Linked seasonal outbreaks of Salmonella Typhimurium among passerine birds, domestic cats and humans, Sweden, 2009 to 2016.

In 2016, an outbreak of Salmonella Typhimurium (STm) with multilocus variable-number tandem repeat analysis (MLVA) profiles historically associated with passerine birds (2-[11-15]-[3-4]-NA-212) occurred among passerines, cats and humans in Sweden. Our retrospective observational study investigated the outbreak and revisited historical data from 2009-16 to identify seasonality, phylogeography and other characteristics of this STm variant. Outbreak isolates were analysed by whole-genome single nucleotide polymorphism (SNP) typing. The number of notified cases of passerine-associated STm among passerines, cats and humans per month and county, and their MLVA profiles, were compared to birdwatchers' counts of passerines. Seasonal trend decomposition and correlation analysis was performed. Outbreak isolates did not cluster by host on SNP level. Passerine-associated STm was seasonal for birds, cats and humans, with a peak in March. Cases and counts of passerines at bird feeders varied between years. The incidence of passerine-associated STm infections in humans was higher in the boreal north compared with the southern and capital regions, consistent with passerine population densities. Seasonal mass migration of passerines appears to cause STm outbreaks among cats certain years in Sweden, most likely via predation on weakened birds. Outbreaks among humans can follow, presumably caused by contact with cats or environmental contamination.

Outbreak of Campylobacteriosis Following a Dairy Farm Visit: Confirmation by Genotyping.

In April-May 2014, an outbreak of campylobacteriosis occurred after a preschool visit to a dairy farm in the South Western part of Sweden. During the visit, a meal, including unpasteurized milk, was served. A retrospective cohort study using a web-based questionnaire was performed among the participants (n = 30) of the farm visit. A total of 24 of the 30 (80%) cohort members completed the questionnaire. Eleven cases were identified, and Campylobacter jejuni was isolated from eight of them. Seven of the cases were 2- to 7-year-old children. We found the highest attack rates among those who usually drink milk (45%) and those who consumed unpasteurized milk during the farm visit (42%). No cases were unexposed (risk ratio incalculable). As result of the farm investigation, Campylobacter was isolated from cattle on the farm. Genotyping with pulsed-field gel electrophoresis and whole genome sequencing confirmed that human and cattle isolates of C. jejuni belonged to one cluster. Thus, cattle on the farm are considered the source of infection, and the most likely vehicle of transmission was contaminated unpasteurized milk. We recommend consumption of heat-treated milk only and increased awareness of the risk of consuming unpasteurized milk.

Salmonella spp. in poultry production-A review of the role of interventions along the production continuum.

Salmonella is a significant pathogen of human and animal health and poultry are one of the most common sources linked with foodborne illness worldwide. Global production of poultry meat and products has increased significantly over the last decade or more as a result of consumer demand and the changing demographics of the world's population, where poultry meat forms a greater part of the diet. In addition, the relatively fast growth rate of birds which is significantly higher than other meat species also plays a role in how poultry production has intensified. In an effort to meet the greater demand for poultry meat and products, modern poultry production and processing practices have changed and practices to target control and reduction of foodborne pathogens such as Salmonella have been implemented. These strategies are implemented along the continuum from parent and grandparent flocks to breeders, the farm and finished broilers to transport and processing and finally from retail to the consumer. This review focuses on common practices, interventions and strategies that have potential impact for the control of Salmonella along the poultry production continuum from farm to plate.

Leptospira Status in Sweden during the Past Century, Neglected and Re-Emerging?

We compiled data on notified cases of leptospirosis in animals and humans in Sweden. Published studies on leptospirosis in humans and animals from the beginning of the 20th century onwards are summarized. During the Second World War, hundreds of leptospirosis cases in humans were reported in Sweden, but since then, there have been only a few severe cases. Surveillance of leptospirosis in domestic animals demonstrates that the pathogen is still occurring. The occurrence of Leptospira in humans and animals in the other Nordic countries resembles that in Sweden. Leptospirosis is an underdiagnosed and underreported disease globally, both in animals and humans, partly due to the lack of simple, rapid diagnostic tools but possibly also due to the lack of awareness among physicians, veterinarians and nurses. Traditionally, leptospirosis has been mostly diagnosed by serology, but development of molecular methodshas improved the capability for correct diagnosis. As of today, leptospirosis is regarded as a relatively uncommon disease in the Nordic countries, but in some other countries, it is considered a neglected zoonosis or a (re-)emerging disease that may become more common in the future. Possible factors that could contribute to an increase in incidence are discussed in this review. Active surveillance of humans and domestic and wild animals and stringent rodent control in society and animal farms are of outmost importance for prevention.

Type 2 diabetes and cognitive performance in middle age: a cross-sectional study.

INTRODUCTION: Type 2 diabetes has been associated with cognitive decrements already in middle-age. However, the sample sizes of the studies have been small and the neuropsychological tests used have been heterogeneous. In addition, only a few studies have matched the groups in terms of age, education and gender. In this cross-sectional matched pairs study, we investigated the cognitive performance of Finnish middle-aged type 2 diabetes patients compared to healthy individuals. METHOD: A neuropsychological test battery consisting of 16 tests and 21 outcome measures was applied to 28 patients and 28 age-, education- and gender-matched healthy individuals. Various exclusion criteria were applied to minimize the risk of cognitive dysfunction due to factors other than diabetes. RESULTS: We did not find between-group differences in any of the neuropsychological tests measuring attention, concept formation and reasoning, construction and motor performance, executive functions, memory, processing speed or working memory. In addition, there were no group differences in the frequency or severity of subjective cognitive symptoms, or in anxiety, depression, burnout, fatigue or alcohol use disorder symptoms. The effect sizes in this study were mostly negligible or small, with the mean effect size being -0.12. CONCLUSIONS: In a carefully matched sample of middle-aged type 2 diabetes patients and healthy individuals, we found no significant effects and no meaningful evidence of cognitive differences between the groups.

Biomarkers of viral and bacterial infection in rhinovirus pneumonia.

Background: Rhinovirus (RV) is often detected in children hospitalized with pneumonia, but the role of RV in causing pneumonia is still unclear. Methods: White blood cell count, C-reactive protein, procalcitonin, and myxovirus resistance protein A (MxA) levels were determined from blood samples in children (n = 24) hospitalized with radiologically verified pneumonia. Respiratory viruses were identified from nasal swabs by using reverse transcription polymerase chain reaction assays. Among RV-positive children, the cycle threshold value, RV subtyping by sequence analysis, and the clearance of RV by weekly nasal swabs were determined. RV-positive children with pneumonia were compared to other virus-positive children with pneumonia, and to children (n = 13) with RV-positive upper respiratory tract infection from a separate earlier study. Results: RV was detected in 6 children and other viruses in 10 children with pneumonia (viral co-detections excluded). All RV-positive children with pneumonia had high white blood cell counts, plasma C-reactive protein or procalcitonin levels, or alveolar changes in chest radiograph strongly indicating bacterial infection. The median cycle threshold value for RV was low (23.2) indicating a high RV load, and a rapid clearance of RV was observed in all. Blood level of viral biomarker MxA was lower among RV-positive children with pneumonia (median 100 µg/L) than among other virus-positive children with pneumonia (median 495 µg/L, p = 0.034) or children with RV-positive upper respiratory tract infection (median 620 µg/L, p = 0.011). Conclusions: Our observations suggest a true viral-bacterial coinfection in RV-positive pneumonia. Low MxA levels in RV-associated pneumonia need further studies.

Dairy milk from cow and goat as a sentinel for tick-borne encephalitis virus surveillance.

Tick-borne encephalitis (TBE) is one of the most severe human tick-borne diseases in Europe. It is caused by the tick-borne encephalitis virus (TBEV), which is transmitted to humans mainly via bites of Ixodes ricinus or I. persulcatus ticks. The geographical distribution and abundance of I. ricinus is expanding in Sweden as has the number of reported human TBE cases. In addition to tick bites, alimentary TBEV infection has also been reported after consumption of unpasteurized dairy products. So far, no alimentary TBEV infection has been reported in Sweden, but knowledge about its prevalence in Swedish ruminants is scarce. In the present study, a total of 122 bulk tank milk samples and 304 individual milk samples (including 8 colostrum samples) were collected from dairy farms (n = 102) in Sweden. All samples were analysed for the presence of TBEV antibodies by ELISA test and immunoblotting. Participating farmers received a questionnaire about milk production, pasteurization, tick prophylaxis used on animals, tick-borne diseases, and TBE vaccination status. We detected specific anti-TBEV antibodies, i.e., either positive (>126 Vienna Units per ml, VIEU/ml) or borderline (63-126 VIEU/ml) in bulk tank milk from 20 of the 102 farms. Individual milk samples (including colostrum samples) from these 20 farms were therefore collected for further analysis. Our results revealed important information for detection of emerging TBE risk areas. Factors such as consumption of unpasteurized milk, limited use of tick prophylaxis on animals and a moderate coverage of human TBE vaccination, may be risk factors for alimentary TBEV infection in Sweden.

The emergence of Brucella canis as a public health threat in Europe: what we know and what we need to learn.

The zoonotic bacteria, Brucella canis, is becoming the leading cause of canine brucellosis in Europe. In dogs, it causes reproductive problems as well as non-specific lameness or discospondilitis. In humans, B. canis can be origin of chronic debilitating conditions characteristic to its genus such as undulant fever, splenomegaly, and lymphadenopathy. Although B. canis shows some pathogenic characteristics similar to B. abortus and B. melitensis, it lacks surface O-polysaccharide, like nonzoonotic B. ovis. This review shows that host-B. canis interactions are still poorly understood, with many knowledge and capability gaps, causing relatively poor sensitivity and specificity of existing diagnostic tools. Currently, there is no vaccine for this rough Brucella species. Besides, antimicrobial therapy does not guarantee bacterial elimination, and infection relapses are frequently reported, increasing the risks of antibiotic resistance development. B. canis has been detected in dogs in almost all European countries which increased human exposure, but currently there is no systematic surveillance. Moreover, B. canis caused brucellosis is not included in Animal Health Law, and therefore there is no legal framework to tackle this emerging infectious disease. To map out the diagnostic strategies, identify risks for human infections and propose management scheme for infected pet and kennel dogs, we present current understanding of canine B. canis caused brucellosis, outline major knowledge gaps and propose future steps. To address and highlight challenges veterinary and public health services encounter in Europe, we developed two B. canis infection scenarios: of a single household pet and of a kennel dog in larger group.

One Health surveillance-A cross-sectoral detection, characterization, and notification of foodborne pathogens.

Introduction: Several Proficiency Test (PT) or External Quality Assessment (EQA) schemes are currently available for assessing the ability of laboratories to detect and characterize enteropathogenic bacteria, but they are usually targeting one sector, covering either public health, food safety or animal health. In addition to sector-specific PTs/EQAs for detection, cross-sectoral panels would be useful for assessment of the capacity to detect and characterize foodborne pathogens in a One Health (OH) perspective and further improving food safety and interpretation of cross-sectoral surveillance data. The aims of the study were to assess the cross-sectoral capability of European public health, animal health and food safety laboratories to detect, characterize and notify findings of the foodborne pathogens Campylobacter spp., Salmonella spp. and Yersinia enterocolitica, and to develop recommendations for future cross-sectoral PTs and EQAs within OH. The PT/EQA scheme developed within this study consisted of a test panel of five samples, designed to represent a theoretical outbreak scenario. Methods: A total of 15 laboratories from animal health, public health and food safety sectors were enrolled in eight countries: Denmark, France, Italy, the Netherlands, Poland, Spain, Sweden, and the United Kingdom. The laboratories analyzed the samples according to the methods used in the laboratory and reported the target organisms at species level, and if applicable, serovar for Salmonella and bioserotype for Yersinia. Results: All 15 laboratories analyzed the samples for Salmonella, 13 for Campylobacter and 11 for Yersinia. Analytical errors were predominately false negative results. One sample (S. Stockholm and Y. enterocolitica O:3/BT4) with lower concentrations of target organisms was especially challenging, resulting in six out of seven false negative results. These findings were associated with laboratories using smaller sample sizes and not using enrichment methods. Detection of Salmonella was most commonly mandatory to notify within the three sectors in the eight countries participating in the pilot whereas findings of Campylobacter and Y. enterocolitica were notifiable from human samples, but less commonly from animal and food samples. Discussion: The results of the pilot PT/EQA conducted in this study confirmed the possibility to apply a cross-sectoral approach for assessment of the joint OH capacity to detect and characterize foodborne pathogens.

Viral pneumonia.

About 200 million cases of viral community-acquired pneumonia occur every year-100 million in children and 100 million in adults. Molecular diagnostic tests have greatly increased our understanding of the role of viruses in pneumonia, and findings indicate that the incidence of viral pneumonia has been underestimated. In children, respiratory syncytial virus, rhinovirus, human metapneumovirus, human bocavirus, and parainfluenza viruses are the agents identified most frequently in both developed and developing countries. Dual viral infections are common, and a third of children have evidence of viral-bacterial co-infection. In adults, viruses are the putative causative agents in a third of cases of community-acquired pneumonia, in particular influenza viruses, rhinoviruses, and coronaviruses. Bacteria continue to have a predominant role in adults with pneumonia. Presence of viral epidemics in the community, patient's age, speed of onset of illness, symptoms, biomarkers, radiographic changes, and response to treatment can help differentiate viral from bacterial pneumonia. However, no clinical algorithm exists that will distinguish clearly the cause of pneumonia. No clear consensus has been reached about whether patients with obvious viral community-acquired pneumonia need to be treated with antibiotics. Apart from neuraminidase inhibitors for pneumonia caused by influenza viruses, there is no clear role for use of specific antivirals to treat viral community-acquired pneumonia. Influenza vaccines are the only available specific preventive measures. Further studies are needed to better understand the cause and pathogenesis of community-acquired pneumonia. Furthermore, regional differences in cause of pneumonia should be investigated, in particular to obtain more data from developing countries.

The temporal pattern and relationship of Campylobacter prevalence in broiler slaughter batches and human campylobacteriosis cases in Sweden 2009-2019.

Thermophilic Campylobacter species are the most common cause of bacterial gastroenteritis worldwide, and handling and consumption of broiler meat is considered a major foodborne transmission route. Both the incidence of campylobacteriosis and the prevalence of Campylobacter in broilers show seasonality but the impact of this association and broiler prevalence on human incidence is not clear. To explore this relationship we applied two approaches for analyzing time series data using different time resolutions (weekly, bi-weekly or monthly data) of human campylobacteriosis cases and prevalence of Campylobacter spp. in broiler slaughter batches in Sweden between 2009 and 2019. The decomposition of time series into seasonal (S), long-term trend (T) and residual components (STL model) showed a close overlap in seasonal patterns in terms of timing and the proportional change of peaks from normalized yearly levels. Starting 2016, when a large outbreak was reported, there was significant overlap in the trend components as well. The trend component of human cases prior to the outbreak corresponded to a linear increase of 6.5 % cases annually. In comparison, the estimated annual increase in broiler consumption was 2.7 %. An additive approach for time-series counts incorporating seasonal and epidemic (cases are a function of previous cases) components found a positive association between human cases and broiler prevalence with an optimal lag of 2 weeks, 1 bi-week, or 0 months. Considering the estimated time between slaughter and consumption, incubation time, and the time between on-set of disease and testing, a 2-week lag may be consistent with transmission via handling and consumption of fresh broiler meat. The best model included broiler prevalence as a factor in the epidemic model component, not in the seasonal component. The outcomes in terms of best model, optimal lags and significance of parameters, using weekly, bi-weekly or monthly data were, in general, in agreement but varied with data resolution when only a subset of the time series, not including any known broiler associated outbreaks, was analyzed. The optimal resolution based on the available data and conditions of the present analysis appeared to be weekly or bi-weekly data. Results suggest that broiler prevalence with a 2 week lag period can explain part of the human cases but has a smaller explanatory impact during the part of the study period not including the large known outbreaks. There is no simple relationship between broiler prevalence and human cases. Additional factors than broiler prevalence need to be evaluated in order to understand the transmission routes and epidemiology of campylobacteriosis.

Parental socioeconomic and psychological determinants of the 2009 pandemic influenza A(H1N1) vaccine uptake in children.

BACKGROUND: Before COVID-19, the previous pandemic was caused by influenza A(H1N1)pdm09 virus in 2009. Identification of factors behind parental decisions to have their child vaccinated against pandemic influenza could be helpful in planning of other pandemic vaccination programmes. We investigated the association of parental socioeconomic and psychosocial factors with uptake of the pandemic influenza vaccine in children in 2009-2010. METHODS: This study was conducted within a prospective birth-cohort study (STEPS Study), where children born in 2008-2010 are followed from pregnancy to adulthood. Demographic and socioeconomic factors of parents were collected through questionnaires and vaccination data from electronic registers. Before and after the birth of the child, the mother's and father's individual and relational psychosocial well-being, i.e. depressive symptoms, dissatisfaction with the relationship, experienced social and emotional loneliness, and maternal anxiety during pregnancy, were measured by validated questionnaires (BDI-II, RDAS, PRAQ, and UCLA). RESULTS: Of 1020 children aged 6-20 months at the beginning of pandemic influenza vaccinations, 820 (80%) received and 200 (20%) did not receive the vaccine against influenza A(H1N1)pdm09. All measures of parents' psychosocial well-being were similar between vaccinated and non-vaccinated children. Children of younger mothers had a higher risk of not receiving the influenza A(H1N1)pdm09 vaccine than children of older mothers (OR 2.59, 95% CI 1.52-4.43, for mothers < 27.7 years compared to ≥ 33.6 years of age). Children of mothers with lower educational level had an increased risk of not receiving the vaccine (OR 1.46, 95% CI 1.00-2.14). CONCLUSIONS: Mother's younger age and lower education level were associated with an increased risk for the child not to receive the 2009 pandemic influenza vaccine, but individual or relational psychosocial well-being of parents was not associated with children's vaccination. Our findings suggest that young and poorly educated mothers should receive targeted support in order to promote children's vaccinations during a pandemic.

Detection of Campylobacter species in different types of samples from dairy farms.

BACKGROUND: Livestock, domestic pets and wildlife can be intestinal carriers of thermotolerant Campylobacter species. These reservoirs can in turn contaminate the environment and food products, thus creating pathways to campylobacteriosis in human beings. The purposes of this study were to investigate sampling strategies applied for surveillance of Campylobacter on dairy cattle farms and to identify the presence and species of Campylobacter in different age groups. METHODS: Boot sock and faecal samples were collected from five dairy herds from three age groups-cows, heifers and calves younger than 12 months-and from milk filters. RESULTS: Campylobacter species were isolated in 152 of 250 samples, of which 93 isolates were identified as C jejuni, 51 as C hyointestinalis, two as C lari and one as C coli, whereas five isolates could not be identified to species level. Campylobacter species were isolated from 86 of 110 faecal samples, 60 of 97 sock samples and six of 43 milk filter samples. CONCLUSION: Faecal samples were the optimal sample type for detection of Campylobacter on dairy farms. However, taking multiple types of samples could be recommended in order to optimise the recovery rate and variety of Campylobacter species detected when investigating the presence of Campylobacter on dairy farms.

Characteristics of Hospitalized Rhinovirus-Associated Community-Acquired Pneumonia in Children, Finland, 2003-2014.

Background: Rhinovirus (RV) is the most common cause of respiratory tract infections in children but, still, the clinical characteristics of RV-associated pneumonia have not been sufficiently investigated. Methods: We identified children and adolescents younger than 18 years of age treated for community-acquired pneumonia as inpatients at the Turku University Hospital from 2003 to 2014 and analyzed for RV by PCR of a respiratory tract specimen. We collected the data from medical records and compared RV-positive children with RV-negative children. Results: Of the study population of 313 children with pneumonia who were studied for RV, it was detected in 82 (26%). RV-positive children were younger (median age 2.6 years, interquartile range [IQR] 1.1-4.6 vs. 3.5 years, IQR 1.7-8.3, p = 0.002) and they had more often a history of preterm birth (16% vs. 5%, adjusted odds ratio 2.89, 95% confidence interval 1.21-6.92, p = 0.017) than RV-negative children. RV-positive children had a higher median white blood cell count than RV-negative children at presentation with pneumonia. The signs, symptoms, and severity of pneumonia were mostly similar in RV-positive and RV-negative children. Conclusions: RV was frequently detected in young children hospitalized with community-acquired pneumonia. We identified premature birth as a factor associated with RV-positive pneumonia. The clinical features of pneumonia did not clearly differ between RV-positive and RV-negative children. Further studies are needed to clarify the clinical significance of detection of RV in children with pneumonia.

Parents' depression and loneliness during pregnancy and respiratory infections in the offspring: A prospective birth cohort study.

BACKGROUND: An association between maternal prenatal stress and increased rates of respiratory tract infections in the offspring has been described earlier. Data regarding the father's role is lacking. In this study our aim was to evaluate, whether mothers' and fathers' depressive symptoms and loneliness during pregnancy predict higher rates of respiratory tract infections in the offspring. METHODS: In this longitudinal cohort study we gathered information on parental psychological risk during gestational week 20 using the BDI-II and UCLA loneliness scale questionnaires for the parents of 929 children. Loneliness was divided into social and emotional components, the former describing patterns of social isolation and the latter a perceived lack of intimate attachments. Episodes of acute otitis media, physician visits due to respiratory tract infections, and antibiotic consumption relating to respiratory tract infections were documented in the infants, excluding twins, from birth until 10 months of age using study diaries. Analyses were carried out by structural equation modeling, which provides dynamic estimates of covariances. RESULTS: Maternal depressive symptoms during pregnancy predicted higher rates of acute otitis media in the infant and maternal emotional loneliness predicted higher rates of physician visits. Acute otitis media, physician visits and antibiotic consumption in the infant were slightly less frequent for families who reported social loneliness in the father or mother. Associations remained when taking into account confounders. CONCLUSIONS: Maternal prenatal depression and emotional loneliness predicted a higher burden of respiratory tract infections in the offspring. The protective influence of parental social loneliness on the burden of respiratory tract infections in infants was not in line with our study hypothesis, but could be explained by reduced use of healthcare services in these socially isolated families.

Prevalence of human pathogenic Yersinia enterocolitica in Swedish pig farms.

BACKGROUND: Pigs are the most important reservoir for human pathogenic Yersinia enterocolitica. We investigated the herd prevalence of human pathogenic Y. enterocolitica in Swedish pig farms by analysing pen faecal samples using a cold enrichment of 1 week and thereafter subsequent plating onto chromogenic selective media (CAY agar). RESULTS: Pathogenic Y. enterocolitica was found in 32 (30.5%) of the 105 sampled farms with finisher pigs. Bioserotype 4/O:3 was identified at all but one farm, where 2/O:9 was identified. Pen-prevalence within the positive herds varied from 1/4 to 4/4 pens. The calculated intra-class correlation coefficient ICC (0.89) from a model with a random effect for grouping within herd indicated a very high degree of clustering by herd. None of the explored risk factors, including herd size, herd type, pig flow, feed type, access to outdoors, evidence of birds and rodents in the herd, usage of straw, number of pigs in sampled pen and age of pigs in pen were significantly associated with Y. enterocolitica status of the pen. The use of high pressure washing with cold water was significantly associated with Y. enterocolitica in the pen (OR = 84.77, 4.05-1772). Two culture methods were assessed for detection of Y. enterocolitica, one of which included the use of a chromogenic agar (CAY agar) intended for detection of human pathogenic Y. enterocolitica. The chromogenic media was found equal or superior to traditional methods and was used in this study. The isolates obtained were characterised by biotyping, serotyping, mass spectrometry (MALDI-TOF) and PCR. Characterisation by MALDI-TOF gave identical results to that of conventional bioserotyping. All porcine isolates were positive for the ail and inv genes by PCR, indicating that the isolates were most likely pathogenic to humans. CONCLUSIONS: Human pathogenic Y. enterocolitica was found in nearly one-third of the Swedish pig farms with finisher pigs. The use of high pressure washing with cold water was associated with the presence of Y. enterocolitica in the pen. A modified culturing method using a chromogenic agar was efficient for detection of pathogenic Y. enterocolitica in pig faeces. The use of masspectrometry for identification and subtyping was in agreement with conventional biotyping and serotyping methods.

Two outbreaks of cryptosporidiosis associated with cattle spring pasture events.

Over a period of less than four weeks, 50 human cases of cryptosporidiosis were reported from a relatively small geographical area in Sweden. All cases were associated with visits to cattle spring pasture events at two farms (referred to as Farm A and B). Epidemiological and microbiological evidence show that contact with calves at the farms was the most likely source of Cryptosporidium infections. Gp60 sequences from human and calf isolates at Farm A were identical to each other, but differed from those at Farm B where, again, human and calf gp60 sequences were identical, proving that the two outbreaks had no common origin. As a direct consequence of these two outbreaks, and guided by knowledge gained from the outbreak investigations, the Swedish Board of Agriculture and all relevant farmer advisory organizations have updated their hygiene instructions for farm visits.

Occurrence of Salmonella spp.: a comparison between indoor and outdoor housing of broilers and laying hens.

BACKGROUND: Outdoor production of poultry is rapidly increasing, which could be associated with increased risks for exposure to different environmental sources of Salmonella. We report a comparison on the occurrence of Salmonella during 2007-2015 in broilers and laying hens in outdoor and indoor production subjected to the same requirements for the prevention and control of Salmonella as applied in Sweden. RESULTS: Our results give no indication that, during the period studied, the exposure to Salmonella in outdoor poultry production was higher than in the indoor production. The annual incidence of Salmonella infected flocks in outdoor production remained at a very low and at a similar level as for indoor production. For laying hens the annual proportion of birds in test positive flocks ranged from 0 to 1.3% for indoor production from 0 to 2.0% for outdoor production. For broilers the proportion of Salmonella infected flocks (2013-2015) was 0.16% for indoor, and 0% in outdoor production. The difference was not statistically significant and was further reduced when flocks infected due to vertical transmission or from a hatchery source were excluded. It should, however, be considered that the number of outdoor flocks included in this evaluation is very small and continuous evaluation is needed. CONCLUSIONS: New animal production systems, including those driven by consumer and welfare demands, may be associated with a higher risk for the exposure of potential pathogens to food animals and possibly also subsequent outbreaks of food borne infections. In this study no increase in the risk for exposure of flocks to Salmonella in outdoor poultry production was found. The situation may well change and the possibility of Salmonella contamination in outdoor poultry production requires continuous attention.

Influenza pneumonia.

BACKGROUND: Influenza and pneumonia are common childhood illnesses, but few studies have been conducted on influenza-related pneumonia in children. The aim of this study was to describe the frequency and characteristics of laboratory-documented and radiologically detected influenza pneumonia in children. METHODS: This study involved children treated at the Department of Pediatrics, Turku University Hospital, from 1980 through 2003. Influenza A or B infection was documented with the use of antigen detection from nasopharyngeal aspirates. Children with chest radiographs obtained during influenza episodes were identified. Chest radiographs were reevaluated by a pediatric radiologist for verification of pneumonic infiltrates. Clinical and laboratory data were collected from medical records. RESULTS: Pneumonia was detected in 134 (14%) of 936 children with influenza infection. The most frequent signs of influenza pneumonia were fever and cough. Of these children, 47% had no specific clinical signs or symptoms suggesting pneumonia. White blood cell count was <15 x 10/L in 89% and serum C-reactive protein concentration <80 mg/L in 85% of the children. One-half of the children had solely interstitial infiltrates, one-fourth solely alveolar and one- fourth both alveolar and interstitial infiltrates on the chest radiograph. The hospitalization rate was 68%, and the median duration of hospitalization was 2 days. Complicated pneumonias were rare, and mortality was low (0.7%). CONCLUSIONS: Pneumonia is detected in a minority of children treated for influenza at a tertiary center. Unlike in adults, influenza pneumonia in children is usually a benign illness, and the mortality is low.

An outbreak of Streptococcus equi subspecies zooepidemicus associated with consumption of fresh goat cheese.

BACKGROUND: Streptococcus equi subspecies zooepidemicus is a rare infection in humans associated with contact with horses or consumption of unpasteurized milk products. On October 23, 2003, the National Public Health Institute was alerted that within one week three persons had been admitted to Tampere University Central Hospital (TaYS) because of S. equi subsp. zooepidemicus septicaemia. All had consumed fresh goat cheese produced in a small-scale dairy located on a farm. We conducted an investigation to determine the source and the extent of the outbreak. METHODS: Cases were identified from the National Infectious Disease Register. Cases were persons with S. equi subsp. zooepidemicus isolated from a normally sterile site who had illness onset 15.9-31.10.2003. All cases were telephone interviewed by using a standard questionnaire and clinical information was extracted from patient charts. Environmental and food specimens included throat swabs from two persons working in the dairy, milk from goats and raw milk tank, cheeses made of unpasteurized milk, vaginal samples of goats, and borehole well water. The isolates were characterized by ribotyping and pulsed-field gel electrophoresis (PFGE). RESULTS: Seven persons met the case definition; six had septicaemia and one had purulent arthritis. Five were women; the median age was 70 years (range 54-93). None of the cases were immunocompromized and none died. Six cases were identified in TaYS, and one in another university hospital in southern Finland. All had eaten goat cheese produced on the implicated farm. S. equi subsp. zooepidemicus was isolated from throat swabs, fresh goat cheese, milk tank, and vaginal samples of one goat. All human and environmental strains were indistinguishable by ribotyping and PFGE. CONCLUSION: The outbreak was caused by goat cheese produced from unpasteurized milk. Outbreaks caused by S. equi subsp. zooepidemicus may not be detected if streptococcal strains are only typed to the group level. S. equi subsp. zooepidemicus may be a re-emerging disease if unpasteurized milk is increasingly used for food production. Facilities using unpasteurized milk should be carefully monitored to prevent this type of outbreaks.