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Context: The 2022 United States mpox outbreak disproportionately affected racial and ethnic minority gay, bisexual, and other men who have sex with men., Program: We utilized surveillance data and vaccination registries to determine whether populations most impacted by mpox in Alameda County received JYNNEOS vaccines and tecovirimat (TPOXX) during June 1-October 31, 2022., Implementation: Alameda County Public Health Department responded to the mpox epidemic through partnerships with local health care providers who serve communities disproportionately affected by mpox., Evaluation: During June 1-October 31, 2022, a total of 242 mpox cases were identified in Alameda County. Mpox incidence rates per 100 000 were highest among Black/African American (35.7; 95% confidence interval [CI], 26.8-46.5) and Hispanic/Latinx (25.1; CI, 20.1-30.9) residents, compared to Asian (3.8; CI, 2.3-5.9) and White (10.5; CI, 7.7-13.9) residents. Most confirmed cases were identified as gay, lesbian, or same-gender-loving (134, 67.3%) and bisexual (31, 15.6%); 226 (93.8%) cases were male. Sixty-nine (28.5%) mpox patients received TPOXX. There were no statistically significant differences in demographic and clinical characteristics of mpox cases when compared by TPOXX receipt status. JYNNEOS vaccine was received by 8277 Alameda County residents. The largest proportion of vaccinees were White residents (40.2%). Administration rates per 100 000 men who have sex with men were lowest among Asian and Hispanic/Latinx individuals, at 8779 (CI, 8283-9296) and 14 953 (CI, 14 156-15 784), respectively. Black/African American and Hispanic/Latinx males had the lowest vaccination-to-case ratios at 16.7 and 14.8, respectively., Discussion: Mpox disproportionately affected Black/African American and Hispanic/Latinx men who have sex with men in Alameda County. Strong partnerships with local health care providers ensured that persons with mpox received TPOXX treatment when indicated. However, higher JYNNEOS vaccine uptake in Black and Latinx communities needs improvement through ongoing and meaningful engagement with Black/African American and Hispanic/Latinx gay, bisexual, and transgender communities., Competing Interests: The authors declare that they have no conflicts of interest., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Reducing spillover of zoonotic pathogens is an appealing approach to preventing human disease and minimizing the risk of future epidemics and pandemics. Although the immediate human health benefit of reducing spillover is clear, over time, spillover reduction could lead to counterintuitive negative consequences for human health. Here, we use mathematical models and computer simulations to explore the conditions under which unanticipated consequences of spillover reduction can occur in systems where the severity of disease increases with age at infection. Our results demonstrate that, because the average age at infection increases as spillover is reduced, programs that reduce spillover can actually increase population-level disease burden if the clinical severity of infection increases sufficiently rapidly with age. If, however, immunity wanes over time and reinfection is possible, our results reveal that negative health impacts of spillover reduction become substantially less likely. When our model is parameterized using published data on Lassa virus in West Africa, it predicts that negative health outcomes are possible, but likely to be restricted to a small subset of populations where spillover is unusually intense. Together, our results suggest that adverse consequences of spillover reduction programs are unlikely but that the public health gains observed immediately after spillover reduction may fade over time as the age structure of immunity gradually re-equilibrates to a reduced force of infection., Competing Interests: I have read the journal’s policy and the authors of this manuscript have the following competing interests: S.L. Nuismer is listed as an inventor on a pending patent for a Lassa virus vaccine., (Copyright: © 2024 Nuismer et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Rotavirus is globally recognized as an important cause of acute gastroenteritis in young children. Whereas previous studies focused more on sporadic diarrhea, the epidemiological characteristics of rotavirus outbreaks have not been systematically understood., Methods: This systematic review was carried out according to the Preferred Reporting Items for Systematic Review and Meta-Analysis standards, WANFANG, China National Knowledge Infrastructure (CNKI), PubMed, and Web of Science databases were searched from database inception to February 20, 2022. We used SPSS 21.0 statistical software for data analysis, RStudio1.4.1717, and ArcGIS trial version for plotting bar graphs and maps., Results: Among 1,596 articles, 78 were included, with 92 rotavirus outbreaks and 96,128 cases. Most outbreaks (67.39%, 62/92) occurred in winter and spring. The number of rotavirus outbreaks reported in the eastern region was more than that in the western region. Outbreaks were most commonly reported in villages (33/92, 35.87%), followed by hospitals (19, 20.65%). The outbreak duration was longer in factories and workers' living places, and villages, while it was shorter in hospitals. Waterborne transmission was the main transmission mode, with the longest duration and the largest number of cases. Rotavirus groups were identified in 66 outbreaks, with 40 outbreaks (60.61%) caused by Group B rotaviruses and 26 outbreaks (39.39%) caused by Group A rotaviruses. Significant differences were found in duration, number of cases, settings, population distribution, and transmission modes between Groups A and B rotavirus outbreaks., Conclusion: Rotavirus is an important cause of acute gastroenteritis outbreaks in China. It should also be considered in the investigation of acute gastroenteritis outbreaks, especially norovirus-negative outbreaks., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Tian, Yu, Zhang, Tian, Wang, Chen, Yan, Jia, Zhang, Wang and Gao.)

Human behaviors have non-negligible impacts on spread of contagious disease. For instance, large-scale gathering and high mobility of population could lead to accelerated disease transmission, while public behavioral changes in response to pandemics may effectively reduce contacts and suppress the peak of the outbreak. In order to understand how spatial characteristics like population mobility and clustering interplay with epidemic outbreaks, we formulate a stochastic-statistical environment-epidemic dynamic system (SEEDS) via an agent-based biased random walk model on a two-dimensional lattice. The "popularity" and "awareness" variables are taken into consideration to capture human natural and preventive behavioral factors, which are assumed to guide and bias agent movement in a combined way. It is found that the presence of the spatial heterogeneity, like social influence locality and spatial clustering induced by self-aggregation, potentially suppresses the contacts between agents and consequently flats the epidemic curve. Surprisedly, disease responses might not necessarily reduce the susceptibility of informed individuals and even aggravate disease outbreak if each individual responds independently upon their awareness. The disease control is achieved effectively only if there are coordinated public-health interventions and public compliance to these measures. Therefore, our model may be useful for quantitative evaluations of a variety of public-health policies., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Xiong et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Objective: Epidemics are sudden and rapidly spreading. Hospitals in underdeveloped areas are particularly vulnerable in case of an outbreak. This paper aims to assess the epidemic risk state and its change trend of hospitals in different epidemic stages, identify the key factors affecting hospital epidemic risk change, provide priority reference for hospital epidemic risk control, and enhance the hospital's ability to respond to sudden epidemics., Methods: Based on Grounded theory, the epidemic risk indicators that affect hospital safety are summarized. The concept of epidemic risk state and its random state space is proposed according to Markov chain theory. The impact of each indicator on the random risk state and its change is comprehensively assessed from two aspects: risk occurrence probability and risk loss. Finally, the assessment of the hospital epidemic risk state and its change at different stages is achieved., Results: The stable risk states of public hospitals in underdeveloped areas in non-epidemic stage t 0, early epidemic stage t 1, and outbreak stage t 2 are P ^ t 0 ( S n ) = { 0 . 142 , 0 . 546 , 0 . 220 , 0 . 093 } , P ^ t 1 ( S n ) = { 0 . 025 , 0 . 364 , 0 . 254 , 0 . 357 } , and P ^ t 2 ( S n ) = { 0 . 020 , 0 . 241 , 0 . 191 , 0 . 548 } , respectively. In non-epidemic stage, the key factor in improving the hospital epidemic risk state is emergency funding. In early epidemic stage, the key factors in improving the hospital epidemic risk state are the training of medical staff in epidemic prevention skills and the management of public health. In outbreak state, the key factor in improving the hospital epidemic risk state is the training of medical staff in epidemic prevention skills and psychological awareness., Conclusion: This paper proposes the concept of epidemic risk state, providing an effective assessment method for the epidemic risk state and its change trend in public hospitals. According to the assessment, public hospitals in underdeveloped areas in different epidemic stages should adopt different risk control strategies to improve their current risk state. Blind risk control is inefficient and may even cause the epidemic risk to transition toward a more dangerous state., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Yang, Miao, Li, Jiang and Jiang.)

The emergence of dengue viruses in new, susceptible human populations worldwide is increasingly influenced by a combination of local and global human movements and favorable environmental conditions. While various mathematical models have explored the impact of environmental factors on dengue outbreaks, the significant role of human mobility both internationally and domestically in transmitting the disease has been less frequently addressed. In this context, we introduce a modeling framework that integrates the effects of international travel-induced imported cases, climatic conditions, and local human movements to assess the spatiotemporal dynamics of dengue transmission. Utilizing the generation matrix method, we calculate the basic reproduction number and its sensitivity to various model parameters. Through numerical simulations using data on climate, human mobility, and reported dengue cases in mainland China, our model demonstrates a good agreement with observed data upon validation. Our findings reveal that while climatic conditions are a key driver for the rapid dengue transmission, human mobility plays a crucial role in its local spread. Importantly, the model highlights the significant impact of imported cases from overseas on the initiation of dengue outbreaks and their contribution to increasing the disease incidence rate by 34.6%. Furthermore, the analysis identifies that dengue cases originating from regions, such as Cambodia and Myanmar internationally, and Guangzhou and Xishuangbanna domestically, have the potential to significantly increase the disease burden in mainland China. These insights emphasize the critical need to include data on imported cases and domestic travel patterns in disease outbreak models to improve the precision of predictions, thereby enhancing dengue prevention, surveillance, and response strategies., (© 2024 Author(s). Published under an exclusive license by AIP Publishing.)

The presence of heterogeneity in susceptibility, differences between hosts in their likelihood of becoming infected, can fundamentally alter disease dynamics and public health responses, for example, by changing the final epidemic size, the duration of an epidemic, and even the vaccination threshold required to achieve herd immunity. Yet, heterogeneity in susceptibility is notoriously difficult to detect and measure, especially early in an epidemic. Here we develop a method that can be used to detect and estimate heterogeneity in susceptibility given contact by using contact tracing data, which are typically collected early in the course of an outbreak. This approach provides the capability, given sufficient data, to estimate and account for the effects of this heterogeneity before they become apparent during an epidemic. It additionally provides the capability to analyze the wealth of contact tracing data available for previous epidemics and estimate heterogeneity in susceptibility for disease systems in which it has never been estimated previously. The premise of our approach is that highly susceptible individuals become infected more often than less susceptible individuals, and so individuals not infected after appearing in contact networks should be less susceptible than average. This change in susceptibility can be detected and quantified when individuals show up in a second contact network after not being infected in the first. To develop our method, we simulated contact tracing data from artificial populations with known levels of heterogeneity in susceptibility according to underlying discrete or continuous distributions of susceptibilities. We analyzed these data to determine the parameter space under which we are able to detect heterogeneity and the accuracy with which we are able to estimate it. We found that our power to detect heterogeneity increases with larger sample sizes, greater heterogeneity, and intermediate fractions of contacts becoming infected in the discrete case or greater fractions of contacts becoming infected in the continuous case. We also found that we are able to reliably estimate heterogeneity and disease dynamics. Ultimately, this means that contact tracing data alone are sufficient to detect and quantify heterogeneity in susceptibility., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Tuschhoff, Kennedy. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

This analysis considers circulation of bacterial disease in wartime Ukraine. Anthrax, brucellosis, botulism and tularaemia are all naturally occurring in the country. The causative agents of these diseases also formed components of the biological weapons programme the Russian Federation inherited from the Soviet Union at the end of the Cold War. Differentiating between natural and unnatural outbreaks of disease in Ukraine is essential for combating disinformation and maintaining health security as the war intensifies., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: West Nile virus (WNV) is an emerging mosquito-borne pathogen in Serbia, where it has been detected as a cause of infection in humans since 2012. We analyzed and modelled WNV transmission patterns in the country between 2012 and 2023., Methods: We applied a previously developed modelling approach to quantify epidemiological parameters of interest and to identify the most important environmental drivers of the force of infection (FOI) by means of statistical analysis in the human population in the country., Results: During the study period, 1,387 human cases were recorded, with substantial heterogeneity across years. We found that spring temperature is of paramount importance for WNV transmission, as FOI magnitude and peak timing are positively associated with it. Furthermore, FOI is also estimated to be greater in regions with a larger fraction of older adult people, who are at higher risk to develop severe infections., Conclusion: Our results highlight that temperature plays a key role in shaping WNV outbreak magnitude in Serbia, confirming the association between spring climatic conditions and WNV human transmission risk and thus pointing out the importance of this factor as a potential early warning predictor for timely application of preventive and control measures., Competing Interests: WW was employed by Environmental Research Group Oxford Ltd, c/o Dept Biology. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Marini, Drakulovic, Jovanovic, Dagostin, Wint, Tagliapietra, Vasic and Rizzoli.)

Emerging infectious diseases with zoonotic potential often have complex socioecological dynamics and limited ecological data, requiring integration of epidemiological modeling with surveillance. Although our understanding of SARS-CoV-2 has advanced considerably since its detection in late 2019, the factors influencing its introduction and transmission in wildlife hosts, particularly white-tailed deer (Odocoileus virginianus), remain poorly understood. We use a Susceptible-Infected-Recovered-Susceptible epidemiological model to investigate the spillover risk and transmission dynamics of SARS-CoV-2 in wild and captive white-tailed deer populations across various simulated scenarios. We found that captive scenarios pose a higher risk of SARS-CoV-2 introduction from humans into deer herds and subsequent transmission among deer, compared to wild herds. However, even in wild herds, the transmission risk is often substantial enough to sustain infections. Furthermore, we demonstrate that the strength of introduction from humans influences outbreak characteristics only to a certain extent. Transmission among deer was frequently sufficient for widespread outbreaks in deer populations, regardless of the initial level of introduction. We also explore the potential for fence line interactions between captive and wild deer to elevate outbreak metrics in wild herds that have the lowest risk of introduction and sustained transmission. Our results indicate that SARS-CoV-2 could be introduced and maintained in deer herds across a range of circumstances based on testing a range of introduction and transmission risks in various captive and wild scenarios. Our approach and findings will aid One Health strategies that mitigate persistent SARS-CoV-2 outbreaks in white-tailed deer populations and potential spillback to humans., Competing Interests: The authors have declared that no competing interests exist., (Copyright: This is an open access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 public domain dedication.)

The Ebola virus disease (EVD) has been endemic since 1976, and the case fatality rate is extremely high. EVD is spread by infected animals, symptomatic individuals, dead bodies, and contaminated environment. In this paper, we formulate an EVD model with four transmission modes and a time delay describing the incubation period. Through dynamical analysis, we verify the importance of blocking the infection source of infected animals. We get the basic reproduction number without considering the infection source of infected animals. And, it is proven that the model has a globally attractive disease-free equilibrium when the basic reproduction number is less than unity; the disease eventually becomes endemic when the basic reproduction number is greater than unity. Taking the EVD epidemic in Sierra Leone in 2014-2016 as an example, we complete the data fitting by combining the effect of the media to obtain the unknown parameters, the basic reproduction number and its time-varying reproduction number. It is shown by parameter sensitivity analysis that the contact rate and the removal rate of infected group have the greatest influence on the prevalence of the disease. And, the disease-controlling thresholds of these two parameters are obtained. In addition, according to the existing vaccination strategy, only the inoculation ratio in high-risk areas is greater than 0.4, the effective reproduction number can be less than unity. And, the earlier the vaccination time, the greater the inoculation ratio, and the faster the disease can be controlled., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Objective: The objective of this study was to identify the factors associated with the outcome of the 2023 diphtheria outbreak in Jigawa State, Nigeria., Methods: A descriptive cross-sectional study was conducted amongst all line-listed diphtheria cases reported from Jigawa State, Nigeria, using the 2023 Integrated Disease and Surveillance Response line list of cases that met the World Health Organization case definition of diphtheria. A total of 245 line-listed cases from January 2023 to December 2023 met the criteria for inclusion in the study. Data were analysed using IBM SPSS version 22.0 with a P value set at ≤5%. Binary logistic regression was used to identify the independent predictors of the outcome of the 2023 outbreak., Results: The maximum age of the line-listed cases was 39 years, and the minimum was 1 year with a median of 8 (interquartile range = 5-8) years. More than two-thirds (68.2%) of the cases were ≥5 years of age. More than one-third of the cases (39.6%) were from the northeast senatorial zone of the state. Out of the total 245 cases, 14 died of the disease representing a case fatality rate of 6%, and an attack rate of 3.4 per 100,000 populations. The majority of the cases (95.5%) had fever, cough (81.2%), pharyngitis (86.9%), tonsillitis (96.7%) and laryngitis (82.0%). More diphtheria-related mortalities were recorded amongst cases <5 years of age (7.7%), female cases (5.9%), rural residence (7.7%) and cases from the northeast senatorial zone (8.2%) of the state. Significantly higher mortalities (8.8%, P = 0.003) were recorded amongst cases with nasopharyngitis. The odds of diphtheria-related mortality were higher amongst cases who presented clinically with nasopharyngitis and were 4 times more likely to die (adjusted odds ratio = 3.9; 95% confidence interval = 1.1-14.3) compared with those with no nasopharyngitis., Conclusions: Significantly higher mortalities were recorded amongst diphtheria cases whose samples were not taken, and those with nasopharyngitis. These findings underscored the importance of improved immunisation uptake, early and prompt case detection, investigation and proper management., (Copyright © 2024 Copyright: © 2024 Nigerian Postgraduate Medical Journal.)

BackgroundBy mid-September 2023, several event notifications related to cryptosporidiosis had been identified from different regions in Spain. Therefore, a request for urgent notification of cryptosporidiosis cases to the National Surveillance Network was launched.AimWe aimed at assessing the extent of the increase in cases, the epidemiological characteristics and the transmission modes and compared to previous years.MethodsWe analysed data on case notifications, outbreak reports and genotypes focusing on June-October 2023 and compared the results to 2016-2022.ResultsIn 2023, 4,061 cryptosporidiosis cases were notified in Spain, which is an increase compared to 2016-2022. The cumulative incidence was 8.3 cases per 100,000 inhabitants in 2023, sixfold higher than the median of 1.4 cases per 100,000 inhabitants 2016-2022. Almost 80% of the cases were notified between June and October. The largest outbreaks were related to contaminated drinking water or swimming pools. Cryptosporidium hominis was the most common species in the characterised samples (115/122), and the C. hominis IfA12G1R5 subtype, previously unusual in Spain, was detected from 76 (62.3%) of the 122 characterised samples.ConclusionsA substantial increase in cryptosporidiosis cases was observed in 2023. Strengthening surveillance of Cryptosporidium is essential for prevention of cases, to better understand trends and subtypes circulating and the impact of adverse meteorological events.

Diverse modelling techniques in cholera epidemiology have been developed and used to (1) study its transmission dynamics, (2) predict and manage cholera outbreaks, and (3) assess the impact of various control and mitigation measures. In this study, we carry out a critical and systematic review of various approaches used for modelling the dynamics of cholera. Also, we discuss the strengths and weaknesses of each modelling approach. A systematic search of articles was conducted in Google Scholar, PubMed, Science Direct, and Taylor & Francis. Eligible studies were those concerned with the dynamics of cholera excluding studies focused on models for cholera transmission in animals, socio-economic factors, and genetic & molecular related studies. A total of 476 peer-reviewed articles met the inclusion criteria, with about 40% (32%) of the studies carried out in Asia (Africa). About 52%, 21%, and 9%, of the studies, were based on compartmental (e.g., SIRB), statistical (time series and regression), and spatial (spatiotemporal clustering) models, respectively, while the rest of the analysed studies used other modelling approaches such as network, machine learning and artificial intelligence, Bayesian, and agent-based approaches. Cholera modelling studies that incorporate vector/housefly transmission of the pathogen are scarce and a small portion of researchers (3.99%) considers the estimation of key epidemiological parameters. Vaccination only platform was utilized as a control measure in more than half (58%) of the studies. Research productivity in cholera epidemiological modelling studies have increased in recent years, but authors used diverse range of models. Future models should consider incorporating vector/housefly transmission of the pathogen and on the estimation of key epidemiological parameters for the transmission of cholera dynamics., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Introduction: Norovirus is widely recognized as a leading cause of both sporadic cases and outbreaks of acute gastroenteritis (AGE) across all age groups. The GII.4 Sydney 2012 variant has consistently prevailed since 2012, distinguishing itself from other variants that typically circulate for a period of 2-4 years., Objective: This review aims to systematically summarize the prevalence of norovirus gastroenteritis following emergence of the GII.4 Sydney 2012 variant., Methods: Data were collected from PubMed, Embase, Web of Science, and Cochrane databases spanning the period between January 2012 and August 2022. A meta-analysis was conducted to investigate the global prevalence and distribution patterns of norovirus gastroenteritis from 2012 to 2022., Results: The global pooled prevalence of norovirus gastroenteritis was determined to be 19.04% (16.66-21.42%) based on a comprehensive analysis of 70 studies, which included a total of 85,798 sporadic cases with acute gastroenteritis and identified 15,089 positive cases for norovirus. The prevalence rate is higher in winter than other seasons, and there are great differences among countries and age groups. The pooled attack rate of norovirus infection is estimated to be 36.89% (95% CI, 36.24-37.55%), based on a sample of 6,992 individuals who tested positive for norovirus out of a total population of 17,958 individuals exposed during outbreak events., Conclusion: The global prevalence of norovirus gastroenteritis is always high, necessitating an increased emphasis on prevention and control strategies with vaccine development for this infectious disease, particularly among the children under 5 years old and the geriatric population (individuals over 60 years old)., Competing Interests: XD was employed by Chengdu Kanghua Biological Products Co., Ltd. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Zhang, Hao, Di, Chuizhao, Jinsong, Guisen, Hui and Zhaojun.)

Background: Legionnaires' disease is a type of severe pneumonia caused by Legionella bacteria. The case fatality rate in this disease is 5-10%. People with various comorbidities, smokers and the elderly are at greater risk of developing the disease., Objective: The aim of the work is to present the results of an epidemiological investigation into the outbreak of Legionnaires' disease that occurred in the city of Rzeszów and the surrounding area in August and September 2023 and to present the threat related to the presence of Legionella bacteria in water supply installations and networks., Material and Methods: The material for this publication was data from an epidemiological investigation conducted in the outbreak of Legionnaires disease in Rzeszów in 2023., Results: Epidemiological investigation revealed 165 cases of Legionnaires' disease in the outbreak, including 152 confirmed cases and 13 probable cases. The case fatality rate in a legionellosis outbreak was 15%. Environmental tests were carried out in residential and public buildings and industrial installations during the investigation. As part of environmental tests, 187 water samples were collected, including 87 warm water samples., Conclusions: The outbreak of Legionnaires' disease in the city of Rzeszów draws attention to the potential threat from the Legionella bacteria to the health and life of especially elderly people suffering from chronic diseases. The environmental tests carried out confirmed the highest number of Legionella bacteria at medium and high levels in water samples taken in the private apartments of sick people. Despite the lack of strict legal regulations clearly specifying the obligations regarding periodic disinfection of internal hot water supply installations, cooperation with their owners should be undertaken to enforce plans and actions in this area.

Background: The outbreak of norovirus represents a significant public health emergency within densely populated, impoverished, and underdeveloped areas and countries. Our objective is to conduct an epidemiology study of a norovirus outbreak that occurred in a kindergarten located in rural western China. We aim to raise awareness and garner increased attention towards the prevention and control of norovirus, particularly in economically underdeveloped regions., Methods: Retrospective on-site epidemiological investigation results, including data on school layout, case symptoms, onset time, disposal methods and sample testing results, questionnaire surveys, and case-control study were conducted in a kindergarten to analyze the underlying causes of the norovirus outbreak., Results: A total of 15 cases were identified, with an attack rate of 44.12% (15/34). Among them, 10 cases were diagnosed through laboratory tests, and 5 cases were diagnosed clinically. Vomiting (100%, 15/15) and diarrhea (93.33%, 14/15) were the most common symptoms in the outbreak. Case control study revealed that cases who had close contact (<1 m) with the patient's vomitus (OR = 5.500) and those who had close contact with similar patients (OR = 8.000) had significantly higher ORs compared to the control participants. The current study demonstrated that improper handling of vomitus is positively associated with norovirus outbreak. The absence of standardized disinfection protocols heightens the risk of norovirus outbreaks., Conclusion: To our knowledge, this study represents the first investigation into a norovirus outbreak in rural areas of western China. We aspire that amidst rapid economic development, a greater emphasis will be placed on the prevention and control of infectious diseases in economically underdeveloped areas and countries., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Xiong, Ma, Tang and Liu.)

Tracking pathogen transmissibility during infectious disease outbreaks is essential for assessing the effectiveness of public health measures and planning future control strategies. A key measure of transmissibility is the time-dependent reproduction number, which has been estimated in real-time during outbreaks of a range of pathogens from disease incidence time series data. While commonly used approaches for estimating the time-dependent reproduction number can be reliable when disease incidence is recorded frequently, such incidence data are often aggregated temporally (for example, numbers of cases may be reported weekly rather than daily). As we show, commonly used methods for estimating transmissibility can be unreliable when the timescale of transmission is shorter than the timescale of data recording. To address this, here we develop a simulation-based approach involving Approximate Bayesian Computation for estimating the time-dependent reproduction number from temporally aggregated disease incidence time series data. We first use a simulated dataset representative of a situation in which daily disease incidence data are unavailable and only weekly summary values are reported, demonstrating that our method provides accurate estimates of the time-dependent reproduction number under such circumstances. We then apply our method to two outbreak datasets consisting of weekly influenza case numbers in 2019-20 and 2022-23 in Wales (in the United Kingdom). Our simple-to-use approach will allow accurate estimates of time-dependent reproduction numbers to be obtained from temporally aggregated data during future infectious disease outbreaks., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Background: Candida auris was sporadically detected in Greece until 2019. Thereupon, there has been an increase in isolations among inpatients of healthcare facilities., Aim: We aim to report active surveillance data on MALDI-TOF confirmed Candida auris cases and outbreaks, from November 2019 to September 2021., Methods: A retrospective study on hospital-based Candida auris data, over a 23-month period was conducted, involving 11 hospitals within Attica region. Antifungal susceptibility testing and genotyping were conducted. Case mortality and fatality rates were calculated and p-values less than 0.05 were considered statistically significant. Infection control measures were enforced and enhanced., Results: Twenty cases with invasive infection and 25 colonized were identified (median age: 72 years), all admitted to hospitals for reasons other than fungal infections. Median hospitalisation time until diagnosis was 26 days. Common risk factors among cases were the presence of indwelling devices (91.1 %), concurrent bacterial infections during hospitalisation (60.0 %), multiple antimicrobial drug treatment courses prior to hospitalisation (57.8 %), and admission in the ICU (44.4 %). Overall mortality rate was 53 %, after a median of 41.5 hospitalisation days. Resistance to fluconazole and amphotericin B was identified in 100 % and 3 % of tested clinical isolates, respectively. All isolates belonged to South Asian clade I. Outbreaks were identified in six hospitals, while remaining hospitals detected sporadic C. auris cases., Conclusion: Candida auris has proven its ability to rapidly spread and persist among inpatients and environment of healthcare facilities. Surveillance focused on the presence of risk factors and local epidemiology, and implementation of strict infection control measures remain the most useful interventions., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 SFMM. Published by Elsevier Masson SAS. All rights reserved.)

Background: The COVID-19 pandemic has generated numerous hospital outbreaks. This study aimed to identify factors related to the extent of nosocomial COVID-19 outbreaks in the largest French public health institution., Methods: An observational study was conducted from July 2020 to September 2021. Outbreaks were defined as at least 2 cases, patients and/or health care workers (HCWs), linked by time and geographic location. Logistic regression was performed to identify risk factors for large outbreaks among nine variables: variant, medical ward, COVID-19 vaccination rate and incidence among HCWs and Paris population, number of weekly COVID-19 tests among HCWs and the positivity rate, epidemic waves., Results: Within 14 months, 799 outbreaks were identified: 450 small ones (≤6 cases) and 349 large ones (≥7 cases), involving 3,260 patients and 3,850 HCWs. In univariate analysis, large outbreaks were positively correlated to geriatrics wards, COVID-19 incidence, and rate of weekly positive tests among HCWs; and negatively correlated to intensive care units, variant Delta, fourth wave, vaccination rates of the Paris region's population and that of the HCWs. In multivariate analysis, factors that remained significant were the type of medical ward and the vaccination rate among HCWs., Conclusions: Intensive care unit and high vaccination rates among HCWs were associated with a lower risk of large COVID-19 outbreaks, as opposed to geriatric wards, which are associated with a higher risk., (Copyright © 2024 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.)

Purpose: In late 2022, a surge of severe S. pyogenes infections was reported in several European countries. This study assessed hospitalizations and disease severity of community-acquired bacterial infections with S. pyogenes, S. pneumoniae, N. meningitidis, and H. influenzae among children in North Rhine-Westphalia (NRW), Germany, during the last quarter of 2022 compared to long-term incidences., Methods: Hospital cases due to bacterial infections between October and December 2022 were collected in a multicenter study (MC) from 59/62 (95%) children's hospitals in NRW and combined with surveillance data (2016-2023) from the national reference laboratories for streptococci, N. meningitidis, and H. influenzae. Overall and pathogen-specific incidence rates (IR) from January 2016 to March 2023 were estimated via capture-recapture analyses. Expected annual deaths from the studied pathogens were calculated from national death cause statistics., Results: In the MC study, 153 cases with high overall disease severity were reported with pneumonia being most common (59%, n = 91). IRs of bacterial infections declined at the beginning of the COVID-19 pandemic and massively surged to unprecedented levels in late 2022 and early 2023 (overall hospitalizations 3.5-fold), with S. pyogenes and S. pneumoniae as main drivers (18-fold and threefold). Observed deaths during the study period exceeded the expected number for the entire year in NRW by far (7 vs. 0.9)., Discussion: The unprecedented peak of bacterial infections and deaths in late 2022 and early 2023 was caused mainly by S. pyogenes and S. pneumoniae. Improved precautionary measures are needed to attenuate future outbreaks., (© 2024. The Author(s).)

The mosquito-borne dengue virus remains a major public health concern in Malaysia. Despite various control efforts and measures introduced by the Malaysian Government to combat dengue, the increasing trend of dengue cases persists and shows no sign of decreasing. Currently, early detection and vector control are the main methods employed to curb dengue outbreaks. In this study, a coupled model consisting of the statistical ARIMAX model and the deterministic SI-SIR model was developed and validated using the weekly reported dengue data from year 2014 to 2019 for Selangor, Malaysia. Previous studies have shown that climate variables, especially temperature, humidity, and precipitation, were able to influence dengue incidence and transmission dynamics through their effect on the vector. In this coupled model, climate is linked to dengue disease through mosquito biting rate, allowing real-time forecast of dengue cases using climate variables, namely temperature, rainfall and humidity. For the period chosen for model validation, the coupled model can forecast 1-2 weeks in advance with an average error of less than 6%, three weeks in advance with an average error of 7.06% and four weeks in advance with an average error of 8.01%. Further model simulation analysis suggests that the coupled model generally provides better forecast than the stand-alone ARIMAX model, especially at the onset of the outbreak. Moreover, the coupled model is more robust in the sense that it can be further adapted for investigating the effectiveness of various dengue mitigation measures subject to the changing climate., (© 2024. The Author(s), under exclusive licence to the Society for Mathematical Biology.)

Shared ablutions and stairwells, corridor cross-ventilation and non-deliberate perflation (natural draft blowing through a space) are potential risk factors for COVID-19 transmission in corridor-based accommodation. This paper uses retrospective spatial analysis to identify potential built environmental risk factors during the January-March 2021 outbreak in Victory College, Royal Military Academy Sandhurst.Distance was measured in units of single room spacing. Odds, ORs and 95% CIs were calculated to identify and measure associations between distance from exposure and having COVID-19. Distance response trends were assessed using Pearson's χ 2 for trend test. Linear relationships were tested using the t-test or rank-sum test.Stairwells and ablutions were not identified as likely sources of infection for all corridor occupants. Assuming occupants used their nearest ablutions, closer distance among those attributed to using ablutions 2 (one of four sets of ablutions), was identified as a risk factor (p=0.05). Testing distance response by χ 2 linear trend testing showed a potential association between nearest adjacent positive room and COVID-19 (p=0.06), strongest if dominant air movement along the corridor length was from the left (p=0.10) compared with the right (p=0.24).Formal qualitative spatial analysis and environmental assessment of ventilation and air movement has a role in outbreak investigation in assessing factors related to the built environment. Environmental investigations would best inform outbreak investigations if undertaken contemporaneously. Pre-emptive and retrospective studies can help inform public health advice to military establishments in business continuity planning for isolation facilities, during outbreaks or in future development of the built environment., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

Introduction: A disproportionate number of COVID-19 deaths occur in Residential Aged Care Facilities (RACFs), where better evidence is needed to target COVID-19 interventions to prevent mortality. This study used an agent-based model to assess the role of community prevalence, vaccination strategies, and non-pharmaceutical interventions (NPIs) on COVID-19 outcomes in RACFs in Victoria, Australia., Methods: The model simulated outbreaks in RACFs over time, and was calibrated to distributions for outbreak size, outbreak duration, and case fatality rate in Victorian RACFs over 2022. The number of incursions to RACFs per day were estimated to fit total deaths and diagnoses over time and community prevalence.Total infections, diagnoses, and deaths in RACFs were estimated over July 2023-June 2024 under scenarios of different: community epidemic wave assumptions (magnitude and frequency); RACF vaccination strategies (6-monthly, 12-monthly, no further vaccines); additional non-pharmaceutical interventions (10, 25, 50% efficacy); and reduction in incursions (30% or 60%)., Results: Total RACF outcomes were proportional to cumulative community infections and incursion rates, suggesting potential for strategic visitation/staff policies or community-based interventions to reduce deaths. Recency of vaccination when epidemic waves occurred was critical; compared with 6-monthly boosters, 12-monthly boosters had approximately 1.2 times more deaths and no further boosters had approximately 1.6 times more deaths over July 2023-June 2024. Additional NPIs, even with only 10-25% efficacy, could lead to a 13-31% reduction in deaths in RACFs., Conclusion: Future community epidemic wave patterns are unknown but will be major drivers of outcomes in RACFs. Maintaining high coverage of recent vaccination, minimizing incursions, and increasing NPIs can have a major impact on cumulative infections and deaths., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 McAndrew, Sacks-Davis, Abeysuriya, Delport, West, Parta, Majumdar, Hellard and Scott.)

Introduction: Measles is one of the most contagious childhood diseases, and the behavior also occurs in adults. This is a multi-year vaccination covered by an elimination program coordinated by the World Health Organization (WHO). Elimination of measles in the country is conditional on a 95% incidence of infection with two victims, monitoring the epidemiological situation, registering all suspected cases of measles, and monitoring by the WHO Reference Laboratory. In our country, the Department of Virology of the NIZP PZH-PIB in Warsaw serves as the head of the Department of Virology., Objectives: The aim of this study was to evaluate epidemiological indicators of measles in Poland in 2021 compared to previous years, taking into account the impact of the COVID-19 pandemic., Material and Methods: The assessment of the epidemiological situation was based on a review of data from the bulletin, "Infectious Diseases and Poisons in Poland in 2021" (5), and the assessment of the immunization status of the population was based on data from the bulletin, "Immunization in Poland in 2021" (6). Classification of cases was made based on the definition used in the 2021 surveillance (7). Data from the epidemiological surveillance system "EpiBase" were also used., Results: In 2021, 13 measles cases were registered in Poland (incidence 0.03 per 100,000), 44.8% less than in 2020 and 80% less than the median in 2014-2018. In 2021, the highest incidence was recorded at 0.32 per 100,000 children aged 0-4 years. 6 patients (46.2%) were hospitalized; no deaths due to measles were reported. 32 suspected measles cases were recorded, with over a hundred cases expected. Vaccination status of children aged 3 with the first dose was 90.8%, and the second dose was given to children at the age of 9. - 84.6%., Conclusions: Epidemiological indicators of measles in 2021 in Poland compared to 2020 have decreased. A similar trend observed throughout Europe. This is related to the extinguishment of outbreaks that occurred before the pandemic, mainly in 2019.

Aim: The aim of the study is to present and evaluate the epidemiological situation of listeriosis in Poland in the years 2012-2021., Material and Methods: The analysis material consisted of data from individual epidemiological case reports on listeriosis submitted to the Department of Epidemiology of Infectious Diseases and Surveillance of the NIPH NIH - NRI by state sanitaryepidemiological stations in the form of paper questionnaires (2012-2019) and in the electronic form through the EpiBaza system (2020 and 2021), as well as aggregated data from the bulletin "Infectious Diseases and Poisoning in Poland"., Results: Between 2012 and 2021, a total of 896 cases of listeriosis were registred in Poland. The median incidence was 0.23 per 100,000 population, which was an increase by 52.2% compared to the previous 5-year period (2007-2011). Every year, more than 90% of cases were hospitalized. The highest percentage of patients were in the age group >60 years old (65.5%). From 2012 to 2019 (in the years when information on cases was collected on a paper form), a total of 275 deaths of patients from listeriosis were recorded (38.4% of all reported cases). According to data from the EpiBaza system, in 2020 and 2021 there were 5 (8.33%) and 25 (20.83%) deaths due to listeriosis. A total of 92.1% of patients with listeriosis had significant predisposing factors for the occurrence of this disease, most of which were associated with neoplasia and heart disease and were present in half of all cases. As part of routine surveillance, no epidemic outbreak associated with Listeria monocytogenes infection was reported in Poland in the years 2012-2021.A total number of 49 pregnant women with listeriosis were reported during described period. Between 2012 and 2021, 37 cases of congenital listeriosis were reported. The median of incidence was 1.07/100 thousand live births, a decrease of 26% compared to the previous 5-year period (2007-2011). Of all congenital infections in newborns, 12 deaths (32.43%) were reported., Conclusions: The epidemiology of listeriosis is changing both in the EU/EEA countries and in Poland: the incidence is increasing and the distribution of cases in different age groups is changing, affecting primarily the elderly, especially those with predisposing diseases. Although 2020 tere was a decrease in the number of cases at EU level, possibly related to the COVID-19 pandemic, the overall trend of listeriosis cases isincreasing. The clinical condition has a significant impact on the course of L. monocytogenes infection: in healthy people, infection is usually asymptomatic. The disease primarily affects immunocompromised people. In contrast, infection of pregnant women can lead to premature birth, miscarriage, meningitis and neonatal sepsis with mortality rate of 20-30%. The growing trend in listeriosis is alarming and requires greater attention in terms of prevention and control of the disease.

Introduction: Giardiosis is a parasitic disease caused by the protozoa Giardia lamblia (also known as Giardia intestinalis and Giardia duodenalis), which causes gastrointestinal symptoms. Infection usually occurs through the ingestion of contaminated water/food or through contact with an infected person. In Poland, giardiasis is notifiable disease, acoording to the EU deffinition implement in the polish surveillance system., Aim of the Study: The aim of this study is to asses epidemiological situation of giardiasis in Poland in 2021 and compare it to the previous years., Materials and Methods: The assessment of the epidemiological situation of giardiasis in Poland in 2021 was performed on the basis of data from the annual bulletins "Infectious diseases and poisoning in Poland" for the years 2008-2021, data on individual cases collected for the purposes of epidemiological surveillance in the EpiBaza system and data from food-born outbreak investigations recorded in the Registry of Epidemic Outbreaks (ROE)., Results: In 2021, 559 cases of giardiasis were reported in Poland (558 confirmed case, 1 probable case). There was an increase in the number of reported cases in comparision to 2020 by 56% and decrease to 2019 by 29%. Cases of giardiasis were reported in all voivodeships, with the highest incidence rate in Podlaskie voivodeship (9.1/100 000), incidence rate for Poland was 1.5/100 000. Giardiasis was diagnosed in patiens in all age group, the largest group of patiens were children (age groups 0-4 and 5-9). The hospitalization rate of patients diagnosed with giardiasis was 9.7% and was lower than in 2020, when it was 12.4%. As in previous years, no deaths from giardiasis were reported., Conclusions: The number of cases of giardiasis has increased compared to 2020, but has not reached pre-pandemic levels. As in previous years, differences in the incidence by age and sex of people with the disease were noted when comparing data reported from Poland and EU/EEA countries.

Aim: The aim of the article is to present and assess the epidemiological situation of salmonellosis in Poland in 2021, in relation to previous years., Material and Methods: The assessment of the epidemiological situation of salmonellosis in Poland was made on the basis of individual data on salmonellosis cases, entered by sanitary-epidemiological stations into the EpiBaza System, data on outbreaks caused by Salmonella bacilli from the Registry of Epidemic Outbreaks System (ROE), as well as on the basis of aggregated data published in the annual bulletins "Infectious Diseases and Poisoning in Poland" (NIPH NIH - NRI, GIS, Warsaw), including information sent by laboratories of sanitary-epidemiological stations, data from the article on the epidemiological situation of salmonellosis in Poland in 2020 and data from the Demographic Research Department of the Central Statistical Office., Results: In 2021, in Poland sanitary-epidemiological stations registered 8,294 cases of salmonellosis - 8,014 cases of intestinal salmonellosis and 280 extra-intestinal salmonellosis, including 190 cases of salmonellosis septicemia. The incidence rate for total salmonellosis was 21.7/100,000 population, for intestinal salmonellosis 21.0, for salmonellosis septicemia 0.50, and 0.23 per 100,000 population for other extra-intestinal infections of salmonellosis etiology. The reported 7,988 cases were classified as confirmed and 306 as probable. There were 5,127 hospitalizations due to salmonellosis, mainly children and the elderly. The peak of the incidence was registered in July. The highest incidence rate of salmonellosis in 2021 was recorded in the Podkarpackie voivodeship (39.8/100,000 population), the lowest in the Świętokrzyskie voivodeship (10.7/100,000 population). The highest incidence of intestinal salmonellosis was registered in the age group 0-4 years, accounting for 44.2% of the total number of cases. Among extra-intestinal infections, almost 62% of cases occurred in people aged 60+. In 2021, sanitary-epidemiological stations were detected and reported 229 outbreaks of food poisoning caused by Salmonella bacilli, 75% of them was Enteritidis serotype. In 2021, the most frequently isolated serotypes were S. Enteritidis 72%, S. Typhimurium (2%) and S. Infantis (0.5%). The serotype was not determined in 24.3% of cases. There were 24 imported cases of salmonellosis from different regions of the world. Due to Salmonella infection 11 people died in 2021. Laboratories of sanitary-epidemiological stations performed 438,183 tests for the presence of Salmonella and Shigella bacilli among humans, 92% of these tests concerned people working in contact with food., Conclusions: In 2021, there was an increase in the number of salmonellosis cases in Poland, compared to 2020. It can therefore be concluded that the COVID-19 pandemic did not have a long-term impact on reducing the number of Salmonella infections. At the same time, despite the increase, the situation of salmonellosis in Poland has not fully returned to the state before the COVID-19 pandemic.The area where we observe a significant difference, is the percentage of hospitalizations, which is the lowest in 2021 since 1998. It can be assumed, that one of the reasons for this, could be a stricter qualification of people with milder symptoms for hospital treatment, in favour of outpatient care.

From 1949 to 1950, an acute epidemic of schistosomiasis struck several elite units of the People's Liberation Army during the Chinese Civil War that were preparing for an amphibious invasion of Taiwan. The crucial delay brought by the sudden outbreak of the disease may have cost communist forces control of the strategic island, changing the geopolitical calculus of the Pacific in the decades since., (Published by Oxford University Press on behalf of the Association of Military Surgeons of the United States 2023. This work is written by (a) US Government employee(s) and is in the public domain in the US.)

Background: Emerging infectious diseases pose a significant threat to global public health. Timely detection and response are crucial in mitigating the spread of such epidemics. Inferring the onset time and epidemiological characteristics is vital for accelerating early interventions, but accurately predicting these parameters in the early stages remains challenging., Methods: We introduce a Bayesian inference method to fit epidemic models to time series data based on state-space modeling, employing a stochastic Susceptible-Exposed-Infectious-Removed (SEIR) model for transmission dynamics analysis. Our approach uses the particle Markov chain Monte Carlo (PMCMC) method to estimate key epidemiological parameters, including the onset time, the transmission rate, and the recovery rate. The PMCMC algorithm integrates the advantageous aspects of both MCMC and particle filtering methodologies to yield a computationally feasible and effective means of approximating the likelihood function, especially when it is computationally intractable., Results: To validate the proposed method, we conduct case studies on COVID-19 outbreaks in Wuhan, Shanghai and Nanjing, China, respectively. Using early-stage case reports, the PMCMC algorithm accurately predicted the onset time, key epidemiological parameters, and the basic reproduction number. These findings are consistent with empirical studies and the literature., Conclusion: This study presents a robust Bayesian inference method for the timely investigation of emerging infectious diseases. By accurately estimating the onset time and essential epidemiological parameters, our approach is versatile and efficient, extending its utility beyond COVID-19., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Shi, Yang, Tan, Zhou, Liu, Zhou and Liu.)

Introduction: Measles, though usually self-limiting, can have severe consequences influenced by factors such as vaccination and nutrition, notably vitamin A deficiency and malnutrition. Despite progress, contextual changes and implementation issues have hampered efforts, resulting in increased outbreaks and cases of measles. This study seeks to pinpoint outbreak features, risk factors, and strategies for preventing and controlling measles., Methods: A descriptive cross-sectional study and a 1:2 unmatched case-control study design were employed. All 101 suspected measles cases listed on the line-list were included in the descriptive research, with 60 measles patients and 120 controls included in the case-control investigation. Line-list data were cleaned and analyzed using a pivot table in Microsoft Excel 2016. Subsequently, the data were cleaned, entered into Epi Info 7.2, and exported to SPSS 26 for analysis., Results: Twenty cases occurred per 10,000 individuals. Men accounted for 67.3% of cases, with ages ranging from 5 months to 45 years and mean and standard deviations of 9.6 and 7.6, respectively. Age group of 5-14 years comprised 57.4% of cases, followed by 1-4 years with 24.8%. Being unvaccinated against measles showed an adjusted odds ratio (AOR) of 12.06 (95% CI: 3.12-46.52). Travel history to regions with active cases had an AOR of 5.73 (95% CI: 1.78-18.38). Contact with a measles patient showed an AOR of 10.3 (95% CI: 3.48-30.5). Understanding the measles transmission mechanism had an AOR of 0.164 (95% CI: 0.049-0.55), and awareness of the disease's preventability had an AOR of 0.233 (95% CI: 0.67-0.811). All factors were independently associated with the illness., Conclusion: This outbreak affected a broader age range with a high attack rate, mainly in the age group of 5-14-years. Over 35% of cases lacked measles vaccination, indicating low administrative vaccine coverage. Factors contributing to the outbreak include lack of measles vaccination, travel to areas with active disease, contact with cases, and insufficient knowledge of measles transmission and prevention strategies among mothers and caregivers., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Shimelis, Asrat, Tadege and Feleke.)

Background: Hand, foot, and mouth disease (HFMD) is a common infectious disease in children. Enterovirus A71 (EV71) and coxsackievirus A16 (CA16) have been identified as the predominant pathogens for several decades. In recent years, coxsackievirus A6 (CA6) and coxsackievirus A10 (CA10) have played increasingly important roles in a series of HFMD outbreaks. We performed a retrospective analysis of the epidemiology of HFMD and the spectrum of different viral serotypes, to elucidate the genetic and phylogenetic characteristics of the main serotypes in the Jiashan area during 2016 to 2022., Methods: Descriptive epidemiological methods were used to analyze the time and population distribution of HFMD in Jiashan during 2016 to 2022 based on surveillance data. Molecular diagnostic methods were performed to identify the viral serotypes and etiological characteristics of HFMD. Phylogenetic analyses was based on VP1 region of CA16 and CA6., Results: The average annual incidence rate of HFMD fluctuated from 2016 to 2022. Children aged 1-5 years accounted for 81.65% of cases and boys were more frequently affected than girls. Except when HFMD was affected by the COVID-19 epidemic in 2020 and 2022, epidemics usually peak in June to July, followed by a small secondary peak from October to December and a decline in February. Urban areas had a high average incidence and rural areas had the lowest. Among 560 sample collected in Jiashan, 472 (84.29%) were positive for enterovirus. The most frequently identified serotypes were CA6 (296, 52.86%), CA16 (102, 18.21%), EV71 (16, 2.86%), CA10 (14, 2.50%) and other enteroviruses (44, 7.86%). There were 71 and 142 VP1 sequences from CA16 and CA6, respectively. Substitution of N218D, A220L and V251I was detected in CA16 and may have been related to viral infectivity. Phylogenetic analysis showed that CA16 could be assigned to two genogroups, B1a and B1b, while all the CA6 sequences belonged to the D3a genogroup., Conclusion: CA6 and CA16 were the two major serotypes of enteroviruses circulating in the Jiashan area during 2016 to 2022. Continuous and comprehensive surveillance for HFMD is needed to better understand and evaluate the prevalence and evolution of the associated pathogens., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Yuan, Chen, Huang, Bao, Shen, Sun and Mao.)

The time-varying effective reproduction number Rt is a widely used indicator of transmission dynamics during infectious disease outbreaks. Timely estimates of Rt can be obtained from reported cases counted by their date of symptom onset, which is generally closer to the time of infection than the date of report. Case counts by date of symptom onset are typically obtained from line list data, however these data can have missing information and are subject to right truncation. Previous methods have addressed these problems independently by first imputing missing onset dates, then adjusting truncated case counts, and finally estimating the effective reproduction number. This stepwise approach makes it difficult to propagate uncertainty and can introduce subtle biases during real-time estimation due to the continued impact of assumptions made in previous steps. In this work, we integrate imputation, truncation adjustment, and Rt estimation into a single generative Bayesian model, allowing direct joint inference of case counts and Rt from line list data with missing symptom onset dates. We then use this framework to compare the performance of nowcasting approaches with different stepwise and generative components on synthetic line list data for multiple outbreak scenarios and across different epidemic phases. We find that under reporting delays realistic for hospitalization data (50% of reports delayed by more than a week), intermediate smoothing, as is common practice in stepwise approaches, can bias nowcasts of case counts and Rt, which is avoided in a joint generative approach due to shared regularization of all model components. On incomplete line list data, a fully generative approach enables the quantification of uncertainty due to missing onset dates without the need for an initial multiple imputation step. In a real-world comparison using hospitalization line list data from the COVID-19 pandemic in Switzerland, we observe the same qualitative differences between approaches. The generative modeling components developed in this work have been integrated and further extended in the R package epinowcast, providing a flexible and interpretable tool for real-time surveillance., Competing Interests: I have read the journal’s policy and the authors of this manuscript have the following competing interests: Tanja Stadler is president of the Swiss “Scientific Advisory Panel COVID-19” (https://science-panel-covid19.ch/)., (Copyright: © 2024 Lison et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

In the midst of an outbreak or sustained epidemic, reliable prediction of transmission risks and patterns of spread is critical to inform public health programs. Projections of transmission growth or decline among specific risk groups can aid in optimizing interventions, particularly when resources are limited. Phylogenetic trees have been widely used in the detection of transmission chains and high-risk populations. Moreover, tree topology and the incorporation of population parameters (phylodynamics) can be useful in reconstructing the evolutionary dynamics of an epidemic across space and time among individuals. We now demonstrate the utility of phylodynamic trees for transmission modeling and forecasting, developing a phylogeny-based deep learning system, referred to as DeepDynaForecast. Our approach leverages a primal-dual graph learning structure with shortcut multi-layer aggregation, which is suited for the early identification and prediction of transmission dynamics in emerging high-risk groups. We demonstrate the accuracy of DeepDynaForecast using simulated outbreak data and the utility of the learned model using empirical, large-scale data from the human immunodeficiency virus epidemic in Florida between 2012 and 2020. Our framework is available as open-source software (MIT license) at github.com/lab-smile/DeepDynaForcast., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Sun et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Measles continues to be a public health challenge in Ethiopia. Rumors of suspected measles were notified on April 8, 2023 from Tocha district. We conducted an assessment to describe measles outbreak and determine risk factors for measles infection in the Tocha district of the Dawuro zone, Southwest Ethiopia., Methods: We conducted a 1:2 unmatched case-control studies from April to May 2023. We took all 147 cases registered on line list for descriptive analyses. We used a total of 74 randomly selected cases and 147 controls for case-control part. Any person in Tocha district with laboratory-confirmed measles IgM antibody; or any suspected person epidemiologically linked to confirmed measles cases from March 23 to April 26 2023, were included in the case. Neighborhood who did not fulfill this standard case definition were included in controls. Data were collected using standardized questionnaires deployed on Kobo Collect. Descriptive analyses were conducted using Epi info version 7.2.5.0. The analyses were performed using Statistical Package for Social Science (SPSS) version 26. Binary logistic regression analyses were utilized to select candidate variables. We conducted multiple logistic regression analysis to identify determinants of measles infection at a p value ≤0.05 with 95% confidence interval., Results: The overall attack rate of 22.64/10,000 for general population and 104.59/10,000 among under-five children were attributed to the outbreak with a case fatality rate of 2.72%. Vaccine coverage in the last year and this year were 73.52 and 53.88%, respectively, while vaccine effectiveness in the district was 79%. Poor house ventilation (AOR = 3.540, 95% CI: 1.663-7.535) and having contact history with the case (AOR = 2.528, 95% CI: 1.180-4.557) were positively related to measles infection while being previously vaccinated for measles (AOR = 0.209, 95% CI: 0.180-4.577) reduce risk of measles infections., Conclusion: The highest attack rate was observed among children under 5 years of age, with a case fatality rate of 2.72%. Vaccination coverage was less than what expected to develop herd immunity. Strategies to increase vaccination coverage and strengthening surveillance systems for rumor identification and early responses to prevent person to person transmission are recommended., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Tefera, Admasu, Abebe, Feyisa and Midaksa.)

A multinational outbreak of nosocomial fusarium meningitis occurred among immunocompetent patients who had undergone surgery with epidural anesthesia in Mexico. The pathogen involved had a high predilection for the brain stem and vertebrobasilar arterial system and was associated with high mortality from vessel injury. Effective treatment options remain limited; in vitro susceptibility testing of the organism suggested that it is resistant to all currently approved antifungal medications in the United States. To highlight the severe complications associated with fusarium infection acquired in this manner, we report data, clinical courses, and outcomes from 13 patients in the outbreak who presented with symptoms after a median delay of 39 days., (Copyright © 2024 Massachusetts Medical Society.)

Importance: Ebola disease (EBOD) is a public health threat with a high case fatality rate. Most EBOD outbreaks have occurred in remote locations, but the 2013-2016 Western Africa outbreak demonstrated how devastating EBOD can be when it reaches an urban population. Here, the 2022 Sudan virus disease (SVD) outbreak in Mubende District, Uganda, is summarized, and the genetic relatedness of the new variant is evaluated. The Mubende variant exhibited 96% amino acid similarity with historic SUDV sequences from the 1970s and a high degree of conservation throughout the outbreak, which was important for ongoing diagnostics and highly promising for future therapy development. Genetic differences between viruses identified during the Mubende SVD outbreak were linked with epidemiological data to better interpret viral spread and contact tracing chains. This methodology should be used to better integrate discrete epidemiological and sequence data for future viral outbreaks., Competing Interests: The authors declare no conflict of interest.

Highly pathogenic avian influenza (HPAI) H5N1 activity has intensified globally since 2021, increasingly causing mass mortality in wild birds and poultry and incidental infections in mammals 1-3 . However, the ecological and virological properties that underscore future mitigation strategies still remain unclear. Using epidemiological, spatial and genomic approaches, we demonstrate changes in the origins of resurgent HPAI H5 and reveal significant shifts in virus ecology and evolution. Outbreak data show key resurgent events in 2016-2017 and 2020-2021, contributing to the emergence and panzootic spread of H5N1 in 2021-2022. Genomic analysis reveals that the 2016-2017 epizootics originated in Asia, where HPAI H5 reservoirs are endemic. In 2020-2021, 2.3.4.4b H5N8 viruses emerged in African poultry, featuring mutations altering HA structure and receptor binding. In 2021-2022, a new H5N1 virus evolved through reassortment in wild birds in Europe, undergoing further reassortment with low-pathogenic avian influenza in wild and domestic birds during global dissemination. These results highlight a shift in the HPAI H5 epicentre beyond Asia and indicate that increasing persistence of HPAI H5 in wild birds is facilitating geographic and host range expansion, accelerating dispersion velocity and increasing reassortment potential. As earlier outbreaks of H5N1 and H5N8 were caused by more stable genomic constellations, these recent changes reflect adaptation across the domestic-bird-wild-bird interface. Elimination strategies in domestic birds therefore remain a high priority to limit future epizootics., (© 2023. The Author(s), under exclusive licence to Springer Nature Limited.)

Introduction: China experienced a record surge of coronavirus disease 2019 cases in December 2022, during the pandemic., Methods: We conducted a randomized, parallel-controlled prospective cohort study to evaluate efficacy and antibody duration after a fourth-dose booster with Ad5-nCoV or inactivated severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccine., Results: A total of 191 participants aged ≥18 years who had completed a three-dose regimen of the inactivated SARS-CoV-2 vaccine 6 months earlier were recruited to receive the intramuscular Ad5-nCoV booster or the inactivated SARS-CoV-2 vaccine. The Ad5-nCoV group had significantly higher antibody levels compared with the inactivated vaccine group at 6 months after the fourth vaccination dose. After the pandemic, the breakthrough infection rate for the Ad5-nCoV and the inactivated vaccine groups was 77.89% and 78.13%, respectively. Survival curve analysis ( p = 0.872) and multivariable logistic regression analysis ( p = 0.956) showed no statistically significant differences in breakthrough infection between the two groups., Discussion: Compared with a homologous fourth dose, a heterologous fourth dose of Ad5-nCoV elicited a higher immunogenic response in healthy adults who had been immunized with three doses of inactivated vaccine. Nevertheless, the efficacy of the two vaccine types was equivalent after the pandemic., Competing Interests: YX and PW are employees of CanSino Biologics and contributed to the conceptualization of the study clinical protocol and electronic case report form design but did not participate in the analysis or interpretation of the data presented in the manuscript. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Xu, Xu, Dai, Zheng, Qin, Wan, Yang, Jiang, Zhang, Hu and Lv.)

Introduction: Cholera remains a significant public health threat for many countries, and the severity largely varies by the population and local conditions that drive disease spread, especially in endemic areas prone to natural disasters and flooding. Epidemiological models can provide useful information to military planners for understanding disease spread within populations and the effectiveness of response options for preventing the transmission among deployed and stationed personnel. This study demonstrates the use of epidemiological modeling to understand the dynamics of cholera transmission to inform emergency planning and military preparedness in areas with highly communicable diseases., Materials and Methods: Areas with higher probability for a potential cholera outbreak in Haiti followed by a natural disaster were identified. The hotspots were then used to seed an extended compartmental model, EpiGrid, to simulate notional spread scenarios of cholera originating in three distinct areas in Haiti. Disease parameters were derived from the 2010 cholera outbreak in Haiti, and disease spread was simulated over a 12-week period under uncontrolled and controlled spread., Results: For each model location, scenarios of mitigated (intervention with 30% transmission reduction via international aid) and unmitigated (without intervention) are simulated. The results depict the geographical spread and estimate the cumulative cholera infection for each notional scenario over the course of 3 months. Disease transmission differs considerably across origin site with an outbreak originating in the department of Nippes spanning the largest geographic area and resulting in the largest number of cumulative cases after 12 weeks under unmitigated (79,518 cases) and mitigated (35,667 cases) spread scenarios., Conclusions: We modeled the notional re-emergence and spread of cholera following the August 2021 earthquake in Haiti while in the midst of the global COVID-19 pandemic. This information can help guide military and emergency response decision-making during an infectious disease outbreak and considerations for protecting military personnel in the midst of a humanitarian response. Military planners should consider the use of epidemiological models to assess the health risk posed to deployed and stationed personnel in high-risk areas., (Published by Oxford University Press on behalf of the Association of Military Surgeons of the United States 2022. This work is written by (a) US Government employee(s) and is in the public domain in the US.)