Influenza-associated severe acute respiratory infections (SARI) are a major contributor to global morbidity and mortality. In response to a cluster of SARI cases and deaths in pregnant women, with ...two deceased cases testing positive for influenza A(H1N1)pdm09, an investigation was initiated to determine whether there was an increase of paediatric SARI cases admitted to divisional hospital intensive care units in Fiji in may 2016 compared to May 2013-2015.
Retrospective case finding was conducted at the paediatric intensive care units (PICUs) in Fiji's three divisional hospitals. Data were collected from 1 January 2013 to 26 May 2016. Cases were identified using a list of clinical diagnoses compatible with SARI.
A total of 632 cases of paediatric SARI with complete details were identified. The median age of cases was 6 months (Interquartile range: 2-14 months). Children aged less than 5 years had a higher rate of paediatric SARI requiring admission to a divisional hospital PICU in May 2016 compared to May 2013-2015 (Incidence rate ratio: 1.7 95% CI: 1.1-2.6). This increase was not observed in children aged 5-14 years. The case-fatality ratio was not significantly different in 2016 compared to previous years.
The investigation enabled targeted public health response measures, including enhanced SARI surveillance at divisional hospitals and an emergency influenza vaccination campaign in the Northern Division.
The World Health Organization considers an Ebola outbreak to have ended once 42 days have passed since the last possible exposure to a confirmed case. Benefits of a quick end-of-outbreak declaration, ...such as reductions in trade/travel restrictions, must be balanced against the chance of flare-ups from undetected residual cases. We show how epidemiological modelling can be used to estimate the surveillance level required for decision-makers to be confident that an outbreak is over. Results from a simple model characterizing an Ebola outbreak suggest that a surveillance sensitivity (i.e. case reporting percentage) of 79% is necessary for 95% confidence that an outbreak is over after 42 days without symptomatic cases. With weaker surveillance, unrecognized transmission may still occur: if the surveillance sensitivity is only 40%, then 62 days must be waited for 95% certainty. By quantifying the certainty in end-of-outbreak declarations, public health decision-makers can plan and communicate more effectively.
This article is part of the theme issue 'Modelling infectious disease outbreaks in humans, animals and plants: epidemic forecasting and control'. This issue is linked with the earlier theme issue 'Modelling infectious disease outbreaks in humans, animals and plants: approaches and important themes'.
We compared the characteristics of a cultured human "Helicobacter heilmannii" isolate with those of other helicobacters found in animals. Phenotypic, protein profile, 16S rDNA sequence, and DNA-DNA ...hybridization analyses identified the human strain as H. bizzozeronii, a species frequently found in dogs. Thus, H. bizzozeronii may have zoonotic potential.
'Gastrospirillum suis' is an uncultured, tightly spiral micro-organism that has been associated with ulcer disease in the stomachs of pigs. It was the purpose of this study to determine the ...phylogenetic position of 'G. suis'. Stomachs of five slaughterhouse pigs, originating from different Belgian and Dutch farms, were selected on the basis of the presence of 'G. suis'-like bacteria, as demonstrated by biochemical, immunohistochemical and electron microscopical data. Bacterial 16S rDNA was amplified by PCR using broad-range primers and five helicobacter-like sequences were determined either by direct or indirect sequence analysis. An inter-sequence homology of 99.7% was observed, suggesting that the sequences originated from strains belonging to a single species. Phylogenetic analysis of the consensus sequence placed the organism within the genus Helicobacter, where it formed a distinct sub-group together with other gastrospirillum-like bacteria (Helicobacter felis, Helicobacter bizzozeronii, Helicobacter salomonis and 'Helicobacter heilmannii' types 1 and 2). Diagnostic PCR primers and a probe were developed that differentiated the porcine sequences from all known helicobacters. These results indicate that the porcine sequences represent a single taxon within the genus Helicobacter. The low similarity level towards H. salomonis (96.6%), its closest validly named neighbour, strongly suggests that this taxon is a novel Helicobacter species. In situ hybridization experiments linked the reference sequence to the 'G. suis'-like bacteria. On the basis of these results, we propose the name 'Candidatus Helicobacter suis' for this gastric helicobacter from pigs.
The zoonotic pathogen Shiga toxin-producing Escherichia coli (STEC) O157:H7 emerged during the 1980s as a causative agent of foodborne outbreaks associated with haemorrhagic colitis and haemolytic ...uraemic syndrome, which can be fatal. We investigated the emerging lineage IIc that was causing outbreaks of STEC O157:H7, identified and quantified the domestic and non-domestic reservoirs, and quantified patient exposures across the population of England.
In this genomic epidemiological analysis study, all human STEC O157:H7 lineage IIc (n=925) isolates cultured from faecal specimens submitted to the UK Health Security Agency between June 1, 2015, and Dec 31, 2020, from patients in England in the community or in hospital, were whole-genome sequenced and the genomic population structure was described. Explanatory variables were obtained from microbiological surveillance data and STEC Enhanced Surveillance Questionnaire responses. Ancestral-state reconstruction using patient travel information was used to define domestic and non-domestic clades and transmission dynamics. Exposures for patients infected with isolates from domestic clades were assessed using mixed-effects multinomial univariable and multivariable regression.
Lineage IIc emerged 50 years ago, and subsequent clonal expansions have resolved into six major extant clades. We defined two English domestic clades that emerged during the past 30 years, and four non-domestic clades comprising isolates that infected or were transmitted to patients in England via international travel or the consumption or handling of imported food. Throughout the study period, non-domestic clades contributed approximately twice the number of infections as domestic clades did. Patients infected with domestic IIc clade strains reported more frequent exposure to fresh produce (raw vegetables p=0·012; prepackaged salad p=0·0009), contact with animals (cattle p=0·021), and visits to farms (p=0·0053) than patients infected with strains from other STEC O157:H7 lineages. A multivariable mixed-effects multinomial model confirmed that within the domestic clades, the major risk factors for infection were prepackaged salad (clade 2.3.3, relative risk ratio RRR 1·72, 95% CI 1·09–2·72; p=0·019) and visits to farms (clade 2.5.2, RRR 1·98, 1·12–3·52; p=0·020) as fixed effects. Local authority district as a random variable had a strong but variable effect for clades 2.3.3 and 2.5.2.
Lineage IIc has emerged as the most prevalent lineage of STEC O157:H7 in England, with a sizeable domestic reservoir. Human infection is associated with the consumption of contaminated fresh produce and contact with domestic livestock. The collection of routine, detailed exposure data on patients who are infected, integrated with high-resolution microbiological typing, enables powerful reframing of our understanding of foodborne disease risk within a One Health context.
National Institute for Health and Care Research Health and UK Health Security Agency.
Four decades into the HIV epidemic, CNS infection remains a leading cause of preventable HIV-related deaths in routine care. The Driving Reduced AIDS-associated Meningo-encephalitis Mortality ...(DREAMM) project aimed to develop, implement, and evaluate pragmatic implementation interventions and strategies to reduce mortality from HIV-related CNS infection.
DREAMM took place in five public hospitals in Cameroon, Malawi, and Tanzania. The main intervention was a stepwise algorithm for HIV-related CNS infections including bedside rapid diagnostic testing and implementation of WHO cryptococcal meningitis guidelines. A health system strengthening approach for hospitals was adopted to deliver quality care through a co-designed education programme, optimised clinical and laboratory pathways, and communities of practice. DREAMM was led and driven by local leadership and divided into three phases: observation (including situational analyses of routine care), training, and implementation. Consecutive adults (aged ≥18 years) living with HIV presenting with a first episode of suspected CNS infection were eligible for recruitment. The primary endpoint was the comparison of 2-week all-cause mortality between observation and implementation phases. This study completed follow-up in September, 2021. The project was registered on ClinicalTrials.gov, NCT03226379.
From November, 2016 to April, 2019, 139 eligible participants were enrolled in the observation phase. From Jan 9, 2018, to March 25, 2021, 362 participants were enrolled into the implementation phase. 216 (76%) of 286 participants had advanced HIV disease (209 participants had missing CD4 cell count), and 340 (69%) of 494 participants had exposure to antiretroviral therapy (ART; one participant had missing ART data). In the implementation phase 269 (76%) of 356 participants had a probable CNS infection, 203 (76%) of whom received a confirmed microbiological or radiological diagnosis of CNS infection using existing diagnostic tests and medicines. 63 (49%) of 129 participants died at 2 weeks in the observation phase compared with 63 (24%) of 266 in the implementation phase; and all-cause mortality was lower in the implementation phase when adjusted for site, sex, age, ART exposure (adjusted risk difference –23%, 95% CI –33 to –13; p<0·001). At 10 weeks, 71 (55%) died in the observation phase compared with 103 (39%) in the implementation phase (–13%, –24 to –3; p=0·01).
DREAMM substantially reduced mortality from HIV-associated CNS infection in resource-limited settings in Africa. DREAMM scale-up is urgently required to reduce deaths in public hospitals and help meet Sustainable Development Goals.
European and Developing Countries Clinical Trials Partnership, French Agency for Research on AIDS and Viral Hepatitis.
For the French and Portuguese translations of the abstract see Supplementary Materials section.
BackgroundOutbreaks of Yersinia pseudotuberculosis infection have been epidemiologically linked to fresh produce, but the bacterium has not been recovered from the food items implicated. In May 2003, ...a cluster of gastrointestinal illness and erythema nodosum was detected among schoolchildren who had eaten lunches prepared by the same institutional kitchen MethodsWe conducted a case-control study and trace-back, environmental, and laboratory investigations. Case patients had culture-confirmed Y. pseudotuberculosis O:1 infection, erythema nodosum, or reactive arthritis. Bacterial isolates from clinical and environmental samples were compared using pulsed-field gel electrophoresis (PFGE) ResultsOf 7392 persons at risk, 111 (1.5%) met the case definition; 76 case patients and 172 healthy control subjects were enrolled in the case-control study. Only raw grated carrots were significantly associated with illness in a logistic-regression model (multivariable odds ratio, 5.7 95% confidence interval, 1.7–19.5); a dose response was found for increasing amount of consumption. Y. pseudotuberculosis O:1 isolates from 39 stool specimens and from 5 (42%) of 12 soil samples that contained carrot residue and were obtained from peeling and washing equipment at the production farm were indistinguishable by PFGE ConclusionsCarrots contaminated early in the production process caused a large point-source outbreak. Our findings enable the development of evidence-based strategies to prevent outbreaks of this emerging foodborne pathogen
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