Identifying SARS-CoV-2 regional introductions and transmission clusters in real time

The unprecedented SARS-CoV-2 global sequencing effort has suffered from an analytical bottleneck. Many existing methods for phylogenetic analysis are designed for sparse, static datasets and are too computationally expensive to apply to densely sampled, rapidly expanding datasets when results are needed immediately to inform public health action. For example, public health is often concerned with identifying clusters of closely related samples, but the sheer scale of the data prevents manual inspection and the current computational models are often too expensive in time and resources. Even when results are available, intuitive data exploration tools are of critical importance to effective public health interpretation and action. To help address this need, we present a phylogenetic summary statistic which quickly and efficiently identifies newly introduced strains in a region, resulting clusters of infected individuals, and their putative geographic origins. We show that this approach performs well on simulated data and is congruent with a more sophisticated analysis performed during the pandemic. We also introduce Cluster Tracker (https://clustertracker.gi.ucsc.edu/), a novel interactive web-based tool to facilitate effective and intuitive SARS-CoV-2 geographic data exploration and visualization. Cluster-Tracker is updated daily and automatically identifies and highlights groups of closely related SARS-CoV-2 infections resulting from inter-regional transmission across the United States, streamlining public health tracking of local viral diversity and emerging infection clusters. The combination of these open-source tools will empower detailed investigations of the geographic origins and spread of SARS-CoV-2 and other densely-sampled pathogens.

A sensitive and rapid wastewater test for SARS-COV-2 and its use for the early detection of a cluster of cases in a remote community

Throughout the COVID-19 pandemic, wastewater surveillance has been used to monitor trends in SARS-CoV-2 prevalence in the community. A major challenge in establishing wastewater surveillance programs, especially in remote areas, is the need for a well-equipped laboratory for sample analysis. Currently, no options exist for rapid, sensitive, mobile, and easy-to-use wastewater tests for SARS-CoV-2. The performance of the GeneXpert System, which offers cartridge-based, rapid molecular clinical testing for SARS-CoV-2 in a portable platform, was evaluated using wastewater as the input. The GeneXpert demonstrated a SARS-CoV-2 limit of detection in wastewater below 32 copies/mL with a sample processing time of less than an hour. Using wastewater samples collected from multiple sites across Canada during February and March 2021, a high overall agreement (97.8%) was observed between the GeneXpert assay and laboratory-developed tests regarding the presence or absence of SARS-CoV-2. Additionally, with the use of centrifugal filters the detection threshold of the GeneXpert system was improved to <10 copies/mL in wastewater. Finally, to support on-site wastewater surveillance, GeneXpert testing was implemented in Yellowknife, a remote community in Northern Canada where its use successfully alerted public health authorities to undetected transmission of COVID-19. The identification of SARS-CoV-2 in wastewater triggered clinical testing of recent travelers and identification of new COVID-19 cases/clusters. Taken together, these results suggest the GeneXpert is a viable option for surveillance of SARS-CoV-2 in wastewater in locations that do not have access to established testing laboratories. Importance: Wastewater-based surveillance is a powerful tool that provides an unbiased measure of COVID-19 prevalence in a community. This work describes a sensitive wastewater rapid test for SARS-CoV-2 based on a widely distributed technology, the GeneXpert. The advantages of an easy-to-use wastewater test for SARS-CoV-2 are clear – it supports surveillance in remote communities, improves access to testing, and provides faster results allowing for an immediate public health response. The application of wastewater rapid testing in a remote community facilitated the detection of a COVID-19 cluster and triggered public health action, clearly demonstrating the utility of this technology. Wastewater surveillance will become increasingly important in the post-vaccination pandemic landscape as individuals with asymptomatic/mild infections continue transmitting SARS-CoV-2 but are unlikely to be tested.

The Nutritional Profile and On-Pack Marketing of Toddler-Specific Food Products Launched in Australia between 1996 and 2020

With the food system evolving, it is not clear how the nutrition and on-pack claims of toddler foods have been impacted. Data on the trends in Australia are lacking, so we sought to determine the changes in the nutrition and on-pack claims of toddler-specific packaged foods over time. A retrospective cross-sectional analysis was conducted using the Mintel Global New Products Database. The number of toddler-specific foods increased from 1996 to 2020. Over time, a lower proportion of meals and snacks were classified as “ultra-processed”, but a higher proportion of snacks were classified as “discretionary”. Meals launched after 2014 had higher median values for energy, saturated fat, and sugar than those in earlier years. Toddler snacks launched after 2014 had lower median values for sodium, and higher median values for fat, saturated fat, and sugar than those in earlier years. The mean number of total claims per package increased over time for snacks, with an increase in unregulated claims for both meals and snacks. Public health action is needed to ensure that the retail food environment for young children is health-promoting, including stringent and clear regulations for on-pack claims, and compositional guidelines and guidance on how to reduce the number of ultra-processed foods for toddlers.

Quality of Life of Adult Patients with Type 2 Diabetes Mellitus in Kuwait

Objectives: This study aimed to evaluate the Quality of Life (QoL) on Kuwaiti adult patients with Type 2 Diabetes Mellitus (T2DM), aged ≥ 45 years of both genders, who attended primary healthcare centers and to identify factors associated with QoL. Methods: This is a cross-sectional study conducted on a random sample stratified by gender, consisting of 604 Kuwaiti adult patients with T2DM, aged ≥ 45 years, diagnosed by physicians as diabetics for ≥ 6 months. A validated demographic and WHOQOL-BREF questionnaires were used to assess the QoL. Results: The sample consisted of both genders with equal proportions, the age of 46% of patients was within 56-65 years’ class. Only 24% of the participants had secondary school, while 57% were retired, and the income of 54% exceeds 1000 KD/month. The majority of patients (76%) were married, and 99% were living with their families. Obesity was reported in 54% of patients, and 16% were smokers. Only oral antidiabetic drugs were used by 50% of patients, and 24% of the sample had complications, 11% of them developed retinopathy. A family history of diabetes was reported in 74% of patients, and 45% of them have a duration of diabetes >10 years. Regarding the QoL, the median score was 71, around 77% of the sample has a good QoL. Conclusion: There is more need for public health action to control the disease, thus improving their QoL; this can be achieved by improving the patients’ health status and maintaining their abilities.

New UK Chapter of the Alliance for a Cavity-Free Future

The Alliance for a Cavity-Free Future (ACFF), started in 2010, has been based at King's College London since 2013. It is a dental caries-focused charity promoting integrated clinical and public health action. ACFF Chapters seek to improve caries prevention and management locally, based on best global evidence. The UK Chapter has been created in response to a continuing need combined with opportunities including the implementation of the latest UK version of the Delivering better oral health guidance on prevention (version 4). The Chapter has been formed through a coordinating committee with UKwide representation combining expertise in dental caries management across the patient life course. This committee co-created the Chapter Values Statement: 'in pursuit of a cavity-free future across the UK we value: collaboration and innovation; realistic and implementable prevention-based solutions; approaches that reduce health inequalities; action across both oral and general health settings; and working comprehensively from the population through to the individual level.' The agreed Chapter focus is on advocating for the implementation of appropriate, effective, pragmatic caries prevention and care across three themes: 1) in everyday dental practice; 2) in health and social care curricula; and 3) for vulnerable people across their life course on the basis of increased caries risk/susceptibility.

The Study to Investigate COVID-19 Infection in People Living in Ireland (SCOPI): A seroprevalence study, June to July 2020

Background Robust data on SARS-CoV-2 population seroprevalence supplement surveillance data in providing evidence for public health action. Aim To conduct a SARS-CoV-2 population-based seroprevalence survey in Ireland. Methods Using a cross-sectional study design, we selected population samples from individuals aged 12–69 years in counties Dublin and Sligo using the Health Service Executive Primary Care Reimbursement Service database as a sampling frame. Samples were selected with probability proportional to the general population age–sex distribution, and by simple random sampling within age–sex strata. Antibodies to SARS-CoV-2 were detected using the Abbott Architect SARS-CoV-2 IgG Assay and confirmed using the Wantai Assay. We estimated the population SARS-CoV-2 seroprevalence weighted for age, sex and geographic area. Results Participation rates were 30% (913/3,043) and 44% (820/1,863) in Dublin and Sligo. Thirty-three specimens had detectable SARS-CoV-2 antibodies (1.9%). We estimated weighted seroprevalences of 3.12% (95% confidence interval (CI): 2.05–4.53) and 0.58% (95% CI: 0.18–1.38) for Dublin and Sligo, and 1.69% (95% CI: 1.13–2.41) nationally. This equates to an estimated 59,482 (95% CI: 39,772–85,176) people aged 12–69 years nationally having had infection with SARS-CoV-2, 3.0 (95% CI: 2.0–4.3) times higher than confirmed notifications. Ten participants reported a previous laboratory-confirmed SARS-CoV-2 -infection; eight of these were antibody-positive. Twenty-five antibody-positive participants had not reported previous laboratory-confirmed infection. Conclusion The majority of people in Ireland are unlikely to have been infected with SARS-CoV-2 by June–July 2020. Non-pharmaceutical public health measures remained key pending widespread availability of vaccination, and effective treatments.

Defining Priorities for Action and Research on the Commercial Determinants of Health: A Conceptual Review

In recent years, the concept of commercial determinants of health (CDoH) has attracted scholarly, public policy, and activist interest. To date, however, this new attention has failed to yield a clear and consistent definition, well-defined metrics for quantifying its impact, or coherent directions for research and intervention. By tracing the origins of this concept over 2 centuries of interactions between market forces and public health action and research, we propose an expanded framework and definition of CDoH. This conceptualization enables public health professionals and researchers to more fully realize the potential of the CDoH concept to yield insights that can be used to improve global and national health and reduce the stark health inequities within and between nations. It also widens the utility of CDoH from its main current use to study noncommunicable diseases to other health conditions such as infectious diseases, mental health conditions, injuries, and exposure to environmental threats. We suggest specific actions that public health professionals can take to transform the burgeoning interest in CDoH into meaningful improvements in health. (Am J Public Health. 2021;111(12):2202–2211. https://doi.org/10.2105/AJPH.2021.306491 )

A systematic review on mobile health applications for foodborne disease outbreak management

Background Foodborne disease outbreaks are common and notifiable in South Africa; however, they are rarely reported and poorly investigated. Surveillance data from the notification system is suboptimal and limited, and does not provide adequate information to guide public health action and inform policy. We performed a systematic review of published literature to identify mobile application-based outbreak response systems for managing foodborne disease outbreaks and to determine the elements that the system requires to generate foodborne disease data needed for public action. Methods Studies were identified through literature searches using online databases on PubMed/Medline, CINAHL, Academic Search Complete, Greenfile, Library, Information Science & Technology. Search was limited to studies published in English during the period January 1990 to November 2020. Search strategy included various terms in varying combinations with Boolean phrases “OR” and “AND”. Data were collected following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement. A standardised data collection tool was used to extract and summarise information from identified studies. We assessed qualities of mobile applications by looking at the operating system, system type, basic features and functionalities they offer for foodborne disease outbreak management. Results Five hundred and twenty-eight (528) publications were identified, of which 48 were duplicates. Of the remaining 480 studies, 2.9% (14/480) were assessed for eligibility. Only one of the 14 studies met the inclusion criteria and reported on one mobile health application named MyMAFI (My Mobile Apps for Field Investigation). There was lack of detailed information on the application characteristics. However, based on minimal information available, MyMAFI demonstrated the ability to generate line lists, reports and offered functionalities for outbreak verification and epidemiological investigation. Availability of other key components such as environmental and laboratory investigations were unknown. Conclusions There is limited use of mobile applications on management of foodborne disease outbreaks. Efforts should be made to set up systems and develop applications that can improve data collection and quality of foodborne disease outbreak investigations.

Integrating Alzheimer's Messages into Chronic Disease Programs

The number of people in the United States with dementia is increasing, with nearly six million people living with Alzheimer’s disease and related dementias. It is the fifth leading cause of death for those aged ≥65 years. Over 95% of people with dementia have another comorbid chronic condition. The Healthy Brain Initiative’s State and Local Public Health Partnerships to Address Dementia: The 2018-2023 Road Map notes that public health agencies should raise awareness of the link between brain health and physical health, and specifically calls out tobacco prevention and control, cardiovascular health management diabetes prevention and management, obesity prevention and control, and injury prevention as intervention points. The National Association of Chronic Disease Directors developed brain health messages targeted to reduce risk for cognitive decline through the prevention and control of comorbid chronic conditions. These messages can be leveraged for public health action by integrating them into existing chronic disease programs.

Documenting elimination of co-circulating COVID-19 clusters using genomics in New South Wales, Australia

Objective To adapt ‘fishplots’ to describe real-time evolution of SARS-CoV-2 genomic clusters. Results This novel analysis adapted the fishplot to depict the size and duration of circulating genomic clusters over time in New South Wales, Australia. It illuminated the effectiveness of interventions on the emergence, spread and eventual elimination of clusters and distilled genomic data into clear information to inform public health action.