Norovirus genotype profiles associated with foodborne transmission, 1999-2012.

Worldwide, noroviruses are a leading cause of gastroenteritis. They can be transmitted from person to person directly or indirectly through contaminated food, water, or environments. To estimate the proportion of foodborne infections caused by noroviruses on a global scale, we used norovirus transmission and genotyping information from multiple international outbreak surveillance systems (Noronet, CaliciNet, EpiSurv) and from a systematic review of peer-reviewed literature. The proportion of outbreaks caused by food was determined by genotype and/or genogroup. Analysis resulted in the following final global profiles: foodborne transmission is attributed to 10% (range 9%%-11%) of all genotype GII.4 outbreaks, 27% (25%-30%) of outbreaks caused by all other single genotypes, and 37% (24%%-52%) of outbreaks caused by mixtures of GII.4 and other noroviruses. When these profiles are applied to global outbreak surveillance data, results indicate that ≈14% of all norovirus outbreaks are attributed to food.

Mobilisation, politics, investment and constant adaptation: lessons from the Australian health-promotion response to HIV.

ISSUE ADDRESSED: The Australian response to HIV oversaw one of the most rapid and sustained changes in community behaviour in Australia's health-promotion history. The combined action of communities of gay men, sex workers, people who inject drugs, people living with HIV and clinicians working in partnership with government, public health and research has been recognised for many years as highly successful in minimising the HIV epidemic. METHODS: This article will show how the Australian HIV partnership response moved from a crisis response to a constant and continuously adapting response, with challenges in sustaining the partnership. Drawing on key themes, lessons for broader health promotion are identified. RESULTS: The Australian HIV response has shown that a partnership that is engaged, politically active, adaptive and resourced to work across multiple social, structural, behavioural and health-service levels can reduce the transmission and impact of HIV. CONCLUSIONS: The experience of the response to HIV, including its successes and failures, has lessons applicable across health promotion. This includes the need to harness community mobilisation and action; sustain participation, investment and leadership across the partnership; commit to social, political and structural approaches; and build and use evidence from multiple sources to continuously adapt and evolve. So what? The Australian HIV response was one of the first health issues to have the Ottawa Charter embedded from the beginning, and has many lessons to offer broader health promotion and common challenges. As a profession and a movement, health promotion needs to engage with the interactions and synergies across the promotion of health, learn from our evidence, and resist the siloing of our responses.

Declining Guillain-Barré syndrome after campylobacteriosis control, New Zealand, 1988-2010.

Infection with Campylobacter spp. commonly precedes Guillain-Barré syndrome (GBS). We therefore hypothesized that GBS incidence may have followed a marked rise and then decline in campylobacteriosis rates in New Zealand. We reviewed records for 1988-2010: hospitalization records for GBS case-patients and campylobacteriosis case-patients plus notifications of campylobacteriosis. We identified 2,056 first hospitalizations for GBS, an average rate of 2.32 hospitalizations/100,000 population/year. Annual rates of hospitalization for GBS were significantly correlated with rates of notifications of campylobacteriosis. For patients hospitalized for campylobacteriosis, risk of being hospitalized for GBS during the next month was greatly increased. Three years after successful interventions to lower Campylobacter spp. contamination of fresh poultry meat, notifications of campylobacteriosis had declined by 52% and hospitalizations for GBS by 13%. Therefore, regulatory measures to prevent foodborne campylobacteriosis probably have an additional health and economic benefit of preventing GBS.

Willingness of university nursing students to volunteer during a pandemic.

OBJECTIVE: The global threat of an influenza pandemic continues to grow and thus universities have begun emergency preparedness planning. This study examined stakeholder's knowledge, risk-perception, and willingness to volunteer. DESIGN AND SAMPLE: The design of this study is a cross-sectional survey. Questionnaires were sent to 1,512 nursing students and were returned by 484, yielding a response rate of 32% for this subgroup. Nursing students may be a much-needed human resource in the event of an influenza pandemic. MEASURES: The measurement tool was a Web-based questionnaire regarding pandemic influenza designed by a subgroup of researchers on the Public Health Response Committee. RESULTS: Most nursing students (67.9%) said they were likely to volunteer in the event of a pandemic if they were able to do so. An even higher number (77.4%) said they would volunteer if provided protective garments. Overall, 70.7% of students supported the proposition that nursing students have a professional obligation to volunteer during a pandemic. Nursing students indicated that they have had a wealth of volunteer experience in the past and they would apply this service ethic to a pandemic situation. CONCLUSIONS: Emergency preparedness competencies should be integrated into existing nursing curricula and other health science programs. University administrations need to engage in planning to create protocol for recruitment, practice, and protection of volunteers.

Nursing students' general knowledge and risk perception of pandemic influenza.

The threat of an influenza pandemic continues to grow, and various institutions have started planning initiatives to manage the potentially high rates of mortality, morbidity and absenteeism. The authors surveyed nursing students at the University of Alberta to determine their general knowledge of, and perception of risk associated with, pandemic influenza. The results indicated that there are many misconceptions about the nature of a potential influenza pandemic that affect nursing students' perceptions of personal and familial risk. It is imperative that nursing students receive adequate information, education and preparation along with the necessary personal protection equipment if they are going to be relied upon as a labour reserve in the event of a pandemic.

The burden of parasitic zoonoses in Nepal: a systematic review.

BACKGROUND: Parasitic zoonoses (PZs) pose a significant but often neglected threat to public health, especially in developing countries. In order to obtain a better understanding of their health impact, summary measures of population health may be calculated, such as the Disability-Adjusted Life Year (DALY). However, the data required to calculate such measures are often not readily available for these diseases, which may lead to a vicious circle of under-recognition and under-funding. METHODOLOGY: We examined the burden of PZs in Nepal through a systematic review of online and offline data sources. PZs were classified qualitatively according to endemicity, and where possible a quantitative burden assessment was conducted in terms of the annual number of incident cases, deaths and DALYs. PRINCIPAL FINDINGS: Between 2000 and 2012, the highest annual burden was imposed by neurocysticercosis and congenital toxoplasmosis (14,268 DALYs [95% Credibility Interval (CrI): 5450-27,694] and 9255 DALYs [95% CrI: 6135-13,292], respectively), followed by cystic echinococcosis (251 DALYs [95% CrI: 105-458]). Nepal is probably endemic for trichinellosis, toxocarosis, diphyllobothriosis, foodborne trematodosis, taeniosis, and zoonotic intestinal helminthic and protozoal infections, but insufficient data were available to quantify their health impact. Sporadic cases of alveolar echinococcosis, angiostrongylosis, capillariosis, dirofilariosis, gnathostomosis, sparganosis and cutaneous leishmaniosis may occur. CONCLUSIONS/SIGNIFICANCE: In settings with limited surveillance capacity, it is possible to quantify the health impact of PZs and other neglected diseases, thereby interrupting the vicious circle of neglect. In Nepal, we found that several PZs are endemic and are imposing a significant burden to public health, higher than that of malaria, and comparable to that of HIV/AIDS. However, several critical data gaps remain. Enhanced surveillance for the endemic PZs identified in this study would enable additional burden estimates, and a more complete picture of the impact of these diseases.

Source attribution of nontyphoid salmonellosis in new zealand using outbreak surveillance data.

In this study, 204 New Zealand outbreaks of non-typhoid salmonellosis reported from 2000 to 2009 were analyzed for information on the sources of human infection. Data were extracted from the outbreak module of EpiSurv, New Zealand's notifiable diseases database, and augmented with information from individual case reports and separate investigation reports. The outbreaks involved 1,426 cases, representing an estimated 9% of the total salmonellosis cases reported for the study period. Salmonella Typhimurium was the causative serotype in 78% of 172 outbreaks for which a serotype was available, involving 71% of outbreak cases. The most commonly reported outbreak setting was the home (47% of outbreaks), followed by commercial food operations (31%). Foodborne transmission was reported for 63% of the 123 outbreaks for which only one mode of transmission was reported, followed by person-to-person transmission (32%), waterborne transmission (3%), and zoonotic transmission (2%). However, evidence for the mode of transmission was weak or absent for 107 (63%) of the 169 outbreaks for which a mode of transmission was reported. For only 22 outbreaks was laboratory evidence successfully used to identify a potential source of infection. Of these 22 outbreaks, 7 were foodborne, 11 involved an infected food handler, 2 were attributed to contact with animals, 1 was attributed to consumption of drinking water, and 1 was attributed to multiple sources. The laboratory-confirmed contaminated foods were diverse and included imported and domestically produced foods. The results of this analysis support the hypothesis that non-typhoid salmonellosis is primarily a foodborne disease in New Zealand, but there is insufficient evidence to confirm important food vehicles.

Acute gastrointestinal illness in New Zealand: information from a survey of community and hospital laboratories.

AIM: To describe and quantify laboratory testing of faecal samples for enteric pathogens as a component of the reporting pyramid of acute gastrointestinal illness (AGI) in New Zealand. METHOD: Postal survey of community and hospital laboratories throughout New Zealand conducted in mid-2006, requesting data from the 2005 calendar year. RESULTS: Of the 47 laboratories eligible for the survey, responses were received from 35 (74%, 16 hospital laboratories, 12 community laboratories, five hospital and community laboratories, and two Public Health Laboratories). Based on survey data and extrapolation it was estimated that approximately 250,000 faecal samples were received by New Zealand laboratories in 2005. The majority of these (77%) were requested by primary healthcare providers on people in the community. Routine testing of these samples would include bacteria (Salmonella, Shigella, Campylobacter, Yersinia) and parasites (Cryptosporidium, Giardia) and (depending principally on the age of the patient) rotavirus. Testing for other pathogens was comparatively infrequent. The frequency of detection of a pathogen in community samples was estimated as approximately 20%. CONCLUSION: The positivity rate of 20% for faecal samples from people in the community is consistent with overseas results. Although there was considerable variation in the testing methods employed by the laboratories the methods were considered appropriate based on consultation with ESR Public Health and Reference Laboratory staff. These data on the number and type of samples, and positivity rate , will assist in the determination of a reporting pyramid for AGI in New Zealand.

Lack of association between long-term illness and infectious intestinal disease in New Zealand.

AIMS: To investigate whether the increase in notified cases of infectious intestinal disease in New Zealand from 1988 to 2001 has resulted in a concurrent increase in associated secondary illness cases. METHODS: National surveillance system data were compared to hospital discharge data. RESULTS: No statistically significant correlation between the number of cases of campylobacteriosis and Guillain-Barre syndrome (GBS) was found. There was no statistically significant correlation between the number of cases of campylobacteriosis, salmonellosis, shigellosis, and any of the categories of reactive arthritis; apart from two correlations with campylobacteriosis: with arthropathy associated with Reiter's disease and nonspecific urethritis (Pearson correlation R2=0.69; p<0.02) and unspecified infective arthritis (Pearson correlation R2=0.75; p<0.008). The later category is likely to include cases of both infective and non-infective aetiology. CONCLUSION: In New Zealand, infectious intestinal diseases are not making a significant contribution to the burden of hospitalisation for reactive arthritis or GBS.