Predicting the time to detect moderately virulent African swine fever virus in finisher swine herds using a stochastic disease transmission model.

BACKGROUND: African swine fever (ASF) is a highly contagious and devastating pig disease that has caused extensive global economic losses. Understanding ASF virus (ASFV) transmission dynamics within a herd is necessary in order to prepare for and respond to an outbreak in the United States. Although the transmission parameters for the highly virulent ASF strains have been estimated in several articles, there are relatively few studies focused on moderately virulent strains. Using an approximate Bayesian computation algorithm in conjunction with Monte Carlo simulation, we have estimated the adequate contact rate for moderately virulent ASFV strains and determined the statistical distributions for the durations of mild and severe clinical signs using individual, pig-level data. A discrete individual based disease transmission model was then used to estimate the time to detect ASF infection based on increased mild clinical signs, severe clinical signs, or daily mortality. RESULTS: Our results indicate that it may take two weeks or longer to detect ASF in a finisher swine herd via mild clinical signs or increased mortality beyond levels expected in routine production. A key factor contributing to the extended time to detect ASF in a herd is the fairly long latently infected period for an individual pig (mean 4.5, 95% P.I., 2.4 - 7.2 days). CONCLUSION: These transmission model parameter estimates and estimated time to detection via clinical signs provide valuable information that can be used not only to support emergency preparedness but also to inform other simulation models of evaluating regional disease spread.

Best practices to optimize utilization of the National Living Donor Assistance Center for the financial assistance of living organ donors.

Living organ donors face direct costs when donating an organ, including transportation, lodging, meals, and lost wages. For those most in need, the National Living Donor Assistance Center (NLDAC) provides reimbursement to defray travel and subsistence costs associated with living donor evaluation, surgery, and follow-up. While this program currently supports 9% of all US living donors, there is tremendous variability in its utilization across US transplant centers, which may limit patient access to living donor transplantation. Based on feedback from the transplant community, NLDAC convened a Best Practices Workshop on August 2, 2018, in Arlington, VA, to identify strategies to optimize transplant program utilization of this valuable resource. Attendees included team members from transplant centers that are high NLDAC users; the NLDAC program team; and Advisory Group members. After a robust review of NLDAC data and engagement in group discussions, the workgroup identified concrete best practices for administrative and transplant center leadership involvement; for individuals filing NLDAC applications at transplant centers; and to improve patient education about potential financial barriers to living organ donation. Multiple opportunities were identified for intervention to increase transplant programs' NLDAC utilization and reduce financial burdens inhibiting expansion of living donor transplantation in the United States.

Incentives for Bushmeat Consumption and Importation among West African Immigrants, Minnesota, USA.

The knowledge, attitudes, and practices surrounding bushmeat consumption and importation in the United States are not well described. Focus groups of West African persons living in Minnesota, USA, found that perceived risks are low and unlikely to deter consumers. Incentives for importation and consumption were multifactorial in this community.

Simulated Flock-Level Shedding Characteristics of Turkeys in Ten Thousand Bird Houses Infected with H7 Low Pathogenicity Avian Influenza Virus Strains.

Understanding the amount of virus shed at the flock level by birds infected with low pathogenicity avian influenza virus (LPAIV) over time can help inform the type and timing of activities performed in response to a confirmed LPAIV-positive premises. To this end, we developed a mathematical model which allows us to estimate viral shedding by 10,000 turkey toms raised in commercial turkey production in the United States, and infected by H7 LPAIV strains. We simulated the amount of virus shed orally and from the cloaca over time, as well as the amount of virus in manure. In addition, we simulated the threshold cycle value (Ct) of pooled oropharyngeal swabs from birds in the infected flock tested by real-time reverse transcription polymerase chain reaction. The simulation model predicted that little to no shedding would occur once the highest threshold of seroconversion was reached. Substantial amounts of virus in manure (median 1.5×108 and 5.8×109; 50% egg infectious dose) were predicted at the peak. Lastly, the model results suggested that higher Ct values, indicating less viral shedding, are more likely to be observed later in the infection process as the flock approaches recovery.

Exploring Risk for Echinococcosis Spillover in Northern Minnesota Tribal Communities.

Echinococcus spp. are zoonotic cestode parasites with a worldwide distribution and a complex, two-host life cycle involving carnivore definitive hosts and small mammal or ungulate intermediate hosts. Surveillance for Echinococcus spp. in the Midwestern United States (USA) is rare. Using a mixed-methods approach, we examined Echinococcus infection risks in wildlife and domestic dogs in four Minnesota Tribal Nations. We hypothesized that the spillover of Echinococcus spp. into domestic dogs would vary with the presence or absence of suspected wildlife host species and certain behaviors associated with domestic dog ownership, like feeding wildlife host carcasses or frequency of veterinary care. Among 83 dogs tested, three (3.6%) were positive for Echinococcus spp. Despite low prevalence, pet owner survey and focus group findings indicated that dogs encounter peri-domestic wildlife most often when they roam freely or consume wildlife carcasses. This study demonstrates a need for further research into spillover potential of endemic zoonotic Echinococcus spp. in the Midwest USA.

The Risk of Highly Pathogenic Influenza A Virus Transmission to Turkey Hen Flocks Through Artificial Insemination.

Artificial insemination is a routine practice for turkeys that can introduce pathogens into breeder flocks in a variety of ways. In this manuscript, a risk analysis on the potential transmission of highly pathogenic avian influenza (HPAI) to naïve hens through artificial insemination is presented. A case of HPAI on a stud farm where the potential transmission of the virus to susceptible hens in the 2015 H5N2 HPAI outbreak in Minnesota is described along with documentation of known and potential transmission pathways from the case. The pathways by which artificial insemination might result in the spread of HPAI to susceptible hens were determined by considering which could result in the 1) entry of HPAI virus onto a premises through semen movement; and 2) exposure of susceptible hens to HPAI as a result of this movement. In the reported case, HPAI virus was detected in semen from infected toms, however, transmission of HPAI to naïve hens through semen is unclear since the in utero infectious dose is not known. This means that the early detection of infection might limit but not eliminate the risk of hen exposure. Because of the numerous potential pathways of spread and the close contact with the birds, it is highly likely that if semen from an HPAI-infected tom flock is used, there will be spread of the virus to naïve hens through insemination. If insemination occurs with semen from stud farms in an HPAI control area, receiving hen farms should have restricted movements to prevent outbreak spread in the event that they become infected.

Artículo regular­Riesgo de transmisión del virus de la influenza A altamente patógeno a parvadas de pavos hembras mediante inseminación artificial. La inseminación artificial es una práctica de rutina para los pavos que puede introducir patógenos en las parvadas de reproductores de diversas formas. En este manuscrito, se presenta un análisis de riesgo sobre la posible transmisión de la influenza aviar altamente patógena a gallinas susceptibles mediante inseminación artificial. Un caso de influenza aviar altamente patógena en una granja de machos sementales donde se describe la posible transmisión del virus a gallinas susceptibles en el brote de influenza aviar altamente patógena H5N2 del año 2015 en Minnesota, junto con la documentación de las vías de transmisión conocidas y potenciales del caso. Las vías por las cuales la inseminación artificial podría resultar en la propagación de la influenza aviar altamente patógena a las gallinas susceptibles se determinaron considerando cuáles podrían resultar en 1) la entrada del virus de la influenza aviar altamente patógena en una granja a través del movimiento del semen; y 2) exposición de gallinas susceptibles a la influenza aviar altamente patógena como resultado de este movimiento. Sin embargo, se demostró la detección del virus de la influenza aviar altamente patógena en el semen de machos infectados. Debido a que se desconoce la dosis infecciosa del virus de la influenza aviar administrada en el útero necesaria para transmitir la influenza aviar altamente patógena a las gallinas susceptibles, está claro que la detección de la infección no puede ser la única estrategia de contención. La detección temprana de la infección puede limitar, pero no eliminar, el riesgo de exposición de las gallinas. Debido a las numerosas vías potenciales de propagación y al estrecho contacto con las aves, es muy probable que si se usa semen de una parvada de machos infectados con influenza aviar de alta patogenicidad, se propague el virus a gallinas susceptibles a través de la inseminación. Si la inseminación ocurre con semen de granjas de sementales en un área de control de influenza aviar de alta patogenicidad, las granjas de gallinas receptoras deben tener movimientos restringidos para prevenir la propagación del brote en caso de que se infecten.

Barriers to malaria prevention among immigrant travelers in the United States who visit friends and relatives in sub-Saharan Africa: A cross-sectional, multi-setting survey of knowledge, attitudes, and practices.

BACKGROUND: Despite achievements in the reduction of malaria globally, imported malaria cases to the United States by returning international travelers continue to increase. Immigrants to the United States from sub-Saharan Africa (SSA) who then travel back to their homelands to visit friends and relatives (VFRs) experience a disproportionate burden of malaria illness. Various studies have explored barriers to malaria prevention among VFRs and non-VFRs-travelers to the same destinations with other purpose for travel-but few employed robust epidemiologic study designs or performed comparative analyses of these two groups. To better quantify the key barriers that VFRs face to implement effective malaria prevention measures, we conducted a comprehensive community-based, cross-sectional, survey to identify differences in malaria prevention knowledge, attitudes, and practices (KAP) among VFRs and others traveling to Africa and describe the differences between VFRs and other types of international travelers. METHODS AND FINDINGS: Three distinct populations of travelers with past or planned travel to malaria-endemic countries of SSA were surveyed: VFRs diagnosed with malaria as reported through a state health department; members of the general VFR population (community); and VFR and non-VFR travelers presenting to a travel health clinic, both before their pretravel consultation and again, after return from travel. A Community Advisory Board of African immigrants and prior qualitative research informed survey development and dissemination. Across the three groups, 489 travelers completed surveys: 351 VFRs and 138 non-VFRs. VFRs who reported taking antimalarials on their last trip rated their concern about malaria higher than those who did not. Having taken five or more trips to SSA was reported more commonly among VFRs diagnosed with malaria than community VFRs (44.0% versus 20.4%; p = 0.008). Among travel health clinic patients surveyed before and after travel, VFR travelers were less successful than non-VFRs in adhering to their planned use of antimalarials (82.2% versus 98.7%; p = 0.001) and employing mosquito bite avoidance techniques (e.g., using bed nets: 56.8% versus 81.8%; p = 0.009). VFRs who visited the travel health clinic were more likely than VFR respondents from the community to report taking an antimalarial (83.0% versus 61.9%; p = 0.009), or to report bite avoidance behaviors (e.g., staying indoors when mosquitoes were out: 80.9% versus 59.5%; p = 0.009). CONCLUSIONS: We observed heterogeneity in malaria prevention behaviors among VFRs and between VFR and non-VFR traveler populations. Although VFRs attending the travel health clinic appear to demonstrate better adherence to malaria prevention measures than VFR counterparts surveyed in the community, specialized pretravel care is not sufficient to ensure chemoprophylaxis use and bite avoidance behaviors among VFRs. Even when seeking specialized pretravel care, VFRs experience greater barriers to the use of malaria prevention than non-VFRs. Addressing access to health care and upstream barrier reduction strategies that make intended prevention more achievable, affordable, easier, and resonant among VFRs may improve malaria prevention intervention effectiveness.

Planning "Plan B": The Case of Moving Cattle From an Infected Feedlot Premises During a Hypothetical Widespread FMD Outbreak in the United States.

In the event of a foot-and-mouth disease (FMD) outbreak in the United States, "stamping out" FMD infected premises has been proposed as the method of choice for the control of outbreaks. However, if a widespread, catastrophic FMD outbreak in the U.S. were to occur, alternative solutions to stamping out may be required, particularly for large feedlots with over 10,000 cattle. Such strategies include moving cattle from infected or not known to be infected operations to slaughter facilities either with or without prior implementation of vaccination. To understand the risk of these strategies, it is important to estimate levels of herd viremia. Multiple factors must be considered when determining risk and feasibility of moving cattle from a feedlot to a slaughter facility during an FMD outbreak. In addition to modeling within-herd disease spread to estimate prevalence of viremic animals, we explore potential pathways for viral spread associated with the movement of asymptomatic beef cattle (either pre-clinical or recovered) from an infected feedlot premises to offsite harvest facilities. This analysis was proactive in nature, however evaluation of the likelihood of disease spread relative to disease (infection) phase, time of movement, and vaccination status are all factors which should be considered in managing and containing a large-scale FMD outbreak in the United States.

Modeling the Transmission of Foot and Mouth Disease to Inform Transportation of Infected Carcasses to a Disposal Site During an Outbreak Event.

In the event of a Food and Mouth Disease (FMD) outbreak in the United States, an infected livestock premises is likely to result in a high number of carcasses (swine and/or cattle) as a result of depopulation. If relocating infected carcasses to an off-site disposal site is allowed, the virus may have increased opportunity to spread to uninfected premises and result in exposure of susceptible livestock. A stochastic within-herd disease spread model was used to predict the time to detect the disease by observation of clinical signs within the herd, and the number of animals in different disease stages over time. Expert opinion was elicited to estimate depopulation parameters in various scenarios. Disease detection was assumed when 5% of the population showed clinical signs by direct observation. Time to detection (5 and 95th percentile values) was estimated for all swine farm sizes (500-10,000 head) ranged from 102 to 282 h, from 42 to 216 h for all dairy cattle premises sizes (100-2,000 head) and from 66 to 240 h for all beef cattle premises sizes (5,000-50,000 head). Total time from infection to beginning depopulation (including disease detection and confirmation) for the first FMD infected case was estimated between 8.5-14.3 days for swine, 6-12.8 days for dairy or beef cattle premises. Total time estimated for subsequent FMD cases was between 6.8-12.3 days for swine, 4.3-10.8 days for dairy and 4.5-10.5 days for beef cattle premises. On an average sized operation, a sizable proportion of animals in the herd (34-56% of swine, 48-60% of dairy cattle, and 47-60% of beef cattle for the first case and 49-60% of swine, 55-60% of dairy cattle, 56-59% of beef cattle for subsequent cases) would be viremic at the time of beginning depopulation. A very small fraction of body fluids from the carcasses (i.e., 1 mL) would contain virus that greatly exceeds the minimum infectious dose by oral (4-7x) or inhalation (7-13x) route for pigs and cattle.

Barriers to malaria prevention in US-based travellers visiting friends and relatives abroad: a qualitative study of West African immigrant travellers†.

BACKGROUND: Over half of malaria cases reported in the USA occur among people travelling to visit friends and relatives (VFRs), predominantly to West Africa. Few studies have queried VFR travellers directly on barriers to seeking pre-travel care. We aim to describe the knowledge, attitudes and practices of VFRs travelling to malaria-endemic countries from the USA. With these findings, we aim to design interventions to encourage preventive behaviours before and during travel. METHODS: Sixteen focus groups were held in two US metropolitan areas with West African immigrant populations: Minneapolis-St. Paul, MN, and New York City, NY. A total of 172 people from 13 African countries participated. Focus group discussions were audio-recorded and transcribed, and modified grounded theory analysis was performed. Participants reviewed themes to verify intent of statements. RESULTS: Participants described the high cost of provider visits and chemoprophylaxis, challenges in advocating for themselves in healthcare settings and concerns about offending or inconveniencing hosts as barriers to malaria prevention. Cultural barriers to accessing pre-travel care included competing priorities when trip planning, such as purchasing gifts for family, travel logistics and safety concerns. When participants sought pre-travel care, most consulted their primary care provider. Participants expressed low confidence in US providers' knowledge and training about malaria and other tropical diseases. CONCLUSION: Barriers to pre-travel care for VFR travellers are multifaceted and extend beyond their perception of disease risk. Only some barriers previously reported in anecdotal and qualitative literature were supported in our findings. Future interventions should be aimed at barriers identified by individual communities and involve primary and travel specialist healthcare providers. Additional work is needed to address systems-level barriers to accessing care and establishing community-based programs to support West African VFR traveller health.

Garbage Management: An Important Risk Factor for HPAI-Virus Infection in Commercial Poultry Flocks.

Garbage management represents a potential pathway of HPAI-virus infection for commercial poultry operations as multiple poultry premises may share a common trash collection service provider, trash collection site (e.g., shared dumpster for multiple premises) or disposal site (e.g., landfill). The types of potentially infectious or contaminated material disposed of in the garbage has not been previously described but is suspected to vary by poultry industry sector. A survey of representatives from the broiler, turkey, and layer sectors in the United States revealed that many potentially contaminated or infectious items are routinely disposed of in the trash on commercial poultry premises. On-farm garbage management practices, along with trash hauling and disposal practices are thus key components that must be considered to evaluate the risk of commercial poultry becoming infected with HPAI virus.

Preparing for a Foreign Animal Disease Outbreak Using a Novel Tabletop Exercise.

IntroductionForeign animal disease (FAD) outbreaks can have devastating impacts, but they occur infrequently in any specific sector anywhere in the United States (US). Training to proactively discuss implementation of control and prevention strategies are beneficial in that they provide stakeholders with the practical information and educational experience they will need to respond effectively to an FAD. Such proactive approaches are the mission of the Secure Food System (SFS; University of Minnesota; St. Paul, Minnesota USA). METHODS: The SFS exercises were designed as educational activities based on avian influenza (AI) outbreaks in commercial poultry scenarios. These scenarios were created by subject matter experts and were based on epidemiology reports, risk pathway analyses, local industry practices, and site-specific circumstances. Target audiences of an exercise were the groups involved in FAD control: animal agriculture industry members; animal health regulators; and diagnosticians. Groups of industry participants seated together at tables represented fictional poultry premises and were guided by a moderator to respond to an on-farm situation within a simulated outbreak. The impact of SFS exercises was evaluated through interviews with randomized industry participants and selected table moderators. Descriptive statistics and qualitative analyses were performed on interview feedback. RESULTS: Eleven SFS exercises occurred from December 2016 through October 2017 in multiple regions of the US. Exercises were conducted as company-wide, state-wide, or regional trainings. Nine were based on highly pathogenic avian influenza (HPAI) outbreaks and two focused on outbreaks of co-circulating HPAI and low pathogenicity avian influenza (LPAI). Poultry industry participants interviewed generally found attending an SFS exercise to be useful. The most commonly identified benefits of participation were its value to people without prior outbreak experience and knowledge gained about Continuity of Business (COB)-permitted movement. After completing an exercise, most participants evaluated their preparedness to respond to an outbreak as somewhat to very ready, and more than one-half reported their respective company or farms had discussions or changed actions due to participation. CONCLUSION: Evaluation feedback suggests the SFS exercises were an effective training method to supplement preparedness efforts for an AI outbreak. The concept of using multi-faceted scenarios and multiple education strategies during a tabletop exercise may be translatable to other emergency preparedness needs. LinskensEJ, NeuAE, WalzEJ, St. CharlesKM, CulhaneMR, SsematimbaA, GoldsmithTJ, HalvorsonDA, CardonaCJ. Preparing for a foreign animal disease outbreak using a novel tabletop exercise. Prehosp Disaster Med. 2018;33(6):640-646.

Changing cultural and social environments: implications for older East Asian women.

The world is aging and the trend is towards a global feminization of aging. In the Asia Pacific region, which already contains approximately 50% of the world's population over age 60, the number of older women exceeds that of older men in most countries. This article explores the changes that are occurring in East Asian social and cultural traditions for aging and discusses the implications of those changes for women who aged in that culture. In the traditional culture, Chinese, Japanese, and Korean families are influenced by values of family centrality and collective orientation to life that are mostly rooted in Confucian values and ethics. In those traditions, older women assume and maintain a valued status within the family and community through respected roles and productive contributions. However, various factors, such as migration to urban areas and demographic shifts, have precipitated modernization of these societies and alterations of traditional culture. These cultural shifts are relevant to the United States where, according to the 2000 U.S. Census, 71.0% of Asian and Pacific Islander-Americans over the age 65 are foreign-born. Immigration can prompt an immediate cultural shift and create a fast forward insight into the slower cultural evolution currently occurring in East Asian societies.