Public health investigation and response to a hepatitis A outbreak from imported scallops consumed raw-Hawaii, 2016.

During the summer of 2016, the Hawaii Department of Health responded to the second-largest domestic foodborne hepatitis A virus (HAV) outbreak in the post-vaccine era. The epidemiological investigation included case finding and investigation, sequencing of RNA positive clinical specimens, product trace-back and virologic testing and sequencing of HAV RNA from the product. Additionally, an online survey open to all Hawaii residents was conducted to estimate baseline commercial food consumption. We identified 292 confirmed HAV cases, of whom 11 (4%) were possible secondary cases. Seventy-four (25%) were hospitalised and there were two deaths. Among all cases, 94% reported eating at Oahu or Kauai Island branches of Restaurant Chain A, with 86% of those cases reporting raw scallop consumption. In contrast, a food consumption survey conducted during the outbreak indicated 25% of Oahu residents patronised Restaurant Chain A in the 7 weeks before the survey. Product trace-back revealed a single distributor that supplied scallops imported from the Philippines to Restaurant Chain A. Recovery, amplification and sequence comparison of HAV recovered from scallops revealed viral sequences matching those from case-patients. Removal of product from implicated restaurants and vaccination of those potentially exposed led to the cessation of the outbreak. This outbreak further highlights the need for improved imported food safety.

The impact of the COVID-19 pandemic on health service use in sub-Saharan Africa.

SETTING: Six hospitals in four sub-Saharan African countries. OBJECTIVE: To examine the indirect effects of COVID-19 on health service utilisation and to explore the risk of bias in studies on prediction models. DESIGN: Monthly data were analysed using interrupted time-series modelling. We used linear mixed-effect models for the analysis of antenatal care visits, institutional deliveries, vaccinations, outpatient visits and hospital admissions, and generalised linear mixed-effect models for hospital mortality. RESULTS: During 2018-2020, the six hospitals recorded a total of 57,075 antenatal care visits, 38,706 institutional deliveries, 312,961 vaccinations, 605,925 out-patient visits and 143,915 hospital admissions. The COVID-19 period was associated with decreases in vacci-nations (- 575 vaccinations, P < 0.0001), outpatient visits (- 700 visits, P < 0.0001) and hospital admission (- 102 admission, P = 0.001); however, no statistically significant effects were found for antenatal care visits (P = 0.71) or institutional deliveries (P = 0.14). Mortality rate increased by 2% per month in the pre-COVID-19 period; however, a decreasing trend (by 2% per month) was observed during the COVID-19 period (P = 0.004). Subgroup and sensitivity analyses broadly confirmed the main findings with only minor inconsistencies. A reduction in outpatient visits was also observed in hospitals from countries with a higher Stringency Index and in urban hospitals. CONCLUSIONS: The pandemic resulted in a reduction in health service utilisation. The decreases were less than anticipated from modelling studies.

CONTEXTE: Six hôpitaux de quatre pays d'Afrique subsaharienne. OBJECTIF: Examiner les effets indirects de la COVID-19 sur l'utilisation des services de santé et analyser le risque de biais dans les études utilisant des modèles de prédiction. MÉTHODES: Des données mensuelles ont été analysées en utilisant une modélisation de séries chronologiques interrompues. L'analyse principale a mis en place des modèles linéaires à effets mixtes (pour les consultations anténatales, les accouchements en institutions, les vaccinations, les consultations ambulatoires et les admissions à l'hôpital) et des modèles linéaires généralisés à effets mixtes (pour la mortalité hospitalière). RÉSULTATS: En 2018­2020, les six hôpitaux ont enregistré un total de 57 075 consultations anténatales, 38 706 accouchements en institutions, 312 961 vaccinations, 605 925 consultations ambulatoires et 143 915 admissions hospitalières. La période de la COVID-19 a été associée à une baisse des vaccinations (− 575 vaccinations, P<0,0001), des consultations ambulatoires (− 700 consultations, P < 0,0001) et des admissions hospitalières (− 102 admissions, P = 0,001). Cependant, aucun effet statistiquement significatif n'a été observé pour les consultations anténatales (P = 0,71) ou les accouchements en institutions (P = 0,14). Le taux de mortalité augmentait de 2% par mois avant la période de la COVID-19, mais nous avons observé une tendance à la baisse (de 2% par mois) pendant la période de la COVID-19 (P = 0,004). Les analyses des sous-groupes et de sensibilité ont globalement confirmé les résultats principaux ; seules des incohérences mineures ont été observées. Une diminution des consultations ambulatoires a également été observée dans les hôpitaux des pays dont l'Indice de sévérité des mesures publiques était plus élevé, ainsi que dans les hôpitaux urbains. CONCLUSIONS: La pandémie a été associée à une utilisation réduite des services de santé. Ces diminutions étaient moindres que celles anticipées par les études de modélisation.

An outbreak of norovirus gastroenteritis associated with wedding cakes.

We sought to determine the source of a norovirus outbreak among attendees of 46 weddings taking place during a single weekend. Norovirus-compatible illness was experienced by 332 (39%) of wedding guests surveyed; the outbreak affected up to 2700 persons. Illness was associated with eating wedding cake provided by a bakery common to the weddings (adjusted RR 4.5, P<0.001). A cake requiring direct hand contact during its preparation accounted for the majority of illness. At least two bakery employees experienced norovirus-compatible illness during the week preceding the weddings. Identical sequence types of norovirus were detected in stool specimens submitted by two wedding guests, a wedding hall employee, and one of the ill bakery employees. It is likely that one or more food workers at the bakery contaminated the wedding cakes through direct and indirect contact. These findings reinforce the necessity of proper food-handling practices and of policies that discourage food handlers from working while ill.