Lean back and wait for the alarm? Testing an automated alarm system for nosocomial outbreaks to provide support for infection control professionals

INTRODUCTION: Outbreaks of communicable diseases in hospitals need to be quickly detected in order to enable immediate control. The increasing digitalization of hospital data processing offers potential solutions for automated outbreak detection systems (AODS). Our goal was to assess a newly developed AODS. METHODS: Our AODS was based on the diagnostic results of routine clinical microbiological examinations. The system prospectively counted detections per bacterial pathogen over time for the years 2016 and 2017. The baseline data covers data from 2013-2015. The comparative analysis was based on six different mathematical algorithms (normal/Poisson and score prediction intervals, the early aberration reporting system, negative binomial CUSUMs, and the Farrington algorithm). The clusters automatically detected were then compared with the results of our manual outbreak detection system. RESULTS: During the analysis period, 14 different hospital outbreaks were detected as a result of conventional manual outbreak detection. Based on the pathogens' overall incidence, outbreaks were divided into two categories: outbreaks with rarely detected pathogens (sporadic) and outbreaks with often detected pathogens (endemic). For outbreaks with sporadic pathogens, the detection rate of our AODS ranged from 83% to 100%. Every algorithm detected 6 of 7 outbreaks with a sporadic pathogen. The AODS identified outbreaks with an endemic pathogen were at a detection rate of 33% to 100%. For endemic pathogens, the results varied based on the epidemiological characteristics of each outbreak and pathogen. CONCLUSION: AODS for hospitals based on routine microbiological data is feasible and can provide relevant benefits for infection control teams. It offers in-time automated notification of suspected pathogen clusters especially for sporadically occurring pathogens. However, outbreaks of endemically detected pathogens need further individual pathogen-specific and setting-specific adjustments

Dynamical epidemic suppression using stochastic prediction and control

We consider the effects of noise on a model of epidemic outbreaks, where the outbreaks appear. randomly. Using a constructive transition approach that predicts large outbreaks, prior to their occurrence, we derive an adaptive control. scheme that prevents large outbreaks from occurring. The theory inapplicable to a wide range of stochastic processes with underlying deterministic structure.Comment: 14 pages, 6 figure

Spatial and seasonal patterns of FMD primary outbreaks in cattle in Zimbabwe between 1931 and 2016

Foot and mouth disease (FMD) is an important livestock disease impacting mainly intensive production systems. In southern Africa, the FMD virus is maintained in wildlife and its control is therefore complicated. However, FMD control is an important task to allow countries access to lucrative foreign meat market and veterinary services implement drastic control measures on livestock populations living in the periphery of protected areas, negatively impacting local small-scale livestock producers. This study investigated FMD primary outbreak data in Zimbabwe from 1931 to 2016 to describe the spatio-temporal distribution of FMD outbreaks and their potential drivers. The results suggest that: (i) FMD outbreaks were not randomly distributed in space across Zimbabwe but are clustered in the Southeast Lowveld (SEL); (ii) the proximity of protected areas with African buffalos was potentially responsible for primary FMD outbreaks in cattle; (iii) rainfall per se was not associated with FMD outbreaks, but seasons impacted the temporal occurrence of FMD outbreaks across regions; (iv) the frequency of FMD outbreaks increased during periods of major socio-economic and political crisis. The differences between the spatial clusters and other areas in Zimbabwe presenting similar buffalo/cattle interfaces but with fewer FMD outbreaks can be interpreted in light of the recent better understanding of wildlife/livestock interactions in these areas. The types of wildlife/livestock interfaces are hypothesized to be the key drivers of contacts between wildlife and livestock, triggering a risk of FMD inter-species spillover. The management of wildlife/livestock interfaces is therefore crucial for the control of FMD in southern Africa

Secondary contact and admixture between independently invading populations of the Western corn rootworm, diabrotica virgifera virgifera in Europe

The western corn rootworm, Diabrotica virgifera virgifera (Coleoptera: Chrysomelidae), is one of the most destructive pests of corn in North America and is currently invading Europe. The two major invasive outbreaks of rootworm in Europe have occurred, in North-West Italy and in Central and South-Eastern Europe. These two outbreaks originated from independent introductions from North America. Secondary contact probably occurred in North Italy between these two outbreaks, in 2008. We used 13 microsatellite markers to conduct a population genetics study, to demonstrate that this geographic contact resulted in a zone of admixture in the Italian region of Veneto. We show that i) genetic variation is greater in the contact zone than in the parental outbreaks; ii) several signs of admixture were detected in some Venetian samples, in a Bayesian analysis of the population structure and in an approximate Bayesian computation analysis of historical scenarios and, finally, iii) allelic frequency clines were observed at microsatellite loci. The contact between the invasive outbreaks in North-West Italy and Central and South-Eastern Europe resulted in a zone of admixture, with particular characteristics. The evolutionary implications of the existence of a zone of admixture in Northern Italy and their possible impact on the invasion success of the western corn rootworm are discussed

Spatial and Temporal Pattern of Rift Valley Fever Outbreaks in Tanzania; 1930 to 2007

Rift Valley fever (RVF)-like disease was first reported in Tanzania more than eight decades ago and the last large outbreak of the disease occurred in 2006–07. This study investigates the spatial and temporal pattern of RVF outbreaks in Tanzania over the past 80 years in order to guide prevention and control strategies. A retrospective study was carried out based on disease reporting data from Tanzania at district or village level. The data were sourced from the Ministries responsible for livestock and human health, Tanzania Meteorological Agency and research institutions involved in RVF surveillance and diagnosis. The spatial distribution of outbreaks was mapped using ArcGIS 10. The space-time permutation model was applied to identify clusters of cases, and a multivariable logistic regression model was used to identify risk factors associated with the occurrence of outbreaks in the district. RVF outbreaks were reported between December and June in 1930, 1947, 1957, 1960, 1963, 1968, 1977– 79, 1989, 1997–98 and 2006–07 in 39.2% of the districts in Tanzania. There was statistically significant spatio-temporal clustering of outbreaks. RVF occurrence was associated with the eastern Rift Valley ecosystem (OR = 6.14, CI: 1.96, 19.28), total amount of rainfall of .405.4 mm (OR = 12.36, CI: 3.06, 49.88), soil texture (clay [OR = 8.76, CI: 2.52, 30.50], and loam [OR = 8.79, CI: 2.04, 37.82]). RVF outbreaks were found to be distributed heterogeneously and transmission dynamics appeared to vary between areas. The sequence of outbreak waves, continuously cover more parts of the country. Whenever infection has been introduced into an area, it is likely to be involved in future outbreaks. The cases were more likely to be reported from the eastern Rift Valley than from the western Rift Valley ecosystem and from areas with clay and loam rather than sandy soil texture

Knowledge discovery from mining the association between H5N1 outbreaks and environmental factors

The global spread of highly pathogenic avian influenza H5N1 in poultry, wild birds and humans, poses a significant panzootic threat and a serious public health risk. An efficient surveillance and disease control system requires a deep understanding of their spread mechanisms, including environmental factors responsible for the outbreak of the disease. Previous studies suggested that H5N1 viruses occurred under specific environmental circumstances in Asia and Africa. These studies were mainly derived from poultry outbreaks. In Europe, a large number of wild bird outbreaks were reported in west Europe with few or no poultry infections nearby. This distinct outbreak pattern in relation to environmental characteristics, however, has not yet been explored. This research demonstrated the use of logistic regression analyses to examine quantitative associations between anthropogenic and physical environmental factors, and the wild bird H5N1outbreaks in Europe. A geographic information system is used to visualize and analyze the data. Our results indicate that the H5N1 outbreaks occur in wild birds in Europe under predictable environmental conditions, which are highly correlated with increased NDVI in December, decreased aspect and slope, increased minimum temperature in October and decreased precipitation in January. It suggests that H5N1 outbreaks in wild birds are strongly influenced by food resource availability and facilitated by the increased temperature and the decreased precipitation. We therefore deduce that the H5N1 outbreaks in wild birds in Europe may be mainly caused by contact with wild birds. These findings are of great importance for global surveillance of H5N1 outbreaks in wild birds

A review of epidemiological parameters from Ebola outbreaks to inform early public health decision-making.

The unprecedented scale of the Ebola outbreak in West Africa has, as of 29 April 2015, resulted in more than 10,884 deaths among 26,277 cases. Prior to the ongoing outbreak, Ebola virus disease (EVD) caused relatively small outbreaks (maximum outbreak size 425 in Gulu, Uganda) in isolated populations in central Africa. Here, we have compiled a comprehensive database of estimates of epidemiological parameters based on data from past outbreaks, including the incubation period distribution, case fatality rate, basic reproduction number (R 0), effective reproduction number (R t) and delay distributions. We have compared these to parameter estimates from the ongoing outbreak in West Africa. The ongoing outbreak, because of its size, provides a unique opportunity to better understand transmission patterns of EVD. We have not performed a meta-analysis of the data, but rather summarize the estimates by virus from comprehensive investigations of EVD and Marburg outbreaks over the past 40 years. These estimates can be used to parameterize transmission models to improve understanding of initial spread of EVD outbreaks and to inform surveillance and control guidelines

Modeling highly pathogenic avian influenza transmission in wild birds and poultry in West Bengal, India.

Wild birds are suspected to have played a role in highly pathogenic avian influenza (HPAI) H5N1 outbreaks in West Bengal. Cluster analysis showed that H5N1 was introduced in West Bengal at least 3 times between 2008 and 2010. We simulated the introduction of H5N1 by wild birds and their contact with poultry through a stochastic continuous-time mathematical model. Results showed that reducing contact between wild birds and domestic poultry, and increasing the culling rate of infected domestic poultry communities will reduce the probability of outbreaks. Poultry communities that shared habitat with wild birds or those indistricts with previous outbreaks were more likely to suffer an outbreak. These results indicate that wild birds can introduce HPAI to domestic poultry and that limiting their contact at shared habitats together with swift culling of infected domestic poultry can greatly reduce the likelihood of HPAI outbreaks

Fighting covid-19 outbreaks in prisons

Improving prison health services is critical for fighting epidemics such as covid-19. Prisoners are at much higher risk of infectious diseases than communities outside. Eruption of covid-19 in prisons emphasises the need to improve prison healthcare. Health education for inmates and prison staff must be intensified, and better treatment and prevention measures require increased funding. More non-custodial sentences would decongest prisons, reducing the potential for the outbreaks. Links between prison and national health services should be strengthened