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Godínez-Oviedo A, Tamplin ML, Bowman JP, Hernández-Iturriaga M. Effects of intrinsic characteristics of Salmonella enterica strains isolated from foods and humans, and their interaction with food matrices during simulated gastric conditions. Int J Food Microbiol 2024; 413:110584. [PMID: 38295484 DOI: 10.1016/j.ijfoodmicro.2024.110584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 12/21/2023] [Accepted: 01/15/2024] [Indexed: 02/02/2024]
Abstract
The stomach's acidic pH is a crucial barrier against foodborne pathogens such as Salmonella enterica. This study investigated the survival of S. enterica under simulated oral and gastric conditions (SGC; pH 2 for 120 min) as a function of intrinsic pathogen characteristics and food matrix. Fifty-seven S. enterica strains isolated from food and human infections (previously characterized by serotype, virulotype, multi-drug resistance, isolation source, and isolation season) were subjected to SGC using water as a vehicle. Population reduction among the 57 isolates ranged from 2.7 to 4.7 log CFU, revealing that human isolates were inactivated less than food isolates (p = 0.0008). Among food strains, strains isolated during the cold season (food sampled from December to February) displayed the highest reduction (p = 0.00002). Six representatives of the 57 S. enterica strains were selected according to their virulotype and antimicrobial profile. They were further used to evaluate their survival under SGC in four food matrices (water, mango, tomato, and chicken), measuring S. enterica at 30 min intervals. The strains in chicken showed the lowest reduction and inactivation rate (1.42 ± 0.35 log CFU; 0.03 ± 0.005 min-1), followed by tomato (3.75 ± 0.57 log CFU; 0.15 ± 0.02 min-1), water (4.23 ± 0.27 log CFU; 0.17 ± 0.02 min-1), and mango (4.49 ± 0.39 log CFU; 0.17 ± 0.03 min-1). These data suggest that not all S. enterica strains have the same ability to survive under SGC, influencing the probability of arriving into the small intestine.
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Affiliation(s)
- A Godínez-Oviedo
- Departamento de Investigación y Posgrado de Alimentos, Facultad de Química, Universidad Autónoma de Querétaro, Cerro de las Campanas s/n, Col. Las Campanas, 76010 Querétaro, Qro., Mexico; Food Safety and Innovation Centre, Tasmanian Institute of Agriculture, University of Tasmania, Hobart 7005, Australia
| | - M L Tamplin
- Food Safety and Innovation Centre, Tasmanian Institute of Agriculture, University of Tasmania, Hobart 7005, Australia
| | - J P Bowman
- Food Safety and Innovation Centre, Tasmanian Institute of Agriculture, University of Tasmania, Hobart 7005, Australia
| | - M Hernández-Iturriaga
- Departamento de Investigación y Posgrado de Alimentos, Facultad de Química, Universidad Autónoma de Querétaro, Cerro de las Campanas s/n, Col. Las Campanas, 76010 Querétaro, Qro., Mexico.
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2
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Zhan Y, Gu H, Li X. Study on association factors of intestinal infectious diseases based-Bayesian spatio-temporal model. BMC Infect Dis 2023; 23:720. [PMID: 37875791 PMCID: PMC10598920 DOI: 10.1186/s12879-023-08665-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 10/03/2023] [Indexed: 10/26/2023] Open
Abstract
BACKGROUND Intestinal infectious diseases (IIDs) are a significant public health issue in China, and the incidence and distribution of IIDs vary greatly by region and are affected by various factors. This study aims to describe the spatio-temporal trends of IIDs in the Chinese mainland and investigate the association between socioeconomic and meteorological factors with IIDs. METHODS In this study, IIDs in mainland China from 2006 to 2017 was analyzed using data obtained from the China Center for Disease Control and Prevention. Spatio-temporal mapping techniques was employed to visualize the spatial and temporal distribution of IIDs. Additionally, mean center and standard deviational ellipse analyses were utilized to examine the spatial trends of IIDs. To investigate the potential associations between IIDs and meteorological and socioeconomic variables, spatiotemporal zero-inflated Poisson and negative binomial models was employed within a Bayesian framework. RESULTS During the study period, the occurrence of most IIDs has dramatically reduced, with uneven reductions in different diseases. Significant regional differences were found among IIDs and influential factors. Overall, the access rate to harmless sanitary toilets (ARHST) was positively associated with the risk of cholera (RR: 1.73, 95%CI: 1.08-2.83), bacillary dysentery (RR: 1.32, 95%CI: 1.06-1.63), and other intestinal infectious diseases (RR: 1.88, 95%CI: 1.52-2.36), and negatively associated with typhoid fever (RR: 0.66, 95%CI: 0.51-0.92), paratyphoid fever (RR: 0.71, 95%CI: 0.55-0.92). Urbanization is only associated with hepatitis E (RR: 2.48, 95%CI: 1.12-5.72). And GDP was negatively correlated with paratyphoid fever (RR: 0.82, 95%CI: 0.70-0.97), and bacillary dysentery (RR: 0.77, 95%CI: 0.68-0.88), and hepatitis A (RR: 0.84, 95%CI: 0.73-0.97). Humidity showed positive correlation with some IIDs except for amoebic dysentery (RR: 1.64, 95%CI: 1.23-2.17), while wind speed showed a negative correlation with most IIDs. High precipitation was associated with an increased risk of typhoid fever (RR: 1.52, 95%CI: 1.09-2.13), and high temperature was associated with an increased risk of typhoid fever (RR: 2.82, 95%CI: 2.06-3.89), paratyphoid fever (RR: 2.79, 95%CI: 2.02-3.90), and HMFD (RR: 1.34, 95%CI: 1.01-1.77). CONCLUSIONS This research systematically and quantitatively studied the effect of socioeconomic and meteorological factors on IIDs, which provided causal clues for future studies and guided government planning.
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Affiliation(s)
- Yancen Zhan
- Department of Big Data in Health Sciences, and Center for Clinical Big Data and Statistics, Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310058, Zhejiang, China
| | - Hua Gu
- The Cancer Hospital, University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Institute of Basic Medicine and Cancer, Chinese Academy of Sciences, Hangzhou, 310022, China
| | - Xiuyang Li
- Department of Big Data in Health Sciences, and Center for Clinical Big Data and Statistics, Second Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, 310058, Zhejiang, China.
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Xu X, Rothrock MJ, Dev Kumar G, Mishra A. Assessing the Risk of Seasonal Effects of Campylobacter Contaminated Broiler Meat Prepared In-Home in the United States. Foods 2023; 12:2559. [PMID: 37444297 DOI: 10.3390/foods12132559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 06/20/2023] [Accepted: 06/27/2023] [Indexed: 07/15/2023] Open
Abstract
Campylobacter has consistently posed a food safety issue in broiler meat. This study aimed to create a quantitative microbial risk assessment model from retail to consumption, designed to evaluate the seasonal risk of campylobacteriosis associated with broiler meat consumption in the United States. To achieve this, data was gathered to build distributions that would enable us to predict the growth of Campylobacter during various stages such as retail storage, transit, and home storage. The model also included potential fluctuations in concentration during food preparation and potential cross-contamination scenarios. A Monte Carlo simulation with 100,000 iterations was used to estimate the risk of infection per serving and the number of infections in the United States by season. In the summer, chicken meat was estimated to have a median risk of infection per serving of 9.22 × 10-7 and cause an average of about 27,058,680 infections. During the winter months, the median risk of infection per serving was estimated to be 4.06 × 10-7 and cause an average of about 12,085,638 infections. The risk assessment model provides information about the risk of broiler meat to public health by season. These results will help understand the most important steps to reduce the food safety risks from contaminated chicken products.
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Affiliation(s)
- Xinran Xu
- Department of Food Science and Technology, College of Agricultural & Environmental Science, University of Georgia, 100 Cedar St., Athens, GA 30602, USA
| | - Michael J Rothrock
- Egg Safety and Quality Research Unit, U.S. National Poultry Research Center, Agricultural Research Service, United States Department of Agriculture, Athens, GA 30605, USA
| | | | - Abhinav Mishra
- Department of Food Science and Technology, College of Agricultural & Environmental Science, University of Georgia, 100 Cedar St., Athens, GA 30602, USA
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Liu J, Luo B, Zhou Y, Ma X, Liang J, Sang X, Lyu L, Chen W, Fu P, Liu H, Zhen S, Wang C, Wu Y, Huang Q, Liang X, Bai G, Lan Z, Zhang S, Wu Y, Li N, Guo Y. Prevalence and distribution of acute gastrointestinal illness in the community of China: a population-based face-to-face survey, 2014-2015. BMC Public Health 2023; 23:836. [PMID: 37158857 PMCID: PMC10165855 DOI: 10.1186/s12889-023-15337-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 02/28/2023] [Indexed: 05/10/2023] Open
Abstract
BACKGROUND The true incidence of acute gastrointestinal illness in China is underrecognized by surveillance systems. The aims of this study were to estimate the incidence and prevalence of self-reported AGI in the community of China, and to investigate sociodemographic and epidemiological determinants of AGI. METHODS We conducted a 12-months cross-sectional population-based survey in eight provinces of China during 2014-2015. The survey determined the prevalence and incidence of acute gastrointestinal illness (AGI) in the total permanent resident population in China according to the census of the population in 2010. The random multilevel population sample was stratified by geographic, population, and socioeconomic status. We used a recommended case definition of AGI, with diarrhea (three loose or watery stools) and/or any vomiting in a four-week recall. A face-to-face survey was conducted by selecting the member in the household with the most recent birthday. RESULTS Among 56,704 sampled individuals, 948 (1,134 person-time) fulfilled the case definition; 98.5% reported diarrhea. This corresponds to 2.3% (95% CI:1.9%-2.8%) of an overall standardized four-week prevalence and 0.3 (95% CI: 0.23-0.34) episodes per person-year of annual adjusted incidence rate. There was no significant difference between males and females. The incidence rates were higher among urban residents, and in the spring and summer. In the whole study period, 50% of the cases sought medical care, of which 3.9% were hospitalized and 14.3% provided a biological sample for laboratory identification of the causative agent. Children aged 0-4 and young adults aged 15-24, people living in rural areas and people who traveled frequently had higher prevalence of AGI. CONCLUSION Results showed that AGI represents a substantial burden in China, and will contribute to the estimation of the global burden of AGI. Complemented with data on the etiologies of AGI, these estimates will form the basis to estimate the burden of foodborne diseases in China.
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Affiliation(s)
- Jikai Liu
- NHC Key Laboratory of Food Safety Risk Assessment, Food Safety Research Unit (2019RU4) of Chinese Academy of Medical Science, China National Center for Food Safety Risk Assessment, Beijing, China
| | - Baozhang Luo
- Shanghai Municipal Center for Disease Prevention and Control, Shanghai, China
| | - Yijing Zhou
- Jiangsu Provincial Center for Disease Prevention and Control, Nanjing, China
| | - Xiaochen Ma
- Beijing Center for Disease Prevention and Control, Beijing, China
| | - Junhua Liang
- Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
| | - Xianglai Sang
- Gansu Provincial Center for Disease Control and Prevention, Lanzhou, China
| | - Le Lyu
- Jilin Provincial Center for Disease Control and Prevention, Changchun, China
| | - Wen Chen
- Sichuan Provincial Center for Disease Control and Prevention, Chengdu, China
| | - Pengyu Fu
- Henan Provincial Center for Disease Control and Prevention, Zhengzhou, China
| | - Hong Liu
- Shanghai Municipal Center for Disease Prevention and Control, Shanghai, China
| | - Shiqi Zhen
- Jiangsu Provincial Center for Disease Prevention and Control, Nanjing, China
| | - Chao Wang
- Beijing Center for Disease Prevention and Control, Beijing, China
| | - Yangbo Wu
- Beijing Center for Disease Prevention and Control, Beijing, China
| | - Qiong Huang
- Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
| | - Xiaocheng Liang
- Gansu Provincial Center for Disease Control and Prevention, Lanzhou, China
| | - Guangda Bai
- Jilin Provincial Center for Disease Control and Prevention, Changchun, China
| | - Zhen Lan
- Sichuan Provincial Center for Disease Control and Prevention, Chengdu, China
| | - Shufang Zhang
- Henan Provincial Center for Disease Control and Prevention, Zhengzhou, China
| | - Yongning Wu
- NHC Key Laboratory of Food Safety Risk Assessment, Food Safety Research Unit (2019RU4) of Chinese Academy of Medical Science, China National Center for Food Safety Risk Assessment, Beijing, China
| | - Ning Li
- NHC Key Laboratory of Food Safety Risk Assessment, Food Safety Research Unit (2019RU4) of Chinese Academy of Medical Science, China National Center for Food Safety Risk Assessment, Beijing, China.
| | - Yunchang Guo
- NHC Key Laboratory of Food Safety Risk Assessment, Food Safety Research Unit (2019RU4) of Chinese Academy of Medical Science, China National Center for Food Safety Risk Assessment, Beijing, China.
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Balachandran N, Cates J, Kambhampati AK, Marconi VC, Whitmire A, Morales E, Brown ST, Lama D, Rodriguez-Barradas MC, Moronez RG, Domiguez GR, Beenhouwer DO, Poteshkina A, Matolek ZA, Holodniy M, Lucero-Obusan C, Agarwal M, Cardemil C, Parashar U, Mirza SA. Risk Factors for Acute Gastroenteritis Among Patients Hospitalized in 5 Veterans Affairs Medical Centers, 2016-2019. Open Forum Infect Dis 2022; 9:ofac339. [PMID: 35949407 PMCID: PMC9356693 DOI: 10.1093/ofid/ofac339] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 07/22/2022] [Indexed: 01/26/2024] Open
Abstract
BACKGROUND In the United States, ∼179 million acute gastroenteritis (AGE) episodes occur annually. We aimed to identify risk factors for all-cause AGE, norovirus-associated vs non-norovirus AGE, and severe vs mild/moderate AGE among hospitalized adults. METHODS We enrolled 1029 AGE cases and 624 non-AGE controls from December 1, 2016, to November 30, 2019, at 5 Veterans Affairs Medical Centers. Patient interviews and medical chart abstractions were conducted, and participant stool samples were tested using the BioFire Gastrointestinal Panel. Severe AGE was defined as a modified Vesikari score of ≥11. Multivariate logistic regression was performed to assess associations between potential risk factors and outcomes; univariate analysis was conducted for norovirus-associated AGE due to limited sample size. RESULTS Among 1029 AGE cases, 551 (54%) had severe AGE and 44 (4%) were norovirus positive. Risk factors for all-cause AGE included immunosuppressive therapy (adjusted odds ratio [aOR], 5.6; 95% CI, 2.7-11.7), HIV infection (aOR, 3.9; 95% CI, 1.8-8.5), severe renal disease (aOR, 3.1; 95% CI, 1.8-5.2), and household contact with a person with AGE (aOR, 2.9; 95% CI, 1.3-6.7). Household (OR, 4.4; 95% CI, 1.6-12.0) and non-household contact (OR, 5.0; 95% CI, 2.2-11.5) with AGE was associated with norovirus-associated AGE. Norovirus positivity (aOR, 3.4; 95% CI, 1.3-8.8) was significantly associated with severe AGE. CONCLUSIONS Patients with immunosuppressive therapy, HIV, and severe renal disease should be monitored for AGE and may benefit from targeted public health messaging regarding AGE prevention. These results may also direct future public health interventions, such as norovirus vaccines, to specific high-risk populations.
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Affiliation(s)
- Neha Balachandran
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
- Cherokee Nation Assurance, Arlington, Virginia, contracting agency to the Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Diseases Control and Prevention, Atlanta, Georgia, USA
| | - Jordan Cates
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Anita K Kambhampati
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Vincent C Marconi
- Atlanta VA Medical Center, Atlanta, Georgia, USA
- Emory University School of Medicine and Rollins School of Public Health, Atlanta, Georgia, USA
| | | | | | - Sheldon T Brown
- James J. Peters VA Medical Center, Bronx, New York, USA
- Icahn School of Medicine at Mt. Sinai, New York, New York, USA
| | - Diki Lama
- James J. Peters VA Medical Center, Bronx, New York, USA
| | - Maria C Rodriguez-Barradas
- Infectious Diseases Section, Michael E. DeBakey VA Medical Center and Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Rosalba Gomez Moronez
- Infectious Diseases Section, Michael E. DeBakey VA Medical Center and Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Gilberto Rivera Domiguez
- Infectious Diseases Section, Michael E. DeBakey VA Medical Center and Department of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - David O Beenhouwer
- VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
- David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | | | | | - Mark Holodniy
- Department of Veterans Affairs, Public Health Surveillance and Research, Washington DC, USA
- VA Palo Alto Health Care System, Palo Alto California, USA
- Stanford University, Stanford, California, USA
| | - Cynthia Lucero-Obusan
- Department of Veterans Affairs, Public Health Surveillance and Research, Washington DC, USA
- VA Palo Alto Health Care System, Palo Alto California, USA
| | - Madhuri Agarwal
- Department of Veterans Affairs, Public Health Surveillance and Research, Washington DC, USA
| | - Cristina Cardemil
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Umesh Parashar
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Sara A Mirza
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Ryan U, Hill K, Deere D. Review of generic screening level assumptions for quantitative microbial risk assessment (QMRA) for estimating public health risks from Australian drinking water sources contaminated with Cryptosporidium by recreational activities. Water Res 2022; 220:118659. [PMID: 35635918 DOI: 10.1016/j.watres.2022.118659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Revised: 04/26/2022] [Accepted: 05/21/2022] [Indexed: 06/15/2023]
Abstract
As urban communities continue to grow, demand for recreational access (including swimming) in drinking water sources have increased, yet relatively little is understood about the public health implications this poses for drinking water consumers. Preventative risk-based approaches to catchment management, informed by quantitative microbial risk assessment (QMRA), requires accurate input data to effectively model risks. A sound understanding of the knowledge gaps is also important to comprehend levels of uncertainty and help prioritise research needs. Cryptosporidium is one of the most important causes of waterborne outbreaks of gastroenteritis globally due to its resistance to chlorine. This review was undertaken by Water Research Australia to provide the most up-to-date information on current Cryptosporidium epidemiological data and underlying assumptions for exposure assessment, dose response and risk assessment for generic components of QMRA for Cryptosporidium and highlights priorities for common research. Key interim recommendations and guidelines for numerical values for relatively simple screening level QMRA modelling are provided to help support prospective studies of risks to drinking water consumers from Cryptosporidium due to body-contact recreation in source water. The review does not cover site-specific considerations, such as the levels of activity in the source water, the influence of dilution and inactivation in reservoirs, or water treatment. Although the focus is Australia, the recommendations and numerical values developed in this review, and the highlighted research priorities, are broadly applicable across all drinking source water sources that allow recreational activities.
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Affiliation(s)
- U Ryan
- Harry Butler Institute, Murdoch University, 90 South Street, Perth, Australia.
| | - Kelly Hill
- Water Research Australia, 250 Victoria Square, Adelaide, South Australia, Australia
| | - Dan Deere
- Water Futures, Sydney, Australia and Water Research Australia, Australia
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Chang Q, Wang K, Zhang H, Li C, Wang Y, Jing H, Li S, Guo Y, Cui Z, Zhang W. Effects of daily mean temperature and other meteorological variables on bacillary dysentery in Beijing-Tianjin-Hebei region, China. Environ Health Prev Med 2022; 27:13. [PMID: 35314583 PMCID: PMC9251629 DOI: 10.1265/ehpm.21-00005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background Although previous studies have shown that meteorological factors such as temperature are related to the incidence of bacillary dysentery (BD), researches about the non-linear and interaction effect among meteorological variables remain limited. The objective of this study was to analyze the effects of temperature and other meteorological variables on BD in Beijing-Tianjin-Hebei region, which is a high-risk area for BD distribution. Methods Our study was based on the daily-scale data of BD cases and meteorological variables from 2014 to 2019, using generalized additive model (GAM) to explore the relationship between meteorological variables and BD cases and distributed lag non-linear model (DLNM) to analyze the lag and cumulative effects. The interaction effects and stratified analysis were developed by the GAM. Results A total of 147,001 cases were reported from 2014 to 2019. The relationship between temperature and BD was approximately liner above 0 °C, but the turning point of total temperature effect was 10 °C. Results of DLNM indicated that the effect of high temperature was significant on lag 5d and lag 6d, and the lag effect showed that each 5 °C rise caused a 3% [Relative risk (RR) = 1.03, 95% Confidence interval (CI): 1.02–1.05] increase in BD cases. The cumulative BD cases delayed by 7 days increased by 31% for each 5 °C rise in temperature above 10 °C (RR = 1.31, 95% CI: 1.30–1.33). The interaction effects and stratified analysis manifested that the incidence of BD was highest in hot and humid climates. Conclusions This study suggests that temperature can significantly affect the incidence of BD, and its effect can be enhanced by humidity and precipitation, which means that the hot and humid environment positively increases the incidence of BD. Supplementary information The online version contains supplementary material available at https://doi.org/10.1265/ehpm.21-00005.
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Affiliation(s)
- Qinxue Chang
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University
| | - Keyun Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University
| | - Honglu Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University
| | - Changping Li
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University
| | - Yong Wang
- Chinese PLA Center for Disease Control and Prevention
| | - Huaiqi Jing
- State Key Laboratory of Infectious Disease Prevention and Control, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention
| | - Shanshan Li
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University
| | - Yuming Guo
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University
| | - Zhuang Cui
- Department of Epidemiology and Biostatistics, School of Public Health, Tianjin Medical University
| | - Wenyi Zhang
- Chinese PLA Center for Disease Control and Prevention
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Zahedi A, Monis P, Deere D, Ryan U. Wastewater-based epidemiology-surveillance and early detection of waterborne pathogens with a focus on SARS-CoV-2, Cryptosporidium and Giardia. Parasitol Res 2021; 120:4167-4188. [PMID: 33409629 PMCID: PMC7787619 DOI: 10.1007/s00436-020-07023-5] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 12/14/2020] [Indexed: 12/21/2022]
Abstract
Waterborne diseases are a major global problem, resulting in high morbidity and mortality, and massive economic costs. The ability to rapidly and reliably detect and monitor the spread of waterborne diseases is vital for early intervention and preventing more widespread disease outbreaks. Pathogens are, however, difficult to detect in water and are not practicably detectable at acceptable concentrations that need to be achieved in treated drinking water (which are of the order one per million litre). Furthermore, current clinical-based surveillance methods have many limitations such as the invasive nature of the testing and the challenges in testing large numbers of people. Wastewater-based epidemiology (WBE), which is based on the analysis of wastewater to monitor the emergence and spread of infectious disease at a population level, has received renewed attention in light of the current coronavirus disease 2019 (COVID-19) pandemic. The present review will focus on the application of WBE for the detection and surveillance of pathogens with a focus on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and the waterborne protozoan parasites Cryptosporidium and Giardia. The review highlights the benefits and challenges of WBE and the future of this tool for community-wide infectious disease surveillance.
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Affiliation(s)
- Alireza Zahedi
- Harry Butler Institute, Murdoch University, Perth, Australia
| | - Paul Monis
- South Australian Water Corporation, Adelaide, Australia
| | - Daniel Deere
- Water Futures and Water Research Australia, Sydney, Australia
| | - Una Ryan
- Harry Butler Institute, Murdoch University, Perth, Australia.
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Mazumdar S, Fletcher-Lartey SM, Zajaczkowski P, Jalaludin B. Giardiasis notifications are associated with socioeconomic status in Sydney, Australia: a spatial analysis. Aust N Z J Public Health 2020; 44:508-513. [PMID: 33197099 DOI: 10.1111/1753-6405.13019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Revised: 05/01/2020] [Accepted: 06/01/2020] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE In developed countries prolonged symptoms due to, or following, Giardia intestinalis infection can have a significant impact on the quality of life. In this research, we investigate the presence of a socioeconomic status (SES) gradient in the reporting of giardiasis in South West Sydney Local Health District (SWSLHD), New South Wales (NSW), Australia, across geographic scales. METHODS We used a large database, spatial-cluster analysis and a linear model. RESULTS Firstly, we found one spatial cluster of giardiasis in one of the most advantaged neighbourhoods of SWSLHD. Secondly, rates of giardiasis notifications were significantly and consistently lower in SWSLHD compared to an unnamed advantaged Local Health District and NSW over multiple years. Finally, we found an overall significant positive dose-response relationship between counts of giardiasis and area-level SES. CONCLUSIONS Lower reporting in disadvantaged areas may represent true differences in incidence across SES groups or may result from differential use of health services and reporting. Implications for public health: If the disparities result from differential use of health services, research should be directed toward identifying barriers and facilitators of use. If disparities result from a true difference in incidence, then the behavioural mediators between SES and giardiasis should be identified and addressed.
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Affiliation(s)
- Soumya Mazumdar
- South Western Sydney Local Health District, Division of Population Health, New South Wales.,South Western Sydney Medical School, University of New South Wales
| | | | - Patricia Zajaczkowski
- South Western Sydney Local Health District, Division of Population Health, New South Wales.,School of Life Sciences, University of Technology Sydney, New South Wales
| | - Bin Jalaludin
- South Western Sydney Local Health District, Division of Population Health, New South Wales
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Ecollan M, Guerrisi C, Souty C, Rossignol L, Turbelin C, Hanslik T, Colizza V, Blanchon T. Determinants and risk factors of gastroenteritis in the general population, a web-based cohort between 2014 and 2017 in France. BMC Public Health 2020; 20:1146. [PMID: 32693787 PMCID: PMC7372820 DOI: 10.1186/s12889-020-09212-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 07/05/2020] [Indexed: 12/19/2022] Open
Abstract
Background Although it is rarely fatal in developed countries, acute gastroenteritis (AGE) still induces significant morbidity and economic costs. The objective of this study was to identify factors associated with AGE in winter in the general population. Methods A prospective study was performed during winter seasons from 2014 to 2015 to 2016–2017. Participants filled an inclusion survey and reported weekly data on acute symptoms. Factors associated with having at least one AGE episode per winter season were analyzed using the generalized estimating equations (GEE) approach. Results They were 13,974 participants included in the study over the three seasons. On average, 8.1% of participants declared at least one AGE episode during a winter season. People over 60 declared fewer AGE episodes (adjusted OR (aOR) = 0.76, 95% CI [0.64; 0.89]) compared to individuals between 15 and 60 years old, as well as children between 10 and 15 (aOR = 0.60 [0.37; 0.98]). Overweight (aOR = 1.25 [1.07; 1.45]) and obese (aOR = 1.47 [1.19; 1.81]) individuals, those having frequent cold (aOR = 1.63 [1.37; 1.94]) and those with at least one chronic condition (aOR = 1.35 [1.16; 1.58]) had more AGE episodes. Living alone was associated with a higher AGE episode rate (aOR = 1.31 [1.09; 1.59]), as well as having pets at home (aOR = 1.23 [1.08; 1.41]). Conclusions Having a better knowledge of AGE determinants will be useful to adapt public health prevention messages.
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Affiliation(s)
- Marie Ecollan
- Sorbonne Université, INSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique, IPLESP, F75012, Paris, France.,Department of Family Medicine, Faculté de Médecine, Université Paris Descartes, Paris, France
| | - Caroline Guerrisi
- Sorbonne Université, INSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique, IPLESP, F75012, Paris, France
| | - Cécile Souty
- Sorbonne Université, INSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique, IPLESP, F75012, Paris, France
| | - Louise Rossignol
- Sorbonne Université, INSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique, IPLESP, F75012, Paris, France.,Département de Médecine Générale, Université Paris Diderot, Paris, France
| | - Clément Turbelin
- Sorbonne Université, INSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique, IPLESP, F75012, Paris, France
| | - Thomas Hanslik
- Sorbonne Université, INSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique, IPLESP, F75012, Paris, France.,Service de Médecine Interne, Hôpital Ambroise-Paré, Assistance Publique - Hôpitaux de Paris, APHP, 92100, Boulogne-Billancourt, France.,UFR des Sciences de la Santé Simone-Veil, Université de Versailles Saint-Quentin-en-Yvelines, 78280, Versailles, France
| | - Vittoria Colizza
- Sorbonne Université, INSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique, IPLESP, F75012, Paris, France
| | - Thierry Blanchon
- Sorbonne Université, INSERM, Institut Pierre Louis d'épidémiologie et de Santé Publique, IPLESP, F75012, Paris, France.
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11
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Godínez-Oviedo A, Tamplin ML, Bowman JP, Hernández-Iturriaga M. Salmonella entericain Mexico 2000–2017: Epidemiology, Antimicrobial Resistance, and Prevalence in Food. Foodborne Pathog Dis 2020; 17:98-118. [DOI: 10.1089/fpd.2019.2627] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Affiliation(s)
- Angélica Godínez-Oviedo
- Departamento de Investigación y Posgrado de Alimentos (DIPA), Facultad de Química, Universidad Autónoma de Querétaro, Querétaro, México
| | - Mark L. Tamplin
- Food Safety and Innovation Centre, Tasmanian Institute of Agriculture, University of Tasmania, Hobart, Australia
| | - John P. Bowman
- Food Safety and Innovation Centre, Tasmanian Institute of Agriculture, University of Tasmania, Hobart, Australia
| | - Montserrat Hernández-Iturriaga
- Departamento de Investigación y Posgrado de Alimentos (DIPA), Facultad de Química, Universidad Autónoma de Querétaro, Querétaro, México
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12
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White AE, Ciampa N, Chen Y, Kirk M, Nesbitt A, Bruce BB, Walter ES. Characteristics of Campylobacter and Salmonella Infections and Acute Gastroenteritis in Older Adults in Australia, Canada, and the United States. Clin Infect Dis 2019; 69:1545-1552. [PMID: 30602004 PMCID: PMC6606397 DOI: 10.1093/cid/ciy1142] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 12/31/2018] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND The early detection of enteric infections in older adults is challenging because typical signs and symptoms of disease may be less common, absent, or overlooked. Understanding illness characteristics of enteric infections among older adults could improve the timeliness and accuracy of clinical diagnoses, thereby improving patient outcomes and increasing cases reported to surveillance. METHODS Here, we describe illness characteristics (percentage reporting bloody diarrhea, fever, vomiting, abdominal pain; percentage hospitalized; duration of hospitalization; and duration of illness) among older adults (≥65 years) with acute gastroenteritis and culture-confirmed Campylobacter and nontyphoidal Salmonella infections in Australia, Canada, and the United States and compare these characteristics with those among younger people (<5 years, 5-24 years, and 25-64 years). RESULTS A significant negative correlation was found between all symptoms and increasing age group, except for bloody diarrhea in cases of acute gastroenteritis. Adults aged ≥85 years reported bloody diarrhea in only 9% of nontyphoidal Salmonella and 4% of Campylobacter infections compared with 59% and 55% among children aged <5 years. Conversely, a greater percentage of older adults (≥65) than younger persons (<5, 5-24, 25-64) reported being hospitalized, with an increasing linear relationship in age groups 65 years and older. CONCLUSIONS Although older adults are more likely to have severe illness and be hospitalized, we found that the proportion of persons reporting symptoms typically associated with enteric infections decreases with age. These findings have implications for clinical recognition and treatment of gastrointestinal illness, as well as for public health research.
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Affiliation(s)
- Alice E. White
- Department of Epidemiology, Colorado School of Public Health, Aurora, CO, United States
| | - Nadia Ciampa
- Public Health Agency of Canada, Centre for Foodborne, Environmental, and Zoonotic Infectious Disease, Guelph, Ontario, Canada
| | - Yingxi Chen
- Australian National University, Canberra, Australian Capital Territory, Australia
| | - Martyn Kirk
- Australian National University, Canberra, Australian Capital Territory, Australia
| | - Andrea Nesbitt
- Public Health Agency of Canada, Centre for Foodborne, Environmental, and Zoonotic Infectious Disease, Guelph, Ontario, Canada
| | - Beau B. Bruce
- Enteric Diseases Epidemiology Branch, Centers for Disease Control and Prevention, Atlanta, Georgia, United States
| | - Elaine Scallan Walter
- Department of Epidemiology, Colorado School of Public Health, Aurora, CO, United States
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13
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Abstract
BACKGROUND Most of the patients with gastroenteritis seeking health care services are managed in primary care; yet, little is known about these consultations. Syndromic-based surveillance of gastrointestinal infections is used in several countries, including Norway. AIM To investigate the extent of, and explore characteristics associated with, consultations for gastroenteritis in primary care and to compare consultations in daytime general practice and out-of-hours (OOH) services in Norway. DESIGN AND SETTING Registry-based study using reimbursement claims data from all consultations in general practice and OOH services in Norway over the 10-year period, 2006-15. METHODS The main outcome variable was whether the consultation took place in general practice or OOH services. Possible associations with patient age and sex, time and use of point-of-care C-reactive protein (CRP) testing and sickness certificate issuing were investigated. RESULTS Gastroenteritis consultations (n = 1 281 048) represented 0.9% of all consultations in primary care (n = 140 199 637), of which 84.4% were conducted in general practice and 15.6% in OOH services. Young children and young adults dominated among the patients. Point-of-care CRP testing was used in 36.1% of the consultations. Sickness certificates were issued in 43.6% of consultations with patients in working age. Age-specific time variations in consultation frequencies peaking in winter months were observed. CONCLUSIONS The proportion of gastroenteritis consultations was higher in the OOH services when compared with daytime general practice. Young children and young adults dominated among the patients. The seasonal variation in consultation frequency is similar to that shown for gastroenteritis caused by norovirus.
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Affiliation(s)
- Knut Erik Emberland
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,Research Unit for General Practice, NORCE Norwegian Research Centre, Bergen, Norway
| | - Knut-Arne Wensaas
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,Research Unit for General Practice, NORCE Norwegian Research Centre, Bergen, Norway
| | - Sverre Litleskare
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,Research Unit for General Practice, NORCE Norwegian Research Centre, Bergen, Norway
| | - Guri Rortveit
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,Research Unit for General Practice, NORCE Norwegian Research Centre, Bergen, Norway
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14
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Pijnacker R, Mangen MJJ, van den Bunt G, Franz E, van Pelt W, Mughini-Gras L. Incidence and economic burden of community-acquired gastroenteritis in the Netherlands: Does having children in the household make a difference? PLoS One 2019; 14:e0217347. [PMID: 31120975 PMCID: PMC6532970 DOI: 10.1371/journal.pone.0217347] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 05/09/2019] [Indexed: 11/18/2022] Open
Abstract
This study aimed at estimating gastroenteritis (GE) incidence in all age groups of the Netherlands’ general population, with special emphasis on the role of children in GE burden, and the associated costs. Monthly from November 2014 to November 2016, a random sample of 2000 residents in the Netherlands was invited to complete a questionnaire on household characteristics and health complaints. We calculated GE incidence rates standardized to the Dutch population and used multivariable logistic regression models to identify potential risk factors. We calculated the costs related to resources used within the healthcare sector, the resources used by patients and their families, and productivity losses (paid worktime) due to GE. The overall standardized incidence rate was 0.81 GE episodes/person-year, with the highest rate in children ≤4 years (1.96 episodes/person-year). GE was observed more often in households with children (≤17 years), especially if children attended out-of-home childcare services, and among individuals with non-native Dutch ethnic background. Less GE was observed among employed persons aged 25–64 years, compared with those unemployed, but the opposite was observed in persons ≥65 years. The average costs per GE episode was €191, resulting in €945 million annual total costs for GE in the Netherlands (€55 per inhabitant). The majority of costs (55%) were attributable to productivity losses of the ill or their caregivers. In conclusion, GE still poses a significant burden, particularly in preschool children and adults living in households with children. Similar to other industrialized countries, the major factor driving the costs due to GE was the loss of productivity. This study also provides up-to-date baseline GE incidence rates and associated societal costs to better contextualize the burden of the disease in support of policy making.
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Affiliation(s)
- Roan Pijnacker
- Center for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
- * E-mail:
| | - Marie-Josée J. Mangen
- Center for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Gerrita van den Bunt
- Center for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht (UMCU), Utrecht, the Netherlands
| | - Eelco Franz
- Center for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Wilfrid van Pelt
- Center for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
| | - Lapo Mughini-Gras
- Center for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), Bilthoven, the Netherlands
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands
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15
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WU G, WANG L, WANG Q, HAN R, ZHAO J, CHU Z, ZHUANG M, ZHANG Y, WANG K, XIAO P, LIU Y, DU Z. Descriptive Study of Foodborne Disease Using Case Monitoring Data in Shandong Province, China, 2016-2017. Iran J Public Health 2019; 48:722-729. [PMID: 31110983 PMCID: PMC6500530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND In order to generate data on the burden of foodborne diseases in Shandong Province, we aimed to use the case monitoring data of foodborne diseases from 2016 to 2017 to estimate. METHODS Data were obtained from the foodborne disease surveillance reporting system with dates of onset from Jan 1, 2016, to Dec 31, 2017, in Shandong, China. RESULTS The places of food exposure were categorized by settings as follows: private home, catering facility, collective canteens, retail markets, rural banquets and other. Exposed food is divided into 23 categories. Overall incidence rate and proportions by exposure categories, age, and sex-specific incidence rates were calculated and sex proportions compared. Approximately 75.00% of cases who had at least one exposure settings were in private homes. The most frequently reported exposed food was a variety of food (meaning more than two kinds of food). The two-year average incidence rate was 75.78/100,000, sex-specific incidence rate was much higher for females compared to males (78.23 vs. 74.69 cases per 100,000 population). An age-specific trend was observed in the cases reported (Chi-Square for linear trend, χ2=4.39, P=0.036<0.05). CONCLUSION A preliminary estimate of 14 million cases of foodborne diseases in Shandong province each year. Future studies should focus on cross-sectional and cohort studies to facilitate the assessment of the distribution and burden of foodborne disease of the population in Shandong. Considering strengthening the burden of foodborne diseases in foodborne disease surveillance is also a feasible way.
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Affiliation(s)
- Guangjian WU
- School of Public Health, Jilin University, Changchun, China,Shandong Center for Disease Control and Prevention, Jinan, China,Shandong Center for Food Safety Risk Assessment, Jinan, China,Academy of Preventive Medicine, Shandong University, Jinan, China
| | - Liansen WANG
- Shandong Center for Disease Control and Prevention, Jinan, China,Shandong Center for Food Safety Risk Assessment, Jinan, China,Academy of Preventive Medicine, Shandong University, Jinan, China
| | - Qiang WANG
- Department of Preventive Medicine and Public Health Laboratory Science, School of Medicine, Jiangsu University, Zhenjiang, China
| | - Ru HAN
- Shandong Academy of Occupational Health and Occupational Medicine, Shandong Academy of Medical Sciences, Jinan, China
| | - Jinshan ZHAO
- Shandong Center for Disease Control and Prevention, Jinan, China,Shandong Center for Food Safety Risk Assessment, Jinan, China,Academy of Preventive Medicine, Shandong University, Jinan, China
| | - Zunhua CHU
- Shandong Center for Disease Control and Prevention, Jinan, China,Shandong Center for Food Safety Risk Assessment, Jinan, China,Academy of Preventive Medicine, Shandong University, Jinan, China
| | - Maoqiang ZHUANG
- Shandong Center for Disease Control and Prevention, Jinan, China,Shandong Center for Food Safety Risk Assessment, Jinan, China,Academy of Preventive Medicine, Shandong University, Jinan, China
| | - Yingxiu ZHANG
- Shandong Center for Disease Control and Prevention, Jinan, China,Shandong Center for Food Safety Risk Assessment, Jinan, China,Academy of Preventive Medicine, Shandong University, Jinan, China
| | - Kebo WANG
- Shandong Center for Disease Control and Prevention, Jinan, China,Shandong Center for Food Safety Risk Assessment, Jinan, China,Academy of Preventive Medicine, Shandong University, Jinan, China
| | - Peirui XIAO
- Shandong Center for Disease Control and Prevention, Jinan, China,Shandong Center for Food Safety Risk Assessment, Jinan, China,Academy of Preventive Medicine, Shandong University, Jinan, China
| | - Ya LIU
- School of Public Health, Jilin University, Changchun, China,Corresponding Author:
| | - Zhongjun DU
- Shandong Academy of Occupational Health and Occupational Medicine, Shandong Academy of Medical Sciences, Jinan, China,Corresponding Author:
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16
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Wright CJ, Sargeant JM, Edge VL, Ford JD, Farahbakhsh K, Shiwak I, Flowers C, Harper SL. Water quality and health in northern Canada: stored drinking water and acute gastrointestinal illness in Labrador Inuit. Environ Sci Pollut Res Int 2018; 25:32975-32987. [PMID: 28702908 DOI: 10.1007/s11356-017-9695-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Accepted: 06/09/2017] [Indexed: 06/07/2023]
Abstract
One of the highest self-reported incidence rates of acute gastrointestinal illness (AGI) in the global peer-reviewed literature occurs in Inuit communities in the Canadian Arctic. This high incidence of illness could be due, in part, to the consumption of contaminated water, as many northern communities face challenges related to the quality of municipal drinking water. Furthermore, many Inuit store drinking water in containers in the home, which could increase the risk of contamination between source and point-of-use (i.e., water recontamination during storage). To examine this risk, this research characterized drinking water collection and storage practices, identified potential risk factors for water contamination between source and point-of-use, and examined possible associations between drinking water contamination and self-reported AGI in the Inuit community of Rigolet, Canada. The study included a cross-sectional census survey that captured data on types of drinking water used, household practices related to drinking water (e.g., how it was collected and stored), physical characteristics of water storage containers, and self-reported AGI. Additionally, water samples were collected from all identified drinking water containers in homes and analyzed for presence of Escherichia coli and total coliforms. Despite municipally treated tap water being available in all homes, 77.6% of households had alternative sources of drinking water stored in containers, and of these containers, 25.2% tested positive for total coliforms. The use of transfer devices and water dippers (i.e., smaller bowls or measuring cups) for the collection and retrieval of water from containers were both significantly associated with increased odds of total coliform presence in stored water (ORtransfer device = 3.4, 95% CI 1.2-11.7; ORdipper = 13.4, 95% CI 3.8-47.1). Twenty-eight-day period prevalence of self-reported AGI during the month before the survey was 17.2% (95% CI 13.0-22.5), which yielded an annual incidence rate of 2.4 cases per person per year (95% CI 1.8-3.1); no water-related risk factors were significantly associated with AGI. Considering the high prevalence of, and risk factors associated with, indicator bacteria in drinking water stored in containers, potential exposure to waterborne pathogens may be minimized through interventions at the household level.
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Affiliation(s)
- Carlee J Wright
- Department of Population Medicine, University of Guelph, 50 Stone Road East, Guelph, Ontario, N1G 2W1, Canada.
| | - Jan M Sargeant
- Department of Population Medicine, University of Guelph, 50 Stone Road East, Guelph, Ontario, N1G 2W1, Canada
- Centre for Public Health and Zoonoses, Ontario Veterinary College, University of Guelph, 50 Stone Road East, Guelph, Ontario, N1G 2W1, Canada
| | - Victoria L Edge
- Public Health Agency of Canada, 160 Research Lane, Guelph, Ontario, N1G 5B2, Canada
- Indigenous Health Adaptation to Climate Change, Montréal, Canada
| | - James D Ford
- Indigenous Health Adaptation to Climate Change, Montréal, Canada
- Priestly International Centre for Climate, University of Leeds, Leeds, LS2 9JT, UK
- Department of Geography, McGill University, 845 Rue Sherbrooke Ouest, Montréal, Québec, H3A 0G4, Canada
| | - Khosrow Farahbakhsh
- School of Engineering, University of Guelph, 50 Stone Road East, Guelph, Ontario, N1G 2W1, Canada
| | - Inez Shiwak
- Rigolet Inuit Community Government, Rigolet, Labrador, A0P 1P0, Canada
| | - Charlie Flowers
- Rigolet Inuit Community Government, Rigolet, Labrador, A0P 1P0, Canada
| | - Sherilee L Harper
- Department of Population Medicine, University of Guelph, 50 Stone Road East, Guelph, Ontario, N1G 2W1, Canada.
- Indigenous Health Adaptation to Climate Change, Montréal, Canada.
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17
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Zahedi A, Monis P, Gofton AW, Oskam CL, Ball A, Bath A, Bartkow M, Robertson I, Ryan U. Cryptosporidium species and subtypes in animals inhabiting drinking water catchments in three states across Australia. Water Res 2018; 134:327-340. [PMID: 29438893 DOI: 10.1016/j.watres.2018.02.005] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 01/22/2018] [Accepted: 02/04/2018] [Indexed: 06/08/2023]
Abstract
As part of long-term monitoring of Cryptosporidium in water catchments serving Western Australia, New South Wales (Sydney) and Queensland, Australia, we characterised Cryptosporidium in a total of 5774 faecal samples from 17 known host species and 7 unknown bird samples, in 11 water catchment areas over a period of 30 months (July 2013 to December 2015). All samples were initially screened for Cryptosporidium spp. at the 18S rRNA locus using a quantitative PCR (qPCR). Positives samples were then typed by sequence analysis of an 825 bp fragment of the 18S gene and subtyped at the glycoprotein 60 (gp60) locus (832 bp). The overall prevalence of Cryptosporidium across the various hosts sampled was 18.3% (1054/5774; 95% CI, 17.3-19.3). Of these, 873 samples produced clean Sanger sequencing chromatograms, and the remaining 181 samples, which initially produced chromatograms suggesting the presence of multiple different sequences, were re-analysed by Next- Generation Sequencing (NGS) to resolve the presence of Cryptosporidium and the species composition of potential mixed infections. The overall prevalence of confirmed mixed infection was 1.7% (98/5774), and in the remaining 83 samples, NGS only detected one species of Cryptosporidium. Of the 17 Cryptosporidium species and four genotypes detected (Sanger sequencing combined with NGS), 13 are capable of infecting humans; C. parvum, C. hominis, C. ubiquitum, C. cuniculus, C. meleagridis, C. canis, C. felis, C. muris, C. suis, C. scrofarum, C. bovis, C. erinacei and C. fayeri. Oocyst numbers per gram of faeces (g-1) were also determined using qPCR, with medians varying from 6021-61,064 across the three states. The significant findings were the detection of C. hominis in cattle and kangaroo faeces and the high prevalence of C. parvum in cattle. In addition, two novel C. fayeri subtypes (IVaA11G3T1 and IVgA10G1T1R1) and one novel C. meleagridis subtype (IIIeA18G2R1) were identified. This is also the first report of C. erinacei in Australia. Future work to monitor the prevalence of Cryptosporidium species and subtypes in animals in these catchments is warranted.
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Affiliation(s)
- Alireza Zahedi
- School of Veterinary and Life Sciences, Murdoch University, Perth, Australia
| | - Paul Monis
- Australian Water Quality Centre, South Australian Water Corporation, Adelaide, Australia
| | - Alexander W Gofton
- School of Veterinary and Life Sciences, Murdoch University, Perth, Australia
| | - Charlotte L Oskam
- School of Veterinary and Life Sciences, Murdoch University, Perth, Australia
| | | | | | | | - Ian Robertson
- School of Veterinary and Life Sciences, Murdoch University, Perth, Australia; China-Australia Joint Research and Training Center for Veterinary Epidemiology, College of Veterinary Medicine, Huazhong Agricultural University, Wuhan 430070, China
| | - Una Ryan
- School of Veterinary and Life Sciences, Murdoch University, Perth, Australia.
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18
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Barker SF, Zomer E, O'Toole J, Sinclair M, Gibney K, Liew D, Leder K. Cost of gastroenteritis in Australia: A healthcare perspective. PLoS One 2018; 13:e0195759. [PMID: 29649285 DOI: 10.1371/journal.pone.0195759] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Accepted: 03/28/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Acute gastroenteritis illness is a common illness that causes considerable morbidity, but current estimates of the cost to the Australian healthcare system are unknown. OBJECTIVE To estimate the current healthcare utilisation and direct public healthcare system costs attributable to acute gastroenteritis illness in Australia. METHODS This is an incidence-based cost-of-illness study focused on quantifying direct health care costs using a bottom-up approach. Data on general practitioner consultations, prescribed medications, diagnostic tests, specialist consultations, emergency department visits and hospital admissions were collected from national reports. RESULTS Using 2016 prices, the estimated annual direct per capita cost of acute gastroenteritis illness was AUD$14.87 (USD$10.71), equating to AUD$20.27 (USD$14.59) per case. The estimated overall economic burden in Australia was AUD$359 million (USD$258 million; AUD$1.5 million per 100,000 people). The major contributors to this cost were hospital admissions (57.1%), emergency department visits (17.7%), and general practitioner consultations (14.0%). Children under five years of age have the highest per capita rates of acute gastroenteritis illness; however, service utilisation rates vary by age group and both young children and older adults accounted for a substantial proportion of the overall economic burden attributable to acute gastroenteritis illness. CONCLUSIONS Although chronic diseases comprise a large cost burden on the healthcare system, acute illnesses, including acute gastroenteritis illness, also impose substantial direct healthcare system costs. Providing data on current cost estimates is useful for prioritizing public health interventions, with our findings suggesting that it would be ideal if targeted interventions to reduce hospitalisation rates among young children and older adults were available.
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19
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Adams NL, Rose TC, Hawker J, Violato M, O’Brien SJ, Whitehead M, Barr B, Taylor-Robinson DC. Socioeconomic status and infectious intestinal disease in the community: a longitudinal study (IID2 study). Eur J Public Health 2018; 28:134-138. [PMID: 29016791 PMCID: PMC5965370 DOI: 10.1093/eurpub/ckx091] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background Infectious intestinal diseases (IID) are common, affecting around 25% of people in UK each year at an estimated annual cost to the economy, individuals and the NHS of £1.5 billion. While there is evidence of higher IID hospital admissions in more disadvantaged groups, the association between socioeconomic status (SES) and risk of IID remains unclear. This study aims to investigate the relationship between SES and IID in a large community cohort. Methods Longitudinal analysis of a prospective community cohort in the UK following 6836 participants of all ages was undertaken. Hazard ratios for IID by SES were estimated using Cox proportional hazard, adjusting for follow-up time and potential confounding factors. Results In the fully adjusted analysis, hazard ratio of IID was significantly lower among routine/manual occupations compared with managerial/professional occupations (HR 0.74, 95% CI 0.61-0.90). Conclusion In this large community cohort, lower SES was associated with lower IID risk. This may be partially explained by the low response rate which varied by SES. However, it may be related to differences in exposure or recognition of IID symptoms by SES. Higher hospital admissions associated with lower SES observed in some studies could relate to more severe consequences, rather than increased infection risk.
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Affiliation(s)
- Natalie L Adams
- NIHR Health Protection Research Unit in Gastrointestinal Infections,
Liverpool, UK
- Department of Public Health and Policy, University of Liverpool,
Liverpool, UK
- National Infection Service, Public Health England, London/Birmingham,
UK
| | - Tanith C Rose
- NIHR Health Protection Research Unit in Gastrointestinal Infections,
Liverpool, UK
- Department of Public Health and Policy, University of Liverpool,
Liverpool, UK
| | - Jeremy Hawker
- NIHR Health Protection Research Unit in Gastrointestinal Infections,
Liverpool, UK
- National Infection Service, Public Health England, London/Birmingham,
UK
| | - Mara Violato
- NIHR Health Protection Research Unit in Gastrointestinal Infections,
Liverpool, UK
- Health Economics Research Centre, University of Oxford, Oxford, UK
| | - Sarah J O’Brien
- NIHR Health Protection Research Unit in Gastrointestinal Infections,
Liverpool, UK
- Department of Public Health and Policy, University of Liverpool,
Liverpool, UK
| | - Margaret Whitehead
- NIHR Health Protection Research Unit in Gastrointestinal Infections,
Liverpool, UK
- Department of Public Health and Policy, University of Liverpool,
Liverpool, UK
| | - Benjamin Barr
- NIHR Health Protection Research Unit in Gastrointestinal Infections,
Liverpool, UK
- Department of Public Health and Policy, University of Liverpool,
Liverpool, UK
| | - David C Taylor-Robinson
- NIHR Health Protection Research Unit in Gastrointestinal Infections,
Liverpool, UK
- Department of Public Health and Policy, University of Liverpool,
Liverpool, UK
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Thomas MK, Murray R, Nesbitt A, Pollari F. The Incidence of Acute Gastrointestinal Illness in Canada, Foodbook Survey 2014-2015. Can J Infect Dis Med Microbiol 2017; 2017:5956148. [PMID: 29410684 DOI: 10.1155/2017/5956148] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Revised: 09/15/2017] [Accepted: 09/24/2017] [Indexed: 12/25/2022]
Abstract
Acute gastrointestinal illness (AGI) is an important public health issue, with many pathogen sources and modes of transmission. A one-year telephone survey was conducted in Canada (2014-2015) to estimate the incidence of self-reported AGI in the previous 28 days and to describe health care seeking behaviour, using a symptom-based case definition. Excluding cases with respiratory symptoms, it is estimated that there are 0.57 self-reported AGI episodes per person-year, almost 19.5 million episodes in Canada each year. The proportion of cases seeking medical care was nearly 9%, of which 17% reported being requested to submit a sample for laboratory testing, and 49% of those requested complied and provided a sample. Results can be used to inform burden of illness and source attribution studies and indicate that AGI continues to be an important public health issue in Canada.
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Abstract
Foodborne illness, the majority of which is caused by enteric infectious agents, costs global economies billions of dollars each year. The protozoan parasite Cryptosporidium is particularly suited to foodborne transmission and is responsible for >8 million cases of foodborne illness annually. Procedures have been developed for sensitive detection of Cryptosporidium oocysts on fresh produce and molecular diagnostic assays have been widely used in case linkages and infection source tracking, especially during outbreak investigations. The integrated use of advanced diagnostic techniques with conventional epidemiological studies is essential to improve our understanding of the occurrence, source and epidemiology of foodborne cryptosporidiosis. The implementation of food safety management tools such as Good Hygienic Practices (GHP), Hazard Analysis and Critical Control Points (HACCP), and Quantitative Microbial Risk Assessment (QMRA) in industrialised nations and Water, Sanitation, and Hygiene (WASH) in developing countries is central for prevention and control and foodborne cryptosporidiosis in the future.
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Affiliation(s)
- Una Ryan
- School of Veterinary and Life Sciences, Vector- and Water-Borne Pathogen Research Group, Murdoch University, Murdoch, Western Australia 6150, Australia.
| | - Nawal Hijjawi
- Department of Medical Laboratory Sciences, Faculty of Allied Health Sciences, The Hashemite University, PO Box 150459, Zarqa 13115, Jordan
| | - Lihua Xiao
- Centers for Disease Control and Prevention, Atlanta, GA 30329, USA
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Hawash YA, Ismail KA, Almehmadi M. High Frequency of Enteric Protozoan, Viral, and Bacterial Potential Pathogens in Community-Acquired Acute Diarrheal Episodes: Evidence Based on Results of Luminex Gastrointestinal Pathogen Panel Assay. Korean J Parasitol 2017; 55:513-521. [PMID: 29103266 PMCID: PMC5678467 DOI: 10.3347/kjp.2017.55.5.513] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 09/05/2017] [Accepted: 09/24/2017] [Indexed: 02/04/2023]
Abstract
Infectious diarrhea is endemic in most developing countries. We aimed to investigate the protozoan, viral, and bacterial causes of acute diarrhea in Taif, Saudi Arabia. A cross-sectional prospective 1-year study was conducted on 163 diarrheal patients of various ages. Stool samples were collected, 1 per patient, and tested for 3 protozoa, 3 viruses, and 9 bacteria with the Luminex Gastrointestinal Pathogen Panel. Overall, 53.4% (87/163) of samples were positives (20.8% protozoa, 19.6% viruses, 2.8% bacteria, and 9.8% mixed). Rotavirus (19.6%), Giardia duodenalis (16.5%), and Cryptosporidium spp. (8.5%) were the mostly detected pathogens. Adenovirus 40/41 (4.2%), Salmonella (3%), Shiga toxin-producing Escherichia coli (3%), and Entamoeba histolytica (2.4%) were also detected. Norovirus GI/II, Vibrio cholerae, Yersinia enterocolitica, and Clostridium difficile toxin A/B were not detected in any patients. All pathogens were involved in coinfections except E. histolytica. Giardia (5.5%) and rotavirus (3%) were the most commonly detected in co-infections. Enterotoxigenic E. coli (2.4%), Campylobacter spp. (2.4%), E. coli 0157 (1.8%), and Shigella spp. (1.2%) were detected in patients only as co-infections. Infections were more in children 0–4 years, less in adults <40 years, and least >40 years, with statistically significant differences in risk across age groups observed with rotavirus (P<0.001), Giardia (P=0.006), and Cryptosporidium (P=0.036) infections. Lastly, infections were not significantly more in the spring. This report demonstrates the high burden of various enteropathogens in the setting. Further studies are needed to define the impact of these findings on the clinical course of the disease.
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Affiliation(s)
- Yousry A Hawash
- Medical Laboratory Department, Faculty of Applied Medical Science, Taif University, Taif, Saudi Arabia.,Clinical and Molecular Parasitology Department, National Liver Institute (NLI), Menoufia University, Shebin Al Koom, Menoufia, Egypt
| | - Khadiga A Ismail
- Medical Laboratory Department, Faculty of Applied Medical Science, Taif University, Taif, Saudi Arabia.,Parasitology Department, Faculty of Medicine, Ain-Shams University, Cairo, Egypt
| | - Mazen Almehmadi
- Medical Laboratory Department, Faculty of Applied Medical Science, Taif University, Taif, Saudi Arabia
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23
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Ng-hublin JS, Combs B, Reid S, Ryan U. Differences in the occurrence and epidemiology of cryptosporidiosis in Aboriginal and non-Aboriginal people in Western Australia (2002 − 2012). Infection, Genetics and Evolution 2017; 53:100-6. [DOI: 10.1016/j.meegid.2017.05.018] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 05/16/2017] [Accepted: 05/20/2017] [Indexed: 01/08/2023]
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Milazzo A, Giles LC, Zhang Y, Koehler AP, Hiller JE, Bi P. The effects of ambient temperature and heatwaves on daily Campylobacter cases in Adelaide, Australia, 1990–2012. Epidemiol Infect 2017; 145:2603-10. [DOI: 10.1017/s095026881700139x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
SUMMARYCampylobacterspp. is a commonly reported food-borne disease with major consequences for morbidity. In conjunction with predicted increases in temperature, proliferation in the survival of microorganisms in hotter environments is expected. This is likely to lead, in turn, to an increase in contamination of food and water and a rise in numbers of cases of infectious gastroenteritis. This study assessed the relationship ofCampylobacterspp. with temperature and heatwaves, in Adelaide, South Australia.We estimated the effect of (i) maximum temperature and (ii) heatwaves on dailyCampylobactercases during the warm seasons (1 October to 31 March) from 1990 to 2012 using Poisson regression models.There was no evidence of a substantive effect of maximum temperature per 1 °C rise (incidence rate ratio (IRR) 0·995, 95% confidence interval (95% CI) 0·993–0·997) nor heatwaves (IRR 0·906, 95% CI 0·800–1·026) onCampylobactercases. In relation to heatwave intensity, which is the daily maximum temperature during a heatwave, notifications decreased by 19% within a temperature range of 39–40·9 °C (IRR 0·811, 95% CI 0·692–0·952). We found little evidence of an increase in risk and lack of association betweenCampylobactercases and temperature or heatwaves in the warm seasons. Heatwave intensity may play a role in that notifications decreased with higher temperatures. Further examination of the role of behavioural and environmental factors in an effort to reduce the risk of increasedCampylobactercases is warranted.
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Milazzo A, Giles LC, Zhang Y, Koehler AP, Hiller JE, Bi P. Heatwaves differentially affect risk of Salmonella serotypes. J Infect 2016; 73:231-40. [PMID: 27317378 DOI: 10.1016/j.jinf.2016.04.034] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Revised: 04/05/2016] [Accepted: 04/20/2016] [Indexed: 12/20/2022]
Abstract
OBJECTIVES Given increasing frequency of heatwaves and growing public health concerns associated with foodborne disease, we examined the relationship between heatwaves and salmonellosis in Adelaide, Australia. METHODS Poisson regression analysis with Generalised Estimating Equations was used to estimate the effect of heatwaves and the impact of intensity, duration and timing on salmonellosis and specific serotypes notified from 1990 to 2012. Distributed lag non-linear models were applied to assess the non-linear and delayed effects of temperature during heatwaves on Salmonella cases. RESULTS Salmonella typhimurium PT135 notifications were sensitive to the effects of heatwaves with a twofold (IRR 2.08, 95% CI 1.14-3.79) increase in cases relative to non-heatwave days. Heatwave intensity had a significant effect on daily counts of overall salmonellosis with a 34% increase in risk of infection (IRR 1.34, 95% CI 1.01-1.78) at >41 °C. The effects of temperature during heatwaves on Salmonella cases and serotypes were found at lags of up to 14 days. CONCLUSION This study confirms heatwaves have a significant effect on Salmonella cases, and for the first time, identifies its impact on specific serotypes and phage types. These findings will contribute to the understanding of the impact of heatwaves on salmonellosis and provide insights that could mitigate their impact.
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Affiliation(s)
- Adriana Milazzo
- School of Public Health, The University of Adelaide, Adelaide, 5000, South Australia, Australia.
| | - Lynne C Giles
- School of Public Health, The University of Adelaide, Adelaide, 5000, South Australia, Australia.
| | - Ying Zhang
- School of Public Health, The University of Adelaide, Adelaide, 5000, South Australia, Australia; School of Public Health, The University of Sydney, Sydney, 2006, New South Wales, Australia.
| | - Ann P Koehler
- Communicable Disease Control Branch, Department for Health and Ageing, Adelaide, 5000, South Australia, Australia.
| | - Janet E Hiller
- School of Public Health, The University of Adelaide, Adelaide, 5000, South Australia, Australia; School of Health Sciences, Swinburne University of Technology, Melbourne, 3122, Victoria, Australia.
| | - Peng Bi
- School of Public Health, The University of Adelaide, Adelaide, 5000, South Australia, Australia.
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Zhang H, Si Y, Wang X, Gong P. Patterns of Bacillary Dysentery in China, 2005-2010. Int J Environ Res Public Health 2016; 13:164. [PMID: 26828503 PMCID: PMC4772184 DOI: 10.3390/ijerph13020164] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Revised: 01/19/2016] [Accepted: 01/21/2016] [Indexed: 02/06/2023]
Abstract
Although the incidence of bacillary dysentery in China has been declining progressively, a considerable disease burden still exists. Few studies have analyzed bacillary dysentery across China and knowledge gaps still exist in the aspects of geographic distribution and ecological drivers, seasonality and its association with meteorological factors, urban-rural disparity, prevalence and distribution of Shigella species. Here, we performed nationwide analyses to fill the above gaps. Geographically, we found that incidence increased along an east-west gradient which was inversely related to the economic conditions of China. Two large endemically high-risk regions in western China and their ecological drivers were identified for the first time. We characterized seasonality of bacillary dysentery incidence and assessed its association with meteorological factors, and saw that it exhibits north-south differences in peak duration, relative amplitude and key meteorological factors. Urban and rural incidences among China’s cities were compared, and disparity associated with urbanization level was invariant in most cities. Balanced decrease of urban and rural incidence was observed for all provinces except Hunan. S. flexneri and S. sonnei were identified as major causative species. Increasing prevalence of S. sonnei and geographic distribution of Shigella species were associated with economic status. Findings and inferences from this study draw broader pictures of bacillary dysentery in mainland China and could provide useful information for better interventions and public health planning.
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Affiliation(s)
- Han Zhang
- Ministry of Education Key Laboratory for Earth System Modeling, Center for Earth System Science, Institute for Global Change Studies, Tsinghua University, Beijing 100084, China.
| | - Yali Si
- Ministry of Education Key Laboratory for Earth System Modeling, Center for Earth System Science, Institute for Global Change Studies, Tsinghua University, Beijing 100084, China.
- Joint Center for Global Change Studies, Beijing 100875, China.
| | - Xiaofeng Wang
- Center for Disease Surveillance and Information Services, Chinese Center for Disease Control and Prevention, Beijing 102206, China.
| | - Peng Gong
- Ministry of Education Key Laboratory for Earth System Modeling, Center for Earth System Science, Institute for Global Change Studies, Tsinghua University, Beijing 100084, China.
- Joint Center for Global Change Studies, Beijing 100875, China.
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Fletcher S, Sibbritt D, Stark D, Harkness J, Rawlinson W, Andresen D, Van Hal S, Merif J, Ellis J. Descriptive epidemiology of infectious gastrointestinal illnesses in Sydney, Australia, 2007-2010. Western Pac Surveill Response J 2015; 6:7-16. [PMID: 26798556 DOI: 10.5365/WPSAR.2015.6.2.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE There is a lack of information about the prevalence of gastrointestinal illnesses in Australia. Current disease surveillance systems capture only a few pathogens. The aim of this study is to describe the epidemiology of infectious gastrointestinal illnesses in Sydney, Australia. METHODS A retrospective cross-sectional study of patients with gastrointestinal symptoms who visited tertiary public hospitals in Sydney was conducted between 2007 and 2010. Patients with diarrhoea or loose stools with an enteric pathogen detected were identified. Demographic, clinical and potential risk factor data were collected from their medical records. Measures of association, descriptive and inferential statistics were analysed. RESULTS In total, 1722 patients were included in this study. Campylobacter (22.0%) and Clostridium difficile (19.2%) were the most frequently detected pathogens. Stratified analysis showed that rotavirus (22.4%), norovirus (20.7%) and adenovirus (18.1%) mainly affected children under 5 years; older children (5-12 years) were frequently infected with Campylobacter spp. (29.8%) and non-typhoid Salmonella spp. (24.4%); infections with C. difficile increased with age.Campylobacter and non-typhoid Salmonella spp. showed increased incidence in summer months (December to February), while rotavirus infections peaked in the cooler months (June to November). DISCUSSION This study revealed that gastrointestinal illness remains a major public health issue in Sydney. Improvement of current disease surveillance and prevention and control measures are required. This study emphasizes the importance of laboratory diagnosis of enteric infections and the need for better clinical data collection to improve management of disease risk factors in the community.
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Lal A, Fearnley E, Kirk M. The Risk of Reported Cryptosporidiosis in Children Aged <5 Years in Australia is Highest in Very Remote Regions. Int J Environ Res Public Health 2015; 12:11815-28. [PMID: 26393636 PMCID: PMC4586709 DOI: 10.3390/ijerph120911815] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Revised: 08/25/2015] [Accepted: 08/26/2015] [Indexed: 12/29/2022]
Abstract
The incidence of cryptosporidiosis is highest in children <5 years, yet little is known about disease patterns across urban and rural areas of Australia. In this study, we examine whether the risk of reported cryptosporidiosis in children <5 years varies across an urban-rural gradient, after controlling for season and gender. Using Australian data on reported cryptosporidiosis from 2001 to 2012, we spatially linked disease data to an index of geographic remoteness to examine the geographic variation in cryptosporidiosis risk using negative binomial regression. The Incidence Risk Ratio (IRR) of reported cryptosporidiosis was higher in inner regional (IRR 1.4 95% CI 1.2–1.7, p < 0.001), and outer regional areas (IRR 2.4 95% CI 2.2–2.9, p < 0.001), and in remote (IRR 5.2 95% CI 4.3–6.2, p < 0.001) and very remote (IRR 8.2 95% CI 6.9–9.8, p < 0.001) areas, compared to major cities. A linear test for trend showed a statistically significant trend with increasing remoteness. Remote communities need to be a priority for future targeted health promotion and disease prevention interventions to reduce cryptosporidiosis in children <5 years.
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Affiliation(s)
- Aparna Lal
- National Centre for Epidemiology and Population Health, Building 62, Australian National University, Acton, Canberra 2602, Australia.
| | - Emily Fearnley
- National Centre for Epidemiology and Population Health, Building 62, Australian National University, Acton, Canberra 2602, Australia.
| | - Martyn Kirk
- National Centre for Epidemiology and Population Health, Building 62, Australian National University, Acton, Canberra 2602, Australia.
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Abstract
Foodborne disease is a major public health problem worldwide. To examine changes in foodborne illness in Australia, we estimated the incidence, hospitalizations, and deaths attributed to contaminated food circa 2010 and recalculated estimates from circa 2000. Approximately 25% of gastroenteritis cases were caused by contaminated food; to account for uncertainty we used simulation techniques to estimate 90% credible intervals. We estimate that circa 2010, 4.1 million foodborne gastroenteritis cases occurred, and circa 2000, 4.3 million cases occurred. Circa 2010, contaminated food was estimated to be responsible for 30,840 gastroenteritis-associated hospitalizations, 76 associated deaths, and 5,140 nongastrointestinal illnesses. Cases of salmonellosis and campylobacteriosis increased from 2000 to 2010 and were the leading causes of gastroenteritis-associated hospitalizations; Listeria monocytogenes and nontyphoidal Salmonella spp. infections were the leading causes of death. Although the overall incidence of foodborne illnesses declined over time in Australia, cases of foodborne gastroenteritis are still common.
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30
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Chen Y, Ford L, Hall G, Dobbins T, Kirk M. Healthcare utilization and lost productivity due to infectious gastroenteritis, results from a national cross-sectional survey Australia 2008-2009. Epidemiol Infect 2016; 144:241-6. [PMID: 26095130 DOI: 10.1017/S0950268815001375] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
The aim of this study was to estimate the healthcare usage and loss of productivity due to gastroenteritis in Australia using the National Gastroenteritis Survey II. In 2008-2009, 7578 participants across Australia were surveyed about infectious gastroenteritis by telephone interview. A gastroenteritis case was defined as a person experiencing ⩾ 3 loose stools and/or ⩾ 2 vomits in a 24-h period, excluding cases with a non-infectious cause for their symptoms, such as pregnancy or consumption of alcohol. Lost productivity was considered any lost time from full- or part-time paid work due to having gastroenteritis or caring for someone with the illness. Interference with other daily activities was also examined along with predictors of healthcare-seeking practices using multivariable regression. Results were weighted to obtain nationally representative estimates using Stata v. 13·1. Of the 341 cases, 52 visited a doctor due to gastroenteritis, 126 reported taking at least one medication for their symptoms and 79 cases reported missing ⩾ 1 days' paid work due to gastroenteritis. Gastroenteritis results in a total of 13·1 million (95% confidence interval 6·7-19·5) days of missed paid work each year in Australia. The indirect costs of gastroenteritis are significant, particularly from lost productivity.
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Abstract
The last century has been marked by major advances in the understanding of microbial disease risks from water supplies and significant changes in expectations of drinking water safety. The focus of drinking water quality regulation has moved progressively from simple prevention of detectable waterborne outbreaks towards adoption of health-based targets that aim to reduce infection and disease to a level well below detection limits at the community level. This review outlines the changes in understanding of community disease and waterborne risks that prompted development of these targets, and also describes their underlying assumptions and current context. Issues regarding the appropriateness of selected target values, and how continuing changes in knowledge and practice may influence their evolution, are also discussed.
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Affiliation(s)
- Martha Sinclair
- Department of Epidemiology and Preventive Medicine, Monash University, The Alfred Centre, 99 Commercial Road, Melbourne, VIC 3004, Australia E-mail:
| | - Joanne O'Toole
- Department of Epidemiology and Preventive Medicine, Monash University, The Alfred Centre, 99 Commercial Road, Melbourne, VIC 3004, Australia E-mail:
| | - Katherine Gibney
- Department of Epidemiology and Preventive Medicine, Monash University, The Alfred Centre, 99 Commercial Road, Melbourne, VIC 3004, Australia E-mail:
| | - Karin Leder
- Department of Epidemiology and Preventive Medicine, Monash University, The Alfred Centre, 99 Commercial Road, Melbourne, VIC 3004, Australia E-mail:
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Harper SL, Edge VL, Ford J, Thomas MK, Pearl D, Shirley J, McEwen SA. Healthcare use for acute gastrointestinal illness in two Inuit communities: Rigolet and Iqaluit, Canada. Int J Circumpolar Health 2015; 74:26290. [PMID: 26001982 PMCID: PMC4441732 DOI: 10.3402/ijch.v74.26290] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Revised: 03/15/2015] [Accepted: 03/22/2015] [Indexed: 01/19/2023] Open
Abstract
Background The incidence of self-reported acute gastrointestinal illness (AGI) in Rigolet, Nunatsiavut, and Iqaluit, Nunavut, is higher than reported elsewhere in Canada; as such, understanding AGI-related healthcare use is important for healthcare provision, public health practice and surveillance of AGI. Objectives This study described symptoms, severity and duration of self-reported AGI in the general population and examined the incidence and factors associated with healthcare utilization for AGI in these 2 Inuit communities. Design Cross-sectional survey data were analysed using multivariable exact logistic regression to examine factors associated with individuals’ self-reported healthcare and over-the-counter (OTC) medication utilization related to AGI symptoms. Results In Rigolet, few AGI cases used healthcare services [4.8% (95% CI=1.5–14.4%)]; in Iqaluit, some cases used healthcare services [16.9% (95% CI=11.2–24.7%)]. Missing traditional activities due to AGI (OR=3.8; 95% CI=1.18–12.4) and taking OTC medication for AGI symptoms (OR=3.8; 95% CI=1.2–15.1) were associated with increased odds of using healthcare services in Iqaluit. In both communities, AGI severity and secondary symptoms (extreme tiredness, headache, muscle pains, chills) were significantly associated with increased odds of taking OTC medication. Conclusions While rates of self-reported AGI were higher in Inuit communities compared to non-Inuit communities in Canada, there were lower rates of AGI-related healthcare use in Inuit communities compared to other regions in Canada. As such, the rates of healthcare use for a given disease can differ between Inuit and non-Inuit communities, and caution should be exercised in making comparisons between Inuit and non-Inuit health outcomes based solely on clinic records and healthcare use.
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Affiliation(s)
- Sherilee L Harper
- Department of Population Medicine, University of Guelph, Guelph, Ontario, Canada;
| | - Victoria L Edge
- Department of Population Medicine, University of Guelph, Guelph, Ontario, Canada.,Office of Public Health Practice, Public Health Agency of Canada, Guelph, Ontario, Canada
| | - James Ford
- Department of Geography, McGill University, Montreal, Quebec, Canada
| | - M Kate Thomas
- Department of Population Medicine, University of Guelph, Guelph, Ontario, Canada.,Centre for Food-borne, Environmental & Zoonotic Infectious Diseases, Public Health Agency of Canada, Guelph, Ontario, Canada
| | - David Pearl
- Department of Population Medicine, University of Guelph, Guelph, Ontario, Canada
| | - Jamal Shirley
- Nunavut Research Institute, Iqaluit, Nunavut, Canada
| | | | | | - Scott A McEwen
- Department of Population Medicine, University of Guelph, Guelph, Ontario, Canada
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Harper SL, Edge VL, Ford J, Thomas MK, Pearl DL, Shirley J, McEwen SA; IHACC. Acute gastrointestinal illness in two Inuit communities: burden of illness in Rigolet and Iqaluit, Canada. Epidemiol Infect 2015; 143:3048-63. [PMID: 25697261 DOI: 10.1017/S0950268814003744] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Food- and waterborne disease is thought to be high in some Canadian Indigenous communities; however, the burden of acute gastrointestinal illness (AGI) is not well understood due to limited availability and quality of surveillance data. This study estimated the burden of community-level self-reported AGI in the Inuit communities of Rigolet, Nunatsiavut, and Iqaluit, Nunavut, Canada. Cross-sectional retrospective surveys captured information on AGI and potential environmental risk factors. Multivariable logistic regression models identified potential AGI risk factors. The annual incidence of AGI ranged from 2·9-3·9 cases/person per year in Rigolet and Iqaluit. In Rigolet, increased spending on obtaining country foods, a homeless person in the house, not visiting a cabin recently, exposure to puppies, and alternative sources of drinking water were associated with increased odds of AGI. In Iqaluit, eating country fish often, exposure to cats, employment status of the person responsible for food preparation, not washing the countertop with soap after preparing meat, a homeless person in the house, and overcrowding were associated with increased odds of AGI. The results highlight the need for systematic data collection to better understand and support previously anecdotal indications of high AGI incidence, as well as insights into unique AGI environmental risk factors in Indigenous populations.
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Newman KL, Leon JS, Rebolledo PA, Scallan E. The impact of socioeconomic status on foodborne illness in high-income countries: a systematic review. Epidemiol Infect 2015; 143:2473-85. [PMID: 25600652 DOI: 10.1017/S0950268814003847] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Foodborne illness is a major cause of morbidity and loss of productivity in developed nations. Although low socioeconomic status (SES) is generally associated with negative health outcomes, its impact on foodborne illness is poorly understood. We conducted a systematic review to examine the association between SES and laboratory-confirmed illness caused by eight important foodborne pathogens. We completed this systematic review using PubMed for all papers published between 1 January 1980 and 1 January 2013 that measured the association between foodborne illness and SES in highly developed countries and identified 16 studies covering four pathogens. The effect of SES varied across pathogens: the majority of identified studies for Campylobacter, salmonellosis, and E. coli infection showed an association between high SES and illness. The single study of listeriosis showed illness was associated with low SES. A reporting bias by SES could not be excluded. SES should be considered when targeting consumer-level public health interventions for foodborne pathogens.
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Clark S, Berrang-Ford L, Lwasa S, Namanya DB, Edge VL, Harper S; IHACC Research Team. The burden and determinants of self-reported acute gastrointestinal illness in an Indigenous Batwa Pygmy population in southwestern Uganda. Epidemiol Infect 2015; 143:2287-98. [PMID: 25500189 DOI: 10.1017/S0950268814003124] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Acute gastrointestinal illness (AGI) is an important public health priority worldwide. Few studies have captured the burden of AGI in developing countries, and even fewer have focused on Indigenous populations. This study aimed to estimate the incidence and determinants of AGI within a Batwa Pygmy Indigenous population in southwestern Uganda. A retrospective cross-sectional survey was conducted in January 2013 via a census of 10 Batwa communities (n = 583 participants). The AGI case definition included any self-reported symptoms of diarrhoea or vomiting in the past 2 weeks. The 14-day prevalence of AGI was 6·17% [95% confidence interval (CI) 4·2-8·1], corresponding to an annual incidence rate of 1·66 (95% CI 1·1-2·2) episodes of AGI per person-year. AGI prevalence was greatest in children aged <3 years (11·3%). A multivariable mixed-effects logistic regression model controlling for clustering at the community level indicated that exposure to goats [odds ratio (OR) 2·6, 95% CI 1·0-6·8], being a child aged <3 years (OR 4·8, 95% CI 1·2-18·9), and being a child, adolescent or senior Batwa in the higher median of wealth (OR 7·0, 95% CI 3·9-9·2) were significantly associated with having AGI. This research represents the first Indigenous community-census level study of AGI in Uganda, and highlights the substantial burden of AGI within this population.
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Gibney KB, O'Toole J, Sinclair M, Leder K. Disease burden of selected gastrointestinal pathogens in Australia, 2010. Int J Infect Dis 2014; 28:176-85. [PMID: 25281904 DOI: 10.1016/j.ijid.2014.08.006] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Revised: 05/07/2014] [Accepted: 08/08/2014] [Indexed: 10/24/2022] Open
Abstract
OBJECTIVE To estimate and compare disease burden attributable to six gastrointestinal pathogens (norovirus, rotavirus, Campylobacter, non-typhoidal Salmonella, Giardia, and Cryptosporidium) in Australia, 2010. METHODS We estimated the number of acute gastroenteritis (AGE) cases and deaths, disability-adjusted life years (DALYs), and DALY/case for each pathogen. We included AGE cases that did not require medical care. Sequelae were included for Campylobacter (Guillain-Barré syndrome, reactive arthritis (ReA), irritable bowel syndrome (IBS)) and Salmonella (ReA, IBS). RESULTS We estimated 16626069 AGE cases in Australia in 2010 (population 22 million). Of the pathogens studied, most AGE cases were attributed to norovirus (2180145), Campylobacter (774003), and Giardia (614740). Salmonella caused the fewest AGE cases (71255) but the most AGE deaths (90). The DALY burden was greatest for Campylobacter (18222 DALYs) and Salmonella (3856 DALYs), followed by the viral and protozoal pathogens. The average DALY/case was greatest for Salmonella (54.1 DALY/1000 cases), followed by Campylobacter (23.5 DALY/1000 cases). CONCLUSIONS The pathogen causing the greatest disease burden varied according to the metric used, however DALYs are considered most useful given the incorporation of morbidity, mortality, and sequelae. These results can be used to prioritize public health interventions toward Salmonella and Campylobacter infections and to measure the impact of these interventions.
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Sang XL, Liang XC, Chen Y, Li JD, Li JG, Bai L, Sun JY. Estimating the burden of acute gastrointestinal illness in the community in Gansu Province, northwest China, 2012-2013. BMC Public Health 2014; 14:787. [PMID: 25086445 PMCID: PMC4246514 DOI: 10.1186/1471-2458-14-787] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2013] [Accepted: 07/23/2014] [Indexed: 11/18/2022] Open
Abstract
Background Acute gastrointestinal illness (AGI) imposes considerable social and economic burden on low and middle-income countries. This study aimed to estimate the occurrence, distribution, and burden of self-reported AGI in Gansu Province of northwest China, where economic growth rates have lagged far behind those of other regions in China and systematic studies to investigate the burden of AGI are still lacking. Methods Twelve-month, retrospective face-to-face surveys were conducted in three sentinel sites between June 2012 and May 2013. Respondents were asked if they had experienced diarrhoea or vomiting in the 28 days prior to the interview. Results In total, 2094 interviews were completed. The adjusted monthly prevalence was 8.5% with an incidence rate of 1.16 episodes of AGI per person-year. Healthcare was sought by 73.8% of those reporting illness. Of the cases who visited a doctor, 50.5% submitted a stool sample. The use of antibiotics was reported by 65.6% of the cases and 53.3% took antidiarrhoeals. In the multivariable model, age, household income and sentinel site were significant risk factors of being a case of AGI. Conclusions The burden of AGI was considerable in Gansu Province of northwest China. Ongoing research to identify the main causes of AGI is needed for more accurate estimate of the burden of AGI in this region. Electronic supplementary material The online version of this article (doi:10.1186/1471-2458-14-787) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | | | - Yan Chen
- Institute of Food Safety, Gansu Provincial Center for Disease Control and Prevention, No, 230 Dong Gang West Road, Chengguan District, Lanzhou 730030 Gansu Province, China.
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Abstract
OBJECTIVES The objective of this study was to identify the risk factors for ARI in the Australian community. METHODS We used a national survey of 7578 randomly selected respondents in 2008-2009 to identify the risk factors of ARI. A case was defined as a person experiencing cold or flu with one or more symptoms of: fever, chills, sore throat, runny nose, or cough in the previous four weeks. RESULTS There were 19.8% (1505/7578) of respondents who reported ARI in the four weeks prior to the survey. Age was an independent risk factor for ARI, with the risk of acquiring ARI decreasing as age increased. Respondents reporting asthma (OR 1.4, 95%CI: 1.2-1.7) or having someone in their house attending childcare (OR 1.6, 95%CI: 1.2-2.1) were more likely to report ARI. CONCLUSIONS It is important to identify ways of interrupting transmission of ARI amongst children. Improving identification of risk factors will enable targeted interventions for this exceedingly common syndrome.
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Affiliation(s)
- Yingxi Chen
- National Centre for Epidemiology and Population Health, The Australian National University, Canberra, Australia
| | - Emlyn Williams
- Statistical Consulting Unit, The Australian National University, Canberra, Australia
| | - Martyn Kirk
- National Centre for Epidemiology and Population Health, The Australian National University, Canberra, Australia
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Mok HF, Barker SF, Hamilton AJ. A probabilistic quantitative microbial risk assessment model of norovirus disease burden from wastewater irrigation of vegetables in Shepparton, Australia. Water Res 2014; 54:347-62. [PMID: 24594660 DOI: 10.1016/j.watres.2014.01.060] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Revised: 01/24/2014] [Accepted: 01/26/2014] [Indexed: 05/22/2023]
Abstract
Wastewater can be an important resource for water-scarce regions of the world, but a major barrier to its use is the associated health risk. Quantitative microbial risk assessment (QMRA) is a probabilistic modeling technique used to determine the health risks from wastewater reuse, but only a handful of QMRA studies have examined the norovirus health risks from consumption of vegetables irrigated with human wastewater, even though norovirus is a, if not the most, significant microbial cause of diarrheal disease world-wide. Furthermore, the majority of these studies have focused only on risks from lettuce consumption. To meet the knowledge gap in health risks for other vegetables, a QMRA model was constructed for agricultural wastewater irrigation in the regional city of Shepparton, Australia, using fecal shedding rates to estimate norovirus concentration in raw sewage. Annual norovirus disease burden was estimated for the consumption of lettuce, broccoli, cabbage, Asian vegetables, and cucumber after irrigation with treated wastewater. Results indicate that the waste stabilization pond treatment did not have sufficient virus removal to meet the World Health Organization (WHO) threshold for acceptable level of risk for wastewater reuse, but addition of disinfection treatments provided acceptable results for consumption of cucumber and broccoli. This is the first QMRA study to incorporate virus accumulation from previous wastewater irrigation events.
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Affiliation(s)
- Hoi-Fei Mok
- Department of Agriculture and Food Systems, Melbourne School of Land and Environment, University of Melbourne, Parkville, VIC 3010, Australia
| | - S Fiona Barker
- Department of Resource Management and Geography, Melbourne School of Land and Environment, University of Melbourne, Parkville, VIC 3010, Australia
| | - Andrew J Hamilton
- Department of Agriculture and Food Systems, Melbourne School of Land and Environment, University of Melbourne, Parkville, VIC 3010, Australia.
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Davis C, Vally H, Bell R, Sheehan F, Beard F. Viral gastrointestinal outbreaks in residential care facilities: an examination of the value of public health unit involvement. Aust N Z J Public Health 2014; 38:177-83. [DOI: 10.1111/1753-6405.12171] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2013] [Revised: 07/01/2013] [Accepted: 10/01/2013] [Indexed: 01/29/2023] Open
Affiliation(s)
- Craig Davis
- Communicable Diseases Unit; Department of Health; Queensland
- National Centre for Epidemiology and Population Health, The Australian National University, Australian Capital Territory
- School of Population Health, The University of Queensland
| | - Hassan Vally
- National Centre for Epidemiology and Population Health, The Australian National University, Australian Capital Territory
- School of Public Health and Human Biosciences; La Trobe University; Victoria
| | - Robert Bell
- OzFoodNet (Queensland), Communicable Diseases Unit, Department of Health; Queensland
| | - Frances Sheehan
- Communicable Diseases Unit; Department of Health; Queensland
| | - Frank Beard
- Communicable Diseases Unit; Department of Health; Queensland
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Abstract
We used a national survey of 7578 randomly selected respondents in 2008-2009 to identify the period prevalence of acute respiratory infection (ARI) by season and state, and to estimate the incidence of ARI in the Australian community. A case was defined as any episode of cold or flu with at least one of the following symptoms: fever, chills, sore throat, running nose, or cough in the past 4 weeks. Frequency data were weighted to the Australian population. The response rate to the survey was 49%, and 19·9% (1505/7578) of respondents reported an ARI in the previous 4 weeks, which extrapolated to 68·9 million cases [95% confidence interval (CI) 65·1-72·7] of ARI in Australia annually. The incidence was 3·2 (95% CI 3·0-3·4) cases of ARI/person per year, and was highest in young children and lowest in older people. ARI imposes a significant burden on Australian society.
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Abstract
There is some evidence that neighborhood deprivation increases residents' risk of foodborne illnesses. Because urban areas with the least available access to adequate amounts of nutritious or affordable food options (or "food deserts") also tend to be the most deprived areas within a city, it is hypothesized that food access and foodborne illness risk are linked. However, the complexity of tracking numbers and sources of gastrointestinal (GI) illnesses often leads researchers to speculate about reasons for disproportionate rates of pathogen outbreaks among demographic groups. This study explores the suitability of existing data to examine associations between food deserts and the spatial distribution of GI illnesses in Hamilton, Ontario, Canada. A spatial analysis by using GIS software methodology was used to identify and map food retail outlets and accessibility, as well as GI illness outbreaks and sales of antidiarrhea, antinausea, and rehydration products (used as a proxy for GI cases) within the city, based on available data. Statistical analysis of the maps shows no statistical relationship between location, access to food outlets, and rates of GI illness. The analysis points to shortfalls and gaps in the existing data, which leaves us unable to draw conclusions either supporting or refuting our hypothesis. This article includes recommendations to improve the current system of illness reporting and to continue to refine the definition and process of mapping food access issues. A more comprehensive set of data would enable municipalities to more easily identify groups most at risk, depending on exposures and the type of pathogen, and reduce the occurrence of foodborne disease.
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Affiliation(s)
- Bruce Newbold
- School of Geography and Earth Sciences, McMaster University, 1280 Main Street W, Hamilton, Ontario L8S 4L8, Canada.
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Barker SF, Packer M, Scales PJ, Gray S, Snape I, Hamilton AJ. Pathogen reduction requirements for direct potable reuse in Antarctica: evaluating human health risks in small communities. Sci Total Environ 2013; 461-462:723-733. [PMID: 23770553 DOI: 10.1016/j.scitotenv.2013.05.059] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Revised: 05/20/2013] [Accepted: 05/20/2013] [Indexed: 06/02/2023]
Abstract
Small, remote communities often have limited access to energy and water. Direct potable reuse of treated wastewater has recently gained attention as a potential solution for water-stressed regions, but requires further evaluation specific to small communities. The required pathogen reduction needed for safe implementation of direct potable reuse of treated sewage is an important consideration but these are typically quantified for larger communities and cities. A quantitative microbial risk assessment (QMRA) was conducted, using norovirus, giardia and Campylobacter as reference pathogens, to determine the level of treatment required to meet the tolerable annual disease burden of 10(-6) DALYs per person per year, using Davis Station in Antarctica as an example of a small remote community. Two scenarios were compared: published municipal sewage pathogen loads and estimated pathogen loads during a gastroenteritis outbreak. For the municipal sewage scenario, estimated required log10 reductions were 6.9, 8.0 and 7.4 for norovirus, giardia and Campylobacter respectively, while for the outbreak scenario the values were 12.1, 10.4 and 12.3 (95th percentiles). Pathogen concentrations are higher under outbreak conditions as a function of the relatively greater degree of contact between community members in a small population, compared with interactions in a large city, resulting in a higher proportion of the population being at risk of infection and illness. While the estimates of outbreak conditions may overestimate sewage concentration to some degree, the results suggest that additional treatment barriers would be required to achieve regulatory compliance for safe drinking water in small communities.
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Affiliation(s)
- S Fiona Barker
- Department of Resource Management and Geography, The University of Melbourne, Parkville, VIC, 3010 Australia.
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Chen Y, Yan WX, Zhou YJ, Zhen SQ, Zhang RH, Chen J, Liu ZH, Cheng HY, Liu H, Duan SG, Lan Z, Sun JC, You XY, Li JG, Wu YN. Burden of self-reported acute gastrointestinal illness in China: a population-based survey. BMC Public Health 2013; 13:456. [PMID: 23656835 PMCID: PMC3655923 DOI: 10.1186/1471-2458-13-456] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2012] [Accepted: 05/03/2013] [Indexed: 11/25/2022] Open
Abstract
Background Acute gastrointestinal illness (AGI) is an important public-health problem worldwide. Previous national studies of the incidence of AGI in China were performed decades ago, and detailed information was not available. This study therefore sought to determine the magnitude, distribution, and burden of self-reported AGI in China. Methods Twelve-month, retrospective face-to-face surveys were conducted in 20 sentinel sites from six provinces between July 2010 and July 2011. Results In total, 39686 interviews were completed. The overall adjusted monthly prevalence of AGI was 4.2% (95% confidence interval, 4.0–4.4), corresponding to 0.56 episodes of AGI per person-year. Rates of AGI were highest in children aged < 5 years. Healthcare was sought by 56.1% of those reporting illness. Of the cases who visited a doctor, 32.7% submitted a stool sample. The use of antibiotics was reported by 49.7% of the cases who sought medical care and 54.0% took antidiarrhoeals. In the multivariable model, gender, age, education, household type, residence, season, province and travel were significant risk factors of being a case of AGI. Conclusions This first population-based study in China indicated that AGI represents a substantial burden of health. Further research into the specific pathogens is needed to better estimate the burden of AGI and foodborne disease in China.
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Affiliation(s)
- Yan Chen
- Key Laboratory of Food Safety Risk Assessment of Ministry of Health, China National Center for Food Safety Risk Assessment, 7 Panjiayuan Nanli, Chaoyang District, Beijing 100021, China
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Fletcher SM, McLaws ML, Ellis JT. Prevalence of gastrointestinal pathogens in developed and developing countries: systematic review and meta-analysis. J Public Health Res 2013; 2:42-53. [PMID: 25170480 PMCID: PMC4140330 DOI: 10.4081/jphr.2013.e9] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2013] [Accepted: 05/14/2013] [Indexed: 12/13/2022] Open
Abstract
ABSTRACT Diarrhoeal illness is a leading cause of child mortality and morbidity worldwide. There are no precise or current estimates of the types and prevalence of pathogens associated with diarrheal illnesses in developed and developing settings. This systematic review assessed data from 60 studies published in the English language from five developing regions and developed countries worldwide to provide regional estimates of enteric pathogens affecting children. The random-effect method was used to establish the weighted average prevalence of pathogens in adults and children for each region. Significantly more pathogens were reported by studies from developing regions compared with Organisation for Economic Co-operation and Development countries (P<0.016). The identification rates of pathogens from community based and hospital based studies were similar (58.5% and 58.1% respectively, P<0.619). The overall detection of enteric pathogens in developing countries was higher in adults (74.8%; 95% CI 63.1-83.8%) compared with children (56.7%; 95% CI 53.0-60.4%) (P<0.001). Rotavirus was the most frequently detected pathogen in all regions with the highest rate, 24.8% (95% CI 18.0-33.1%), detected in the developed countries. This systematic review is the first to provide an estimate of the prevalence of enteric pathogens associated with diarrhoeal illnesses in adults and children in developed and developing settings. While pathogen detection rate is greater in developing regions the consistently high prevalence of rotavirus in both developed and developing settings underscores the urgent need for access to rotavirus vaccines. Increased travel between developing and developed countries increases disease risk, and hence developed countries have a vested interest in supporting vaccine accessibility in developing settings.
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Affiliation(s)
- Stephanie M. Fletcher
- The iThree Institute and School of Medical and Molecular Biosciences, University of Technology, Sydney
| | | | - John T. Ellis
- The iThree Institute and School of Medical and Molecular Biosciences, University of Technology, Sydney
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Wilking H, Spitznagel H, Werber D, Lange C, Jansen A, Stark K. Acute gastrointestinal illness in adults in Germany: a population-based telephone survey. Epidemiol Infect 2013; 141:2365-75. [PMID: 23369668 DOI: 10.1017/S0950268813000046] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Population-based estimates of incidence and risk factors for acute gastrointestinal illness (AGI) are important for infectious disease surveillance and healthcare planning. We conducted a nationwide representative cross-sectional telephone survey of 21,262 adults over a 12-month period during 2008-2009 in Germany. Participants were asked if they had either AGI-related diarrhoea or vomiting in a 4-week recall period. We estimated 0·95 episodes/person per year (95% confidence interval 0·90-0·99), corresponding to 64·9 million episodes of AGI annually in adults, which results in 24·5 million outpatient visits, 19·9 million hospital days and 63·2 million days of work lost. We observed an overall declining trend of AGI with increasing age. Diarrhoea was more often reported than vomiting. The mean duration of illness was 3·8 days and did not differ between age groups. Social factors seemed to be weak predictors compared to state of health and health behaviour characteristics. This study allows international comparisons and contributes to the estimation of the global burden of AGI.
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O'Toole J, Sinclair M, Malawaraarachchi M, Hamilton A, Barker SF, Leder K. Microbial quality assessment of household greywater. Water Res 2012; 46:4301-13. [PMID: 22673341 DOI: 10.1016/j.watres.2012.05.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2012] [Revised: 04/20/2012] [Accepted: 05/02/2012] [Indexed: 05/04/2023]
Abstract
A monitoring program was undertaken to assess the microbial quality of greywater collected from 93 typical households in Melbourne, Australia. A total of 185 samples, comprising 75 washing machine wash, 74 washing machine rinse and 36 bathroom samples were analysed for the faecal indicator Escherichia coli. Of these, 104 were also analysed for genetic markers of pathogenic E coli and 111 for norovirus (genogroups GI and GII), enterovirus and rotavirus using RT-PCR. Enteric viruses were detected in 20 out of the 111 (18%) samples comprising 16 washing machine wash water and 4 bathroom samples. Eight (7%) samples were positive for enterovirus, twelve (11%) for norovirus genogroup GI, one (1%) for norovirus genogroup GII and another (1%) for rotavirus. Two washing machine samples contained more than one virus. Typical pathogenic E. coli were detected in 3 out of 104 (3%) samples and atypical enteropathogenic E. coli in 11 (11%) of samples. Levels of indicator E. coli were highly variable and the presence of E. coli was not associated with the presence of human enteric viruses in greywater. There was also little correlation between reported gastrointestinal illness in households and detection of pathogens in greywater.
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Affiliation(s)
- Joanne O'Toole
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, 99 Commercial Road, Melbourne, Victoria 3004, Australia.
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MacRitchie LA, Hunter CJ, Strachan NJ. A population-based exposure assessment of risk factors associated with gastrointestinal pathogens: a Campylobacter study. Epidemiol Infect 2013; 141:976-86. [PMID: 22877359 DOI: 10.1017/S0950268812001641] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
A questionnaire survey was undertaken to determine the exposure of a study population to campylobacteriosis source risk factors (environmental, water, food) and results were stratified by age, population density and deprivation. Data were gathered using an exposure assessment carried out by telephone in the Grampian region of Scotland. Univariate analysis showed that children aged 5-14 years, living in low population density (0-44.4 persons/km2) and affluent areas had elevated exposure to environmental and water risk factors. Multivariate logistic regression analysis revealed that younger age groups and lower population density were significant indicators for most environmental risk factors. The results compared to reported disease incidence in Grampian showed that greater exposure to risk factors does not necessarily coincide with greater disease incidence for age groups, particularly for the 0-4 years age group. Further research is required to explain the relationship between exposure and disease incidence.
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Najnin N, Sinclair M, Forbes A, Leder K. Community based study to compare the incidence and health services utilization pyramid for gastrointestinal, respiratory and dermal symptoms. BMC Health Serv Res 2012; 12:211. [PMID: 22824457 PMCID: PMC3411466 DOI: 10.1186/1472-6963-12-211] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2011] [Accepted: 07/23/2012] [Indexed: 11/24/2022] Open
Abstract
Background Gastrointestinal (GI), respiratory and dermal symptoms are common and cause substantial morbidity, although the information on their exact incidence and comparative burden is limited. The aim of this study was to describe the epidemiology and rate these three major symptom complexes in order to improve our understanding of the health burden imposed by these symptoms. Methods We used data from a community based randomised control trial conducted from June 2007 to August 2008 among 277 South Australian families consuming rainwater. Using weekly health diaries, we prospectively collected information on GI (diarrhoea or vomiting), respiratory (sore throat, runny nose or cough) and dermal (rash, generalised itch or dermal infection) symptoms, as well as on relevant GP visits, time off work and/or hospitalisation due to these symptoms. Data were analysed using generalized estimating equations approach taking into account the variable number of weeks of follow-up of each individual and within-family clustering of responses. Results Over one year, at least one episode of GI symptoms was reported by 54% of participants (95% CI 50%-58%), at least one respiratory episode by 91% (95% CI 88%-93%) and at least one episode of dermal symptoms by 27% (95% CI 24%-30%). The average number of weeks per year during which respiratory symptoms occurred was four times greater than for GI or dermal symptoms (4.9, 1.2 and 1.2 weeks, respectively, p<0.001), with an average number of GP visits per person per year being twice as frequent (0.48, 0.26, 0.19 respectively, p<0.001). However, on a per episode basis, a higher proportion of people saw a GP or were hospitalised for GI symptoms. Conclusions This first comparative study of three different symptom complexes showed that although respiratory symptoms are most common, GI symptoms cause a greater per episode burden on healthcare resources. Measuring and comparing the community based burden of these symptom complexes will assist evidence-based allocation of resources.
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Affiliation(s)
- Nusrat Najnin
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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Wei PL, Chen CS, Keller JJ, Lin HC. Monthly variation in acute appendicitis incidence: a 10-year nationwide population-based study. J Surg Res 2012; 178:670-6. [PMID: 22795352 DOI: 10.1016/j.jss.2012.06.034] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2012] [Revised: 06/02/2012] [Accepted: 06/15/2012] [Indexed: 12/15/2022]
Abstract
BACKGROUND The present study investigated the monthly variation of acute appendicitis and its association with climatic factors (ambient temperature, relative humidity, atmospheric pressure, rainfall, and hours of sunshine) using a nationwide population-based data set in Taiwan. METHODS We identified 237,760 first-time hospitalizations for acute appendicitis from 2000 to 2009. We used the auto-regressive integrated moving average method to examine the monthly variation in the acute appendicitis incidence rates after adjusting for the time-trend effect and seasonality. RESULTS Throughout the 10-year study period, we found that the monthly incidence rate of acute appendicitis demonstrated a fairly similar monthly pattern for each gender independently and for the pooled data. May through July had the greatest rates, decreasing in August to a trough in February. We used the autoregressive integrated moving average test for seasonality and found a significant difference in the monthly incidence rate for the pooled genders and for the male- and female-only groups (all P < 0.001). Furthermore, the auto-regressive integrated moving average regression models for the male, female, and combined groups all suggested that a significant positive association exists between the monthly incidence rates of acute appendicitis per 100,000 population and the ambient temperature after adjusting for time trends and month. CONCLUSIONS The results of our study have revealed a significant difference in the monthly incidence rate of acute appendicitis.
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Affiliation(s)
- Po-Li Wei
- Division of General Surgery, Department of Surgery, Taipei Medical University Hospital, Taipei, Taiwan
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