Risk factors and monitoring for water quality to determine best management practices for splash parks.

Splash parks have been associated with infectious disease outbreaks as a result of exposure to poor water quality. To be able to protect public health, risk factors were identified that determine poor water quality. Samples were taken at seven splash parks where operators were willing to participate in the study. Higher concentrations of Escherichia coli were measured in water of splash parks filled with rainwater or surface water as compared with sites filled with tap water, independent of routine inspection intervals and employed disinfection. Management practices to prevent fecal contamination and guarantee maintaining good water quality at splash parks should include selection of source water of acceptable quality.

Health risk assessment for splash parks that use rainwater as source water.

In the Netherlands, rainwater becomes more and more popular as an economic and environmentally sustainable water source for splash parks, however, the associated public health risk and underlying risk factors are unknown. Since splash parks have been associated with outbreaks of infectious diseases, a quantitative microbial risk assessment was performed using Legionella pneumophila as a target pathogen to quantify the risk of infection for exposure due to inhalation and Campylobacter jejuni for ingestion. Data for L. pneumophila and C. jejuni concentrations in rainfall generated surface runoff from streets were extracted from literature. Data for exposure were obtained by observing 604 people at splash parks, of whom 259 were children. Exposure volumes were estimated using data from literature to determine the volume of exposure through inhalation at 0.394 µL/min (95% CI-range 0.0446-1.27 µL/min), hand-to-mouth contact at 22.6 µL/min, (95% CI-range 2.02-81.0 µL/min), ingestion of water droplets at 94.4 µL/min (95% CI-range 5.1-279 µL/min) and ingestion of mouthfuls of water at 21.5·10(3) µL/min (95% CI-range 1.17 ·10(3)-67.0·10(3) µL/min). The corresponding risk of infection for the mean exposure duration of 3.5 min was 9.3·10(-5) (95% CI-range 0-2.4·10(-4)) for inhalation of L. pneumophila and 3.6·10(-2) (95% CI-range 0-5.3·10(-1)) for ingestion of C. jejuni. This study provided a methodology to quantify exposure volumes using observations on site. We estimated that using rainwater as source water for splash parks may pose a health risk, however, further detailed quantitative microbial analysis is required to confirm this finding. Furthermore we give insight into the effect of water quality standards, which may limit infection risks from exposure at splash parks.

Quantitative assessment of infection risk from exposure to waterborne pathogens in urban floodwater.

Flooding and heavy rainfall have been associated with waterborne infectious disease outbreaks, however, it is unclear to which extent they pose a risk for public health. Here, risks of infection from exposure to urban floodwater were assessed using quantitative microbial risk assessment (QMRA). To that aim, urban floodwaters were sampled in the Netherlands during 23 events in 2011 and 2012. The water contained Campylobacter jejuni (prevalence 61%, range 14- >10(3) MPN/l), Giardia spp. (35%, 0.1-142 cysts/l), Cryptosporidium (30%, 0.1-9.8 oocysts/l), noroviruses (29%, 10(2)-10(4) pdu/l) and enteroviruses (35%, 10(3)-10(4) pdu/l). Exposure data collected by questionnaire, revealed that children swallowed 1.7 ml (mean, 95% Confidence Interval 0-4.6 ml) per exposure event and adults swallowed 0.016 ml (mean, 95% CI 0-0.068 ml) due to hand-mouth contact. The mean risk of infection per event for children, who were exposed to floodwater originating from combined sewers, storm sewers and rainfall generated surface runoff was 33%, 23% and 3.5%, respectively, and for adults it was 3.9%, 0.58% and 0.039%. The annual risk of infection was calculated to compare flooding from different urban drainage systems. An exposure frequency of once every 10 years to flooding originating from combined sewers resulted in an annual risk of infection of 8%, which was equal to the risk of infection of flooding originating from rainfall generated surface runoff 2.3 times per year. However, these annual infection risks will increase with a higher frequency of urban flooding due to heavy rainfall as foreseen in climate change projections.

Human exposure to endotoxins and fecal indicators originating from water features.

Exposure to contaminated aerosols and water originating from water features may pose public health risks. Endotoxins in air and water and fecal bacteria in water of water features were measured as markers for exposure to microbial cell debris and enteric pathogens, respectively. Information was collected about wind direction, wind force, distance to the water feature, the height of the water feature and the tangibility of water spray. The mean concentration of endotoxins in air nearby and in water of 31 water features was 10 endotoxin units (EU)/m(3) (Geometric Mean (GM), range 0-85.5 EU/m(3) air) and 773 EU/mL (GM, range 9-18,170 EU/mL water), respectively. Such mean concentrations may be associated with respiratory health effects. The water quality of 26 of 88 water features was poor when compared to requirements for recreational water in the Bathing Water Directive 2006/7/EC. Concentrations greater than 1000 colony forming units (cfu) Escherichia coli per 100 mL and greater than 400 cfu intestinal enterococci per 100 mL increase the probability of acquiring gastrointestinal health complaints. Regression analyses showed that the endotoxin concentration in air was significantly influenced by the concentration of endotoxin in water, the distance to the water feature and the tangibility of water spray. Exposure to air and water near water features was shown to lead to exposure to endotoxins and fecal bacteria. The potential health risks resulting from such exposure to water features may be estimated by a quantitative microbial risk assessment (QMRA), however, such QMRA would require quantitative data on pathogen concentrations, exposure volumes and dose-response relationships. The present study provides estimates for aerosolisation ratios that can be used as input for QMRA to quantify exposure and to determine infection risks from exposure to water features.

Specific serum antibody responses following a Toxoplasma gondii and Trichinella spiralis co-infection in swine.

The aim of this study was to examine the dynamics of parasite specific antibody development in Trichinella spiralis and Toxoplasma gondii co-infections in pigs and to compare these with antibody dynamics in T. spiralis and T. gondii single infections. In this experiment, fifty-four pigs were divided into five inoculated groups of ten animals, and one control group of four animals. Two groups were inoculated with a single dose of either T. gondii tissue cysts or T. spiralis muscle larvae, one group was inoculated simultaneously with both parasites and two groups were successively inoculated at an interval of four weeks. Specific IgG responses to the parasites were measured by ELISA. T. gondii burden was determined by MC-PCR carried out on heart muscle and T. spiralis burden by artificial digestion of diaphragm samples. Specific IgG responses to T. gondii and T. spiralis in single and simultaneously inoculated animals showed a respective T. gondii and T. spiralis inoculation effect but no significant interaction of these parasites to the development of specific antibodies with the serum dilutions used. Moreover, our data showed that the specific IgG response levels in groups of animals successively or simultaneously co-infected were independent of a respective previous or simultaneous infection with the other parasite. Additionally, no differences in parasite burden were found within groups inoculated with T. gondii and within groups inoculated with T. spiralis. Conclusively, for the infection doses tested in this experiment, the dynamics of specific antibody development does not differ between single and simultaneous or successive infection with T. gondii and T. spiralis. However, lower parasitic doses and other ratios of doses, like low-low, low-high and high-low of T. gondii and T. spiralis in co-infection, in combination with other time intervals between successive infections may have different outcomes and should therefore be studied in further detail.

Prevalence of antibodies against Ascaris suum and its association with allergic manifestations in 4-year-old children in The Netherlands: the PIAMA birth cohort study.

The association between helminth infections and childhood atopic diseases remains controversial. The majority of studies have been carried out in tropical areas, whereas less information is available from western countries with low intensity of helminth infections. In the Netherlands, the infection of pigs with Ascaris suum is very common, particularly on pig farms with outdoor facilities. This helminth can also infect humans, causing visceral larva migrans. This study aims at determining the prevalence of antibodies against A. suum and its association with allergic symptoms and sensitisation in a population of 4-year-old children living in The Netherlands. Blood samples from 629 children from the prospective birth cohort Prevention and Incidence of Asthma and Mite Allergy (PIAMA) study were examined for Ascaris antibodies. Data on allergic symptoms and sensitisation were collected using questionnaires and radioallergosorbent tests (RAST). A total of 45 out of 629 (7%) were found to be Ascaris-seropositive. In addition, a positive association between Ascaris seropositivity and wheeze in the last year, doctor-diagnosed asthma and food and aero-allergen sensitisation was found. These results support the hypothesis that low-level or transient infection with helminths enhances allergic reactivity.

Quantification of horizontal transmission of Salmonella enterica serovar Enteritidis bacteria in pair-housed groups of laying hens.

An important source of human salmonellosis is the consumption of table eggs contaminated with Salmonella enterica serovar Enteritidis. Optimization of the various surveillance programs currently implemented to reduce human exposure requires knowledge of the dynamics of S. Enteritidis infection within flocks. The aim of this study was to provide parameter estimates for a transmission model of S. Enteritidis in laying-type chicken flocks. An experiment was carried out with 60 pairs of laying hens. Per pair, one hen was inoculated with S. Enteritidis and the other was contact exposed. After inoculation, cloacal swab samples from all hens were collected over 18 days and tested for the presence of S. Enteritidis. On the basis of this test, it was determined if and when each contact-exposed hen became colonized. A transmission model including a latency period of 1 day and a slowly declining infectivity level was fitted. The mean initial transmission rate was estimated to be 0.47 (95% confidence interval [CI], 0.30 to 0.72) per day. The reproduction number R(0), the average number of hens infected by one colonized hen in a susceptible population, was estimated to be 2.8 (95% CI, 1.9 to 4.2). The generation time, the average time between colonization of a "primary" hen and colonization of contact-exposed hens, was estimated to be 7.0 days (95% CI, 5.0 to 11.6 days). Simulations using these parameters showed that a flock of 20,000 hens would reach a maximum colonization level of 92% within 80 days after colonization of the first hen. These results can be used, for example, to evaluate the effectiveness of control and surveillance programs and to optimize these programs in a cost-benefit analysis.

Integrating the issues of global and public health into the veterinary education curriculum: a European perspective.

Veterinary public health is an essential field in public health activities, based upon veterinary skills, knowledge and resources and which aims to protect and improve human health and welfare. This discipline has evolved through three stages, beginning with the fight against animal diseases, moving on to include meat inspection and control of zoonoses and now encompassing a much broader health sciences education, with the goal of guaranteeing a safe and wholesome food supply, protecting human wellbeing and conserving the environment. Within the veterinary medicine curriculum, veterinary public health has undergone a similar development. At first, it was mainly concerned with slaughterhouse-based courses but in time it included the teaching of such subjects as epidemiology, the control of communicable (zoonotic) diseases and emergency preparedness. Veterinary medical faculties in Europe have adjusted their curricula over the past few years to reflect these changes in the subject and to meet the need for specialisation. It could be said that veterinary public health education has literally moved from the local abattoir to the global community. In this paper, the authors briefly discuss examples of veterinary medicine curricula at different universities. The veterinary public health curriculum of the Faculty of Veterinary Medicine, Utrecht, is then discussed in detail, as an example of the European perspective on integrating global and public health issues into the veterinary curriculum.

[Negligible risk of visceral or ocular larva migrans from petting a dog]. / Verwaarloosbaar risico op viscerale of oculaire larva migrans door het aaien van een hond.

In a recent publication it was suggested that human toxocarosis, including ocular larva migrans, may result from petting dogs infected with Toxocara canis, the dog roundworm. Recalculating the eggs per gram in the dog's coat revealed that in 7 of the 15 positive dogs only one Toxocara egg per dog was found. Only 4% of all eggs were embryonated and hence infectious. It is, however, very plausible that this is contamination originating from the environment. The authors found also many other parasite eggs and free-living larvae in their samples, which points to the dog being merely a passive transport host. The risk to man of acquiring the infection by stroking a dog is therefore considered to be extremely limited.

Effect of acidified feed on susceptibility of broiler chickens to intestinal infection by Campylobacter and Salmonella.

Consumption of poultry meat is associated with human Campylobacter and Salmonella infections. One way to control the presence of these bacteria in broiler flocks is to make chickens less susceptible for colonisation. Acidification of feed may be a tool to reduce the Campylobacter and Salmonella carriage in broiler chickens. In the present experiments an acidified feed with high levels of organic acid, 5.7% lactic acid and 0.7% acetic acid, was applied. In an in vitro experiment the reduction or growth of Campylobacter and Salmonella was measured after addition of 10(7)cfu of these bacteria into a conventional broiler feed, acidified feed and fermented feed, whereas the numbers of Salmonella increased in non-acidified feed. The number of Campylobacter decreased 2-3 (10)log cfu. In the acidified and fermented feed a complete reduction of Campylobacter was observed within 20 min, and a total Salmonella reduction started after 1h, and was complete after 2h. Subsequently, an in vivo experiment with 100 individually housed broiler chickens showed that chickens fed acidified feed were less susceptible to an infection with Campylobacter than were chickens fed conventional feed. The size of reduction was however limited. The susceptibility for Salmonella colonisation was not affected by acidified feed. It is concluded that the role for acidified feed in the control of Campylobacter and Salmonella is limited.

Effect of organic acids in drinking water for young broilers on Campylobacter infection, volatile fatty acid production, gut microflora and histological cell changes.

Water is a prominent vehicle for Campylobacter spread throughout a chicken flock. The aim of this study was to evaluate the effect of organic acids administered through the drinking water, as a decontamination method, on gut microflora and the development of lesions in the gastrointestinal tracts of young broilers inoculated with 2 different doses of Campylobacter. The results revealed that most of the chickens were infected with Campylobacter at the end of the experiment. The drinking water was free of Campylobacter throughout the study. No difference of volatile fatty acid levels between treatment and control groups was observed in the crop and cecal contents. In the cecal contents, the total aerobic bacteria numbers were significantly higher in the treatment groups compared with the control groups (P < 0.01 and P < 0.04, respectively). Moreover, no damaged epithelial cells were observed in the chicken gut due to consumption of acidified drinking water. Acidified drinking water could therefore play a crucial role in a biosecurity strategy of preventing Campylobacter spread via drinking water in broiler flocks.

Antagonistic activities of several bacteria on in vitro growth of 10 strains of Campylobacter jejuni/coli.

Chicken meat contaminated with Campylobacter jejuni can be the source of human enteritis. To decrease the risk of human infection, Campylobacter should be controlled at farm levels. Orally given probiotic bacteria could prevent colonisation of chicken with pathogenic bacteria like Campylobacter. The aim of this study was to investigate the effect of different bacteria on Campylobacter growth. Our results demonstrated that bacteria isolated from conventional chicken had potential inhibitory activities against Campylobacter. Other bacteria not isolated from chickens but with known antagonistic capacities, e.g. Enterococcus (56 strains) and Escherichia coli (20 strains), did not show any negative effect on Campylobacter. Interestingly, one Lactobacillus (P93) strain isolated from the chicken gut showed bactericidal activity against all tested Campylobacter. The bactericidal effect was characterised as the production of organic acids in combination with probably production of an anti-Campylobacter protein. In a co-culture study of Campylobacter and Lactobacillus (P93), the culturability of Campylobacter was under the detection limit after 48 h of incubation. A chicken experiment is needed to further evaluate the effect of the promising probiotic bacteria against Campylobacter colonisation in chicken.

Fermented liquid feed reduces susceptibility of broilers for Salmonella enteritidis.

The presence of Salmonella in chickens is a problem because poultry meat is recognized as a source of human salmonellosis. Fermented feed has characteristics like a high number of lactobacilli and high concentration of lactic acid, which could make chickens less susceptible for infection with Salmonella. Fermented feed might therefore prevent the colonization of chickens with Salmonella. Two studies were performed to quantify the effect of fermented liquid feed on the susceptibility of broilers for Salmonella. The fermented feed was prepared by fermenting a dry broiler feed supplemented with 1.4 parts of water. Lactobacillus plantarum was used for fermentation. The fermented liquid feed (FLF) contained 10(9) to 10(10) cfu lactobacilli per gram, and the pH was 4. Individually housed control chickens and FLF-fed chickens were inoculated with 10(2) to 10(7) cfu Salmonella enteritidis (SE). Colonization was estimated by cloacal swabs and quantitative caecal culture. The proportion of SE-shedding chickens was decreased in FLF-fed chickens. FLF-fed chickens required a longer time after inoculation or a higher inoculation dose to get the same proportion of infected chickens in comparison with dry feed-fed chickens. The level of cecal colonization with Salmonella in the ceca was not different at the end of the experimental period. The results indicate that FLF can hamper the introduction of Salmonella in broiler flocks because the chickens are less susceptible for infection. Fermented liquid feed might therefore be a new hurdle in the strategy to control Salmonella in chicken flocks.

Survival and resuscitation of ten strains of Campylobacter jejuni and Campylobacter coli under acid conditions.

The culturability of 10 strains of Campylobacter jejuni and Campylobacter coli was studied after the bacteria were exposed to acid conditions for various periods of time. Campylobacter cells could not survive 2 h under acid conditions (formic acid at pH 4). The 10 Campylobacter strains could not be recovered, even when enrichment media were used. Viable cells, however, could be detected by a double-staining (5-cyano-2,3-ditolyl tetrazolium chloride [CTC]-4',6'-diamidino-2-phenylindole [DAPI]) technique, demonstrating that the treated bacteria changed into a viable but nonculturable (VBNC) form; the number of VBNC forms decreased over time. Moreover, some VBNC forms of Campylobacter could be successfully resuscitated in specific-free-pathogen fertilized eggs via two routes, amniotic and yolk sac injecting.