Uncovering the Genetic Diversity of Giardia Isolates from Outbreaks in New Zealand

BackgroundGiardia is one of the most common causes of diarrhoea in the world and is a notifiable disease in New Zealand. Recent advances in molecular techniques, such as PCR and Sanger sequencing, have greatly improved our understanding of the taxonomic classification and epidemiology of this parasite. However, there has been an inability to identify shared subtypes between samples from the same epidemiologically linked cases, due to samples showing multiple dominant subtypes within the same outbreak when characterised using Sanger sequencing. MethodsHere, NGS was employed to uncover the genetic diversity within samples from sporadic and outbreak cases of giardiasis that occurred in New Zealand between 2010 and 2018. ResultsThis strategy exposed the significant diversity of subtypes of Giardia present in each sample. The utilisation of NGS and metabarcoding at the glutamate dehydrogenase (gdh) locus enabled the identification of shared subtypes between samples from shared outbreaks, providing a better understanding of the epidemiology of outbreaks of giardiasis in New Zealand.ConclusionsNext-generation sequencing technologies provides a superior tool, when compared to consensus sequencing technologies, for capturing the genetic diversity of Giardia within hosts. This study showed that infections in humans are frequently mixed, with multiple subtypes present in each host.

Retrospective cohort study of COVID-19 among children in Fulton County, Georgia, March 2020–June 2021

ObjectiveTo describe case rates, testing rates and percent positivity of COVID-19 among children aged 0–18 years by school-age grouping.DesignWe abstracted data from Georgia’s State Electronic Notifiable Disease Surveillance System on all 10 437 laboratory-confirmed COVID-19 cases among children aged 0–18 years during 30 March 2020 to 6 June 2021. We examined case rates, testing rates and percent positivity by school-aged groupings, namely: preschool (0–4 years), elementary school (5–10 years), middle school (11–13 years), and high school (14–18 years) and compared these data among school-aged children with those in the adult population (19 years and older).SettingFulton County, Georgia.Main outcome measuresCOVID-19 case rates, testing rates and percent positivity.ResultsOver time, the proportion of paediatric cases rose substantially from 1.1% (April 2020) to 21.6% (April 2021) of all cases in the county. Age-specific case rates and test rates were consistently highest among high-school aged children. Test positivity was similar across school-age groups, with periods of higher positivity among high-school aged children.ConclusionsLow COVID-19 testing rates among children, especially early in the pandemic, likely underestimated the true burden of disease in this age group. Despite children having lower measured incidence of COVID-19, we found when broader community incidence increased, incidence also increased among all paediatric age groups. As the COVID-19 pandemic continues to evolve, it remains critical to continue learning about the incidence and transmissibility of COVID-19 in children.

Rhino-orbital COVID-19 associated mucormycosis- A case report

COVID-19 Associated Mucormycosis (CAM) is an emerging infectious disease that has caused increased mortality & morbidity in India during this second wave of the pandemic. The country has reported more than 30,000 cases and over 2,000 deaths by Mucormycosis so far, according to sources from Union Health Ministry. CAM is now a notifiable disease. At our Tertiary care teaching hospital, which caters for COVID 19 management, we are reporting the first case of Rhino orbital CAM, which was caused by Rhizopus spp. Our patient had a history of contact with a suspected COVID 19 patient and was recently diagnosed with uncontrolled diabetes mellitus. A direct KOH microscopic examination of purulent material aspirated from the sinonasal polyp of the patient revealed fungal elements, and Rhizopus spp was isolated. Due to a shortage of Amphotericin B, the patient was referred to a government higher speciality centre for further management. The patient was followed up & was noted that he was treated with antifungal and discharged following recovery.

Atypical paralytic rabies — A case-study from Kerala, India

Rabies, though endemic in India, has been a disease of low public health priority throughout the years. Being a non-notifiable disease together with limited diagnostic facilities, it often ends up in under-reporting of cases, especially atypical rabies. Failure of complete rabies Post Exposure Prophylaxis (PEP) with Immunoglobulin has been rarely reported. We report a case of atypical rabies in a 60-year-old man from a rural village in Kerala, who presented with fever, paralysis of limbs, fluctuating consciousness, phonophobia and without classical signs of hydrophobia and aerophobia 22 days after dog bite. The case is supplemented with supportive Magnetic Resonance Imaging (MRI) findings and corneal imprint smear Fluorescent Antibody Test (FAT). The death of the patient on the 28th day of exposure despite early PEP with rabies vaccine and immunoglobulin is suggestive of PEP failure. The case study stresses on the need in making rabies a notifiable disease in the study setting, encouraging disease specific investigation, ensuring availability of vaccine and immunoglobulins with adherence to standardized treatment protocols.Deviations from the recommended protocol for Animal bite management, such as delay in seeking PEP, lack of or improper administration of rabies immunoglobulin (e.g. missing out bite sites), lack of or improper primary wound care, and/or poor-quality rabies vaccine, may lead to death.

A Retrospective Cohort Study of COVID-19 among Children in Fulton County, Georgia, March 2020 - June 2021

Objective: To describe case rates, testing rates, and percent positivity of coronavirus disease 2019 (COVID-19) among children aged 0-18 years by school-age grouping. Design: We abstracted data from Georgia's State Electronic Notifiable Disease Surveillance System on all 10,437 laboratory-confirmed COVID-19 cases among children aged 0-18 years during March 30, 2020 to June 6, 2021. We examined case rates, testing rates, and percent positivity by school-aged groupings, namely: preschool (0-4 years), elementary school (5-10 years), middle school (11-13 years), and high school (14-18 years) and compared these data among school aged children to those in the adult population (19 years and older). Setting: Fulton County, Georgia. Main outcome measures: COVID-19 case rates, testing rates, and percent positivity. Results: Over time, the proportion of pediatric cases rose substantially from 1.1% (April 2020) to 21.6% (April 2021) of all cases in the county. Age-specific case rates and test rates were consistently highest among high-school aged children. Test positivity was similar across school-age groups, with periods of higher positivity among high-school aged children. Conclusions: Low COVID-19 testing rates among children, especially early in the pandemic, likely underestimate the true burden of disease in this age group. Despite children having lower measured incidence of COVID-19, we found when broader community incidence increased, incidence also increased among all pediatric age groups. As the COVID-19 pandemic continues to evolve, it remains critical to continue learning about the incidence and transmissibility of COVID-19 in children.

New Matrixes to Diagnose Aethina Tumida Presence at Apiary Level

Aethina tumida (Coleoptera: Nitidulidae - Small Hive Beetle - SHB), is a parasite of honey bee colonies that causes the notifiable disease called aethinosis. In 2014, SHB was detected in Southern Italy, where it is still present (Calabria region). As part of surveillance activities, official diagnosis of the disease is performed by veterinary services via visual inspection of single hives in the apiaries. New outbreaks can be eradicated and the spread of SHBs limited by early detection of new introductions. We report an alternative protocol for the diagnosis of SHB through swabs and hive debris analysis by PCR. This was tested in three apiaries through the evaluation of different SHB infestation levels with a hive inspection method. This approach for sampling, followed by biomolecular methods, was fast and useful in unfavorable conditions (bad weather, aggressiveness, robbing), could be integrated in the official diagnosis procedures and may act as pre-clinic indicator.

Describing the burden of diphtheria in Canada from 2006 to 2017, using hospital administrative data and reportable disease data

Background: Canada has maintained a low incidence of toxigenic diphtheria since the 1990s, supported by continued commitment to publicly funded vaccination programs. Objective: To determine whether hospitalization data, complemented with notifiable disease data, can describe the toxigenic respiratory and cutaneous diphtheria burden in Canada, and to assess if Canada is meeting its diphtheria vaccine–preventable disease-reduction target of zero annual cases of locally transmitted respiratory diphtheria. Methods: Diphtheria-related hospital discharge data from 2006 to 2017 were extracted from the Discharge Abstract Database (DAD), and diphtheria case counts for the same period were retrieved from the Canadian Notifiable Disease Surveillance System (CNDSS), for descriptive analyses. As data from the province of Québec are not included in the DAD, CNDSS cases from Québec were excluded. Results: A total of 233 diphtheria-related hospitalizations were recorded in the DAD. Of these, diphtheria was the most responsible diagnosis in 23. Half the patients were male (52%), and 57% were 60 years and older. Central region (Ontario) accounted for the most discharge records (61%), followed by Prairie region (Alberta, Manitoba and Saskatchewan; 23%). Cutaneous diphtheria accounted for 43% of records, and respiratory diphtheria accounted for 3%, with the remainder being other diphtheria complications or site unspecified. Two records with diphtheria as the most responsible diagnosis resulted in inpatient deaths. Eighteen cases of diphtheria were reported through CNDSS. Cases occurred in all age groups, with the largest proportions among those aged 20 to 59 years (39%) and those aged 19 years and younger (33%). Cases were only reported in the Prairie (89%) and West Coast (British Columbia; 11%) regions. Conclusion: Hospital administrative data are consistent with the low incidence of diphtheria reported in CNDSS, and a low burden of respiratory diphtheria in Canada. Although Canada appears to be on track to meet its disease-reduction target, information on endemic transmission is not available.

Syndromic Surveillance as a Tool for Case-Based Varicella Reporting in Georgia, 2016-2019

Objectives Syndromic surveillance can be used to enhance notifiable disease case-based surveillance. We analyzed features of varicella reported in Georgia to evaluate case detection through syndromic surveillance and to compare varicella reported through syndromic surveillance with varicella reported from all other sources. Methods Syndromic surveillance was incorporated into case-based varicella surveillance by the Georgia Department of Public Health (GDPH) in May 2016. A cross-sectional study design evaluated syndromic and nonsyndromic varicella reported to GDPH from May 1, 2016, through December 31, 2019. Varicella was reported by nonsyndromic sources including health care providers, schools, and laboratories. We identified syndromic varicella cases from urgent care and emergency department visit data with discharge diagnoses containing the terms “varicella” or “chickenpox.” Results Syndromic notifications accounted for 589 of 2665 (22.1%) suspected varicella reports investigated by GDPH. The positive predictive value was 33.1% for syndromic notifications and 31.3% for nonsyndromic notifications. Mean days from rash onset to GDPH notification was 3.2 days fewer ( P < .001) among patients identified through syndromic notification than among patients identified through nonsyndromic notification. The odds of varicella identified by syndromic notification being outbreak-associated were 0.18 (95% CI, 0.09-0.36) times those of varicella identified through nonsyndromic notification. Practice Implications Syndromic notifications were an effective, timely means for varicella case detection. Syndromic patients were significantly less likely than nonsyndromic patients to be outbreak-associated, possibly because of early detection. Syndromic surveillance enhanced case-based reporting for varicella in Georgia and was a useful tool to improve notifiable disease surveillance.

Pentavalent Disabled Infectious Single Animal (DISA)/DIVA Vaccine Provides Protection in Sheep and Cattle against Different Serotypes of Bluetongue Virus

Bluetongue (BT) is a midge-borne OIE-notifiable disease of ruminants caused by the bluetongue virus (BTV). There are at least 29 BTV serotypes as determined by serum neutralization tests and genetic analyses of genome segment 2 encoding serotype immunodominant VP2 protein. Large parts of the world are endemic for multiple serotypes. The most effective control measure of BT is vaccination. Conventionally live-attenuated and inactivated BT vaccines are available but have their specific pros and cons and are not DIVA compatible. The prototype Disabled Infectious Single Animal (DISA)/DIVA vaccine based on knockout of NS3/NS3a protein of live-attenuated BTV, shortly named DISA8, fulfills all criteria for modern veterinary vaccines of sheep. Recently, DISA8 with an internal in-frame deletion of 72 amino acid codons in NS3/NS3a showed a similar ideal vaccine profile in cattle. Here, the DISA/DIVA vaccine platform was applied for other serotypes, and pentavalent DISA/DIVA vaccine for “European” serotypes 1, 2, 3, 4, 8 was studied in sheep and cattle. Protection was demonstrated for two serotypes, and neutralization Ab titers indicate protection against other included serotypes. The DISA/DIVA vaccine platform is flexible in use and generates monovalent and multivalent DISA vaccines to combat specific field situations with respect to Bluetongue.