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Marou V, Vardavas CI, Aslanoglou K, Nikitara K, Plyta Z, Leonardi-Bee J, Atkins K, Condell O, Lamb F, Suk JE. The impact of conflict on infectious disease: a systematic literature review. Confl Health 2024; 18:27. [PMID: 38584269 PMCID: PMC11000310 DOI: 10.1186/s13031-023-00568-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 12/28/2023] [Indexed: 04/09/2024] Open
Abstract
BACKGROUND Conflict situations, armed or not, have been associated with emergence and transmission of infectious diseases. This review aims to identify the pathways through which infectious diseases emerge within conflict situations and to outline appropriate infectious disease preparedness and response strategies. METHODS A systematic review was performed representing published evidence from January 2000 to October 2023. Ovid Medline and Embase were utilised to obtain literature on infectious diseases in any conflict settings. The systematic review adhered to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analysis). No geographical restrictions were imposed. FINDINGS Our review identified 51 studies covering AIDS, Hepatitis B, Tuberculosis, Cholera, Coronavirus 2, Ebola, Poliomyelitis, Malaria, Leishmaniasis, Measles, Diphtheria, Dengue and Acute Bacterial Meningitis within conflict settings in Europe, Middle East, Asia, and Africa since October 2023. Key factors contributing to disease emergence and transmission in conflict situations included population displacement, destruction of vital infrastructure, reduction in functioning healthcare systems and healthcare personnel, disruption of disease control programmes (including reduced surveillance, diagnostic delays, and interrupted vaccinations), reduced access by healthcare providers to populations within areas of active conflict, increased population vulnerability due to limited access to healthcare services, and disruptions in the supply chain of safe water, food, and medication. To mitigate these infectious disease risks reported preparedness and response strategies included both disease-specific intervention strategies as well as broader concepts such as the education of conflict-affected populations through infectious disease awareness programmes, investing in and enabling health care in locations with displaced populations, intensifying immunisation campaigns, and ensuring political commitment and intersectoral collaborations between governments and international organisations. CONCLUSION Conflict plays a direct and indirect role in the transmission and propagation of infectious diseases. The findings from this review can assist decision-makers in the development of evidence-based preparedness and response strategies for the timely and effective containment of infectious disease outbreaks in conflict zones and amongst conflict-driven displaced populations. FUNDING European Centre for Disease Prevention and Control under specific contract No. 22 ECD.13,154 within Framework contract ECDC/2019/001 Lot 1B.
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Affiliation(s)
- Valia Marou
- School of Medicine, University of Crete, Heraklion, Crete, Greece
| | - Constantine I Vardavas
- School of Medicine, University of Crete, Heraklion, Crete, Greece
- Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Harvard University, Boston, MA, USA
| | | | | | - Zinovia Plyta
- School of Medicine, University of Crete, Heraklion, Crete, Greece
| | - Jo Leonardi-Bee
- Centre for Evidence Based Healthcare, School of Medicine, University of Nottingham, Nottingham, UK
| | - Kirsty Atkins
- Centre for Evidence Based Healthcare, School of Medicine, University of Nottingham, Nottingham, UK
| | - Orla Condell
- Emergency Preparedness and Response Support, European Centre for Disease Prevention and Control, Solna, Sweden
| | - Favelle Lamb
- Emergency Preparedness and Response Support, European Centre for Disease Prevention and Control, Solna, Sweden
| | - Jonathan E Suk
- Emergency Preparedness and Response Support, European Centre for Disease Prevention and Control, Solna, Sweden.
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2
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Vardavas C, Zisis K, Nikitara K, Lagou I, Marou V, Aslanoglou K, Athanasakis K, Phalkey R, Leonardi-Bee J, Fernandez E, Condell O, Lamb F, Sandmann F, Pharris A, Deogan C, Suk JE. Cost of the COVID-19 pandemic versus the cost-effectiveness of mitigation strategies in EU/UK/OECD: a systematic review. BMJ Open 2023; 13:e077602. [PMID: 37907290 PMCID: PMC10619092 DOI: 10.1136/bmjopen-2023-077602] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 09/18/2023] [Indexed: 11/02/2023] Open
Abstract
OBJECTIVES The economic burden of COVID-19 pandemic is substantial, with both direct and indirect costs playing a significant role. DESIGN A systematic literature review was conducted to estimate the cost of the COVID-19 pandemic and the cost-effectiveness of pharmaceutical or non-pharmaceutical interventions. All cost data were adjusted to the 2021 Euro, and interventions compared with null. DATA SOURCES Ovid MEDLINE and EMBASE were searched from January 2020 through 22 April 2021. ELIGIBILITY CRITERIA Studies regarding COVID-19 outbreak or public health preparedness measures or interventions with outcome measures related to the direct and indirect costs for disease and preparedness and/or response in countries of the European Union (EU), the European Economic Area (EEA), the UK and the Organisation for Economic Co-operation and Development (OECD) of all relevant epidemiological designs which estimate cost within the selected time frame were considered eligible. DATA EXTRACTION AND SYNTHESIS Studies were searched, screened and coded independently by two reviewers with high measure of inter-rater agreement. Data were extracted to a predefined data extraction sheet. The risk of bias was assessed using the Consensus on Health Economic Criteria checklist. RESULTS We included data from 41 economic studies. Ten studies evaluated the cost of the COVID-19 pandemic, while 31 assessed the cost-benefit of public health surveillance, preparedness and response measures. Overall, the economic burden of the COVID-19 pandemic was found to be substantial. Community screening, bed provision policies, investing in personal-protective-equipment and vaccination strategies were cost-effective. Physical distancing measures were associated with health benefits; however, their cost-effectiveness was dependent on the duration, compliance and the phase of the epidemic in which it was implemented. CONCLUSIONS COVID-19 pandemic is associated with substantial short-term and long-term economic costs to healthcare systems, payers and societies, while interventions including testing and screening policies, vaccination and physical distancing policies were identified as those presenting cost-effective options to deal with the pandemic, dependent on population vaccination and the Re at the stage of the pandemic.
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Affiliation(s)
- Constantine Vardavas
- School of Medicine, University of Crete, Heraklion, Greece
- Department of Oral Health Policy and Epidemiology, Harvard School of Dental Medicine, Harvard University, Boston, Massachusetts, USA
| | - Konstantinos Zisis
- School of Medicine, University of Crete, Heraklion, Greece
- Department of Public Health Policy, University of West Attica, Egaleo, Greece
| | | | - Ioanna Lagou
- School of Medicine, University of Crete, Heraklion, Greece
| | - Valia Marou
- School of Medicine, University of Crete, Heraklion, Greece
| | | | | | - Revati Phalkey
- Public Health England, London, UK
- University of Nottingham, Nottingham, UK
| | - Jo Leonardi-Bee
- Centre for Evidence-Based Healthcare, School of Medicine, University of Nottingham, Nottingham, UK
| | - Esteve Fernandez
- Tobacco Control Unit, Catalan Institute of Oncology, L'Hospitalet de Llobregat, Spain
| | - Orla Condell
- European Centre for Disease Prevention and Control, Solna, Sweden
| | - Favelle Lamb
- European Centre for Disease Prevention and Control, Solna, Sweden
| | - Frank Sandmann
- European Centre for Disease Prevention and Control, Solna, Sweden
| | | | - Charlotte Deogan
- European Centre for Disease Prevention and Control, Solna, Sweden
| | - Jonathan E Suk
- European Centre for Disease Prevention and Control, Solna, Sweden
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3
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Vardavas CI, Nikitara K, Aslanoglou K, Kamekis A, Puttige Ramesh N, Symvoulakis E, Agaku I, Phalkey R, Leonardi-Bee J, Fernandez E, Condell O, Lamb F, Deogan C, Suk JE. Systematic review of outbreaks of COVID-19 within households in the European region when the child is the index case. BMJ Paediatr Open 2023; 7:10.1136/bmjpo-2022-001718. [PMID: 36649374 PMCID: PMC9835947 DOI: 10.1136/bmjpo-2022-001718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 12/07/2022] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVES This systematic review aims to identify the secondary attack rates (SAR) to adults and other children when children are the index cases within household settings. METHODS This literature review assessed European-based studies published in Medline and Embase between January 2020 and January 2022 that assessed the secondary transmission of SARS-CoV-2 within household settings. The inclusion criteria were based on the Population, Exposure, Outcome framework for systematic reviews. Thus, the study population was restricted to humans within the household setting in Europe (population), in contact with paediatric index cases 1-17 years old (exposure) that led to the transmission of SARS-CoV-2 reported as either an SAR or the probability of onward infection (outcome). RESULTS Of 1819 studies originally identified, 19 met the inclusion criteria. Overall, the SAR ranged from 13% to 75% in 15 studies, while there was no evidence of secondary transmission from children to other household members in one study. Evidence indicated that asymptomatic SARS-CoV-2 index cases also have a lower SAR than those with symptoms and that younger children may have a lower SAR than adolescents (>12 years old) within household settings. CONCLUSIONS SARS-CoV-2 secondary transmission from paediatric index cases ranged from 0% to 75%, within household settings between January 2020 and January 2022, with differences noted by age and by symptomatic/asymptomatic status of the index case. Given the anticipated endemic circulation of SARS-CoV-2, continued monitoring and assessment of household transmission is necessary.
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Affiliation(s)
- Constantine I Vardavas
- School of Medicine, University of Crete School of Medicine, Heraklion, Greece.,Department of Oral Health Policy and Epidemiology, Harvard University, Cambridge, Massachusetts, USA
| | - Katerina Nikitara
- School of Medicine, University of Crete School of Medicine, Heraklion, Greece
| | - Katerina Aslanoglou
- School of Medicine, University of Crete School of Medicine, Heraklion, Greece
| | - Apostolos Kamekis
- School of Medicine, University of Crete School of Medicine, Heraklion, Greece
| | - Nithya Puttige Ramesh
- Department of Oral Health Policy and Epidemiology, Harvard University, Cambridge, Massachusetts, USA
| | | | - Israel Agaku
- Department of Oral Health Policy and Epidemiology, Harvard University, Cambridge, Massachusetts, USA
| | - Revati Phalkey
- Centre for Evidence Based Healthcare, University of Nottingham, Nottingham, UK
| | - Jo Leonardi-Bee
- Centre for Evidence Based Healthcare, University of Nottingham, Nottingham, UK
| | - Esteve Fernandez
- Tobacco Control Unit, Catalan Institute of Oncology Institut Català d'Oncologia (ICO), L'Hospitalet de Llobregat, Barcelona, Spain.,Tobacco Control Research Group, Institut d'Investigació Biomèdica de Bellvithe (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain.,CIBER Respiratory Diseases (CIBERES), Madrid, Spain.,Department of Clinical Sciences, School of Medicine and Health Sciences, Universitat de Barcelona, Barcelona, Spain
| | - Orla Condell
- European Centre for Disease Prevention and Control (ECDC), Solna, Stockholm, Sweden
| | - Favelle Lamb
- European Centre for Disease Prevention and Control (ECDC), Solna, Stockholm, Sweden
| | - Charlotte Deogan
- European Centre for Disease Prevention and Control (ECDC), Solna, Stockholm, Sweden
| | - Jonathan E Suk
- European Centre for Disease Prevention and Control (ECDC), Solna, Stockholm, Sweden
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Otsu S, Do H, Ha TA, Ngo TH, Tran QD, Condell O, Le TV, Ngu ND, Hoang TV, Dang TQ, Tran PD, Tran PTN, Lai AT, Kato M, Chiu C. Enhancing hospital event-based surveillance system – Findings from a pilot study, Vietnam, 2017-2018. Global Security: Health, Science and Policy 2020. [DOI: 10.1080/23779497.2020.1786431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Affiliation(s)
- Satoko Otsu
- Disease Control and Health Emergency Program, World Health Organization Vietnam Country Office, Ha Noi, Vietnam
| | - Hien Do
- Disease Control and Health Emergency Program, World Health Organization Vietnam Country Office, Ha Noi, Vietnam
| | - Tuan Anh Ha
- Epidemiology Department, Pasteur Institute Nha Trang, Nha Trang, Vietnam
| | - Tu H. Ngo
- Department of Communicable Disease Control, National Institute of Hygiene and Epidemiology, Ha Noi, Vietnam
| | - Quang D. Tran
- General Department of Preventive Medicine, Division of Communicable Disease Control, Ha Noi, Vietnam
| | - Orla Condell
- Disease Control and Health Emergency Program, World Health Organization Vietnam Country Office, Ha Noi, Vietnam
| | - Tuan V. Le
- Disease Control and Health Emergency Program, World Health Organization Vietnam Country Office, Ha Noi, Vietnam
| | - Nghia D. Ngu
- Department of Communicable Disease Control, National Institute of Hygiene and Epidemiology, Ha Noi, Vietnam
| | - Thanh V. Hoang
- Epidemiology Department, Pasteur Institute Nha Trang, Nha Trang, Vietnam
| | - Tan Q. Dang
- General Department of Preventive Medicine, Division of Communicable Disease Control, Ha Noi, Vietnam
| | - Phu D. Tran
- General Department of Preventive Medicine, Division of Communicable Disease Control, Ha Noi, Vietnam
| | - Phuong T. N. Tran
- Binh Thuan Provincial Centre of Disease Control, Binh Thuan, Vietnam
| | - Anh T. Lai
- Nam Dinh Provincial Centre of Disease Control, Nam Dinh, Vietnam
| | - Masaya Kato
- Disease Control and Health Emergency Program, World Health Organization Vietnam Country Office, Ha Noi, Vietnam
| | - Cindy Chiu
- Disease Control and Health Emergency Program, World Health Organization Vietnam Country Office, Ha Noi, Vietnam
- Department of Community Health, School of Health Sciences, Tohoku University Graduate School of Medicine, Sendai, Japan
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5
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Katawera V, Kohar H, Mahmoud N, Raftery P, Wasunna C, Humrighouse B, Hardy P, Saindon J, Schoepp R, Makvandi M, Hensley L, Condell O, Durski K, Singaravelu S, Gahimbare L, Olinger G, Kateh F, Naidoo D, Nsubuga P, Formenty P, Nyenswah T, Coulibaly SO, Okeibunor JC, Talisuna A, Yahaya AA, Rajatonirina S, Williams D, Dahn B, Gasasira A, Fall IS. Enhancing laboratory capacity during Ebola virus disease (EVD) heightened surveillance in Liberia: lessons learned and recommendations. Pan Afr Med J 2019; 33:8. [PMID: 31404295 PMCID: PMC6675925 DOI: 10.11604/pamj.supp.2019.33.2.17366] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 01/28/2019] [Indexed: 11/19/2022] Open
Abstract
Introduction Following a declaration by the World Health Organization that Liberia had successfully interrupted Ebola virus transmission on May 9th, 2015; the country entered a period of enhanced surveillance. The number of cases had significantly reduced prior to the declaration, leading to closure of eight out of eleven Ebola testing laboratories. Enhanced surveillance led to an abrupt increase in demand for laboratory services. We report interventions, achievements, lessons learned and recommendations drawn from enhancing laboratory capacity. Methods Using archived data, we reported before and after interventions that aimed at increasing laboratory capacity. Laboratory capacity was defined by number of laboratories with Ebola Virus Disease (EVD) testing capacity, number of competent staff, number of specimens tested, specimen backlog, daily and surge testing capacity, and turnaround time. Using Stata 14 (Stata Corporation, College Station, TX, USA), medians and trends were reported for all continuous variables. Results Between May and December 2015, interventions including recruitment and training of eight staff, establishment of one EVD laboratory facility, implementation of ten Ebola GeneXpert diagnostic platforms, and establishment of working shifts yielded an 8-fold increase in number of specimens tested, a reduction in specimens backlog to zero, and restoration of turn-around time to 24 hours. This enabled a more efficient surveillance system that facilitated timely detection and containment of two EVD clusters observed thereafter. Conclusion Effective enhancement of laboratory services during high demand periods requires a combination of context-specific interventions. Building and ensuring sustainability of local capacity is an integral part of effective surveillance and disease outbreak response efforts.
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Affiliation(s)
| | | | | | | | - Christine Wasunna
- Formarly Academic Consortium Combating Ebola in Liberia, Monrovia, Liberia
| | - Ben Humrighouse
- United States Centers for Disease Control and Prevention, Atlanta, United States of America
| | | | - John Saindon
- United States Centers for Disease Control and Prevention, Atlanta, United States of America
| | - Randal Schoepp
- United States Army Medical Research Institute of Infectious Diseases, Fort Detrick, Maryland, United States of America
| | - Monear Makvandi
- Sandia National Laboratories, Albuquerque, New Mexico, United States of America
| | - Lisa Hensley
- National Institutes of Health,Bethesda, United States of America
| | | | - Kara Durski
- World Health Organization, Geneva, Switzerland
| | | | | | - Gene Olinger
- National Institutes of Health,Bethesda, United States of America
| | | | | | - Peter Nsubuga
- Global Public Health Solutions, Atlanta, Georgia, United States of America
| | | | | | | | | | - Ambrose Talisuna
- World Health Organization, Regional Office for Africa, Brazzaville, Congo
| | - Ali Ahmed Yahaya
- World Health Organization, Regional Office for Africa, Brazzaville, Congo
| | | | - Desmond Williams
- United States Centers for Disease Control and Prevention, Atlanta, United States of America
| | | | - Alex Gasasira
- World Health Organization, Monrovia, Liberia.,Ministry of Health, Monrovia, Liberia.,Formarly Academic Consortium Combating Ebola in Liberia, Monrovia, Liberia.,United States Centers for Disease Control and Prevention, Atlanta, United States of America.,United States Army Medical Research Institute of Infectious Diseases, Fort Detrick, Maryland, United States of America.,Sandia National Laboratories, Albuquerque, New Mexico, United States of America.,National Institutes of Health,Bethesda, United States of America.,World Health Organization, Geneva, Switzerland.,Global Public Health Solutions, Atlanta, Georgia, United States of America.,World Health Organization, Regional Office for Africa, Brazzaville, Congo
| | - Ibrahima Socé Fall
- World Health Organization, Regional Office for Africa, Brazzaville, Congo
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6
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Durski KN, Singaravelu S, Teo J, Naidoo D, Bawo L, Jambai A, Keita S, Yahaya AA, Muraguri B, Ahounou B, Katawera V, Kuti-George F, Nebie Y, Kohar TH, Hardy PJ, Djingarey MH, Kargbo D, Mahmoud N, Assefa Y, Condell O, N'Faly M, Van Gurp L, Lamanu M, Ryan J, Diallo B, Daffae F, Jackson D, Malik FA, Raftery P, Formenty P. Development, Use, and Impact of a Global Laboratory Database During the 2014 Ebola Outbreak in West Africa. J Infect Dis 2017; 215:1799-1806. [PMID: 28520958 DOI: 10.1093/infdis/jix236] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Accepted: 05/11/2017] [Indexed: 11/13/2022] Open
Abstract
Background The international impact, rapid widespread transmission, and reporting delays during the 2014 Ebola outbreak in West Africa highlighted the need for a global, centralized database to inform outbreak response. The World Health Organization and Emerging and Dangerous Pathogens Laboratory Network addressed this need by supporting the development of a global laboratory database. Methods Specimens were collected in the affected countries from patients and dead bodies meeting the case definitions for Ebola virus disease. Test results were entered in nationally standardized spreadsheets and consolidated onto a central server. Results From March 2014 through August 2016, 256343 specimens tested for Ebola virus disease were captured in the database. Thirty-one specimen types were collected, and a variety of diagnostic tests were performed. Regular analysis of data described the functionality of laboratory and response systems, positivity rates, and the geographic distribution of specimens. Conclusion With data standardization and end user buy-in, the collection and analysis of large amounts of data with multiple stakeholders and collaborators across various user-access levels was made possible and contributed to outbreak response needs. The usefulness and value of a multifunctional global laboratory database is far reaching, with uses including virtual biobanking, disease forecasting, and adaption to other disease outbreaks.
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Affiliation(s)
- Kara N Durski
- World Health Organization, Geneva, Switzerland.,University of Minnesota School of Public Health, Minneapolis, Minnesota
| | | | - Junxiong Teo
- World Health Organization, Geneva, Switzerland.,Ministry of Health, Singapore
| | | | - Luke Bawo
- Ministry of Health and Social Welfare
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Julia Ryan
- World Health Organization, Geneva, Switzerland
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7
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Condell O, Midgley S, Christiansen CB, Chen M, Chen Nielsen X, Ellermann-Eriksen S, Mølvadgaard M, Schønning K, Vermedal Hoegh S, Andersen PH, Voldstedlund M, Fischer TK. Evaluation of the enterovirus laboratory surveillance system in Denmark, 2010 to 2013. ACTA ACUST UNITED AC 2017; 21:30218. [PMID: 27173593 DOI: 10.2807/1560-7917.es.2016.21.18.30218] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Accepted: 02/20/2016] [Indexed: 11/20/2022]
Abstract
The primary aim of the Danish enterovirus (EV) surveillance system is to document absence of poliovirus infection. The conflict in Syria has left many children unvaccinated and movement from areas with polio cases to Europe calls for increased awareness to detect and respond to virus-transmission in a timely manner. We evaluate the national EV laboratory surveillance, to generate recommendations for system strengthening. The system was analysed for completeness of viral typing analysis and clinical information and timeliness of specimen collection, laboratory results and reporting of clinical information. Of 23,720 specimens screened, 2,202 (9.3%) were EV-positive. Submission of cerebrospinal fluid and faecal specimens from primary diagnostic laboratories was 79.5% complete (845/1,063), and varied by laboratory and patient age. EV genotypes were determined in 68.5% (979/1,430) of laboratory-confirmed cases, clinical information was available for 63.1% (903/1,430). Primary diagnostic results were available after a median of 1.4 days, typing results after 17 days, detailed clinical information after 33 days. The large number of samples typed demonstrated continued monitoring of EV-circulation in Denmark. The system could be strengthened by increasing the collection of supplementary faecal specimens, improving communication with primary diagnostic laboratories, adapting the laboratory typing methodology and collecting clinical information with electronic forms.
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Affiliation(s)
- Orla Condell
- Department of Microbiological Diagnostics and Virology, Statens Serum Insitut, Copenhagen S, Denmark
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Raftery P, Wasunna C, Kpaka J, Zwizwai R, Condell O, Katwerra V, Hardy P, Sahr P, Gasasira A, Nyenswah T. Establishing EVD testing at a mobile laboratory using GeneXpert Technology in Liberia - Impact on Surveillance System, Outbreak Detection and Patient Management. Int J Infect Dis 2016. [DOI: 10.1016/j.ijid.2016.11.077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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9
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Mousavi ZE, Condell O, Fanning S, Butler F. Quaternary Ammonium Compounds (QACs) induced inactivation of Pseudomonas spp.: Effect of material surface. Food and Bioproducts Processing 2016. [DOI: 10.1016/j.fbp.2015.12.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Périamé M, Philippe N, Condell O, Fanning S, Pagès JM, Davin-Regli A. Phenotypic changes contributing to Enterobacter gergoviae
biocide resistance. Lett Appl Microbiol 2015; 61:121-9. [DOI: 10.1111/lam.12435] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Revised: 04/07/2015] [Accepted: 04/23/2015] [Indexed: 12/11/2022]
Affiliation(s)
- M. Périamé
- UMR-MD1, Aix-Marseille Université; IRBA, Transporteurs Membranaires; Chimiorésistance et Drug Design; Marseille France
| | - N. Philippe
- UMR-MD1, Aix-Marseille Université; IRBA, Transporteurs Membranaires; Chimiorésistance et Drug Design; Marseille France
- Laboratoire Information Génomique et Structurale (IGS); UMR 7256 (IMM FR 3479) CNRS Aix-Marseille Université; Marseille France
| | - O. Condell
- UCD-Centre for Food Safety; School of Public Health, Physiotherapy & Population Science; University College Dublin; Belfield Dublin 4 Ireland
| | - S. Fanning
- UCD-Centre for Food Safety; School of Public Health, Physiotherapy & Population Science; University College Dublin; Belfield Dublin 4 Ireland
| | - J-M. Pagès
- UMR-MD1, Aix-Marseille Université; IRBA, Transporteurs Membranaires; Chimiorésistance et Drug Design; Marseille France
| | - A. Davin-Regli
- UMR-MD1, Aix-Marseille Université; IRBA, Transporteurs Membranaires; Chimiorésistance et Drug Design; Marseille France
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11
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Condell O, Power KA, Händler K, Finn S, Sheridan A, Sergeant K, Renaut J, Burgess CM, Hinton JCD, Nally JE, Fanning S. Comparative analysis of Salmonella susceptibility and tolerance to the biocide chlorhexidine identifies a complex cellular defense network. Front Microbiol 2014; 5:373. [PMID: 25136333 PMCID: PMC4117984 DOI: 10.3389/fmicb.2014.00373] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Accepted: 07/03/2014] [Indexed: 12/04/2022] Open
Abstract
Chlorhexidine is one of the most widely used biocides in health and agricultural settings as well as in the modern food industry. It is a cationic biocide of the biguanide class. Details of its mechanism of action are largely unknown. The frequent use of chlorhexidine has been questioned recently, amidst concerns that an overuse of this compound may select for bacteria displaying an altered susceptibility to antimicrobials, including clinically important anti-bacterial agents. We generated a Salmonella enterica serovar Typhimurium isolate (ST24CHX) that exhibited a high-level tolerant phenotype to chlorhexidine, following several rounds of in vitro selection, using sub-lethal concentrations of the biocide. This mutant showed altered suceptibility to a panel of clinically important antimicrobial compounds. Here we describe a genomic, transcriptomic, proteomic, and phenotypic analysis of the chlorhexidine tolerant S. Typhimurium compared with its isogenic sensitive progenitor. Results from this study describe a chlorhexidine defense network that functions in both the reference chlorhexidine sensitive isolate and the tolerant mutant. The defense network involved multiple cell targets including those associated with the synthesis and modification of the cell wall, the SOS response, virulence, and a shift in cellular metabolism toward anoxic pathways, some of which were regulated by CreB and Fur. In addition, results indicated that chlorhexidine tolerance was associated with more extensive modifications of the same cellular processes involved in this proposed network, as well as a divergent defense response involving the up-regulation of additional targets such as the flagellar apparatus and an altered cellular phosphate metabolism. These data show that sub-lethal concentrations of chlorhexidine induce distinct changes in exposed Salmonella, and our findings provide insights into the mechanisms of action and tolerance to this biocidal agent.
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Affiliation(s)
- Orla Condell
- UCD Centre for Food Safety, School of Public Health, Physiotherapy and Population Science, University College Dublin Belfield, Dublin, Ireland ; European Program for Public Health Microbiology Training, European Centre for Disease Prevention and Control Stockholm, Sweden
| | - Karen A Power
- UCD Centre for Food Safety, School of Public Health, Physiotherapy and Population Science, University College Dublin Belfield, Dublin, Ireland
| | - Kristian Händler
- Department of Microbiology, School of Genetics and Microbiology, Moyne Institute of Preventive Medicine, Trinity College Dublin Dublin, Ireland
| | - Sarah Finn
- UCD Centre for Food Safety, School of Public Health, Physiotherapy and Population Science, University College Dublin Belfield, Dublin, Ireland
| | - Aine Sheridan
- Food Safety Department, Teagasc Food Research Centre Ashtown, Dublin, Ireland
| | - Kjell Sergeant
- Department of Environment and Agrobiotechnologies (EVA), Centre de Recherche Public-Gabriel Lippmann Belvaux, Luxembourg
| | - Jenny Renaut
- Department of Environment and Agrobiotechnologies (EVA), Centre de Recherche Public-Gabriel Lippmann Belvaux, Luxembourg
| | - Catherine M Burgess
- Food Safety Department, Teagasc Food Research Centre Ashtown, Dublin, Ireland
| | - Jay C D Hinton
- Department of Microbiology, School of Genetics and Microbiology, Moyne Institute of Preventive Medicine, Trinity College Dublin Dublin, Ireland ; Institute of Integrative Biology, University of Liverpool Liverpool, UK
| | - Jarlath E Nally
- School of Veterinary Medicine, University College Dublin Belfield, Dublin, Ireland
| | - Séamus Fanning
- UCD Centre for Food Safety, School of Public Health, Physiotherapy and Population Science, University College Dublin Belfield, Dublin, Ireland ; Institute for Global Food Security, Queen's University Belfast Belfast, Northern Ireland
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12
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Finn S, Condell O, McClure P, Amézquita A, Fanning S. Mechanisms of survival, responses and sources of Salmonella in low-moisture environments. Front Microbiol 2013; 4:331. [PMID: 24294212 PMCID: PMC3827549 DOI: 10.3389/fmicb.2013.00331] [Citation(s) in RCA: 194] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Accepted: 10/18/2013] [Indexed: 01/22/2023] Open
Abstract
Some Enterobacteriaceae possess the ability to survive in low-moisture environments for extended periods of time. Many of the reported food-borne outbreaks associated with low-moisture foods involve Salmonella contamination. The control of Salmonella in low-moisture foods and their production environments represents a significant challenge for all food manufacturers. This review summarizes the current state of knowledge with respect to Salmonella survival in intermediate- and low-moisture food matrices and their production environments. The mechanisms utilized by this bacterium to ensure their survival in these dry conditions remain to be fully elucidated, however, in depth transcriptomic data is now beginning to emerge regarding this observation. Earlier research work described the effect(s) that low-moisture can exert on the long-term persistence and heat tolerance of Salmonella, however, data are also now available highlighting the potential cross-tolerance to other stressors including commonly used microbicidal agents. Sources and potential control measures to reduce the risk of contamination will be explored. By extending our understanding of these geno- and phenotypes, we may be able to exploit them to improve food safety and protect public health.
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Affiliation(s)
- Sarah Finn
- UCD Centre for Food Safety, School of Public Health, Physiotherapy and Population Science, University College DublinBelfield, Dublin 4, Ireland
| | - Orla Condell
- UCD Centre for Food Safety, School of Public Health, Physiotherapy and Population Science, University College DublinBelfield, Dublin 4, Ireland
| | - Peter McClure
- Safety and Environmental Assurance Centre, Unilever, Colworth Science ParkSharnbrook, Bedfordshire, UK
| | - Alejandro Amézquita
- Safety and Environmental Assurance Centre, Unilever, Colworth Science ParkSharnbrook, Bedfordshire, UK
| | - Séamus Fanning
- UCD Centre for Food Safety, School of Public Health, Physiotherapy and Population Science, University College DublinBelfield, Dublin 4, Ireland
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Sheridan Á, Lenahan M, Condell O, Bonilla-Santiago R, Sergeant K, Renaut J, Duffy G, Fanning S, Nally J, Burgess C. Proteomic and phenotypic analysis of triclosan tolerant verocytotoxigenic Escherichia coli O157:H19. J Proteomics 2013; 80:78-90. [DOI: 10.1016/j.jprot.2012.12.025] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2012] [Revised: 11/09/2012] [Accepted: 12/11/2012] [Indexed: 12/11/2022]
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14
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Condell O, Sheridan Á, Power KA, Bonilla-Santiago R, Sergeant K, Renaut J, Burgess C, Fanning S, Nally JE. Comparative proteomic analysis of Salmonella tolerance to the biocide active agent triclosan. J Proteomics 2012; 75:4505-19. [PMID: 22579747 DOI: 10.1016/j.jprot.2012.04.044] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2012] [Revised: 04/26/2012] [Accepted: 04/28/2012] [Indexed: 01/01/2023]
Abstract
Concern has been expressed about the overuse of biocides in farm animal production and food industries. Biocide application can create selective pressures that lead to increased tolerance to one or more of these compounds and are concomitant with the emergence of cross-resistance to antibiotics. A triclosan sensitive Salmonella enterica serovar Typhimurium and the isogenic triclosan tolerant mutant were studied at the proteomic level in order to elucidate cellular mechanisms that facilitate biocide tolerance. 2-D differential fluorescent gel electrophoresis (DIGE) compared protein profiles of parent and mutant Salmonella, in the presence and absence of triclosan. Differentially expressed proteins were identified by mass spectrometry and divided into two groups: Group A describes proteins differentially expressed between susceptible and triclosan tolerant Salmonella and includes the known triclosan target FabI which contained a mutation at the triclosan target binding site. Group B identified proteins differentially expressed in response to triclosan exposure and defines a general cell defence network. Only four proteins were common to both groups highlighting the diverse range of pathways employed by Salmonella to counteract biocides. These data suggest that sub-lethal concentrations of triclosan induce discernible changes in the proteome of exposed Salmonella and provide insights into mechanisms of response and tolerance.
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Affiliation(s)
- O Condell
- UCD Centre for Food Safety & the Centre for Food-borne Zoonomics, School of Public Health, Physiotherapy & Population Science, Ireland
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15
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Condell O, Iversen C, Cooney S, Power KA, Walsh C, Burgess C, Fanning S. Efficacy of biocides used in the modern food industry to control salmonella enterica, and links between biocide tolerance and resistance to clinically relevant antimicrobial compounds. Appl Environ Microbiol 2012; 78:3087-97. [PMID: 22367085 PMCID: PMC3346496 DOI: 10.1128/aem.07534-11] [Citation(s) in RCA: 120] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2011] [Accepted: 02/13/2012] [Indexed: 11/20/2022] Open
Abstract
Biocides play an essential role in limiting the spread of infectious disease. The food industry is dependent on these agents, and their increasing use is a matter for concern. Specifically, the emergence of bacteria demonstrating increased tolerance to biocides, coupled with the potential for the development of a phenotype of cross-resistance to clinically important antimicrobial compounds, needs to be assessed. In this study, we investigated the tolerance of a collection of susceptible and multidrug-resistant (MDR) Salmonella enterica strains to a panel of seven commercially available food-grade biocide formulations. We explored their abilities to adapt to these formulations and their active biocidal agents, i.e., triclosan, chlorhexidine, hydrogen peroxide, and benzalkonium chloride, after sequential rounds of in vitro selection. Finally, cross-tolerance of different categories of biocidal formulations, their active agents, and the potential for coselection of resistance to clinically important antibiotics were investigated. Six of seven food-grade biocide formulations were bactericidal at their recommended working concentrations. All showed a reduced activity against both surface-dried and biofilm cultures. A stable phenotype of tolerance to biocide formulations could not be selected. Upon exposure of Salmonella strains to an active biocidal compound, a high-level of tolerance was selected for a number of Salmonella serotypes. No cross-tolerance to the different biocidal agents or food-grade biocide formulations was observed. Most tolerant isolates displayed changes in their patterns of susceptibility to antimicrobial compounds. Food industry biocides are effective against planktonic Salmonella. When exposed to sublethal concentrations of individual active biocidal agents, tolerant isolates may emerge. This emergence was associated with changes in antimicrobial susceptibilities.
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Affiliation(s)
- Orla Condell
- UCD Centre for Food Safety & Centre for Food-borne Zoonomics, UCD Veterinary Sciences Centre, School of Public Health, Physiotherapy & Population Science, University College Dublin, Belfield, Dublin, Ireland
| | - Carol Iversen
- UCD Centre for Food Safety & Centre for Food-borne Zoonomics, UCD Veterinary Sciences Centre, School of Public Health, Physiotherapy & Population Science, University College Dublin, Belfield, Dublin, Ireland
- Nestlé Research Centre, Lausanne, Switzerland
| | - Shane Cooney
- UCD Centre for Food Safety & Centre for Food-borne Zoonomics, UCD Veterinary Sciences Centre, School of Public Health, Physiotherapy & Population Science, University College Dublin, Belfield, Dublin, Ireland
| | - Karen A. Power
- UCD Centre for Food Safety & Centre for Food-borne Zoonomics, UCD Veterinary Sciences Centre, School of Public Health, Physiotherapy & Population Science, University College Dublin, Belfield, Dublin, Ireland
| | - Ciara Walsh
- UCD Centre for Food Safety & Centre for Food-borne Zoonomics, UCD Veterinary Sciences Centre, School of Public Health, Physiotherapy & Population Science, University College Dublin, Belfield, Dublin, Ireland
- Food Safety Authority of Ireland, Dublin, Ireland
| | - Catherine Burgess
- UCD Centre for Food Safety & Centre for Food-borne Zoonomics, UCD Veterinary Sciences Centre, School of Public Health, Physiotherapy & Population Science, University College Dublin, Belfield, Dublin, Ireland
- Food Safety Department, Teagasc Food Research Centre, Ashtown, Dublin, Ireland
| | - Séamus Fanning
- UCD Centre for Food Safety & Centre for Food-borne Zoonomics, UCD Veterinary Sciences Centre, School of Public Health, Physiotherapy & Population Science, University College Dublin, Belfield, Dublin, Ireland
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16
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Yan QQ, Condell O, Power K, Butler F, Tall BD, Fanning S. Cronobacter species (formerly known as Enterobacter sakazakii) in powdered infant formula: a review of our current understanding of the biology of this bacterium. J Appl Microbiol 2012; 113:1-15. [PMID: 22420458 DOI: 10.1111/j.1365-2672.2012.05281.x] [Citation(s) in RCA: 98] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Cronobacter species (formerly known as Enterobacter sakazakii) are opportunistic pathogens that can cause necrotizing enterocolitis, bacteraemia and meningitis, predominantly in neonates. Infection in these vulnerable infants has been linked to the consumption of contaminated powdered infant formula (PIF). Considerable research has been undertaken on this organism in the past number of years which has enhanced our understanding of this neonatal pathogen leading to improvements in its control within the PIF production environment. The taxonomy of the organism resulted in the recognition of a new genus, Cronobacter, which consists of seven species. This paper presents an up-to-date review of our current knowledge of Cronobacter species. Taxonomy, genome sequencing, current detection protocols and epidemiology are all discussed. In addition, consideration is given to the control of this organism in the manufacturing environment, as a first step towards reducing the occurrence of this pathogen in PIF.
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Affiliation(s)
- Q Q Yan
- UCD Centre for Food Safety, WHO Collaborating Centre for Research, Reference & Training on Cronobacter, School of Public Health, Physiotherapy & Population Science, University College Dublin, Dublin, Ireland
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