Genomic variation of Salmonella Typhimurium and dynamics of epidemics

Non-typhoidal salmonellosis (NTS) is responsible of a large proportion of foodborne gastroenteritis worldwide. Molecular identification of Salmonella with assessment of exposure and epidemiological analysis of outbreak-linked cases are main approaches to control NTS. This study focussed on Salmonella Typhimurium (STM) as the most common causative agent of foodborne NTS in Australia. The aims of this thesis were to examine temporal dynamics of STM in New South Wales; to analyse the discrimination power of evolving typing methods for STM and the understanding of within- and between-host variations and adaptations in STM genomes. We examined 11,799 STM isolates between 2009 and 2016. Our findings suggest that multi-locus variable sequence typing (MLST) can be successfully applied for molecular serotyping of Salmonella isolates circulating in NSW. However, its approach lacks discriminatory power for public health surveillance. In contrast, multi-locus variable number tandem repeat analysis (MLVA) identified major clades associated with extensive epidemics over time. A small number of MLVA profiles have been associated with clusters, masking the diversity of profiles and reducing investigations on transmission networks. The sequencing of STM isolates, confirmed the high-resolution and discriminatory power of whole genome sequencing (WGS) elucidating transmission pathways. A relatively constant core genome for STM population over time was revealed, translated in stable diversity with predominance of endemic STM MLVA profiles. A chronic model of salmonellosis in mice showed the adaptive evolution of STM in association within its host. It involved limited number of mutations, without compromising the ability of STM to maintain the infection. The temporal relation between the incidence of STM infections in NSW and the corresponding increase of particular STM clades was unveiled. The comparative genomic analysis performed on STM clades identified genomic polymorphisms within the successful clades. These observations emphasize the stability of accessory genomes, but require further in vivo validation. Our results and analyses have offered evidence to guide the interpretation of STM public health laboratory surveillance and the translation of WGS into more effective control of foodborne diseases

Dendritic cell deficiencies persist seven months after SARS-CoV-2 infection

Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV)-2 infection induces an exacerbated inflammation driven by innate immunity components. Dendritic cells (DCs) play a key role in the defense against viral infections, for instance plasmacytoid DCs (pDCs), have the capacity to produce vast amounts of interferon-alpha (IFN-α). In COVID-19 there is a deficit in DC numbers and IFN-α production, which has been associated with disease severity. In this work, we described that in addition to the DC deficiency, several DC activation and homing markers were altered in acute COVID-19 patients, which were associated with multiple inflammatory markers. Remarkably, previously hospitalized and nonhospitalized patients remained with decreased numbers of CD1c+ myeloid DCs and pDCs seven months after SARS-CoV-2 infection. Moreover, the expression of DC markers such as CD86 and CD4 were only restored in previously nonhospitalized patients, while no restoration of integrin β7 and indoleamine 2,3-dyoxigenase (IDO) levels were observed. These findings contribute to a better understanding of the immunological sequelae of COVID-19

Global commercial passenger airlines and travel health information regarding infection control and the prevention of infectious disease: What's in a website?

Background: Air travel has never been easier, cheaper or faster, with large volumes of people travelling around the world. These factors increase the risk of the spread of infectious diseases by air travel. Little is known, however, about the extent to which airlines provide information to passengers on infection control and measures to prevent the spread of infectious diseases. This study examined the websites of the global commercial passenger airlines to see if they contained information about infection control and prevention of infectious diseases and appraised the clinical usefulness of that information. Method: A cross-sectional text-based analysis of the 73 airline websites from the six global commercial passenger airline conglomerates was performed to identify information about infection control and prevention of infectious between July and August 2019. Results: Of the 73 airline websites, less than half (n = 35, 28.6%) contained information deemed useful for passengers. While there was a range of general health advice within the websites, there was limited information about infection control and preventing infectious diseases. A minority of websites contained information about vaccination status prior to travel, and to a lesser extent handwashing and hand hygiene, with very few including disease-specific advice or preventive measures. Conclusions: Airline websites are an underutilised source of information for infection control and the prevention of infectious diseases. Providing passengers with information on basic infection control and prevention measures may support the global efforts against the spread of infectious diseases

Air travel in a COVID-19 world: Commercial airline passengers’ health concerns and attitudes towards infection prevention and disease control measures

Background COVID-19 and its associated travel bans have reduced international passenger traffic by over 80% below 2019 levels. If airlines are to resume flying at commercially sustainable levels, they must work to restore passengers confidence and sense of security. This study examined commercial airline passengers’ health concerns and attitudes towards infection prevention and control measures for travel health and safety in the current COVID-19 global pandemic. Methods A cross-sectional study was conducted inviting adult members of 39 frequent flyer groups across three social media platforms to participate in an online survey. Results A total of 205 respondents completed the survey. The majority (75.6%) reported feeling ‘somewhat’ to ‘extremely concerned’ about contracting an infectious disease while flying, particularly respiratory-related. Few (9.8%) reported perceiving their health as an ‘essential priority’ for their preferred airline. Most respondents agreed airlines should provide complimentary hand sanitisers (86.8%), sanitary wipes (82.9%) and masks (64.4%) for passengers to use while flying as well as more information about preventing the spread of infections (90.7%), which would make the majority feel safer to fly. Conclusions COVID-19 has extensively challenged the air travel industry. Passengers have signalled that they expect more from airlines, and that they would actively engage in additional infection prevention and disease control measures while flying. Airlines must ensure passengers about the steps taken to minimize travel-associated risks, and their commitment towards passengers’ health and wellbeing, in order to rebuild consumers’ confidence in the recovery of the air travel industry

Australian critical care nurses’ knowledge, preparedness and experiences of managing SARS-COV-2 and COVID-19 pandemic

Background COVID-19 has again highlighted the crucial role of healthcare workers in case management, disease surveillance, policy development, and healthcare education and training. The ongoing pandemic demonstrates the importance of having an emergency response plan that accounts for the safety of frontline healthcare workers, including those working in critical care settings. Objectives To explore Australian critical care nurses’ knowledge, preparedness and experiences of managing patients diagnosed with SARS-CoV-2 and COVID-19. Methods An exploratory cross-sectional study of Australian critical care nurses was conducted between June and September 2020. An anonymous online survey was sent to Australian College of Critical Care Nurses (ACCCN) members to collect information about their knowledge, preparedness and experiences during the COVID-19 pandemic. Descriptive statistics were used to summarise and report data. Results A total of 157 critical care nurses participated, with 138 fully complete surveys analysed. Most respondents reported ‘good’ to ‘very good’ level of knowledge about COVID-19, and obtained up-to-date COVID-19 information from international and local sources. To manage patients with COVID-19, 82.3% felt sufficiently prepared at the time of data collection, and 93.4% had received specific education, training or instruction. Most participants were involved in assessing (89.3%) and treating (92.4%) COVID-19 patients. Varying levels of concerns about contracting SARS-CoV-2 were expressed by respondents, and 55.7% thought the pandemic had increased their workload. The most frequent concerns expressed by participants were a lack of appropriate PPE and fear of the PPE shortage. Conclusions While most nurses expressed sufficient preparedness for managing COVID-19 patients, specific education had been undertaken and experiential learning was evident. Fears of insufficient or appropriate PPE made the response more difficult for nurses and the community. Preparedness and responsiveness are critical to successful management of the COVID-19 pandemic and future outbreaks of emerging infectious diseases

Scope of Practice and Educational Needs of Infection Prevention and Control Professionals in Australian Residential Aged Care Facilities

Background: Healthcare-associated infections are serious and significant complications present across healthcare services, including residential aged care facilities. Although ensuring high quality personal and clinical care delivered to older people residing in these facilities is a high national priority, there is a paucity of evidence published about outbreaks, governance and education programs held for healthcare workers within Australian residential aged care facilities. The aim of this study is to examine the scope of practice of Infection Prevention and Control professionals within Australian residential aged care facilities and the types of infection prevention and control education and training delivered. Methods: A cross-sectional study was conducted inviting all Australian residential aged care facilities to participate in an online survey. Results: A total of 134 residential aged care facilities completed the survey. The majority (88.1%) reported having a designated Infection Prevention and Control professional responsible for surveillance and educational activities. Hand hygiene (94%), personal protective equipment (PPE) (79.9%) and environmental cleaning (70.1%) were some of the available Infection Prevention and Control programs. The lack of access to Infection Prevention and Control education (69.5%) and lack of Infection Prevention and Control expert advice (67.2%) were also reported by some Residential aged care facilities. Conclusion: Australian residential aged care facilities recognise the importance of Infection Prevention and Control training programs to manage infection surveillance and outbreaks. Considerable activities are carried out to increase knowledge on breaking the chain of infection. Yet, more support and resources are needed to assist these efforts

General practitioners’ knowledge, preparedness, and experiences of managing COVID-19 in Australia

BACKGROUND: COVID-19 has brought unprecedented demands to general practitioners (GPs) worldwide. We examined their knowledge, preparedness, and experiences managing COVID-19 in Australia. METHODS: A cross-sectional online survey of GPs members of the Royal Australian College of General Practitioners (RACGP) was conducted between June and September 2020. RESULTS: Out of 244 survey responses, a majority of GPs (76.6%) indicated having good knowledge of COVID-19, relying mostly on state/territory department of health (84.4%) and the RACGP (76.2%) websites to source up-to-date information. Most felt prepared to manage patients with COVID-19 (75.7%), yet over half reported not receiving training in the use of PPE. The majority were concerned about contracting SARS-CoV-2, more stressed than usual, and have heavier workloads. Their greatest challenges included scarcity of PPE, personal distress, and information overload. CONCLUSION: Access to PPE, training, accurate information, and preparedness are fundamental for the successful role of general practices during outbreaks

Global Burden, Point Sources, and Outbreak Management of Healthcare-Associated Burkholderia Cepacia Infections: An Integrative Review

Objective: To examine the global burden, associated point sources, and successful prevention and control measures for documented outbreaks of Burkholderia cepacia healthcare-associated infections (HAIs). Design: Integrative review. Methods: A review of all outbreaks of Burkholderia cepacia HAIs published in the peer-reviewed literature between January 1970 and October 2019 was conducted to identify the global burden, associated point sources, and successful prevention and control measures using the Guidelines for Outbreak Reports and Intervention Studies of Nosocomial Infections (ORION). Results: In total, we reviewed 125 documented outbreaks of Burkholderia cepacia–related HAIs worldwide. The reported B. cepacia HAIs for this period involved 3,287 patients. The point sources were identified in most outbreaks of B. cepacia HAIs (n = 93; 74.4%); they included medication vials, disinfectants, and antiseptics. Moreover, 95 of the outbreak reports (76%) described effective prevention and control measures, but only 33 reports indicated the use of a combination of environment-, patient- and staff-related measures. None of the outbreak reports used the ORION guidelines. Conclusions: Outbreaks of Burkholderia cepacia HAIs are an ongoing challenge. They are often associated with immunocompromised patients who acquire the infection from exposure to contaminated medications, products, and equipment. These outbreaks are not infrequent, and a range of infection prevention and control measures have been effective in arresting spread. The use of ORION guidelines for outbreak reporting would improve the quality of information and data to generate evidence for translation into practice