Mpox Discourse on Twitter by Sexual Minority Men and Gender-Diverse Individuals: Infodemiological Study Using BERTopic.

BACKGROUND: The mpox outbreak resulted in 32,063 cases and 58 deaths in the United States and 95,912 cases worldwide from May 2022 to March 2024 according to the US Centers for Disease Control and Prevention (CDC). Like other disease outbreaks (eg, HIV) with perceived community associations, mpox can create the risk of stigma, exacerbate homophobia, and potentially hinder health care access and social equity. However, the existing literature on mpox has limited representation of the perspective of sexual minority men and gender-diverse (SMMGD) individuals. OBJECTIVE: To fill this gap, this study aimed to synthesize themes of discussions among SMMGD individuals and listen to SMMGD voices for identifying problems in current public health communication surrounding mpox to improve inclusivity, equity, and justice. METHODS: We analyzed mpox-related posts (N=8688) posted between October 2020 and September 2022 by 2326 users who self-identified on Twitter/X as SMMGD and were geolocated in the United States. We applied BERTopic (a topic-modeling technique) on the tweets, validated the machine-generated topics through human labeling and annotations, and conducted content analysis of the tweets in each topic. Geographic analysis was performed on the size of the most prominent topic across US states in relation to the University of California, Los Angeles (UCLA) lesbian, gay, and bisexual (LGB) social climate index. RESULTS: BERTopic identified 11 topics, which annotators labeled as mpox health activism (n=2590, 29.81%), mpox vaccination (n=2242, 25.81%), and adverse events (n=85, 0.98%); sarcasm, jokes, and emotional expressions (n=1220, 14.04%); COVID-19 and mpox (n=636, 7.32%); government or public health response (n=532, 6.12%); mpox symptoms (n=238, 2.74%); case reports (n=192, 2.21%); puns on the naming of the virus (ie, mpox; n=75, 0.86%); media publicity (n=59, 0.68%); and mpox in children (n=58, 0.67%). Spearman rank correlation indicated significant negative correlation (ρ=-0.322, P=.03) between the topic size of health activism and the UCLA LGB social climate index at the US state level. CONCLUSIONS: Discussions among SMMGD individuals on mpox encompass both utilitarian (eg, vaccine access, case reports, and mpox symptoms) and emotionally charged (ie, promoting awareness, advocating against homophobia, misinformation/disinformation, and health stigma) themes. Mpox health activism is more prevalent in US states with lower LGB social acceptance, suggesting a resilient communicative pattern among SMMGD individuals in the face of public health oppression. Our method for social listening could facilitate future public health efforts, providing a cost-effective way to capture the perspective of impacted populations. This study illuminates SMMGD engagement with the mpox discourse, underscoring the need for more inclusive public health programming. Findings also highlight the social impact of mpox: health stigma. Our findings could inform interventions to optimize the delivery of informational and tangible health resources leveraging computational mixed-method analyses (eg, BERTopic) and big data.

Epidemiological, Pathological, and Molecular Studies on Sheeppox Disease Outbreaks in Karnataka, India.

An epidemiological study spanning twelve years has revealed that sheeppox disease is both widespread and endemic, predominantly surging during the winter and summer seasons. This investigation focused on sheeppox across 11 field outbreaks, involving 889 animals from non-migratory flocks across six districts in Karnataka, in the southern peninsula of India. Among these, 105 animals exhibited clinical signs suggestive of sheeppox, such as lesions on the body, and 95 cases were confirmed through PCR testing. The overall positivity rate for sheeppox stood at 10.68% (95 out of 889 animals). The incidence of sheeppox was notably higher in animals aged between 1 and 2 years and was more prevalent in females. Affected animals displayed symptoms including respiratory distress, weakness, fever, loss of appetite, depression, and various skin lesions ranging from papular to pock lesions across their bodies. There was a significant increase in total leukocyte count, while hemoglobin levels, red blood cell counts, and hematocrit values significantly decreased. On gross examination, sheeppox lesions, varying from vesicular to nodular forms, were predominantly found on hairless areas of the body. Microscopic examination of skin lesions revealed extensive changes, such as hyperkeratosis, parakeratosis, acanthosis, hydropic degeneration, and necrosis of epithelial cells, along with characteristic intracytoplasmic viral inclusions. The lungs exhibited type-II pneumocyte hyperplasia and proliferative bronchiolitis, also with intracytoplasmic inclusions. Confirmation of the sheeppox virus was achieved through PCR and subsequent sequence analysis. Phylogenetic analysis of the full-length P32 and RPO30 gene demonstrated homology with sheeppox isolates from various parts of India and neighboring countries, indicating that Indian sheeppox viruses are highly lineage-specific and correlate with the host of origin. Based on these findings, it is recommended to implement a homologous vaccination strategy, utilizing selective host/viral strains to enhance protection in susceptible animals.

Non-typhoidal Salmonella in Nigeria: do outcomes of 'multisectoral' surveillance, treatment and control justify the intervention costs?

Non-typhoidal salmonellosis (NTS) is significant and an economic burden in Nigeria. To determine whether investment in NTS control is economically justifiable, Outbreak Costing Tool (OCT) was used to estimate the robust funding of public and animal health systems for epidemio-surveillance and control of multisectoral NTS outbreaks in Nigeria. Health, production, and economic data were collected and used to populate the tool for evaluation. The multisectoral NTS burden for the year 2020 in Nigeria was US$ 930,887,379.00. Approximately 4,835 technical officers, and 3,700 non-technical staff (n = 8,535) were needed with an investment of >2.2 million work hours. The investment cost for NTS control was US$ 53,854,660.87. The non-labour-related cost was 89.21% of the total intervention costs. The overall intervention's investment was 374.15% of the estimated national and subnational systems' annual budget for diarrhoeal diseases, and the outbreak response period attracted the highest costs (53%) of the total intervention. In conclusion, intervention against NTS was beneficial (benefit - cost ratio: 17.29), hence justifying the need for multisectoral surveillance-response against NTS in Nigeria. Complex sectoral silos must give way to coordinated collaborations to optimize benefits; and over-centralization of health interventions' associated delays must be removed through decentralized sub-national-focused framework that empowers rapid investigation, response, control, data collection, and analyses. It should assist anticipatory planning, and outbreak investigation and reduce critical response time. Anticipatory planning tools, when applied pre-emptively, can benefit budgeting, identify gaps, and assist in the delivery of cost-saving and effective measures against infectious disease.

Voriconazole successfully treats chytridiomycosis in frogs.

Chytridiomycosis is a devastating disease and is a key cause of amphibian population declines around the world. Despite active research on this amphibian disease system for over 2 decades, we still do not have treatment methods that are safe and that can be broadly used across species. Here, we show evidence that voriconazole is a successful method of treatment for 1 species of amphibian in captivity and that this treatment could offer benefits over other treatment options like heat or itraconazole, which are not able to be used for all species and life stages. We conducted 2 treatments of chytridiomycosis using voriconazole. The treatment was effective and resulted in 100% pathogen clearance, and mortality ceased. Additionally, treating frogs with voriconazole requires less handling than treatment methods like itraconazole and requires no specialized equipment, like heat treatment. We highlight that clinical treatment trials should be conducted to identify an optimum dosage and treatment time and that trials should test whether this treatment is safe and effective for tadpoles and other species.

Virtual Objective Structured Clinical Examination (OSCE) Training in the Pandemic Era: Feasibility, Satisfaction, and the Road Ahead.

INTRODUCTION: Objective Structured Clinical Examinations (OSCEs) are essential assessments for evaluating the clinical competencies of medical students. The COVID-19 pandemic caused a significant disruption in medical education, prompting institutions to adopt virtual formats for academic activities. This study analyzes the feasibility, satisfaction, and experiences of pediatric board candidates and faculty during virtual or electronic OSCE (e-OSCE) training sessions using Zoom video communication (Zoom Video Communications, Inc., San Jose, USA). METHODS: This is a post-event survey assessing the perceptions of faculty and candidates and the perceived advantages and obstacles of e-OSCE. RESULTS: A total of 142 participants were invited to complete a post-event survey, and 105 (73.9%) completed the survey. There was equal gender representation. More than half of the participants were examiners. The overall satisfaction with the virtual e-OSCE was high, with a mean score of 4.7±0.67 out of 5. Most participants were likely to recommend e-OSCE to a friend or colleague (mean score 8.84±1.51/10). More faculty (66.1%) than candidates (40.8%) preferred e-OSCE (P=0.006). CONCLUSION: Transitioning to virtual OSCE training during the pandemic proved feasible, with high satisfaction rates. Further research on virtual training for OSCE in medical education is recommended to optimize its implementation and outcomes.

Spatial and temporal transmission dynamics of respiratory syncytial virus in New Zealand before and after the COVID-19 pandemic.

Human respiratory syncytial virus (RSV) is a major cause of acute respiratory infection. In 2020, RSV was effectively eliminated from the community in New Zealand due to non-pharmaceutical interventions (NPI) used to control the spread of COVID-19. However, in April 2021, following a brief quarantine-free travel agreement with Australia, there was a large-scale nationwide outbreak of RSV that led to reported cases more than five times higher, and hospitalisations more than three times higher, than the typical seasonal pattern. In this study, we generated 1,471 viral genomes of both RSV-A and RSV-B sampled between 2015 and 2022 from across New Zealand. Using a phylodynamics approach, we used these data to better understand RSV transmission patterns in New Zealand prior to 2020, and how RSV became re-established in the community following the relaxation of COVID-19 restrictions. We found that in 2021, there was a large epidemic of RSV in New Zealand that affected a broader age group range compared to the usual pattern of RSV infections. This epidemic was due to an increase in RSV importations, leading to several large genomic clusters of both RSV-A ON1 and RSV-B BA9 genotypes in New Zealand. However, while a number of importations were detected, there was also a major reduction in RSV genetic diversity compared to pre-pandemic seasonal outbreaks. These genomic clusters were temporally associated with the increase of migration in 2021 due to quarantine-free travel from Australia at the time. The closest genetic relatives to the New Zealand RSV genomes, when sampled, were viral genomes sampled in Australia during a large, off-season summer outbreak several months prior, rather than cryptic lineages that were sustained but not detected in New Zealand. These data reveal the impact of NPI used during the COVID-19 pandemic on other respiratory infections and highlight the important insights that can be gained from viral genomes.

Health Care Workers' Motivations for Enrolling in Massive Open Online Courses During a Public Health Emergency: Descriptive Analysis.

Background: Massive open online courses (MOOCs) are increasingly used to educate health care workers during public health emergencies. In early 2020, the World Health Organization (WHO) developed a series of MOOCs for COVID-19, introducing the disease and strategies to control its outbreak, with 6 courses specifically targeting health care workers as learners. In 2020, Stanford University also launched a MOOC designed to deliver accurate and timely education on COVID-19, equipping health care workers across the globe to provide health care safely and effectively to patients with the novel infectious disease. Although the use of MOOCs for just-in-time training has expanded during the pandemic, evidence is limited regarding the factors motivating health care workers to enroll in and complete courses, particularly in low-income countries (LICs) and lower-middle-income countries (LMICs). Objective: This study seeks to gain insights on the characteristics and motivations of learners turning to MOOCs for just-in-time training, to provide evidence that can better inform MOOC design to meet the needs of health care workers. We examine data from learners in 1 Stanford University and 6 WHO COVID-19 courses to identify (1) the characteristics of health care workers completing the courses and (2) the factors motivating them to enroll. Methods: We analyze (1) course registration data of the 49,098 health care workers who completed the 7 focal courses and (2) survey responses from 6272 course completers. The survey asked respondents to rank their motivations for enrollment and share feedback about their learning experience. We use descriptive statistics to compare responses by health care profession and by World Bank country income classification. Results: Health care workers completed the focal courses from all regions of the world, with nearly one-third (14,159/49,098, 28.84%) practicing in LICs and LMICs. Survey data revealed a diverse range of professional roles among the learners, including physicians (2171/6272, 34.61%); nurses (1599/6272, 25.49%); and other health care professionals such as allied health professionals, community health workers, paramedics, and pharmacists (2502/6272, 39.89%). Across all health care professions, the primary motivation to enroll was for personal learning to improve clinical practice. Continuing education credit was also an important motivator, particularly for nonphysicians and learners in LICs and LMICs. Course cost (3423/6272, 54.58%) and certification (4238/6272, 67.57%) were also important to a majority of learners. Conclusions: Our results demonstrate that a diverse range of health care professionals accessed MOOCs for just-in-time training during a public health emergency. Although all health care workers were motivated to improve their clinical practice, different factors were influential across professions and locations. These factors should be considered in MOOC design to meet the needs of health care workers, particularly those in lower-resource settings where alternative avenues for training may be limited.

The impact of sink removal and other water-free interventions in intensive care units on water-borne healthcare-associated infections: a systematic review.

With increasing awareness of water sinks as potential sources of outbreaks and transmission of multi-drug resistant (MDR) bacteria in intensive care units (ICUs), there is growing interest in water-free patient care systems. This systematic review reviewed and synthesized available evidence on the effectiveness of sink removal with or without water-free activities in the ICU environment to reduce water-borne healthcare-associated infections. We searched five databases (PubMed, MEDLINE, Scopus, Web of Science and Embase) for studies published from 1st January 1980 to 2nd April 2024 that examined water-less or water-free activities in the ICU to reduce healthcare-associated infections and patient colonization. Of 2075 articles, seven quasi-experimental studies (total: 332 patient beds) met the study selection criteria. Six of these seven studies (85.7%) were based in adult ICUs; one (14%) was in a neonatal ICU. Five of seven sites (71.4%) implemented water-less interventions after an outbreak. Water-free alternatives used included water-less bath products (six of seven; 85.7%), bottled water for consumption (three of seven; 42.9%), oral care (three of seven; 42.9%) and dissolving of oral medication (four of seven; 57.1%), designated 'contaminated' sink outside of patient and medication preparation areas for disposal of wastewater (four of seven; 57.1%). Implicated pathogens studied included MDR Gram-negative bacteria (four of seven; 57.1%), MDR Pseudomonas aeruginosa only (two of seven; 28.6%), and pulmonary non-tuberculous mycobacterium (NTB) (one of seven; 14.3%). Five of seven (71.4%) studies reported outbreak cessation. Preliminary evidence, from a limited number of studies of which the majority were conducted in an outbreak setting, suggest that sink removal and other water-free interventions in the ICU helped terminate outbreaks involving taps and decrease hospital-onset respiratory isolation of pulmonary NTB.

Exploring treatment and antifungal resistance in an outbreak of tinea caused by Microsporum audouinii.

BACKGROUND: Microsporum audouinii has resurged recently. Infections with the dermatophyte are difficult to treat, which raises the question if we treat M. audouinii infections with the most effective antifungal (AF) agent. OBJECTIVES: The aims of this study was to investigate an outbreak of tinea capitis (TC) in Denmark, address the challenges in outbreak management and to conduct two reviews regarding previous outbreaks and minimal inhibitory concentration (MIC). METHODS: We used Wood's light, culture, direct microscopy, and PCR for screening and antifungal susceptibility testing (AFST) for treatment optimization. We performed two reviews to explore M. audouinii outbreaks and MIC values using broth microdilution method. RESULTS: Of 73 screened individuals, 10 had confirmed M. audouinii infections. Clinical resistance to griseofulvin was observed in 4 (66%) cases. While previous outbreaks showed high griseofulvin efficacy, our study favoured terbinafine, fluconazole and itraconazole in our hard-to-treat cases. AFST guided the choice of AF. Through the literature search, we identified five M. audouinii outbreaks, where differences in management included the use of Wood's light and prophylactic topical AF therapy. Terbinafine MIC values from the literature ranged from 0.002 to 0.125 mg/L. CONCLUSION: Use of Wood's light and preventive measurements were important for limiting infection. The literature lacked MIC data for griseofulvin against M. audouinii, but indicated sensitivity for terbinafine. The clinical efficacy for M. audouinii treatment was contradictory favouring both terbinafine and griseofulvin. AFST could have a key role in the treatment of difficult cases, but lack of standardisation of AFST and MIC breakpoints limits its usefulness.

Clostridium and Cryptosporidium outbreak linked to a splash pad.

BACKGROUND: . Splash pads for recreational purposes are widespread. Using these pads can pose a health risk if they lack installation regulation and water quality supervision. Our aim was to describe a waterborne disease outbreak caused by Clostridium perfringens and Cryptosporidium spp. in a Barcelona district and the measures taken for its control. METHODS: . On August 2018, 71 cases of acute gastroenteritis were detected, affecting people who used a splash pad or were in contact with a user. Microbiological and environmental investigations were carried out. A descriptive analysis of the sample and Poisson regression models adjusted for age and sex were performed, obtaining frequencies, median values, and adjusted prevalence ratios with their 95% confidence intervals. RESULTS: The median age of the cases was 6.7 years, 27 (38%) required medical care, and three (4.2%) were hospitalized. The greater the number of times a person entered the area, the greater the number of symptoms and their severity. Nineteen (76%) of the 25 stool samples collected from cases showed the presence of one or both pathogens. Environmental investigations showed deficiencies in the facilities and identified the presence of both species in the splash pad. Health education and hygiene measures were carried out, and 14 days after the closure of the facilities, no more cases related to the pad were recorded. CONCLUSIONS: . Specific regulations are needed on the use of splash pads for recreational purposes. Until these regulations are in place, these types of facility should comply with the regulations that apply to swimming pools and spas, including those related to the design of the tanks, water recirculation systems, and adequate disinfection systems.

Missingness and algorithmic bias: an example from the United States National Outbreak Reporting System, 2009-2019.

Growing debates about algorithmic bias in public health surveillance lack specific examples. We tested a common assumption that exposure and illness periods coincide and demonstrated how algorithmic bias can arise due to missingness of critical information related to illness and exposure durations. We examined 9407 outbreaks recorded by the United States National Outbreak Reporting System (NORS) from January 1, 2009 through December 31, 2019 and detected algorithmic bias, a systematic over- or under-estimation of foodborne disease outbreak (FBDO) durations due to missing start and end dates. For 7037 (75%) FBDOs with complete date-time information, ~ 60% reported that the exposure period ended before the illness period started. For 2079 (87.7%) FBDOs with missing exposure dates, average illness durations were ~ 5.3 times longer (p < 0.001) than those with complete information, prompting the potential for algorithmic bias. Modern surveillance systems must be equipped with investigative capacities to examine and assess structural data missingness that can lead to bias.

Rapid management of Serratia marcescens outbreak in neonatology unit in Singapore: Risk factors and infection control measures.

BACKGROUND: We describe the investigations for control of two consecutive Serratia marcescens outbreaks in neonatology unit of Singapore General Hospital. METHODS: Epidemiological investigations, environmental sampling and risk-factors analysis were performed to guide infection control measures. Active surveillance sampling of nasopharyngeal aspirate and/or stool from neonates was conducted during both outbreaks. Whole-genome-sequencing was done to determine clonal links. Retrospective case-control study was conducted for second outbreak to identify risk factors for S marcescens acquisition. RESULTS: In 2022, two genetically unrelated S marcescens outbreaks were managed involving five neonates in March 2022 (outbreak 1) and eight neonates in November 2022 (outbreak 2). A link to positive isolates from sinks in intensive care units and milk preparation room was identified during outbreak 1. Neonatal jaundice (aOR, 16.46; p-value= 0.023) and non-formula milk feeding (aOR, 13.88; p-value= 0.02) were identified as risk factors during second outbreak. Multiple interventions adopted were cohorting of positive cases, carriage-screening, enhanced environmental cleaning, and emphasis on alcohol-based handrubs for hand-hygiene. CONCLUSION: The two outbreaks were likely due to infection prevention practices lapses and favourable environmental conditions. Nosocomial S marcescens outbreaks in neonatology units are difficult to control and require multidisciplinary approach with strict infection prevention measures to mitigate risk factors.

Distinct Patterns of Liver Chemistry Changes in Pediatric Acute Hepatitis of Unknown Origin and COVID-19 Patients: A Systematic Review.

In 2021 and 2022, there were noted to be clusters of pediatric acute hepatitis of unknown origin (AHUO) occurring across the globe. While there was not necessarily a global increase in cases, understanding the pattern of liver injury in AHUO is crucial to properly identify cases of this unexplained phenomenon, especially since it occurred simultaneously with a global resurgence of COVID-19. The objective of this study was to contrast the patterns in liver-relevant biochemical data from COVID-19 patients and AHUO. Studies reporting liver chemistries for cases of AHUO and COVID-19 were identified by a systematic review and search of the literature. For each case, alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin, direct bilirubin, and international normalized ratio (INR) levels were extracted as available. These were normalized to multiples of the upper limit of normal by patient age. There were statistically significant greater elevations of ALT and AST in patients with AHUO than in those with COVID-19. Only a subset of patients with COVID-19 had an AST or ALT greater than the normal range. INR elevation could be substantial for both conditions but was also statistically higher in the AHUO group. Liver chemistry changes were not statistically correlated with age. The pattern of liver chemistry changes between AHUO and COVID-19 have some distinctions, which suggests that AHUO is not a phenomenon driven primarily by SARS-CoV-2 infection alone. Differentiating AHUO and COVID-19 would be challenging based on patterns of liver chemistry changes alone.

Assessment of using Google Trends for real-time monitoring of infectious disease outbreaks: a measles case study.

Measles remains a significant threat to children worldwide despite the availability of effective vaccines. The COVID-19 pandemic exacerbated the situation by leading to the postponement of supplementary measles immunization activities. Along with this postponement, measles surveillance also deteriorated, with the lowest number of submitted specimens in over a decade. In this study, we focus on measles as a challenging case study due to its high vaccination coverage, which leads to smaller outbreaks and potentially weaker signals on Google Trends. Our research aimed to explore the feasibility of using Google Trends for real-time monitoring of infectious disease outbreaks. We evaluated the correlation between Google Trends searches and clinical case data using the Pearson correlation coefficient and Spearman's rank correlation coefficient across 30 European countries and Japan. The results revealed that Google Trends was most suitable for monitoring acute disease outbreaks at the regional level in high-income countries, even when there are only a few weekly cases. For example, from 2017 to 2019, the Pearson correlation coefficient was 0.86 (p-value< 0.05) at the prefecture level for Okinawa, Japan, versus 0.33 (p-value< 0.05) at the national level for Japan. Furthermore, we found that the Pearson correlation coefficient may be more suitable than Spearman's rank correlation coefficient for evaluating the correlations between Google Trends search data and clinical case data. This study highlighted the potential of utilizing Google Trends as a valuable tool for timely public health interventions to respond to infectious disease outbreaks, even in the context of diseases with high vaccine coverage.

One Health communication channels: a qualitative case study of swine influenza in Canada in 2020.

BACKGROUND: With increased attention to the importance of integrating the One Health approach into zoonotic disease surveillance and response, a greater understanding of the mechanisms to support effective communication and information sharing across animal and human health sectors is needed. The objectives of this qualitative case study were to describe the communication channels used between human and animal health stakeholders and to identify the elements that have enabled the integration of the One Health approach. METHODS: We combined documentary research with interviews with fifteen stakeholders to map the communication channels used in human and swine influenza surveillance in Alberta, Canada, as well as in the response to a human case of H1N2v in 2020. A thematic analysis of the interviews was also used to identify the barriers and facilitators to communication among stakeholders from the animal and human health sectors. RESULTS: When a human case of swine influenza emerged, the response led by the provincial Chief Medical Officer of Health involved players at various levels of government and in the human and animal health sectors. The collaboration of public and animal health laboratories and of the swine sector, in addition to the information available through the surveillance systems in place, was swift and effective. Elements identified as enabling smooth communication between the human and animal health systems included preexisting relationships between the various stakeholders, a relationship of trust between them (e.g., the swine sector and their perception of government structures), the presence of stakeholders acting as permanent liaisons between the ministries of health and agriculture, and stakeholders' understanding of the importance of the One Health approach. CONCLUSIONS: Information flows through formal and informal channels and both structural and relational features that can support rapid and effective communication in infectious disease surveillance and outbreak response.

Cost-effectiveness of One Health intervention to reduce risk of human exposure and infection with non-typhoidal salmonellosis (NTS) in Nigeria.

Background: Non-typhoidal Salmonella infection (NTS) is an important foodborne zoonosis with underappreciated health and economic burdens, and low case fatality. It has global prevalence, with more burdens in under-resourced countries with poor health infrastructures. Using a cohort study, we determined the cost-effectiveness of NTS in humans in Nigeria for the year 2020. Methods: Using a customized Excel-based cost-effectiveness analysis tool, structured (One Health) and unstructured (episodic intervention against NTS) in Nigeria were evaluated. Input data on the disease burdens, costs surveillance, response and control of NTS were obtained from validated sources and the public health system. Results: The non-complicated and complicated cases were 309,444 (95%) and 16,287 (5%) respectively, and the overall programme cost was US$ 31,375,434.38. The current non-systematic episodic intervention costed US$ 14,913,480.36, indicating an additional US$ 16,461,954 to introduce the proposed intervention. The intervention will avert 4036.98 NTS DALYs in a single year. The non-complicated NTS case was US$ 60/person with significant rise in complicated cases. The cumulative costs of NTS with and without complications far outweighed the program cost for One Health intervention with an incremental cost-effectiveness ratio (ICER) of -US$ 221.30). Conclusions: Utilising structured One Health intervention is cost-effective against NTS in Nigeria, it carries additional mitigative benefits for other diseases and is less costly and more effective, indicative of a superior health system approach. Identified limitations must be improved to optimize benefits associated and facilitate policy discussions and resource allocation.

Vesicular Stomatitis Virus.

Vesicular stomatitis (VS) is a vector-borne livestock disease caused by either VS New Jersey virus or VS Indiana virus. The disease circulates endemically in northern South America, Central America, and Mexico and only occasionally causes outbreaks in the United States. During the past 20 years, VS outbreaks in the southwestern and Rocky Mountain regions occurred periodically with incursion years followed by virus overwintering and subsequent expansion outbreak years. Regulatory response by animal health officials prevents spread from lesioned animals and manages trade impacts. Recent US outbreaks highlight potential climate change impacts on insect vectors or other transmission-related variables.

Vesicular stomatitis virus in two species of rhinoceros at a California zoological park.

OBJECTIVE: To describe an outbreak of vesicular stomatitis virus (VSV) in southern white rhinoceros (SWR; Ceratotherium simum simum) and greater one-horned rhinoceros (GOHR; Rhinoceros unicornis) at a safari park in San Diego, CA, from May to September 2023. ANIMALS: 21 SWR and 5 GOHR in professionally managed care. METHODS: Rhinoceros of both species presented with a range of clinical signs and severities. Lesion locations were categorized as cutaneous (coronary bands, heels and soles, limbs, ventrum, neck folds, and ears) and mucocutaneous (lips, nostrils, mucous membranes of the oral cavity, and vulva). Clinical signs included lethargy, lameness, difficulty with prehension, hyporexia to anorexia, and hypersalivation. Severely affected rhinoceros had clinical pathology findings consistent with systemic inflammation. RESULTS: Vesicular stomatitis New Jersey virus was confirmed via PCR from swabs of lesions in 10/26 (38%) rhinoceros. Of these 10 confirmed cases, 9 (90%) were SWR and 1 (10%) was a GOHR. A further 6/26 (24%) were considered probable cases, and 10/26 (38%) were considered suspect cases based on clinical signs, but the inability to appropriately sample due to the housing environment precluded confirmation. Histopathology samples from 3 rhinoceros were consistent with VSV, and viral RNA was localized in histologic lesions via RNA in situ hybridization for 1 case. All rhinoceros survived infection despite severe systemic illness in 2 animals. CLINICAL RELEVANCE: This case series describes the clinical appearance and progression of VSV in 2 rhinoceros species. To the authors' knowledge, this is the first report of VSV in a rhinoceros.

Multimodal Surveillance Model for Enterovirus D68 Respiratory Disease and Acute Flaccid Myelitis among Children in Colorado, USA, 2022.

Surveillance for emerging pathogens is critical for developing early warning systems to guide preparedness efforts for future outbreaks of associated disease. To better define the epidemiology and burden of associated respiratory disease and acute flaccid myelitis (AFM), as well as to provide actionable data for public health interventions, we developed a multimodal surveillance program in Colorado, USA, for enterovirus D68 (EV-D68). Timely local, state, and national public health outreach was possible because prospective syndromic surveillance for AFM and asthma-like respiratory illness, prospective clinical laboratory surveillance for EV-D68 among children hospitalized with respiratory illness, and retrospective wastewater surveillance led to early detection of the 2022 outbreak of EV-D68 among Colorado children. The lessons learned from developing the individual layers of this multimodal surveillance program and how they complemented and informed the other layers of surveillance for EV-D68 and AFM could be applied to other emerging pathogens and their associated diseases.

Inference of Infectious Disease Transmission through a Relaxed Bottleneck Using Multiple Genomes Per Host.

In recent times, pathogen genome sequencing has become increasingly used to investigate infectious disease outbreaks. When genomic data is sampled densely enough amongst infected individuals, it can help resolve who infected whom. However, transmission analysis cannot rely solely on a phylogeny of the genomes but must account for the within-host evolution of the pathogen, which blurs the relationship between phylogenetic and transmission trees. When only a single genome is sampled for each host, the uncertainty about who infected whom can be quite high. Consequently, transmission analysis based on multiple genomes of the same pathogen per host has a clear potential for delivering more precise results, even though it is more laborious to achieve. Here, we present a new methodology that can use any number of genomes sampled from a set of individuals to reconstruct their transmission network. Furthermore, we remove the need for the assumption of a complete transmission bottleneck. We use simulated data to show that our method becomes more accurate as more genomes per host are provided, and that it can infer key infectious disease parameters such as the size of the transmission bottleneck, within-host growth rate, basic reproduction number, and sampling fraction. We demonstrate the usefulness of our method in applications to real datasets from an outbreak of Pseudomonas aeruginosa amongst cystic fibrosis patients and a nosocomial outbreak of Klebsiella pneumoniae.