For facilitating tuberculosis (TB) control, we used a whole-genome sequencing (WGS)-based approach to delineate transmission networks in a country with an intermediate burden of TB. A cluster was defined as Mycobacterium tuberculosis isolates with identical genotypes, and an outbreak was defined as clustered cases with epidemiological links (epi-links). To refine a cluster predefined using space oligonucleotide typing and mycobacterial interspersed repetitive unit variable tandem repeat typing, we analyzed one pansusceptible TB (C1) and three multidrug-resistant (MDR)-TB (C2-C4) clusters from different scenarios. Pansusceptible TB cluster (C1) consisting of 28 cases had ≤5 single nucleotide polymorphisms (SNPs) difference between their isolates. C1 was a definite outbreak, with cases attending the same junior high school in 2012. Three MDR-TB clusters (C2-C4) with distinct genotypes were identified, each consisting of 12-22 cases. Some of the cases had either ≤5 or ≤15 SNPs difference with clear or probable epi-links. Of note, even though WGS could effectively assist TB contact tracing, we still observed missing epi-links in some cases within the same cluster. Our results showed that thresholds of ≤5 and ≤15 SNPs difference between isolates were used to categorize definite and probable TB transmission, respectively. Furthermore, a higher SNP threshold might be required to define an MDR-TB outbreak. WGS still needs to be combined with classical epidemiological methods for improving outbreak investigations. Importantly, different SNP thresholds have to be applied to define outbreaks.
OBJECTIVE: TB is a chronic disease. Depending on host factors and TB burden, clusters of cases may continue to increase for several years. Conventional genotyping methods overestimate TB transmission, hampering precise detection of outbreaks and comprehensive surveillance. WGS can be used to obtain SNP information of M. tuberculosis to improve discriminative limitations of conventional methods and to strengthen delineation of transmission networks. It is important to define the country-specific SNP thresholds for investigation of transmission. This study demonstrated the use of thresholds of ≤5 and ≤15 SNPs difference between isolates to categorize definite and probable transmission, respectively. Different SNP thresholds should be applied while a higher cutoff was required to define an MDR-TB outbreak. The utilization of SNP thresholds proves to be crucial for guiding public health interventions, eliminating the need for unnecessary public health actions, and potentially uncovering undisclosed TB transmissions.

UNASSIGNED: Despite a recent increase in the representation of female authors in scientific literature, a significant gap persists concerning the inclusion of women in research. This necessitates the analysis of published literature from a gender perspective. This study aimed to provide gender distribution in authorship in the 100 most-cited articles on food-borne pathogen outbreaks from 1990 to 2020.
UNASSIGNED: Bibliometric analysis was conducted using the Scopus database. Two reviewers were selected to search the database. We included the 100 most-cited articles on foodborne outbreak investigations. The analysis was conducted using Statistical Package for Social Sciences (SPSS) version 26 and Microsoft Excel version 2016. The citation data, including total citations, citations per year, and representation of women as first and senior authors, was analyzed in terms of frequencies, mean, median, and interquartile range. The correlation between journal impact factor and the representation of women in high-impact factor journals was determined. A p-value of <0.05 was considered significant.
UNASSIGNED: Most of the top-cited articles were published between 2001 and 2010 (n=47). The top 3 most-cited articles were from the USA. Of the total 100 articles, women were the first and last authors in 46% and 28% of the articles, respectively, reflecting a significant gender gap. However, the proportion of females as principal investigators gradually increased from 25% (n=10/30) to 52% (n=24/47) during the period 2001-2010 and to 92% (n=12/13) during 2011-2020. The USA had the highest number of included articles (n=48), and women were principal authors in 56% (n=27) of them. The lowest representation of women was observed in Austria, Denmark, Japan, Netherlands, New Zealand, Nigeria, Portugal, and the United Kingdom.
UNASSIGNED: Women are under-represented in published literature on food-borne pathogen outbreaks. Although the representation of women as principal authors has recently increased, disparities still exist at the senior-author level, calling for women\'s advancement in academic science.
UNASSIGNED: Obwohl der Anteil von Frauen in der wissenschaftlichen Literatur in letzter Zeit zugenommen hat, besteht nach wie vor eine erhebliche Lücke bei der Einbeziehung von Frauen in die Forschung. Das macht eine Analyse der Literatur aus der Geschlechterperspektive erforderlich. Ziel dieser Studie war es, die geschlechtsspezifische Verteilung der Autorenschaft in den 100 meist zitierten Artikeln zu lebensmittelbedingten Ausbrüchen im Zeitraum 1990–2020 zu ermitteln.
UNASSIGNED: Die bibliometrische Analyse wurde mit Hilfe der Datenbank Scopus durchgeführt. Zwei Reviewer wurden mit der Suche in der Datenbank beauftragt. Es wurden die 100 am häufigsten zitierten Artikel zur Untersuchung lebensmittelbedingter Krankheitsausbrüche berücksichtigt. Die Analyse wurde mit SPSS, Version 26, und Microsoft Excel, Version 2016, durchgeführt. Die Zitationsdaten einschließlich der Gesamtzahl der Zitate, der Zitate pro Jahr und des Anteils von Frauen als Erst- und Seniorautorin, wurden in Form von Häufigkeiten, Mittelwert, Median und Interquartilsbereich analysiert. Die Korrelation zwischen dem Impact-Faktor der Zeitschrift und dem Anteil von Frauen in Zeitschriften mit hohem Impact-Faktor wurde ermittelt. Ein p-Wert von <0,05 wurde als signifikant angesehen.
UNASSIGNED: Die meisten der am häufigsten zitierten Artikel wurden im Zeitraum 2001–2010 veröffentlicht (n=47). Die 3 am häufigsten zitierten Artikel stammten aus den USA. Von den 100 Artikeln waren Frauen in 46% der Artikel Erstautorin und in 28% der Artikel Letztautorin, was ein erhebliches Geschlechtergefälle widerspiegelt. Der Anteil von Frauen als Hauptautorin stieg jedoch allmählich von 25% (n=10/30) auf 52% (n=24/47) im Zeitraum 2001–2010 und auf 92% (n=12/13) im Zeitraum 2011–2020. Da die USA die höchste Anzahl an eingeschlossenen Artikeln (n=48) aufwiesen, waren Frauen in 56% (n=27) der Artikel Hauptautorin. Der geringste Frauenanteil wurde in Österreich, Dänemark, Japan, den Niederlanden, Neuseeland, Nigeria, Portugal und UK beobachtet.
UNASSIGNED: Frauen sind in der veröffentlichten Literatur über die Untersuchung von lebensmittelbedingten Krankheitsausbrüchen unterrepräsentiert. Obwohl der Anteil von Frauen als Hauptautorin in letzter Zeit zugenommen hat, gibt es immer noch Ungleichheiten auf der Ebene der leitenden Autoren und Autorinnen, die eine Förderung von Frauen in der akademischen Wissenschaft erfordern.

Objective: In April 2022, the University of Illinois Chicago (UIC) COVID-19 Contact Tracing & Epidemiology Program identified an outbreak associated with an indoor student gala. This study\'s aims were to characterize COVID-19 transmission dynamics and measure symptom severity among cases.Participants: The study population included UIC-affiliated gala attendees. Outbreak-associated cases tested positive for COVID-19 between April 2 and April 11, 2022. Attendees who did not test positive or develop symptoms within ten days of the event were classified as contacts.Methods: We ascertained cases through phone-based contact tracing and a survey and evaluated symptom severity using a novel classification system.Results: Among 307 UIC students registered to attend the gala, the minimum attack rate was 14.0%. Approximately 56% of cases were mildly symptomatic, and 38.9% reported severe symptoms.Conclusions: Our findings align with prior research documenting heightened transmissibility of Omicron-variant-related strains and highlight the need for nuanced symptom assessment methodologies.

Foodborne outbreak investigations have traditionally included the detection of a cluster of illnesses first, followed by an epidemiologic investigation to identify a food of interest. The increasing use of whole genome sequencing (WGS) subtyping technology for clinical, environmental, and food isolates of foodborne pathogens, and the ability to share and compare the data on public platforms, present new opportunities to identify earlier links between illnesses and their potential sources. We describe a process called sample-initiated retrospective outbreak investigations (SIROIs) used by federal public health and regulatory partners in the United States. SIROIs begin with an evaluation of the genomic similarity between bacterial isolates recovered from food or environmental samples and clusters of clinical isolates while subsequent and parallel epidemiologic and traceback investigations are initiated to corroborate their connection. SIROIs allow for earlier hypothesis generation, followed by targeted collection of information about food exposures and the foods and manufacturer of interest, to confirm a link between the illnesses and their source. This often leads to earlier action that could reduce the breadth and burden of foodborne illness outbreaks. We describe two case studies of recent SIROIs and present the benefits and challenges. Benefits include insight into foodborne illness attribution, international collaboration, and opportunities for enhanced food safety efforts in the food industry. Challenges include resource intensiveness, variability of epidemiologic and traceback data, and an increasingly complex food supply chain. SIROIs are valuable in identifying connections among small numbers of illnesses that may span significant time periods; detecting early signals for larger outbreaks or food safety issues associated with manufacturers; improving our understanding of the scope of contamination of foods; and identifying novel pathogen/commodity pairs.

Carbapenem-resistant Pseudomonas aeruginosa (CRPA) are a serious cause of healthcare-associated infections. Part of the infection prevention and control measures are outbreak investigations (OI) of patients, healthcare workers (HCW), and the environment after identifying a CRPA in order to identify carriers and environmental reservoirs, so that targeted actions can be taken to prevent further transmission. However, little is known on when and how to perform such OI. Therefore, this systematic review aims to summarize OI performed after detection of CRPA in the endemic and epidemic hospital setting.
Articles related to our research question were identified through a literature research in multiple databases (Embase, Medline Ovid, Cochrane, Scopus, Cinahl, Web of Science, and Google Scholar) until January 12, 2022 (Prospero registration number CRD42020194165). Hundred-twenty-six studies were included. In both the endemic and the epidemic setting, a median number of two out of seven predefined components of OI were identified. In the endemic setting, the most frequent component of OI was screening of the environment (28 studies, 62.2%). In the epidemic setting, screening of the environment (72 studies, 88.9%), and screening of patients during hospitalization (30 studies, 37%) were most frequently performed. Only 19 out of 126 studies (15.1%) reported screening of contact patients, and 37 studies reported screening of healthcare workers (HCW, 29.4%).
Due to probable underreporting of OI in the literature, the available evidence for the usefulness of the individual components of OI is scarce. This could lead to inhomogeneous performance of OI after detection of CRPA in the healthcare setting, and with this, potential under- or overscreening. While we could show evidence for the usefulness for environmental screening in order to identify the mode of transmission, evidence for HCW screening is scarce and might not lead to the identification of modes of transmission. Further studies are needed to better understand CI in different settings and, finally, develop guidance on when and how to best perform OI.

Serological tests are widely used for the detection of Trichinella spp. infections in animals and humans. Despite some limitations, (such as low sensitivity in the early period after infection) ELISA and western blot testing have demonstrated good performance when excretory/secretory products from muscle larvae are used as antigens in agreement with the International Commission on Trichinellosis. Over recent decades, considerable progress has been made in the characterization of Trichinella-derived molecules in the hope of improving diagnosis, mainly during the early days post infection. Despite these efforts, validated tests using characterized antigens for early diagnosis are still not available. However, combining currently available sero-diagnostic tools with clinical and epidemiological data provides valuable information on Trichinella infections in humans and animals as shown in this review.

UNASSIGNED: During foodborne illness outbreak investigations, comparing food exposure frequencies of cases to those of a control population can help identify suspect food sources. The Public Health Agency of Canada (PHAC) conducted an online survey between February and April 2015 to collect seven-day food exposures from a convenience sample. The study period overlapped with a national, population-based exposure survey being conducted via telephone using random digit dialling. A subset of the food exposure questions from the telephone-based survey was included in the online survey.
UNASSIGNED: The online survey study objectives were to: 1) describe the survey methodology, survey respondents and response behaviour; and 2) determine if the online methodology is an appropriate alternative to telephone surveys by comparing food exposures.
UNASSIGNED: The online survey link was distributed via email to employees and public health partners, and was promoted on the PHAC website and social media channels.
UNASSIGNED: In total 2,100 surveys were completed. The majority of respondents were female, with high income and education, aged 30 to 39 years. The proportion reporting consuming the food items in the online survey was generally higher than those reported in the telephone survey, with a mean difference of 6.0% (95% CI: 4.2, 7.8).
UNASSIGNED: In an outbreak investigation, the 6.0% bias could make it more difficult to detect a difference between the case and control food exposures. Nevertheless, given the speed of response and lower resource expenditure of online surveys as well as the willing, able and convenient sample, a bias of 6.0% is considered small enough to be acceptable for future surveys.

An incursion of an important exotic transboundary animal disease requires a prompt and intensive response. The routine analysis of up-to-date data, as near to real time as possible, is essential for the objective assessment of the patterns of disease spread or effectiveness of control measures and the formulation of alternative control strategies. In this paper, we describe the Standard Analysis of Disease Investigation (SADI), a toolbox for informing disease outbreak response, which was developed as part of New Zealand\'s biosecurity preparedness. SADI was generically designed on a web-based software platform, Integrated Real-time Information System (IRIS). We demonstrated the use of SADI for a hypothetical foot-and-mouth disease (FMD) outbreak scenario in New Zealand. The data standards were set within SADI, accommodating a single relational database that integrated the national livestock population data, outbreak data, and tracing data. We collected a well-researched, standardised set of 16 epidemiologically relevant analyses for informing the FMD outbreak response, including farm response timelines, interactive outbreak/network maps, stratified epidemic curves, estimated dissemination rates, estimated reproduction numbers, and areal attack rates. The analyses were programmed within SADI to automate the process to generate the reports at a regular interval (daily) using the most up-to-date data. Having SADI prepared in advance and the process streamlined for data collection, analysis and reporting would free a wider group of epidemiologists during an actual disease outbreak from solving data inconsistency among response teams, daily \"number crunching,\" or providing largely retrospective analyses. Instead, the focus could be directed into enhancing data collection strategies, improving data quality, understanding the limitations of the data available, interpreting the set of analyses, and communicating their meaning with response teams, decision makers and public in the context of the epidemic.

Transmission of pathogens during endoscopy and subsequent outbreak investigations generated by potential nosocomial transmissions have become a major concern for gastroenterologists. These investigations have resulted in significant media coverage for individual institutions and can cause massive disruption to the institution if not handled well. Gastroenterologists should have a central role in investigation of these outbreaks and management of the communications and patient notification that is required. This article summarizes important aspects of outbreak investigations for physicians who do not frequently manage these investigations and gives practical advice for how gastroenterologists can help identify outbreaks and manage these investigations successfully.

BACKGROUND: In the absence of a comprehensive review, we conducted a systematic review on the use of systematic approach in outbreak investigation using reports from India.
OBJECTIVE: The primary objective was to estimate the proportion of outbreak reports from India during 2008-16, that reported the steps in outbreak investigation. The secondary objectives were to (1) describe the outbreak reports by selected characteristics (source, investigating agency, disease, time, place and person) (2) estimate the proportion of outbreaks that conducted analytical and additional studies.
METHODS: We searched eight electronic databases and grey literature for outbreak investigation reports among humans at community settings from India during 2008-2016. We developed a check-list based on the 10-steps approach used by Field Epidemiology Training Programme (FETP) of ICMR-National Institute of Epidemiology (ICMR-NIE), Chennai, India. This checklist was used to independently screen and extract data on general characteristics of the outbreak investigation reports and the steps completed. We adopted The Joanna Briggs Institute (JBI) check list for prevalence studies to examine the credibility and consistency. The protocol was registered at Prospero (CRD42017065038). We calculated proportion of reports that followed the steps in their investigation and descriptive statistics on selected characteristics.
RESULTS: Of 10,657 articles screened, 136 articles were included for the review. Completion of the ten steps in the outbreak investigations was seen in 16% of reports. The highest level of completion was for drawing conclusion in outbreak investigation (98%) and the lowest completion (29%) was for developing a case definition by time, place and person followed by conducting an analytic study (24%).
CONCLUSIONS: Outbreak reports from India either lacked application of systematic steps for investigation or failed to report the actual procedures followed. We recommend improving systematic investigation of outbreaks through training and supervision of outbreak response teams and encouraging publications.