Epidemiology and Infection最新文献

In England, Shiga toxin-producing Escherichia coli (STEC) serogroup O26 has recently emerged as a public health concern, despite fewer than half of diagnostic laboratories in England having the capability to detect non-O157 STEC. STEC O26 cases frequently report exposure to farms or nurseries. We describe the epidemiology of STEC O26 and examine evidence for a relationship between O26 and exposure to these settings. We analysed national surveillance data describing laboratory-confirmed STEC cases and public health incidents over the past 10 years to explore the incidence, clinical outcomes, and association with farms and nurseries for STEC O26 cases compared to STEC O157 and other serogroups. Between 2014 and 2023, the proportion of STEC notifications which were STEC O26 increased from 2% (19/956) to 12% (234/1946). After adjusting for age, we found no difference in the likelihood of farm or nursery attendance between O26 and O157 cases but a significantly higher risk of HUS in O26 (adjusted risk ratio 3.13 (2.18-4.51)). We demonstrate that STEC O26 is associated with the same risk of farm or nursery attendance as other STEC serogroups but a higher risk of severe morbidity. Our findings reinforce the need for improved surveillance of non-O157 STEC.

Acute gastrointestinal illness (AGI) remains a significant public health issue and differences in risk based on a comprehensive set of sociodemographic characteristics remain poorly understood. Thus, this retrospective cohort study was conducted to identify the risk of incurring an AGI-related emergency department (ED) visit or inpatient hospitalization based on various sociodemographic factors. Linked respondents of Canadian Community Health Survey cycles 2.1, 3.1, and 2007-2015 were followed from their interview date until 31 December 2017, using the National Ambulatory Care Reporting System (NACRS) and the Discharge Abstract Database (DAD) to capture emergency ED visits and hospitalizations due to AGI, respectively. Effects of identified potential risk factors for the incidence of AGI-related ED visits or hospitalizations were estimated Cox proportional hazards regression to generate hazard ratios (HRs) with 95% confidence intervals (CIs). A total of 190,700 respondents were linked to NACRS and 470,700 were linked to DAD. Six per cent of respondents visited an ED and 2% were hospitalized for AGI. Fully-adjusted estimates revealed that high-risk groups with the strongest effects were people with poor self-perceived health (ED visits: HR 1.47 (95% CI 1.40-1.54), hospitalizations: HR 1.92 (95% CI 1.82-2.02)), and people living with at least one chronic condition (ED visits: HR 1.54 (95% CI 1.47-1.61), hospitalizations: HR 1.65 (95% CI 1.57-1.73)). This study identified risk factors for requiring hospital care for AGI in the Canadian context. Additional research is needed to investigate mechanisms for differential exposure to pathogens by sociodemographic characteristics that might lead to increased risks of AGI.

This descriptive and exploratory observational case series examined intestinal colonisation and subsequent bacteraemia due to ESBL-producing Klebsiella pneumoniae (ESBL-Kp) in preterm neonates in Morocco. Prospective bacteriological cultures and antibiotic susceptibility testing were supported by phenotypic methods, including Brilliance ESBL Agar and the NG-Test CARBA-5 assay, for the rapid detection of ESBL and carbapenemase producers. Molecular analysis using PCR was also undertaken to identify specific resistance genes. A total of 567 rectal swabs were collected from 339 preterm neonates, yielding 293 K. pneumoniae isolates. ESBL-producing strains were identified in 53.6% of the neonates (182/339). Detected resistance genes included blaSHV (26.3%), blaCTX-M-1 (42.8%), blaTEM (30.2%), blaOXA-48 (50.0%), blaNDM(15.3%), and blaVIM (4.9%). Principal risk factors for colonisation were low birth weight (OR 1.69), very preterm birth (OR 6.24), enteral tube feeding (OR 2.02), and prolonged use of third-generation cephalosporins (OR 1.26). Among the neonates studied, 32 (9.4%) developed healthcare-associated bacteraemia, with 56.2% of these cases preceded by intestinal colonisation with ESBL-Kp. Clinically, severe respiratory distress and alveolar haemorrhage were strongly associated with increased mortality (aRR = 29.32 and 4.45, respectively). The findings highlight the clinical importance of early screening to guide infection control and antimicrobial stewardship in neonatal intensive care settings.

The objective of this study was to evaluate the impact on SARS-CoV-2 transmission prevention of mask wearing by index cases and their household contacts. A prospective study of SARS-CoV-2 transmission to household contacts aged ≥18 years was conducted between May 2022 and February 2024 in Spain. Contacts underwent a rapid antigen test on day zero and a real-time polymerase chain reaction test 7 days later if results were negative. The dependent variable was SARS-CoV-2 infection in contacts. Index case and contact mask use effects were estimated using the adjusted odds ratio (aOR) and its 95% confidence interval (CI). Studied were 230 household contacts, mean (standard deviation) age 53.3 (16.6) years, and 47.8% (110/230) women. Following index case diagnosis, 36.1% of contacts (83/230) used a mask, and 54.3% (125/230) were exposed to a mask-wearing index case. Infection incidence in contacts was 45.2% (104/230) and was lower in contacts exposed to mask-wearing index cases (36.0% vs. 56.2%; p < 0.002). The logistic regression model indicated a protective effect for contacts of both index case mask use (aOR = 0.31; 95% CI: 0.15-0.65) and vaccination (aOR = 0.24; 95% CI: 0.08-0.77). Index case mask use reduced SARS-CoV-2 transmission to contacts, while mask effectiveness was not observed for contacts.

In large public health jurisdictions, only a small proportion of people infected with Salmonella are interviewed due to resource constraints. As such, sources of illness are rarely found, and preventative action not implemented. We trialled alternative methods to contact notified salmonellosis cases to collect information on exposures and risks, focusing particularly on the feasibility of SMS (short message service)-based surveillance. Over five-years period we sequentially mailed letters, sent online surveys, and then text messages. The SMS approach was designed to assess the efficiency of a two-way personalized messaging model in gathering actionable public health data. The personalized SMS-follow-up model demonstrated the highest success: 56% of cases responded, enabling the identification and intervention of 10 distinct point-source outbreaks of Salmonella. SMS-based surveillance offers a novel, efficient, and acceptable method for collecting critical food exposure data in Salmonella cases. In settings where resources are constrained, SMS can complement traditional case follow-up methods, enhancing both the timeliness and effectiveness of outbreak detection. Integrating this follow-up with routine clinical care could further enhance the acceptance and success of this method. This study highlights the promise of SMS in streamlining surveillance efforts and warrants further exploration for application to other infectious diseases.

We investigated the potential yield of conducting active case finding for tuberculosis (TB) within a defined geographic radius (50 or 100 m) around the households of individuals diagnosed with TB at health facilities. In a well-defined geographic area within Kampala, Uganda, residential locations were determined for 85 people diagnosed with TB at local health facilities over an 18-month period and for 60 individuals diagnosed with TB during a subsequent community-wide door-to-door screening campaign. Ten of the individuals diagnosed through community screening lived within 50 m of an individual previously diagnosed with TB in a local health facility (TB prevalence: 0.98%), and 15 lived at a distance of 50-100 m (prevalence: 0.87%). The prevalence ratio was 1.4 (95% confidence interval (CI): 0.7-2.9) for those <50 m and 1.2 (95% CI 0.6-2.2) for those 50-100 m, compared to >100 m. Using TB notifications to identify areas for geographically targeted case finding is at most moderately more efficient than screening the general population in the context of urban Uganda.

Attaining the target of <0.1% HBsAg positives in children aged <5 years in vaccinated populations by 2030 is a WHO indicator of hepatitis B elimination. We aimed to calculate the prevalence of HBsAg- and anti-HBc-positive children and adolescents in the low-prevalence country of Germany. In total, 3567 children and adolescents aged 3-17 years participated in a national population based cross-sectional study. Data were collected between 2014 and 2017 using questionnaires and health examinations, including blood samples. Applying a weighted analysis to account for survey design and participant characteristics, we calculated the HBsAg and anti-HBc prevalence and described them by anti-HBs positivity. In total, 3007 participants had all three sero-markers measured. None were found HBsAg and anti-HBc positive. Seven (0.3%, 95% CI: 0.1-0.8) were anti-HBc positive and HBsAg negative; six were also anti-HBs positive. All anti-HBc-positive participants were aged ≥7 years and three had no migration background. Four anti-HBc-positive participants had known vaccination status; three had been vaccinated according to national recommendations. This very low hepatitis B virus sero-prevalence among children and adolescents indicates that Germany is reaching some hepatitis B virus elimination targets. We recommend maintaining preventive measures, in particular a high vaccination coverage, in order to reach hepatitis B elimination.

β-Lactam/β-lactamase inhibitor combinations and carbapenems are the first-line treatments for multidrug-resistant Pseudomonas aeruginosa (P. aeruginosa) infections. However, carbapenem resistance is increasing globally at an alarming rate, which is especially concerning given the pivotal role of these agents. This study comprehensively evaluated the global distribution of carbapenem resistance in clinical P. aeruginosa isolates. The keywords including 'Pseudomonas', P. aeruginosa', 'P. aeruginosa', 'resistance', 'susceptibility', 'carbapenem antibiotics', 'carbapenems', 'imipenem', 'meropenem', 'ertapenem', 'doripenem', as well as 'prevalence' and 'incidence' were searched in electronic databases as the appropriate keywords. After screening, 160 studies were excluded, with 87 eligible studies from diverse geographic regions retained for final analysis. A comprehensive meta-analysis was then conducted on the data collected. The mean resistance rates (95% CI) were 33.3% (imipenem), 23.3% (meropenem), 60.9% (ertapenem), and 36.7% (doripenem). The time trend analysis showed that the resistance to meropenem has increased from the year 1997 to 2023. Meta-analysis showed substantial heterogeneity (I² = 92%, p < 0.05) but no significant publication bias by Egger's or Begg's test. Global carbapenem resistance is alarmingly high in clinical P. aeruginosa isolates. The increasing prevalence of carbapenem-resistant P. aeruginosa is a major global health threat requiring urgent action through new antimicrobials and improved antibiotic stewardship to protect these last-line drugs.

In 2022, an Mpox clade II outbreak affected many countries. To optimize control, knowledge on the number of new introductions (human cases infected from outside the study population) versus local transmission is important. We extracted sequences of all 48 Mpox cases in Slovenia in 2022 from the NCBI database, of which 42 passed quality control. We estimated the number of introductions using the phylodynamic model phybreak by integrating genomic and epidemiological data and inferred transmission events. By repeating this analysis with weekly cumulative case data, we assessed if introductions could have been reliably inferred in real time. The number of introductions, estimated after the outbreak ended, was 19 (95% CI: 13-29), and two larger transmission clusters existed. As these introductions occurred throughout the outbreak, we conclude that the Slovenian Mpox outbreak was mainly driven by new introductions. Analysing the data 'in real time' would have only slightly overestimated the number of introductions per week, capturing the trend of introductions as main driver of the outbreak. This makes it useful for guiding control policy during outbreaks, prioritizing the rapid identification of cases among travellers, and with that preventing emergence of new transmission chains.