wattanakulpanich, C. Lajaunie, A. Binot, M. Tanita, S. Rattanapikul, D. Sutdan, S. Morand, A. Ribas
      Abstract: The present study integrates several aspects of a parasitological survey in a rural community village combining community knowledge of parasites, their potential transmission routes and health risk factors. A rural community located in Northern Thailand was surveyed for intestinal parasites, and an overall prevalence of 45.2% for helminths and 4.8% for protozoan infections was identified. Socio-demographic characteristics, customs and perceptions were compiled using individual questionnaires and interviews for participants surveyed for parasitic screening. The results allowed us to determine the knowledge and perception of local people concerning helminthic infection and transmission. Despite the fact that the participants in this community were aware of parasitic transmission routes, their widespread custom of eating raw fish and meat render the reduction of helminthiasis difficult. A detailed study on the infection of fish-borne parasitic trematodes, the most prevalent helminth, allowed us to determine that the distance from a given household to the river is a determinant of infection intensity. Health education activities organised in the local community resulted in a change in perception of risks associated with parasite transmission.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268818002996
      Issue No: Vol. 147 (2019)
  • Human rabies control in Lebanon: a call for action
    • Authors: M. F. Kassir; T. El Zarif, G. Kassir, A. Berry, U. Musharrafieh, A. R. Bizri
      Abstract: The status of rabies as a neglected disease has made its eradication rather challenging in different parts of the world despite the availability of a successful vaccine. Lebanon, in particular, is a country endemic to the disease with several cases of rabies deaths reported over the past 30 years. The risk of rabies, however, has taken a new turn over the past few years in Lebanon with two emerging situations that have made the control of the disease rather challenging: the neighbouring Syrian war and the local garbage crisis. Both of these milestone events might have contributed to an increase in the number of disease vectors as well as individuals at risk, thus nourishing the cycle of disease transmission. In this observational study, the effect of these two events are investigated, with an update on the status of this preventable, yet often neglected, disease in the country. Both events were found to be concomitant with a notable increase in the number of dog bites and thus possible rabies exposure. Current regulations are explored through interviews with veterinarians, and custom recommendations, ranging from policies to control dog populations to awareness campaigns in high-risk individuals, are then proposed to help control the disease.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S095026881800300X
      Issue No: Vol. 147 (2019)
  • Giardia+infections+among+children+under+5-years+of+age+with+acute+watery+diarrhoea+in+Abakaliki,+Nigeria&rft.title=Epidemiology+&+Infection&rft.issn=0950-2688&,+O.+N.+I.+Onyekachi,+M.+I.+Ugwu,+B.+König,+L.+J.+Robertson&rft_id=info:doi/10.1017/S0950268818003151">Apparent absence of Giardia infections among children under 5-years of age
           with acute watery diarrhoea in Abakaliki, Nigeria
    • Authors: A. M. Efunshile; O. Ezeanosike, O. N. I. Onyekachi, M. I. Ugwu, B. König, L. J. Robertson
      Abstract: Although the impact of diarrhoeal disease on paediatric health in Nigeria has decreased in recent years, it remains an important cause of morbidity and mortality in children under 5 years. Rotavirus is recognised as an important aetiological agent, but information on the contribution of intestinal protozoa to watery diarrhoea in this age group in Nigeria is scarce. In this cross-sectional study, faecal samples from children admitted to healthcare centres in Abakaliki, Nigeria with acute watery diarrhoea (N = 199) and faecal samples from age-matched controls (N = 37) were examined for Cryptosporidium and Giardia using immunofluorescent antibody testing and molecular methods. Cryptosporidium was identified in 13 case samples (6.5%) and no control samples. For three samples, molecular characterisation indicated C. hominis, GP60 subtypes IaA30R3, IaA14R3 and IdA11. Giardia was not detected in any samples. This contrast in prevalence between the two intestinal protozoa may reflect their variable epidemiologies and probably differing routes of infection. Given that these two parasitic infections are often bracketed together, it is key to realise that they not only have differing clinical spectra but also that the importance of each parasite is not the same in different age groups and/or settings.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268818003151
      Issue No: Vol. 147 (2019)
  • The use of capture-recapture methods to provide better estimates of the
           burden of norovirus outbreaks from seafood in England, 2004–2011
    • Authors: J.L. Hardstaff; H.E. Clough, J.P. Harris, J.A. Lowther, D.N. Lees, S.J. O'Brien
      Abstract: Norovirus (NoV) is the greatest cause of infectious intestinal disease in the UK. The burden associated with foodborne outbreaks is underestimated in part because data are dispersed across different organisations. Each looks at outbreaks through a different lens. To estimate the burden of NoV from seafood including shellfish we used a capture-recapture technique using datasets from three different organisations currently involved in collecting information on outbreaks. The number of outbreaks of NoV related to seafood including shellfish in England was estimated for the period of 2004–2011. The combined estimates were more than three times as high (N = 360 using Chao's sample coverage approach) as the individual count from organisation three (N = 115), which captured more outbreaks than the other two organisations. The estimates were calculated for both independence and dependence between the datasets. There was evidence of under-reporting of NoV outbreaks and inconsistency of reporting between organisations, which means that, currently, more than one data source needs to be used to estimate as accurately as possible the total number of NoV outbreaks and associated cases. Furthermore, either the integration of reporting mechanisms or simplifying the process of reporting outbreaks to organisations is essential for understanding and, hence, controlling disease burden.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268818003217
      Issue No: Vol. 147 (2019)
  • Association between Rift Valley fever virus seroprevalences in livestock
           and humans and their respective intra-cluster correlation coefficients,
           Tana River County, Kenya
    • Authors: B. Bett; J. Lindahl, R. Sang, M. Wainaina, S. Kairu-Wanyoike, S. Bukachi, I. Njeru, J. Karanja, E. Ontiri, M. Kariuki Njenga, D. Wright, G. M. Warimwe, D. Grace
      Abstract: We implemented a cross-sectional study in Tana River County, Kenya, a Rift Valley fever (RVF)-endemic area, to quantify the strength of association between RVF virus (RVFv) seroprevalences in livestock and humans, and their respective intra-cluster correlation coefficients (ICCs). The study involved 1932 livestock from 152 households and 552 humans from 170 households. Serum samples were collected and screened for anti-RVFv immunoglobulin G (IgG) antibodies using inhibition IgG enzyme-linked immunosorbent assay (ELISA). Data collected were analysed using generalised linear mixed effects models, with herd/household and village being fitted as random variables. The overall RVFv seroprevalences in livestock and humans were 25.41% (95% confidence interval (CI) 23.49–27.42%) and 21.20% (17.86–24.85%), respectively. The presence of at least one seropositive animal in a household was associated with an increased odds of exposure in people of 2.23 (95% CI 1.03–4.84). The ICCs associated with RVF virus seroprevalence in livestock were 0.30 (95% CI 0.19–0.44) and 0.22 (95% CI 0.12–0.38) within and between herds, respectively. These findings suggest that there is a greater variability of RVF virus exposure between than within herds. We discuss ways of using these ICC estimates in observational surveys for RVF in endemic areas and postulate that the design of the sentinel herd surveillance should consider patterns of RVF clustering to enhance its effectiveness as an early warning system for RVF epidemics.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268818003242
      Issue No: Vol. 147 (2019)
  • Epidemiology & Infection goes open access
    • Authors: Norman Noah; Fiona G. Hutton
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268818003047
      Issue No: Vol. 147 (2019)
  • Syndromic surveillance and its utilisation for mass gatherings
    • Authors: A.C. Berry
      Abstract: Tremendous advancements in syndromic surveillance strategies over the last two decades, and specifically from prior mass gatherings, have been incorporated into day-to-day healthcare analysis worldwide and have left a lasting indirect impact since their inception. Mass gatherings are a daily occurrence worldwide and provide a scenario ripe for public health aims and objectives utilising syndromic surveillance. Europe is less than a decade away from hosting a colossal worldwide gathering (2024 Summer Olympics) in likely a time when the global agreement is in flux. A call to arms is needed for additional surveillance strategies incorporating mobile application symptom checker data, telemedicine, social media and social data sensing. There remains a need for an optimal combination of real-time data sensing that captures the whole population, but to reach that goal we must incorporate new advancements into baseline epidemiologic data monitoring, otherwise we will be tracking real-time mass gathering events on top of inaccurate baseline epidemiologic data.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268818001735
      Issue No: Vol. 147 (2019)
  • Using evidence to inform response to the 2017 plague outbreak in
           Madagascar: a view from the WHO African Regional Office
    • Authors: K. Heitzinger; B. Impouma, B. L. Farham, E. L. Hamblion, C. Lukoya, C. Machingaidze, L. A. Rakotonjanabelo, M. Yao, B. Diallo, M. H. Djingarey, N. Nsenga, C. F. Ndiaye, I. S. Fall
      Abstract: The 2017 plague outbreak in Madagascar was unprecedented in the African region, resulting in 2417 cases (498 confirmed, 793 probable and 1126 suspected) and 209 deaths by the end of the acute urban pneumonic phase of the outbreak. The Health Emergencies Programme of the WHO Regional Office for Africa together with the WHO Country Office and WHO Headquarters assisted the Ministry of Public Health of Madagascar in the rapid implementation of plague prevention and control measures while collecting and analysing quantitative and qualitative data to inform immediate interventions. We document the key findings of the evidence available to date and actions taken as a result. Based on the four goals of operational research – effective dissemination of results, peer-reviewed publication, changes to policy and practice and improvements in programme performance and health – we evaluate the use of evidence to inform response to the outbreak and describe lessons learned for future outbreak responses in the WHO African region. This article may not be reprinted or reused in any way in order to promote any commercial products or services.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268818001875
      Issue No: Vol. 147 (2019)
  • Streptococcus+diseases&rft.title=Epidemiology+&+Infection&rft.issn=0950-2688&,+J.+R.+Carapetis&rft_id=info:doi/10.1017/S0950268818002285">The fall and rise of Group A Streptococcus
    • Authors: T. C. Barnett; A. C. Bowen, J. R. Carapetis
      Abstract: Streptococcus pyogenes (or Group A Streptococcus, GAS) is a Gram-positive human pathogen responsible for a diverse array of superficial, invasive and immune-related diseases. GAS infections have historically been diseases of poverty and overcrowding, and remain a significant problem in the developing world and in disadvantaged populations within developed countries. With improved living conditions and access to antibiotics, the rates of GAS diseases in developed societies have gradually declined during the 20th century. However, genetic changes in circulating GAS strains and/or changes in host susceptibility to infection can lead to dramatic increases in the rates of specific diseases. No situations exemplify this more than the global upsurge of invasive GAS disease that originated in the 1980s and the regional increases in scarlet fever in north-east Asia and the UK. In each case, increased disease rates have been associated with the emergence of new GAS strains with increased disease-causing capability. Global surveillance for new GAS strains with increased virulence is important and determining why certain populations suddenly become susceptible to circulating strains remains a research priority. Here, we overview the changing epidemiology of GAS infections and the genetic alterations that accompany the emergence of GAS strains with increased capacity to cause disease.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268818002285
      Issue No: Vol. 147 (2019)
  • Reduced susceptibility in leptospiral strains of bovine origin might
           impair antibiotic therapy
    • Authors: L. Correia; A. P. Loureiro, W. Lilenbaum
      Abstract: Leptospirosis is a worldwide zoonotic disease determined by pathogenic spirochetes of the genus Leptospira. The control of bovine leptospirosis involves several measures including antibiotic treatment of carriers. Despite its importance, few studies regarding antimicrobial susceptibility of strains from bovine origin have been conducted. The aim of this study was to determine the in vitro susceptibility of Leptospira strains obtained from cattle in Rio de Janeiro, Brazil, against the main antibiotics used in bovine veterinary practice. A total of 23 Leptospira spp. strains were investigated for minimum inhibitory concentrations (MICs) and minimum bactericidal concentrations (MBCs) using broth macrodilution. At the species level, there were not differences in MIC susceptibility except for tetracycline (P < 0.05). Nevertheless, at the serogroup level, differences in MIC were observed among Sejroe strains, mainly for ceftiofur, doxycycline and in MBC for streptomycin (P < 0.05). One strain presented MBC values above maximum plasmatic concentration described for streptomycin and was classified as presenting reduced susceptibility. Efficacy of antimicrobial therapy on bovine leptospirosis could be compromised due to occurrence of infection by Leptospira strains presenting reduced susceptibility.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268818002510
      Issue No: Vol. 147 (2019)
  • Escherichia+coli&rft.title=Epidemiology+&+Infection&rft.issn=0950-2688&,+S.+Jacquinet,+D.+Piérard&rft_id=info:doi/10.1017/S0950268818002546">Risk determinants for the development of typical haemolytic uremic
           syndrome in Belgium and proposition of a new virulence typing algorithm
           for Shiga toxin-producing Escherichia coli
    • Authors: K. De Rauw; R. Buyl, S. Jacquinet, D. Piérard
      Abstract: In Belgium, it is mandatory to report Shiga toxin-producing Escherichia coli (STEC) infections to the health inspection authorities. To facilitate the decision making regarding infection control measures, information about the risk factors for the development of the haemolytic uremic syndrome (HUS) can be helpful. We performed statistical analyses on a dataset of 411 Belgian STEC strains. Demographic and clinical patient characteristics as well as phenotypical and genotypical STEC strain characteristics were taken into account. Multivariate logistic regression models indicated that age categories ⩽5, 6–12 and ⩾75; the stx2 gene; and the eae gene were significant HUS development risk determinants. The stx2a subtype had the highest risk (OR 29.6, 95% CI 7.0–125.1), while all stx1 subtypes encompassed a significant lower risk (OR 0.3, 95% CI 0.1–0.5). Presence of the stx1 gene without stx2 encompassed a lower risk than the combined presence of stx1 and stx2, or stx2 solely. Based on these results, we propose a new virulence typing algorithm that will enable the National Reference Centre to provide the physicians and health inspection authorities with a risk classification for the development of HUS. We believe this will contribute to a more efficient STEC infection control management in Belgium.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268818002546
      Issue No: Vol. 147 (2019)
  • Screening of more than 2000 Hungarian healthcare workers’ anti-measles
           antibody level: results and possible population-level consequences
    • Authors: G. Lengyel; A. Marossy, N. Ánosi, S. L. Farkas, B. Kele, É. Nemes-Nikodém, V. Szentgyörgyi, I. Kopcsó, M. Mátyus
      Abstract: Due to the European measles epidemic and the increased number of imported cases, it can be theorised that the risk of exposure among Hungarian healthcare workers (HCWs) has increased. In 2017, the increased measles circulation in the region led to the emergence of smaller local and hospital epidemics. Therefore, our objective was to determine the herd immunity in the high-risk group of HCWs. A hospital-based study of detecting anti-measles IgG activity was performed in 2017 and included 2167 employees of the Military Medical Centre (Hungary). The screening of HCWs presented a good general seropositivity (90.6%). The highest seroprevalence value (99.1%) was found in the age group of 60 years or older. The lowest number of seropositive individuals was seen in the 41–45 years (86.2%) age group, indicating a significant herd immunity gap between groups. Regarding the Hungarian data, there might be gaps in the seroprevalence of the analysed HCWs, implying that susceptible HCWs may generate healthcare-associated infections. This study suggests that despite the extensive vaccination and high vaccine coverage, it is still important to monitor the level of protective antibodies in HCWs, or in a representative group of the whole population of Hungary, and possibly in other countries as well.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268818002571
      Issue No: Vol. 147 (2019)
  • Temporal relationship between occurrences of hand, foot and mouth disease,
           respiratory virus detection and febrile seizures in children in tropical
           Singapore: a time-series analysis
    • Authors: Y. Chen; C. Y. Chong, A. R. Cook, N. T. W. Sim, P. Horby, H. H. La
      Abstract: Febrile seizure (FS) in children is a common complication of infections with respiratory viruses and hand, foot and mouth disease (HFMD). We conducted a retrospective ecological time-series analysis to determine the temporal relationship between hospital attendances for FS and HFMD or respiratory virus infections. Epilepsy attendance was used as a control. Data from 2004 to 2012 FS and epilepsy hospital attendance, HFMD notifications to the Ministry of Health and from laboratory-confirmed viral respiratory infections among KK Women's and Children's Hospital inpatients were used. A multivariate linear regression analysis was conducted to evaluate the relationship between FS and the virus time series. Relative risks of FS by age were calculated using Bayesian statistical methods. Paediatric accident and emergency (A&E) attendances for FS were found to be associated with influenza A (extra 0.47 FS per influenza A case), B (extra 0.32 per influenza B case) and parainfluenza 3 (extra 0.35 per parainfluenza type 3 case). However, other viruses were not significantly associated with FS. None of the viruses were associated with epileptic seizure attendance. Influenza A, B and parainfluenza 3 viruses contributed to the burden of FS resulting in A&E attendance. Children at risk of FS should be advised to receive seasonal influenza vaccination.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268818002509
      Issue No: Vol. 147 (2019)
  • Estimating the probability of freedom from bovine brucellosis in the
           Galapagos Islands
    • Authors: G. Gioia; R. L. Vinueza, M. Cruz, M. Jay, Y. Corde, M. Marsot, G. Zanella
      Abstract: Bovine brucellosis is a worldwide zoonotic disease that still burdens several countries in the Mediterranean, Asia, Africa and Latin America. Although the disease is present in Ecuador, the Galapagos Islands seem to be free from the disease based on a survey conducted in 1997 where all tested animals showed negative results. This study aimed at estimating the probability of freedom from brucellosis in this Ecuadorian province in 2014. A survey was implemented on the three main cattle-producing islands of the province: Santa Cruz, Isabela and San Cristóbal. Thirty-three cattle farms and 410 cattle were tested for brucellosis using the Rose Bengal test and indirect ELISA. All animals showed negative results for both tests. Probability of freedom was estimated at 98%, 91% and 88% for Santa Cruz, Isabela and San Cristóbal, respectively, considering a herd-level design seroprevalence of 20% and animal-level design seroprevalence of 15%, and assuming a perfect specificity of the survey. The negative results found in 1997 and present surveys suggest that the Galapagos Islands are free from bovine brucellosis.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268818002534
      Issue No: Vol. 147 (2019)
  • Escherichia+coli+and+Escherichia+albertii+in+Brazil:+pathotypes+and+serotypes+over+a+6-year+period+of+surveillance&rft.title=Epidemiology+&+Infection&rft.issn=0950-2688&,+T.+S.+Andrade,+B.+T.+Miguel,+M.+C.+Cergole-Novella,+B.+E.+C.+Guth,+R.+T.+Hernandes,+R.+C.+B.+Dias,+S.+R.+S.+Pinheiro,+C.+H.+Camargo,+E.+C.+Romero,+L.+F.+Dos+Santos&rft_id=info:doi/10.1017/S0950268818002595">Diarrhoeagenic Escherichia coli and Escherichia albertii in Brazil:
           pathotypes and serotypes over a 6-year period of surveillance
    • Authors: E. L. Ori; E. H. Takagi, T. S. Andrade, B. T. Miguel, M. C. Cergole-Novella, B. E. C. Guth, R. T. Hernandes, R. C. B. Dias, S. R. S. Pinheiro, C. H. Camargo, E. C. Romero, L. F. Dos Santos
      Abstract: Diarrhoeagenic Escherichia coli (DEC) is a leading cause of infectious diarrhoea worldwide. In recent years, Escherichia albertii has also been implicated as a cause of human enteric diseases. This study describes the occurrence of E. coli pathotypes and serotypes associated with enteric illness and haemolytic uremic syndrome (HUS) isolated in Brazil from 2011 to 2016. Pathotypes isolated included enteropathogenic E. coli (EPEC), enteroaggregative E. coli (EAEC), enterotoxigenic E. coli (ETEC), enteroinvasive E. coli (EIEC) and Shiga toxin-producing E. coli (STEC). PCR of stool enrichments for DEC pathotypes was employed, and E. albertii was also sought. O:H serotyping was performed on all DEC isolates. A total of 683 DEC and 10 E. albertii strains were isolated from 5047 clinical samples. The frequencies of DEC pathotypes were 52.6% (359/683) for EPEC, 32.5% for EAEC, 6.3% for ETEC, 4.4% for EIEC and 4.2% for STEC. DEC strains occurred in patients from 3 months to 96 years old, but EPEC, EAEC and STEC were most prevalent among children. Both typical and atypical isolates of EPEC and EAEC were recovered and presented great serotype heterogeneity. HUS cases were only associated with STEC serotype O157:H7. Two E. albertii isolates belonged to serogroup O113 and one had the stx2f gene. The higher prevalence of atypical EPEC in relation to EAEC in community-acquired diarrhoea in Brazil suggests a shift in the trend of DEC pathotypes circulation as previously EAEC predominated. This is the first report of E. albertii isolation from active surveillance. These results highlight the need of continuing DEC and E. albertii surveillance, as a mean to detect changes in the pattern of pathotypes and serotypes circulation and provide useful information for intervention and control strategies.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268818002595
      Issue No: Vol. 147 (2019)
  • Use of whole genome sequencing to complement characterisation of a typhoid
           fever outbreak among a Marshallese community: Oklahoma, 2015
    • Authors: L. J. Burnsed; L. D. Kovar, K. M. Angelo, E. K. Trees, J. Concepción-Acevedo, M. D. McDermott, D. Wagner, K. K. Bradley
      Abstract: Typhoid fever is an illness caused by Salmonella enterica serotype Typhi. In developing regions, it affects an estimated 20 million people annually, causing 200 000 deaths. Although uncommon, cases occur in the USA each year, predominantly due to international travel. During February 2015, the Oklahoma State Department of Health (OSDH) detected an outbreak of typhoid fever among residents of northwestern Oklahoma. OSDH conducted case-patient interviews to identify the source and symptomatic contacts. Whole genome sequencing (WGS) was performed to characterise the genetic relatedness of isolates among the four outbreak-associated pulsed-field gel electrophoresis (PFGE) patterns. We identified 38 cases, 25 confirmed and 13 probable, in two states. WGS revealed a 0–10 single-nucleotide polymorphism variation between isolates. Although we were unable to determine the source, almost all case-patients were members of the Marshallese community that attended a common event in Oklahoma, or were contacts to a confirmed case. This is the largest outbreak of typhoid fever in the USA since 1989, and first to apply WGS to complement interpretation of PFGE results during a typhoid fever outbreak investigation. This investigation illustrates the potential risk of outbreaks among communities comprised of international populations from regions where typhoid fever remains endemic.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268818002601
      Issue No: Vol. 147 (2019)
  • The slow dynamics of mycoplasma infections in a tortoise host reveal
           heterogeneity pertinent to pathogen transmission and monitoring
    • Authors: C. M. Aiello; T. C. Esque, K. E. Nussear, P. G. Emblidge, P. J. Hudson
      Abstract: The epidemiology of infectious diseases depends on many characteristics of disease progression, as well as the consistency of these processes across hosts. Longitudinal studies of infection can thus inform disease monitoring and management, but can be challenging in wildlife, particularly for long-lived hosts and persistent infections. Numerous tortoise species of conservation concern can be infected by pathogenic mycoplasmas that cause a chronic upper respiratory tract disease (URTD). Yet, a lack of detailed data describing tortoise responses to mycoplasma infections obscures our understanding of URTDs role in host ecology. We therefore monitored Mycoplasma agassizii infections in 14 captive desert tortoises and characterised clinical signs of disease, infection intensity, pathogen shedding and antibody production for nearly 4 years after initial exposure to donor hosts. Persistent infections established in all exposed tortoises within 10 weeks, but hosts appeared to vary in resistance, which affected the patterns of pathogen shedding and apparent disease. Delays in host immune response and changes to clinical signs and infection intensity over time resulted in inconsistencies between diagnostic tools and changes in diagnostic accuracy throughout the study. We discuss the implications these results have for URTD epidemiology and past and future research assessing disease prevalence and dynamics in tortoise populations.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268818002613
      Issue No: Vol. 147 (2019)
  • The+Last+Days+of+Smallpox:+Tragedy+in+Birmingham+By+Mark+Pallen.+2018.+Independently+published,+9th+April+2018+–+ISBN-13:+978-1980455226&rft.title=Epidemiology+&+Infection&rft.issn=0950-2688&">The Last Days of Smallpox: Tragedy in Birmingham By Mark Pallen. 2018.
           Independently published, 9th April 2018 – ISBN-13: 978-1980455226
    • Authors: Philip Mortimer
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268818002297
      Issue No: Vol. 147 (2019)
  • Compartmental models for seasonal hyperendemic bacterial meningitis in the
           African meningitis belt
    • Authors: T. Koutangni; P. Crépey, M. Woringer, S. Porgho, B. W. Bicaba, H. Tall, J. E. Mueller
      Abstract: The pathophysiological mechanisms underlying the seasonal dynamic and epidemic occurrence of bacterial meningitis in the African meningitis belt remain unknown. Regular seasonality (seasonal hyperendemicity) is observed for both meningococcal and pneumococcal meningitis and understanding this is critical for better prevention and modelling. The two principal hypotheses for hyperendemicity during the dry season imply (1) an increased risk of invasive disease given asymptomatic carriage of meningococci and pneumococci; or (2) an increased transmission of these bacteria from carriers and ill individuals. In this study, we formulated three compartmental deterministic models of seasonal hyperendemicity, featuring one (model1-‘inv’ or model2-‘transm’), or a combination (model3-‘inv-transm’) of the two hypotheses. We parameterised the models based on current knowledge on meningococcal and pneumococcal biology and pathophysiology. We compared the three models' performance in reproducing weekly incidences of suspected cases of acute bacterial meningitis reported by health centres in Burkina Faso during 2004–2010, through the meningitis surveillance system. The three models performed well (coefficient of determination R2, 0.72, 0.86 and 0.87, respectively). Model2-‘transm’ and model3-‘inv-transm’ better captured the amplitude of the seasonal incidence. However, model2-‘transm’ required a higher constant invasion rate for a similar average baseline transmission rate. The results suggest that a combination of seasonal changes of the risk of invasive disease and carriage transmission is involved in the hyperendemic seasonality of bacterial meningitis in the African meningitis belt. Consequently, both interventions reducing the risk of nasopharyngeal invasion and the bacteria transmission, especially during the dry season are believed to be needed to limit the recurrent seasonality of bacterial meningitis in the meningitis belt.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268818002625
      Issue No: Vol. 147 (2019)
  • Epidemiology and associated risk factors of giardiasis in a peri-urban
           setting in New South Wales Australia
    • Authors: P. Zajaczkowski; S. Mazumdar, S. Conaty, J. T. Ellis, S. M. Fletcher-Lartey
      Abstract: Giardiasis is one of the most important non-viral causes of human diarrhoea. Yet, little is known about the epidemiology of giardiasis in the context of developed countries such as Australia and there is a limited information about local sources of exposure to inform prevention strategies in New South Wales. This study aimed to (1) describe the epidemiology of giardiasis and (2) identify potential modifiable risk factors associated with giardiasis that are unique to south-western Sydney, Australia. A 1:2 matched case-control study of 190 confirmed giardiasis cases notified to the South-Western Local Health District Public Health Unit from January to December 2016 was employed to investigate the risk factors for giardiasis. Two groups of controls were selected to increase response rate; Pertussis cases and neighbourhood (NBH) controls. A matched analysis was carried out for both control groups separately. Variables with a significant odds ratio (OR) in the univariate analysis were placed into a multivariable regression for each matched group, respectively. In the regression model with the NBH controls, age and sex were controlled as potential confounders. Identified risk factors included being under 5 years of age (aOR = 7.08; 95% confidence intervals (CI) 1.02–49.36), having a household member diagnosed with a gastrointestinal illness (aOR = 15.89; 95% CI 1.53–164.60) and having contact with farm animals, domestic animals or wildlife (aOR = 3.03; 95% CI 1.08–8.54). Cases that travelled overseas were at increased risk of infection (aOR = 19.89; 95% CI 2.00–197.37) when compared with Pertussis cases. This study provides an update on the epidemiology and associated risk factors of a neglected tropical disease, which can inform enhanced surveillance and prevention strategies in the developed metropolitan areas.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268818002637
      Issue No: Vol. 147 (2019)
  • Self-reported patient history to assess hepatitis B virus serological
           status during a large screening campaign
    • Authors: A. Boyd; J. Gozlan, F. Carrat, H. Rougier, P.-M. Girard, K. Lacombe, J. Bottero
      Abstract: When assessing hepatitis B virus (HBV) status in clinical settings, it is unclear whether self-reports on vaccination history and previous HBV-test results have any diagnostic capacity. Of 3997 participants in a multi-centre HBV-screening study in Paris, France, 1090 were asked questions on their last HBV-test result and vaccination history. Discordance between self-reported history compared with infection status (determined by serology) was calculated for participants claiming ‘negative’, ‘effective vaccine’, ‘past infection’, or ‘chronic infection’ HBV-status. Serological testing revealed that 320 (29.4%) were non-immunised, 576 (52.8%) were vaccinated, 173 (15.9%) had resolved the infection and 21 (1.9%) were hepatitis B surface antigen positive. In total 208/426 (48.8%) participants with a self-reported history of ‘negative’ infection had a discordant serological result, in whom 128 (61.5%) were vaccinated and 74 (35.6%) had resolved infections. A total of 153/599 (25.5%) participants self-reporting ‘effective vaccine’ had a discordant serological result, in whom 100 (65.4%) were non-immunised and 50 (32.7%) were resolved infections. Discordance for declaring ‘past’ or ‘chronic infection’ occurred in 9/55 (16.4%) and 3/10 (30.0%) individuals, respectively. In conclusion, self-reported HBV-status based on participant history is partially inadequate for determining serological HBV-status, especially between negative/vaccinated individuals. More adapted patient education about HBV-status might be helpful for certain key populations.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268818002650
      Issue No: Vol. 147 (2019)
  • Laboratory capacity of Greek hospitals for diagnosis of salmonellosis and
           surveillance systems’ performance in the years of economic crisis,
    • Authors: K. Mellou; E. Saranti-Papasaranti, G. Mandilara, T. Georgakopoulou
      Abstract: Austerity might have affected the capacity of public hospitals in Greece to diagnose salmonellosis (laboratory capacity) over the period 2010–2016, as well as the performance of the existing surveillance systems. The scope of this paper is to present data on laboratory capacity over these years, as well as the results of a two-source capture-recapture study (data from Mandatory Notification System and National Reference Laboratory System for Salmonella). The main findings were that: (a) laboratory capacity was high and steady besides the financial crisis, (b) the estimated number of laboratory-confirmed cases (n = 6017, 95% CI 5892–6142) resulted in an incidence rate (7.9 cases/100 000 population) almost twice than that reported by the two systems Mandatory Notification System (MNS); 4.1 and National Reference Laboratory System (NRLS); 4.5 cases/100 000 population, (c) underreporting was high for both systems (MNS; 47.5% and NRLS; 42.8%) and (d) differences by geographical region, size and type of hospital were identified. We suggest that (a) specific interventions are needed to increase completeness of the systems by type of hospital and geographical region, (b) record linkage can help in estimating the disease burden in a more valid way than each system separately and (c) a common electronic database in order to feed one system to the other could significantly increase completeness of both systems.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268818002686
      Issue No: Vol. 147 (2019)
  • Chlamydia+trachomatis+infections+are+associated+with+lower+bacterial+loads&rft.title=Epidemiology+&+Infection&rft.issn=0950-2688&,+B.+Van+Der+Pol,+G.+Daniel,+L.+Brown,+C.+G.+Press,+R.+Gorwitz,+J.+Papp,+J.+Y.+Lee,+W.+M.+Geisler&rft_id=info:doi/10.1017/S0950268818002704">Repeated Chlamydia trachomatis infections are associated with lower
           bacterial loads
    • Authors: K. Gupta; R. K. Bakshi, B. Van Der Pol, G. Daniel, L. Brown, C. G. Press, R. Gorwitz, J. Papp, J. Y. Lee, W. M. Geisler
      Abstract: Chlamydia trachomatis (CT) infections remain highly prevalent. CT reinfection occurs frequently within months after treatment, likely contributing to sustaining the high CT infection prevalence. Sparse studies have suggested CT reinfection is associated with a lower organism load, but it is unclear whether CT load at the time of treatment influences CT reinfection risk. In this study, women presenting for treatment of a positive CT screening test were enrolled, treated and returned for 3- and 6-month follow-up visits. CT organism loads were quantified at each visit. We evaluated for an association of CT bacterial load at initial infection with reinfection risk and investigated factors influencing the CT load at baseline and follow-up in those with CT reinfection. We found no association of initial CT load with reinfection risk. We found a significant decrease in the median log10 CT load from baseline to follow-up in those with reinfection (5.6 CT/ml vs. 4.5 CT/ml; P = 0.015). Upon stratification of reinfected subjects based upon presence or absence of a history of CT infections prior to their infection at the baseline visit, we found a significant decline in the CT load from baseline to follow-up (5.7 CT/ml vs. 4.3 CT/ml; P = 0.021) exclusively in patients with a history of CT infections prior to our study. Our findings suggest repeated CT infections may lead to possible development of partial immunity against CT.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268818002704
      Issue No: Vol. 147 (2019)
  • Mycobacterium+ulcerans&rft.title=Epidemiology+&+Infection&rft.issn=0950-2688&'Brien&rft.aufirst=D.&'Brien&,+K.+Blasdell,+M.+Avumegah,+E.+Athan&rft_id=info:doi/10.1017/S0950268818002662">The changing epidemiology worldwide of Mycobacterium
    • Authors: D. P. O'Brien; I. Jeanne, K. Blasdell, M. Avumegah, E. Athan
      Abstract: Mycobacterium ulcerans is recognised as the third most common mycobacterial infection worldwide. It causes necrotising infections of skin and soft tissue and is classified as a neglected tropical disease by the World Health Organization (WHO). However, despite extensive research, the environmental reservoir of the organism and mode of transmission of the infection to humans remain unknown. This limits the ability to design and implement public health interventions to effectively and consistently prevent the spread and reduce the incidence of this disease. In recent years, the epidemiology of the disease has changed. In most endemic regions of the world, the number of cases reported to the WHO are reducing, with a 64% reduction in cases reported worldwide in the last 9 years. Conversely, in a smaller number of countries including Australia and Nigeria, reported cases are increasing at a rapid rate, new endemic areas continue to appear, and in Australia cases are becoming more severe. The reasons for this changing epidemiology are unknown. We review the epidemiology of M. ulcerans disease worldwide, and document recent changes. We also outline and discuss the current state of knowledge on the ecology of M. ulcerans, possible transmission mechanisms to humans and what may be enabling the spread of M. ulcerans into new endemic areas.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268818002662
      Issue No: Vol. 147 (2019)
  • Salmonella+Paratyphi+B+variant+L(+)+tartrate(+)+infections+linked+to+raw+sprouted+nut+butters,+October+2015&rft.title=Epidemiology+&+Infection&rft.issn=0950-2688&,+J.+Harrang,+K.+Lamba,+A.+Folley,+M.+Ching-Lee,+E.+Hannapel,+V.+Greene,+A.+Classon,+L.+Whitlock,+L.+Shade,+S.+Viazis,+T.+Nguyen,+K.+P.+Neil&rft_id=info:doi/10.1017/S0950268818002716">New product, old problem(s): multistate outbreak of Salmonella Paratyphi B
           variant L(+) tartrate(+) infections linked to raw sprouted nut butters,
           October 2015
    • Authors: K. E. Heiman Marshall; H. Booth, J. Harrang, K. Lamba, A. Folley, M. Ching-Lee, E. Hannapel, V. Greene, A. Classon, L. Whitlock, L. Shade, S. Viazis, T. Nguyen, K. P. Neil
      Abstract: A cluster of Salmonella Paratyphi B variant L(+) tartrate(+) infections with indistinguishable pulsed-field gel electrophoresis patterns was detected in October 2015. Interviews initially identified nut butters, kale, kombucha, chia seeds and nutrition bars as common exposures. Epidemiologic, environmental and traceback investigations were conducted. Thirteen ill people infected with the outbreak strain were identified in 10 states with illness onset during 18 July–22 November 2015. Eight of 10 (80%) ill people reported eating Brand A raw sprouted nut butters. Brand A conducted a voluntary recall. Raw sprouted nut butters are a novel outbreak vehicle, though contaminated raw nuts, nut butters and sprouted seeds have all caused outbreaks previously. Firms producing raw sprouted products, including nut butters, should consider a kill step to reduce the risk of contamination. People at greater risk for foodborne illness may wish to consider avoiding raw products containing raw sprouted ingredients.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268818002716
      Issue No: Vol. 147 (2019)
  • Temporal dynamics of Middle East respiratory syndrome coronavirus in the
           Arabian Peninsula, 2012–2017
    • Authors: M. A. Alkhamis; A. Fernández-Fontelo, K. VanderWaal, S. Abuhadida, P. Puig, A. Alba-Casals
      Abstract: Middle East respiratory syndrome coronavirus (MERS-CoV) remains a notable disease and poses a significant threat to global public health. The Arabian Peninsula is considered a major global epicentre for the disease and the virus has crossed regional and continental boundaries since 2012. In this study, we focused on exploring the temporal dynamics of MERS-CoV in human populations in the Arabian Peninsula between 2012 and 2017, using publicly available data on case counts and combining two analytical methods. Disease progression was assessed by quantifying the time-dependent reproductive number (TD-Rs), while case series temporal pattern was modelled using the AutoRegressive Integrated Moving Average (ARIMA). We accounted for geographical variability between three major affected regions in Saudi Arabia including Eastern Province, Riyadh and Makkah. In Saudi Arabia, the epidemic size was large with TD-Rs >1, indicating significant spread until 2017. In both Makkah and Riyadh regions, the epidemic progression reached its peak in April 2014 (TD-Rs > 7), during the highest incidence period of MERS-CoV cases. In Eastern Province, one unique super-spreading event (TD-R > 10) was identified in May 2013, which comprised of the most notable cases of human-to-human transmission. Best-fitting ARIMA model inferred statistically significant biannual seasonality in Riyadh region, a region characterised by heavy seasonal camel-related activities. However, no statistical evidence of seasonality was identified in Eastern Province and Makkah. Instead, both areas were marked by an endemic pattern of cases with sporadic outbreaks. Our study suggested new insights into the epidemiology of the virus, including inferences about epidemic progression and evidence for seasonality. Despite the inherent limitations of the available data, our conclusions provide further guidance to currently implement risk-based surveillance in high-risk populations and, subsequently, improve related interventions strategies against the epidemic at country and regional levels.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268818002728
      Issue No: Vol. 147 (2019)
  • Burkholderia+pseudomallei+in+Hainan,+China&rft.title=Epidemiology+&+Infection&rft.issn=0950-2688&,+H.+Chen,+J.+Gu,+H.+Hu,+L.+Qu,+X.+Mao&rft_id=info:doi/10.1017/S0950268818002741">Multilocus sequencing-based evolutionary analysis of 52 strains of
           Burkholderia pseudomallei in Hainan, China
    • Authors: Y. Fang; Z. Hu, H. Chen, J. Gu, H. Hu, L. Qu, X. Mao
      Abstract: Previously, we reported a phylogenetic study of 98 Burkholderia pseudomallei clinical isolates from Hainan, China. Here, we update the B. pseudomallei strain library with 52 strains from newly identified cases dating from 2014 to 2017, analysed by multilocus sequence typing. Twenty-two sequence types (STs) were identified from the 52 cases, illustrating high genetic diversity; five of them (ST1480, ST1481, ST1482, ST1483 and ST1484) were novel. ST46, ST50 and ST58 predominated (34.6%) as was the case in the previous study (35.7%). An e-BURST map of the ST profiles of the two collections of isolates showed their genetic foundation to be largely unchanged. Neighbour-joining tree analysis was suggestive of a close phylogenetic relationship between the novel STs from this series and those first reported from Hainan (ST1105, ST1099, ST55 and ST1095). Moreover, the two novel STs (1481 and 1483) showed close similarity to ST58 which originated in Thailand indicating a close relationship between B. pseudomallei strains from both countries. The previously described allele profiles gmhD-36 and lepA-68 were found for the first time in our strain collections. Our study emphasises the importance of monitoring the epidemiological status and evolutionary trends of B. pseudomallei in China.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268818002741
      Issue No: Vol. 147 (2019)
  • The tip of the iceberg: incompleteness of measles reporting during a large
           outbreak in The Netherlands in 2013–2014
    • Authors: T. Woudenberg; F. Woonink, J. Kerkhof, K. Cox, W.L.M. Ruijs, R. van Binnendijk, H. de Melker, S.J.M. Hahné, J. Wallinga
      Abstract: Measles is a notifiable disease, but not everyone infected seeks care, nor is every consultation reported. We estimated the completeness of reporting during a measles outbreak in The Netherlands in 2013–2014. Children below 15 years of age in a low vaccination coverage community (n = 3422) received a questionnaire to identify measles cases. Cases found in the survey were matched with the register of notifiable diseases to estimate the completeness of reporting. Second, completeness of reporting was assessed by comparing the number of susceptible individuals prior to the outbreak with the number of reported cases in the surveyed community and on a national level.We found 307 (15%) self-identified measles cases among 2077 returned questionnaires (61%), of which 27 could be matched to a case reported to the national register; completeness of reporting was 8.8%. Based on the number of susceptible individuals and number of reported cases in the surveyed community and on national level, the completeness of reporting was estimated to be 9.1% and 8.6%, respectively. Estimating the completeness of reporting gave almost identical estimates, which lends support to the credibility and validity of both approaches. The size of the 2013–2014 outbreak approximated 31 400 measles infections.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268818002698
      Issue No: Vol. 147 (2019)
  • Declining hepatitis E virus antibody prevalence in Phnom Penh, Cambodia
           during 1996–2017
    • Authors: J. Nouhin; Y. Madec, S. Prak, M. Ork, A. Kerleguer, Y. Froehlich, N. Pavio, F. Rouet
      Abstract: Hepatitis E virus (HEV) infection is endemic in Cambodia. However, little relevant data were available and there is no clue if HEV is an emerging or decreasing pathogen in that setting. The aim of our study was to describe temporal trends of anti-HEV IgG and IgM prevalences during the last two decades (1996–2017) in the context of population growth and urbanisation in Cambodia. A total of 2004 human plasma samples collected between 1996 and 2017 were tested for anti-HEV IgG and IgM using the commercial Wantai anti-HEV assays. Overall, the prevalences of anti-HEV IgG and IgM were 41.1% and 2.7%, respectively. Analysis by calendar period showed a decreasing trend of anti-HEV IgG prevalence over the last 21 years. After age- and gender-standardisation, the anti-HEV IgG prevalence rates decreased from 61.3% during the 1996–2000 period to 32.3% during the 2016–2017 period, but no trends were observed for anti-HEV IgM rates, which fluctuated around the overall one. In conclusion, our results suggest that HEV is not an emerging pathogen, but rather seems to circulate less in Cambodia, in particular, in Phnom Penh, since the prevalence of anti-HEV IgG has been significantly decreased during the past two decades.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268818002790
      Issue No: Vol. 147 (2019)
  • Assessing the relationship between epidemic growth scaling and epidemic
           size: The 2014–16 Ebola epidemic in West Africa
    • Authors: Tapiwa Ganyani; Kimberlyn Roosa, Christel Faes, Niel Hens, Gerardo Chowell
      Abstract: We assess the relationship between epidemic size and the scaling of epidemic growth of Ebola epidemics at the level of administrative areas during the 2014–16 Ebola epidemic in West Africa. For this purpose, we quantify growth scaling parameters from the ascending phase of Ebola outbreaks comprising at least 7 weeks of epidemic growth. We then study how these parameters are associated with observed epidemic sizes. For validation purposes, we also analyse two historic Ebola outbreaks. We find a high monotonic association between the scaling of epidemic growth parameter and the observed epidemic size. For example, scaling of growth parameters around 0.3–0.4, 0.4–0.6 and 0.6 are associated with epidemic sizes on the order of 350–460, 460–840 and 840–2500 cases, respectively. These results are not explained by differences in epidemic onset across affected areas. We also find the relationship between the scaling of epidemic growth parameter and the observed epidemic size to be consistent for two past Ebola outbreaks in Congo (1976) and Uganda (2000). Signature features of epidemic growth could become useful to assess the risk of observing a major epidemic outbreak, generate improved diseases forecasts and enhance the predictive power of epidemic models. Our results indicate that the epidemic growth scaling parameter is a useful indicator of epidemic size, which may have significant implications to guide control of Ebola outbreaks and possibly other infectious diseases.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268818002819
      Issue No: Vol. 147 (2019)
  • Public health investigation and response to a hepatitis A outbreak from
           imported scallops consumed raw—Hawaii, 2016
    • Authors: M. A. Viray; M. G. Hofmeister, D. I. Johnston, V. P. Krishnasamy, C. Nichols, M. A. Foster, R. Balajadia, M. E. Wise, A. Manuzak, Y. Lin, G. Xia, C. Basler, J. Nsubuga, J. Woods, S. Y. Park
      Abstract: During the summer of 2016, the Hawaii Department of Health responded to the second-largest domestic foodborne hepatitis A virus (HAV) outbreak in the post-vaccine era. The epidemiological investigation included case finding and investigation, sequencing of RNA positive clinical specimens, product trace-back and virologic testing and sequencing of HAV RNA from the product. Additionally, an online survey open to all Hawaii residents was conducted to estimate baseline commercial food consumption. We identified 292 confirmed HAV cases, of whom 11 (4%) were possible secondary cases. Seventy-four (25%) were hospitalised and there were two deaths. Among all cases, 94% reported eating at Oahu or Kauai Island branches of Restaurant Chain A, with 86% of those cases reporting raw scallop consumption. In contrast, a food consumption survey conducted during the outbreak indicated 25% of Oahu residents patronised Restaurant Chain A in the 7 weeks before the survey. Product trace-back revealed a single distributor that supplied scallops imported from the Philippines to Restaurant Chain A. Recovery, amplification and sequence comparison of HAV recovered from scallops revealed viral sequences matching those from case-patients. Removal of product from implicated restaurants and vaccination of those potentially exposed led to the cessation of the outbreak. This outbreak further highlights the need for improved imported food safety.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268818002844
      Issue No: Vol. 147 (2019)
  • Simulation of Legionnaires’ disease prospective spatiotemporal cluster
           detection, Allegheny County, Pennsylvania, USA
    • Authors: L. T. Orkis; E. R. Peterson, M. M. Brooks, K. J. Mertz, L. H. Harrison, J. E. Stout, S. K. Greene
      Abstract: Legionnaires’ disease (LD) incidence in the USA has quadrupled since 2000. Health departments must detect LD outbreaks quickly to identify and remediate sources. We tested the performance of a system to prospectively detect simulated LD outbreaks in Allegheny County, Pennsylvania, USA. We generated three simulated LD outbreaks based on published outbreaks. After verifying no significant clusters existed in surveillance data during 2014–2016, we embedded simulated outbreak-associated cases into 2016, assigning simulated residences and report dates. We mimicked daily analyses in 2016 using the prospective space-time permutation scan statistic to detect clusters of ⩽30 and ⩽180 days using 365-day and 730-day baseline periods, respectively. We used recurrence interval (RI) thresholds of ⩾20, ⩾100 and ⩾365 days to define significant signals. We calculated sensitivity, specificity and positive and negative predictive values for daily analyses, separately for each embedded outbreak. Two large, simulated cooling tower-associated outbreaks were detected. As the RI threshold was increased, sensitivity and negative predictive value decreased, while positive predictive value and specificity increased. A small, simulated potable water-associated outbreak was not detected. Use of a RI threshold of ⩾100 days minimised time-to-detection while maximizing positive predictive value. Health departments should consider using this system to detect community-acquired LD outbreaks.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268818002789
      Issue No: Vol. 147 (2019)
  • The incidence of symptomatic infection with influenza virus in the
           Netherlands 2011/2012 through 2016/2017, estimated using Bayesian evidence
    • Authors: A. C. Teirlinck; B. de Gier, A. Meijer, G. Donker, M. de Lange, C. Koppeschaar, W. van der Hoek, M. E. Kretzschmar, S. A. McDonald
      Abstract: Due to differences in the circulation of influenza viruses, distribution and antigenic drift of A subtypes and B lineages, and susceptibility to infection in the population, the incidence of symptomatic influenza infection can vary widely between seasons and age-groups. Our goal was to estimate the symptomatic infection incidence in the Netherlands for the six seasons 2011/2012 through 2016/2017, using Bayesian evidence synthesis methodology to combine season-specific sentinel surveillance data on influenza-like illness (ILI), virus detections in sampled ILI cases and data on healthcare-seeking behaviour. Estimated age-aggregated incidence was 6.5 per 1000 persons (95% uncertainty interval (UI): 4.7–9.0) for season 2011/2012, 36.7 (95% UI: 31.2–42.8) for 2012/2013, 9.1 (95% UI: 6.3–12.9) for 2013/2014, 41.1 (95% UI: 35.0–47.7) for 2014/2015, 39.4 (95% UI: 33.4–46.1) for 2015/2016 and 27.8 (95% UI: 22.7–33.7) for season 2016/2017. Incidence varied substantially between age-groups (highest for the age-group
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S095026881800273X
      Issue No: Vol. 147 (2019)
  • An 8-year point-prevalence surveillance of healthcare-associated
           infections and antimicrobial use in a tertiary care teaching hospital in
    • Authors: Yi-Le Wu; Xi-Yao Yang, Meng-Shu Pan, Ruo-Jie Li, Xiao-Qian Hu, Jing-Jing Zhang, Li-Qi Yang
      Abstract: Healthcare-associated infections (HAIs) are a major worldwide public-health problem, but less data are available on the long-term trends of HAIs and antimicrobial use in Eastern China. This study describes the prevalence and long-term trends of HAIs and antimicrobial use in a tertiary care teaching hospital in Hefei, Anhui, China from 2010 to 2017 based on annual point-prevalence surveys. A total of 12 505 inpatients were included; 600 HAIs were recorded in 533 patients, with an overall prevalence of 4.26% and a frequency of 4.80%. No evidence was found for an increasing or decreasing trend in prevalence of HAI over 8 years (trend χ2 = 2.15, P = 0.143). However, significant differences in prevalence of HAI were evident between the surveys (χ2 = 21.14, P < 0.001). The intensive care unit had the highest frequency of HAIs (24.36%) and respiratory tract infections accounted for 62.50% of all cases; Escherichia coli was the most common pathogen (16.67%). A 44.13% prevalence of antimicrobial use with a gradually decreasing trend over time was recorded. More attention should be paid to potential high-risk clinical departments and HAI types with further enhancement of rational antimicrobial use.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268818002856
      Issue No: Vol. 147 (2019)
  • Risk factors spatial-temporal detection for dengue fever in Guangzhou
    • Authors: Lingcai Kong; Chengdong Xu, Pengfei Mu, Jialiang Li, Senyue Qiu, Haixia Wu
      Abstract: Dengue fever (DF) has been a growing public-health concern in China since its emergence in Guangdong Province in 1978. Of all the regions that have experienced dengue outbreaks in mainland China, the city of Guangzhou is the most affected. This study aims to investigate the potential risk factors for dengue virus (DENV) transmission in Guangzhou, China, from 2006 to 2014. The impact of risk factors on DENV transmission was qualified by the q-values calculated using a novel spatial-temporal method, the GeoDetector model. Both climatic and socioeconomic factors were considered. The impacts on DF incidence of each single factor and the interaction of two factors were analysed. The results show that the number of days with rainfall of the month before last has the highest determinant power, with a q-value of 0.898 (P < 0.01); the q-values of the other factors related to temperature and precipitation were around 0.38–0.50. Integrating a Pearson correlation analysis, nonlinear associations were found between the DF incidence in Guangzhou and the climatic factors considered. The coupled impact of the different variables considered was enhanced compared with their individual effects. In addition, an increased number of tourists in the city were associated with a high incidence of DF. This study demonstrates that the number of rain days in a month has great influence on the DF incidence of the month after next; the temperature and precipitation have nonlinear impacts on the DF incidence in Guangzhou; both the domestic and overseas tourists coming to the city increase the risk of DENV transmission. These findings are useful in the risk assessment of DENV transmission, to predict DF outbreaks and to implement preventive DF reduction strategies.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268818002820
      Issue No: Vol. 147 (2019)
  • Bayesian spatial and spatio-temporal approaches to modelling dengue fever:
           a systematic review
    • Authors: A. Aswi; S. M. Cramb, P. Moraga, K. Mengersen
      Abstract: Dengue fever (DF) is one of the world's most disabling mosquito-borne diseases, with a variety of approaches available to model its spatial and temporal dynamics. This paper aims to identify and compare the different spatial and spatio-temporal Bayesian modelling methods that have been applied to DF and examine influential covariates that have been reportedly associated with the risk of DF. A systematic search was performed in December 2017, using Web of Science, Scopus, ScienceDirect, PubMed, ProQuest and Medline (via Ebscohost) electronic databases. The search was restricted to refereed journal articles published in English from January 2000 to November 2017. Thirty-one articles met the inclusion criteria. Using a modified quality assessment tool, the median quality score across studies was 14/16. The most popular Bayesian statistical approach to dengue modelling was a generalised linear mixed model with spatial random effects described by a conditional autoregressive prior. A limited number of studies included spatio-temporal random effects. Temperature and precipitation were shown to often influence the risk of dengue. Developing spatio-temporal random-effect models, considering other priors, using a dataset that covers an extended time period, and investigating other covariates would help to better understand and control DF transmission.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268818002807
      Issue No: Vol. 147 (2019)
  • Reconstruction and prediction of viral disease epidemics
    • Authors: M. U. G. Kraemer; D. A. T. Cummings, S. Funk, R. C. Reiner, N. R. Faria, O. G. Pybus, S. Cauchemez
      Abstract: A growing number of infectious pathogens are spreading among geographic regions. Some pathogens that were previously not considered to pose a general threat to human health have emerged at regional and global scales, such as Zika and Ebola Virus Disease. Other pathogens, such as yellow fever virus, were previously thought to be under control but have recently re-emerged, causing new challenges to public health organisations. A wide array of new modelling techniques, aided by increased computing capabilities, novel diagnostic tools, and the increased speed and availability of genomic sequencing allow researchers to identify new pathogens more rapidly, assess the likelihood of geographic spread, and quantify the speed of human-to-human transmission. Despite some initial successes in predicting the spread of acute viral infections, the practicalities and sustainability of such approaches will need to be evaluated in the context of public health responses.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268818002881
      Issue No: Vol. 147 (2019)
  • Prevalence of comorbidities in cases of Middle East respiratory syndrome
           coronavirus: a retrospective study
    • Authors: F.Y. Alqahtani; F.S. Aleanizy, R. Ali El Hadi Mohamed, M. S. Alanazi, N. Mohamed, M. M. Alrasheed, N. Abanmy, T. Alhawassi
      Abstract: The Middle East respiratory syndrome coronavirus (MERS-CoV) is a life-threatening respiratory disease with a high case fatality rate; however, its risk factors remain unclear. We aimed to explore the influence of demographic factors, clinical manifestations and underlying comorbidities on mortality in MERS-CoV patients. Retrospective chart reviews were performed to identify all laboratory-confirmed cases of MERS-COV infection in Saudi Arabia that were reported to the Ministry of Health of Saudi Arabia between 23 April 2014 and 7 June 2016. Statistical analyses were conducted to assess the effect of sex, age, clinical presentation and comorbidities on mortality from MERS-CoV. A total of 281 confirmed MERS-CoV cases were identified: 167 (59.4%) patients were male and 55 (20%) died. Mortality predominantly occurred among Saudi nationals and older patients and was significantly associated with respiratory failure and shortness of breath. Of the 281 confirmed cases, 160 (56.9%) involved comorbidities, wherein diabetes mellitus, hypertension, ischemic heart disease, congestive heart failure, end-stage renal disease and chronic kidney disease were significantly associated with mortality from MERS-CoV and two or three comorbidities significantly affected the fatality rates from MERS-CoV. The findings of this study show that old age and the existence of underlying comorbidities significantly increase mortality from MERS-CoV.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268818002923
      Issue No: Vol. 147 (2019)
  • Toxoplasma+gondii+in+clinical+samples&rft.title=Epidemiology+&+Infection&rft.issn=0950-2688&,+M.+Sharif,+Sh.+Sarvi,+L.+Galal,+J.+Javidnia,+A.+S.+Pagheh,+S.+Gholami,+A.+Mizani,+A.+Daryani&rft_id=info:doi/10.1017/S0950268818002947">Human toxoplasmosis: a systematic review for genetic diversity of
           Toxoplasma gondii in clinical samples
    • Authors: S. A. Hosseini; A. Amouei, M. Sharif, Sh. Sarvi, L. Galal, J. Javidnia, A. S. Pagheh, S. Gholami, A. Mizani, A. Daryani
      Abstract: Toxoplasma gondii (T. gondii) as an obligate intracellular protozoan with a worldwide distribution can infect virtually all warm-blooded animals and humans. This study aims to provide a summary of the available data on genotypes of T. gondii in human. Five databases including MEDLINE in PubMed, Scopus, Science Direct, Web of Science and Google Scholar were searched for the T. gondii genotyping in human during 1995–August 2017. Next, we screened all the articles based on the inclusion and exclusion criteria. Overall, 26 studies were eligible regarding genotyping T. gondii in human samples. In clonal genotyping, 167 out of 286 cases (58%) were infected with type II. Genetic characterisation of T. gondii isolates displayed that type II was the most predominant genotype in human with the prevalence of 64.3%, 62.1% and 41.7% in patients with AIDS, congenital and ocular toxoplasmosis, respectively. In ToxoDB genotyping, most individuals were infected with genotypes #9 and #65 (21.2%). Based on these results, genotype profile of T. gondii isolates is different throughout the world. The strains in Asian and African countries are characterised by low genetic diversity, while in North and South America a wide diversity of this parasite is found. In countries without any data (e.g. Australia, Western and Southern Africa and Western Asia), identification of T. gondii genotypes might discover higher genetic diversity.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268818002947
      Issue No: Vol. 147 (2019)
  • Childhood infections and common carotid intima media thickness in
    • Authors: A. C. Prins-van Ginkel; P. C. J. Bruijning-Verhagen, A. H. Wijga, M. L. Bots, U. Gehring, W. van der Hoek, G. H. Koppelman, L. van Rossem, C. S. P. M. Uiterwaal, H. A. Smit, M. A. B. van der Sande
      Abstract: Atherosclerotic changes can be measured as changes in common carotid intima media thickness (CIMT). It is hypothesised that repeated infection-associated inflammatory responses in childhood contribute to the atherosclerotic process. We set out to determine whether the frequency of infectious diseases in childhood is associated with CIMT in adolescence. The study is part of the Prevention and Incidence of Asthma and Mite Allergy (PIAMA) population-based birth cohort. At age 16 years, common CIMT was measured. We collected general practitioner (GP) diagnosed infections and prescribed antibiotics. Parent-reported infections were retrieved from annual questionnaires. Linear regression analysis assessed the association between number of infections during the first 4 years of life and common CIMT. Common CIMT measurement, GP and questionnaire data were available for 221 participants. No association was observed between the infection measures and CIMT. In a subgroup analysis, significant positive associations with CIMT were observed in participants with low parental education for 2–3 or ⩾7 GP diagnosed infections (+26.4 µm, 95% CI 0.4–52.4 and +26.8 µm, 95% CI 3.6–49.9, respectively) and ⩾3 antibiotic prescriptions (+35.5 µm, 95%CI 15.8–55.3). Overall, early childhood infections were not associated with common CIMT in adolescence. However, a higher number of childhood infections might contribute to the inflammatory process of atherosclerosis in subgroups with low education, this needs to be confirmed in future studies.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S095026881800287X
      Issue No: Vol. 147 (2019)
  • Trends in incidence and mortality of tuberculosis in Japan: a
           population-based study, 1997–2016
    • Authors: H. Hagiya; T. Koyama, Y. Zamami, Y. Minato, Y. Tatebe, N. Mikami, Y. Teratani, A. Ohshima, K. Shinomiya, Y. Kitamura, T. Sendo, S. Hinotsu, K. Tomono, M. R. Kano
      Abstract: Japan is still a medium-burden tuberculosis (TB) country. We aimed to examine trends in newly notified active TB incidence and TB-related mortality in the last two decades in Japan. This is a population-based study using Japanese Vital Statistics and Japan Tuberculosis Surveillance from 1997 to 2016. We determined active TB incidence and mortality rates (per 100 000 population) by sex, age and disease categories. Joinpoint regression was applied to calculate the annual percentage change (APC) in age-adjusted mortality rates and to identify the years showing significant trend changes. Crude and age-adjusted incidence rates reduced from 33.9 to 13.9 and 37.3 to 11.3 per 100 000 population, respectively. Also, crude and age-adjusted mortality rates reduced from 2.2 to 1.5 and 2.8 to 1.0 per 100 000 population, respectively. Average APC in the incidence and mortality rates showed significant decline both in men (−6.2% and −5.4%, respectively) and women (−5.7% and −4.6%, respectively). Age-specific analysis demonstrated decreases in incidence and mortality rates for every age category, except for the incidence trend in the younger population. Although trends in active TB incidence and mortality rates in Japan have favourably decreased, the rate of decline is far from achieving TB elimination by 2035.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S095026881800290X
      Issue No: Vol. 147 (2019)
  • Association between rs12252 and influenza susceptibility and severity: an
           updated meta-analysis
    • Authors: T. Chen; M. Xiao, J. Yang, Y. K. Chen, T. Bai, X. J. Tang, Y. L. Shu
      Abstract: In several lately published studies, the association between single-nucleotide polymorphism (SNP, rs12252) of IFITM3 and the risk of influenza is inconsistent. To further understand the association between the SNP of IFITM3 and the risk of influenza, we searched related studies in five databases including PubMed published earlier than 9 November 2017. Ten sets of data from nine studies were included and data were analysed by Revman 5.0 and Stata 12.0 in our updated meta-analysis, which represented 1365 patients and 5425 no-influenza controls from four different ethnicities. Here strong association between rs12252 and influenza was found in all four genetic models. The significant differences in the allelic model (C vs. T: odds ratio (OR) = 1.35, 95% confidence interval (CI) (1.03–1.79), P = 0.03) and homozygote model (CC vs. TT: OR = 10.63, 95% CI (3.39–33.33), P < 0.00001) in the Caucasian subgroup were discovered, which is very novel and striking. Also novel discoveries were found in the allelic model (C vs. T: OR = 1.37, 95% CI (1.08–1.73), P = 0.009), dominant model (CC + CT vs. TT: OR = 1.48, 95% CI (1.08–2.02), P = 0.01) and homozygote model (CC vs. TT: OR = 2.84, 95% CI (1.36–5.92), P = 0.005) when we compared patients with mild influenza with healthy individuals. Our meta-analysis suggests that single-nucleotide T to C polymorphism of IFITM3 associated with increasingly risk of severe and mild influenza in both Asian and Caucasian populations.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268818002832
      Issue No: Vol. 147 (2019)
  • How differing methods of ascribing ethnicity and socio-economic status
           affect risk estimates for hospitalisation with infectious disease
    • Authors: Mark R. Hobbs; Polly Atatoa Carr, Jacinta Fa'alili-Fidow, Avinesh Pillai, Susan M. B. Morton, Cameron C. Grant
      Abstract: Significant ethnic and socio-economic disparities exist in infectious diseases (IDs) rates in New Zealand, so accurate measures of these characteristics are required. This study compared methods of ascribing ethnicity and socio-economic status. Children in the Growing Up in New Zealand longitudinal cohort were ascribed to self-prioritised, total response and single-combined ethnic groups. Socio-economic status was measured using household income, and both census-derived and survey-derived deprivation indices. Rates of ID hospitalisation were compared using linked administrative data. Self-prioritised ethnicity was simplest to use. Total response accounted for mixed ethnicity and allowed overlap between groups. Single-combined ethnicity required aggregation of small groups to maintain power but offered greater detail. Regardless of the method used, Māori and Pacific children, and children in the most socio-economically deprived households had a greater risk of ID hospitalisation. Risk differences between self-prioritised and total response methods were not significant for Māori and Pacific children but single-combined ethnicity revealed a diversity of risk within these groups. Household income was affected by non-random missing data. The census-derived deprivation index offered a high level of completeness with some risk of multicollinearity and concerns regarding the ecological fallacy. The survey-derived index required extra questions but was acceptable to participants and provided individualised data. Based on these results, the use of single-combined ethnicity and an individualised survey-derived index of deprivation are recommended where sample size and data structure allow it.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268818002935
      Issue No: Vol. 147 (2019)
  • Evolution of incidence and geographical distribution of Chagas disease in
           Mexico during a decade (2007–2016)
    • Authors: G. Ibáñez-Cervantes; G. León-García, G. Castro-Escarpulli, J. Mancilla-Ramírez, G. Victoria-Acosta, M.A. Cureño-Díaz, O. Sosa-Hernández, J.M. Bello-López
      Abstract: Chagas disease, whose aetiological agent is the protozoan Trypanosoma cruzi, mainly occurs in Latin America. In order to know the epidemiology and the geographical distribution of this disease in Mexico, the present work analyses the national surveillance data (10 years) for Chagas disease issued by the General Directorate of Epidemiology (GDE). An ecological analysis of Chagas disease (2007–2016) was performed in the annual reports issued by the GDE in Mexico. The cases and incidence were classified by year, state, age group, gender and seasons. A national distribution map showing Chagas disease incidence was generated. An increase of new cases was identified throughout the country (rates from 0.37 to 0.81 per 100 000 inhabitants). Of the total cases accumulated (7388), the major cases were attributed to the states of Veracruz, Chiapas, Quintana Roo, Oaxaca, Morelos and Yucatán. The analysis per age groups and gender revealed that, in most age groups, the incidence was higher in the male population. The most number of cases was identified in spring and summer; a direct relationship between the environmental temperature increase and the number of new cases was identified. The analysis showed that the rate of Chagas disease increased presumably due to state programmes; the search for new cases has expanded and we speculate that the disease is associated with occupational activities. These results summarise and recall how important it is to implement the monitoring of Chagas disease mainly in south states of the Mexican Republic in order to implement strategies to control this disease.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268818002984
      Issue No: Vol. 147 (2019)
  • Human papillomaviruses 16 and 58 are distributed widely among women living
           in Shanghai, China, with high-grade, squamous intraepithelial lesions
    • Authors: J. Xu; Z. Xia, L. Wang, B. Yang, Y. Zhu, X. Zhu, L. Xu
      Abstract: The distribution of human papillomaviruses (HPVs) must be understood for the control and prevention of cervical cancer. Community-based Papanicolaou and HPV DNA tests were performed on 41 578 women. The prevalences of HPV genotypes 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66 and 68 were assessed. In total, 10% women were infected/co-infected by these HPVs. The infection rate increased from 7.1% in women aged ⩽30 years to 10.4% in those aged 50–60 years, and then decreased slightly to 9.9% in those aged >60 years. The HPV 16 and 58 positivity rates were significantly higher among women with high-grade squamous intraepithelial lesions (HSILs) than among those with cervicitis/negativity for intraepithelial lesion or malignancy (NILM) or low-grade SILs (LSILs). The HPV 18, 52 and 68 infection rates were significantly lower in women with HSILs than in those with NILM or LSILs. The proportion of women infected by multiple HPV strains was higher among those with HSILs. The proportions of the five most common genotypes, HPV 16, 18, 33, 52 and 58, increased with the number of co-infecting strains. HPV 16 and 58 were the high-risk HPVs in the Shanghai community and should be the focus in HPV screening and vaccination.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268818003011
      Issue No: Vol. 147 (2019)
  • Salmonella+infections+in+Norway:+epidemiology+of+salmonellosis,+2000–2015,+and+results+of+a+national+prospective+case–control+study,+2010–2012&rft.title=Epidemiology+&+Infection&rft.issn=0950-2688&,+R.+Mexia,+T.+Bruun,+G.+Kapperud,+L.+T.+Brandal,+H.+Lange,+K.+Nygård,+L.+Vold&rft_id=info:doi/10.1017/S0950268818002911">The role of domestic reservoirs in domestically acquired Salmonella
           infections in Norway: epidemiology of salmonellosis, 2000–2015, and
           results of a national prospective case–control study, 2010–2012
    • Authors: E. MacDonald; R. White, R. Mexia, T. Bruun, G. Kapperud, L. T. Brandal, H. Lange, K. Nygård, L. Vold
      Abstract: In Norway, incidence of sporadic domestically acquired salmonellosis is low, and most frequently due to Salmonalla Typhimurium. We investigated the risk factors for sporadic Salmonella infections in Norway to improve control and prevention measures. Surveillance data for all Salmonella infections from 2000 to 2015 were analysed for seasonality and proportion associated with domestic reservoirs, hedgehogs and wild birds. A prospective case–control study was conducted from 2010 to 2012 by recruiting cases from the Norwegian Surveillance System for Communicable Diseases and controls from the Norwegian Population Registry (389 cases and 1500 controls). Univariable analyses using logistic regression were conducted and a multivariable model was developed using regularised/penalised logistic regression. In univariable analysis, eating snow, dirt, sand or playing in a sandbox (aOR 4.14; CI 2.15–7.97) was associated with salmonellosis. This was also the only exposure significantly associated with illness in the multivariable model. Since 2004, 34.2% (n = 354) of S. Typhimuirum cases had an MLVA profile linked to a domestic reservoir. A seasonal trend with a peak in August for all Salmonella types and in February for S. Typhimurium was observed. Indirect exposure to domestic reservoirs remains a source of salmonellosis in Norway, particularly for children. Information to the public about avoiding environmental exposure should be strengthened and initiatives to combat salmonellosis in the food chain should be reinforced.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268818002911
      Issue No: Vol. 147 (2019)
  • Diarrhoea, enteric pathogen detection and nutritional indicators among
           controls in the Global Enteric Multicenter Study, Kenya site: an
           opportunity to understand reference populations in case–control studies
           of diarrhoea
    • Authors: D. M. Berendes; C. E. O'Reilly, S. Kim, R. Omore, J. B. Ochieng, T. Ayers, K. Fagerli, T. H. Farag, D. Nasrin, S. Panchalingam, J. P. Nataro, K. L. Kotloff, M. M. Levine, J. Oundo, K. Laserson, R. F. Breiman, E. D. Mintz
      Abstract: Given the challenges in accurately identifying unexposed controls in case–control studies of diarrhoea, we examined diarrhoea incidence, subclinical enteric infections and growth stunting within a reference population in the Global Enteric Multicenter Study, Kenya site. Within ‘control’ children (0–59 months old without diarrhoea in the 7 days before enrolment, n = 2384), we examined surveys at enrolment and 60-day follow-up, stool at enrolment and a 14-day post-enrolment memory aid for diarrhoea incidence. At enrolment, 19% of controls had ⩾1 enteric pathogen associated with moderate-to-severe diarrhoea (‘MSD pathogens’) in stool; following enrolment, many reported diarrhoea (27% in 7 days, 39% in 14 days). Controls with and without reported diarrhoea had similar carriage of MSD pathogens at enrolment; however, controls reporting diarrhoea were more likely to report visiting a health facility for diarrhoea (27% vs. 7%) or fever (23% vs. 16%) at follow-up than controls without diarrhoea. Odds of stunting differed by both MSD and ‘any’ (including non-MSD pathogens) enteric pathogen carriage, but not diarrhoea, suggesting control classification may warrant modification when assessing long-term outcomes. High diarrhoea incidence following enrolment and prevalent carriage of enteric pathogens have implications for sequelae associated with subclinical enteric infections and for design and interpretation of case–control studies examining diarrhoea.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268818002972
      Issue No: Vol. 147 (2019)
  • et+al.+in+response+to+Imported+leishmaniasis+in+Sweden+1993–2016&rft.title=Epidemiology+&+Infection&rft.issn=0950-2688&öbirk&rft.aufirst=S.&öbirk&,+M.+Collin,+L.+Davidsson&rft_id=info:doi/10.1017/S0950268818002959">Comments on letter to the editor by Faniyan et al. in response to Imported
           leishmaniasis in Sweden 1993–2016
    • Authors: S. K. Söbirk; M. Inghammar, M. Collin, L. Davidsson
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268818002959
      Issue No: Vol. 147 (2019)
  • Staphylococcus+aureus+at+a+tertiary+hospital+in+China+before+and+after+introduction+of+an+antimicrobial+stewardship+programme&rft.title=Epidemiology+&+Infection&rft.issn=0950-2688&,+Taotao+Wang,+Haiyan+Dong,+Weiyi+Feng,+Chen+Ma,+Yalin+Dong&rft_id=info:doi/10.1017/S0950268818003059">Trends in and correlations between antibiotic consumption and resistance
           of Staphylococcus aureus at a tertiary hospital in China before and after
           introduction of an antimicrobial stewardship programme
    • Authors: Di Zhang; Kai Cui, Taotao Wang, Haiyan Dong, Weiyi Feng, Chen Ma, Yalin Dong
      Abstract: The overuse of antibiotics and the rapid emergence of antibiotic resistance prompted the launch of an antimicrobial stewardship programme in 2011. This study aimed to investigate the trends and correlations between antibiotic consumption and resistance of Staphylococcus aureus in a tertiary hospital of northwest China from 2010 to 2016. Trends were analysed by linear regression, and correlations were assessed by an autoregressive integrated moving average model. The total consumption of antibiotics halved during the 7-year study period, while the rates of resistance of S. aureus decreased significantly or remained stable; methicillin-resistant S. aureus (MRSA) declined markedly, from 73.3% at the beginning of the study to 41.4% by the end. This latter decrease was significantly correlated with the consumption of several classes of antibiotics. In conclusion, reduction in antibiotic use impacted significantly on resistance rates and contributed to a decline in MRSA prevalence.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268818003059
      Issue No: Vol. 147 (2019)
  • Epidemiological survey and sequence information analysis of swine
           hepatitis E virus in Sichuan, China
    • Authors: Y. Y. Li; Z. W. Xu, X. J. Li, S. Y. Gong, Y. Cai, Y. Q. Chen, Y. M. Li, Y. F. Xu, X. G. Sun, L. Zhu
      Abstract: Hepatitis E is an important zoonosis that is prevalent in China. Hepatitis E virus (HEV) is a pathogen that affects humans and animals and endangers public health in China. In this study, the detection of HEV epidemics in swine in Sichuan Province, China, was carried out by nested real-time PCR. A total of 174 stool samples and 160 bile samples from swine in Sichuan Province were examined. In addition, software was used to analyse the biological evolution of HEV. The results showed that within 2 years of swine HEV (SHEV) infection in China, SHEV was first detected in Sichuan Province. HEV was endemic in Sichuan; the positive rate for pig farms was 11.1%, and the total positive sample rate was 10.5%. The age of swine with the highest positive rate (17.9%) was 5–9 weeks. The examined swine species in order of highest to lowest HEV infection rates were Chenghua pig, Large White, Duroc, Pietrain, Landrace and Hampshire. Nucleotide and amino acid sequence analysis showed that the HEV epidemic in swine in Sichuan Province was related to genotype IV, which had the highest homology to HEV in Beijing. Sichuan strains have greater variation than Chinese representative strains, which may indicate the presence of new HEV strains.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268818002893
      Issue No: Vol. 147 (2019)
  • Meteorological factors and its association with hand, foot and mouth
           disease in Southeast and East Asia areas: a meta-analysis
    • Authors: Chunxiao Duan; Xuefeng Zhang, Hui Jin, Xiaoqing Cheng, Donglei Wang, Cangjun Bao, Minghao Zhou, Tauseef Ahmad, Jie Min
      Abstract: Since the late 1990s, hand, foot and mouth disease (HFMD) has become a common health problem that mostly affects children and infants in Southeast and East Asia. Global climate change is considered to be one of the major risk factors for HFMD. This study aimed to assess the correlation between meteorological factors and HFMD in the Asia-Pacific region. PubMed, Web of Science, Embase, China National Knowledge Infrastructure, Wanfang Data and Weipu Database were searched to identify relevant articles published before May 2018. Data were collected and analysed using R software. We searched 2397 articles and identified 51 eligible papers in this study. The present study included eight meteorological factors; mean temperature, mean highest temperature, mean lowest temperature, rainfall, relative humidity and hours of sunshine were positively correlated with HFMD, with correlation coefficients (CORs) of 0.52 (95% confidence interval (CI) 0.42–0.60), 0.43 (95% CI 0.23–0.59), 0.43 (95% CI 0.23–0.60), 0.27 (95% CI 0.19–0.35), 0.19 (95% CI 0.02–0.35) and 0.19 (95% CI 0.11–0.27), respectively. There were sufficient data to support a negative correlation between mean pressure and HFMD (COR = −0.51, 95% CI −0.63 to −0.36). There was no notable correlation with wind speed (COR = 0.10, 95% CI −0.03 to 0.23). Our findings suggest that meteorological factors affect the incidence of HFMD to a certain extent.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268818003035
      Issue No: Vol. 147 (2019)
  • Geospatial cluster analyses of pneumonia-associated hospitalisations among
           adults in New York City, 2010–2014
    • Authors: P. A. Kache; T. Julien, R. E. Corrado, N. M. Vora, D. C. Daskalakis, J. K. Varma, D. E. Lucero
      Abstract: Pneumonia is a leading cause of death in New York City (NYC). We identified spatial clusters of pneumonia-associated hospitalisation for persons residing in NYC, aged ⩾18 years during 2010–2014. We detected pneumonia-associated hospitalisations using an all-payer inpatient dataset. Using geostatistical semivariogram modelling, local Moran's I cluster analyses and χ2 tests, we characterised differences between ‘hot spots’ and ‘cold spots’ for pneumonia-associated hospitalisations. During 2010–2014, there were 141 730 pneumonia-associated hospitalisations across 188 NYC neighbourhoods, of which 43.5% (N = 61 712) were sub-classified as severe. Hot spots of pneumonia-associated hospitalisation spanned 26 neighbourhoods in the Bronx, Manhattan and Staten Island, whereas cold spots were found in lower Manhattan and northeastern Queens. We identified hot spots of severe pneumonia-associated hospitalisation in the northern Bronx and the northern tip of Staten Island. For severe pneumonia-associated hospitalisations, hot-spot patients were of lower mean age and a greater proportion identified as non-Hispanic Black compared with cold spot patients; additionally, hot-spot patients had a longer hospital stay and a greater proportion experienced in-hospital death compared with cold-spot patients. Pneumonia prevention efforts within NYC should consider examining the reasons for higher rates in hot-spot neighbourhoods, and focus interventions towards the Bronx, northern Manhattan and Staten Island.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268818003060
      Issue No: Vol. 147 (2019)
  • Aedes+aegypti+and+Culex+quinquefasciatus:+a+scenario+of+Zika+virus+exposure&rft.title=Epidemiology+&+Infection&rft.issn=0950-2688&,+Antonella+Bacigalupo,+Pedro+E.+Cattan&rft_id=info:doi/10.1017/S0950268818003102">Global spatial assessment of Aedes aegypti and Culex quinquefasciatus: a
           scenario of Zika virus exposure
    • Authors: Alberto J. Alaniz; Mario A. Carvajal, Antonella Bacigalupo, Pedro E. Cattan
      Abstract: Zika virus (ZIKV) is an arbovirus transmitted mainly by Aedes aegypti mosquitoes. Recent scientific evidence on Culex quinquefasciatus has suggested its potential as a vector for ZIKV, which may change the current risk zones. We aimed to quantify the world population potentially exposed to ZIKV in a spatially explicit way, considering the primary vector (A. aegypti) and the potential vector (C. quinquefasciatus). Our model combined species distribution modelling of mosquito species with spatially explicit human population data to estimate ZIKV exposure risk. We estimated the potential global distribution of C. quinquefasciatus and estimated its potential interaction zones with A. aegypti. Then we evaluated the risk zones for ZIKV considering both vectors. Finally, we quantified and compared the people under risk associated with each vector by risk level, country and continent. We found that C. quinquefasciatus had a more temperate distribution until 42° in both hemispheres, while the risk involving A. aegypti is concentrated mainly in tropical latitudes until 35° in both hemispheres. Globally, 4.2 billion people are under risk associated with ZIKV. Around 2.6 billon people are under very high risk associated with C. quinquefasciatus and 1 billion people associated with A. aegypti. Several countries could be exposed to ZIKV, which emphasises the need to clarify the competence of C. quinquefasciatus as a potential vector as soon as possible. The models presented here represent a tool for risk management, public health planning, mosquito control and preventive actions, especially to focus efforts on the most affected areas.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268818003102
      Issue No: Vol. 147 (2019)
  • Waterborne outbreak of gastroenteritis on the KwaZulu-Natal Coast, South
           Africa, December 2016/January 2017 – CORRIGENDUM
    • Authors: P. G. Sekwadi; K. G. Ravhuhali, A. Mosam, V. Essel, G. M. Ntshoe, A. M. Shonhiwa, K. McCarthy, J. Mans, M. B. Taylor, N. A. Page, N. Govender
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268818003084
      Issue No: Vol. 147 (2019)
  • Sexual risk behaviour in a cohort of HIV-negative and HIV-positive Rwandan
    • Authors: M. F. Mukanyangezi; O. Manzi, G. Tobin, S. Rulisa, E. Bienvenu, D. Giglio
      Abstract: Here we wanted to assess whether sexual risk behaviour differs dependent by human immunodeficiency virus (HIV) status by following 100 HIV− and 137 HIV+ women recruited at two university teaching hospitals in Rwanda. Women were tested for sexually transmitted infections (STIs; trichomoniasis, syphilis, hepatitis B and C) and for reproductive tract infections (RTIs; candidiasis, bacterial vaginosis (BV)) and were interviewed at baseline and 9 months later. BV was the most prevalent infection, while syphilis was the most common STI with a 9-month incidence of 10.9% in HIV+ women. Only 24.5% of women positive for any RTI/STI contacted their health facility and got treatment. More HIV− women than HIV+ women had had more than one sexual partner and never used condoms during the follow-up period. The use of condoms was affected neither by marital status nor by concomitant STIs besides HIV. Our data highlight the importance of public education regarding condom use to protect against STIs in an era when HIV no longer is a death sentence.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268818003023
      Issue No: Vol. 147 (2019)
  • Escherichia+coli+sequence+type+131+or+its+H30+subclone+among+US+Veterans+with+a+clinical+E.+coli+isolate&rft.title=Epidemiology+&+Infection&rft.issn=0950-2688&,+Stephen+Porter,+James+R.+Johnson&rft_id=info:doi/10.1017/S0950268818003114">Self-reported risk factors for having Escherichia coli sequence type 131
           or its H30 subclone among US Veterans with a clinical E. coli isolate
    • Authors: Amee R. Manges; Paul Thuras, Stephen Porter, James R. Johnson
      Abstract: Among 469 US military veterans with an Escherichia coli clinical isolate (2012–2013), we explored healthcare and non-healthcare risk factors for having E. coli sequence type 131 and its H30 subclone (ST131-H30). Overall, 66 (14%) isolates were ST131; 51 (77%) of these were ST131-H30. After adjustment for healthcare-associated factors, ST131 remained positively associated with medical lines and nursing home residence. After adjustment for environmental factors, ST131 remained associated with wild animal contact (positive), meat consumption (negative) and pet cat exposure (negative). Thus, ST131 was associated predominantly with healthcare-associated exposures, while non-ST131 E. coli were associated with some environmental exposures.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268818003114
      Issue No: Vol. 147 (2019)
  • Cryptosporidium+outbreak+in+Hungary,+linked+to+a+treated+recreational+water+venue+in+2015&rft.title=Epidemiology+&+Infection&rft.issn=0950-2688&,+E.+Varga,+I.+Kucsera,+G.+Reusz,+A.+J.+Szabó,+Á.+Fehér,+R.+M.+Chalmers&rft_id=info:doi/10.1017/S0950268818003138">First Cryptosporidium outbreak in Hungary, linked to a treated
           recreational water venue in 2015
    • Authors: J. Plutzer; K. Kelen, E. Varga, I. Kucsera, G. Reusz, A. J. Szabó, Á. Fehér, R. M. Chalmers
      Abstract: In June 2015, an outbreak of cryptosporidiosis with 35 cases (23 probable and 12 laboratory-confirmed) occurred among 191 attendees of a residential rehabilitation holiday for paediatric organ transplant patients (n = 49) and their families at a hotel in Somogy county, Hungary. The overall attack rate was 18%. Most of the cases were transplanted children who experienced severe acute disease and required adjustment to their tacrolimus immunosuppression. A retrospective case-control study suggested an association between recreational water exposures and illness: cases were seven times more likely than controls to have swum in the children's pool (odds ratio 7.17; 95% confidence interval 2.9–17.2; P < 0.0001) and five times more likely to have used the jetted whirlpool (odds ratio 5.25; 95% confidence interval 2.1–13.1; P < 0.0001). This was the first outbreak of cryptosporidiosis in Hungary and it is especially unfortunate that it affected vulnerable children who experienced severe symptoms. Cryptosporidium presents specific infection control difficulties in treated recreational water venues; the link to a whirlpool is unusual and highlights the importance of the age-appropriate use of these facilities and reminding users not to immerse their heads or swallow the water. Cryptosporidiosis is more commonly linked to children’ pools where improved bather hygiene and promoting exclusion of diarrhoea cases could help to avoid similar outbreaks.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268818003138
      Issue No: Vol. 147 (2019)
  • An outbreak of norovirus infection caused by ice cubes and a leaking air
           ventilation valve
    • Authors: K. Jalava; A. Kauppinen, H. Al-Hello, S. Räsänen
      Abstract: A gastrointestinal outbreak was reported among 154 diners who attended a Christmas buffet on the 9 and 10 December 2016. A retrospective cohort study was undertaken. Faecal samples, water, ice and an air ventilation device were tested for indicators and routine pathogens. Altogether 26% (24/91) fulfilled the case definition of having typical viral gastrointestinal symptoms. Norovirus genogroup I was detected in faecal samples from three cases. One of these cases tested positive also for sapovirus and had a family member testing positive for both norovirus and sapovirus. A diner who drank water or drinks with ice cubes (risk ratios (RR) 6.5, 95% confidence intervals (CI) 1.5–113.0) or both (RR 8.2, 95% CI 1.7–145.5) had an increased risk in a dose-response manner. Ice cubes from three vending machines had high levels of heterotrophic bacteria. A faulty air ventilation valve in the space where the ice cube machine was located was considered a likely cause of this outbreak. Leaking air ventilation valves may represent a neglected route of transmission in viral gastrointestinal outbreaks.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S095026881800314X
      Issue No: Vol. 147 (2019)
  • Ureaplasma+urealyticum,+Chlamydia+trachomatis,+Neisseria+gonorrhoeae+and+herpes+simplex+virus+in+Beijing,+China&rft.title=Epidemiology+&+Infection&rft.issn=0950-2688&,+Z.+J.+Li,+X.+Jin,+Y.+Chen,+S.+P.+Chen&rft_id=info:doi/10.1017/S0950268818003163">Prevalence of Ureaplasma urealyticum, Chlamydia trachomatis, Neisseria
           gonorrhoeae and herpes simplex virus in Beijing, China
    • Authors: Y. Y. Liang; H. Y. Zhai, Z. J. Li, X. Jin, Y. Chen, S. P. Chen
      Abstract: The prevalence of sexually transmitted infection (STI) pathogens in Beijing, China, is rarely reported. In this study, 34 911 symptomatic outpatients with suspected genital infections who attended outpatient clinics in a tertiary care hospital were included to investigate the updated prevalence of Ureaplasma urealyticum (UU), Chlamydia trachomatis (CT), Neisseria gonorrhoeae (NG) and herpes simplex virus (HSV) from 1 January 2013 to 31 December 2016 in Beijing, China. Results indicated that a decrease trend (UU, CT, NG and HSV) in male and an increase trend (UU, CT and NG) in female were observed during the period. Patients aged 20–39 years old were mostly affected by these pathogens, while the prevalence in patients aged 20–29 years old was the highest, The prevalence of UU in male was significantly lower than in female (31.5% vs. 49.3%, P < 0.05), while the prevalence of NG in male was significantly higher than in female (2.5% vs. 0.8%, P < 0.05). In patients with co-infections, 60.6% of male and 71.4% of female were co-infected by UU + CT. In total, 11.9% and 88.1% of patients with HSV infections were confirmed to be infected by HSV-1 and HSV-2. This study could contribute to a better understanding of the current epidemiological features of UU, NG, CT and HSV among symptomatic patients attending an outpatient clinic in Beijing, China, and thus facilitate to develop more effective intervention, prevention and treatment of STI.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268818003163
      Issue No: Vol. 147 (2019)
  • Dynamic transmission model of routine mumps vaccination in Japan
    • Authors: Taito Kitano
      Abstract: The mumps vaccine is not included in the national immunisation programme (NIP) of approximately 80 countries including Japan. To investigate the vaccine's cost-effectiveness, we developed a dynamic transmission model for routine one- and two-dose mumps vaccination programs in Japan. We calculated the incremental cost-effectiveness ratio compared with a current programme over a projected 50-year period. We created a Japanese population model and performed dynamic simulation to estimate the number of patients enrolled in the current programme, the routine one-dose programme, and the routine two-dose programme over the next 50 years using the Berkeley Madonna program. We estimated the medical and social costs of natural mumps infections and vaccinations to analyse cost-effectiveness. Finally, we performed a sensitivity analysis with parameters including vaccine cost, vaccine efficacy, medical costs per case, social costs per case, incidence of adverse events and discount rate. Base case analysis showed that both the one-dose and two-dose programmes predominated and that quality-adjusted life years (QALYs) were saved, compared with the current programme. The medical costs, total cost and QALYs saved during the study period in the two-dose programme compared with the current programme were 217 billion JPY, 860 billion JPY and 184 779, respectively. The two-dose programme surpassed the one-dose programme throughout the study period. In all the scenarios of the sensitivity analysis, two-dose vaccination was better than the one-dose programme. This simulation confirmed that the routine two-dose vaccination programme was more cost-effective and QALY-saving than either the one-dose programme or the current programme. Because of the variability of the results between the various models, further simulations with different models should be conducted.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268818003230
      Issue No: Vol. 147 (2019)
  • The association between seasonal influenza-like illness cases and foetal
           death: a time series analysis
    • Authors: I. S. Rasmussen; L. H. Mortensen, T. G. Krause, A-M. Nybo Andersen
      Abstract: It has been reported that foetal death follows a seasonal pattern. Influenza virus infection has been postulated as one possible contributor to this seasonal variation. This ecological study explored the temporal association between the influenza activity and the frequency of foetal death. Time series analysis was conducted using weekly influenza-like illness consultation proportions from the Danish sentinel surveillance system and weekly proportions of spontaneous abortions and stillbirths from hospital registers from 1994 to 2009. The association was examined in an autoregressive (AR) integrated (I) moving average (MA) model and subsequently analysed with cross-correlation functions. Our findings confirmed the well-known seasonality in influenza, but also seasonality in spontaneous abortion. No clear pattern of seasonality was found for stillbirths, although the analysis exposed dependency between observations. One final AR integrated MA model was identified for the influenza-like illness (ILI) series. We found no statistically significant relationship between weekly influenza-like illness consultation proportions and weekly spontaneous abortion proportions (five lags: P = 0.52; 11 lags: P = 0.91) or weekly stillbirths (five lags: P = 0.93; 11 lags: P = 0.40). Exposure to circulating influenza during pregnancy was not associated with rates of spontaneous abortions or stillbirths. Seasonal variations in spontaneous abortion were confirmed and this phenomenon needs further investigation.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268818003254
      Issue No: Vol. 147 (2019)
  • Travel-associated Legionnaires’ disease: would changing cluster
           definition lead to the prevention of a larger number of cases'
    • Authors: M. C. Rota; A. Bella, M. G. Caporali, A. Nicolau, V. Drasar, M. L. Ricci, M. Scaturro, M. Gumá, S. Crespi
      Abstract: According to European Guidelines for Legionnaires’ Disease prevention and control, travel-associated Legionnaires’ disease (TALD) cases are managed differently if classified as sporadic or as part of a cluster and more stringent control measures are deployed after clusters are identified. In this study, we propose to modify the current cluster definition: ‘two or more cases of Legionnaires’ disease (LD) who stayed at, or visited, the same commercial accommodation site 2–10 days before onset of illness and whose onset is within the same 2-year period’ with a new cluster definition, i.e. accommodation sites associated with multiple cases regardless of the time elapsed between them. TALD cases occurred in Italy and in the Balearic Islands between 2005 and 2015 were analysed applying the current European Legionnaires’ Disease Surveillance Network (ELDSNet) cluster definition. In a sample of selected accommodation sites with multiple cases, a microbiological study was also conducted. Using the new definition, 63 additional sites (16.4% increase) and 225 additional linked cases (19.5% increase) were identified. Legionella pneumophila sg1 was isolated from 90.7% of the selected accommodation sites. The use of the here proposed TALD cluster definition would warrant a full investigation for each new identified case. This approach should therefore increase the number of sites that will require a risk assessment and, in the presence of an increased risk, the adoption of LD control measures to hopefully prevent additional cases.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268818003266
      Issue No: Vol. 147 (2019)
  • Active and passive surveillance for bat lyssaviruses in Italy revealed
           serological evidence for their circulation in three bat species
    • Authors: S. Leopardi; P. Priori, B. Zecchin, G. Poglayen, K. Trevisiol, D. Lelli, S. Zoppi, M. T. Scicluna, N. D'Avino, E. Schiavon, H. Bourhy, J. Serra-Cobo, F. Mutinelli, D. Scaravelli, P. De Benedictis
      Abstract: The wide geographical distribution and genetic diversity of bat-associated lyssaviruses (LYSVs) across Europe suggest that similar viruses may also be harboured in Italian insectivorous bats. Indeed, bats were first included within the passive national surveillance programme for rabies in wildlife in the 1980s, while active surveillance has been performed since 2008. The active surveillance strategies implemented allowed us to detect neutralizing antibodies directed towards European bat 1 lyssavirus in six out of the nine maternity colonies object of the study across the whole country. Seropositive bats were Myotis myotis, M. blythii and Tadarida teniotis. On the contrary, the virus was neither detected through passive nor active surveillance, suggesting that fatal neurological infection is rare also in seropositive colonies. Although the number of tested samples has steadily increased in recent years, submission turned out to be rather sporadic and did not include carcasses from bat species that account for the majority of LYSVs cases in Europe, such as Eptesicus serotinus, M. daubentonii, M. dasycneme and M. nattereri. A closer collaboration with bat handlers is therefore mandatory to improve passive surveillance and decrypt the significance of serological data obtained up to now.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268818003072
      Issue No: Vol. 147 (2019)
  • Post-exposure prophylaxis vaccination rate and risk factors of human
           rabies in mainland China: a meta-analysis
    • Authors: D. L. Wang; X. F. Zhang, H. Jin, X. Q. Cheng, C. X. Duan, X. C. Wang, C. J. Bao, M. H. Zhou, T. Ahmad
      Abstract: Rabies is one of the major public health problems in China, and the mortality rate of rabies remains the highest among all notifiable infectious diseases. A meta-analysis was conducted to investigate the post-exposure prophylaxis (PEP) vaccination rate and risk factors for human rabies in mainland China. The PubMed, Web of Science, Chinese National Knowledge Infrastructure, Chinese Science and Technology Periodical and Wanfang databases were searched for articles on rabies vaccination status (published between 2007 and 2017). In total, 10 174 human rabies cases from 136 studies were included in this meta-analysis. Approximately 97.2% (95% confidence interval (CI) 95.1–98.7%) of rabies cases occurred in rural areas and 72.6% (95% CI 70.0–75.1%) occurred in farmers. Overall, the vaccination rate in the reported human rabies cases was 15.4% (95% CI 13.7–17.4%). However, among vaccinated individuals, 85.5% (95% CI 79.8%–83.4%) did not complete the vaccination regimen. In a subgroup analysis, the PEP vaccination rate in the eastern region (18.8%, 95% CI 15.9–22.1%) was higher than that in the western region (13.3%, 95% CI 11.1–15.8%) and this rate decreased after 2007. Approximately 68.9% (95% CI 63.6–73.8%) of rabies cases experienced category-III exposures, but their PEP vaccination rate was 27.0% (95% CI 14.4–44.9%) and only 6.1% (95% CI 4.4–8.4%) received rabies immunoglobulin. Together, these results suggested that the PEP vaccination rate among human rabies cases was low in mainland China. Therefore, standardised treatment and vaccination programs of dog bites need to be further strengthened, particularly in rural areas.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268818003175
      Issue No: Vol. 147 (2019)
  • La Crosse virus: a scoping review of the global evidence
    • Authors: S. Harding; J. Greig, M. Mascarenhas, I. Young, L. A. Waddell
      Abstract: Urbanisation and climate change are altering the pattern of California serogroup viruses in North America. As La Crosse virus (LACV) is the most pathogenic of the California serogroup, it is important to identify changes in distribution, transmission and pathogenesis. A scoping review (ScR) was prioritised to summarise the global evidence on LACV. A comprehensive search strategy was used, identified references were screened for relevance and relevant articles were characterised. Each step was conducted by two independent reviewers using pre-tested forms. Analysis identified areas of research saturation and gaps. The ScR included 481 research articles that were mostly journal articles (78.2%) conducted in North America (90.9%) from 1969 to 2016. Most evidence focused on epidemiology (44.9%), virus characteristics (25.8%), transmission conditions (18.7%) and pathogenesis of LACV in hosts (18.3%). Fewer studies evaluated the accuracy of diagnostic tests (8.7%), the efficacy of treatments (3.5%), prevention and control strategies (3.1%), the economic burden of infection (0.6%) and social impact (0.2%) of LACV. None of the literature predicted the impact of climate change on LACV, nor were any cases reported in Canada. These findings are intended to guide research to close knowledge gaps and inform evidence-based decisions surrounding activities for the prevention and control of LACV.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268818003096
      Issue No: Vol. 147 (2019)
  • Deviating from IDSA treatment guidelines for non-purulent skin infections
           increases the risk of treatment failure in emergency department patients
    • Authors: J. P. Haran; E. Wilsterman, T. Zeoli, M. Goulding, E. McLendon, M. A. Clark
      Abstract: The Infectious Disease Society of America (IDSA) publishes guidelines regularly for the management of skin and soft tissue infections; however, the extent to which practice patterns follow these guidelines and if this can affect treatment failure rates is unknown. We observed the treatment failure rates from a multicentre retrospective ambulatory cohort of adult emergency department patients treated for a non-purulent skin infection. We used multivariable logistic regression to examine the role of IDSA classification and whether adherence to IDSA guidelines reduced treatment failure. A total of 759 ambulatory patients were included in the cohort with 17.4% failing treatment. Among all patients, 56.0% had received treatments matched to the IDSA guidelines with 29.1% over-treated, and 14.9% under-treated based on the guidelines. After adjustment for age, gender, infection location and medical comorbidities, patients with a moderate infection type had three times increased risk of treatment failure (adjusted risk ratio (aRR) 2.98; 95% confidence interval (CI) 1.15–7.74) and two times increased risk with a severe infection type (aRR 2.27; 95% CI 1.25–4.13) compared with mild infection types. Patients who were under-treated based on IDSA guidelines were over two times more likely to fail treatment (aRR 2.65; 95% CI 1.16–6.05) while over-treatment was not associated with treatment failure. Patients ⩾70 years of age had a 56% increased risk of treatment failure (aRR 1.56; 95% CI 1.04–2.33) compared with those
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S0950268818003291
      Issue No: Vol. 147 (2019)
  • Salmonella+in+ground+turkey&rft.title=Epidemiology+&+Infection&rft.issn=0950-2688&,+J.+B.+Bender,+C.+W.+Hedberg&rft_id=info:doi/10.1017/S095026881800328X">Developing a risk management framework to improve public health outcomes
           by enumerating Salmonella in ground turkey
    • Authors: F. Sampedro; S. J. Wells, J. B. Bender, C. W. Hedberg
      Abstract: Salmonella spp. continue to be a leading cause of foodborne morbidity worldwide. To assess the risk of foodborne disease, current national regulatory schemes focus on prevalence estimates of Salmonella and other pathogens. The role of pathogen quantification as a risk management measure and its impact on public health is not well understood. To address this information gap, a quantitative risk assessment model was developed to evaluate the impact of pathogen enumeration strategies on public health after consumption of contaminated ground turkey in the USA. Public health impact was evaluated by using several dose–response models for high- and low-virulent strains to account for potential under- or overestimation of human health impacts. The model predicted 2705–21 099 illnesses that would result in 93–727 reported cases of salmonellosis. Sensitivity analysis predicted cooking an unthawed product at home as the riskiest consumption scenario and microbial concentration the most influential input on the incidence of human illnesses. Model results indicated that removing ground turkey lots exceeding contamination levels of 1 MPN/g and 1 MPN in 25 g would decrease the median number of illnesses by 86–94% and 99%, respectively. For a single production lot, contamination levels higher than 1 MPN/g would be needed to result in a reported case to public health officials. At contamination levels of 10 MPN/g, there would be a 13% chance of detecting an outbreak, and at 100 MPN/g, the likelihood of detecting an outbreak increases to 41%. Based on these model prediction results, risk management strategies should incorporate pathogen enumeration. This would have a direct impact on illness incidence linking public health outcomes with measurable food safety objectives.
      PubDate: 2019-01-01T00:00:00.000Z
      DOI: 10.1017/S095026881800328X
      Issue No: Vol. 147 (2019)
School of Mathematical and Computer Sciences
Heriot-Watt University
Edinburgh, EH14 4AS, UK
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Fax: +00 44 (0)131 4513327
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