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Ikejezie J, Miglietta A, Hammermeister Nezu I, Adele S, Higdon MM, Feikin D, Lata H, Mesfin S, Idoko F, Shimizu K, Acma A, Moro S, Attar Cohen H, Sinnathamby MA, Otieno JR, Temre Y, Ajong BN, Mirembe BB, Guinko TN, Sodagar V, Schultz C, Muianga J, De Barros S, Escobar Corado Waeber AR, Jin Y, Rico Chinchilla A, Izawa Y, Khare S, Poole M, Alexander N, Ciobanu S, Dorji T, Hassan M, Kato M, Matsui T, Ogundiran O, Pebody RG, Phengxay M, Riviere-Cinnamond A, Greene-Cramer BJ, Peron E, Archer BN, Subissi L, Kassamali ZA, Awofisayo-Okuyelu A, le Polain de Waroux O, Hamblion E, Pavlin BI, Morgan O, Fall IS, Van Kerkhove MD, Mahamud A. Informing the pandemic response: the role of the WHO's COVID-19 Weekly Epidemiological Update. BMJ Glob Health 2024; 9:e014466. [PMID: 38580376 PMCID: PMC11002403 DOI: 10.1136/bmjgh-2023-014466] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 01/19/2024] [Indexed: 04/07/2024] Open
Abstract
On 31 December 2019, the Municipal Health Commission of Wuhan, China, reported a cluster of atypical pneumonia cases. On 5 January 2020, the WHO publicly released a Disease Outbreak News (DON) report, providing information about the pneumonia cases, implemented response interventions, and WHO's risk assessment and advice on public health and social measures. Following 9 additional DON reports and 209 daily situation reports, on 17 August 2020, WHO published the first edition of the COVID-19 Weekly Epidemiological Update (WEU). On 1 September 2023, the 158th edition of the WEU was published on WHO's website, marking its final issue. Since then, the WEU has been replaced by comprehensive global epidemiological updates on COVID-19 released every 4 weeks. During the span of its publication, the webpage that hosts the WEU and the COVID-19 Operational Updates was accessed annually over 1.4 million times on average, with visits originating from more than 100 countries. This article provides an in-depth analysis of the WEU process, from data collection to publication, focusing on the scope, technical details, main features, underlying methods, impact and limitations. We also discuss WHO's experience in disseminating epidemiological information on the COVID-19 pandemic at the global level and provide recommendations for enhancing collaboration and information sharing to support future health emergency responses.
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Affiliation(s)
| | | | | | - Sandra Adele
- Health Emergencies Programme, World Health Organization, Geneva, Switzerland
| | - Melissa M Higdon
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Daniel Feikin
- Department of Immunization, Vaccines and Biologicals, World Health Organization, Geneva, Switzerland
| | - Harsh Lata
- Health Emergencies Programme, World Health Organization, Geneva, Switzerland
| | - Samuel Mesfin
- Health Emergencies Programme, World Health Organization, Geneva, Switzerland
| | - Friday Idoko
- Health Emergencies Programme, World Health Organization, Geneva, Switzerland
| | - Kazuki Shimizu
- Health Emergencies Programme, World Health Organization, Geneva, Switzerland
| | - Ayse Acma
- Health Emergencies Programme, World Health Organization, Geneva, Switzerland
| | - Samuel Moro
- Health Emergencies Programme, World Health Organization, Geneva, Switzerland
| | - Homa Attar Cohen
- Health Emergencies Programme, World Health Organization, Geneva, Switzerland
| | | | | | - Yosef Temre
- Health Emergencies Programme, World Health Organization, Geneva, Switzerland
| | | | | | - Tondri Noe Guinko
- Health Emergencies Programme, World Health Organization, Geneva, Switzerland
| | - Vaishali Sodagar
- Health Emergencies Programme, World Health Organization, Geneva, Switzerland
| | - Craig Schultz
- Health Emergencies Programme, World Health Organization, Geneva, Switzerland
| | - Joao Muianga
- Health Emergencies Programme, World Health Organization, Geneva, Switzerland
| | - Stéphane De Barros
- Health Emergencies Programme, World Health Organization, Geneva, Switzerland
| | | | - Yeowon Jin
- Health Emergencies Programme, World Health Organization, Geneva, Switzerland
| | | | - Yurie Izawa
- Health Emergencies Programme, World Health Organization, Geneva, Switzerland
| | - Shagun Khare
- Health Emergencies Programme, World Health Organization, Geneva, Switzerland
| | - Marcia Poole
- Health Emergencies Programme, World Health Organization, Geneva, Switzerland
| | - Nyka Alexander
- Health Emergencies Programme, World Health Organization, Geneva, Switzerland
| | - Silviu Ciobanu
- World Health Organization Regional Office for Europe, Copenhagen, Denmark
| | - Tshewang Dorji
- World Health Organization Regional Office for South-East Asia, New Delhi, India
| | - Mahmoud Hassan
- World Health Organisation Regional Office for the Eastern Mediterranean, Cairo, Egypt
| | - Masaya Kato
- World Health Organization Regional Office for South-East Asia, New Delhi, India
| | - Tamano Matsui
- World Health Organization Regional Office for the Western Pacific, Manila, Philippines
| | - Opeayo Ogundiran
- World Health Organization Regional Office for Africa, Brazzaville, Congo
| | - Richard G Pebody
- World Health Organization Regional Office for Europe, Copenhagen, Denmark
| | - Manilay Phengxay
- World Health Organization Regional Office for the Western Pacific, Manila, Philippines
| | | | | | - Emilie Peron
- Health Emergencies Programme, World Health Organization, Geneva, Switzerland
| | | | - Lorenzo Subissi
- Health Emergencies Programme, World Health Organization, Geneva, Switzerland
| | | | | | | | - Esther Hamblion
- Health Emergencies Programme, World Health Organization, Geneva, Switzerland
| | - Boris Igor Pavlin
- Health Emergencies Programme, World Health Organization, Geneva, Switzerland
| | - Oliver Morgan
- Health Emergencies Programme, World Health Organization, Geneva, Switzerland
| | - Ibrahima Socé Fall
- Health Emergencies Programme, World Health Organization, Geneva, Switzerland
| | | | - Abdi Mahamud
- Health Emergencies Programme, World Health Organization, Geneva, Switzerland
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2
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Lata H, Saad Duque NJ, Togami E, Miglietta A, Perkins D, Corpuz A, Kato M, Babu A, Dorji T, Matsui T, Almiron M, Cheng KY, MacDonald LE, Pukkila JT, Williams GS, Andraghetti R, Dolea C, Mahamud A, Morgan O, Olowokure B, Fall IS, Awofisayo-Okuyelu A, Hamblion E. Disseminating information on acute public health events globally: experiences from the WHO's Disease Outbreak News. BMJ Glob Health 2024; 9:e012876. [PMID: 38413101 PMCID: PMC10900317 DOI: 10.1136/bmjgh-2023-012876] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 12/20/2023] [Indexed: 02/29/2024] Open
Abstract
WHO works, on a daily basis, with countries globally to detect, prepare for and respond to acute public health events. A vital component of a health response is the dissemination of accurate, reliable and authoritative information. The Disease Outbreak News (DON) reports are a key mechanism through which WHO communicates on acute public health events to the public. The decision to produce a DON report is taken on a case-by-case basis after evaluating key criteria, and the subsequent process of producing a DON report is highly standardised to ensure the robustness of information. DON reports have been published since 1996, and up to 2022 over 3000 reports have been published. Between 2018 and 2022, the most frequently published DON reports relate to Ebola virus disease, Middle East respiratory syndrome, yellow fever, polio and cholera. The DON web page is highly visited with a readership of over 2.6 million visits per year, on average. The DON report structure has evolved over time, from a single paragraph in 1996 to a detailed report with seven sections currently. WHO regularly reviews the DON report process and structure for improvements. In the last 25 years, DON reports have played a unique role in rapidly disseminating information on acute public health events to health actors and the public globally. They have become a key information source for the global public health response to the benefit of individuals and communities.
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Affiliation(s)
- Harsh Lata
- Health Emergencies, World Health Organization, Geneva, Switzerland
| | | | - Eri Togami
- Health Emergencies, World Health Organization, Geneva, Switzerland
| | | | - Devin Perkins
- Health Emergencies, World Health Organization, Geneva, Switzerland
| | - Aura Corpuz
- Health Emergencies, World Health Organization Regional Office for the Eastern Mediterranean, Cairo, Egypt
| | - Masaya Kato
- World Health Organization Regional Office for South-East Asia, New Delhi, Delhi, India
| | - Amarnath Babu
- World Health Organization Regional Office for South-East Asia, New Delhi, Delhi, India
| | - Tshewang Dorji
- Health Emergencies, World Health Organization Regional Office for South-East Asia, New Delhi, Delhi, India
| | - Tamano Matsui
- World Health Organization Regional Office for the Western Pacific, Manila, The Philippines
| | - Maria Almiron
- Health Emergencies, Pan American Health Organization, Washington, District of Columbia, USA
| | - Ka Yeung Cheng
- Health Emergencies, World Health Organization Regional Office for Europe, Copenhagen, Denmark
| | - Lauren E MacDonald
- Health Emergencies, World Health Organization Regional Office for Europe, Copenhagen, Denmark
| | - Jukka Tapani Pukkila
- Health Emergencies, World Health Organization Regional Office for Europe, Copenhagen, Denmark
| | - George Sie Williams
- Health Emergencies, World Health Organization Regional Office for Africa, Brazzaville, Congo
| | | | - Carmen Dolea
- Health Emergencies, World Health Organization, Geneva, Switzerland
| | | | - Oliver Morgan
- Health Emergencies, World Health Organization, Geneva, Switzerland
| | - Babatunde Olowokure
- Health Emergencies, World Health Organization Regional Office for the Western Pacific, Manila, The Philippines
| | | | | | - Esther Hamblion
- Health Emergencies, World Health Organization, Geneva, Switzerland
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3
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Hamblion E, Saad NJ, Greene-Cramer B, Awofisayo-Okuyelu A, Selenic Minet D, Smirnova A, Engedashet Tahelew E, Kaasik-Aaslav K, Alexandrova Ezerska L, Lata H, Allain Ioos S, Peron E, Abdelmalik P, Perez-Gutierrez E, Almiron M, Kato M, Babu A, Matsui T, Biaukula V, Nabeth P, Corpuz A, Pukkila J, Cheng KY, Impouma B, Koua E, Mahamud A, Barboza P, Socé Fall I, Morgan O. Global public health intelligence: World Health Organization operational practices. PLOS Glob Public Health 2023; 3:e0002359. [PMID: 37729134 PMCID: PMC10511126 DOI: 10.1371/journal.pgph.0002359] [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] [Subscribe] [Scholar Register] [Indexed: 09/22/2023]
Abstract
Early warning and response are key to tackle emerging and acute public health risks globally. Therefore, the World Health Organization (WHO) has implemented a robust approach to public health intelligence (PHI) for the global detection, verification and risk assessment of acute public health threats. WHO's PHI operations are underpinned by the International Health Regulations (2005), which require that countries strengthen surveillance efforts, and assess, notify and verify events that may constitute a public health emergency of international concern (PHEIC). PHI activities at WHO are conducted systematically at WHO's headquarters and all six regional offices continuously, throughout every day of the year. We describe four interlinked steps; detection, verification, risk assessment, and reporting and dissemination. For PHI operations, a diverse and interdisciplinary workforce is needed. Overall, PHI is a key feature of the global health architecture and will only become more prominent as the world faces increasing public health threats.
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Affiliation(s)
- Esther Hamblion
- Department of Alert and Response Coordination, Health Emergencies Programme, World Health Organization, Geneva, Switzerland
| | - Neil J. Saad
- Department of Alert and Response Coordination, Health Emergencies Programme, World Health Organization, Geneva, Switzerland
| | - Blanche Greene-Cramer
- Department of Alert and Response Coordination, Health Emergencies Programme, World Health Organization, Geneva, Switzerland
| | - Adedoyin Awofisayo-Okuyelu
- Department of Alert and Response Coordination, Health Emergencies Programme, World Health Organization, Geneva, Switzerland
| | - Dubravka Selenic Minet
- Department of Alert and Response Coordination, Health Emergencies Programme, World Health Organization, Geneva, Switzerland
| | - Anastasia Smirnova
- Department of Alert and Response Coordination, Health Emergencies Programme, World Health Organization, Geneva, Switzerland
| | - Etsub Engedashet Tahelew
- Department of Alert and Response Coordination, Health Emergencies Programme, World Health Organization, Geneva, Switzerland
| | - Kaja Kaasik-Aaslav
- Department of Alert and Response Coordination, Health Emergencies Programme, World Health Organization, Geneva, Switzerland
| | - Lidia Alexandrova Ezerska
- Department of Alert and Response Coordination, Health Emergencies Programme, World Health Organization, Geneva, Switzerland
| | - Harsh Lata
- Department of Alert and Response Coordination, Health Emergencies Programme, World Health Organization, Geneva, Switzerland
| | - Sophie Allain Ioos
- Epidemic and Pandemic Preparedness and Prevention Department, Health Emergencies Programme, World Health Organization, Geneva, Switzerland
| | - Emilie Peron
- WHO Hub for Pandemic and Epidemic Intelligence, Health Emergencies Programme, World Health Organization, Berlin, Germany
| | - Philip Abdelmalik
- WHO Hub for Pandemic and Epidemic Intelligence, Health Emergencies Programme, World Health Organization, Berlin, Germany
| | - Enrique Perez-Gutierrez
- Health Emergency Information & Risk Assessment, Health Emergencies, World Health Organization Regional Office for the Americas, Washington DC, United States of America
| | - Maria Almiron
- Health Emergency Information & Risk Assessment, Health Emergencies, World Health Organization Regional Office for the Americas, Washington DC, United States of America
| | - Masaya Kato
- Health Emergencies Programme, World Health Organization South-East Asia Regional Office, New Delhi, India
| | - Amarnath Babu
- Health Emergencies Programme, World Health Organization South-East Asia Regional Office, New Delhi, India
| | - Tamano Matsui
- Health Emergencies Programme, World Health Organization Western Pacific Regional Office, Manilla, Philippines
| | - Viema Biaukula
- Health Emergencies Programme, World Health Organization Western Pacific Regional Office, Manilla, Philippines
| | - Pierre Nabeth
- Health Emergencies Programme, World Health Organization Eastern Mediterranean Regional Office, Cairo, Egypt
| | - Aura Corpuz
- Health Emergencies Programme, World Health Organization Eastern Mediterranean Regional Office, Cairo, Egypt
| | - Jukka Pukkila
- Health Emergencies Programme, World Health Organization European Regional Office, Copenhagen, Denmark
| | - Ka-Yeung Cheng
- Health Emergencies Programme, World Health Organization European Regional Office, Copenhagen, Denmark
| | - Benido Impouma
- Health Emergencies Programme, World Health Organization Africa Regional Office, Brazzaville, Congo
| | - Etien Koua
- Health Emergencies Programme, World Health Organization Africa Regional Office, Brazzaville, Congo
| | - Abdi Mahamud
- Department of Alert and Response Coordination, Health Emergencies Programme, World Health Organization, Geneva, Switzerland
| | - Phillipe Barboza
- Office of the Assistant Director-General for Emergencies Response, Health Emergencies Programme, World Health Organization, Geneva, Switzerland
| | - Ibrahima Socé Fall
- Department of Health Emergency Interventions, Health Emergencies Programme, World Health Organization, Geneva, Switzerland
| | - Oliver Morgan
- WHO Hub for Pandemic and Epidemic Intelligence, Health Emergencies Programme, World Health Organization, Berlin, Germany
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Wong MK, Brooks DJ, Ikejezie J, Gacic-Dobo M, Dumolard L, Nedelec Y, Steulet C, Kassamali Z, Acma A, Ajong BN, Adele S, Allan M, Cohen HA, Awofisayo-Okuyelu A, Campbell F, Cristea V, De Barros S, Edward NV, Waeber AREC, Guinko TN, Laurenson-Schafer H, Mahran M, Carrera RM, Mesfin S, Meyer E, Miglietta A, Mirembe BB, Mitri M, Nezu IH, Ngai S, Ejoh OO, Parikh SR, Peron E, Sklenovská N, Stoitsova S, Shimizu K, Togami E, Jin YW, Pavlin BI, Novak RT, Le Polain O, Fuller JA, Mahamud AR, Lindstrand A, Hersh BS, O’Brien K, Van Kerkhove MD. COVID-19 Mortality and Progress Toward Vaccinating Older Adults - World Health Organization, Worldwide, 2020-2022. MMWR Morb Mortal Wkly Rep 2023; 72:113-118. [PMID: 36730046 PMCID: PMC9927068 DOI: 10.15585/mmwr.mm7205a1] [Citation(s) in RCA: 20] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
After the emergence of SARS-CoV-2 in late 2019, transmission expanded globally, and on January 30, 2020, COVID-19 was declared a public health emergency of international concern.* Analysis of the early Wuhan, China outbreak (1), subsequently confirmed by multiple other studies (2,3), found that 80% of deaths occurred among persons aged ≥60 years. In anticipation of the time needed for the global vaccine supply to meet all needs, the World Health Organization (WHO) published the Strategic Advisory Group of Experts on Immunization (SAGE) Values Framework and a roadmap for prioritizing use of COVID-19 vaccines in late 2020 (4,5), followed by a strategy brief to outline urgent actions in October 2021.† WHO described the general principles, objectives, and priorities needed to support country planning of vaccine rollout to minimize severe disease and death. A July 2022 update to the strategy brief§ prioritized vaccination of populations at increased risk, including older adults,¶ with the goal of 100% coverage with a complete COVID-19 vaccination series** for at-risk populations. Using available public data on COVID-19 mortality (reported deaths and model estimates) for 2020 and 2021 and the most recent reported COVID-19 vaccination coverage data from WHO, investigators performed descriptive analyses to examine age-specific mortality and global vaccination rollout among older adults (as defined by each country), stratified by country World Bank income status. Data quality and COVID-19 death reporting frequency varied by data source; however, persons aged ≥60 years accounted for >80% of the overall COVID-19 mortality across all income groups, with upper- and lower-middle-income countries accounting for 80% of the overall estimated excess mortality. Effective COVID-19 vaccines were authorized for use in December 2020, with global supply scaled up sufficiently to meet country needs by late 2021 (6). COVID-19 vaccines are safe and highly effective in reducing severe COVID-19, hospitalizations, and mortality (7,8); nevertheless, country-reported median completed primary series coverage among adults aged ≥60 years only reached 76% by the end of 2022, substantially below the WHO goal, especially in middle- and low-income countries. Increased efforts are needed to increase primary series and booster dose coverage among all older adults as recommended by WHO and national health authorities.
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Awofisayo-Okuyelu A, Brainard J, Hall I, McCarthy N. Incubation Period of Shiga Toxin-Producing Escherichia coli. Epidemiol Rev 2020; 41:121-129. [PMID: 31616910 PMCID: PMC7108491 DOI: 10.1093/epirev/mxz001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 03/20/2019] [Accepted: 05/08/2019] [Indexed: 01/21/2023] Open
Abstract
Shiga toxin–producing Escherichia coli are pathogenic bacteria found in the gastrointestinal tract of humans. Severe infections could lead to life-threatening complications, especially in young children and the elderly. Understanding the distribution of the incubation period, which is currently inconsistent and ambiguous, can help in controlling the burden of disease. We conducted a systematic review of outbreak investigation reports, extracted individual incubation data and summary estimates, tested for heterogeneity, classified studies into subgroups with limited heterogeneity, and undertook a meta-analysis to identify factors that may contribute to the distribution of the pathogen’s incubation period. Twenty-eight studies were identified for inclusion in the review (1 of which included information on 2 outbreaks), and the resulting I2 value was 77%, indicating high heterogeneity. Studies were classified into 5 subgroups, with the mean incubation period ranging from 3.5 to 8.1 days. The length of the incubation period increased with patient age and decreased by 7.2 hours with every 10% increase in attack rate.
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Affiliation(s)
- Adedoyin Awofisayo-Okuyelu
- Correspondence to Adedoyin Awofisayo-Okuyelu, Department of Zoology, University of Oxford, Peter Medawar Building for Pathogen Research, South Parks Road, Oxford, United Kingdom OX1 3SY ()
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Awofisayo-Okuyelu A, Pratt A, McCarthy N, Hall I. Within-host mathematical modelling of the incubation period of Salmonella Typhi. R Soc Open Sci 2019; 6:182143. [PMID: 31598273 PMCID: PMC6774937 DOI: 10.1098/rsos.182143] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/23/2018] [Accepted: 08/06/2019] [Indexed: 06/10/2023]
Abstract
Mechanistic mathematical models are often employed to understand the dynamics of infectious diseases within a population or within a host. They provide estimates that may not be otherwise available. We have developed a within-host mathematical model in order to understand how the pathophysiology of Salmonella Typhi contributes to its incubation period. The model describes the process of infection from ingestion to the onset of clinical illness using a set of ordinary differential equations. The model was parametrized using estimated values from human and mouse experimental studies and the incubation period was estimated as 9.6 days. A sensitivity analysis was also conducted to identify the parameters that most affect the derived incubation period. The migration of bacteria to the caecal lymph node was observed as a major bottle neck for infection. The sensitivity analysis indicated the growth rate of bacteria in late phase systemic infection and the net population of bacteria in the colon as parameters that most influence the incubation period. We have shown in this study how mathematical models aid in the understanding of biological processes and can be used in estimating parameters of infectious diseases.
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Affiliation(s)
- Adedoyin Awofisayo-Okuyelu
- National Institute of Health Research Health Protection Research Unit in Gastrointestinal Infections, University of Oxford, Oxford, UK
- Department of Zoology, University of Oxford, Oxford, UK
| | - Adrian Pratt
- Emergency Response Department Science and Technology (ERD S&T), Health Protection Directorate, Public Health England, Porton Down, UK
| | - Noel McCarthy
- National Institute of Health Research Health Protection Research Unit in Gastrointestinal Infections, University of Oxford, Oxford, UK
- Department of Zoology, University of Oxford, Oxford, UK
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Ian Hall
- School of Mathematics, University of Manchester, Manchester, UK
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Elson R, Awofisayo-Okuyelu A, Greener T, Swift C, Painset A, Amar CFL, Newton A, Aird H, Swindlehurst M, Elviss N, Foster K, Dallman TJ, Ruggles R, Grant K. Utility of Whole Genome Sequencing To Describe the Persistence and Evolution of Listeria monocytogenes Strains within Crabmeat Processing Environments Linked to Two Outbreaks of Listeriosis. J Food Prot 2019; 82:30-38. [PMID: 30702931 DOI: 10.4315/0362-028x.jfp-18-206] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
This article describes the identification and investigation of two extended outbreaks of listeriosis in which crabmeat was identified as the vehicle of infection. Comparing contemporary and retrospective typing data of Listeria monocytogenes isolates from clinical cases and from food and food processing environments allowed the detection of cases going back several years. This information, combined with the analysis of routinely collected enhanced surveillance data, helped to direct the investigation and identify the vehicle of infection. Retrospective whole genome sequencing (WGS) analysis of isolates provided robust microbiological evidence of links between cases, foods, and the environments in which they were produced and demonstrated that for some cases and foods, identified by fluorescent amplified fragment length polymorphism, the molecular typing method in routine use at the time, were not part of the outbreak. WGS analysis also showed that the strains causing illness had persisted in two food production environments for many years and in one producer had evolved into two strains over a period of around 8 years. This article demonstrates the value of reviewing L. monocytogenes typing data from clinical cases together with that from foods as a means of identifying potential vehicles and sources of infection in outbreaks of listeriosis. It illustrates the importance of reviewing retrospective L. monocytogenes typing alongside enhanced surveillance data to characterize extended outbreaks and inform control measures. Also, this article highlights the advantages of WGS analysis for strain discrimination and clarification of evolutionary relationships that refine outbreak investigations and improve our understanding of L. monocytogenes in the food chain.
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Affiliation(s)
- Richard Elson
- 1 Public Health England, National Infection Service, 61 Colindale Avenue, London NW9 5EQ, UK.,2 National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Gastrointestinal Infections, University of Liverpool, Liverpool L3 5TR, UK
| | - Adedoyin Awofisayo-Okuyelu
- 2 National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Gastrointestinal Infections, University of Liverpool, Liverpool L3 5TR, UK
| | - Trevor Greener
- 3 North Tyneside Council, Public Protection Services, The Silverlink North, Cobalt Business Park, North Tyneside NE27 0BY, UK
| | - Craig Swift
- 1 Public Health England, National Infection Service, 61 Colindale Avenue, London NW9 5EQ, UK
| | - Anaïs Painset
- 1 Public Health England, National Infection Service, 61 Colindale Avenue, London NW9 5EQ, UK.,2 National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Gastrointestinal Infections, University of Liverpool, Liverpool L3 5TR, UK
| | | | - Autilia Newton
- 4 Public Health England UKOT Program IHR, 133-135, Wellington Road, London SE1 8UG, UK
| | - Heather Aird
- 5 Public Health England, National Infection Service, Food, Water and Environmental Microbiology Laboratory, National Agri-Food Innovation Campus, Block 10, Sand Hutton, York YO41 1LZ, UK
| | - Mark Swindlehurst
- 5 Public Health England, National Infection Service, Food, Water and Environmental Microbiology Laboratory, National Agri-Food Innovation Campus, Block 10, Sand Hutton, York YO41 1LZ, UK
| | - Nicola Elviss
- 5 Public Health England, National Infection Service, Food, Water and Environmental Microbiology Laboratory, National Agri-Food Innovation Campus, Block 10, Sand Hutton, York YO41 1LZ, UK
| | - Kirsty Foster
- 6 Public Health England, North East PHE Centre, Floor 2 Citygate, Gallowgate, Newcastle-upon-Tyne NE1 4WH, UK
| | - Timothy J Dallman
- 1 Public Health England, National Infection Service, 61 Colindale Avenue, London NW9 5EQ, UK.,2 National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Gastrointestinal Infections, University of Liverpool, Liverpool L3 5TR, UK
| | - Ruth Ruggles
- 1 Public Health England, National Infection Service, 61 Colindale Avenue, London NW9 5EQ, UK
| | - Kathie Grant
- 1 Public Health England, National Infection Service, 61 Colindale Avenue, London NW9 5EQ, UK.,2 National Institute for Health Research Health Protection Research Unit (NIHR HPRU) in Gastrointestinal Infections, University of Liverpool, Liverpool L3 5TR, UK
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Awofisayo-Okuyelu A, McCarthy N, Mgbakor I, Hall I. Incubation period of typhoidal salmonellosis: a systematic review and meta-analysis of outbreaks and experimental studies occurring over the last century. BMC Infect Dis 2018; 18:483. [PMID: 30261843 PMCID: PMC6161394 DOI: 10.1186/s12879-018-3391-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Accepted: 09/17/2018] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Salmonella Typhi is a human pathogen that causes typhoid fever. It is a major cause of morbidity and mortality in developing countries and is responsible for several outbreaks in developed countries. Studying certain parameters of the pathogen, such as the incubation period, provides a better understanding of its pathophysiology and its characteristics within a population. Outbreak investigations and human experimental studies provide an avenue to study these relevant parameters. METHODS In this study, the authors have undertaken a systematic review of outbreak investigation reports and experimental studies, extracted reported data, tested for heterogeneity, identified subgroups of studies with limited evidence of heterogeneity between them and identified factors that may contribute to the distribution of incubation period. Following identification of relevant studies, we extracted both raw and summary incubation data. We tested for heterogeneity by deriving the value of I2 and conducting a KS-test to compare the distribution between studies. We performed a linear regression analysis to identify the factors associated with incubation period and using the resulting p-values from the KS-test, we conducted a hierarchical cluster analysis to classify studies with limited evidence of heterogeneity into subgroups. RESULTS We identified thirteen studies to be included in the review and extracted raw incubation period data from eleven. The value of I2 was 84% and the proportion of KS test p-values that were less than 0.05 was 63.6% indicating high heterogeneity not due to chance. We identified vaccine history and attack rates as factors that may be associated with incubation period, although these were not significant in the multivariable analysis (p-value: 0.1). From the hierarchical clustering analysis, we classified the studies into five subgroups. The mean incubation period of the subgroups ranged from 9.7 days to 21.2 days. Outbreaks reporting cases with previous vaccination history were clustered in a single subgroup and reported the longest incubation period. CONCLUSIONS We identified attack rate and previous vaccination as possible associating factors, however further work involving analyses of individual patient data and developing mathematical models is needed to confirm these as well as examine additional factors that have not been included in our study.
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Affiliation(s)
- Adedoyin Awofisayo-Okuyelu
- NIHR Health Protection Research Unit in Gastrointestinal Infection, University of Liverpool, Liverpool, UK
- Department of Zoology, University of Oxford, Oxford, UK
| | - Noel McCarthy
- NIHR Health Protection Research Unit in Gastrointestinal Infection, University of Liverpool, Liverpool, UK
- Department of Zoology, University of Oxford, Oxford, UK
- Warwick Medical School, University of Warwick, Warwick, UK
| | - Ifunanya Mgbakor
- Warwick Medical School, University of Warwick, Warwick, UK
- Epidemiology, Strategic Information and Health Systems Strengthening Branch, Nigeria Office, Lagos, Nigeria
| | - Ian Hall
- School of Mathematics, University of Manchester, Manchester, UK
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Kanagarajah S, Mook P, Crook P, Awofisayo-Okuyelu A, McCarthy N. Taste and Safety: Is the Exceptional Cuisine Offered by High End Restaurants Paralleled by High Standards of Food Safety? PLoS Curr 2016; 8. [PMID: 27617168 PMCID: PMC5001641 DOI: 10.1371/currents.outbreaks.007219ac3b9a2117418df7ab629686b6] [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] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Introduction: Restaurant guides such as the Good Food Guide Top 50 create a hierarchy focussing on taste and sophistication. Safety is not explicitly included. We used restaurant associated outbreaks to assess evidence for safety. Methods: All foodborne disease outbreaks in England reported to the national database from 2000 to 2014 were used to compare the Top 50 restaurants (2015) to other registered food businesses using the Public Health England (PHE) outbreak database. Health Protection Teams were also contacted to identify any outbreaks not reported to the national database. Among Good Food Guide Top 50 restaurants, regression analysis estimated the association between outbreak occurrence and position on the list. Results: Four outbreaks were reported to the PHE national outbreak database among the Top 50 giving a rate 39 times higher (95% CI 14.5–103.2) than other registered food businesses. Eight outbreaks among the 44 English restaurants in the Top 50 were identified by direct contact with local Health Protection Teams. For every ten places higher ranked, Top 50 restaurants were 66% more likely to have an outbreak (Odds Ratio 1.66, 95% CI 0.89–3.13). Discussion: Top 50 restaurants were substantially more likely to have had reported outbreaks from 2000-2014 than other food premises, and there was a trend for higher rating position to be associated with higher probability of reported outbreaks. Our findings, that eating at some of these restaurants may pose an increased risk to health compared to other dining out, raises the question of whether food guides should consider aspects of food safety alongside the clearly important complementary focus on taste and other aspects of the dining experience.
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Affiliation(s)
- Sanch Kanagarajah
- Field Epidemiology Service, National Infection Service, Public Health England, London, United Kingdom
| | - Piers Mook
- Field Epidemiology Service, National Infection Service, Public Health England, London, United Kingdom
| | - Paul Crook
- Field Epidemiology Service, National Infection Service, Public Health England, London, United Kingdom
| | - Adedoyin Awofisayo-Okuyelu
- Gastrointestinal Infections, National Infection Service, Public Health England, London, United Kingdom; NIHR Health Protection Research Unit in Gastrointestinal Infections, United Kingdom
| | - Noel McCarthy
- Field Epidemiology Service, National Infection Service, Public Health England, London, United Kingdom; NIHR Health Protection Research Unit in Gastrointestinal Infections, United Kingdom; Warwick Medical School, Division of Health Sciences, University of Warwick, Coventry, United Kingdom
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Awofisayo-Okuyelu A, Verlander NQ, Amar C, Elson R, Grant K, Harris J. Factors influencing the time between onset of illness and specimen collection in the diagnosis of non-pregnancy associated listeriosis in England and Wales. BMC Infect Dis 2016; 16:311. [PMID: 27341796 PMCID: PMC4919868 DOI: 10.1186/s12879-016-1638-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Accepted: 06/07/2016] [Indexed: 11/10/2022] Open
Abstract
Background Listeriosis is an opportunistic bacterial infection caused by Listeria monocytogenes and predominantly affects people who are immunocompromised. Due to its severity and the population at risk, prompt clinical diagnosis and treatment of listeriosis is essential. A major step to making a clinical diagnosis is the collection of the appropriate specimen(s) for testing. This study explores factors that may influence the time between onset of illness and collection of specimen in order to inform clinical policy and develop necessary interventions. Methods Enhanced surveillance data on non-pregnancy associated listeriosis in England and Wales between 2004 and 2013 were collected and analysed. The difference in days between onset of symptoms and collection of specimen was calculated and factors influencing the time difference were identified using a gamma regression model. Results The median number of days between onset of symptoms and collection of specimen was two days with 27.1 % of cases reporting one day between onset of symptoms and collection of specimen and 18.8 % of cases reporting more than seven days before collection of specimen. The median number of days between onset of symptoms and collection of specimen was shorter for cases infected with Listeria monocytogenes serogroup 1/2b (one day) and cases with an underlying condition (one day) compared with cases infected with serotype 4 (two days) and cases without underlying conditions (two days). Conclusions Our study has shown that Listeria monocytogenes serotype and the presence of an underlying condition may influence the time between onset of symptoms and collection of specimen. Electronic supplementary material The online version of this article (doi:10.1186/s12879-016-1638-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Adedoyin Awofisayo-Okuyelu
- Gastrointestinal Infections Department, National Infection Service, Public Health England, 61 Colindale Avenue, London, NW9 5EQ, UK. .,National Institute for Health Research, Health Protection Research Unit in Gastrointestinal Infections, Colindale, London, UK.
| | - Neville Q Verlander
- Department of Statistics, Public Health England, 61 Colindale Avenue, London, NW9 5EQ, UK
| | - Corinne Amar
- Gastrointestinal Bacterial Reference Unit, Public Health England, 61 Colindale Avenue, London, NW9 5EQ, UK
| | - Richard Elson
- Gastrointestinal Infections Department, National Infection Service, Public Health England, 61 Colindale Avenue, London, NW9 5EQ, UK
| | - Kathie Grant
- Gastrointestinal Bacterial Reference Unit, Public Health England, 61 Colindale Avenue, London, NW9 5EQ, UK
| | - John Harris
- Gastrointestinal Infections Department, National Infection Service, Public Health England, 61 Colindale Avenue, London, NW9 5EQ, UK.,National Institute for Health Research, Health Protection Research Unit in Gastrointestinal Infections, Colindale, London, UK
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11
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Awofisayo-Okuyelu A, Arunachalam N, Dallman T, Grant KA, Aird H, McLauchlin J, Painset A, Amar C. An Outbreak of Human Listeriosis in England between 2010 and 2012 Associated with the Consumption of Pork Pies. J Food Prot 2016; 79:732-40. [PMID: 27296419 DOI: 10.4315/0362-028x.jfp-15-456] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
An outbreak of listeriosis in England affecting 14 people between 2010 and 2012 and linked to the consumption of pork pies was investigated. All 14 individuals were older than 55 years, 12 were men, and 10 reported the presence of an underlying condition. All were resident in or had visited either of two English regions and were infected with the same strain of Listeria monocytogenes. In interviews with 12 patients, 9 reported eating pork pies, and individuals that consumed pork pies were significantly more likely to be infected with an outbreak strain than were individuals with sporadic cases of listeriosis infections in England from 2010 to 2012. Pork pies were purchased from seven retailers in South Yorkshire or the East Midlands, and the outbreak strain was recovered from pork pies supplied by only the producer in South Yorkshire. The outbreak strain was also recovered from samples of finished product and from environmental samples collected from the manufacturer. The likely source of contamination was environmental sites within the manufacturing environment, and the contamination was associated with the process of adding gelatin to the pies after cooking. Inadequate temperature control and poor hygienic practices at one of the retailers were also identified as possible contributory factors allowing growth of the pathogen. Following improvements in manufacturing practices and implementation of additional control measures at the retailers' premises, L. monocytogenes was not recovered from subsequent food and environmental samples, and the outbreak strain was not detected in further individuals with listeriosis in England.
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Affiliation(s)
- A Awofisayo-Okuyelu
- Gastrointestinal Infections Department, Public Health England, London NW9 5EQ, UK.
| | - N Arunachalam
- South Yorkshire Health Protection Team, Yorkshire and Humber Centre, Public Health England, Sheffield S9 1BY, UK
| | - T Dallman
- Gastrointestinal Bacteria Reference Unit, Public Health England, London NW9 5EQ, UK
| | - K A Grant
- Gastrointestinal Bacteria Reference Unit, Public Health England, London NW9 5EQ, UK
| | - H Aird
- Food Water and Environmental Microbiology Laboratory York, National Agri-Food Innovation Campus, Public Health England, York YO41 1LZ, UK
| | - J McLauchlin
- Food, Water, and Environmental Microbiology Services, Public Health England, London NW9 5EQ, UK; Institute of Infection and Global Health, University of Liverpool, Liverpool L69 3GL, UK
| | - A Painset
- Gastrointestinal Bacteria Reference Unit, Public Health England, London NW9 5EQ, UK
| | - C Amar
- Gastrointestinal Bacteria Reference Unit, Public Health England, London NW9 5EQ, UK
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