179. Identification and Whole Genome Sequencing Analysis of an Oxacillinase (OXA)-48-like-producing Acinetobacter baumannii Outbreak in California, January-May 2021

Background In January 2021, a California acute care hospital (ACH A), a sentinel site for Acinetobacter baumannii (AB) surveillance, identified OXA-48-like-carbapenemase producing (CP) AB in a patient admitted from a ventilator-equipped skilled nursing facility (vSNF A); OXA-48-like AB had not been previously reported in the United States. Methods Our investigation included onsite infection control (IC) assessments, contact tracing, and point prevalence surveys (PPS) at vSNF A. The Antibiotic Resistance (AR) Laboratory Network performed carbapenemase testing on AB isolates (including those from ACH A) and PPS swabs. A case was defined as a patient with an OXA-48-like AB isolate, or an epidemiologically-linked patient with an OXA-48-like gene detected via screening. We performed whole genome sequencing (WGS) of OXA-48-like AB and other CP organisms on the Illumina MiSeq and Oxford Nanopore MinION for short and long read sequencing, respectively. Results Since January 2021, we have identified five OXA-48-like AB cases (including the index), six OXA-48-like cases (no organism recovered), and six patients with other CP organisms at ACH A and vSNF A. Since August 2019, vSNF A has concurrently been experiencing an OXA-109 AB outbreak. A second vSNF A patient, Patient 2, who overlapped with the index patient, had OXA-48-like Klebsiella pneumoniae (KP) (November 2019) and OXA-109 AB (May 2020) isolates. WGS of the index patient’s AB and Patient 2’s KP isolates identified a rare OXA-48-like gene located on the AB chromosome and a KP plasmid. The OXA-48-like AB was also carrying an OXA-109 gene, and hqSNP analysis indicated it varied by 9-44 single-nucleotide polymorphisms (SNPs) from 14 OXA-109 AB isolates linked to that outbreak, and 0-3 SNPs from the other OXA-48-like AB case isolates. Figure 1. Phylogenetic Tree Comparison of OXA-109 AB and OXA-48-like AB Isolates Figure 2. Epidemic Curve of OXA-109 AB, OXA-48-like AB, and Other CP Organism Cases, 2019-2021 Conclusion The first reported case of OXA-48-like AB in the US was identified through public health sentinel laboratory surveillance, allowing prompt response to contain spread of a novel multidrug-resistant organism (MDRO). WGS detected a rare OXA-48-like gene in AB and KP and provides evidence for possible interspecies transfer of this gene from KP to AB through plasmid transfer followed by chromosomal integration. Disclosures All Authors: No reported disclosures

Risk Factors of Influenza-Associated Respiratory Illnesses Reported to a Sentinel Hospital of Lahore, Pakistan: 2015-2016

Epidemiological data about determinants of influenza A virus (IAV) in the Pakistani population is scarce. We aimed to conduct a prospective hospital-based active surveillance study from October 2015 to May 2016 to identify potential risk factors associated with IAV infection among patients with influenza-like illness (ILI) and severe acute respiratory illness (SARI). Surveillance was conducted in Lahore General Hospital, selected as a sentinel site in Lahore District, Pakistan. Nasal/throat samples were collected along with epidemiological and clinical data from enrolled patients. Real-time reverse-transcription polymerase chain reaction (rRT-PCR) was performed to identify IAV and its subtypes (H1N1pdm09, H3N2). Data were analyzed to determine risk factors and risk markers associated with IAV infections. A total of 311 suspected ILI and SARI cases were enrolled in the study, and among these 50 were IAV-positive. Of these 50 confirmed cases of IAV, 14 were subtyped as H1N1pdm09 and 15 were H3N2; the remaining 21 were untyped. A final multivariable model identified four independent risk factors/markers for IAV infection: exposure history to ILI patients within last 7 days and gender being male were identified as risk factors of IAV infection, while use of antibiotics prior to hospital consultation and presence of fever were identified as risk markers. We concluded that adopting nonpharmaceutical interventions like hand hygiene, masks, social distancing, and where possible, avoiding identified risk factors could decrease the risk of IAV infection and may prevent imminent outbreaks of IAV in the community.

Assessing factors influencing communities’ acceptability of mass drug administration for the elimination of lymphatic filariasis in Guyana

Background Guyana is one of four countries in the Latin American Region where lymphatic filariasis (LF) remains endemic. In preparation for the introduction of a new triple drug therapy regimen (ivermectin, diethylcarbamazine, and albendazole (IDA)) in 2019, an acceptability study was embedded within sentinel site mapping in four regions to assess mass drug administration (MDA) coverage and compliance, acceptability, and perceptions about treatment and disease. The results from this survey would inform the rollout of IDA in Guyana in 2019. Methods Data collection for the study occurred in August 2019, using a validated questionnaire administered by trained enumerators. Across all regions, a total of 1,248 participants were sampled by the Filarial Mapping team. Four-hundred and fifty-one participants aged over 18 years were randomly selected for participation in an expanded acceptability questionnaire. All data were captured in Secure Data Kit (SDK). Results Acceptability was measured using a mean acceptability score. Unadjusted mean scores ranged from 24.6 to 29.3, with 22.5 as the threshold of acceptability. Regional variation occurred across many indicators of interest: self-rated understanding about LF, mechanisms of LF transmission, LF drug safety and history of treatment during MDA. Region IV (Georgetown) recorded higher knowledge about LF, but lower compliance and acceptability. Number of pills was not perceived as a concern. Conclusion Acceptability of MDA was good across all four regions under study. Results from this study set a baseline level for key indicators and acceptability, from which the acceptability of IDA can be measured. Regional variations across indicators suggest that localized approaches should be considered for social mobilization and MDA delivery to capture these contextual differences.

Improved kala-azar case management through implementation of health facility-based sentinel sites surveillance system in Bihar, India

Background Visceral leishmaniasis (VL), also known as kala-azar (KA), is a neglected vector-borne disease, targeted for elimination, but several affected blocks of Bihar are posing challenges with the high incidence of cases, and moreover, the disease is spreading in newer areas. High-quality kala-azar surveillance in India, always pose great concern. The complete and accurate patient level data is critical for the current kala-azar management information system (KMIS). On the other side, no accurate data on the burden of post kala-azar dermal leishmaniasis (PKDL) and co-infections are available under the current surveillance system, which might emerge as a serious concern. Additionally, in low case scenario, sentinel surveillance may be useful in addressing post-elimination activities and sustaining kala-azar (KA) elimination. Health facility-based sentinel site surveillance system has been proposed, first time to do a proper accounting of KA, PKDL and co-infection morbidity, mortality, diagnosis, case management, hotspot identification and monitoring the impact of elimination interventions. Methodology/principal findings Kala-azar sentinel site surveillance was established and activated in thirteen health facilities of Bihar, India, using stratified sampling technique during 2011 to 2014. Data were collected through specially designed performa from all patients attending the outpatient departments of sentinel sites. Among 20968 symptomatic cases attended sentinel sites, 2996 cases of KA and 53 cases of PKDL were registered from 889 endemic villages. Symptomatic cases meant a person with fever of more than 15 days, weight loss, fatigue, anemia, and substantial swelling of the liver and spleen (enlargement of spleen and liver).The proportion of new and old cases was 86.1% and 13.9% respectively. A statistically significant difference was observed for reduction in KA incidence from 4.13/10000 in 2011 to 1.75/10000 in 2014 (p<0.001). There were significant increase (0.08, 0.10 per 10 000 population) in the incidences of PKDL and co-infection respectively in the year 2014 as compared to that of 2011 (0.03, 0.06 per 10 000 population). The proportion of HIV-VL co-infection was significantly higher (1.6%; p<0.05) as compared to other co-infections. Proportions of male in all age groups were higher and found statistically significant (Chi-square test = 7.6; P = 0.026). Utilization of laboratory services was greatly improved. Friedman test showed statistically significant difference between response of different anti kala-azar drugs (F = 25.0, P = 0.004).The initial and final cure rate of AmBisome was found excellent (100%). The results of the signed rank sum test showed significant symmetry of unresponsiveness rate (P = 0.03). Similarly, relapse rate of sodium antimony gluconate (SAG) was also found significantly higher as compared to other drugs (95%CI 0.2165 to 19.7035; P = 0.03). A statistically significant difference was found (p<0.001) between villages having 1–2 cases (74%) and villages with 3–5 cases (15%). Significantly higher proportion (95%) of cases were captured by existing Govt. surveillance system (KMIS) (p<0.001), as compared to private providers (5%). Conclusions/significance Establishment of a sentinel site based kala-azar surveillance system in Bihar, India effectively detected the rising trend of PKDL and co-infections and captured complete and accurate patient level data. Further, this system may provide a model for improving laboratory services, KA, PKDL and co-infection case management in other health facilities of Bihar without further referral. Program managers may use these results for evaluating program’s effectiveness. It may provide an example for changing the practices of health care workers in Bihar and set a benchmark of high quality surveillance data in a resource limited setting. However, the generalizability of this sentinel surveillance finding to other context remains a major limitation of this study. The justifications for this; the sentinel sites were made in the traditionally high endemic PHC’s. The other conditions were Program commitment for diagnostic (rk-39) and the first line anti kala-azar drug i.e. miltefosine throughout the study period in the sentinel sites. In addition, there were clause of fulfillment of readiness criteria at each sentinel site (already described in the line no 171 to 180 at page no-8, 181–189 at page no-9 and 192–212 at page no-10). Rigorous efforts were taken to improve all the sentinel sites to meet the readiness criteria and research activities started only after meeting readiness criteria at the site. Therefore sentinel site surveillance described under the present study cannot be integrated into other set up (medium and low endemic areas). However, it can be integrated into highly endemic areas with program commitment and fulfillment of readiness criteria.

Decreased human respiratory syncytial virus activity during the COVID-19 pandemic in Japan: an ecological time-series analysis

Background Non-pharmaceutical interventions (NPIs), such as sanitary measures and travel restrictions, aimed at controlling the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), may affect the transmission dynamics of human respiratory syncytial virus (HRSV). We aimed to quantify the contribution of the sales of hand hygiene products and the number of international and domestic airline passenger arrivals on HRSV epidemic in Japan. Methods The monthly number of HRSV cases per sentinel site (HRSV activity) in 2020 was compared with the average of the corresponding period in the previous 6 years (from January 2014 to December 2020) using a monthly paired t-test. A generalized linear gamma regression model was used to regress the time-series of the monthly HRSV activity against NPI indicators, including sale of hand hygiene products and the number of domestic and international airline passengers, while controlling for meteorological conditions (monthly average temperature and relative humidity) and seasonal variations between years (2014–2020). Results The average number of monthly HRSV case notifications in 2020 decreased by approximately 85% (p < 0.001) compared to those in the preceding 6 years (2014–2019). For every average ¥1 billion (approximately £680,000/$9,000,000) spent on hand hygiene products during the current month and 1 month before there was a 0.29% (p = 0.003) decrease in HRSV infections. An increase of average 1000 domestic and international airline passenger arrivals during the previous 1–2 months was associated with a 3.8 × 10− 4% (p < 0.001) and 1.2 × 10− 3% (p < 0.001) increase in the monthly number of HRSV infections, respectively. Conclusions This study suggests that there is an association between the decrease in the monthly number of HRSV cases and improved hygiene and sanitary measures and travel restrictions for COVID-19 in Japan, indicating that these public health interventions can contribute to the suppression of HRSV activity. These findings may help in public health policy and decision making.

A Governmentality of Online Gambling: Quebec’s Contested Internet Gambling Website Blocking Provisions

This article examines Canada’s first internet gambling website blocking scheme, which was enacted in Quebec as part of the implementation of the province’s 2015 budget. Using qualitative research methods, the article illustrates the complexities of regulating online gambling. Influenced by critical sociological and anthropological studies of gambling, and taking a socio-legal, governmentality perspective, it shows how socio-legal studies can illuminate research on the regulation of gambling, and how the study of online gambling can, as a sentinel site for the regulation of online consumption, contribute to the development of socio-legal studies. Our analysis shows that the governmentality of online gambling is framed so as to exclude 1) a range of risks (e.g., related to consumer profiling and the capacity to stimulate “addictive consumption”), 2) the heterogeneity of everyday experience that connects online gambling with online addictive consumption more generally, and 3) a range of possibilities for governing online gambling otherwise.

Molecular Epidemiology of Rotavirus A Strains Pre- and Post-Vaccine (Rotarix®) Introduction in Mozambique, 2012–2019: Emergence of Genotypes G3P[4] and G3P[8]

Group A rotavirus (RVA) remains the most important etiological agent associated with severe acute diarrhea in children. Rotarix® monovalent vaccine was introduced into Mozambique’s Expanded Program on Immunization in September 2015. In the present study, we report the diversity and prevalence of rotavirus genotypes, pre- (2012–2015) and post-vaccine (2016–2019) introduction in Mozambique, among diarrheic children less than five years of age. Genotyping data were analyzed for five sentinel sites for the periods indicated. The primary sentinel site, Mavalane General Hospital (HGM), was analyzed for the period 2012–2019, and for all five sites (country-wide analyses), 2015–2019. During the pre-vaccine period, G9P[8] was the most predominant genotype for both HGM (28.5%) and the country-wide analysis (46.0%). However, in the post-vaccine period, G9P[8] was significantly reduced. Instead, G3P[8] was the most common genotype at HGM, while G1P[8] predominated country-wide. Genotypes G9P[4] and G9P[6] were detected for the first time, and the emergence of G3P[8] and G3P[4] genotypes were observed during the post-vaccine period. The distribution and prevalence of rotavirus genotypes were distinct in pre- and post-vaccination periods, while uncommon genotypes were also detected in the post-vaccine period. These observations support the need for continued country-wide surveillance to monitor changes in strain diversity, due to possible vaccine pressure, and consequently, the effect on vaccine effectiveness.

Effect of Proper Management of Cocoa Plants on the Occurrence of Swollen Shoot Disease in Kipiri - Côte d'Ivoire

This study aimed to evaluate the relationship between plot maintenance level and the prevalence of Cocoa swollen shoot disease in Kipiri (Department of Soubré) in Côte d'Ivoire. Indeed, the strong pressure of Swollen shoot disease in this department causes enormous damage in cocoa plots.The study design is a prospective survey in peasant cocoa plots between 2014 and 2016. The data were collected using the Land Degradation Surface Framework (LDSF). The LDSF device is a sentinel site of 10 Km × 10 Km. The site is divided into 16 Clusters of 2.5 Km × 2.5 Km with 10 plots by cluster. In the case of our study, surveys were carried out on 108 plots carrying cocoa trees within a radius of 50 m around each test plot. The data collected included areas of Cocoa Swollen Shoot Virus (CSSV) outbreaks, the cocoa plot maintenance level and CSSV status like ‘Absence’ or ‘Presence’ in plots observed. CSSV prevalence was deduced from CSSV outbreaks areas of each sampling plot, allowing realization of disease map. The relationship between the level of plot maintenance and the prevalence of CSSV was assessed by using the analysis of variance test (Anova-one-way). The results of Swollen shoot disease’s distribution showed that the Kipiri site had a CSSV prevalence around 50%.These results demonstrated that plots maintenance level has a strong influence on the prevalence of Swollen shoot disease (p =0.00 < 0.05). At the end of this study, it appears that plots maintenance level is a key factor in the rapid spread of the Swollen shoot epidemic in Kipiri site. Cocoa producers would therefore be recommended to regularly maintain their plantations by eliminating the reservoirs of Cocoa Swollen Shoot Virus.