Draft genome of novel cyanobacteria Sphaerothrix Gracilis isolated from coastal microplastics reveal insights to chemical ecology, bloom and plastic-utilization potential.

Cyanobacteria are oxygenic photosynthetic organisms which are found across many ecosystems, including freshwater and marine habitats. They are also found on natural and artificial surfaces. In this study, we cultured and characterise a novel cyanobacterium from the surfaces of foam microplastics of tropical coastal waters. We study the chemical ecology of this cyanobacterium, Sphaerothrix gracilis gen. et sp. nov., together with its potential to form harmful cyanobacterial blooms and bioremediation applications to combat plastic pollution. The genome of S. gracilis spanned 6.7 Mbp, with identification of antibiotic resistance, nitrogen-fixation, plastic-degrading and genes involved in harmful metabolite production. The transport of potentially harmful S. gracilis in coastal environments could have severe implications on human health and food security, especially in times of a cyanobacterial bloom.

Tularemia From Veterinary Occupational Exposure.

Tularemia is a disease caused by Francisella tularensis, a highly infectious bacteria that can be transmitted to humans by direct contact with infected animals. Because of the potential for zoonotic transmission of F. tularensis, veterinary occupational risk is a concern. Here, we report on a human case of tularemia in a veterinarian after an accidental needlestick injury during abscess drainage in a sick dog. The veterinarian developed ulceroglandular tularemia requiring hospitalization but fully recovered after abscess drainage and a course of effective antibiotics. To systematically assess veterinary occupational transmission risk of F. tularensis, we conducted a survey of veterinary clinical staff after occupational exposure to animals with confirmed tularemia. We defined a high-risk exposure as direct contact to the infected animal's body fluids or potential aerosol inhalation without use of standard personal protective equipment (PPE). Survey data included information on 20 veterinary occupational exposures to animals with F. tularensis in 4 states. Veterinarians were the clinical staff most often exposed (40%), followed by veterinarian technicians and assistants (30% and 20%, respectively). Exposures to infected cats were most common (80%). Standard PPE was not used during 80% of exposures; a total of 7 exposures were categorized as high risk. Transmission of F. tularensis in the veterinary clinical setting is possible but overall risk is likely low. Veterinary clinical staff should use standard PPE and employ environmental precautions when handling sick animals to minimize risk of tularemia and other zoonotic infections; postexposure prophylaxis should be considered after high-risk exposures to animals with suspected or confirmed F. tularensis infection to prevent tularemia.

Plankton assemblages from microplastics of tropical coastal environments reveal high diversity and evidence of toxic species.

Microplastics are a major constituent of plastic waste and are of an increasing global concern. Although microplastics are prevalent in marine ecosystems, the characterisation of plankton communities has been largely neglected in this aspect, especially in tropical ecosystems. To better understand the role of microplastics as a carrier of harmful plankton in marine ecosystems, epiplastic plankton communities in tropical marine ecosystems were studied from beach sediments along the Johor and Singapore Straits. Complementary analysis of microscopy and high throughput sequencing of the 16S rRNA (V3-V4) and 18S (V4) rRNA regions provided evidence that the plastisphere provided an appropriate environment to host a wide range of planktonic organisms. An average of 781 OTUs were identified across the three sampling sites. The structures of plankton communities were distinct across the sampling sites and were generally dominated by dinoflagellates, fungi and chlorophytes. We demonstrate that marine microplastics serve as microhabitats that are a host to harmful phytoplankton species, including viable resting cysts of dinoflagellates. Furthermore, plastics isolated from the location with the greatest anthropogenic influence demonstrated the greatest plankton diversity. This study presents evidence of diverse toxic plankton species present on the plastisphere and highlights its importance as a vector of the transport of harmful opportunistic species in relation to anthropogenic influence, in the marine environment.

Impact of Microplastics on the Ocular Surface.

Plastics are synthetic materials made from organic polymers that are ubiquitous in daily living and are especially important in the healthcare setting. However, recent advances have revealed the pervasive nature of microplastics, which are formed by degradation of existing plastic products. Although the impact on human health has yet to be fully characterised, there is increasing evidence that microplastics can trigger inflammatory damage, microbial dysbiosis, and oxidative stress in humans. Although there are limited studies investigating their effect on the ocular surface, studies of microplastics on other organs provide some insights. The prevalence of plastic waste has also triggered public outcry, culminating in the development of legislation aimed at reducing microplastics in commercial products. We present a review outlining the possible sources of microplastics leading to ocular exposure, and analyse the possible mechanisms of ocular surface damage. Finally, we examine the utility and consequences of current legislation surrounding microplastic regulation.

Spatiotemporal characterisation of microplastics in the coastal regions of Singapore.

In the 21st century, plastic production continues to increase at an unprecedented rate, leading to the global issue of plastic pollution. In marine environments, a significant fraction of plastic litter are microplastics, which have a wide range of effects in marine ecosystems. Here, we examine the spatiotemporal distribution of microplastics along the Johor and Singapore Straits, at surface and at depth. Generally, more microplastics were recorded from the surface waters across both Straits. Fragments were the dominant microplastic type (70%), followed by film (25%) and fiber (5%). A total of seven colours of microplastics were identified, with clear microplastics as the most abundant (64.9%), followed by black (25.1%) and blue (5.5%). Microplastics under 500 µm in size accounted for 98.9%, followed by particles 500-1000 µm (1%) and 1-5 mm (0.1%). During the monsoon season, the abundance of microplastics across various sites were observed to be > 1.1 times when compared to the inter-monsoon period. Rainfall was a closely related to the increased microplastic abundance across various sites in the Singapore Strait. This suggests that weather variations during climate change can play critical roles in modulating microplastic availability. Beach sediments facing the Singapore Strait recorded an abundance of 13.1 particles/kg, with polypropylene fragments, polyethylene pellets and thermoplastic polyester foam identified via Fourier transform infrared spectroscopy. Hence, it is crucial to profile the spatiotemporal variation of microplastic abundance in both the surface and in the water column to gain a better understanding of the threat caused by microplastic pollution in the coastal regions of Singapore.

Acceptability of a Chikungunya Virus Vaccine, United States Virgin Islands.

Chikungunya virus, a mosquito-borne alphavirus, causes acute febrile illness with polyarthralgia. Groups at risk for severe disease include neonates, people with underlying medical conditions, and those aged ≥ 65 years. Several chikungunya vaccines are in late clinical development with licensure expected in the United States during 2023. We administered a questionnaire to randomly selected households in the U.S. Virgin Islands (USVI) to assess interest in a hypothetical chikungunya vaccine. Estimates were calibrated to age and sex of USVI population, and univariate and multivariable analyses were performed. Of 966 participants, 520 (adjusted 56%, 95% CI = 51-60%) were interested in receiving the vaccine. Of 446 participants not interested in vaccination, 203 (adjusted 47%, 95% CI = 41-52%) cited safety concerns as the reason. Educational efforts addressing vaccine safety concerns and risk factors for severe disease would likely improve vaccine acceptability and uptake among those most at risk.

COVID-19 Case Investigations Among Federally Quarantined Evacuees From Wuhan, China, and Exposed Personnel at a US Military Base, United States, February 5-21, 2020.

In February 2020, during the early days of the COVID-19 pandemic, 232 evacuees from Wuhan, China, were placed under federal 14-day quarantine upon arrival at a US military base in San Diego, California. We describe the monitoring of evacuees and responders for symptoms of COVID-19, case and contact investigations, infection control procedures, and lessons learned to inform future quarantine protocols for evacuated people from a hot spot resulting from a novel pathogen. Thirteen (5.6%) evacuees had COVID-19-compatible symptoms and 2 (0.9%) had laboratory-confirmed SARS-CoV-2. Two case investigations identified 43 contacts; 3 (7.0%) contacts had symptoms but tested negative for SARS-CoV-2 infection. Daily symptom and temperature screening of evacuees and enacted infection control procedures resulted in rapid case identification and isolation and no detected secondary transmission among evacuees or responders. Lessons learned highlight the challenges associated with public health response to a novel pathogen and the evolution of mitigation strategies as knowledge of the pathogen evolves.

The toxic cosmopolitan cyanobacteria Moorena producens: insights into distribution, ecophysiology and toxicity.

Moorena producens is a benthic filamentous cyanobacteria that has been widely documented for its toxicity. This cyanobacterium colonizes both temperate (37%) and tropical (63%) regions, making it a cosmopolitan cyanobacterium with a global distribution. M. producens grows across coral reefs in multiple locations but recurringly blooms in Queensland, Australia. Today, nuisance blooms of M. producens have resulted in major disruptions to recreational activities along coastal areas and are known to cause adverse effects on organism and human health upon contact or ingestion. Specifically, marine organisms such as the green turtle Chelonia mydas and hawksbill turtle Eretmochelys imbricata were fatally poisoned by M. producens after consumption of this cyanobacterium. Reports record a range of effects on human health, from pain and blistering or even death upon ingestion of contaminated seafood. Blooms of M. producens are triggered by influxes of nitrogen, phosphate and iron, from surrounding coastal runoffs or sewage effluents. Additions of these nutrients can result in an increase in growth rate by 4-16 times. Iron bioavailability also plays a crucial role in bloom formation. A total of 231 natural products from 66 groups were identified from M. producens, with the three dominant groups: malyngamides, microcolins and dolastatins. These bioactive secondary metabolites have displayed toxicities against a range of carcinoma cell lines and organisms such as brine shrimp Artemia salina and goldfish Carassius auratus. This review provides a thorough insight to the distribution, ecophysiology and toxicity of M. producens, with reports on bloom events and implications on organism and human health.

Remote Infection Control Assessments of US Nursing Homes During the COVID-19 Pandemic, April to June 2020.

BACKGROUND: Nursing homes (NHs) provide care in a congregate setting for residents at high risk of severe outcomes from SARS-CoV-2 infection. In spring 2020, NHs were implementing new guidance to minimize SARS-CoV-2 spread among residents and staff. OBJECTIVE: To assess whether telephone and video-based infection control assessment and response (TeleICAR) strategies could efficiently assess NH preparedness and help resolve gaps. DESIGN: We incorporated Centers for Disease Control and Prevention COVID-19 guidance for NH into an assessment tool covering 6 domains: visitor restrictions; health care personnel COVID-19 training; resident education, monitoring, screening, and cohorting; personal protective equipment supply; core infection prevention and control (IPC); and communication to public health. We performed TeleICAR consultations on behalf of health departments. Adherence to each element was documented and recommendations provided to the facility. SETTING AND PARTICIPANTS: Health department-referred NHs that agreed to TeleICAR consultation. METHODS: We assessed overall numbers and proportions of NH that had not implemented each infection control element (gap) and proportion of NH that reported making ≥1 change in practice following the assessment. RESULTS: During April 13 to June 12, 2020, we completed TeleICAR consultations in 629 NHs across 19 states. Overall, 524 (83%) had ≥1 implementation gap identified; the median number of gaps was 2 (interquartile range: 1-4). The domains with the greatest number of facilities with gaps were core IPC practices (428/625; 68%) and COVID-19 education, monitoring, screening, and cohorting of residents (291/620; 47%). CONCLUSIONS AND IMPLICATIONS: TeleICAR was an alternative to onsite infection control assessments that enabled public health to efficiently reach NHs across the United States early in the COVID-19 pandemic. Assessments identified widespread gaps in core IPC practices that put residents and staff at risk of infection. TeleICAR is an important strategy that leverages infection control expertise and can be useful in future efforts to improve NH IPC.

Advancing Diagnostic Stewardship for Healthcare-Associated Infections, Antibiotic Resistance, and Sepsis.

Diagnostic stewardship means ordering the right tests for the right patient at the right time to inform optimal clinical care. Diagnostic stewardship is an integral part of antibiotic stewardship efforts to optimize antibiotic use and improve patient outcomes, including reductions in antibiotic resistance and treatment of sepsis. The Centers for Disease Control and Prevention's Division of Healthcare Quality Promotion hosted a meeting on improving patient safety through diagnostic stewardship with a focus on use of the laboratory. At the meeting, emerging issues in the field of diagnostic stewardship were identified, awareness of these issues among stakeholders was raised, and strategies and interventions to address the issues were discussed-all with an emphasis on improved outcomes and patient safety. Here, we summarize the key takeaways of the meeting including needs for diagnostic stewardship implementation, promising future avenues for diagnostic stewardship implementation, and areas of needed research.

Marine microplastics in the ASEAN region: A review of the current state of knowledge.

Microplastic pollution is a prevalent and serious problem in marine environments. These particles have a detrimental impact on marine ecosystems. They are harmful to marine organisms and are known to be a habitat for toxic microorganisms. Marine microplastics have been identified in beach sand, the seafloor and also in marine biota. Although research investigating the presence of microplastics in various marine environments have increased across the years, studies in Southeast Asia are still relatively limited. In this paper, 36 studies on marine microplastic pollution in Southeast Asia were reviewed and discussed, focusing on microplastics in beach and benthic sediments, seawater and marine organisms. These studies have shown that the presence of fishing harbours, aquaculture farms, and tourism result in an increased abundance of microplastics. The illegal and improper disposal of waste from village settlements and factories also contribute to the high abundance of microplastics observed. Hence, it is crucial to identify the hotspots of microplastic pollution, for assessment and mitigation purposes. Future studies should aim to standardize protocols and quantification, to allow for better quantification and assessment of the levels of microplastic contamination for monitoring purposes.

Cost-Effectiveness and Impact of a Targeted Age- and Incidence-based West Nile Virus Vaccine Strategy.

BACKGROUND: West Nile virus (WNV) is the leading cause of arboviral disease in the United States and is associated with significant morbidity and mortality. A previous analysis found that a vaccination program targeting persons aged ≥60 years was more cost-effective than universal vaccination, but costs remained high. METHODS: We used a mathematical Markov model to evaluate cost-effectiveness of an age- and incidence-based WNV vaccination program. We grouped states and large counties (≥100 000 persons aged ≥60 years) by median annual WNV incidence rates from 2004 to 2017 for persons aged ≥60 years. We defined WNV incidence thresholds, in increments of 0.5 cases per 100 000 persons ≥60 years. We calculated potential cost per WNV vaccine-prevented case and per quality adjusted life-years (QALYs) saved. RESULTS: Vaccinating persons aged ≥60 years in states with an annual incidence of WNV neuroinvasive disease of ≥0.5 per 100 000 resulted in approximately half the cost per health outcome averted compared to vaccinating persons aged ≥60 years in the contiguous United States. This approach could potentially prevent 37% of all neuroinvasive disease cases and 63% of WNV-related deaths nationally. Employing such a threshold at a county level further improved cost-effectiveness ratios while preventing 19% and 30% of WNV-related neuroinvasive disease cases and deaths, respectively. CONCLUSIONS: An age- and incidence-based WNV vaccination program could be a more cost-effective strategy than an age-based program while still having a substantial impact on lowering WNV-related morbidity and mortality.

Evidence of Marine Microplastics in Commercially Harvested Seafood.

Microplastic pollution is a global issue that has a detrimental impact on food safety. In marine environments, microplastics are a threat to marine organisms, as they are often the same size range as prey and are mistaken as food. Consumption of microplastics has led to the damage of digestive organs and a reduction in growth and reproductive output. In this study, microplastic pollution was assessed across three commercially available shrimp species that were obtained from the supermarkets of Singapore. A total of 93 individuals were studied from the Pacific white leg shrimp, Litopenaeus vannamei, the Argentine red shrimp Pleoticus muelleri and the Indian white shrimp Fenneropenaeus indicus. Microplastic fibers, fragments, film and spheres were identified from the digestive tract of these organisms. Microplastic abundance ranged from 13.4 to 7050 items. F. indicus exhibited the highest number of microplastics. Microplastic film was the most abundant in L. vannamei individuals (93-97%) and spheres were the most abundant in P. muelleri (70%) and F. indicus (61%) individuals. This study demonstrates that microplastic contamination is evident in commonly consumed shrimp and highlights the role of shrimp in the trophic transfer and accumulation of microplastics in seafood. The consumption of microplastic-containing seafood is a route of exposure to humans and has implications on human health and food security. Capsule: Microplastics were examined in three shrimp species from the supermarkets of Singapore. Microplastics ranged from 13.4 to 7050 items of shrimp.

Assessment of Immunoglobulin M Enzyme-Linked Immunosorbent Assay Ratios to Identify West Nile Virus and St. Louis Encephalitis Virus Infections During Concurrent Outbreaks of West Nile Virus and St. Louis Encephalitis Virus Diseases, Arizona 2015.

West Nile virus (WNV) and St. Louis encephalitis virus (SLEV) are closely related mosquito-borne flaviviruses that cause clinical disease ranging from febrile illness to encephalitis. The standard for serological diagnosis is immunoglobulin M (IgM) testing followed by confirmatory plaque reduction neutralization test (PRNT) to differentiate the infecting virus. However, the PRNT is time-consuming and requires manipulation of live virus. During concurrent WNV and SLEV outbreaks in Arizona in 2015, we assessed use of a diagnostic algorithm to simplify testing. It incorporated WNV and SLEV ratios based on positive-to-negative (P/N) values derived from the IgM antibody-capture enzyme-linked immunosorbent assay. We compared each sample's ratio-based result with the confirmed WNV or SLEV sample result indicated by PRNT or PCR testing. We analyzed data from 70 patients with 77 serum and cerebrospinal fluid samples, including 53 patients with confirmed WNV infection and 17 patients with confirmed SLEV infection. Both WNV and SLEV ratios had specificity ≥95%, indicating a high likelihood that each ratio was correctly identifying the infecting virus. The SLEV ratio sensitivity of 30% was much lower than the WNV ratio sensitivity of 91%, likely because of higher cross-reactivity of SLEV antibodies and generation of lower P/N values. The standard for serological diagnosis of WNV and SLEV infections remains IgM testing followed by PRNT. However, these results suggest the ratios could potentially be used as part of a diagnostic algorithm in outbreaks to substantially reduce the need for PRNTs.

Reverse Transcription-Polymerase Chain Reaction Testing on Filter Paper-Dried Serum for Laboratory-Based Dengue Surveillance-American Samoa, 2018.

Laboratory-based surveillance for arboviral diseases is challenging in resource-limited settings. We evaluated the use of filter paper-dried sera for detection of dengue virus (DENV) RNA during an outbreak in American Samoa. Matched liquid and filter paper-dried sera were collected from patients with suspected dengue and shipped to a reference laboratory for diagnostic testing. RNA was extracted from each sample and tested for DENV RNA by real-time reverse transcription-polymerase chain reaction (RT-PCR). Of 18 RT-PCR-positive liquid specimens, 14 matched filter paper-dried specimens were positive for a sensitivity of 78% (95% CI, 55-91%). Of 82 RT-PCR-negative liquid specimens, all filter paper-dried specimens were negative for a specificity of 100% (95% CI, 96-100%). Shipping of filter paper-dried specimens was similarly timely but less expensive than shipping liquid sera. Using filter paper-dried serum or blood can be a cost-effective and sustainable approach to surveillance of dengue and other arboviral diseases in resource-limited settings.

Global phylogeography of toxic cyanobacteria Moorea producens reveals distinct genetic partitioning influenced by Proterozoic glacial cycles.

Lyngbya majuscula is a marine filamentous cyanobacteria belonging to the family Oscillatoriaceae. Recent phylogenetic analyses of L. majuscula have reclassified a subset of this species into various genera such as Moorea, Okeania and Dapis. From the genus Moorea, Moorea producens is a toxic invasive cyanobacterium that produces bioactive secondary metabolites that can cause severe inflammation and blistering. Despite the global distribution of M. producens, little information is available on their origin, patterns of dispersal and population structure. In this study, the spatial population structure of M. producens was investigated using near-complete 16S rRNA sequences. Analysis of the global population of M. producens by Isolation by Distance and STRUCTURE revealed two significantly distinct cosmopolitan populations that were separated by a genetic break. Lineage-specific divergence estimates of 147 cyanobacterial taxa, based on a relaxed molecular clock indicated the first global emergence of M. producens during the Mesoarchean and a subsequent global recolonization during the Mesoproterozoic period. We conclude that the genetic discontinuity between both cosmopolitan populations is attributed to refugia associated with Proterozoic glacial cycles.

Profiles of bacterial assemblages from microplastics of tropical coastal environments.

Plastic waste is a global issue of an increasing concern in aquatic ecosystems. Microplastics form a large proportion of plastic pollution in marine environments. Although microplastics are prevalent, their distribution along the coasts of tropical regions is not well studied. Microplastic pieces (1-5 mm) were collected from two distinct regions along the coastlines of Singapore, from the northern coast in the Johor Strait and the southern coast in the Singapore Strait. Microplastics were present in concentrations ranging from 9.20-59.9 particles per kg of dry sand sediment. The majority of microplastics identified were foam particles (55%) and fragments (35%). Microplastics were significantly more abundant on heavily populated beaches compared to pristine beaches. High throughput sequencing was used to profile the communities of bacteria on the surfaces of microplastic particles. The structure of the microbial communities was primarily characterised by Proteobacteria and Bacteroidetes and were distinct across sites. Hydrocarbon-degrading genera such as Erythrobacter were dominant in areas with heavy shipping and pollution. Potential pathogenic genera such as Vibrio and Pseudomonas were also identified. This study highlights the diverse bacterial assemblages present on marine microplastic surfaces and the importance of understanding the bacterial plastisphere.

West Nile Virus and Other Nationally Notifiable Arboviral Diseases - United States, 2017.

Arthropodborne viruses (arboviruses) are transmitted to humans primarily through the bites of infected mosquitoes or ticks. West Nile virus (WNV) is the leading cause of domestically acquired arboviral disease in the continental United States (1). Other arboviruses, including Jamestown Canyon, La Crosse, Powassan, St. Louis encephalitis, and eastern equine encephalitis viruses, cause sporadic cases of disease and occasional outbreaks. This report summarizes surveillance data reported to CDC from U.S. states in 2017 for nationally notifiable arboviruses. It excludes dengue, chikungunya, and Zika viruses because, in the continental United States, these viruses are acquired primarily through travel. In 2017, 48 states and the District of Columbia (DC) reported 2,291 cases of domestic arboviral disease, including 2,097 (92%) WNV disease cases. Among the WNV disease cases, 1,425 (68%) were classified as neuroinvasive disease (e.g., meningitis, encephalitis, or acute flaccid paralysis), for a national rate of 0.44 cases per 100,000 population. More Jamestown Canyon and Powassan virus disease cases were reported in 2017 than in any previous year. Because arboviral diseases continue to cause serious illness, maintaining surveillance is important to direct and promote prevention activities.

St. Louis Encephalitis Virus Disease in the United States, 2003-2017.

St. Louis encephalitis virus (SLEV), an arthropod-borne flavivirus, can cause disease presentations ranging from mild febrile illness through severe encephalitis. We reviewed U.S. national SLEV surveillance data for 2003 through 2017, including human disease cases and nonhuman infections. Over the 15-year period, 198 counties from 33 states and the District of Columbia reported SLEV activity; 94 (47%) of those counties reported SLEV activity only in nonhuman species. A total of 193 human cases of SLEV disease were reported, including 148 cases of neuroinvasive disease. A median of 10 cases were reported per year. The national average annual incidence of reported neuroinvasive disease cases was 0.03 per million. States with the highest average annual incidence of reported neuroinvasive disease cases were Arkansas, Arizona, and Mississippi. No large outbreaks occurred during the reporting period. The most commonly reported clinical syndromes were encephalitis (N = 116, 60%), febrile illness (N = 35, 18%), and meningitis (N = 25, 13%). Median age of cases was 57 years (range 2-89 years). The case fatality rate was 6% (11/193) and all deaths were among patients aged > 45 years with neuroinvasive disease. Nonhuman surveillance data indicated wider SLEV activity in California, Nevada, and Florida than the human data alone suggested. Prevention depends on community efforts to reduce mosquito populations and personal protective measures to decrease exposure to mosquitoes.