A recurring salmonellosis epidemic in New Zealand linked to contact with sheep

Shifts in intestinal microbiota and improvement of sheep immune response to resist Salmonella infection using Toll-like receptor 4 (TLR4) overexpression

Introduction

Toll-like receptor 4 (TLR4) identifies Gram-negative bacteria or their products and plays a crucial role in host defense against invading pathogens. In the intestine, TLR4 recognizes bacterial ligands and interacts with the immune system. Although TLR4 signaling is a vital component of the innate immune system, the influence of TLR4 overexpression on innate immune response and its impact on the composition of the intestinal microbiota is unknown.

Methods

Here, we obtained macrophages from sheep peripheral blood to examine phagocytosis and clearance of Salmonella Typhimurium (S. Typhimurium) in macrophages. Meanwhile, we characterized the complex microbiota inhabiting the stools of TLR4 transgenic (TG) sheep and wild-type (WT) sheep using 16S ribosomal RNA (rRNA) deep sequencing.

Results

The results showed that TLR4 overexpression promoted the secretion of more early cytokines by activating downstream signaling pathways after stimulation by S. Typhimurium. Furthermore, diversity analysis demonstrated TLR4 overexpression increased microbial community diversity and regulated the composition of intestinal microbiota. More importantly, TLR4 overexpression adjusted the gut microbiota composition and maintained intestinal health by reducing the ratio of Firmicutes/Bacteroidetes and inflammation and oxidative stress-producing bacteria (Ruminococcaceae, Christensenellaceae) and upregulating the abundance of Bacteroidetes population and short-chain fatty acid (SCFA)-producing bacteria, including Prevotellaceae. These dominant bacterial genera changed by TLR4 overexpression revealed a close correlation with the metabolic pathways of TG sheep.

Discussion

Taken together, our findings suggested that TLR4 overexpression can counteract S. Typhimurium invasion as well as resist intestinal inflammation in sheep by regulating intestinal microbiota composition and enhancing anti-inflammatory metabolites.

Genetic features of Salmonella enterica subspecies diarizonae serovar 61:k:1,5 isolated from abortion cases in sheep, United States, 2020

Salmonella enterica subspecies diarizonae serovar 61:(k):1, 5, (7) (sheep associated S. diarizonae, SASd) is the most common Salmonella serotype identified in sheep flocks. Despite the involvement with animal and human infections, there is limited information regarding virulence profiles of SASds and their antibiotic resistance gene complement, particularly for those circulating in the U.S. In this study, we genetically characterized three SASds, 20-265, 20-269, and 20-312, isolated from sheep placental tissues during an abortion storm affecting a flock in Connecticut during 2020. SASds were the only bacteria isolated from analyzed sheep tissues. The isolates were sensitive to all the antibiotics tested, but all these SASd isolates carry the aminoglycoside resistance gene, aac(6')-Iaa, and a chromosomal substitution in the parC gene. The proportion of pseudogenes (5.3-5.5%) was similar among the isolates, and these SASds carry IncX1 type plasmids. Comparing with the SASds isolates from Enterobase, the three isolates showed an identical genomic virulence profile carrying virulence genes in the conserved set of other SASd isolates except for steC, iagB, iacP, sseI, and slrP genes. In the SNP-based phylogenetic analysis, SASd sequences were grouped into group A-C, and the group C was further subdivided into subgroup C1-C6. The three isolates clustered with other SASd isolates from the U.S. and Canada in subgroup C6. SASd isolates in the identical phylogenetic groups tended to have similar geographical origin. The results of our study did not provide conclusive evidence about which are the genetic traits that trigger SASds to become virulent in sheep, but our data will provide a point for comparative studies of this Salmonella serovar.

Occupations at risk of contracting zoonoses of public health significance in Québec

Introduction

Climate change plays an important role in the geographic spread of zoonotic diseases. Knowing which populations are at risk of contracting these diseases is critical to informing public health policies and practices. In Québec, 14 zoonoses have been identified as important for public health to guide the climate change adaptation efforts of decision-makers and researchers. A great deal has been learned about these diseases in recent years, but information on at-risk workplaces remains incomplete. The objective of this study is to paint a portrait of the occupations and sectors of economic activity at risk for the acquisition of these zoonoses.

Methods

A rapid review of the scientific literature was conducted. Databases on the Ovid and EBSCO research platforms were searched for articles published between 1995 and 2018, in English and French, on 14 zoonoses (campylobacteriosis, cryptosporidiosis, verocytotoxigenic Escherichia coli, giardiasis, listeriosis, salmonellosis, Eastern equine encephalitis, Lyme disease, West Nile virus, food botulism, Q fever, avian and swine influenza, rabies, hantavirus pulmonary syndrome) and occupational health. The literature search retrieved 12,558 articles and, after elimination of duplicates, 6,838 articles were evaluated based on the title and the abstract. Eligible articles had to address both concepts of the research issue (prioritized zoonoses and worker health). Of the 621 articles deemed eligible, 110 were selected following their full reading.

Results

Of the diseases under study, enteric zoonoses were the most frequently reported. Agriculture, including veterinary services, public administration services and medical and social services were the sectors most frequently identified in the literature.

Conclusion

The results of our study will support public health authorities and decision-makers in targeting those sectors and occupations that are particularly at risk for the acquisition of zoonoses. Doing so will ultimately optimize the public health practices of those responsible for the health of workers.

Ovine abortion and stillbirth investigations in Australia

Fetal loss and lamb mortality between mid-pregnancy and weaning are important economic and welfare issues for the Australian sheep industry. The aim of this study was to determine common causes of ovine abortion and stillbirths based on submissions to veterinary laboratories and identify factors that impact the determination of an aetiological diagnosis. Data for 529 investigations on abortion or stillbirth between 2000 and 2018 were retrieved from four state veterinary laboratories in Western Australia, South Australia, Victoria and Tasmania. An aetiological diagnosis was made for 57% of investigations. Investigations that included placental tissue samples were more than twice as likely to have an aetiological diagnosis compared to investigations without placenta (P = 0.017, 95% confidence interval 1.1, 4.5). Of the investigations where an aetiological diagnosis was made, 81% involved infectious abortion, with Campylobacter spp. (32%), Listeria spp. (25%) and Toxoplasma gondii (9%) being the three most common abortigenic pathogens implicated. The remaining 19% of investigations with an aetiological diagnosis included a wide range of infectious and non-infectious diseases. Diagnoses made varied year to year and between states. No evidence of exotic abortigenic pathogens were reported. Veterinary practitioners can improve the probability of an aetiological diagnosis by emphasising to farmers the importance of collecting any aborted material, especially placenta, and appropriate storage of the tissues until they can be submitted to the laboratory. Some diseases that cause abortion in Australian sheep have zoonotic potential, and veterinary practitioners play an important role in educating clients about appropriate hygiene when handling pregnant and lambing ewes or any aborted material.

Isolates, Antimicrobial Susceptibility Profiles and Multidrug Resistance of Bacteria Cultured from Pig Submissions in New Zealand

Data on the scope of bacterial pathogens present and the frequency of antimicrobial resistance (AMR) in New Zealand's pigs are limited. This study describes bacterial isolates, antimicrobial susceptibility data, and multidrug resistance (MDR; resistance to ≥3 antimicrobial classes) from New Zealand pig submissions. Porcine test data from June 2003 to February 2016 were obtained from commercial veterinary pathology laboratory records. In total, 470/477 unique submissions resulted in bacterial growth, yielding 779 isolates. Sample type was recorded for 360/477 (75.5%); lung (79/360; 21.9%), faecal (61/360; 16.9%) and intestinal (45/360; 12.5%) were most common. The most common isolates were Escherichia coli (186/779, 23.9%), Actinobacillus pleuropneumoniae (43/779; 5.5%), Streptococcus suis (43/779; 5.5%), unidentified Campylobacter spp. (38/779; 4.9%), alpha haemolytic Streptococci (32/779; 4.1%), coagulase negative Staphylococcus spp. (26/779; 3.3%), and Pasteurella multocida (25/779; 3.2%). Susceptibility results were available for 141/779 (18.1%) isolates from 62/470 (13.2%) submissions. Most were susceptible to trimethoprim-sulphonamide (75/81; 92.6%), but fewer were susceptible to penicillin (37/77; 48.1%), tilmicosin (18/43; 41.9%), or tetracyclines (41/114; 36.0%). No susceptibility data were available for Salmonella spp., Campylobacter spp., or Yersinia spp. isolates. MDR was present in 60/141 (42.6%) isolates. More data on sample submission drivers, antimicrobial drug use, and susceptibilities of important porcine bacterial isolates are required to inform guidelines for prudent antimicrobial use, to reduce their prevalence, human transmission, and to minimise AMR and MDR.

One Health Aotearoa: a transdisciplinary initiative to improve human, animal and environmental health in New Zealand

There is increased recognition that complex health challenges at the human-animal-environmental interface require a transdisciplinary, "whole-of-society" approach. This philosophy is particularly pertinent in Aotearoa-New Zealand because of the country's relatively isolated island ecosystem, economic reliance on agriculture and its intensification, and existing indigenous worldview that emphasises holism and interconnectivity between humans, animals and the environment. In New Zealand, the One Health Aotearoa (OHA) alliance was established in order to better connect researchers and to address a growing number of infectious diseases challenges. The emphasis of OHA is to bring together and facilitate interactions between people from diverse disciplines, link to stakeholders and communities, and engage with policy-makers, government operational agencies, and funders, thus providing a holistic and integrative systems-thinking approach to address priority questions and achieve desired outcomes in One Health. The initial focus of OHA has been on infectious diseases, but there is increasing recognition of the potential benefits of the alliance to address broader complex issues. Greater involvement and overlap of the environmental sciences, human and animal health sciences, social science, and indigenous kaupapa Māori research is particularly critical for ensuring its success within the New Zealand context. Given the economic and cultural importance of New Zealand's "clean, green" image, a One Health approach that draws strongly on the environmental sciences makes particular sense. Furthermore, as the global environment becomes increasingly stressed by anthropogenic pressures our research may hold potential solutions for similar challenges elsewhere.

Epidemiology of Campylobacter Gastroenteritis in New Zealand Children and the Effect of The Campylobacter Strategy: A 20-year Observational Study

BACKGROUND

Campylobacter species are a common cause of gastroenteritis in New Zealand (NZ) as well as worldwide. This study aimed to describe epidemiologic trends in disease notifications and hospital admissions because of Campylobacter gastroenteritis in NZ children from 1997 to 2016.

METHODS

In this population-based descriptive study, age-specific and age-standardized notification and hospitalization rates were analyzed for Campylobacter infections in children <15 years of age. Variations in disease by time, sex, age, ethnicity and geography were described.

RESULTS

During the 20-year period considered, there were 39,970 notifications (59.1% male) and 1458 hospitalizations (61.8% male) because of Campylobacter gastroenteritis in NZ children. Before 2006, notification rates increased by 3.4% annually [95% confidence interval (CI): 0.7%-6.2%], with a peak of 340 notifications per 100,000 children in 2003. The average percentage change (APC) in hospitalizations was 7.4% (95% CI: 4.0%-10.9%) in the same period. From 2006 to 2008, notification and hospitalization rates fell by 25% and 30%, respectively. Since 2008, age-standardized incidence rates have been stable at 161 notifications (APC: -3.1; 95% CI: 0.82 to -6.9) and 6.73 hospitalizations (APC: 2.2; 95% CI: -2.0 to 6.5) per 100,000 children per year. Notification rates were highest in children 1-4 years of age. Hospitalizations rates were highest in children <1 year of age.

CONCLUSIONS

NZ has previously had high rates of Campylobacter gastroenteritis in children. Implementation of a national strategy to reduce foodborne Campylobacter infection appears to have contributed to an observed reduction in rates between 2006 and 2008. The burden of Campylobacter disease is highest in the community health setting, with only a small proportion of cases needing hospitalization.

Divergent geography of Salmonella Wangata and Salmonella Typhimurium epidemiology in New South Wales, Australia

Salmonella enterica serovar Wangata is an important cause of salmonellosis in the state of New South Wales, Australia. Standard surveillance has not identified a common food source and cases have been attributed to an unknown environmental or wildlife reservoir. Investigation of the spatial distribution of cases may provide valuable insights into local risk factors for infection and the potential role of the environment and wildlife.

Using conditional autoregressive analysis, we explored the association between laboratory-confirmed cases of S. Wangata reported to the New South Wales Department of Health and human socio-demographic, climate, land cover and wildlife features. For comparison, a model was also fitted to investigate the association of cases of Salmonella enterica serovar Typhimurium, an established foodborne serotype, with the same features. To determine if cases of S. Wangata were associated with potential wildlife reservoir species, additional variables were included in the S. Wangata model that indicated areas of high suitability for each species.

We found that cases of S. Wangata were associated with warmer temperatures, proximity to wetlands and amphibian species richness. In contrast, cases of S. Typhimurium were associated with human demographic features (proportion of the population comprising children <5 years old), climate (mean annual precipitation and mean annual temperature) and land cover (proportion comprising urban and evergreen broadleaf forest). These findings support the hypothesis that S. Wangata is likely to be associated with an environmental source. Whilst we expected S. Typhimurium to be associated with the human socio-demographic feature, the significance of the land cover features was surprising and might suggest the epidemiology of S. Typhimurium in Australia is more complex than currently understood.

Review of Diagnostic Procedures and Approaches to Infectious Causes of Reproductive Failures of Cattle in Australia and New Zealand

Infectious causes of reproductive failure in cattle are important in Australia and New Zealand, where strict biosecurity protocols are in place to prevent the introduction and spread of new diseases. Neospora caninum ranks highly as an important cause of reproductive wastage along with fungal and bacterial infections. Brucella, a leading cause of abortion elsewhere in the world, is foreign, following successful programs to control and eradicate the disease. Leptospirosis in cattle is largely controlled by vaccination, while Campylobacter and Tritrichomonas infections occur at low rates. In both countries, Bovine Viral Diarrhea virus (BVDV) infection rates as the second most economically important disease of cattle and one that also has an effect on reproduction. Effective disease control strategies require rapid diagnoses at diagnostic laboratories. To facilitate this process, this review will discuss the infectious causes of reproductive losses present in both countries, their clinical presentation and an effective pathway to a diagnosis.

Prevalence and pathogen load of Campylobacter spp., Salmonella enterica and Escherichia coli O157/O145 serogroup in sheep faeces collected at sale yards and in abattoir effluent in Western Australia

OBJECTIVE

Develop a multiplex quantitative PCR assay to investigate the prevalence and shedding of Escherichia coli O157/O145, Salmonella spp. and Campylobacter spp. in sheep at sale yards and abattoirs.

METHODS

A qPCR for E. coli O157/O145 was developed, validated and multiplexed with an existing qPCR for Campylobacter and Salmonella enterica. The absolute numbers of E. coli O157/O145, Campylobacter and Salmonella in control samples was determined using droplet digital PCR. These were then used as the controls in the multiplex qPCR on a total of 474 sheep faecal samples collected from two saleyards over a 4-month period (April-July 2014) and 96 effluent samples from an abattoir.

RESULTS

The mutiplex qPCR was specific with a sensitivity of 5 organisms/μL faecal DNA extract for Campylobacter, S. enterica and E. coli O157/O145. The overall prevalence of Campylobacter, S. enterica and E. coli O157/O145 in faecal samples was 5.7%, 3.6% and 8.4% and in effluent samples was 18.8%, 6.3% and 5.2%, respectively. The pathogen loads of Campylobacter, S. enterica and E. coli O157/O145 in faecal and effluent samples was also determined via mutiplex qPCR.

CONCLUSIONS

The overall prevalences of Campylobacter, S. enterica and E. coli O157/O145 were generally low (<6%), but point prevalences ranged considerably in healthy sheep (up to 26% for E. coli O157/O145). Further work to determine risk factors for shedding of bacterial organisms in meat sheep in the pre-slaughter period (on-farm, sale yards and lairage at abattoirs) could further reduce the risk of contamination of meat products.

Microbiology of Fresh Produce: Route of Contamination, Detection Methods, and Remedy

Fresh fruits and vegetables are an important part of a healthful diet. They provide vitamins, minerals and fiber to help keep our body healthy. Occasionally, fresh fruits and vegetables can become contaminated with harmful bacteria or viruses, which are also known as pathogens. The major family of pathogen associated with food are members of Enterobacteriaceae which commonly form a part of microbiological criteria and their presence is traditionally related to hygiene and safety of foods. Organic fertilizers, irrigation water quality and soil are major source of contamination. For removal of pathogens, various decontamination procedures are also followed to reduce microbial load on the fruits. These are chemical preservatives and irradiation. Microbiological study of fresh produce can be done by various phenotypic, biochemical and molecular techniques so that pathogen can properly be identified. The World Health Organization (WHO) developed global risk communication message and training materials to assist countries in strengthening their food educating programs. There is a need for improved surveillance systems on food-borne pathogens, on food products and on outbreaks so that comparable data are available from a wider range of countries.

Non-Typhoidal Salmonella Colonization in Chickens and Humans in the Mekong Delta of Vietnam

Salmonellosis is a public health concern in both the developed and developing countries. Although the majority of human non‐typhoidal Salmonella enterica (NTS) cases are the result of foodborne infections or person‐to‐person transmission, NTS infections may also be acquired by environmental and occupational exposure to animals. While a considerable number of studies have investigated the presence of NTS in farm animals and meat/carcasses, very few studies have investigated the risk of NTS colonization in humans as a result of direct animal exposure. We investigated asymptomatic NTS colonization in 204 backyard chicken farms, 204 farmers and 306 matched individuals not exposed to chicken farming, in southern Vietnam. Pooled chicken faeces, collected using boot or handheld swabs on backyard chicken farms, and rectal swabs from human participants were tested. NTS colonization prevalence was 45.6%, 4.4% and 2.6% for chicken farms, farmers and unexposed individuals, respectively. Our study observed a higher prevalence of NTS colonization among chicken farmers (4.4%) compared with age‐, sex‐ and location‐ matched rural and urban individuals not exposed to chickens (2.9% and 2.0%). A total of 164 chicken NTS strains and 17 human NTS strains were isolated, and 28 serovars were identified. Salmonella Weltevreden was the predominant serovar in both chickens and humans. NTS isolates showed resistance (20–40%) against tetracycline, chloramphenicol, sulfamethoxazole‐trimethoprim and ampicillin. Our study reflects the epidemiology of NTS colonization in chickens and humans in the Mekong delta of Vietnam and emphasizes the need of larger, preferably longitudinal studies to study the transmission dynamics of NTS between and within animal and human host populations.

Isolation, antibiogram and pathogenicity of Salmonella spp. recovered from slaughtered food animals in Nagpur region of Central India

Aim:

To determine the prevalence, antibiogram and pathogenicity of Salmonella spp. in the common food animals slaughtered for consumption purpose at government approved slaughter houses located in and around Nagpur region during a period of 2010-2012.

Materials and Methods:

A total of 400 samples comprising 50 each of blood and meat from each slaughtered male cattle, buffaloes, pigs and goats were collected. Isolation was done by pre-enrichment in buffered peptone water and enrichment in Rappaport-Vassiliadis broth with subsequent selective plating onto xylose lysine deoxycholate agar. Presumptive Salmonella colonies were biochemically confirmed and analyzed for pathogenicity by hemolysin production and Congo red dye binding assay (CRDA). An antibiotic sensitivity test was performed to assess the antibiotic resistance pattern of the isolates.

Results:

A total of 10 isolates of Salmonella spp. from meat (3 from cattle, 1 from buffaloes and 6 from pigs) with an overall prevalence of 5% among food animals was recorded. No isolation was reported from any blood samples. Pathogenicity assays revealed 100% and 80% positivity for CRDA and hemolytic activity, respectively. Antimicrobial sensitivity test showed multi-drug resistance. The overall resistance of 50% was noted for trimethoprim followed by ampicillin (20%). A maximum sensitivity (80%) was reported to gentamycin followed by 40% each to ampicillin and trimethoprim, 30% to amikacin and 10% to kanamycin.

Conclusion:

The presence of multidrug resistant and potentially pathogenic Salmonella spp. in slaughtered food animals in Nagpur region can be a matter of concern for public health.

Willingness to Consult a Veterinarian on Physician's Advice for Zoonotic Diseases: A Formal Role for Veterinarians in Medicine?

Physicians appear to find zoonotic diseases a challenge and consider that this topic belongs more to the veterinary profession. However, veterinarians have no formal role in clinical medicine. Data were collected as part of the Queensland Social Survey 2014 to determine the willingness of the public, if diagnosed with a zoonotic disease, to consult a veterinarian on the advice of a physician. Self-reported willingness to consult with a veterinarian at the respondent’s own expense was 79.8% (95% CI: 81.96%-77.46%) (976/1223). If the cost was funded by Medicare, the Australian public health insurance scheme, 90.7% (95% CI: 92.18%-88.92%) (1109/1223) would be willing to consult a veterinarian. Therefore, a large majority of Australian residents would be willing to consult with a veterinarian on the advice of their physician if they had a zoonotic disease. Does this indicate a possible new role for veterinarians under Clinical One Health?

A meta-analysis of the prevalence of Salmonella in food animals in Ethiopia

BACKGROUND

The globalization of the food supply and the increased movements of people, animals and goods have increased the threat of Salmonella infections in several countries. The objective of this study was to estimate the prevalence of Salmonella in food animals in Ethiopia by using meta-analytical methods.

RESULTS

The prevalence of Salmonella in slaughtered cattle, sheep, goats and pigs were 7.07%, 8.41%, 9.01% and 43.81% respectively. The occurrence of Salmonella was significantly higher in pigs than in slaughtered true ruminants (p <0.001) but not significantly different between cattle, sheep and goats (p >0. 05). S. Mishmarhaemek, S. Infantis and S. Hadar were the predominant isolates in cattle, small ruminants and pigs respectively. S. Typhimurium was isolated from all host species.

CONCLUSIONS

All food animals are considerable reservoirs of Salmonella and pose a significant risk to public health. Safety measures in slaughter houses and butcheries and education of the public could reduce the risk of transmission of Salmonella from animals to humans.

Environmental change and enteric zoonoses in New Zealand: a systematic review of the evidence

OBJECTIVE

To review the available evidence that examines the association between climatic and agricultural land use factors and the risks of enteric zoonoses in humans and consider information needs and possible pathways of intervention.

METHODS

The electronic databases PubMed, Web of Science and Embase and government websites were searched systematically for published literature that investigated the association of climatic and/or agricultural exposures with the incidence of the four most common enteric zoonotic diseases in New Zealand (campylobacteriosis, salmonellosis, cryptosporidiosis and giardiasis). Results The 16 studies in the review demonstrated significant associations between climate, agricultural land use and enteric disease occurrence. The evidence suggests that enteric disease risk from environmental reservoirs is pathogen specific. In some rural regions, environmental pathogen load is considerable, with multiple opportunities for zoonotic transmission.

CONCLUSIONS

Enteric disease occurrence in NZ is associated with climate variability and agricultural land use. However, these relationships interact with demographic factors to influence disease patterns.

IMPLICATIONS

Improved understanding of how environmental and social factors interact can inform effective public health interventions under scenarios of projected environmental change.

Attributing foodborne salmonellosis in humans to animal reservoirs in the European Union using a multi-country stochastic model

A Bayesian modelling approach comparing the occurrence ofSalmonellaserovars in animals and humans was used to attribute salmonellosis cases to broilers, turkeys, pigs, laying hens, travel and outbreaks in 24 European Union countries.Salmonelladata for animals and humans, covering the period from 2007 to 2009, were mainly obtained from studies and reports published by the European Food Safety Authority. Availability of food sources for consumption was derived from trade and production data from the European Statistical Office. Results showed layers as the most important reservoir of human salmonellosis in Europe, with 42·4% (7 903 000 cases, 95% credibility interval 4 181 000–14 510 000) of cases, 95·9% of which was caused byS. Enteritidis. In Finland and Sweden, most cases were travel-related, while in most other countries the main sources were related to the laying hen or pig reservoir, highlighting differences in the epidemiology ofSalmonella, surveillance focus and eating habits across the European Union.

Case-control studies of sporadic enteric infections: a review and discussion of studies conducted internationally from 1990 to 2009

Epidemiologists have used case-control studies to investigate enteric disease outbreaks for many decades. Increasingly, case-control studies are also used to investigate risk factors for sporadic (not outbreak-associated) disease. While the same basic approach is used, there are important differences between outbreak and sporadic disease settings that need to be considered in the design and implementation of the case-control study for sporadic disease. Through the International Collaboration on Enteric Disease "Burden of Illness" Studies (the International Collaboration), we reviewed 79 case-control studies of sporadic enteric infections caused by nine pathogens that were conducted in 22 countries and published from 1990 through to 2009. We highlight important methodological and study design issues (including case definition, control selection, and exposure assessment) and discuss how approaches to the study of sporadic enteric disease have changed over the last 20 years (e.g., making use of more sensitive case definitions, databases of controls, and computer-assisted interviewing). As our understanding of sporadic enteric infections grows, methods and topics for case-control studies are expected to continue to evolve; for example, advances in understanding of the role of immunity can be used to improve control selection, the apparent protective effects of certain foods can be further explored, and case-control studies can be used to provide population-based measures of the burden of disease.

A prospective case-control and molecular epidemiological study of human cases of Shiga toxin-producing Escherichia coli in New Zealand

Background

Shiga toxin-producing Escherichia coli (STEC) O157:H7 and related non-O157 STEC strains are enteric pathogens of public health concern worldwide, causing life-threatening diseases. Cattle are considered the principal hosts and have been shown to be a source of infection for both foodborne and environmental outbreaks in humans. The aims of this study were to investigate risk factors associated with sporadic STEC infections in humans in New Zealand and to provide epidemiological information about the source and exposure pathways.

Methods

During a national prospective case–control study from July 2011 to July 2012, any confirmed case of STEC infection notified to regional public health units, together with a random selection of controls intended to be representative of the national demography, were interviewed for risk factor evaluation. Isolates from each case were genotyped using pulsed-field gel electrophoresis (PFGE) and Shiga toxin-encoding bacteriophage insertion (SBI) typing.

Results

Questionnaire data from 113 eligible cases and 506 controls were analysed using multivariate logistic regression. Statistically significant animal and environmental risk factors for human STEC infections were identified, notably 'Cattle livestock present in meshblock’ (the smallest geographical unit) (odds ratio 1.89, 95% CI 1.04–3.42), 'Contact with animal manure’ (OR 2.09, 95% CI 1.12–3.90), and 'Contact with recreational waters’ (OR 2.95, 95% CI 1.30–6.70). No food-associated risk factors were identified as sources of STEC infection. E. coli O157:H7 caused 100/113 (88.5%) of clinical STEC infections in this study, and 97/100 isolates were available for molecular analysis. PFGE profiles of isolates revealed three distinctive clusters of genotypes, and these were strongly correlated with SBI type. The variable 'Island of residence’ (North or South Island of New Zealand) was significantly associated with PFGE genotype (p = 0.012).

Conclusions

Our findings implicate environmental and animal contact, but not food, as significant exposure pathways for sporadic STEC infections in humans in New Zealand. Risk factors associated with beef and dairy cattle suggest that ruminants are the most important sources of STEC infection. Notably, outbreaks of STEC infections are rare in New Zealand and this further suggests that food is not a significant exposure pathway.

Subclinical infection and asymptomatic carriage of gastrointestinal zoonoses: occupational exposure, environmental pathways, and the anonymous spread of disease

Asymptomatic carriage of gastrointestinal zoonoses is more common in people whose profession involves them working directly with domesticated animals. Subclinical infections (defined as an infection in which symptoms are either asymptomatic or sufficiently mild to escape diagnosis) are important within a community as unknowing (asymptomatic) carriers of pathogens do not change their behaviour to prevent the spread of disease; therefore the public health significance of asymptomatic human excretion of zoonoses should not be underestimated. However, optimal strategies for managing diseases where asymptomatic carriage instigates further infection remain unresolved, and the impact on disease management is unclear. In this review we consider the environmental pathways associated with prolonged antigenic exposure and critically assess the significance of asymptomatic carriage in disease outbreaks. Although screening high-risk groups for occupationally acquired diseases would be logistically problematical, there may be an economic case for identifying and treating asymptomatic carriage if the costs of screening and treatment are less than the costs of identifying and treating those individuals infected by asymptomatic hosts.

Source attribution of human campylobacteriosis using a meta-analysis of case-control studies of sporadic infections

Campylobacter spp. is a widespread and important cause of human illness worldwide. Disease is frequently associated with foodborne transmission, but other routes of exposure, such as direct contact with live animals and person-to-person transmission, are also recognized. Identifying the most important sources of human disease is essential for prioritizing food safety interventions and setting public health goals. Numerous case-control studies of sporadic infections of campylobacteriosis have been published. These studies investigated a variety of potential risk factors for disease, often using different methodologies and settings. Systematic reviews (SRs) consist of a formal process for literature review focused on a specific research question, and include the identification of relevant literature, quality assessment of relevant studies, summarization or statistical analysis of data, and conclusions. With the objective of identifying the most important risk factors for human sporadic campylobacteriosis, we performed a SR of case-control studies of human sporadic cases and a meta-analysis of the obtained results. A combined SR focusing on Salmonella and Campylobacter studies was performed and the results analysed separately. From 1295 identified references, 131 passed the relevance screening, 73 passed the quality assessment stage, and data was extracted from 72 studies. Of these, 38 focused on campylobacteriosis. Information on exposures of cases and controls, and estimated odds ratios for investigated risk factors were collected and analysed. In the meta-analysis, heterogeneity between the studies and possible sources of bias were investigated, and pooled odds ratios for identified risk factors were estimated. Results suggest that travelling abroad, eating undercooked chicken, environmental sources, and direct contact with farm animals were significant risk factors for campylobacteriosis. Sub-analyses by geographical region, age group, and study period were performed, and differences were discussed.

Source attribution of human salmonellosis using a meta-analysis of case-control studies of sporadic infections

Salmonella is an important cause of human illness. Disease is frequently associated with foodborne transmission, but other routes of exposure are recognized. Identifying sources of disease is essential for prioritizing public health interventions. Numerous case-control studies of sporadic salmonellosis have been published, often using different methodologies and settings. Systematic reviews consist of a formal process for literature review focused on a research question. With the objective of identifying the most important risk factors for salmonellosis, we performed a systematic review of case-control studies and a meta-analysis of obtained results. Thirty-five Salmonella case-control studies were identified. In the meta-analysis, heterogeneity between studies and possible sources of bias were investigated, and pooled odds ratios estimated. Results suggested that travel, predisposing factors, eating raw eggs, and eating in restaurants were the most important risk factors for salmonellosis. Sub-analyses by serotype were performed when enough studies were available.

The epidemiology of human salmonellosis in New Zealand, 1997–2008

This study describes the epidemiology of human salmonellosis in New Zealand using notified, hospitalized and fatal cases over a 12-year period (1997–2008). The average annual incidence for notifications was 42·8/100 000 population and 3·6/100 000 population for hospitalizations. Incidence was about twice as high in summer as in winter. Rural areas had higher rates than urban areas (rate ratio 1·23, 95% confidence interval 1·22–1·24 for notifications) and a distinct spring peak. Incidence was highest in the 0–4 years age group (154·2 notifications/100 000 and 11·3 hospitalizations/100 000). Hospitalizations showed higher rates for Māori and Pacific Island populations compared to Europeans, and those living in more deprived areas, whereas notifications showed the reverse, implying that notifications are influenced by health-seeking behaviours.SalmonellaTyphimurium was the dominant serotype followed byS. Enteritidis. For a developed country, salmonellosis rates in New Zealand have remained consistently high suggesting more work is needed to investigate, control and prevent this disease.

Prevalence of Salmonella spp., and serovars isolated from captive exotic reptiles in New Zealand

AIM

To investigate the prevalence of Salmonella spp. in captive exotic reptile species in New Zealand, and identify the serovars isolated from this population.

METHODS

Cloacal swabs were obtained from 378 captive exotic reptiles, representing 24 species, residing in 25 collections throughout New Zealand between 2008 and 2009. Samples were cultured for Salmonella spp., and suspected colonies were serotyped by the Institute of Environmental Science and Research (ESR).

RESULTS

Forty-three of the 378 (11.4%) reptiles sampled tested positive for Salmonella spp., with 95% CI for the estimated true prevalence being 12-25% in exotic reptiles in this study population. Lizards tested positive for Salmonella spp. more often than chelonians. Agamid lizards tested positive more often than any other family group, with 95% CI for the estimated true prevalence being 56-100%.. Six Salmonella serovars from subspecies I and two from subspecies II were isolated. The serovar most commonly isolated was S. Onderstepoort (30.2%), followed by S. Thompson (20.9%), S. Potsdam (14%), S. Wangata (14%), S. Infantis (11.6%) and S. Eastbourne (2.3%). All of the subspecies I serovars have been previously reported in both reptiles and humans in New Zealand, and include serovars previously associated with disease in humans.

CONCLUSIONS AND CLINICAL RELEVANCE

This study showed that Salmonella spp. were commonly carried by exotic reptiles in the study population in New Zealand. Several serovars of Salmonella spp. with known pathogenicity to humans were isolated, including S. Infantis, which is one of the most common serovars isolated from both humans and non-human sources in New Zealand. The limitations of this study included the bias engendered by the need for voluntary involvement in the study, and the non-random sampling design. Based on the serovars identified in this and previous studies, it is recommended native and exotic reptiles be segregated within collections, especially when native reptiles may be used for biodiversity restoration. Veterinarians and reptile keepers are advised to follow hygiene protocols developed to minimise reptile-associated salmonellosis.

Source attribution of nontyphoid salmonellosis in new zealand using outbreak surveillance data

In this study, 204 New Zealand outbreaks of non-typhoid salmonellosis reported from 2000 to 2009 were analyzed for information on the sources of human infection. Data were extracted from the outbreak module of EpiSurv, New Zealand's notifiable diseases database, and augmented with information from individual case reports and separate investigation reports. The outbreaks involved 1,426 cases, representing an estimated 9% of the total salmonellosis cases reported for the study period. Salmonella Typhimurium was the causative serotype in 78% of 172 outbreaks for which a serotype was available, involving 71% of outbreak cases. The most commonly reported outbreak setting was the home (47% of outbreaks), followed by commercial food operations (31%). Foodborne transmission was reported for 63% of the 123 outbreaks for which only one mode of transmission was reported, followed by person-to-person transmission (32%), waterborne transmission (3%), and zoonotic transmission (2%). However, evidence for the mode of transmission was weak or absent for 107 (63%) of the 169 outbreaks for which a mode of transmission was reported. For only 22 outbreaks was laboratory evidence successfully used to identify a potential source of infection. Of these 22 outbreaks, 7 were foodborne, 11 involved an infected food handler, 2 were attributed to contact with animals, 1 was attributed to consumption of drinking water, and 1 was attributed to multiple sources. The laboratory-confirmed contaminated foods were diverse and included imported and domestically produced foods. The results of this analysis support the hypothesis that non-typhoid salmonellosis is primarily a foodborne disease in New Zealand, but there is insufficient evidence to confirm important food vehicles.

Animal contact as a source of human non-typhoidal salmonellosis

Non-typhoidal Salmonella represents an important human and animal pathogen world-wide. Most human salmonellosis cases are foodborne, but each year infections are also acquired through direct or indirect animal contact in homes, veterinary clinics, zoological gardens, farm environments or other public, professional or private settings. Clinically affected animals may exhibit a higher prevalence of shedding than apparently healthy animals, but both can shed Salmonella over long periods of time. In addition, environmental contamination and indirect transmission through contaminated food and water may complicate control efforts. The public health risk varies by animal species, age group, husbandry practice and health status, and certain human subpopulations are at a heightened risk of infection due to biological or behavioral risk factors. Some serotypes such as Salmonella Dublin are adapted to individual host species, while others, for instance Salmonella Typhimurium, readily infect a broad range of host species, but the potential implications for human health are currently unclear. Basic hygiene practices and the implementation of scientifically based management strategies can efficiently mitigate the risks associated with animal contacts. However, the general public is frequently unaware of the specific disease risks involved, and high-risk behaviors are common. Here we describe the epidemiology and serotype distribution of Salmonella in a variety of host species. In addition, we review our current understanding of the public health risks associated with different types of contacts between humans and animals in public, professional or private settings, and, where appropriate, discuss potential risk mitigation strategies.

Climate change and infectious diseases in New Zealand: a brief review and tentative research agenda

AIMS

To review the literature on infectious diseases and meteorological and climate change risk factors in the New Zealand context and to describe a tentative research agenda for future work.

METHODS

We performed literature searches in May 2010 using Medline and Google Scholar. We also searched five health-related government agencies in New Zealand for documentation on climate change and health.

RESULTS

The effect of climate variability and change on vector-borne disease has been considered in more detail than any other infectious disease topic (n=20+ journal articles and reports relating to New Zealand). Generally, concern has arisen around the risk of new mosquito incursions and increased risks of dengue and Ross River fevers in the long term. For enteric diseases, the picture from five New Zealand publications is somewhat mixed, although the data indicate that salmonellosis notifications increase with higher monthly temperatures. One interpretation of the New Zealand data is that communities without reticulated water supplies could be more vulnerable to the effects of climate change-mediated increases in protozoan diseases. This information informed a tentative research agenda to address research gaps. Priorities include the need for further work on a more integrated surveillance framework, vector-borne diseases, enteric diseases, skin infections, and then work on topics for which we found no published New Zealand work (such as influenza and leptospirosis). Finally, we found that health-related government agencies in New Zealand have relatively little 'climate change and health' information on their websites.

CONCLUSIONS

Although some informative work has been done to date, much scope remains for additional research and planning to facilitate prevention, mitigation, and adaptation responses in the New Zealand setting around climate change and infectious disease risks. The tentative research agenda produced could benefit from a wider critique, and government agencies in New Zealand could contribute to informed discussions by better documenting the current state of knowledge on their websites.

Case-case analysis of enteric diseases with routine surveillance data: Potential use and example results

BACKGROUND

Case-control studies and outbreak investigations are the major epidemiological tools for providing detailed information on enteric disease sources and risk factors, but these investigations can be constrained by cost and logistics.

METHODS

We explored the advantages and disadvantages of comparing risk factors for enteric diseases using the case-case method. The main issues are illustrated with an analysis of routine notification data on enteric diseases for 2006 collected by New Zealand's national surveillance system.

RESULTS

Our analyses of aggregated New Zealand surveillance data found that the associations (crude odds ratios) for risk factors of enteric disease were fairly consistent with findings from local case-control studies and outbreak investigations, adding support for the use of the case-case analytical approach. Despite various inherent limitations, such an approach has the potential to contribute to the monitoring of risk factor trends for enteric diseases. Nevertheless, using the case-case method for analysis of routine surveillance data may need to be accompanied by: (i) reduction of potential selection and information biases by improving the quality of the surveillance data; and (ii) reduction of confounding by conducting more sophisticated analyses based on individual-level data.

CONCLUSION

Case-case analyses of enteric diseases using routine surveillance data might be a useful low-cost means to study trends in enteric disease sources and inform control measures. If used, it should probably supplement rather than replace outbreak investigations and case-control studies. Furthermore, it could be enhanced by utilising high quality individual-level data provided by nationally-representative sentinel sites for enteric disease surveillance.