Determining the long-term health burden and risk of sequelae for 14 foodborne infections in British Columbia, Canada: protocol for a retrospective population-based cohort study

Assessing the Dissemination of Federal Risk Communication by News Media Outlets During Enteric Illness Outbreaks: Canadian Content Analysis

Background

Effective dissemination of federal risk communication by news media during multijurisdictional enteric illness outbreaks can increase message reach to rapidly contain outbreaks, limit adverse outcomes, and promote informed decision-making by the public. However, dissemination of risk communication from the federal government by mass media has not been evaluated.

Objective

This study aimed to describe and assess the dissemination of federal risk communication by news media outlets during multijurisdictional enteric illness outbreaks in Canada.

Methods

A comprehensive systematic search of 2 databases, Canadian Newsstream and Canadian Business & Current Affairs, was run using search terms related to the source of enteric illnesses, general outbreak characteristics, and relevant enteric pathogen names to retrieve news media articles issued between 2014 and 2023, corresponding to 46 public health notices (PHNs) communicating information about multijurisdictional enteric illness outbreaks during the same period. A codebook comprised of 3 sections-general characteristics of the article, consistency and accuracy of information presented between PHNs and news media articles, and presence of health belief model constructs-was developed and applied to the dataset. Data were tabulated and visualized using RStudio (Posit).

Results

News media communicated about almost all PHNs (44/46, 96%). News media commonly developed their own articles (320/528, 60.6%) to notify the public about an outbreak and its associated product recall (121/320, 37.8%), but rarely communicated about the conclusion of an outbreak (12/320, 3.8%). News media communicated most outbreak characteristics, such as the number of cases (237/319, 74.3%), but the number of deaths was communicated less than half the time (114/260, 43.8%). Benefit and barrier constructs of the health belief model were infrequently present (50/243, 20.6% and 15/243, 6.2%, respectively).

Conclusions

Canadian news media disseminated information about most multijurisdictional enteric illness outbreaks. However, differences in coverage of multijurisdictional enteric illness outbreaks by news media were evident. Federal organizations can improve future risk communication of multijurisdictional enteric illness outbreaks by news media by maintaining and strengthening interorganizational connections and ensuring the information quality of PHNs as a key information source for news media.

The epidemiology and healthcare costs of pregnancy-related listeriosis in British Columbia, Canada, 2005-2014

This study investigated cases of pregnancy-related listeriosis in British Columbia (BC), Canada, from 2005 to 2014. We described all diagnosed cases in pregnant women (n = 15) and neonates (n = 7), estimated the excess healthcare costs associated with listeriosis, and calculated the fraction of stillbirths attributable to listeriosis, and mask cell sizes 1-5 due to data requirements. Pregnant women had a median gestational age of 31 weeks at listeriosis onset (range: 20-39) and on average delivered at a median of 37 weeks gestation (range: 20-40). Neonates experienced complications but no fatalities. Stillbirths occurred in 1-5 of 15 pregnant women with listeriosis, and very few (0.05-0.24%) of the 2,088 stillbirths in BC in the 10 years were attributed to listeriosis (exact numbers masked). Pregnant women and neonates with listeriosis had significantly more hospital visits, days in the hospital and physician visits than those without listeriosis. Pregnant women with listeriosis had 2.59 times higher mean total healthcare costs during their pregnancy, and neonates with listeriosis had 9.85 times higher mean total healthcare costs during their neonatal period, adjusting for various factors. Despite small case numbers and no reported deaths, these results highlight the substantial additional health service use and costs associated with individual cases of pregnancy-related listeriosis in BC.

Developing International Classification of Disease code definitions for the study of enteric infection sequelae in Canada

Background

Enteric infections and their chronic sequelae are a major cause of disability and death. Despite the increasing use of administrative health data in measuring the burden of chronic diseases in the population, there is a lack of validated International Classification of Disease (ICD) code-based case definitions, particularly in the Canadian context. Our objective was to validate ICD code definitions for sequelae of enteric infections in Canada: acute kidney injury (AKI); hemolytic uremic syndrome (HUS); thrombotic thrombocytopenic purpura (TTP); Guillain-Barré syndrome/Miller-Fisher syndrome (GBS/MFS); chronic inflammatory demyelinating polyneuropathy (CIDP); ankylosing spondylitis (AS); reactive arthritis; anterior uveitis; Crohn's disease, ulcerative colitis, celiac disease, erythema nodosum (EN); neonatal listeriosis (NL); and Graves' disease (GD).

Methods

We used a multi-step approach by conducting a literature review to identify existing validated definitions, a clinician assessment of the validated definitions, a chart review to verify proposed definitions and a final clinician review. We measured the sensitivity and positive predictive value (PPV) of proposed definitions.

Results

Forty studies met inclusion criteria. We identified validated definitions for 12 sequelae; clinicians developed three (EN, NL, GD). We reviewed 181 charts for 6 sequelae (AKI, HUS, TTP, GBS/MFS, CIDP, AS). Sensitivity (42.8%-100%) and PPV (63.6%-100%) of ICD code definitions varied. Six definitions were modified by clinicians following the chart review (AKI, TTP, GBS/MFS, CIDP, AS, reactive arthritis) to reflect coding practices, increase specificity or sensitivity, and address logistical constraints.

Conclusion

The multi-step design to derive ICD code definitions provided flexibility to identify existing definitions, to improve their sensitivity and PPV and adapt them to the Canadian context.

Genomic characterization of molecular markers associated with antimicrobial resistance and virulence of the prevalent Campylobacter coli isolated from retail chicken meat in the United Arab Emirates

Campylobacter is a major cause of gastroenteritis worldwide, with broiler meat accounting for most illnesses. Antimicrobial intervention is recommended in severe cases of campylobacteriosis. The emergence of antimicrobial resistance (AMR) in Campylobacter is a concerning food safety challenge, and monitoring the trends of AMR is vital for a better risk assessment. This study aimed to characterize the phenotypic profiles and molecular markers of AMR and virulence in the prevalent Campylobacter species contaminating chilled chicken carcasses sampled from supermarkets in the United Arab Emirates (UAE). Campylobacter was detected in 90 (28.6%) out of 315 tested samples, and up to five isolates from each were confirmed using multiplex PCR. The species C. coli was detected in 83% (75/90) of the positive samples. Whole-genome sequencing was used to characterize the determinants of AMR and potential virulence genes in 45 non-redundant C. coli isolates. We identified nine resistance genes, including four associated with resistance to aminoglycoside (aph(3')-III, ant(6)-Ia, aph(2″)-Ib, and aac(6')-Im), and three associated with Beta-lactam resistance (blaOXA-61, blaOXA-193, and blaOXA-489), and two linked to tetracycline resistance (tet(O/32/O), and tet(O)), as well as point mutations in gyrA (fluoroquinolones resistance), 23S rRNA (macrolides resistance), and rpsL (streptomycin resistance) genes. A mutation in gyrA 2 p.T86I, conferring resistance to fluoroquinolones, was detected in 93% (42/45) of the isolates and showed a perfect match with the phenotype results. The simultaneous presence of blaOXA-61 and blaOXA-193 genes was identified in 86.6% (39/45) of the isolates. In silico analysis identified 7 to 11 virulence factors per each C. coli isolate. Some of these factors were prevalent in all examined strains and were associated with adherence (cadF, and jlpA), colonization and immune evasion (capsule biosynthesis and transport, lipooligosaccharide), and invasion (ciaB). This study provides the first published evidence from the UAE characterizing Campylobacter virulence, antimicrobial resistance genotype, and phenotype analysis from retail chicken. The prevalent C. coli in the UAE retail chicken carries multiple virulence genes and antimicrobial resistance markers and exhibits frequent phenotype resistance to macrolides, quinolones, and tetracyclines. The present investigation adds to the current knowledge on molecular epidemiology and AMR development in non-jejuni Campylobacter species in the Middle East and globally.

Patterns of enteric infections in a population-wide cohort study of sequelae, British Columbia, Canada

We assessed patterns of enteric infections caused by 14 pathogens, in a longitudinal cohort study of sequelae in British Columbia (BC) Canada, 2005-2014. Our population cohort of 5.8 million individuals was followed for an average of 7.5 years/person; during this time, 40 523 individuals experienced 42 308 incident laboratory-confirmed, provincially reported enteric infections (96.4 incident infections per 100 000 person-years). Most individuals (38 882/40 523; 96%) had only one, but 4% had multiple concurrent infections or more than one infection across the study. Among individuals with more than one infection, the pathogens and combinations occurring most frequently per individual matched the pathogens occurring most frequently in the BC population. An additional 298 557 new fee-for-service physician visits and hospitalisations for enteric infections, that did not coincide with a reported enteric infection, also occurred, and some may be potentially unreported enteric infections. Our findings demonstrate that sequelae risk analyses should explore the possible impacts of multiple infections, and that estimating risk for individuals who may have had a potentially unreported enteric infection is warranted.

Quantification of Campylobacter contamination on chicken carcasses sold in retail markets in the United Arab Emirates

Background

Campylobacter is among the leading causes of foodborne zoonotic disease worldwide, with chicken meat accounting for the majority of human illnesses. This baseline study generates the first quantitative data for Campylobacter contamination in the United Arab Emirates chicken meat. Such data will help inform risk analysis and develop evidence-based food safety management.

Methods

For a year, chilled whole chicken carcasses (n = 315) belonging to seven different companies were collected from retail supermarkets. According to standard methods, Campylobacter enumeration was achieved by a direct plating in all chicken samples, and isolates were confirmed using multiplex PCR.

Results

Campylobacter spp. were recovered from 28.6% (90/315) of the samples. Campylobacter enumeration results indicated that 71.4% of the tested samples were contaminated with < 1 log10 CFU (colony-forming units)/g, and 7% were contaminated with ≥3 log10 CFU/g. The mean Campylobacter concentration was 2.70 log10 CFU/g, with a standard deviation of 0.41 log10 CFU/g. Campylobacter counts varied significantly in relation to the sourcing chicken processing companies. Six out of the seven surveyed companies provided Campylobacter positive samples. Moreover, significantly higher (p-value< 0.0001) counts were found to be associated with smaller size chicken carcasses (weighted 600–700 g; compared to the other categories, 800 g and 900–1000 g). Interestingly, C. coli was present in 83% of the positive samples, while C. jejuni was only detected in 6.4% of the samples. Compared with studies from other countries utilizing the same enumeration method, the UAE chicken appears to have a lower prevalence but a higher Campylobacter count per gram of carcasses. Higher Campylobacter counts were significantly associated with smaller carcasses, and C. coli was the dominant species detected in this study’s samples.

Conclusion

These results add to our understanding of the local, regional and global epidemiology of Campylobacter in chicken meat. Outputs of the current study may aid in developing a risk assessment of Campylobacter in the UAE, a country among the biggest per capita consumption markets for chicken meat worldwide.

Yersiniosis in New Zealand

The rate of yersiniosis in New Zealand (NZ) is high compared with other developed countries, and rates have been increasing over recent years. Typically, >99% of human cases in NZ are attributed to Yersinia enterocolitica (YE), although in 2014, a large outbreak of 220 cases was caused by Yersinia pseudotuberculosis. Up until 2012, the most common NZ strain was YE biotype 4. The emergent strain since this time is YE biotype 2/3 serotype O:9. The pathogenic potential of some YE biotypes remains unclear. Most human cases of yersiniosis are considered sporadic without an identifiable source. Key restrictions in previous investigations included insufficient sensitivity for the isolation of Yersinia spp. from foods, although foodborne transmission is the most likely route of infection. In NZ, YE has been isolated from a variety of sick and healthy domestic and farm animals but the pathways from zoonotic reservoir to human remain unproven. Whole-genome sequencing provides unprecedented discriminatory power for typing Yersinia and is now being applied to NZ epidemiological investigations. A "One-Health" approach is necessary to elucidate the routes of transmission of Yersinia and consequently inform targeted interventions for the prevention and management of yersiniosis in NZ.