Marked increase in cryptosporidiosis cases, Spain, 2023.

BackgroundBy mid-September 2023, several event notifications related to cryptosporidiosis had been identified from different regions in Spain. Therefore, a request for urgent notification of cryptosporidiosis cases to the National Surveillance Network was launched.AimWe aimed at assessing the extent of the increase in cases, the epidemiological characteristics and the transmission modes and compared to previous years.MethodsWe analysed data on case notifications, outbreak reports and genotypes focusing on June-October 2023 and compared the results to 2016-2022.ResultsIn 2023, 4,061 cryptosporidiosis cases were notified in Spain, which is an increase compared to 2016-2022. The cumulative incidence was 8.3 cases per 100,000 inhabitants in 2023, sixfold higher than the median of 1.4 cases per 100,000 inhabitants 2016-2022. Almost 80% of the cases were notified between June and October. The largest outbreaks were related to contaminated drinking water or swimming pools. Cryptosporidium hominis was the most common species in the characterised samples (115/122), and the C. hominis IfA12G1R5 subtype, previously unusual in Spain, was detected from 76 (62.3%) of the 122 characterised samples.ConclusionsA substantial increase in cryptosporidiosis cases was observed in 2023. Strengthening surveillance of Cryptosporidium is essential for prevention of cases, to better understand trends and subtypes circulating and the impact of adverse meteorological events.

Urinary tract infection caused by Edwardsiella tarda: a report of the first case in Iran.

BCKGROUND: Edwardsiella tarda, an Enterobacteriaceae family member, is prevalent in different aquatic settings and rarely infects humans. As a result of eating raw or undercooked seafood, humans become infected through their intestinal tracts. Extraintestinal infections have been reported infrequently, mostly in immunocompromised and chronically ill patients. CASE PRESENTATION: Our report describes a case of urinary tract infection caused by E. tarda in a 4-year-old female patient with a history of urinary tract infection and a complaint of fever, dysuria, and frequency. E. tarda was identified as the pathogen isolated from the urine culture. The patient's symptoms were alleviated after receiving ceftriaxone and then nitrofurantoin. CONCLUSION: This case demonstrates that even in immunocompetent patients, E. tarda can infect extraintestinal organs, including urinary tract. Our patient represents the first case of E. tarda infection in Iran and due to the fact that this pathogen is transmitted by aquatic animals, there is a possibility of infecting more aquatic animals and humans in Iran; therefore, the necessary precautions should be taken.

Investigating seasonal patterns in enteric infections: a systematic review of time series methods.

Foodborne and waterborne gastrointestinal infections and their associated outbreaks are preventable, yet still result in significant morbidity, mortality and revenue loss. Many enteric infections demonstrate seasonality, or annual systematic periodic fluctuations in incidence, associated with climatic and environmental factors. Public health professionals use statistical methods and time series models to describe, compare, explain and predict seasonal patterns. However, descriptions and estimates of seasonal features, such as peak timing, depend on how researchers define seasonality for research purposes and how they apply time series methods. In this review, we outline the advantages and limitations of common methods for estimating seasonal peak timing. We provide recommendations improving reporting requirements for disease surveillance systems. Greater attention to how seasonality is defined, modelled, interpreted and reported is necessary to promote reproducible research and strengthen proactive and targeted public health policies, intervention strategies and preparedness plans to dampen the intensity and impacts of seasonal illnesses.

An outbreak of cryptosporidiosis associated with drinking water in north-eastern Italy, August 2019: microbiological and environmental investigations.

Cryptosporidium is a leading global cause of waterborne disease, with many reported outbreaks related to main water supplies. In August 2019, an outbreak of cryptosporidiosis involving 80 cases occurred among 114 vacationers in a small municipality located in the Tuscan-Emilian Apennines, north-eastern Italy. After excluding a potential food-borne outbreak, the epidemiological investigation focussed on the hypothesis of a waterborne outbreak. This was confirmed by the finding of Cryptosporidium oocysts in stools of the cases and in water samples from the municipal water network. Molecular characterisation revealed the zoonotic species Cryptosporidium parvum as the causative agent. A single subtype (IIdA25G1) was found among all cases, and in one of two positive water samples. The municipality's water supply used spring water that only received a disinfection treatment insufficient to inactivate the parasite. Possible entry means into the water mains were found through further environmental investigations. As these types of water supplies are particularly vulnerable to various environmental factors, a control system based on the risk assessment of each phase of the water supply chain is required to guarantee water safety. Effective methods for detection of protozoan pathogens, which are generally excluded from routine water supply analysis, should be applied.

Planning for the health impacts of climate change: Flooding, private groundwater contamination and waterborne infection - A cross-sectional study of risk perception, experience and behaviours in the Republic of Ireland.

The frequency and severity of flooding events will increase over the coming decades due to global climate change. While close attention has typically been paid to infrastructural and environmental outcomes of flood events, the potential adverse human health consequences associated with post-event consumption from private groundwater sources have received minimal attention, leading to a poor understanding of private well users' preparedness and the drivers of positive behavioural adoption. The current study sought to quantify the capacity of private well users to cope with flood-triggered contamination risks and identify the social psychological determinants of proactive attitudes in the Republic of Ireland, using a cross-sectional questionnaire incorporating two distinct models of health behaviour, the Health Belief Model and Risk-Attitude-Norms-Ability-Self Regulation model. Adoption of healthy behaviours prior to flooding was evaluated with respect to respondents' risk exposure, risk experience and risk perception, in addition to systematic supply stewardship under normal conditions. Associations between adoption of protective behaviours and perception, experience and socio-demographic factors were evaluated through multinomial and multiple logistic regressions, while a multi-model inferential approach was employed with the predictors of health behaviour models. Findings suggest that floods are not considered likely to occur, nor were respondents worried about their occurrence, with 72.5% of respondents who reported previous flooding experience failing to adopt protective actions. Prior experience of well water contamination increased adoption of proactive attitudes when flooding occurred (+47%), with a failure to adopt healthy behaviours higher among rural non-agricultural residents (136%). Low levels of preparedness to deal with flood-related contamination risks are a side-effect of the general lack of appropriate well stewardship under normal conditions; just 10.1% of respondents adopted both water treatment and frequent testing, in concurrence with limited risk perception and poor awareness of the nexus between risk factors (e.g. floods, contamination sources) and groundwater quality. Perceived risk, personal norms and social norms were the best predictors of protective behaviour adoption and should be considered when developing future awareness campaigns.

Drinking Water Consumption Patterns among Private Well Users in Ontario: Implications for Exposure Assessment of Waterborne Infection.

Understanding the water consumption patterns within a specific population informs development of increasingly accurate, spatially specific exposure and/or risk assessment of waterborne infection. The current study examined the consumption patterns of private well users in Ontario while considering potentially influential underlying sociodemographics, household characteristics, and experiential factors. A province-wide online survey was circulated between May and August 2018 (n = 1,162). Overall, 81.5% of respondents reported daily well water consumption (i.e., tap water). Results indicate a mean daily well water consumption rate of 1,132 mL/day (SD = 649 mL/day) among well water consumers. Gender was significantly associated with well water consumption, with higher consumption rates found among female respondents. The experience of acute gastrointestinal illness (AGI) symptoms or diagnosis in the past 12 months did not impact the volume of water consumed, suggesting that experiencing previous AGI does not decrease consumption volumes, and therefore exposure over time. Significantly higher rates of well water consumption were found among respondents who reported previous testing or ongoing water treatment. Approximately 45.5% of survey respondents who stated that they do not consume well water selected bottled water as their primary household drinking water supply. Bottled water consumption was also not associated with previous AGI experiences. Findings will inform future quantitative microbial risk assessments associated with private well water use by providing spatially and demographically specific estimates of well water consumption.

A nosocomial cluster of Roseomonas mucosa bacteremia possibly linked to contaminated hospital environment.

Roseomonas, a genus of pink-pigmented glucose non-fermentative bacteria, has been associated with various primary and hospital-acquired human infections; however, to our knowledge, its nosocomial transmission has never been reported. Clinical and epidemiological investigations were carried out after two cases of R. mucosa bacteremia occurred in our hospital in 2018. Environmental samples were taken of environmental surfaces prone to water contamination in the wards and cultured. The two clinical isolates and all environmental isolates that showed growth of pink colonies were identified using matrix-assisted laser desorption/ionization time of flight mass spectrometry and 16S rRNA gene sequencing. Pulse-field gel electrophoresis (PFGE) was performed and fingerprinting software was used to analyze the DNA restriction patterns and determine their similarity. Two patients who developed R. mucosa bacteremia had received care from the same treatment team. Of 126 environmental samples, five showed growth of R. mucosa. Using 80% similarity as the cut-off, PFGE analysis revealed that the isolates from the two patients' blood cultures and three environmental isolates belonged to the same clone. The hospital water environment was contaminated with the same clone of R. mucosa that caused bacteremia in the two patients, suggesting nosocomial transmission linked to contaminated environment. Increased vigilance is needed to monitor the emergence of Roseomonas in healthcare settings.

Edwardsiella tarda bacteremia. A rare but fatal water- and foodborne infection: Review of the literature and clinical cases from a single centre.

BACKGROUND: Edwardsiella tarda bacteremia (ETB) can be a fatal disease in humans. OBJECTIVES: To determine the significant risk factors associated with death caused by ETB, and to examine the geographical, seasonal, environmental and dietary factors of the disease. METHODS: A retrospective, observational, case control study was performed. The PubMed MEDLINE and Japanese Medical Abstract Society (www.jamas.or.jp) databases were searched for ETB case reports and meeting abstracts. In additon, retrospective chart reviews of patients with ETB at the Tokyo Women's Medical University Hospital (Tokyo, Japan) were conducted to evaluate the risk factors associated with death using multivariate analyses. RESULTS: The literature search yielded 46 publications, comprising 72 cases from the English (n=30), French (n=1), Spanish (n=1) and Japanese (n=14) literature. Five cases at the Tokyo Women's Medical University Hospital were also included. Of the included 77 cases, the mean age was 61 years and 39% of patients were female; 77.2% of the cases occurred between June and November, and 45.5% were reported in Japan. Dietary factors (raw fish/meat exposure) were reported for 10.4% of patients and 12.9% reported environmental (ie, brackish water) exposure. The overall mortality rate was 44.6%; however, this rate increased to 61.1% for ETB patients with soft tissue infections. Liver cirrhosis was determined to be an independent risk factor associated with death (OR 12.0 [95% CI 2.46 to 58.6]; P=0.00213) using multivariate analyses. DISCUSSION: To our knowledge, the present analysis was the first and largest multi-language review of ETB. Clinical characteristics of ETB resemble those of Aeromonas, typhoid fever and Vibrio vulnificus infections, in addition to sharing similar risk factors. CONCLUSION: ETB should be categorized as a severe food- and waterborne infection, which results in high mortality for patients with liver cirrhosis.

HISTORIQUE: Chez les humains, la bactériémie à Edwardsiella tarda (BET) peut être mortelle. OBJECTIFS: Déterminer les facteurs de risque importants liés aux décès causés par la BET et examiner les facteurs géographiques, saisonniers, environnementaux et diététiques de la maladie. MÉTHODOLOGIE: Les chercheurs ont effectué une étude castémoins d'observation rétrospective. Ils ont fait des recherches dans les bases de données MEDLINE de PubMed et de la Société japonaise de communications médicales (www.jamas.or.jp) pour trouver les comptes rendus de BET et les communications de cas lors de colloques et congrès. Ils ont également procédé à une analyse rétrospective des dossiers de patients atteints d'une BET à l'hôpital universitaire de Tokyo pour femmes, au Japon, pour évaluer les facteurs de risque liés aux décès à l'aide d'analyses multivariées. RÉSULTATS: L'analyse bibliographique a permis d'extraire 46 publications, soit 72 cas tirés de publications anglophones (n=30), francophones (n=1), espagnoles (n=1) et japonaises (n=14). Cinq cas de l'hôpital universitaire de Tokyo pour femmes étaient également inclus. Les 77 cas avaient un âge moyen de 61 ans, et 39 % étaient de sexe féminin, 77,2 % s'étaient déclarés entre les mois de juin et novembre et 45,5 % provenaient du Japon. Chez 10,4 % des patients, des facteurs diététiques (poisson cru, exposition à la viande) étaient en cause, tandis que 12,9 % présentaient une exposition environnementale (eau saumâtre). Le taux de mortalité globale s'élevait à 44,6 %, mais passait à 61,1 % chez les patients atteints d'une BET et d'infections des tissus mous. D'après les analyses multivariées, la cirrhose était un facteur de risque indépendant de décès (RC 12,0 [95 % IC 2,46 à 58,6]; P=0,00213). EXPOSÉ: En autant que nous le sachions, il s'agissait de la plus vaste analyse sur la BET et de la première à être multilingue. Les caractéris-tiques cliniques de la BET ressemblent à celles des infections à Aeromonas et à Vibrio vulnificus et de la typhoïde en plus de partager des facteurs de risque similaires. CONCLUSION: La BET devrait être classée parmi les graves infections d'origine hydrique et alimentaire qui entraînent des taux de mortalité élevés chez les patients atteints d'une cirrhose.

Antibiotic resistance pattern of waterborne causative agents of healthcare-associated infections: A call for biofilm control in hospital water systems.

BACKGROUND: In recent years, the global spread of antimicrobial resistance has become a concerning issue, often referred to as a "silent pandemic". Healthcare-associated infections (HAIs) caused by antibiotic-resistant bacteria (ARB) are a recurring problem, with some originating from waterborne route. The study aimed to investigate the presence of clinically relevant opportunistic bacteria and antibiotic resistance genes (ARGs) in hospital water distribution systems (WDSs). METHODS: Water and biofilm samples (n = 192) were collected from nine hospitals in Isfahan and Kashan, located in central Iran, between May 2022 and June 2023. The samples were analyzed to determine the presence and quantities of opportunistic bacteria and ARGs using cultural and molecular methods. RESULTS: Staphylococcus spp. were highly detected in WDS samples (90 isolates), with 33 % of them harboring mecA gene. However, the occurrences of E. coli (1 isolate), Acinetobacter baumannii (3 isolates), and Pseudomonas aeruginosa (14 isolates) were low. Moreover, several Gram-negative bacteria containing ARGs were identified in the samples, mainly belonging to Stenotrophomonas, Sphingomonas and Brevundimonas genera. Various ARGs, as well as intI1, were found in hospital WDSs (ranging from 14 % to 60 %), with higher occurrences in the biofilm samples. CONCLUSION: Our results underscore the importance of biofilms in water taps as hotspots for the dissemination of opportunistic bacteria and ARG within hospital environments. The identification of multiple opportunistic bacteria and ARGs raises concerns about the potential exposure and acquisition of HAIs, emphasizing the need for proactive measures, particularly in controlling biofilms, to mitigate infection risks in healthcare settings.

Global and regional final point-of-drinking water prevalence of Vibrio pathogens: a systematic analysis with socioeconomic, global health security, and WASH indices-guided meta-regressions.

The final point-of-drinking water (FPODW) exposure to Vibrio and waterborne pathogens remains a misaim surveillance target. Therefore, the current study purposed to estimate the global and regional prevalence of Vibrio pathogens in FPODW. Vibrio-FPODW data derived from integrated databases per PRISMA protocol were fitted to a random-intercept-logistic mixed-effects and meta-regression models. The global FPODW Vibrio prevalence was 5.13% (95%CI: 2.24-11.30) with 7.76% (6.84-8.78) cross-validated value. Vibrio prevalence in different FPODW varied with the highest in unclassified (13.98%, 3.98-38.95), household stored (6.42%, 1.16-28.69), municipal (4.39%, 1.54-11.90), and bottled (1.06%, 0.00-98.57) FPODW. Regionally, FPODW Vibrio prevalence varied significantly with highest in Africa (6.31%, 0.49-47.88), then Asia (4.83%, 2.01-11.18). Similarly, it varied significantly among income classification with the highest from low-income (8.77%, 0.91-50.05), then lower-middle-income (6.16%, 2.75-13.20), upper-middle-income (0.23%, 0.00-82.04), and 0.94% (0.19-2.72) in high-income economies. Among the WHO region, it varied significantly from 1.41% (0.17-10.45) in Eastern Mediterranean, 6.31% (0.49-47.88) in Africa to 8.86% (3.85-19.06) in South-East Asia and declining among SDI-quintiles from 11.64% (3.29-33.83) in Low-SDI, 10.59% (4.58-22.61) in High-middle-SDI to 0.26% (0.01-9.09) in Middle-SDI. FPODW Vibrio prevalence was 7.31% (2.94-17.03) in the low-GHSIG, followed by 4.55% (0.00-100.00) in the upper-GHSIG, and 2.21% (0.31-14.24) in middle-GHSIG; rural (4.18%, 0.06-76.17) and urban (5.28%, 2.35-11.44) settings. Also, sample size, SDI, SDI-quintiles, and nation significantly explained 14.12%, 10.91%, 30.35%, and 87.65% variance in FPODW Vibrio prevalence, respectively as a univariate influence. Additionally, 11.90% variance in FPODW Vibrio prevalence explained mortality rate attributed to unsafe WASH services. In conclusion, the study revealed a substantial high FPODW prevalence of Vibrio calling for initiative-taking and intentional surveillances of waterborne pathogens at the neglected stage across nations in order to achieve sustainably the SDG 3.

Outbreak Investigation of Typhoid Fever in the District of Gabes, South of Tunisia.

Typhoid fever is a significant public health concern in many parts of the world, particularly in developing countries with poor sanitation and hygiene conditions. In July 2016, an outbreak of typhoid fever occurred in Ghannouche, located in the south of Tunisia. This paper reports the results of a field investigation undertaken to identify possible transmission pathways and risk factors in order to propose control and preventive measures. A retrospective cohort study including a passive and active case finding, as well as an environmental and bacteriological investigation was conducted from July to September 2016. A case was defined as a person residing or having stayed in Ghannouche and having presented from the beginning of June clinical signs suggestive of typhoid fever, with, for a confirmed case, laboratory isolation of S.Tyhi, and for a probable case, an epidemiological link with a confirmed case. Attack rates were determined, and risk ratios were estimated with respect to exposures. Unadjusted and adjusted odds ratios were estimated using binary logistic regression. Among the 628 subjects investigated, 102 cases of typhoid fever were identified (74 confirmed and 28 probable) with an overall attack rate of 16.24%. Over 56% of cases were male and those under 10 years old were most affected (38.2%% of cases) with a median age of 12 years (interquartile range 5 to 25 years). The main clinical signs were fever (95%) and diarrhea (57%). Young age (adjusted OR = 0.95 and 95% CI = 0.93-0.97), low level of education (adjusted OR = 4.76 and 95% CI = 1.34-16.81), and the habitat type Arab or rudimentary house (adjusted OR = 4.93 and 95% CI = 2.61-8.27) were the socio-demographic factors independently associated with typhoid fever. Typhoid fever was found to be associated with drinking softened water (adjusted OR = 2.64 and 95% CI = 1.16-4.82), eating raw fruit and vegetables from family gardens (adjusted OR = 6.13 and 95% CI = 3.66-11.06), and using uncontrolled waste disposal (adjusted OR = 3.52 and 95% CI = 2.03-6.94). A total of 110 drinking water samples were analyzed; out of the 38 samples of softened water, 12 were non-compliant and 5 were positive for Salmonella. The screening activity identified two asymptomatic carriers, one of whom was a softened water seller. We concluded that drinking softened water from informal or unauthorized sale units, consuming fruit and vegetables from family gardens, uncontrolled dumping of household waste, and poor socio-economic conditions increase the risk of typhoid fever in this region. Many recommendations were implemented to stop this outbreak and to prevent further episodes.

Clustered Cases of Waterborne Hepatitis E Virus Infection, France.

The identification of seven cases of hepatitis E virus infection in a French rural hamlet in April 2015 led to investigations confirming the clustering and identifying the source of the infection. Laboratories and general practitioners in the area actively searched for other cases based on RT-PCR and serological tests. The environment, including water sources, was also checked for HEV RNA. Phylogenetic analyses were performed to compare HEV sequences. No other cases were found. Six of the seven patients lived in the same hamlet, and the seventh used to visit his family who lived there. All HEV strains were very similar and belonged to the HEV3f subgenotype, confirming the clustering of these cases. All the patients drank water from the public network. A break in the water supply to the hamlet was identified at the time the infection probably occurred; HEV RNA was also detected in a private water source that was connected to the public water network. The water flowing from the taps was quite turbid during the break. The private water supply containing HEV RNA was the likely source of the contamination. Private water supplies not disconnected from the public network are still frequent in rural areas, where they may contribute to public water pollution.

Classification of sub-populations for quantitative risk assessment based on awareness and perception: A cross-sectional population study of private well users in Ontario.

Private well users in Ontario are responsible for protective actions, including source maintenance, treatment, and submitting samples for laboratory testing. However, low participation rates are reported, thus constituting a public health concern, as risk mitigation behaviours can directly reduce exposure to waterborne pathogens. The current study examined the combined effects of socio-demographic profile, experience(s), and "risk domains" (i.e., awareness, attitudes, risk perceptions and beliefs) on behaviours, and subsequently classified private well users in Ontario based on cognitive factors. A province-wide online survey (n = 1228) was employed to quantify Ontario well owners' awareness, perceptions, and behaviours in relation to their personal groundwater supply and local contamination sources. A scoring protocol for four risk domains was developed. Two-step cluster analysis was used to classify respondents based on individual risk domain scores. Logistic regression was employed to identify key variables associated with cluster membership (i.e., profile analysis). Overall, 1140 survey respondents were included for analyses. Three distinct clusters were identified based on two risk domains; groundwater awareness and source risk perception. Profile analyses indicate "low awareness and source risk perception" (Low A/SRP) members were more likely male, while "low awareness and moderate source risk perception" (Low A/Mod SRP) members were more likely female and bottled water users. Well users characterised as "high awareness and source risk perception" (High A/SRP) were more likely to report higher educational attainment and previous well water testing. Findings illustrate that socio-cognitive clusters and their components (i.e., demographics, awareness, attitudes, perceptions, experiences, and protective actions) are distinct based on the likelihood, frequency, and magnitude of waterborne pathogen exposures (i.e., risk-based). Risk-based clustering, when incorporated into quantitative microbial risk assessment, enables the development of effective risk management and communication initiatives that are demographically focused and tailored to specific sub-groups.

Investigation and control of an outbreak due to a contaminated hospital water system, identified following a rare case of Cupriavidus pauculus bacteraemia.

BACKGROUND: Cupriavidus pauculus is rare cause of clinical infection. We describe an outbreak of C. pauculus and other Gram-negative bacteraemias in a paediatric haemato-oncology unit secondary to a contaminated water supply and drainage system. AIM: To describe the investigation and control measures implemented for a waterborne infection outbreak in a new build hospital. METHODS: Extensive water testing from various points within the water system was undertaken. Taps, showerheads and components including flow straighteners underwent microbiological analysis. Drains were also swabbed. Surveillance for Gram-negative infections was established on the unit. FINDINGS: Water testing revealed widespread contamination of the water and drainage system. Outlets were also heavily contaminated, including flow straighteners. Drains were found to have underlying structural abnormalities. Water testing enabled us to detect high-risk components within the water system such as the expansion vessels and outlets and the results assisted with hypotheses generation. Review of commissioning data and risk assessments revealed extensive risks present within the water system prior to and after hospital opening. CONCLUSION: Careful design, adequate control measures and maintenance are essential for hospital water systems in order to prevent infections due to waterborne organisms. We discuss what can be learned from this incident with a view to future prevention.

Current state of infection and prevalence of giardiasis in Malaysia: a review of 20 years of research.

BACKGROUND: Giardiasis is a neglected parasitic zoonotic disease caused by Giardia duodenalis that is often overlooked despite the damage inflicted upon humans and domestic/wild animals. Lack of surveillance studies, low sensitivity of diagnostic tools, and resistance to giardiasis treatment add to the challenge in managing giardiasis, leaving a gap that continues to render giardiasis a silent threat to public health worldwide. This situation is not much different in Malaysia, where giardiasis remains a public health problem, especially in the indigenous communities. Realizing the existence of gaps in the literature and information on giardiasis in Malaysia, this review aims to revisit and update the situation of giardiasis in Malaysia based on articles published in 20 years from 2000 to 2020, providing estimates on the incidence of giardiasis in humans, animals, and the environment, which may inform efforts to prevent and control the impact of giardiasis in the country. METHODOLOGY: We searched PubMed, Science Direct, and Scopus using MeSH terms and text keywords "Giardia duodenalis OR Giardia intestinalis OR Giardia lamblia OR intestinal protozoa AND Malaysia". Information was collected from all giardiasis reports published between 2000 and 2020. RESULTS: Giardiasis in Malaysia is more prevalent among the poorest segments of the population, namely the indigenous communities and people living in densely populated areas such as slums and prisons, due to low standard of personal hygiene, unsafe water resources, and improper sanitation. While the prevalence data is hugely dependent on microscopic fecal examination in epidemiological studies of giardiasis, current studies mostly focused on species identification and genotype distribution by multilocus genotyping. Thus far, the outbreak of giardiasis has not been reported in the country, but the disease was found to be significantly associated with stunting, wasting, and malnutrition among children of the indigenous communities. Surveillance studies also discovered the simultaneous presence of Giardia in the animal-environments, including wild animals, ruminants, and treated and untreated water. The data collected here will be a useful addition to the literature body on giardiasis in Malaysia, which can be exploited in efforts to prevent and control the impact of giardiasis in the country. CONCLUSIONS: The last 10 years have shown that the overall mean rate of giardiasis in Malaysia is quite encouraging at 13.7%. While this figure appears to be declining, there has been a slight increase in the prevalence of underweight, stunting, and wasting among rural children in 2019. The fact that giardiasis is linked to long-term childhood developmental problems, indicates that addressing and providing better disease control against giardiasis should be a priority in supporting the national agenda to achieve Malaysia Global Nutrition Targets by 2025.

Transmission of seasonal outbreak of childhood enteroviral aseptic meningitis and hand-foot-mouth disease.

This study was conducted to evaluate the modes of transmission of aseptic meningitis (AM) and hand-foot-mouth disease (HFMD) using a case-control and a case-crossover design. We recruited 205 childhood AM and 116 HFMD cases and 170 non-enteroviral disease controls from three general hospitals in Gyeongju, Pohang, and Seoul between May and August in both 2002 and 2003. For the case-crossover design, we established the hazard and non-hazard periods as week one and week four before admission, respectively. In the case-control design, drinking water that had not been boiled, not using a water purifier, changes in water quality, and contact with AM patients were significantly associated with the risk of AM (odds ratio [OR]=2.8, 2.9, 4.6, and 10.9, respectively), while drinking water that had not been boiled, having a non-water closet toilet, changes in water quality, and contact with HFMD patients were associated with risk of HFMD (OR=3.3, 2.8, 6.9, and 5.0, respectively). In the case-crossover design, many life-style variables such as contact with AM or HFMD patients, visiting a hospital, changes in water quality, presence of a skin wound, eating out, and going shopping were significantly associated with the risk of AM (OR=18.0, 7.0, 8.0, 2.2, 22.3, and 3.0, respectively) and HFMD (OR=9.0, 37.0, 11.0, 12.0, 37.0, and 5.0, respectively). Our findings suggest that person-to-person contact and contaminated water could be the principal modes of transmission of AM and HFMD.

Preventing SARS-CoV-2 transmission in rehabilitation pools and therapeutic water environments.

SARS-CoV-2 is mainly transmitted by respiratory droplets and contact with contaminated surfaces. It can be retrieved in faeces but there is no evidence of faecal-oral transmission, which is the main route of contamination in recreational waters. Standard cleaning and disinfecting procedures, microbiological control and health rules aim to prevent infectious risk regardless of the micro-organisms. In the context of progressive lockdown exit and hospital activities recovery, we assessed the risk of SARS-CoV-2 transmission in rehabilitation pools and therapeutic water environments in order to provide specific recommendations to control the spread of SARS-CoV-2 while ensuring essential rehabilitation care for patients.

Endoscope reprocessing: Comparison of drying effectiveness and microbial levels with an automated drying and storage cabinet with forced filtered air and a standard storage cabinet.

BACKGROUND: Automated drying may help prevent endoscopically transmitted infections. We aimed to assess the efficacy of an automated drying and storage cabinet compared to a standard storage cabinet in achieving endoscope dryness postreprocessing and in reducing the risk of microbial growth. METHODS: Drying times of bronchoscopes, colonoscopes, and duodenoscopes using 2 drying platforms (an automated drying and storage cabinet vs a standard storage cabinet) were measured using cobalt chloride paper. Drying assessments occurred at: 30 minutes, 1 hour, 2 hours, 3 hours, and 24 hours. A simple linear regression analysis compared rates of microbial growth after inoculation with Pseudomonas aeruginosa following high-level disinfection at: 0, 3 hours, 12 hours, 24 hours, and 48 hours. RESULTS: Using the automated drying and storage cabinet, internal channels were dry at 1 hour and external surfaces at 3 hours in all endoscopes. With the standard storage cabinet, there was residual internal fluid at 24 hours, whereas external surfaces were dry at 24 hours. For bronchoscopes, colonoscopes, and duodenoscopes, the standard cabinet allowed for an average rate of colony forming unit growth of 8.1 × 106 per hour, 8.3 × 106 per hour, and 7.0 × 107 per hour, respectively; the automated cabinet resulted in colony forming unit growth at an average rate of -28.4 per hour (P = .02), -38.5 per hour (P = .01), and -200.2 per hour (P = .02), respectively. CONCLUSIONS: An automated cabinet is advantageous for rapid drying of endoscope surfaces and in reducing the risk of microbial growth postreprocessing.

Extreme Precipitation, Public Health Emergencies, and Safe Drinking Water in the USA.

PURPOSE OF REVIEW: This review examines the effectiveness of drinking water regulations to inform public health during extreme precipitation events. This paper estimates the vulnerability of specific populations to flooding in their public water system, reviews the literature linking precipitation to waterborne outbreaks, examines the role that Safe Drinking Water Act and Public Notification (PN) Rule have in public health emergencies, and reviews the effectiveness of the PN Rule during the 2017 Hurricane Maria in Puerto Rico. RECENT FINDINGS: Public water systems in large metropolitan areas have substantial portions of their customer base at risk for a waterborne outbreak during a flooding event. The PN Rule are ambiguous for who is responsible for declaring a "waterborne emergency" following a natural disaster like Hurricane Maria. Revisions to the current PN Rule that mandate public notification and water quality sampling during extreme precipitation events are necessary to ensure the public is aware of their drinking water quality following these events.

Transmission of Seasonal Outbreak of Childhood Enteroviral Aseptic Meningitis and Hand-foot-mouth Disease

This study was conducted to evaluate the modes of transmission of aseptic meningitis (AM) and hand-foot-mouth disease (HFMD) using a case-control and a case-crossover design. We recruited 205 childhood AM and 116 HFMD cases and 170 non-enteroviral disease controls from three general hospitals in Gyeongju, Pohang, and Seoul between May and August in both 2002 and 2003. For the case-crossover design, we established the hazard and non-hazard periods as week one and week four before admission, respectively. In the case-control design, drinking water that had not been boiled, not using a water purifier, changes in water quality, and contact with AM patients were significantly associated with the risk of AM (odds ratio [OR]=2.8, 2.9, 4.6, and 10.9, respectively), while drinking water that had not been boiled, having a non-water closet toilet, changes in water quality, and contact with HFMD patients were associated with risk of HFMD (OR=3.3, 2.8, 6.9, and 5.0, respectively). In the case-crossover design, many life-style variables such as contact with AM or HFMD patients, visiting a hospital, changes in water quality, presence of a skin wound, eating out, and going shopping were significantly associated with the risk of AM (OR=18.0, 7.0, 8.0, 2.2, 22.3, and 3.0, respectively) and HFMD (OR=9.0, 37.0, 11.0, 12.0, 37.0, and 5.0, respectively). Our findings suggest that person-to-person contact and contaminated water could be the principal modes of transmission of AM and HFMD.