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Rickettsiamicroorganisms are causative agents of several neglected emerging infectious diseases transmitted to humans by ticks among other arthropod vectors. In this study, ticks were collected from four geographical regions of Uganda, pooled in sizes of 1-179 ticks based on location, tick species, life stage, host, and time of collection, and were tested by real time PCR forRickettsiaspecies harboured. The tick pools were tested with primers targetinggltA, 17kDaandompA genes, followed by Sanger sequencing of17kDaandompAgenes. Of the 471 tick pools tested, 116 (24.6%) were positive forRickettsiaspp. by thegltAprimers. The prevalence ofRickettsiavaried by district with Gulu recording the highest (30.1%) followed by Luwero (28.1%) and Kasese had the lowest (14%). Tick pools with highest positivity rates were from livestock (cattle, goats, sheep, and pigs), 26.9%, followed by vegetation 23.1% and pets (dogs and cats) 19.7%. Of 116gltA-positive tick pools, 86 pools were positive using17kDaprimers of which 48 purified PCR products were successfully sequenced. The predominantRickettsiaspp. identified wasR. africae(n=15) in four tick species, followed byR. conorii(n=5) in three tick species (Haemaphysalis elliptica, Rhipicephalus appendiculatus, andRh. decoloratus).Rickettsia conoriisubsp.israelensiswas detected in one tick pool. These findings indicate that multipleRickettsiaspp. capable of causing human illness are circulating in the four diverse geographical regions of Uganda including new strains previously known to occur in the Mediterranean region. Physicians should be informed aboutRickettsiaspp. infections as potential causes for acute febrile illnesses in these regions. Continued and expanded surveillance is essential to further identify and locate potential hotspots withRickettsiaspp. of concern.Author SummaryTick-borne rickettsioses are emerging infectious diseases of public health importance worldwide. Spotted fever rickettsioses transmitted by ticks can cause mild to severe human illness depending on theRickettsiaspp. and co-morbidities. Their diagnosis is challenging due to non-specific symptoms particularly in limited resource settings. Little is known about their prevalence in Uganda. Using entomological and molecular tools, we surveyed and studied tick-borne spotted fever rickettsioses in five districts from four diverse eco-regions of Uganda. Overall, 24.6% (116/471) tick pools were positive forRickettsiaspecies. By sequencing the17kDaandompAgenes ofRickettsia, we identifiedR. africaeas the most common agent, followed byR. conoriiandR. conoriisubsp.israelensis. The findings indicate multipleRickettsiaspp. that can cause febrile illness in humans are circulating in the four geographically diverse regions of Uganda. Physicians should be aware these agents are potential causes of febrile illness in these areas, particularly in individuals who encounter livestock or their grazing areas.

The epidemiological profile of rabies virus within Mongolia remains poorly characterized despite 21,302 domestic animal cases being reported between 1970-2005. This lack of knowledge is particularly concerning given that roughly 26% of the population lives a pastoral herding lifestyle and livestock production contributes up to 18% of Mongolia's total gross domestic product (GDP). The gaps in knowledge of the rabies disease ecology within Mongolia combined with the lack of routine vaccination of domestic animals and wildlife poses a significant threat to the more than 60 million heads of livestock within Mongolia. Animal rabies case data from the General Authority for Veterinary Services and National Center for Zoonotic Diseases were used in this study. Each data point included year of report, an animal descriptor, geographic coordinates and the aimag (province) of origin. A total of 2,359 animal rabies cases were reported between 2012-2018. Cattle were the most commonly reported animal overall (861 cases), followed by goats (268), sheep (251) and dogs (221) within the domestic animal category. Red foxes were responsible for most reported wildlife cases (317) followed by wolves (151). Most rabid animals were reported in the Khuvsgul, Uvurkhangai and Govi-Altai aimags, and a positive correlation was found between livestock numbers per soum and the number of rabies cases reported. Rabies poses a significant threat to the Mongolian economy and the health of human and animal populations within Mongolia. The close association of the nomadic pastoralists with both domestic animals and wildlife represents a significant threat for disease emergence and necessitates studies that describe the ecology of rabies, which may threaten these populations.

The impact and disruption of infectious disease outbreaks stretch far beyond their direct death toll, as they often overburden health systems, reduce treatment seeking behaviors, and interrupt treatment regimens. This study examines the impact of the 2014–2016 Ebola virus outbreak on tuberculosis (TB) treatment outcomes at the 34 Military Hospital in Freetown, Sierra Leone. We used retrospective data from 1,085 TB patient outcome data registers to build a multinomial logistic regression model to evaluate the change in TB treatment outcomes before and after the Public Health Emergency of International Concern (PHEIC) declaration in August 2014. These results showed that HIV status, patient age, whether patients had active versus latent TB, and the time since the start of the outbreak were significantly associated with TB treatment outcomes. The model showed an increase in probability of unknown and unsuccessful (died or treatment failed) treatment outcomes with each month after the PHEIC declaration, across age groups, TB status, and HIV status.

Outer surface protein C (OspC) is a commonly used marker in population studies of

Lyme disease is the most common tick-borne disease in North America. Though human infection is mostly transmitted in a limited geography, the range has expanded in recent years. One notable area of recent expansion is in the mountainous region of southwestern Virginia. The ecological factors that facilitate or constrain the range of human Lyme disease in this region remain uncertain. To evaluate this further, we obtained ecological data, including remotely sensed data on forest structure and vegetation, weather data, and elevation. These data were aggregated within the census block groups of a 9,153 km2 area around the cities of Blacksburg and Roanoke, VA, an area with heterogeneous Lyme disease transmission. In this geographic area, 755 individuals were reported to have Lyme disease in the 10 yr from 2006 to 2015, and these cases were aggregated by block group. A zero-inflated negative binomial model was used to evaluate which environmental variables influenced the abundance of Lyme disease cases. Higher elevation and higher vegetation density had the greatest effect size on the abundance of Lyme disease. Measures of forest edge, forest integrity, temperature, and humidity were not associated with Lyme disease cases. Future southward expansion of Lyme disease into the southeastern states may be most likely in ecologically similar mountainous areas.

BackgroundIn 2015 and 2016, the Bioko Island Malaria Control Project (BIMCP) introduced a pilot larvicide program, which recruited local volunteers to assess the sustainability and effectiveness of community-led larval source management. This study evaluates the effectiveness of the community-led LSM program to determine if this type of intervention could be used as a sustainable malaria control method on Bioko Island.MethodsThe pilot program was split into two phases, both taking place between February and December, with phase I in 2015 and phase II in 2016. During phase I, the BIMCP team assisted in identifying and treating Anopheles species mosquito breeding habitats. During phase II, community volunteers, with supervision from designated community leaders, identified and treated breeding habitats. Larval source management took place at thirteen locations around the Island during both phases. Human landing catches were conducted at seven sentinel sites once every month for the duration of the study period to determine average nightly biting rates.ResultsDuring phase I, 1,033 breeding sites were identified with a 100% treatment coverage rate. Only 970 breeding sites were identified in phase II with a 75% treatment coverage rate, a significant decrease from phase I (pConclusionOverall, community-based larval source management can be effective with strong operational management and oversight. However, repeated training and evaluation will be necessary to monitor the effectiveness and sustainability of such interventions.

An effective community response during a pandemic requires public health infrastructure and capacity, the availability of technology and supplies, a knowledgeable and prepared workforce, as well as an incident management and leadership plan. Early in the COVID-19 outbreak in the United States, care providers were challenged by information gaps, supply shortages, and lack of resource coordination in caring for patients, which affected their ability to care for patients. As an emergency unfolds in a community, preemptive planning is needed to prevent barriers to quality patient care, support disease surveillance and contact tracing, and optimize the use of limited resources ranging from personal protective equipment to disease testing and hospital care. The experience of primary health-care providers during this pandemic provides useful information for understanding the gaps in emergency planning and management during a public health emergency.

Background Quality control of indoor residual spraying (IRS) is necessary to ensure that spray operators (SOs) deposit the correct concentration of insecticide on sprayed structures, while also confirming that spray records are not being falsified. Methods Using high-performance liquid chromatography (HPLC), this study conducted quality control of the organophosphate insecticide pirimiphos-methyl (Actellic 300CS), during the 2018 IRS round on Bioko Island, Equatorial Guinea. Approximately 60 SOs sprayed a total of 67,721 structures in 16,653 houses during the round. Houses that were reportedly sprayed were randomly selected for quality control testing. The SOs were monitored twice in 2018, an initial screening in March followed by sharing of results with the IRS management team and identification of SOs to be re-trained, and a second screening in June to monitor the effectiveness of training. Insecticide samples were adhesive-lifted from wooden and cement structures and analysed using HPLC. Results The study suggests that with adequate quality control measures and refresher training, suboptimal spraying was curtailed, with a significant increased concentration delivered to the bedroom (difference = 0.36, P Conclusions The ability to randomly select, locate, and test houses reportedly sprayed within a week via HPLC has led to improvements in the performance of SOs on Bioko Island, enabling the project to better evaluate its own performance.

Background During March of 2020 the Centers for Disease Control and Prevention (CDC) announced non-pharmaceutical intervention (NPI) guidance as the primary mitigation strategy against growing COVID-19 community spread due to the absence of a vaccine or effective treatment at that time. CDC guidance states that NPIs are most effective when instituted in an early, targeted, and layered fashion. NPIs are effective in slowing spread, and measures should be custom-tailored to each population. This study examines factors associated with implementation and timing of NPI interventions across large public and private U.S. universities at the onset of the COVID-19 pandemic. Methods NPI decisions of interest include when U.S. universities canceled international travel, shifted to online learning, moved faculty/staff to remote work, limited campus housing, and closed campus for all non-essential personnel. Cox proportional hazard analyses of retrospective data were conducted to assess the time to NPI events. Hazard ratios were calculated for university governance, campus setting, religious affiliation, health infrastructure, faculty diversity, and student demographics. The methods control for variance inflation factors, COVID case prevalence, and time varying covariates of spring break and states’ state of emergency (SOE) orders. This study captures NPI decisions at 575 U.S. universities during spring of 2020 which affected the movement of seven million students and two million employees. Results Universities located in districts represented by Democratic party congressional members reported earlier NPI implementation than Republican (Cox proportional hazard ratio (HR) range 0.61–0.80). University religious affiliation was not associated with the timing any of the NPI decisions. Universities with more diverse faculty showed an association with earlier NPI implementation (HR range 0.65–0.76). The existence of university-affiliated health infrastructure was not associated with NPI timing. Conclusion University NPI implementation was largely driven by local COVID-19 epidemiology, culture and political concerns. The timing of university NPI decisions varied by regional politics, faculty demographics, university governance, campus setting, and foreign student prevalence adjusting for COVID-19 state case prevalence and spring break timing. Religious affiliation and presence of university health infrastructure were not associated with timing.

Over the past decade, insecticide resistance to malaria vectors has been identified in 71 malaria endemic countries. This has posed a major global health challenge in the fight against malaria, with declining rates of indoor residual spraying coverage attributed to pyrethroid-resistance. As part of its vector control monitoring strategies, the Bioko Island Malaria Control Project (BIMCP) in Equatorial Guinea conducted routine insecticide resistance bioassays using the WHO’s standard susceptibility tests from 2013 to 2018. During the same period, the frequency of the target-site knockdown resistance allele (kdr) in the local vector population was also determined via PCR for detection of the L1014 F mutation. Biochemical analysis for metabolic resistance was also conducted in 2015. From 2016–2017, Fludora™ fusion, a formulated combination of clothianidin (a neonicotinoid) and deltamethrin (a pyrethroid) was evaluated for 9 months on Bioko Island, using the WHO’s standard test procedure for determining residual effectiveness of insecticides on sprayed surfaces. In 2016, the mortality rate of the vectors on 0.05% deltamethrin was as low as 38%. The frequency of the West African form of knockdown resistance allele, L1014 F, in the vector population was as high as 80%, and metabolic resistance analysis indicated high upregulated cytochrome P450 s. However, the residual effectiveness of Fludora™ fusion recorded mortalities above 80% after 72 h of exposure for 8 months. Although both target-site knockdown resistance and metabolic resistance to pyrethroids were implicated in the local malaria vector population, Fludora™ fusion was effective under field conditions in controlling the resistant vectors for a period of 8 months on wooden surfaces on Bioko Island and represents a valuable addition to IRS programs, especially in regions with high levels of pyrethroid resistance.

Years when the deer population is robust during the autumn hunting season may point toward an elevated risk of Lyme disease (LD) in the human population two summers later. We applied overdispersed Poisson regression models to county-specific data from New Jersey for each year from 2000 to 2014. The average relative risk of LD for each additional hunter-killed deer per square mile was 1.12 (1.10, 1.14) for 2000-2007 and 1.11 (1.09, 1.13) for 2008-2014. The hunting data already collected for conservation and wildlife management purposes may be a relevant component of LD surveillance activities.

Background: Lyme disease, caused by Borrelia burgdorferi sensu lato (BBSL), is commonly found in wild and domestic mammals worldwide. In China, human cases of B. burgdorferi infections have been identified across a wide distribution, but little direct surveillance of potential small mammal reservoirs has been performed in Yunnan Province, a tropical region in southwestern China. Here we report a thorough investigation of BBSL in small mammals collected from 2011 to 2016 from this region.Methods: Small mammals were captured using snap traps in 23 counties located in Yunnan Province. DNA was extracted from spleen tissue using DNA blood and tissue kits. A nested PCR targeting the 5S-23S rRNA intergenic spacer gene of BBSL was used for pathogen detection. Amplicons of 252bp expected sizes were sequenced directly and analyzed using BLAST algorithm. A phylogenetic tree was constructed using MEGA software and statistical analysis were conducted using SPSS version 17.0.Results: Overall, 3659 mammals belonging to 57 species were captured at 159 sample sites located in 23 counties in Yunnan Province. Borrelia burgdorferi s.l. was found in 146 mammals (3.99%), from 30 different species, 20 of which represent the first reported detection in that species. Sequence analysis revealed five genotypes of B. burgdorferi s.l., including B. afzelii, B. burgdorferi sensu stricto, B. japonica, B. garinii and B. valaisiana.Conclusions: Significant differences in prevalence rates of BBSL were observed at varying landscape types and altitudes. Small mammals in forested areas had higher prevalence rates than other landscape types, as did small mammals found at altitudes greater than 2500 meters. The five genotypes of BBSL detected, suggests high genetic diversity within this province.

The timing of the pandemic response decision can affect the national mass migration of millions of students back to campus thus limiting community spread. During the initial stages of the COVID-19 pandemic, universities across the United States were faced with making difficult decisions often without explicit or uniform guidance from state and national leadership. This study examines how and when public universities responded to the U.S. COVID-19 outbreak, regarding decisions to cancel international travel, switch to online learning, transition faculty and staff to remote work, limiting on-campus housing, and implementing campus closures. Data was collected on university timing and decision making for medium to large public universities with more than 5,000 enrolled students, representing 412 institutions, 7M people, and all 50 states and Puerto Rico, between February 27 and March 31st, 2020. Substantial heterogeneity in decision making and the timing of those decisions as they relate to key state, national, and global emergency announcements were observed. The WHO pandemic declaration coincided with announcements to move away from on-campus learning. Universities decisions were made largely at the university level and not coordinated by government agencies, leading to staggered announcements and major variations in university timelines between states and within states. The importance of synchronizing university decisions in a national emergency scenario cannot be understated. Dissonant university decisions and announcement dates may potentially lead to mixed messaging and a reduction of the effectiveness of early interventions. Clear guidance is needed moving forward regarding university operations for fall and summer.

Background The radical cure of Plasmodium vivax and P. ovale requires treatment with primaquine or tafenoquine to clear dormant liver stages. Either drug can induce haemolysis in individuals with glucose-6-phosphate dehydrogenase (G6PD) deficiency, necessitating screening. The reference diagnostic method for G6PD activity is ultraviolet (UV) spectrophotometry; however, a universal G6PD activity threshold above which these drugs can be safely administered is not yet defined. Our study aimed to quantify assay-based variation in G6PD spectrophotometry and to explore the diagnostic implications of applying a universal threshold. Methods and findings Individual-level data were pooled from studies that used G6PD spectrophotometry. Studies were identified via PubMed search (25 April 2018) and unpublished contributions from contacted authors (PROSPERO: CRD42019121414). Studies were excluded if they assessed only individuals with known haematological conditions, were family studies, or had insufficient details. Studies of malaria patients were included but analysed separately. Included studies were assessed for risk of bias using an adapted form of the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool. Repeatability and intra- and interlaboratory variability in G6PD activity measurements were compared between studies and pooled across the dataset. A universal threshold for G6PD deficiency was derived, and its diagnostic performance was compared to site-specific thresholds. Study participants (n = 15,811) were aged between 0 and 86 years, and 44.4% (7,083) were women. Median (range) activity of G6PD normal (G6PDn) control samples was 10.0 U/g Hb (6.3–14.0) for the Trinity assay and 8.3 U/g Hb (6.8–15.6) for the Randox assay. G6PD activity distributions varied significantly between studies. For the 13 studies that used the Trinity assay, the adjusted male median (AMM; a standardised metric of 100% G6PD activity) varied from 5.7 to 12.6 U/g Hb (p < 0.001). Assay precision varied between laboratories, as assessed by variance in control measurements (from 0.1 to 1.5 U/g Hb; p < 0.001) and study-wise mean coefficient of variation (CV) of replicate measures (from 1.6% to 14.9%; p < 0.001). A universal threshold of 100% G6PD activity was defined as 9.4 U/g Hb, yielding diagnostic thresholds of 6.6 U/g Hb (70% activity) and 2.8 U/g Hb (30% activity). These thresholds diagnosed individuals with less than 30% G6PD activity with study-wise sensitivity from 89% (95% CI: 81%–94%) to 100% (95% CI: 96%–100%) and specificity from 96% (95% CI: 89%–99%) to 100% (100%–100%). However, when considering intermediate deficiency (, Daniel Pfeffer and coauthors report on the assessment of glucose-6-phosphate dehydrogenase activity, which is required for safe use of some malaria treatments., Author summary Why was this study done? Complete cure of vivax malaria, the most geographically widespread malaria species, requires the use of 8-aminoquinoline drugs to clear dormant liver stages of the parasite (‘radical cure’); however, these drugs can cause severe haemolysis in individuals with glucose-6-phosphate dehydrogenase (G6PD) deficiency. Ultraviolet (UV) spectrophotometry is used as the reference test to measure G6PD activity, for validating new point-of-care diagnostics, and to determine population-specific definitions of G6PD deficiency. Currently, there is no universal threshold to define G6PD deficiency, and each laboratory must invest time and resources to derive site- and laboratory-specific definitions of G6PD deficiency. What did the researchers do and find? We pooled measurements of G6PD activity from studies conducted across different countries and laboratories worldwide. We assessed the comparability of spectrophotometry results between these laboratories to see whether a universal definition and diagnostic cutoff for G6PD deficiency could be determined. There was substantial variation in the performance and absolute measurements of spectrophotometry conducted in different laboratories, hindering the definition of a universal cutoff for G6PD deficiency. What do these findings mean? These findings highlight the importance of quality-control measures to minimise the influence of laboratory procedures on observed measurements. The data suggest that while a robust universal, assay-specific G6PD activity cutoff value can be established for diagnosis of severe G6PD deficiency (

Background: Lyme disease is caused by Borrelia burgdorferi sensu lato which is usually found in wild and domestic mammals worldwide. In China, Human cases of B. burgdorferi infections have been identified in a wide distribution, but little direct surveillance of potential rodent reservoirs has been performed in Yunnan Province, the tropical region, Sino-Burmese border area, southwestern China. Here we report a thoroughly investigation of B. burgdorferi sensu lato in small mammals collected in 2011 to 2016 in the region.Methods: A nested PCR was done for the 5S-23S rRNA intergenic spacer gene of Borrelia burgdorferi sensu lato. The PCR-positive amplicons were directly sequenced. Sequence analysis was carried out using a FASTA search on the Genbank database, with phylogenetic trees constructed using MEGA software, version 6.06. Statistical Analysis were conducted using SPSS.version 17.0.Results: Totally 57 species, 3659 mammals were captured at 159 sample sites located in 23 counties in Yunnan Province. Thirty species, 146 (3.99%) mammals were tested positive for B. bourgdorferi s.l . by nested PCR based on 5S-23S rRNA intergenic spacer gene. 20 species mammals were first reported infected with B. burgdorferi s.l. Sequence analysis revealed that five genotypes of B. burgdorferi s.l. were detected, including B. afzelii , B. burgdorferi sensu stricto, B. japonica , B. garinii and B. valaisiana.Conclusions: Significant differences in prevalence rates of B. bourgdorferi s.l were observed at varying landscape types and altitudes. Small mammals in forested areas had higher prevalence rates than other landscape types as did small mammals found at altitudes greater than 2500 meters. The 5S-23S rRNA intergenic spacer gene revealed that there were five genotypes of B. burgdorferi s.l. detected, indicating high genetic diversity within this province.

Land use boundaries represent human&ndash, physical interfaces where risk of vector-borne disease transmission is elevated. Land development practices, coupled with rural and urban land fragmentation, increases the likelihood that immunologically na&iuml, ve humans will encounter infectious vectors at land use interfaces. This research consolidated land use classes from the GLC-SHARE dataset, calculated landscape metrics in linear (edge) density, proportion abundance, and patch density, and derived the incidence rate ratios of the Zika virus occurrence in Colombia, South America during 2016. Negative binomial regression was used to evaluate vector-borne disease occurrence counts in relation to Population Density, Average Elevation, Per Capita Gross Domestic Product, and each of three landscape metrics. Each kilometer of border length per square kilometer of area increase in the linear density of the Cropland and Grassland classes is associated with an increase in Zika virus risk. These spatial associations inform a risk reduction approach to rural and urban morphology and land development that emphasizes simple and compact land use geometry that decreases habitat availability for mosquito vectors of Zika virus.

BackgroundThe Centers for Disease Control and Prevention (CDC) publishes COVID-19 non-pharmaceutical intervention (NPI) guidance for specific institutional audiences to limit community spread. Audiences include: business, clinical, public health, education, community, and state/local government. The swift, severe, and global nature of COVID-19 offers an opportunity to systematically obtain a national view of how larger institutions of higher education adopted NPI guidance at the onset of the pandemic.MethodAn original database of COVID-19-related university NPI policy changes was compiled. Survey team members manually combed university websites and official statements capturing implementation decisions and dates for five NPI variables from 575 U.S. universities, across 50 states and the District of Columbia, during March of 2020. The universities included in this study were selected from the Department of Education Integrated Postsecondary Education Data System (IPEDS), which provides a set of university explanatory variables. Using IPEDS as the basis for the organizational data allows consistent mapping to event-time and institutional characteristic variables including public health announcements, geospatial, census, and political affiliation.ResultsThe dataset enables event-time analysis and offers a variety of variables to support institutional level study and identification of underlying biases like educational attainment. A descriptive analysis of the dataset reveals that there was substantial heterogeneity in the decisions that were made and the timing of these decisions as they temporally related to key state, national, and global emergency announcements. The WHO pandemic declaration coincided with the largest number of university decisions to implement NPIs.ConclusionThis study provides descriptive observations and produced an original dataset that will be useful for future research focused on drivers and trends of COVID-19 NPIs for U.S. Universities. This preliminary analysis suggests COVID-19 university decisions appeared to be made largely at the university level, leading to major variations in the nature and timing of the responses both between and within states, which requires further study.

The livestock industry in Mongolia accounts for 24% of national revenue, with one third of the population maintaining a pastoral lifestyle. This close connection between Mongolian population and livestock is a major concern for pathogen transfer, especially given the increase in vector-borne diseases globally. This study examines blood samples from livestock to assess the prevalence of tick-borne bacterial infections across three provinces in Mongolia (Dornogovi, Selenge, Tov). Whole blood samples from 243 livestock (cattle=38, camel=11, goat=85, horse=22, sheep=87) were analyzed with 16S metagenomics next-generation sequencing (NGS) to screen for bacterial pathogens. Positive-NGS samples for Anaplasma, Bartonella, Ehrlichia, Francisella, Leptospira, and Rickettsia were confirmed by conventional PCR and DNA sequencing. Prevalence rates of Anaplasma, Bartonella, and Ehrlichia were 57.6%, 12.8%, and 0.4%, respectively. A significant difference in the prevalence of Anaplasma spp. in livestock by province was observed, with a higher prevalence in Selenge (74.2%, p

Burkholderia pseudomallei, the etiological agent of melioidosis, has been hypothesized to be endemic throughout the Caribbean, including the impoverished nation of Haiti. However, because of the protean clinical manifestations, presence of asymptomatic infections, and limited medical diagnostic capacity, the identification of active melioidosis cases remains challenging. A seroepidemiological study was conducted using a novel enzyme-linked immunosorbent assay (ELISA) to detect antibodies toward B. pseudomallei in the native population. The performance of an indirect ELISA with purified lipopolysaccharide (LPS) from B. pseudomallei was evaluated using serum collected from rhesus macaques exposed to aerosolized B. pseudomallei. After optimization, serum collected from asymptomatic population members (n = 756) was screened for polyvalent (immunoglobulin M [IgM]/ immunoglobulin G [IgG]/ immunoglobulin A) and monoclonal (IgG or IgM) immunoglobulins against B. pseudomallei LPS. The population seroprevalence was 11.5% (95% confidence interval [CI]: 9.2, 13.8) for polyvalent immunoglobulins, 9.8% (95% CI: 7.7, 11.9) for IgG, and 1.7% (95% CI: 0.8, 2.6%) for IgM. The seroprevalence was not significantly different by gender (P = 0.16), but increased significantly (P < 0.001) with age, yielding an estimated annual seroconversion rate of 1.05% (95% CI: 0.81, 1.3). The detection of both recent (IgM+) and previous (IgG+) exposure to B. pseudomallei provides serological evidence that melioidosis is endemic in Haiti.

Background To better understand the epidemiology of tick-borne disease in Mongolia, a comprehensive seroprevalence study was conducted investigating exposure to Anaplasma spp . and spotted fever group (SFG) Rickettsia spp . in nomadic herders and their livestock across three provinces from 2014 to 2015. Methods Blood was collected from 397 herders and 2370 livestock, including sheep, goats, cattle, horses and camels. Antibodies against Anaplasma spp . and SFG Rickettsia were determined by indirect immunofluorescence using commercially available slides coated with Anaplasma phagocytophilum and Rickettsia rickettsii antigens. Logistic regression was used to determine if the odds of previous exposure differed by gender, location, and species, with or without adjustment for age. To examine the association between seroprevalence and environmental variables we used ArcGIS to circumscribe the five major clusters where human and animal data were collected. Results Anaplasma spp . exposure was detected in 37.3% (136/365) of humans and 47.3% (1120/2370) of livestock; SFG Rickettsia exposure was detected in 19.5% (73/374) humans and 20.4% (478/2342) livestock. Compared to the southern province (aimag) of Dornogovi, located in the Gobi Desert, humans were significantly more likely to be exposed to Anaplasma spp . and SFG Rickettsia in the northern provinces of Tov (OR = 7.3, 95% CI: 3.5, 15.1; OR = 3.3, 95% CI: 1.7, 7.5), and Selenge (OR = 6.9, 95% CI: 3.4, 14.0; OR = 2.2, 95% CI: 1.1, 4.8). Conclusion The high seroprevalence of Anaplasma spp . and SFG Rickettsia in humans and livestock suggests that exposure to tick-borne pathogens may be common in herders and livestock in Mongolia, particularly in the more northern regions of the country. Until more is known about these pathogens in Mongolia, physicians and veterinarians in the countryside should consider testing for Anaplasma and SFG Rickettsia infections and treating clinically compatible cases, while public health authorities should expand surveillance efforts for these emerging infections.

Human yaws has historically been endemic to Kenya, but current epidemiologic data are lacking. We report seroprevalence for Treponema pallidum antibodies in olive baboons (Papio anubis) and vervet monkeys (Chlorocebus pygerythrus) in Laikipia County, Kenya. Our results suggest endemicity of the yaws bacterium in monkeys, posing a possible zoonotic threat to humans. US Agency for International Development Emerging Pandemic Threats PREDICT ProjectUnited States Agency for International Development (USAID) [GHN-A-OO-09-00010-00]; German Research FoundationGerman Research Foundation (DFG) [DFG KN 1097/3-1] This study was supported by the US Agency for International Development Emerging Pandemic Threats PREDICT Project (cooperative agreement mo. GHN-A-OO-09-00010-00) and the German Research Foundation (grant DFG KN 1097/3-1 to S.K.).

Introduction The governments of Haiti and the Dominican Republic have a binational agreement to work towards malaria elimination for the island of Hispaniola by the year 2020. Understanding malaria-related knowledge and behaviors can help inform elimination efforts. This study examined the association between social-behavioral factors, like bedtime and bed net ownership, with malaria seroconversion status among people in the Ouest and Sud-Est departments of Haiti. Methods In 2013, cross-sectional survey data ( n = 377) and blood samples were collected from a convenience sample of individuals within community, clinic and school settings. Logistic regression models were constructed to examine associations between social-behavioral factors and malaria exposure, adjusting for potential confounders. Results Compared to people going to bed between 6 and 8 pm, those going to bed between 8 and 10 pm were 2.67 (OR, 95% CI: 1.16–6.14) times as likely to have been exposed to malaria. Participants who reported going to bed after 10 pm were 5.96 times as likely to have had previous malaria exposure (OR, 95% CI: 2.26–15.7), compared to 6–8 pm. No significant associations were found between malaria exposure and either insecticide use nor bed net ownership. Discussion These findings are consistent with suspected feeding behaviors of Anopheles albimanus, which prefers feeding at night and outdoors. Study findings may improve overall understanding of malaria transmission in Haiti and potentially guide future studies conducted in this region.

Background Rodents are one of the major taxa most likely to carry zoonotic diseases, harboring more than 85 unique zoonotic pathogens. While the significance of rodents’ capacity to carry and transmit disease has been characterized in urban settings, the zoo environment is particularly unique given the overlap of collection, free-living, and feeder rodents as well as non-rodent collection animals, staff, and visitors. Eligibility Criteria This scoping review examines reports of rodent-borne pathogen detection or transmission in zoo settings extracted from the literature. Papers were included in the final analysis if there was evidence of presence or exposure to a pathogen in a rodent at a zoological institution. Sources of evidence : Publications were included from PubMed, CAB Abstracts and Biological Abstracts searched in August 2019. Charting methods : Data extracted from publications on pathogen presence/exposure included publication identifiers, study identifiers, infectious agent identifiers, rodent identifiers, and non-rodent collection animal identifiers. Extraction from papers with evidence of disease transmission included number of rodents involved in transmission, non-rodent collection animal species and numbers, and job title of humans involved, diagnostic tests performed, and clinical outcomes. Results Aggregate literature examined included 207 publications presenting evidence of pathogen presence and/or exposure in rodents across 43 countries in over 140 zoological institutions. A total of 143 infectious agent genera were identified, comprising 14 viral genera, 31 bacterial genera, 83 parasitic genera, and 15 fungal genera. Of these infectious agents, over 75 % were potentially zoonotic. The most common disease-causing agent genera identified were Leptospira , Toxoplasma , Salmonella , and Yersinia . Additional screening for evidence of pathogen transmission across species yielded 30 publications, indicating an area for future investigation to better inform surveillance and management priorities in order to reduce exposure, infection, and transmission. Conclusions Analyzing the breadth of rodent species and pathogens identified at zoos highlights the unique opportunity zoos have to be at the forefront of the early detection and identification of novel hosts and geographic ranges of rodent-borne pathogens with high impact on both endangered species and people. The overlap of these populations at zoos exemplifies the importance of considering One Health when prioritizing surveillance and risk mitigation of rodent reservoirs at zoos.