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Introduction: Salmonellosis is the second most reported gastrointestinal disease and the first cause of foodborne outbreaks in Spain and in the EU. The aim of this study is to describe the temporal trend and epidemiological characteristics of salmonellosis in Spain during the pre-pandemic period 2013-2019, using three different sources.Methodology: A retrospective descriptive observational study was carried out, in which cases and epidemic outbreaks of salmonellosis reported to the Spanish Epidemiological Surveillance Network, as well as information related to the data registered in the Minimum Basic Data Set of Hospital Discharges between 2013 and 2019 were studied.Results: A total of 60,771 cases, 2,233 outbreaks and 24,096 hospital discharges of campylobacteriosis were reported. The Cumulative Incidence of individualized cases increased until 2016, although 2018 was the year with the highest incidence. The Cumulative Period Incidence was higher in men than in women, both for individualized cases (27.76 and 25.05, respectively) and for hospital discharges (8.32 and 6.50, respectively). In the individualized cases, the highest incidence occurred in the group of 1 to 4 and in hospital discharges in children under one year of age. The number of cases, outbreaks, and hospital discharges was higher in the warmer months. The food item most frequently reported in foodborne outbreaks was egg, and the household was the most frequent setting reported.Conclusions: Incidence of salmonellosis at the national and international level remains high. Eggs and their derivatives are the foods most often associated with food outbreaks. The joint analysis of multiple data sources improves epidemiological surveillance by providing complementary information relevant to decision-making., Introducción: La salmonelosis es la segunda enfermedad gastrointestinal más notificada y la primera causa de brote alimentario en España y en la UE. El objetivo de este estudio es describir la distribución temporal y las características epidemiológicas de la salmonelosis en España durante el periodo prepandémico 2013-2019, utilizando tres fuentes de información diferentes. Metodología: Se realizó un estudio observacional descriptivo retrospectivo en el que se estudiaron los casos individualizados y los brotes de salmonelosis notificados a la Red Nacional de Vigilancia Epidemiológica, y los datos registrados en el Conjunto Mínimo Básico de Datos de Altas Hospitalarias entre 2013 y 2019.Resultados: Se notificaron 60.771 casos de forma individualizada, 2.233 brotes y 24.096 altas hospitalarias de salmonelosis. La incidencia acumulada (IA) de los casos individualizados aumentó hasta 2016, aunque 2018 fue el año de mayor IA. La incidencia acumulada de periodo (IAp) fue más elevada en hombres que en mujeres, tanto para los casos individualizados (27,76 y 25,05, respectivamente) como para las altas hospitalarias (8,32 y 6,50, respectivamente). En los casos individualizados la mayor incidencia se dio en el grupo de 1 a 4 años y en las altas hospitalarias en los menores de un año. El número de casos individualizados, de brotes y de altas hospitalarias fue mayor en los meses cálidos. El alimento notificado con mayor frecuencia en los brotes fue el huevo y el ámbito de ocurrencia el hogar. Conclusiones: La incidencia de la salmonelosis a nivel nacional e internacional sigue siendo elevada. El huevo y sus derivados son los alimentos que se asocian en más ocasiones a brotes alimentarios. El análisis conjunto de varias fuentes de datos mejora la vigilancia epidemiológica al aportar información complementaria relevante para la toma de decisiones.

Background: Health is increasingly affected by multiple types of crises. Community engagement is recognised as being a critical element in successful crisis response, and a number of conceptual frameworks and global guideline documents have been produced. However, little is known about the usefulness of such documents and whether they contain sufficient information to guide effective community engagement in crisis response. We undertake a scoping review to examine the usefulness of conceptual literature and official guidelines on community engagement in crisis response using a realist-informed analysis [exploring contexts, mechanisms, and outcomes(CMOs)]. Specifically, we assess the extent to which sufficient detail is provided on specific health crisis contexts, the range of mechanisms (actions) that are developed and employed to engage communities in crisis response and the outcomes achieved. We also consider the extent of analysis of interactions between the mechanisms and contexts which can explain whether successful outcomes are achieved or not. Scope and findings: We retained 30 documents from a total of 10,780 initially identified. Our analysis found that available evidence on context, mechanism and outcomes on community engagement in crisis response, or some of their elements, was promising, but few documents provided details on all three and even fewer were able to show evidence of the interactions between these categories, thus leaving gaps in understanding how to successfully engage communities in crisis response to secure impactful outcomes. There is evidence that involving community members in all the steps of response increases community resilience and helps to build trust. Consistent communication with the communities in time of crisis is the key for effective responses and helps to improve health indicators by avoiding preventable deaths. Conclusions: Our analysis confirms the complexity of successful community engagement and the need for strategies

In September 2022, the Public Health Agency of Sweden observed an increase in domestic Salmonella Typhimurium cases through the Swedish electronic notification system, and an outbreak strain was identified with whole genome sequencing. Overall, 109 cases with symptom onset between 17 September and 24 November 2022 were reported from 20 of 21 Swedish regions. The median age of cases was 52 years (range 4-87 years) and 62% were female. A case-control study found cases to be associated with consumption of rocket salad (adjusted odds ratio (aOR) = 4.9; 95% confidence interval (CI): 2.4-10, p value < 0.001) and bagged mixed salad (aOR = 4.0; 95% CI: 1.9-8.1, p value < 0.001). Trace-back, supported by Finnish authorities who identified the Swedish outbreak strain in a Finnish cluster during the same time period, identified rocket salad, cultivated, pre-washed and pre-packed in Sweden as the likely source of the outbreak. No microbiological analyses of rocket salad were performed. Our investigation indicates that bagged leafy greens such as rocket salad, regardless of pre-washing procedures in the production chain, may contain Salmonella and cause outbreaks, posing a health risk to consumers. We emphasise the need for primary producers of leafy greens to identify possible contamination points to prevent outbreaks.

La pandémie de COVID-19 constitue un défi de taille pour la santé publique, avec des conséquences directes et indirectes importantes. Dans ce contexte, il est crucial de développer et de perfectionner des stratégies afin de réduire la transmission de cette maladie au sein de la population. C’est dans cette optique que le présent projet se focalise, mettant particulièrement l’accent sur la transmission du SRAS-CoV-2 dans les milieux de travail (MT) de la Montérégie. Objectif : Décrire les éclosions de COVID-19 dans les MT de la région de la Montérégie, Québec, Canada, et évaluer les facteurs de risque potentiels pour l’identification d’au moins une éclosion de COVID-19 dans ces MT. Méthode : Une étude écologique de cohorte rétrospective a été menée en utilisant des bases de données anonymisées d’éclosions de COVID-19 survenues du 27 février 2020 au 30 juin 2021. Résultats : Parmi les 30 489 MT étudiés, au moins une éclosion de COVID-19 a été identifiée chez 897 de ceux-ci. Ces éclosions étaient associées à un plus grand nombre de travailleurs sur le lieu de travail (rapport de cotes ajusté (RCA) : 6,78; IC à 95 % : 5,43- 8,47), à la présence de travailleurs étrangers temporaires (TET) (RCA : 2,26; IC à 95 % : 1,53-3,33), à des contacts avec la clientèle (RCA : 1,93; IC à 95 % : 1,68-2,21), et à être localisé dans la région métropolitaine de Montréal (RCA : 1,26; IC à 95 % : 1,09-1,45). Conclusion : Les résultats permettent d’identifier des facteurs de risque potentiels d’éclosion de COVID-19 dans les MT dans le but de cibler des MT où des mesures de contrôle et de prévention des infections pourraient être rehaussées ou adaptées afin d’améliorer la santé des travailleurs., The COVID-19 pandemic poses a significant challenge to public health, with important direct and indirect consequences. In this context, it is crucial to develop and refine strategies to reduce the transmission of this disease within the population. It is with this perspective that the current project focuses, placing particular emphasis on the SARS-CoV-2 transmission in the workplaces of the Montérégie Region. Objective: Describe COVID-19 outbreaks in workplaces of the Montérégie Region, Quebec, Canada, and evaluate the potential risk for identifying at least one COVID-19 outbreak in these workplaces. Methods: An ecological retrospective cohort study was conducted using de-identified databases of COVID-19 outbreaks that occurred in workplaces from February 27th, 2020 to June 30th, 2021. Results: Among 30,489 workplaces studied, 897 workplaces with at least one COVID-19 outbreak were identified. These outbreaks were associated with a sizeable number of workers in the workplace (adjusted odds ratio (aOR): 6.78; 95% CI: 5.43-8.47), the presence of temporary foreign workers (TFW) (aOR: 2.26; 95% CI: 1.53-3.33), contacts with clients (aOR: 1.93; 95% CI: 1.68-2.21) and being localised in the Montreal Metropolitan Area (aOR: 1.26; 95% CI: 1.09-1.45). Conclusion: These results enable the identification of potential risk factors for COVID-19 outbreaks, with the aim of targeting workplaces where infection control and prevention measures might be enhanced or adapted to improve workers’ health.

According to Donthu and Gustaffson (2020), Numerous tourism and hospitality markets no longer exist. Just one family member was allowed to leave the house to prevent the virus, known as "COVID-19," from spreading. The Philippines' entire street became a ghost town where no one could escape. Therefore, sales of Traditional Businesses are greatly affected.   The Descriptive Qualitative Design is used and suitable in this study. This study aims to determine the effects of the COVID-19 outbreak on Traditional Businesses in Novaliches, Quezon City. The instruments used in this study are survey questionnaires to gather data and get information from a set of individuals. The researchers used purposive sampling, in which Business owners are selected based on the purpose of the study. The results reveal that most business owners and sellers are 18-23. It also shows that the outbreak hurts traditional businesses.   Moreover, they experience various issues regarding their marketing strategy, pricing, and quality. Therefore, researchers give recommendations to solve and improve their sales. In the light of findings and results, researchers recommend to business owners, future business owners, students, community, and future researchers to be prepared, study more about effects, specifically the sales, and develop strategies to survive problems in uncertain situations.

Recent anthropic activity related to the construction of the Bosquesur Green Park in a large urban setting in Madrid (Spain) has resulted in the largest reported community outbreak of human leishmaniosis in Europe. Previous phylogenetic and molecular-typ-ing studies of parasite isolates have implicated the Leishmania infantum ITS-Lombardi genotype in this outbreak. In an unusual scenario, visceral leishmaniosis (VL) is affecting a significant number of individuals, suggesting that an increase in parasite virulence has occurred. In this work, using an in vivo BALB/c model of VL, we aimed to investigate the properties of emergent virulence of the L. infantum POL2FL7 and BOS1FL1 isolates obtained from Phlebotomus perniciosus collected in the outbreak area and compare them with those of the well-characterized strain BCN150 MON-1 isolated from a dog. The P. perniciosus specimens were collected during an entomological survey conducted in the transmission season of 2012. We observed a range of virulence phenotypes from moderately to highly aggressive after 5 weeks of infection. IV challenge of mice with outbreak isolates from sand flies induced higher splenic and liver parasite burdens, higher serological titres of specific anti-Leishmania antibodies and impaired capacities to control infection, as revealed by the arginine metabolism and low ratios of Th1/Th2 cy-tokine profiles analysed, compared with the corresponding measures evaluated in mice infected with the BCN150 strain. The BOS1FL1 isolate showed the highest degree of virulence among the isolates, superior to that of POL2FL7, as evidenced by the analysed biomarkers and the histopathological severity of liver lesions. These results provide in-sight into how L. infantum isolates from sand flies collected in the outbreak area have been able to affect not only immunosuppressed patients but also middle-aged people with normal immunocompetence in the largest human VL outbreak in Europe., UCM-SANTANDER, COMUNIDAD DE MADRID, Depto. de Sanidad Animal, Fac. de Veterinaria, TRUE, pub

Recent anthropic activity related to the construction of the Bosquesur Green Park in a large urban setting in Madrid (Spain) has resulted in the largest reported community outbreak of human leishmaniosis in Europe. Previous phylogenetic and molecular-typing studies of parasite isolates have implicated the Leishmania infantum ITS-Lombardi genotype in this outbreak. In an unusual scenario, visceral leishmaniosis (VL) is affecting a significant number of individuals, suggesting that an increase in parasite virulence has occurred. In this work, using an in vivo BALB/c model of VL, we aimed to investigate the properties of emergent virulence of the L. infantum POL2FL7 and BOS1FL1 isolates obtained from Phlebotomus perniciosus collected in the outbreak area and compare them with those of the well-characterized strain BCN150 MON-1 isolated from a dog. The P. perniciosus specimens were collected during an entomological survey conducted in the transmission season of 2012. We observed a range of virulence phenotypes from moderately to highly aggressive after 5 weeks of infection. IV challenge of mice with outbreak isolates from sand flies induced higher splenic and liver parasite burdens, higher serological titres of specific anti-Leishmania antibodies and impaired capacities to control infection, as revealed by the arginine metabolism and low ratios of Th1/Th2 cytokine profiles analysed, compared with the corresponding measures evaluated in mice infected with the BCN150 strain. The BOS1FL1 isolate showed the highest degree of virulence among the isolates, superior to that of POL2FL7, as evidenced by the analysed biomarkers and the histopathological severity of liver lesions. These results provide insight into how L. infantum isolates from sand flies collected in the outbreak area have been able to affect not only immunosuppressed patients but also middle-aged people with normal immunocompetence in the largest human VL outbreak in Europe., Universidad Complutense de Madrid-Santander, Grant PR75/18-21558, Comunidad de Madrid, PLATESA2-CM (S2018/BAA-4370), Depto. de Sanidad Animal, Fac. de Veterinaria, TRUE, pub

2010 Elsevier Ltd. All rights reserved., Brucella melitensis is a major human and animal pathogen, with a wide host range that includes all domestic ruminant species, although small ruminants are its preferred hosts. Outbreaks in cattle due to B. melitensis have become a worldwide emerging problem particularly difficult to control due to the lack of knowledge on the epidemiology in this host species and of an effective vaccine. However, combination of molecular tools and strict biosecurity measures can help to solve these difficulties and eventually eradicate the disease from infected herds. In the present report, management of an outbreak in Spain involving four farms, more than 2000 cattle and several human cases is described. Application of Multiple Locus VNTR Analysis (MLVA) allowed identifying the most likely source of infection. Stamping out and test-and-slaughter strategies were applied, proving their usefulness to control the outbreak depending on infection level, and without the need of other alternative measures., Depto. de Sanidad Animal, Centro de Vigilancia Sanitaria Veterinaria (VISAVET), Fac. de Veterinaria, TRUE, pub

Unlabelled: Large seasonal outbreaks of bronchiolitis put pressure on healthcare systems and particularly on intensive care units (ICUs). ICU admission is necessary to provide respiratory support to the severest cases, otherwise bronchiolitis can result in substantial mortality. ICU resources are often insufficient and there is scant evidence to guide the ICU clinical management. Most available studies do not cover the ICU-admitted cases and do not consider the associated public health issues. We review this topic through a multidisciplinary approach from both the clinical and public health perspectives, with an analysis based on pathophysiology and cost-effectiveness. We suggest ways to optimise respiratory care, minimise ICU stay, "protect" ICU beds and, whenever possible, make them available for other critically ill children. We also provide guidance on how to prepare ICUs to work under stressful conditions due to outbreaks and to reduce the risk of nosocomial cross-contamination, particularly in ICUs caring for high-risk children. Funding: None.

2023 Acuerdos transformativos CRUE, Background: Real-time PCR is the diagnostic technique of choice for the diagnosis and control of equine herpesvirus-1 (EHV-1) in an outbreak setting. The presence of EHV-1 in nasal swabs (NS), whole blood, brain and spinal cord samples has been extensively described; however, there are no reports on the excretion of EHV-1 in urine, its DNA detection patterns, and the role of urine in viral spread during an outbreak. Objectives: To determine the presence of EHV-1 DNA in urine during natural infection and to compare the DNA detection patterns of EHV-1 in urine, buffy coat (BC) and NS. Study design: Descriptive study of natural infection. Methods: Urine and whole blood/NS samples were collected at different time points during the hospitalisation of 21 horses involved in two EHV-1 myeloencephalopathy outbreaks in 2021 and 2023 in Spain. Quantitative real-time PCR was performed to compare the viral DNA load between BC-urine samples in 2021 and NS-urine samples in 2023. Sex, age, breed, presence of neurological signs, EHV-1 vaccination status and treatment data were recorded for all horses. Results: A total of 18 hospitalised horses during the 2021 and 2023 outbreaks were positive for EHV-1, and viral DNA was detected in urine samples from a total of 11 horses in both outbreaks. Compared with BC samples, DNA presence was detected in urine samples for longer duration and with slightly higher concentration; however, compared with NS, detection of EHV-1 in urine was similar in duration with lower DNA concentrations. Main limitations: Limited sample size, different sampling times and protocols (BC vs. NS) in two natural infection outbreak settings. Conclusions: EHV-1 was detected in the urine from naturally infected horses. Urine should be considered as complimentary to blood and NS in diagnosis of EHV-1 infection., Depto. de Sanidad Animal, Fac. de Veterinaria, Centro de Vigilancia Sanitaria Veterinaria, FALSE, pub, APC financiada por la UCM

In 2019, the biggest listeriosis outbreak by Listeria monocytogenes (Lm) in the South of Spain was reported, resulting in the death of three patients from 207 confirmed cases. One strain, belonging to clonal complex 388 (Lm CC388), has been isolated. We aimed to determine the Lm CC388 virulence in comparison with other highly virulent clones such as Lm CC1 and Lm CC4, in vitro and in vivo. Four L. monocytogenes strains (Lm CC388, Lm CC1, Lm CC4 and ATCC 19115) were used. Attachment to human lung epithelial cells (A549 cells) by these strains was characterized by adherence and invasion assays. Their cytotoxicities to A549 cells were evaluated by determining the cells viability. Their hemolysis activity was determined also. A murine intravenous infection model using these was performed to determine the concentration of bacteria in tissues and blood. Lm CC388 interaction with A549 cells is non-significantly higher than that of ATCC 19115 and Lm CC1, and lower than that of Lm CC4. Lm CC388 cytotoxicity is higher than that of ATCC 19115 and Lm CC1, and lower than that of Lm CC4. Moreover, Lm CC388 hemolysis activity is lower than that of the Lm CC4 strain, and higher than that of Lm CC1. Finally, in the murine intravenous infection model by Lm CC388, higher bacterial loads in tissues and at similar levels of Lm CC4 were observed. Although a lower rate of mortality of patients during the listeriosis outbreak in Spain in 2019 has been reported, the Lm CC388 strain has shown a greater or similar pathogenicity level in vitro and in an animal model, like Lm CC1 and Lm CC4.

Salmonella infection causes epidemic death in wild songbirds, with potential to spread to humans. In February 2021, public health officials in Oregon and Washington, USA, isolated a strain of Salmonella enterica serovar Typhimurium from humans and a wild songbird. Investigation by public health partners ultimately identified 30 illnesses in 12 states linked to an epidemic of Salmonella Typhimurium in songbirds. We report a multistate outbreak of human salmonellosis associated with songbirds, resulting from direct handling of sick and dead birds or indirect contact with contaminated birdfeeders. Companion animals might have contributed to the spread of Salmonella between songbirds and patients; the outbreak strain was detected in 1 ill dog, and a cat became ill after contact with a wild bird. This outbreak highlights a One Health issue where actions like regular cleaning of birdfeeders might reduce the health risk to wildlife, companion animals, and humans.

Norway spruce (Picea abies) is a vital tree species in Sweden's extensive forested landscape. However, the planting of spruce beyond its natural range has made it vulnerable to pests like the spruce bark beetle (Ips typographus), which has caused substantial damage to Swedish forests. With the effects of global warming and climate change becoming increasingly apparent, understanding the factors influencing spruce mortality is crucial for effective forest management. This study aimed to investigate the impact of soil moisture and tree size on the susceptibility of Norway spruce to spruce bark beetle attacks. Using a combination of an Artificial Intelligence (AI) program detecting dead spruce trees and soil moisture data from the Swedish University of Agricultural Sciences (SLU), areas in Stockholm County with dead spruce trees were identified. Spatial analysis using Geographic Information System (GIS) tools and a field survey were conducted to evaluate the hypotheses: H1: Spruce mortality will be higher in areas occurring within mesic soil moisture class (1) than within mesic-moist soil moisture class (2) and moist-wet soil moisture class (3). H2: Large diameter spruce trees will have a higher mortality rate from spruce bark beetle than smaller diameter trees. H3: Spruce mortality will be higher in areas located inside nature reserves. The results confirmed that spruce mortality was higher in areas with dryer soil, Additionally, larger diameter spruce trees exhibited higher mortality rates from spruce bark beetle attacks than smaller trees. Contrary to the initial hypothesis, the study did not find a higher spruce mortality rate in areas located outside nature reserves. The conclusion of this study is that both tree size and soil moisture affect the Norway spruce’s ability to defend itself from spruce bark beetle attacks, but it does not confirm that spruce trees inside nature reserves have a greater mortality rate due to bark beetle attacks than the surrounding area, Gran (Picea abies) är en viktig trädart i Sveriges omfattande skogslandskap. Dock har plantering av gran utanför dess naturliga utbredningsområde gjort den sårbar för skadedjur så som Granbarkborre (Ips typographus), vilket har orsakat betydande skador på svenska skogar. Med effekterna av klimatförändringar är det alltmer viktigt att förstå vilka faktorer som påverkar granens sårbarhet mot granbarkborren för en effektiv skogsförvaltning. Denna studie syftade till att undersöka påverkan av markfuktighet och trädstorlek. Genom att använda en kombination av ett artificiellt intelligensprogram (AI) som identifierar döda granar och markfuktighetsdata från Sveriges lantbruksuniversitet (SLU), identifierades områden i Stockholms län där det fanns döda granar. En spatial analys med hjälp av geografiska informationssystem (GIS) och en fältundersökning genomfördes för att utvärdera hypoteserna: H1: Granens dödlighet kommer att vara högre i områden med torr-frisk mark (1) jämfört med områden med frisk-fuktig markfuktighet (2) och fuktig-våt markfuktighet (3). H2: Granar med större diameter kommer att ha en högre dödlighetsgrad från granbarkborrsangrepp än granar med mindre diameter. H3: Granens dödlighet kommer att vara högre i områden i naturreservat än utanför. Resultaten bekräftade att granens dödlighet var högre i torrare områden. Dessutom uppvisade granar med större diameter högre dödlighetsgrad från garnbarkborreangrepp än mindre träd. Resultatet kunde inte bekräfta hypotes H3, man fann inte en högre dödlighetsgrad hos gran i områden inom naturreservat. Slutsatsen av denna studie är att både trädstorlek och markfuktighet påverkar granens förmåga att försvara sig mot granbarkborreangrepp, men den bekräftar inte att naturreservat har en påverkan på granens dödlighet till följd av granbarkborreangrepp än omgivande områden. Studien har bidragit till en bättre förståelse för hur granbarkborren väljer granar. Den har också tillfört mer kunskap och bekräftat att Skogsstyrelsens

Emerging Infectious Diseases (EIDs) and Re-Emerging Infectious Diseases (REIDs) constitute significant health problems and are becoming of major importance. Up to 75% of EIDs and REIDs have zoonotic origin. Several factors such as the destruction of natural habitats leading humans and animals to live in close proximity, ecological changes due to natural disasters, population migration resulting from war or conflict, interruption or decrease in disease prevention programs, and insufficient vector control applications and sanitation are involved in disease emergence and distribution. War and natural disasters have a great impact on the emergence/re-emergence of diseases in the population. According to a World Bank estimation, two billion people are living in poverty and fragility situations. Wars destroy health systems and infrastructure, curtail existing disease control programs, and cause population movement leading to an increase in exposure to health risks and favor the emergence of infectious diseases. A total of 432 catastrophic cases associated with natural disasters were recorded globally in 2021. Natural disasters increase the risk of EID and REID outbreaks by damaging infrastructure and leading to displacement of populations. A Generic National Action Plan covering risk assessment, mechanism for action, determination of roles and responsibilities of each sector, the establishment of a coordination mechanism, etc. should be developed., This study was supported by TOBB-ETU., This study was supported by TOBB-ETU.

Campylobacteriosis is the most reported gastrointestinal disease in the European Union (EU). In this work, the epidemiological characteristics of campylobacteriosis in Spain before the COVID-19 pandemic were analyzed. A retrospective descriptive observational study was carried out, in which cases and epidemic outbreaks of campylobacteriosis reported to the Spanish Epidemiological Surveillance Network (RENAVE), as well as information related to the data registered in the Minimum Basic Data Set of Hospital Discharges (CMBD) between 2013 and 2019 were studied. A total of 114 273 cases, 211 outbreaks and 16 636 hospital discharges of campylobacteriosis were reported. The cumulative incidence of cases increased until 2018, hospital discharges increased as well for the entire period. The highest incidences appeared in children under 5 years, and the median age was higher in those hospitalized. The number of cases, outbreaks, and hospital discharges was higher in the warmer months. The food item most frequently reported in foodborne outbreaks was chicken meat, and the household was the most frequent setting reported. Campylobacteriosis in Spain has shown an increasing incidence in recent years, in contrast to the EU, so prevention and control measures should be strengthened, considering the most affected age groups and the groups where it is most severe (under 5 years and the elderly). The incorporation of other data sources, such as hospital discharges, can improve epidemiological surveillance by adding other relevant data for decision-making and considering possible differences in surveillance between Autonomous Regions (AA.RR)., La campilobacteriosis es la enfermedad gastrointestinal más notificada en la Unión Europea (UE). En este trabajo se analizaron las características epidemiológicas de la campilobacteriosis en España antes de la pandemia de COVID-19. Se realizó un estudio observacional descriptivo retrospectivo en el que se estudiaron los casos individualizados y los brotes de campilobacteriosis notificados a la Red Nacional de Vigilancia Epidemiológica (RENAVE) y los datos registrados en el Conjunto Mínimo Básico de Datos de Altas Hospitalarias (CMBD) entre 2013 y 2019. Se notificaron 114 273 casos de forma individualizada, 211 brotes y 16 636 altas hospitalarias de campilobacteriosis. La incidencia acumulada (IA) anual de los casos individualizados aumentó hasta 2018, siendo este aumento para todo el periodo en las altas hospitalarias. Las mayores incidencias se dieron en los menores de 5 años y la edad mediana fue mayor en los hospitalizados. El número de casos individualizados, de brotes y de altas hospitalarias fue mayor en los meses cálidos. El alimento notificado con mayor frecuencia en los brotes fue la carne de pollo y el ámbito de ocurrencia el hogar. La campilobacteriosis en España presenta una incidencia al alza en los últimos años, a diferencia de la UE, por lo que habría que reforzar las medidas de prevención y control, teniendo en cuenta los grupos de edad más afectados y en los que es más grave (menores de 5 años y ancianos). La incorporación de otras fuentes de datos como los registros electrónicos de las altas hospitalarias, puede enriquecer la vigilancia epidemiológica al añadir otros datos relevantes para la toma de decisiones, teniendo en cuenta las posibles diferencias en la vigilancia entre Comunidades Autónomas (CC.AA.), A campilobacteriose é a doença gastrointestinal mais relatada na União Europeia (UE). Neste trabalho, foram analisadas as características epidemiológicas da campilobacteriose na Espanha antes da pandemia de COVID-19. Foi realizado um estudo observacional descritivo retrospectivo em que foram estudados os casos individualizados e surtos de campilobacteriose notificados à Rede Nacional de Vigilância Epidemiológica (RENAVE), bem como os dados registrados no Conjunto Mínimo de Dados Básicos de Altas Hospitalares (CMBD) entre 2013 e 2019. Foram notificados 114 273 casos individualizados, 211 surtos e 16 636 altas hospitalares de campilobacteriose. A incidência cumulativa (IA) anual de casos individualizados aumentou até 2018, sendo esse aumento para todo o período nas altas hospitalares. As maiores incidências ocorreram em crianças menores de 5 anos e a mediana de idade foi maior nas internadas. O número de casos individualizados, surtos e altas hospitalares foi maior nos meses mais quentes. O alimento mais relatado nos surtos foi a carne de frango e o local de ocorrência foi o domicílio. A campilobacteriose em Espanha tem apresentado uma incidência crescente nos últimos anos, ao contrário da EU, pelo que as medidas de prevenção e controlo devem ser reforçadas, tendo em conta as faixas etárias mais afetadas e aquelas em que é mais grave (menores de 5 anos e idosos). A incorporação de outras fontes de dados, como registros eletrônicos de altas hospitalares, pode enriquecer a vigilância epidemiológica ao agregar outros dados relevantes para a tomada de decisões, levando em consideração possíveis diferenças de vigilância entre Comunidades Autônomas (CC.AA.).

Coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), can manifest in multiple organs. While the primary manifestations of COVID-19 occur in the respiratory system, other organ systems are also involved, including nervous systems that cause neurological symptoms. The aim of this study was to determine the neurological manifestations of COVID-19 patients and to assess the role of age and sex on neurological manifestation incidence. A cross-sectional study was conducted at Pelamonia Hospital, Makassar, Indonesia, among inpatient COVID-19 cases, using a total sampling method. Demographic data and neurological manifestations of the COVID-19 patients were collected. The associations between age and sex with the incidence of neurological symptoms were analyzed using the Chi-squared test. Out of 424 inpatients with COVID-19 cases, 62.3% were females, with the highest age group was 20–40 years (42.7%). The neurological symptoms were reported in 232 patients, accounting for approximately 54.7%. The most frequently reported neurological symptom was headache (n=104, 44.8%), followed by anosmia (n=44, 18.9%), ageusia (n=48, 20.6%), myopathy (n=14, 6%), stroke (n=10, 4.3%), seizure (n=5, 2.1%), and altered consciousness (n=7, 3%). An association was found between sex and the incidence of headache, myopathy, stroke, and altered consciousness. There was also an association between age and the incidence of headache and stroke. The study highlights that COVID-19 patients commonly exhibit neurological implications affecting the central nervous system and peripheral nervous system. Therefore, it is crucial for the early detection of neurological symptoms in COVID-19 cases to have better management.

Prouzrokovač žute rđe (Puccinia striiformis f.sp. tritici) i lisne rđe (Puccinia triticina) pšenice pripadaju grupi obligatnih patogena koji mogu dovesti do gubitaka prinosa i do 70%. Prouzrokovač žute rđe je dobio na posebnom značaju u Srbiji proizvodne 2013/2014. Tada je potvrđena rasa Warrior koja je dovela do značajnih šteta u proizvodnji pšenice. Prouzrokovač žute rđe ječma Puccinia striiformis f. sp. hordei opisan je u područjima sa hladnom i vlažnom klimom gde dovodi do gubitaka prinosa ječma i do 70%. Treba imati u vidu da su rase žute rđe pšenice retko virulentne za ječam, međutim ipak postoje genotipovi ječma koji mogu biti zaraženi nekim rasama žute rđe pšenice. Za razliku od ječma, prouzrokovači žute rđe pšenice mogu izvršiti zarazu tritikalea. Među njima su rase Warrior i Kranich koje su od 2011. izavale ogromne gubitke prinosa pšenice u Evropi. I pored pojave žute rđe na pšenici u Srbiji prethodnih godina, ona nije registrovana na ječmu i tritikaleu sve do 2023. Imajući u vidu da se žuta rđa prvi put pojavila u Srbiji na ječmu i tritikaleu 2023, i da je kontrola žute rđe bila otežana u proizvodnoj 2022/2023 godini, cilj ovog rada je da ukaže na faktore koji su doveli do epidemije žute rđe i pojava novih patogena strnih žita u Srbiji.

Parastagonospora nodorum (teleomorf Leptosphaeria nodorum) je prouzrokovač sive pegavosti lista i klasa pšenice. Prvi put je otkriven na pšenici 1845. godine i čest je u regionima sa relativno visokim, ili periodično visokim padavinama. P. nodorum izaziva simptome na svim nadzemnim delovima biljke, tj. listovima, stablu, plevama i osju. Patogen prezimljava na žetvenim ostacima pšenice u obliku pseudotecija i piknida. Askospore oslobođene iz pseudotecija obično čine izvor primarnog inokuluma, međutim, konidije oslobođene iz piknida sa žetvenih ostataka takođe mogu izvršiti zarazu klijanaca. Pored toga, poznato je da gljiva preživljava i na semenu u vidu dormantne micelije, tako da i zaraženo seme može biti izvor primarne infekcije. Tokom proizvodne 2022/2023. godine sume padavina u aprilu (63,9 mm) i maju (124,8 mm ) nadmašile su sedamneasetogodišnje proseke čime su se stvorili uslovi za pojavu prouzrokovača sive pegavosti lista i klasa pšenice. Mikroskopskim pregledom pega zaraženih listova pšenice utvrđeno je prisustvo polnog stadijuma (L. nodorum) prvi put u Srbiji. Bespolni stadijum (P. nodorum) uočen je na uzorcima zaraženih klasova na više sorti. Ovaj rad upućuje da se u budućnosti mora posvetiti posebna pažnja praćenju uslova koji bi mogli dovesti do jače pojave ovog patogena na proizvodim površinama pšenice u Srbiji., Parastagonospora nodorum (teleomorph Leptosphaeria nodorum) is the causal agent of septoria nodorum blotch (SNB). It was first discovered on wheat in 1845. and is common in regions with relatively high or periodically high rainfall. P. nodorum causes symptoms on all above-ground parts of the plant, including leaves, stems, glumes, and awns. The pathogen overwinters on wheat crop residues in the form of pseudothecia and pycnidia. Ascospores released from pseudothecia typically serve as the primary source of inoculum, but conidia released from pycnidia on crop residues can also infect seedlings. Additionally, the fungus is known to survive on seeds in the form of dormant mycelium, making infected seeds a potential source of primary infection. During the 2022/2023 growing season, precipitation totals in April (63.9 mm) and May (124.8 mm) exceeded seventeen-year averages, creating conditions conducive to occurence of SNB. Microscopic examination of lesions on leaves of wheat variety revealed the presence of the sexual stage (L. nodorum) for the first time in Serbia. The asexual stage (P. nodorum) was observed on infected ears of different varieties. This study highlights the need for more attention in monitoring conditions that could lead to outbreak SNB in wheat production areas in Serbia.

Objectives To evaluate the clinical and epidemiological impact of a new molecular surveillance strategy based on qPCR to control an outbreak by Serratia marcescens in a Neonatal Intensive Care Unit (NICU). Methods We design a specific qPCR for the detection of S. marcescens in rectal swabs of patients admitted to a NICU. We divided the surveillance study into two periods: (a) the pre-PCR, from the outbreak declaration to the qPCR introduction, and (b) the PCR period, from the introduction of the qPCR until the outbreak was solved. In all cases, S. marcescens isolates were recovered and their clonal relationship was analysed by PFGE. Control measures were implemented during the outbreak. Finally, the number of bloodstream infections (BSI) was investigated in order to evaluate the clinical impact of this molecular strategy. Results Nineteen patients colonized/infected by S. marcescens were detected in the pre-PCR period (October 2020–April 2021). On the contrary, after the PCR implementation, 16 new patients were detected. The PFGE revealed 24 different pulsotypes belonging to 7 different clonal groups, that were not overlapping at the same time. Regarding the clinical impact, 18 months after the qPCR implementation, no more outbreaks by S. marcescens have been declared in the NICU of our hospital, and only 1 episode of BSI has occurred, compared with 11 BSI episodes declared previously to the outbreak control. Conclusions The implementation of this qPCR strategy has proved to be a useful tool to control the nosocomial spread of S. marcescens in the NICU.

In the summer of 2021, African swine fever (ASF) made its reappearance in the Dominican Republic after 40 years of absence. The disease is known for its high mortality amongst pigs and its consequences for human welfare. To be able to provide relevant advice aiming to limit the spread of disease, it is important to understand more about pig farmers’ knowledge and practices concerning the disease and its prevention. This is poorly researched in the Dominican Republic. Therefore this study was carried out to investigate it further. The study was performed through interviews in five selected areas of the Dominican Republic. The participants were farmers, some of which also worked as meat sellers or veterinarians. A questionnaire containing questions concerning common practices in their pig holdings, encountered diseases, transmission, and prevention of ASF as well as expectations on authorities and consequences of outbreaks was used in the interviews. The study showed that, together with diarrhoea, ASF seemed to be the most commonly encountered disease on the farms. If encountering a disease, most farmers treated sick pigs themselves but contacted veterinarians if further help was needed. The majority vaccinated their pigs and the most common vaccines used were against classical swine fever, mycoplasmosis, and circovirus. Many farmers cleaned their farms regularly and used disinfectants effective against ASF. The awareness of ASF, its symptoms, transmission, and prevention was generally high. Economic loss was the biggest consequence of ASF on a farm. In case of an outbreak of ASF authorities euthanised sick animals and compensated for these according to the participants. Some participants, however, questioned whether this actually was implemented. Economic support was the action most wanted from authorities. These results contribute to a preliminary picture of the practices and level of knowledge of ASF in the Dominican Republic. It can serve to better understand the

Linezolid is used as first-line treatment of infections caused by vancomycin-resistant Enterococcus faecium. However, resistance to linezolid is increasingly detected. The aim of the present study was to elucidate the causes and mechanisms for the increase in linezolid-resistant E. faecium at Copenhagen University Hospital – Rigshospitalet. We therefore combined patient information on linezolid treatment with whole-genome sequencing data for vancomycin- or linezolid-resistant E. faecium isolates that had been systematically collected since 2014 (n=458). Whole-genome sequencing was performed for multilocus sequence typing (MLST), identification of linezolid resistance-conferring genes/mutations and determination of phylogenetically closely related strains. The collection of E. faecium isolates belonged to prevalent vancomycin-resistant MLST types. Among these, we identified clusters of closely related linezolid-resistant strains compatible with nosocomial transmission. We also identified linezolid-resistant enterococcus isolates not genetically closely related to other isolates compatible with de novo generation of linezolid resistance. Patients with the latter isolates were significantly more frequently exposed to linezolid treatment than patients with related linezolid-resistant enterococcus isolates. We also identified six patients who initially carried a vancomycin-resistant, linezolid-sensitive enterococcus, but from whom vancomycin-resistant, linezolid-resistant enterococci (LVRE) closely related to their initial isolate were recovered after linezolid treatment. Our data illustrate that linezolid resistance may develop in the individual patient subsequent to linezolid exposure and can be transmitted between patients in a hospital setting.

This course explores the causes of modern war with a focus on preventable causes. Course readings cover theoretical, historical, and methodological topics. Major theories of war are explored and assessed in the first few weeks of the class, asking at each stage "are these good theories?" and "how could they be tested?" Basic social scientific inference -- what are theories? What are good theories? How should theories be framed and tested? -- and case study methodology are also discussed. The second half of the course explores the history of the outbreak of some major wars. We use these cases as raw material for case studies, asking "if these episodes were the subject of case studies, how should those studies be performed, and what could be learned from them?"

In autumn 2011, a disease outbreak caused by Spanish goat encephalitis virus (SGEV) was reported in a herd of goats from Asturias (north-western Spain), expanding the known geographic distribution of tick-borne encephalitis in Europe. The virus was classified as a new subtype (subspecies) within the Louping-ill virus species of the mammalian tick-borne flavivirus group. The aims of the present study were to describe the pathology in goats naturally infected with SGEV, as well as discuss the pathogenesis of the disease in that outbreak. A total of 22/85 (25.88%) goats (20 adults and 2 kids) died between October 2011 and June 2012, showing neurological clinical signs. Over three years, the mortality rate in the herd reached 100%. Neuropathological lesions caused by SGEV were severe and widespread throughout the central nervous system but were more severe and numerous in the proximal cervical spinal cord, medulla oblongata, pons and cerebellar cortex. They consisted of neuron necrosis, neuronophagia, mononuclear inflammatory cell perivascular cuffs (lymphocytes, plasma cells and macrophages) and gliosis. The distribution of viral antigens was restricted to the cytoplasm of neurons in several brain areas but not associated with inflammatory foci nor inflammatory cells. SGEV should be considered a significant pathogen of goats that results in severe neurological clinical disease and high mortality.

In 2019, the biggest listeriosis outbreak by Listeria monocytogenes (Lm) in the South of Spain was reported, resulting in the death of three patients from 207 confirmed cases. One strain, belonging to clonal complex 388 (Lm CC388), has been isolated. We aimed to determine the Lm CC388 virulence in comparison with other highly virulent clones such as Lm CC1 and Lm CC4, in vitro and in vivo. Four L. monocytogenes strains (Lm CC388, Lm CC1, Lm CC4 and ATCC 19115) were used. Attachment to human lung epithelial cells (A549 cells) by these strains was characterized by adherence and invasion assays. Their cytotoxicities to A549 cells were evaluated by determining the cells viability. Their hemolysis activity was determined also. A murine intravenous infection model using these was performed to determine the concentration of bacteria in tissues and blood. Lm CC388 interaction with A549 cells is non-significantly higher than that of ATCC 19115 and Lm CC1, and lower than that of Lm CC4. Lm CC388 cytotoxicity is higher than that of ATCC 19115 and Lm CC1, and lower than that of Lm CC4. Moreover, Lm CC388 hemolysis activity is lower than that of the Lm CC4 strain, and higher than that of Lm CC1. Finally, in the murine intravenous infection model by Lm CC388, higher bacterial loads in tissues and at similar levels of Lm CC4 were observed. Although a lower rate of mortality of patients during the listeriosis outbreak in Spain in 2019 has been reported, the Lm CC388 strain has shown a greater or similar pathogenicity level in vitro and in an animal model, like Lm CC1 and Lm CC4.

The recent spread of the monkeypox virus (MPXV), causing monkeypox (mpox), to non-endemic areas, and the atypical and unusual clinical manifestations observed during its 2022 outbreak has focused international interest on the clinical features of the disease. Mpox is usually a self-limiting disease with mild symptoms with common manifestations, including fever and skin lesions; however, severe manifestations could occur in some vulnerable groups (children and those with impaired immune systems) and may present multisystem complications and fatal outcomes. In most cases, a fever is the first sign of disease, followed by the development of various inflammatory lesions on the skin, such as vesiculopustular rashes and ulcers. Pneumonitis, encephalitis, keratitis, secondary bacterial infections, acute kidney injury, and myocarditis are all possible outcomes of the infection. Myocarditis has been reported to be caused by orthopoxviruses, and it is a serious condition of which its pathophysiology is little understood. Recent reports have indicated myocarditis with cardiac involvement as a possible atypical and unusual consequence of the MPXV infection during present outbreak. This review provides an overview of the clinical manifestations of mpox with a special focus on its effects on the heart, including myocarditis. The evidence of the myocarditis in mpox patients and its possible pathogenesis are discussed.

Outbreak strains of Mycobacterium tuberculosis are promising candidates as targets in the search for intrinsic determinants of transmissibility, as they are responsible for many cases with sustained transmission; however, the use of low-resolution typing methods and restricted geographical investigations represent flaws in assessing the success of long-lived outbreak strains. We can now address the nature of outbreak strains by combining large genomic data sets and phylodynamic approaches. We retrospectively sequenced the whole genome of representative samples assigned to an outbreak circulating in the Canary Islands (the GC strain) since 1993, which accounts for ~20% of local tuberculosis cases. We selected a panel of specific single nucleotide polymorphism (SNP) markers for an in-silico search for additional outbreak-related sequences within publicly available tuberculosis genomic data. Using this information, we inferred the origin, spread, and epidemiological parameters of the GC strain. Our approach allowed us to accurately trace the historical and more recent dispersion of the GC strain. We provide evidence of a highly successful nature within the Canarian archipelago but limited expansion abroad. Estimation of epidemiological parameters from genomic data disagree with a distinctive biology of the GC strain. With the increasing availability of genomic data allowing for the accurate inference of strain spread and critical epidemiological parameters, we can now revisit the link between Mycobacterium tuberculosis genotypes and transmission, as is routinely carried out for SARS-CoV-2 variants of concern. We demonstrate that social determinants rather than intrinsically higher bacterial transmissibility better explain the success of the GC strain. Importantly, our approach can be used to trace and characterize strains of interest worldwide. IMPORTANCE Infectious disease outbreaks represent a significant problem for public health. Tracing outbreak expansion and unde

Since the advent of the worldwide COVID-19 pandemic, analyzing public sentiment has become one of the major concerns for policy and decision-makers. While the priority is to curb the spread of the virus, mass population (user) sentiment analysis is equally important. Though sentiment analysis using different state-of-the-art technologies has been focused on during the COVID-19 pandemic, the reasons behind the variations in public sentiment are yet to be explored. Moreover, how user sentiment varies due to the COVID-19 pandemic from a cross-country perspective has been less focused on. Therefore, the objectives of this study are: to identify the most effective machine learning (ML) technique for classifying public sentiments, to analyze the variations of public sentiment across the globe, and to find the critical contributing factors to sentiment variations. To attain the objectives, 12,000 tweets, 3000 each from the USA, UK, and Bangladesh, were rigorously annotated by three independent reviewers. Based on the labeled tweets, four different boosting ML models, namely, CatBoost, gradient boost, AdaBoost, and XGBoost, are investigated. Next, the top performed ML model predicted sentiment of 300,000 data (100,000 from each country). The public perceptions have been analyzed based on the labeled data. As an outcome, the CatBoost model showed the highest (85.8 %) F1-score, followed by gradient boost (84.3%), AdaBoost (78.9 %), and XGBoost (83.1 %). Second, it was revealed that during the time of the COVID-19 pandemic, the sentiments of the people of the three countries mainly were negative, followed by positive and neutral. Finally, this study identified a few critical concerns that impact primarily varying public sentiment around the globe: lockdown, quarantine, hospital, mask, vaccine, and the like.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) wastewater surveillance has become an increasingly important tool since the initial moments of the coronavirus disease (COVID-19) pandemic, mainly conducted at a large population scale. However, the large-sized sewersheds may not provide suitable information for monitoring localized outbreaks. After the declaration of a community COVID-19 outbreak in two neighborhoods of Castellón (Spain), SARS-CoV-2 RNA levels were monitored in wastewater samples. Moreover, genomic sequencing was performed. Thirty-three samples were collected in 2020, distributed over three points of the sewage network, two of which were close to the areas where the cases were declared. The third point was located at the inlet of the municipal wastewater treatment plant (WWTP). The samples were analyzed by RT-qPCR, using specific N1 and N2 target regions. The sum of confirmed cases, with the date of symptoms onset within the 3 weeks before each sampling day, was calculated. SARS-CoV-2 RNA was detected on most days in the two sampling points at neighborhood level, and the detection became negative when the number of cases with symptoms onset during the last 21 days in the study areas decreased to 0 or 1 case. The genomic sequencing performed for RNA from wastewater and clinical samples showed the same variant. The detection of SARS-CoV-2 and the subsequent non-detection provided the epidemiologists in charge of controlling the outbreak with useful information to confirm its closure, complementing the clinical and epidemiological data. Our findings illustrate the value of wastewater surveillance for localized outbreaks, especially in situations of low incidence of COVID-19 at the broader community level.

[Objectives] To evaluate the clinical and epidemiological impact of a new molecular surveillance strategy based on qPCR to control an outbreak by Serratia marcescens in a Neonatal Intensive Care Unit (NICU)., [Methods] We design a specific qPCR for the detection of S. marcescens in rectal swabs of patients admitted to a NICU. We divided the surveillance study into two periods: (a) the pre-PCR, from the outbreak declaration to the qPCR introduction, and (b) the PCR period, from the introduction of the qPCR until the outbreak was solved. In all cases, S. marcescens isolates were recovered and their clonal relationship was analysed by PFGE. Control measures were implemented during the outbreak. Finally, the number of bloodstream infections (BSI) was investigated in order to evaluate the clinical impact of this molecular strategy., [Results] Nineteen patients colonized/infected by S. marcescens were detected in the pre-PCR period (October 2020–April 2021). On the contrary, after the PCR implementation, 16 new patients were detected. The PFGE revealed 24 different pulsotypes belonging to 7 different clonal groups, that were not overlapping at the same time. Regarding the clinical impact, 18 months after the qPCR implementation, no more outbreaks by S. marcescens have been declared in the NICU of our hospital, and only 1 episode of BSI has occurred, compared with 11 BSI episodes declared previously to the outbreak control., [Conclusions] The implementation of this qPCR strategy has proved to be a useful tool to control the nosocomial spread of S. marcescens in the NICU.

[Background] The global spread of Klebsiella pneumoniae ST15, causing multi-continental outbreaks, contributes to the movement of resistance genes between clones increasing the antimicrobial resistance crisis. The genomic traits providing it with the ability to outcompete other bacteria and cause epidemics remain unclear., [Aim] To identify the specific genomic traits of K. pneumoniae ST15 to develop a diagnostic test., [Methods] An outbreak caused by K. pneumoniae occurred in Hospital A Coruña, Spain. Antimicrobial susceptibility analysis and molecular typing (PGFE and MLST) were performed. One isolate of each sequence type was selected for whole-genome sequencing analysis. Comparative analysis of genomes was performed using RAST. BLASTn was used to evaluate the presence of the fhaC and kpiD genes. Two hundred and ninety-four K. pneumoniae from a Spanish nationwide collection were analysed by PCR., [Findings] Genotyping showed that 87.5% of the isolates tested belonged to a clone with a unique PFGE pattern which corresponded to ST15. Comparative genomic analysis of the different STs enabled us to determine the specific genomic traits of K. pneumoniae ST15. Two adherence-related systems (Kpi and KpFhaB/FhaC) were specific markers of this clone. Multiplex-PCR analysis with kpiD and fhaC oligonucleotides revealed that K. pneumoniae ST15 is specifically detected with a sensitivity of 100% and a specificity of 97.76%. The PCR results showed 100% concordance with the MLST and whole-genome sequencing data., [Conclusion] K. pneumoniae ST15 possesses specific genomic traits that could favour its dissemination. They could be used as targets to detect K. pneumoniae ST15 with high sensitivity and specificity.

The emergence of acute, severe non hepA–E hepatitis of unknown etiology (ASHUE) has attracted global concern owing to the very young age of the patients and its unknown etiology. Although this condition has been linked to several possible causes, including viral infection, drugs and/or toxin exposure, the exact cause remains unknown; this makes treatment recommendation very difficult. In this review, we summarize recent updates on the clinical manifestations, complemented with laboratory results, case numbers with the global distribution and other epidemiological characteristics, and the possible etiologies. We also provide the proposed actions that could be undertaken to control and prevent further spread of this hepatitis. Since many etiological and pathological aspects of the acute non hepA–E hepatitis remain unclear, further research is needed to minimize the severe impact of this disease.

Background: Typhoid fever is endemic in some Pacific Island Countries including Fiji and Samoa yet genomic surveillance is not routine in such settings. Previous studies suggested imports of the global H58 clade of Salmonella enterica var Typhi (Salmonella Typhi) contribute to disease in these countries which, given the MDR potential of H58, does not auger well for treatment. The objective of the study was to define the genomic epidemiology of Salmonella Typhi in Fiji. Methods: Genomic sequencing approaches were implemented to study the distribution of 255 Salmonella Typhi isolates from the Central Division of Fiji. We augmented epidemiological surveillance and Bayesian phylogenomic approaches with a multi-year typhoid case-control study to define geospatial patterns among typhoid cases. Findings: Genomic analyses showed Salmonella Typhi from Fiji resolved into 2 non-H58 genotypes with isolates from the two dominant ethnic groups, the Indigenous (iTaukei) and non-iTaukei genetically indistinguishable. Low rates of international importation of clones was observed and overall, there were very low levels an antibiotic resistance within the endemic Fijian typhoid genotypes. Genomic epidemiological investigations were able to identify previously unlinked case clusters. Bayesian phylodynamic analyses suggested that genomic variation within the larger endemic Salmonella Typhi genotype expanded at discreet times, then contracted. Interpretation: Cyclones and flooding drove ‘waves’ of typhoid outbreaks in Fiji which, through population aggregation, poor sanitation and water safety, and then mobility of the population, spread clones more widely. Minimal international importations of new typhoid clones suggest that targeted local intervention strategies may be useful in controlling endemic typhoid infection. These findings add to our understanding of typhoid transmission networks in an endemic island country with broad implications, particularly across Pacific Island Countries

Background : Global mobility is increasingly associated with the emergence of "unusual" infectious agents. At the beginning of 2019, a putative outbreak of Impetigo contagiosa occurred in a kindergarten in Regensburg, Germany, that was mainly attended by children with a migrant background. After thorough examination, the outbreak was classified as infection with Trichophyton (T.) violaceum.Methods : Based on case investigations, infection control measures, disinfection, and cleaning were implemented. Microscopy of native specimens, fungal cultures, and polymerase chain reaction were used for diagnosis. Additionally, a systematic literature search in Medline, followed by a quantitative analysis of epidemiological data from Europe, were performed.Results : Between January and November 2019, 12 cases of tinea were diagnosed in 7 educators and 2 household members. Children were initially not affected. T. violaceum was only detected in 2 patients. No extensive screening measures were carried out after risk-benefit assessment. Studies on T. violaceum in Europe are heterogeneous, and the number of cases and the prevalence vary considerably. The pathogen is mainly found in children of African descent who clinically present with tinea capitis .Discussion : In the present case, the source of infection and the chain of transmission remained unclear. The pathogen could only be diagnosed in 2 cases. In Europe, the (re)emergence of pathogens such as T. violaceum is likely to be caused by increasing migration and travel. Pathogens should be identified for epidemiological reasons in all cases. In outbreaks, measures must be adapted to the dynamics of the individual outbreak after assessment of the risks, benefits, and proportionality., Hintergrund : Globale Mobilität wird zunehmend mit dem Aufkommen "ungewöhnlicher" Infektionserreger in Verbindung gebracht. Anfang 2019 kam es in einem Kindergarten in Regensburg, Deutschland, der hauptsächlich von Kindern mit Migrationshintergrund besucht wurde, zu einem mutmaßlichen Ausbruch von Impetigo contagiosa . Nach eingehender Untersuchung wurde der Ausbruch als Infektion mit Trichophyton (T.)violaceum eingestuft.Methoden : Auf der Basis von Falluntersuchungen wurden Infektionsschutz-, Desinfektions- und Reinigungsmaßnahmen implementiert. Zur Diagnostik kamen Mikroskopie von Nativpräparaten, Pilzkulturen und Polymerase-Kettenreaktion zum Einsatz. Ergänzend wurde eine systematische Literaturrecherche in Medline mit anschließender quantitativer Analyse epidemiologischer Daten aus Europa durchgeführt.Ergebnisse : Zwischen Januar und November 2019 wurden 12 Fälle von Tinea bei 7 Erziehern und 2 Haushaltsmitgliedern diagnostiziert. Kinder waren zunächst nicht betroffen. T. violaceum wurde nur bei 2 der Patienten nachgewiesen. Nach Nutzen-Risiko-Abwägung wurden keine umfangreichen Screening-Maßnahmen durchgeführt. Studien zu T. violaceum in Europa sind heterogen, die Fallzahlen und die Prävalenz variieren erheblich. Der Erreger wird hauptsächlich bei Kindern afrikanischer Abstammung gefunden, die sich klinisch mit einer Tinea capitis präsentieren.Diskussion : Im vorliegenden Fall blieben die Infektionsquelle und die Übertragungskette unklar. Der Erreger konnte nur in 2 Fällen diagnostiziert werden. In Europa wird das (Wieder-)Auftreten von Krankheitserregern wie T. violaceum wahrscheinlich durch zunehmende Migration und Reisen verursacht. Krankheitserreger sollten grundsätzlich aus epidemiologischen Gründen bei allen Fällen identifiziert werden. Bei Ausbrüchen müssen die Maßnahmen nach Abwägung von Risiken, Nutzen und Verhältnismäßigkeit an die Dynamik des einzelnen Ausbruchs angepasst werden.

OBJECTIVE: To describe the course of the outbreak and infection control measures to stop the spread of sequence type 15 OXA-23-producing Acinetobacter baumannii in the Burn Center of Uppsala University Hospital, between November 2014 and the end of April 2015. METHODS: Compliance with hand hygiene, dress code, and cleaning routines were reviewed, the ward's environment was systematically investigated to identify potential environmental sources. Sampling routines for A. baumannii, from patients and environment, were established, and the epidemiological relationship was analysed for all carbapenem-resistant A. baumannii isolates using arbitrarily primed polymerase chain reaction (AP-PCR) and pulsed-field gel electrophoresis (PFGE). RESULTS: A total of 54 patients were treated at the burn intensive care unit during the studied, approximately five months period, and an OXA-23-producing A. baumannii was isolated from nine patients (9/54, 17%), whereof two died (2/9, 22.2%). All isolates shared identical PFGE-genotype patterns and belonged to sequence type 15; AP-PCR was eligible for prompt epidemiological investigations. CONCLUSIONS: Higher awareness and increased compliance with hand hygiene and dress code as well as intensified cleaning protocols of the environment and equipment were successfully established and likely to have led to stop the spread of sequence type 15 OXA-23-producing Acinetobacter baumannii.

Background: The flagellated parasite Giardia duodenalis is a major and global cause of diarrhoeal disease. Eight genetically very distinct groups, known as assemblages A to H, have been recognized in the G. duodenalis species complex, two of which (assemblages A and B) infect humans and other mammalian hosts. Informative typing schemes are essential to understand transmission pathways, characterize outbreaks and trace zoonotic transmission. In this study, we evaluated a published multi-locus sequence typing (MLST) scheme for G. duodenalis assemblage A, which is based on six polymorphic markers. Methods: We genotyped 60 human-derived and 11 animal-derived G. duodenalis isolates collected in Europe and on other continents based on the published protocol. After retrieving previously published genotyping data and excluding isolates whose sequences showed allelic sequence heterozygosity, we analysed a dataset comprising 146 isolates. Results: We identified novel variants at five of the six markers and identified 78 distinct MLST types in the overall dataset. Phylogenetic interpretation of typing data confirmed that sub-assemblage AII only comprises human-derived isolates, whereas sub-assemblage AI comprises all animal-derived isolates and a few human-derived isolates, suggesting limited zoonotic transmission. Within sub-assemblage AII, isolates from two outbreaks, which occurred in Sweden and Italy, respectively, had unique and distinct MLST types. Population genetic analysis showed a lack of clustering by geographical origin of the isolates. Conclusion: The MLST scheme evaluated provides sufficient discriminatory power for epidemiological studies of G. duodenalis assemblage A.

Fecal contamination of water sources and open defecation have been linked to cholera outbreaks in India. However, a systematic review on the drivers responsible for these outbreaks has yet to be published. Here, we systematically review the published literature on cholera outbreaks in India between 2011 and 2020. We searched studies in English in three databases (MEDLINE, EMBASE, and Web of Science) and the Integrated Disease Surveillance Program that tracks cholera outbreaks throughout India. Two authors independently extracted data and assessed the quality of the included studies. Quantitative data on the modes of transmission reviewed in this study were assessed for any change over time between 2011-2015 and 2016-2020. Our search retrieved 10823 records initially, out of which 81 full-text studies were assessed for eligibility. Among these 81 studies, 20 were eligible for inclusion in this review. There were 565 reported outbreaks between 2011 and 2020 that led to 45,759 cases and 263 deaths. Outbreaks occurred throughout the year; however, they exploded with monsoons (June through September). In Tamil Nadu, a typical peak of cholera outbreaks was observed from December to January. Seventy-two percent (33,089/45,759) of outbreak-related cases were reported in five states, namely Maharashtra, West Bengal, Punjab, Karnataka, and Madhya Pradesh. Analysis of these outbreaks highlighted the main drivers of cholera including contaminated drinking water and food, inadequate sanitation and hygiene (including open defecation), and direct contact between households. The comparison between 2011-2015 and 2016-2020 showed a decreasing trend in the outbreaks that arose due to damaged water pipelines. Many Indians still struggle with open defecation, sanitation, and clean water access. These issues should be addressed critically. In addition, it is essential to interrupt cholera short-cycle transmission (mediated by households, stored drinking water and foodstuffs) during an ou

The purpose of this study was to explore sampling options for a reliable and logistically more feasible protocol during a large EHV-1 outbreak. Seventeen horses with clinical infection as well as nineteen healthy herdmates, all part of an EHM outbreak, were enrolled in the study. Each horse was sampled two-four times at intervals of 2-6 days during the outbreak. All samples were collected using 6'' rayon-tipped swabs. Nasal secretions were used as the diagnostic sample of choice. Additional samples, including swabs from the muzzle/nares, swabs from the front limbs, rectal swabs, swabs of the feed bin, and swabs of the water troughs were collected as well. All swabs were tested for the presence of EHV-1 by qPCR. With the exception of two EHV-1 qPCR-positive swabs from two different horses, all remaining swabs collected from healthy herdmates tested qPCR-negative for EHV-1. For horses with clinical infection, EHV-1 was detected in 31 nasal swabs, 30 muzzle/nares swabs, 7 front limb swabs, 7 feeders, 6 water troughs and 6 rectal swabs. Not all positive muzzle/nares swabs correlated with a positive nasal swab from the same set, however, and all other positive swabs did correlate with a positive nasal swab in their respective set. The agreement between nasal swabs and muzzle/nares swabs was 74%. The sampling of non-invasive swabs from the muzzle/nares should facilitate the identification of EHV-1 shedders during an outbreak, allowing for prompt isolation and implementation of biosecurity measures.

In view of the most recent pandemic declared in 2020 due to the coronavirus, discovered in China at the end of 2019, multiple security measures were adopted worldwide, generating multiple consequences on the emotional, psychological and social well-being of the population, especially in the health personnel working on the front line (García-Iglesias, 2020). The present research is focused on the impact that SARS-COV-2 has had on the mental health of the nursing staff at the Teófilo Dávila Hospital due to the psychosocial changes that have occurred. A 16-question survey on "mental health impact of the COVID -19 pandemic" was applied to the nursing staff working especially in the clinical area, this area was chosen as relevant since they were the ones who attended covid patients during the whole pandemic period. The results obtained showed that the nursing staff during the pandemic presented psychological alterations such as anxiety, depression, anguish, fear and panic; due to the excess of working hours caused by the increase of patients attended, the professionals developed somatic problems, the fear of infecting family members is a constant, although they do not feel rejection by society., Face à mais recente pandemia declarada em 2020 devido ao coronavírus, descoberta na China no final de 2019, foram adoptadas múltiplas medidas de segurança em todo o mundo, gerando múltiplas consequências no bem-estar emocional, psicológico e social da população, especialmente no pessoal de saúde que trabalha na linha da frente (García-Iglesias, 2020). Esta investigação centra-se no impacto que a SRA-COV-2 teve na saúde mental do pessoal de enfermagem do Hospital Teófilo Dávila devido às mudanças psicossociais que ocorreram. O objectivo deste estudo foi avaliar os efeitos psicossociais da SRA-COV-2 nos enfermeiros da linha de frente. Um inquérito de 16 perguntas sobre o "impacto da pandemia COVID-19 na saúde mental" foi administrado a enfermeiros que trabalham na área clínica. Esta área foi escolhida como relevante porque foram eles que cuidaram dos doentes covardes durante todo o período pandémico. Os resultados obtidos mostraram que o pessoal de enfermagem durante a pandemia apresentou alterações psicológicas tais como ansiedade, depressão, angústia, medo e pânico; devido ao excesso de horas de trabalho causado pelo aumento do número de pacientes atendidos, os profissionais desenvolveram problemas somáticos, o medo de infectar os membros da família é uma constante, embora não se sintam rejeitados pela sociedade., Ante la más reciente pandemia declarada en el año 2020 a causa del coronavirus, descubierto en china a fines del año 2019, y debido a las múltiples medidas de seguridad que adoptaron los países en todo el mundo ha llegado a generar consecuencias en la salud mental de la población, especialmente en el personal de salud que laboro en primera línea. La presente investigación está enfocada en el impacto que el SARS-COV2 ha tenido en la salud mental del personal de enfermería en el Hospital Teófilo Dávila debido a los cambios psicosociales que se han presentado (1). Esta investigación fue realizada para evaluar los efectos psicosociales en el personal de enfermería que están en primera línea ante el SARS-COV2. Para su realización se aplicó una encuesta de 16 preguntas sobre “impacto de la salud mental ante la pandemia de covid -19” en el hospital Teófilo Dávila al personal de enfermería que labora especialmente en el área de clínica, se escogió esta área como relevante ya que fueron quienes atendieron pacientes covid durante todo el periodo de pandemia (2). En los resultados obtenidos se reflejó que el personal de enfermería, durante la pandemia, presentó alteraciones psicológicas como ansiedad, depresión, angustia y pánico. Además, se llegó a desarrollar problemas somáticos, debido al exceso de horas laborales que se originó por el aumento de pacientes atendidos en el Hospital Teófilo Dávila.

This contains a set of MATLAB scripts and data that were used to generate the figures and results in the manuscripts.

An extensive multi-country outbreak of multidrug-resistant monophasic Salmonella Typhimurium infection in 10 countries with 150 reported cases, predominantly affecting young children, has been linked to chocolate products produced by a large multinational company. Extensive withdrawals and recalls of multiple product lines have been undertaken. With Easter approaching, widespread product distribution and the vulnerability of the affected population, early and effective real-time sharing of microbiological and epidemiological information has been of critical importance in effectively managing this serious food-borne incident.

There has been a recent outbreak of e-cigarette or vaping-associated lung injury (EVALI) but the exact pathophysiology remains unknown. Tetrahydrocannabinol (THC) and vitamin E derivates are the major components in vaping-generated aerosols that are associated with EVALI. So far, there is no standard treatment for EVALI. Most cases are treated with antibiotics and steroids. Counseling for smoking cessation is an integral part of care for EVALI patients. Referral to addiction medicine may be beneficial. Considering the nonspecific presenting symptoms and the growing popularity of vaping devices, providers need to consider EVALI in the differential diagnosis of bilateral patchy ground-glass opacities with respiratory, constitutional, or gastrointestinal symptoms in patients using e-cigarettes. Here, we present four EVALI cases and review the pertinent imaging and pathological findings.

During infectious disease outbreaks, early warning is crucial to prevent and control the further spread of the disease. While the different waves of the Covid-19 pandemic have demonstrated the need for continued compliance, little is known about the impact of warning messages and risk perception on individual behavior in public health emergencies. To address this gap, this paper uses data from the second wave of Covid-19 in China to analyse how warning information influences preventive behavior through four categories risk perception and information interaction. Drawing on the protective action decision model (PADM) and the social amplification of risk framework (SARF), risk warning information (content, channel, and type), risk perception (threat perception, hazard- and resource-related preparedness behavior perception and stakeholder perception), information interaction, and preparedness behavior intention are integrated into a comprehensive model. To test our model, we run a survey with 724 residents in Northern China. The results show that hazard-related preparedness behavior perception and stakeholder perception act as mediators between warning and preventive action. Stakeholder perception had much stronger mediating effects than the hazard-related attributes. In addition, information interaction is effective in increasing all categories risk perception, stimulating public response, while functioning as a mediator for warning. The risk warning information content, channel, and type are identified as key drivers of risk perception. The research found that information channel was more related to different risk perception than other characteristics. Overall, these associations in our model explain core mechanisms behind compliance and allow policy-makers to gain new insights into preventive risk communication in public health emergencies.

Infectious threats to humans are continuously emerging. The 2022 worldwide monkeypox outbreak is the latest of these threats with the virus rapidly spreading to 106 countries by the end of September 2022. The burden of the ongoing monkeypox outbreak is manifested by 68,000 cumulative confirmed cases and 26 deaths. Although monkeypox is usually a self-limited disease, patients can suffer from extremely painful skin lesions and complications can occur with reported mortalities. The antigenic similarity between the smallpox virus (variola virus) and monkeypox virus can be utilized to prevent monkeypox using smallpox vaccines; treatment is also based on antivirals initially designed to treat smallpox. However, further studies are needed to fully decipher the immune response to monkeypox virus and the immune evasion mechanisms. In this review we provide an up-to-date discussion of the current state of knowledge regarding monkeypox virus with a special focus on innate immune response, immune evasion mechanisms and vaccination against the virus.