Diagnosis of Tuberculosis in Three Zoo Elephants and a Human Contact - Oregon, 2013.

In 2013, public health officials in Multnomah County, Oregon, started an investigation of a tuberculosis (TB) outbreak among elephants and humans at a local zoo. The investigation ultimately identified three bull elephants with active TB and 118 human contacts of the elephants. Ninety-six (81%) contacts were evaluated, and seven close contacts were found to have latent TB infection. The three bulls were isolated and treated (elephants with TB typically are not euthanized) to prevent infection of other animals and humans, and persons with latent infection were offered treatment. Improved TB screening methods for elephants are needed to prevent exposure of human contacts.

The fecal microbiota of Thai school-aged children associated with demographic factors and diet.

Background: Birth delivery method and breastfeeding practices contribute to microbiota colonization. Other factors including diet and demographic factors structure the gut microbiome assembly and diversity through childhood development. The exploration of these factors, especially in Southeast Asian children, remains limited. Methods: We investigated the fecal microbiota of 127 school-aged children in Thailand using quantitative PCR (qPCR) to assess the influence of diet and demographic factors on the gut microbiota. Multivariate analysis (multiple factor analysis (MFA) and Partial Least Squares Discriminant Analysis (PLS-DA)) were used to link particular gut microbes to diet and demographic factors. Results: Diet and demographic factors were associated with variation among gut microbiota. The abundance of Gammaproteobacteria increased in children with infrequent intake of high fat foods. Obese children possessed a lower level of Firmicutes and Ruminococcus. Bifidobacterium was enriched in pre-teen aged children and detected at lower levels among formula-fed children. Prevotella was more abundant in children who were delivered vaginally. While ethnicity explained a small amount of variation in the gut microbiota, it nonetheless was found to be significantly associated with microbiome composition. Conclusions: Exogenous and demographic factors associate with, and possibly drive, the assembly of the gut microbiome of an understudied population of school-aged children in Thailand.

A Non-Randomized Trial Investigating the Impact of Brown Rice Consumption on Gut Microbiota, Attention, and Short-Term Working Memory in Thai School-Aged Children.

While dietary fiber has been shown to influence the composition of gut microbiota and cognitive function in adults, much less is known about the fiber-microbiome-cognition association in children. We profiled gut microbiota using quantitative PCR (qPCR) and evaluated cognitive function using the Corsi block-tapping test (CBT) and the psychomotor vigilance test (PVT) before, during, and after the dietary intervention of 127 school-aged children in northern Thailand. While we found that Sinlek rice (SLR) consumption did not significantly alter the abundance of gut microbiota or the cognitive performance of school-aged children, we did find age to be associated with variations in both the gut microbiota profiles and cognitive outcomes. Gammaproteobacteria was significantly lower in the control and SLR groups during the middle time points of both phases (Weeks 4 and 61), and its abundance was associated with age. Cognitive performance using CBT and PVT were also found to be age-sensitive, as older children outperformed younger children on both of these cognitive assessments. Finally, a multiple factor analysis (MFA) revealed that age and cognitive performance best explain individual variation in this study. Collectively, these findings further describe the influence of host variables on the microbial profiles and cognitive outcomes of school-aged children consuming Sinlek rice in Thailand.

Human Listeria monocytogenes infections in Europe--an opportunity for improved European surveillance.

The 2006 Community Summary Report from the European Food Safety Authority (EFSA) and the European Centre for Disease Prevention and Control (ECDC) was published recently with the latest trends and figures on the occurrence of zoonotic infections and agents, antimicrobial resistance and foodborne outbreaks in the then 25 European Union (EU) Member States and five non-EU countries. This article seeks to expand further upon reports of human listeriosis (Listeria monocytogenes infections) and changes in the epidemiology of this disease, in order to inform of important developments as they relate to an opportunity for the establishment of a formalized listeriosis surveillance network in Europe.

A quarterly update on food- and waterborne diseases in Europe--summary of data for the third quarter of 2007.

This paper highlights findings from the first quarterly report on food- and waterborne diseases produced by the European Centre for Disease Prevention and Control (ECDC). In the past such reports had been generated by Enter-net, a Europe-based international surveillance network for the enteric infections. The quarterly reports are an important surveillance tool for the network participants and other public health professionals to use in order to identify emerging trends and changes taking place in a shorter interval than one year.

Outbreak of Escherichia coli O157:H7 associated with raw milk consumption in the Pacific Northwest.

In late 2005, health officials in Clark County, Washington noted a higher than expected number of Escherichia coli cases among residents and sought to identify a possible common source for infection. In order to identify risk factors, health officials conducted a retrospective cohort study and an environmental site investigation using pulsed-field gel electrophoresis (PFGE) to identify and prevent future cases from occurring. Several lines of evidence supported raw milk as the cause of infections: 1) all ill persons drank raw milk from the same cow share; 2) illness was associated with an increasing amount of milk consumed; 3) E. coli O157:H7 was isolated from raw milk samples and environmental samples collected from the floor of the milking parlour; and 4) PFGE patterns were indistinguishable between case-patients, raw milk samples, and environmental samples. Together, these findings made clear the health risks associated with the consumption of raw milk. The high amount of media interest in this investigation empowered public health officials to work with state legislators to pass State Senate Bill 6377 in Washington State which clarified that state licensing requirements apply to all milk production facilities including cow-share programs.

The Lao Experience in Deploying Influenza A(H1N1)pdm09 Vaccine: Lessons Made Relevant in Preparing for Present Day Pandemic Threats.

The Lao PDR, as did most countries of the Mekong Region, embarked on a pandemic vaccine initiative to counter the threat posed by influenza A(H1N1)pdm09. Overall, estimated vaccine coverage of the Lao population was 14%, with uptake in targeted health care workers and pregnant women 99% and 41%, respectively. Adverse Events Following Immunization accounted for only 6% of survey driven, reported vaccination experiences, with no severe consequences or deaths. Public acceptability of the vaccine campaign was high (98%). Challenges to vaccine deployment included: 1) no previous experience in fielding a seasonal influenza vaccine, 2) safety and efficacy concerns, and 3) late arrival of vaccine 10 months into the pandemic. The Lao success in surmounting these hurdles was in large measure attributed to the oversight assigned the National Immunization Program, and national sensitivities in responding to the avian influenza A(H5N1) crisis in the years leading up to the pandemic. The Lao "lessons learned" from pandemic vaccine deployment are made even more relevant four years on, given the many avian influenza strains circulating in the region, all with pandemic potential.

An epidemic of dengue-1 in a remote village in rural Laos.

In the Lao PDR (Laos), urban dengue is an increasingly recognised public health problem. We describe a dengue-1 virus outbreak in a rural northwestern Lao forest village during the cool season of 2008. The isolated strain was genotypically "endemic" and not "sylvatic," belonging to the genotype 1, Asia 3 clade. Phylogenetic analyses of 37 other dengue-1 sequences from diverse areas of Laos between 2007 and 2010 showed that the geographic distribution of some strains remained focal overtime while others were dispersed throughout the country. Evidence that dengue viruses have broad circulation in the region, crossing country borders, was also obtained. Whether the outbreak arose from dengue importation from an urban centre into a dengue-naïve community or crossed into the village from a forest cycle is unknown. More epidemiological and entomological investigations are required to understand dengue epidemiology and the importance of rural and forest dengue dynamics in Laos.

Vibrio parahaemolyticus enteritis outbreak following a wedding banquet in a rural village - Kampong Speu, Cambodia, April 2012.

INTRODUCTION: Foodborne outbreaks are common in Cambodia, but only a few investigations documenting the etiology and source have been conducted. In April, we learnt of 49 acute diarrhoea cases in a village following a wedding banquet. We undertook an investigation to identify the pathogen, source and mode of transmission. METHODS: We interviewed banquet hosts and food handlers to obtain the menu and guest list. Guests were asked about signs and symptoms and onset of illness, time of meal and food or drinks consumed. Rectal swabs were taken from 13 cases for culture. A case-control study was undertaken; cases were guests who had acute diarrhoea within three days after the wedding and controls were guests who remained well during the same time period. RESULTS: There were 256 guests. Of 69 interviewees, 52 got sick (attack rate 75%). Aside from diarrhoea, cases had abdominal pain (94%), vomiting (48%), nausea (42%) and fever (25%). Incubation periods ranged from seven to 51 hours (median 16.5). Rectal swabs from three cases grew Vibrio parahaemolyticus. Among the food and drinks served, vegetable salad with raw octopus was the only one associated with illness (odds ratio: 6.6, 95% confidence interval: 1.3-36.1, P = 0.01). DISCUSSION: Vegetable salad with raw octopus was the suspected vehicle for transmission of this Vibrio parahaemolyticus enteritis outbreak. Messages regarding the risks from eating raw seafood were disseminated, and food handlers were advised to cook seafood to high temperatures. Efforts to improve foodborne disease surveillance and food safety are being undertaken.