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Reduced availability of agricultural water has spurred increased interest in using recycled irrigation water for U.S. food crop production. However, there are significant knowledge gaps concerning the microbiological quality of these water sources. To address these gaps, we used 16S rRNA gene and metagenomic sequencing to characterize taxonomic and functional variations (e.g., antimicrobial resistance) in bacterial communities across diverse recycled and surface water irrigation sources. We collected 1 L water samples (n = 410) between 2016 and 2018 from the Mid-Atlantic (12 sites) and Southwest (10 sites) U.S. Samples were filtered, and DNA was extracted. The V3-V4 regions of the 16S rRNA gene were then PCR amplified and sequenced. Metagenomic sequencing was also performed to characterize antibiotic, metal, and biocide resistance genes. Bacterial alpha and beta diversities were significantly different (p < 0.001) across water types and seasons. Pathogenic bacteria, such as Salmonella enterica, Staphylococcus aureus, and Aeromonas hydrophilia were observed across sample types. The most common antibiotic resistance genes identified coded against macrolides/lincosamides/streptogramins, aminoglycosides, rifampin and elfamycins, and their read counts fluctuated across seasons. We also observed multi-metal and multi-biocide resistance across all water types. To our knowledge, this is the most comprehensive longitudinal study to date of U.S. recycled water and surface water used for irrigation. Our findings improve understanding of the potential differences in the risk of exposure to bacterial pathogens and antibiotic resistance genes originating from diverse irrigation water sources across seasons and U.S. regions.

Dogs have a key role in law enforcement and military work, and research with the goal of improving working dog performance is ongoing. While there have been intriguing studies from lab animal models showing a potential connection between the gut microbiome and behavior or mental health there is a dearth of studies investigating the microbiome-behavior relationship in working dogs. The overall objective of this study was to characterize the microbiota of working dogs and to determine if the composition of the microbiota is associated with behavioral and performance outcomes. Freshly passed stools from each working canine (Total n = 134) were collected and subject to shotgun metagenomic sequencing using Illumina technology. Behavior, performance, and demographic metadata were collected. Descriptive statistics and prediction models of behavioral/phenotypic outcomes using gradient boosting classification based on Xgboost were used to study associations between the microbiome and outcomes. Regarding machine learning methodology, only microbiome features were used for training and predictors were estimated in cross-validation. Microbiome markers were statistically associated with motivation, aggression, cowardice/hesitation, sociability, obedience to one trainer vs many, and body condition score (BCS). When prediction models were developed based on machine learning, moderate predictive power was observed for motivation, sociability, and gastrointestinal issues. Findings from this study suggest potential gut microbiome markers of performance and could potentially advance care for working canines.

While strategies to mitigate risks for foodborne illness and childhood diarrhea via sanitation and behavioral interventions have been explored, there is a dearth of knowledge about household practices regarding food production and use, livestock, and other sources of risk for foodborne illness in urban and peri-urban areas. The objective of this research was to increase understanding of household agricultural practices in Debre Berhan, Ethiopia in order to design targeted behavioral interventions to improve food safety and decrease diarrheal disease. A convenience sample of 21 teachers and parents were recruited for a mixed-methods pilot survey. The survey covered topical areas such as methods for growing, washing, and cooking produce, specifically focusing on practices in home vegetable gardens. Participants were also asked about fertilizers and manures used, animals on the property, and irrigation water sources. Descriptive statistics were calculated, and data were analyzed with SAS 9.2. The majority ofparticipants (76.2%) reported growing some or all of their own food, and many used compost (62.5%) and manure (62.5%) as fertilizer. Uncomposted manure was used as fertilizer by half (50.0%) of respondents who reported the use of manure. Respondents most commonly reported raising chickens (23.8%), yet among those using manure, they most commonly reported using sheep or lamb manure as fertilizer (50%). Most (93.7%) respondents used municipal water to irrigate their crops, while none of the respondents reported using surface water to irrigate. Nearly all (95.2%) reported always washing their produce before eating it. Respondents most commonly requested education regardinghow to more effectively grow produce. This study suggests that children and adults in Debre Berhan may have a high risk of exposure to pathogens via contact with uncomposted manure and multiple species of animals. Findings identify an opportunity for increased education in the topical areas of urban agriculture and diarrheal disease prevention. In particular, education regarding the safe utilization of manure as fertilizer could be included in agricultural extension programs. Additional research is needed to understand the extent of exposure via common household sources to pathogens that cause diarrheal disease.

A quenching agent is commonly added to chlorinated, reclaimed water during sample collection to prevent chlorine-mediated die-off of viable microbiota. However, the effect of quenching on downstream 16S rRNA-based bacterial community analyses is unclear. We conducted a side-by-side comparison of 16S rRNA sequencing data from reclaimed water samples quenched with sodium thiosulfate and non-quenched samples. Our data showed that 16 S rRNA processing and sequencing methods, and resulting bacterial profiles, were not negatively impacted by quenching.

The microbial quality of irrigation water has increasingly become a concern as a source of contamination for fruits and vegetables. Non-traditional sources of water are being used by more and more growers in smaller, highly diversified farms in the Mid-Atlantic region of the U.S. Shiga-toxigenic E. coli (STEC) have been responsible for several outbreaks of infections associated with the consumption of leafy greens. Our study evaluated the prevalence of the “big seven” STEC serogroups and the associated enterohemorrhagic E. coli (EHEC) virulence factors (VF) genes in conventional and nontraditional irrigation waters in the Mid-Atlantic region of the U.S. Water samples (n = 510) from 170 sampling events were collected from eight untreated surface water sites, two wastewater reclamation facilities, and one vegetable processing plant, over a 12-month period. Ten liters of water were filtered through Modified Moore swabs (MMS); swabs were then enriched into Universal Pre-enrichment Broth (UPB), followed by enrichment into non-O157 STEC R&F broth and isolation on R & F non-O157 STEC chromogenic plating medium. Isolates (n = 2489) from enriched MMS from water samples were screened for frequently reported STEC serogroups that cause foodborne illness: O26, O45, O103, O111, O121, O145, and O157, along with VF genes stx1, stx2, eae, and ehxA. Through this screening process, STEC isolates were found in 2.35% (12/510) of water samples, while 9.0% (46/510) contained an atypical enteropathogenic E. coli (aEPEC) isolate. The eae gene (n = 88 isolates) was the most frequently detected EHEC VF of the isolates screened. The majority of STEC isolates (stx1 or stx2) genes mainly came from either a pond or reclamation pond water site on two specific dates, potentially indicating that these isolates were not spatially or temporally distributed among the sampling sites. STEC isolates at reclaimed water sites may have been introduced after wastewater treatment. None of the isolates containing eae were determined to be Escherichia albertii. Our work showed that STEC prevalence in Mid-Atlantic untreated surface waters over a 12-month period was lower than the prevalence of atypical EPEC.

Post-operative infection is a significant complication of breast implant surgery that may require extensive use of antibiotics and surgical interventions. Here, we developed a biomaterial coating that is chemically bonded to silicone implants which delivers antimicrobial ions over time. After coating the silicone implants with a “mediator” polymer (γ-PGA), the implants were impregnated with silver (Ag) ions. Antimicrobial effects of these implants were assayed with modified Kirby-Bauer disk diffusion method. The silicone disks were transferred to a plate with fresh bacteria. Control was intended to simulate an intra-operative wash. The Ag-γ-PGA coated silicone demonstrated antimicrobial effects against the most common etiological agents of breast implant infections, including Pseudomonas aeruginosa, Staphylococcus aureus, Staphylococcus epidermidis, Escherichia coli and Klebsiella pneumoniae. There was no effect of inhibition of bacterial growth around the control silicone or the silicone coated only with γ-PGA. The zone of inhibition was generally larger around the Ag-γ-PGA coated silicone as compared to the silicone irrigated with gentamicin, and continued antibacterial effect was also observed at 48 hours in the Ag-γ-PGA coated silicone for all bacteria groups with the exception of P. aeruginosa. Gentamicin-irrigated silicone did not inhibit bacterial growth at 48 hours. The observed antibacterial performance of the Ag-γ-PGA coating as compared to simulated intra-operative antibiotic wash is promising and should be further evaluated to develop the next generation of implants with diminished risk for post-operative implant infections.

Water scarcity has resulted in extensive wastewater recycling for agricultural irrigation in both Israel and the Palestinian Territories. However, minimal data have been collected regarding perceptions about wastewater recycling between the populations in these two areas. While geographically close and economically linked, these two populations differ in terms of governance, income, and access to technology for wastewater recycling. To address the data gap pertaining to perceptions of wastewater recycling, a survey was administered among a convenience sample of subjects (n = 236) recruited from Eilat, Israel and Bethlehem, West Bank, from May to November 2018. The survey included questions addressing knowledge of water sources, water scarcity, and recycled water; willingness to use recycled water for produce irrigation and household tasks; and demographics. Israeli willingness to use recycled water for various purposes ranged from 8.3% to 55.1%, and more than half of Israeli respondents were willing to serve both raw and cooked produce irrigated with recycled water. Willingness to use recycled water ranged from 28.9% to 41.7% among the Palestinian respondents, and Palestinian respondents were more willing to engage in high-contact uses (i.e. drinking and cooking) than Israeli respondents. Among the Israeli respondents, experience or familiarity with wastewater recycling and water contamination were frequently significantly associated with willingness to use recycled water. In contrast, among Palestinian respondents, personal water contamination experience, home water safety testing, and trust in authorities to monitor recycled wastewater reuse were frequently significantly associated with willingness to use recycled water. Given the likely increasing water stress in both Israel and the Palestinian Territories, as well as the continued evolution of wastewater treatment technologies and the substantial amount of agricultural trade ongoing between Israel and the Palestinian Territories, it is important to identify effective and appropriate outreach and communication strategies to enable successful and acceptable water recycling.

Background Antimicrobial resistance (AMR) in Helicobacter pylori is increasing globally and can result in treatment failure and inappropriate antibiotic usage. This study used whole genome sequencing (WGS) to conduct an analysis of the H. pylori resistome and phylogeny. Materials/methods A total of 1040 H. pylori isolate sequences were retrieved. Analysis was conducted via an in-house bioinformatics pipeline targeting point mutations in selected genes frequently associated with AMR (pbp1A, 23S rRNA, gyrA, rdxA, frxA, and rpoB) and phylogenomic analyses using core genome multilocus sequence typing (cgMLST). Results Phylogenomic analysis revealed a notable geographical clustering of H. pylori genomes across world regions, but large distances of more than 1000 loci between isolates on individual branches were observed. Resistome analysis revealed the prevalence of common mutations which have previously been found to correlate with phenotypic antibiotic resistance; the most common point mutations for each gene were S589G (pbp1A, 48.8% of perfect aligned sequences), A2143G (23S rRNA, 27.4% of perfectly aligned sequences), N87 K\I\Y (gyrA, 14.7% of perfectly aligned sequences), R131K (rdxA, 65.7% of perfectly aligned sequences), and C193S (frxA, 62.6% of perfectly aligned sequences). Conclusions This is the largest study to date featuring the global phylogeny of H. pylori in conjunction with a global snapshot of the H. pylori resistome based on >1000 genomes. Further analyses that combine WGS and phenotypic methods will provide further understanding of the association between the mutations and resistance.

In disenfranchised communities, untreated greywater (wastewater without sewage) is often environmentally discharged, resulting in potential human exposure to antimicrobial-resistant bacteria (ARB), including extended-spectrum beta-lactamase (ESBL) producers. We sought to examine the abundance of ARB, specifically ESBLs, and antimicrobial resistance genes (ARGs) in greywater from off-grid, pastoral Bedouin villages in Southern Israel. Greywater samples (n = 21) collected from five villages were analyzed to enumerate fecal coliforms and Escherichia coli. ESBL producers were recovered on CHROMagar ESBL and confirmed by VITEK&reg, 2 (bioMerieux, Marcy l'Etoile, France) for identification and antimicrobial susceptibility testing. Total genomic DNA was extracted from greywater samples and quantitative PCR (qPCR) was used to determine relative abundance (gene copies/16S rRNA gene) of class 1 integron-integrase intI1, blaTEM, blaCTX-M-32, sul1, and qnrS. The mean count of presumptive ESBL-producing isolates was 4.5 &times, 106 CFU/100 mL. Of 81 presumptive isolates, 15 ESBL producers were recovered. Phenotypically, 86.7% of ESBL producers were multi-drug resistant. Results from qPCR revealed a high abundance of intI1 (1.4 &times, 10&minus, 1 gene copies/16S rRNA), sul1 (5.2 &times, 2 gene copies/16S rRNA), and qnrS (1.7 &times, 2 gene copies/16S rRNA) followed by blaTEM (3.5 &times, 3 gene copies/16S rRNA) and blaCTX-M-32 (2.2 &times, 5 gene copies/16S rRNA. Results from our study indicate that greywater can be a source of ARB, including ESBL producers, in settings characterized by low sanitary conditions and inadequate wastewater management.

Treating and reusing greywater for agricultural irrigation is becoming increasingly prevalent in water-scarce regions such as the Middle East. However, the potential for antibiotic-resistant bacteria to be introduced into food systems or the environment via greywater reuse is a potential area of concern. It is known that off-grid treated greywater often has elevated levels of bacteria, however, little is known regarding the prevalence of antibiotic-resistant bacteria in this water source. To address this knowledge gap, samples (n = 61) of off-grid, household greywater (influent), treated greywater effluent, and irrigation pond water were collected between October 2017 and June 2018 from four farms in the West Bank, Palestinian Territories. Samples were tested for pH, turbidity, dissolved oxygen, electrical conductivity, and oxidation reduction potential. Standard membrane filtration was used to enumerate presumptive Escherichia coli, and isolates (n = 88) were purified, confirmed using 16S rRNA sequencing, and subjected to antimicrobial susceptibility testing using microbroth dilution. The majority of influent (76.5%) and effluent (70.6%) samples had detectable presumptive E. coli. Interestingly, the majority of the isolates were confirmed as Klebsiella sp. (n = 37), followed by E. coli (n = 32), and the remainder were classified as other Enterobacteriaceae (n = 19). A higher percentage of effluent isolates were fully susceptible to all tested antibiotics when compared to influent isolates (28.6% vs 18.6%). Resistance was most commonly observed against ampicillin (69.3% of all isolates), trimethoprim-sulfamethoxazole (11.4%), tetracycline (9.1%), and cefazolin (7.9%), and 7.9% of isolates were observed to be multidrug-resistant. While most water quality parameters were within Israeli and Palestinian wastewater reuse requirements, E. coli levels in effluent violated available standards. These findings suggest that, despite observed decreases in bacteria and an overall decrease in isolates expressing antibiotic resistance from influent to effluent, off-grid greywater treatment systems are still a potential source of both susceptible and antibiotic-resistant bacteria in the agricultural environment.

BACKGROUND: Diarrheal disease is a major cause of mortality and morbidity for under-five children in Ethiopia. The purpose of this study was to investigate the behavioral and socioeconomic risk factors, etiology, and drug susceptibility of bacteria isolated from under-five children with acute diarrhea who were treated at Debre Berhan Referral Hospital or Health Center in Ethiopia.METHODS: A health facility based cross-sectional study design was used to investigate enteropathogens from 163 under-five children with acute diarrhea. After obtaining written consent from parents or guardians, data were collected using a standardized questionnaire. Freshly passed stool samples were collected for microbiological tests for bacteria and parasites. The chi-square test was used for assessing the relationships of variables.RESULTS: Enteropathogens were detected among 55.8% (91/163) participants. There was a 46%(75/163) bacterial culture positivity rate and a 9.8%(16/163) prevalence of parasites. The isolated enteropathogens were Escherchia coli, Klebsiella specie, Proteus species, Salmonella species, Shigella species, Enterobacter species, Giardia lamblia, Enteameba histolytica, Ascaris lumbricoides, Trichuris trichiura and Hymnoleps nana. Level of antimicrobial resistance of bacterial isolates ranged from 0 to 87.2%. Poor hand washing and poor cleaning of feeding utensils showed significant association with the presence of enteropathogens.CONCLUSION: Bacterial enteropathogens with drug resistance were observed in this study. Continuous health education and promotion about diarrheal disease for mothers/caretakers and regular surveillance of entropathogenes are recommended to reduce under-five mortality.

ObjectiveHurricanes Sandy and Irene damaged and destroyed homes, businesses, and infrastructure, and recovery after these storms took years. The goal of this article was to learn from the lived experience of local-level decision-makers actively involved in the long-term disaster recovery process after Hurricanes Irene and Sandy. Respondents provided professional recommendations, based on their experience, to assist other organizations in preparing for, responding to, and recovering from disasters.MethodsSemi-structured interviews were conducted with professionals actively involved in recovery from Hurricane Irene or Hurricane Sandy in 5 different communities. Transcripts were qualitatively analyzed.ResultsRespondents’ advice fell into 5 main categories: planning and evaluation, education and training, fundraising and donations management, building relationships, and disaster behavioral health.ConclusionsThe lived experience of those in disaster recovery can provide guidance for planning, education, and training both within and outside their communities in order to better respond to and recover from future disasters. These data help to facilitate a community of practice by compiling and sharing the lived experience of leaders who experienced large-scale disasters, and the outcomes of this analysis help to show what areas of planning require special attention in the phases of preparedness, response, and recovery. (Disaster Med Public Health Preparedness. 2016;10:623–630)

Irrigation water contaminated with Salmonella enterica and Listeria monocytogenes may provide a route of contamination of raw or minimally processed fruits and vegetables. While previous work has surveyed specific and singular types of agricultural irrigation water for bacterial pathogens, few studies have simultaneously surveyed different water sources repeatedly over an extended period of time. This study quantified S. enterica and L. monocytogenes levels (MPN/L) at 6 sites, including river waters: tidal freshwater river (MA04, n = 34), non-tidal freshwater river, (MA05, n = 32), one reclaimed water holding pond (MA06, n = 25), two pond water sites (MA10, n = 35; MA11, n = 34), and one produce wash water site (MA12, n = 10) from September 2016—October 2018. Overall, 50% (84/168) and 31% (53/170) of sampling events recovered S. enterica and L. monocytogenes, respectively. Results showed that river waters supported significantly (p < 0.05) greater levels of S. enterica than pond or reclaimed waters. The non-tidal river water sites (MA05) with the lowest water temperature supported significantly greater level of L. monocytogenes compared to all other sites; L. monocytogenes levels were also lower in winter and spring compared to summer seasons. Filtering 10 L of water through a modified Moore swab (MMS) was 43.5 (Odds ratio, p < 0.001) and 25.5 (p < 0.001) times more likely to recover S. enterica than filtering 1 L and 0.1 L, respectively; filtering 10 L was 4.8 (p < 0.05) and 3.9 (p < 0.05) times more likely to recover L. monocytogenes than 1L and 0.1 L, respectively. Work presented here shows that S. enterica and L. monocytogenes levels are higher in river waters compared to pond or reclaimed waters in the Mid-Atlantic region of the U.S., and quantitatively shows that analyzing 10 L water is more likely recover pathogens than smaller samples of environmental waters.

Agricultural water withdrawals account for the largest proportion of global freshwater use. Increasing municipal water demands and droughts are straining agricultural water supplies. Therefore, alternative solutions to agricultural water crises are urgently needed, including the use of nontraditional water sources such as advanced treated wastewater or reclaimed water, brackish water, return flows, and effluent from produce processing facilities. However, it is critical to ensure that such usage does not compromise soil, crop, and public health. Here, we characterized five different nontraditional water types (n = 357 samples) for the presence of pharmaceuticals, herbicides, and disinfectants using ultra-high-pressure liquid chromatography tandem mass spectrometry based method (UPLC-MS/MS). We then evaluated whether the levels of these contaminants were influenced by season. The highest level of herbicides (atrazine) was detected in untreated pond water (median concentration 135.9 ng/L). Reclaimed water had the highest levels of antibiotics and stimulants including azithromycin (215 ng/L), sulfamethoxazole (232.1 ng/L), and caffeine (89.4 ng/L). Produce processing plant water also tended to have high levels of atrazine (102.7 ng/L) and ciprofloxacin (80.1 ng/L). In addition, we observed seasonal variability across water types, with the highest atrazine concentrations observed during summer months, while the highest median azithromycin concentrations were observed in reclaimed water during the winter season. Further studies are needed to evaluate if economically feasible on-farm water treatment technologies can effectively remove such contaminants from nontraditional irrigation water sources.

This study investigates the lived experiences of community leaders affected by Hurricane Irene and/or Superstorm Sandy to better understand education and training needs in the long-term phase of community disaster recovery. Semi-structured interviews were conducted with 92 health and safety leaders in five communities. Local-level emergency managers, public health directors, mental health directors, hospital emergency operations leaders, elected officials, chiefs of fire and police, and leaders of volunteer organizations active in recovery were targeted for inclusion. Data were qualitatively and quantitatively analyzed. Respondents were unlikely to have had pre-event training in considerations for community recovery. Of the professions interviewed, local volunteer organization leaders indicated the lowest amount of pre-event training in disaster medicine and public health, while public health directors reported the most. Across all professions, training in internal and external communication was the most likely to be obtained pre-event. Common training needs included: awareness of Federal Emergency Management Agency programs, the incident command system, rebuilding and recovery, inter-agency, and private sector collaboration, and general disaster preparedness techniques. A multitude of professionals are active contributors to long term community recovery, suggesting the need for an inclusive and collaborative multi-sector approach toward professional education in this realm.

IntroductionThis research aimed to learn from the experiences of leaders of well-developed, disaster preparedness-focused health care coalitions (HCCs), both the challenges and the successes, for the purposes of identifying common areas for improvement and sharing “promising practices.”Hypothesis/ProblemLittle data have been collected regarding the successes and challenges of disaster preparedness-focused HCCs in augmenting health care system preparedness for disasters.MethodsSemi-structured interviews were conducted with a sample of nine HCC leaders. Transcripts were analyzed qualitatively.ResultsThe commonly noted benefits of HCCs were: community-wide and regional partnership building, providing an impartial forum for capacity building, sharing of education and training opportunities, staff- and resource-sharing, incentivizing the participation of clinical partners in preparedness activities, better communication with the public, and the ability to surge. Frequently noted challenges included: stakeholder engagement, staffing, funding, rural needs, cross-border partnerships, education and training, and grant requirements. Promising practices addressed: stakeholder engagement, communicating value and purpose, simplifying processes, formalizing connections, and incentivizing participation.ConclusionsStrengthening HCCs and their underlying systems could lead to improved national resilience to disasters. However, despite many successes, coalition leaders are faced with obstacles that may preclude optimal system functioning. Additional research could: provide further insight regarding the benefit of HCCs to local communities, uncover obstacles that prohibit local disaster-response capacity building, and identify opportunities for an improved system capacity to respond to, and recover from, disasters.WalshL, CraddockH, GulleyK, Strauss-RiggsK, SchorKW. Building health care system capacity to respond to disasters: successes and challenges of disaster preparedness health care coalitions. Prehosp Disaster Med. 2015;30(2):1-10.

Greywater is increasingly treated and reused for agricultural irrigation in off-grid communities in the Middle East and other water scarce regions of the world. However, there is a dearth of data regarding levels of antibiotics and herbicides in off-grid greywater treatment systems. To address this knowledge gap, we evaluated levels of these contaminants in two types of greywater treatment systems on four farms in the West Bank, Palestinian Territories. Samples of household greywater (influent, n = 23), treated greywater effluent intended for agricultural irrigation (n = 23) and pumped groundwater held in irrigation water ponds (n = 12) were collected from October 2017 to June 2018. Samples were analyzed using high performance liquid chromatography tandem mass spectrometry (LC-MS/MS) for the following antibiotics and herbicides: alachlor, ampicillin, atrazine, azithromycin, ciprofloxacin, erythromycin, linezolid, oxacillin, oxolinic acid, penicillin G, pipemidic acid, sulfamethoxazole, triclocarban, tetracycline, triflualin, and vancomycin. All tested antibiotics and herbicides were detected in greywater influent samples at concentrations ranging from 1.3 to 1592.9 ng/L and 3.1–22.4 ng/L, respectively. When comparing influent to effluent concentrations, removal was observed for azithromycin, alachlor, linezolid, oxacillin, penicillin G, pipemidic acid, sulfamethoxazole, triclocarban, and vancomycin. Removal was not observed for atrazine, ciprofloxacin, erythromycin, oxolinic acid, tetracycline, and trifluralin. Pond water also contained the majority of tested contaminants, but at generally lower concentrations. To our knowledge, this is the first description of an extensive array of antibiotics and herbicides detected in household greywater from off-grid treatment systems.

IntroductionThis study aimed to learn from the experiences of well-established, disaster preparedness-focused health care coalition (HCC) leaders for the purpose of identifying opportunities for improved delivery of disaster-health principles to health professionals involved in HCCs. This report describes current HCC education and training needs, challenges, and promising practices.MethodsA semi-structured interview was conducted with a sample of leaders of nine preparedness-focused HCCs identified through a 3-stage purposive strategy. Transcripts were analyzed qualitatively.ResultsTraining needs included: stakeholder engagement; economic sustainability; communication; coroner and mortuary services; chemical, biological, radiological, nuclear, and explosives (CBRNE); mass-casualty incidents; and exercise design. Of these identified training needs, stakeholder engagement, economic sustainability, and exercise design were relevant to leaders within HCCs, as opposed to general HCC membership. Challenges to education and training included a lack of time, little-to-no staff devoted to training, and difficulty getting coalition members to prioritize training. Promising practices to these challenges are also presented.ConclusionsThe success of mature coalitions in improving situational awareness, promoting planning, and enabling staff- and resource-sharing suggest the strengths and opportunities that are inherent within these organizations. However, offering effective education and training opportunities is a challenge in the absence of ubiquitous support, incentives, or requirements among health care professions. Notably, an online resource repository would help reduce the burden on individual coalitions by eliminating the need to continually develop learning opportunities.WalshL, CraddockH, GulleyK, Strauss-RiggsK, SchorKW. Building health care system capacity: training health care professionals in disaster preparedness health care coalitions. Prehosp Disaster Med. 2015;30(2):1-8.