In March 2024, the East Midlands Health Protection Team was notified of a case of invasive Group A Streptococcus (iGAS) infection in an elderly care home resident. Twenty-two days later, another case in a resident from the same floor of the care home was notified. In accordance with national guidelines, an outbreak was declared, and a multidisciplinary outbreak control team (OCT) was urgently convened. Screening for GAS throat carriage was undertaken for staff and residents, excluding those receiving end-of-life care. All isolates were strain typed and characterised. Infection prevention and control (IPC) visits were undertaken to provide ongoing support. Screening identified five residents and five staff members positive for GAS. Antibiotic prophylaxis was provided to all staff throughout the setting (n = 74) and all residents on the affected floor (n = 35). Three individuals were positive on repeat screening. All staff and residents screened negative after 4 months and the two clinical cases recovered. Eleven of the 12 GAS isolates were identified as emm 3.93. This outbreak highlighted the importance of rapid screening, possible only through the deployment of a dedicated team, and rescreening post-decolonising treatment, as a means to contain such outbreaks.

The aim of this study was to describe how the detection of protozoan and helminth parasites has been affected by the introduction of polymerase chain reaction (PCR) and changes in test algorithms. We extracted data about faecal samples tested for parasites (n = 114839) at five Norwegian clinical microbiology laboratories. Samples were classified into prePCR or postPCR depending on whether they were submitted before or after the introduction of PCR, and into diagnostic episodes (n = 99320). The number of diagnostic episodes increased 3.7-fold from prePCR to postPCR. Giardia positive episodes doubled, the positivity rate decreased from 2.0% to 1.3%. Cryptosporidium was hardly detected prePCR and increased to a positivity rate of 1.2%. Entamoeba histolytica was rarely found. Episodes examined for helminths decreased 51%, the number of positive episodes decreased 34%. Samples from immigrants were more likely to be positive for Giardia, E. histolytica, or helminths and less likely to be Cryptosporidium positive. During the COVID-19 pandemic, the number of Giardia and helminth-positive episodes decreased. Cryptosporidium-positive episodes remained unchanged. The implementation of multiplex PCR for protozoa led to a doubling of Giardia cases and a better test for Cryptosporidium. Fewer microscopy examinations raise concerns that helminth infections may be overlooked.

Monkeypox (mpox) has re-emerged as global public health concern including in several non-endemic countries. This study aims to characterize monkeypox virus (MPXV) genomes in Indonesia, to explore viral evolution and transmission. Genomic analysis was conducted on 53 isolates from Indonesian mpox patients between 2023 and 2024. All sequences belonged to Clade IIb, with identified sub-clades including A.1.1, B.1, B.1.3, and C.1 – of which C.1 became dominant during this period. Out of 87 mpox-confirmed cases, 60.9% (53/87) were successfully sequenced and submitted to the Global Initiative on Sharing All Influenza Data (GISAID). The majority of cases in Indonesia occurred among males (95.4%), men who have sex with men (59.8%), and people living with HIV/AIDS (71.3%). Notably, a large portion of cases had no travel history, suggesting local transmission. Initially, only clade IIb (B.1) was detected in October 2022. By August 2023, lineage diversity had increased, with B.1.3 and C.1 emerging as the predominant sub-clades. A time–calibrated phylogenetic tree revealed genetic relatedness and shared ancestry within clade IIb. Integrating genomic and epidemiological data offers valuable insights to improve mpox surveillance and public health response in Indonesia and the broader region

Dengue, the most prevalent urban arbovirus in the world, has triggered recurrent epidemics in Rio de Janeiro, Brazil, since the 1980s. This study aimed to describe the spatial–temporal patterns of dengue spread during the epidemic years of 2002, 2008, 2011, 2012, 2013, and 2024 in Rio de Janeiro. This is an ecological study using secondary data on notified confirmed dengue cases aggregated by neighbourhood. The incidence rates were estimated via the local empirical Bayes method. The local spatial autocorrelation indicators assessed incidence clusters, and the monthly geographic trajectory was outlined for each year. The results revealed changes in the spatial distribution of dengue over time, with clusters of high incidences predominating in the northern and central neighbourhoods in 2002 and 2008, and in the western zone in 2011, 2012, and 2013. In 2024, the distribution was predominant throughout the city, with emphasis in the central and western zones. The monthly geographic centre of dengue cases shifted from the west to the north during the peak of the epidemic. These results highlight the heterogeneous nature of dengue transmission in Rio de Janeiro. The incorporation of spatial and temporal analyses in epidemiological studies can enhance targeted and localized dengue control strategies.

Case-control studies can provide attribution estimates of the likely sources of zoonotic pathogens. We applied a meta-analytical model within a Bayesian estimation framework to pool population attributable fractions (PAFs) from European case-control studies of sporadic campylobacteriosis and salmonellosis. The input data were obtained from two existing systematic reviews, supplemented with additional literature searches, covering the period 2000–2021. In total, 12 studies on Campylobacter providing data for 180 PAFs referring to 5983 cases and 13213 controls, and five studies on Salmonella providing data for 75 PAFs referring to 2908 cases and 5913 controls, were included. All these studies were conducted in Western or Northern European countries. Both pathogens were estimated as being predominantly linked to food- and waterborne transmission, which explained nearly half of the cases, with Campylobacter being mainly attributable to poultry (meat), and Salmonella to poultry (eggs and meat) and pig (meat), as specific foodborne exposures. When also considering contact with animals, around 60% of cases could be explained by the larger group of zoonotic transmission pathways. While environmental transmission was also sizeable (around 10%), about a quarter of cases could be explained by factors such as travel, underlying diseases/medicine use, person-to-person transmission and occupational exposure.

Invasive Group B Streptococcus (GBS) infection caused by the highly virulent Sequence Type 283 (ST283) strain has been linked to consumption of raw freshwater fish. In late summer 2024, enhanced surveillance in Hong Kong detected a surge of invasive ST283 cases.

A retrospective case–control study was conducted involving all invasive GBS patients reported during August to September 2024. Data were collected through standardised interviewer-administered questionnaires. Cases were defined as patients infected with the ST283 strain, while controls had non-ST283 strains. A multivariate logistic regression analysis was conducted to determine the risk factors.

Among 170 invasive GBS patients, 131 (77%) were identified as cases and 39 (23%) as controls. Physical handling of raw freshwater fish was found to be the strongest risk factor for ST283 infection (adjusted odds ratio: 8.4, 95% confidence interval: 1.4–50.1).

This study represents the first epidemiological evidence specifically linking physical contact with raw freshwater fish to an increased risk of invasive GBS ST283 infection. Effective interdepartmental coordination, intensive public health education, active surveillance, and prompt environmental interventions effectively mitigated this large outbreak. The findings underscore the need for sustainable preventive strategies targeting high-risk fish handling practices, particularly during warm periods favouring environmental proliferation of ST283.

This systematic review synthesized evidence on the viral load of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) shedding in exhaled material to understand how the exhaled SARS-CoV-2 viral load of infected individuals varies with days since exposure. Medline, Scopus, and Web of Science databases were searched using a combination of search terms to identify articles that tested exhaled material from SARS-CoV-2 infected patients. Records were systematically screened and assessed for eligibility, following which reference lists of eligible articles were hand-searched to identify further relevant studies. Data extraction and quality assessment of individual studies were conducted prior to synthesizing the evidence. Forty-five articles that sampled exhaled breath, exhaled breath condensate, face masks, and cough samples were reviewed. The variation in the SARS-CoV-2 viral load in these materials was considerable with the detection of viral RNA shed during breathing as far as 43 days after symptom onset. The replication-competent virus was present in all four sample types, with the majority isolated during the first week of symptoms onset. Variations in the sample types and testing protocols precluded meta-analysis. High heterogeneity in exhaled SARS-CoV-2 viral load is likely due to host and viral factors as well as variations in sampling and diagnostic methodologies. Evidence on SARS-CoV-2 shedding in exhaled material is scarce and more controlled fundamental studies are needed to assess this important route of viral shedding.

Acute infection with Toxoplasma gondii in pregnant people can lead to vertical transmission to the foetus and congenital toxoplasmosis. As part of risk assessment, the epidemiology of toxoplasmosis among pregnant people must be quantitatively elucidated. Herein, we investigated the risk of primary T. gondii infection during pregnancy in Japan, estimating the incidence of T. gondii infection among pregnant people as well as that of congenital toxoplasmosis. We used a compartment model that captured the infection dynamics in pregnant people, analysing prescription data for spiramycin in Japan, together with local serological testing results and the screening rate of primary T. gondii infection during pregnancy. The nationwide risk of T. gondii infection pregnant people in Japan was estimated to be 0.016% per month. Among prefectures investigated, the risk estimate was highest in Tokyo with 0.030% per month. Nationally, the number of T. gondii infections among pregnant people in the years 2019, 2020, and 2021 was estimated to be 1507, 1440, and 1388 infections, respectively. The nationwide number of cases of congenital toxoplasmosis in each year was estimated at 613, 588, and 567 cases, respectively. Our study indicated that T. gondii infection continues to place a substantial burden on public health in Japan.

During pregnancy, colonization by genital mycoplasmas may be associated with adverse outcomes. This study was conducted to investigate the prevalence of four species of Mollicutes (Mycoplasma hominis, Mycoplasma genitalium, Ureaplasma parvum, and Ureaplasma urealyticum) in pregnant women receiving high-risk prenatal care and to evaluate possible associated factors. Data collection included the application of a questionnaire and the collection of cervical swabs from pregnant women. Species identification was performed by real-time PCR. The overall prevalence of Mollicutes was 60.97%. 55.9% of pregnant women were colonized by Ureaplasma spp., and 19.51% by Mycoplasma spp. The prevalence rates by species were 48.78% for U. parvum, 11.59% for U. urealyticum, 18.9% for M. hominis, and 1.22% for M. genitalium. Age, 12 years of schooling or more, age at first sexual intercourse up to 14 years, third trimester of pregnancy, having undergone infertility treatment, presence of STI, and groin lymph nodes were associated with a higher prevalence of microorganisms. The results presented are of utmost importance for understanding the prevalence of these microorganisms, the characteristics of colonized pregnant women, and planning screening strategies and interventions that minimize the negative impacts of these infections.

Determining the factors that impact the risk for infection with SARS-CoV-2 is a priority as the virus continues to infect people worldwide. The objective was to determine the effectiveness of vaccines and other factors associated with infection among Canadian healthcare workers (HCWs) followed from 15 June 2020 to 1 December 2023. We also investigate the association between antibodies to SARS-CoV-2 and subsequent infections with SARS-CoV-2. Of the 2474 eligible participants, 2133 (86%) were female, 33% were nurses, the median age was 41 years, and 99.3% had received at least two doses of COVID-19 vaccine by 31 December 2021. The incidence of SARS-CoV-2 was 0.91 per 1000 person-days. Prior to the circulation of the Omicron variants, vaccine effectiveness (VE) was estimated at 85% (95% CI 1, 98) for participants who received the primary series of vaccine. During the Omicron period, relative adjusted VE was 43% (95% CI 29, 54), 56% (95% CI 42, 67), and 46% (95% CI 24, 62) for 3, 4, and ≥ 5 doses compared with those who received primary series after adjusting for previous infection and other covariates. Exposure to infected household members, coworkers, or friends in the previous 14 days were risk factor for infection, while contact with an infected patient was not statistically significant. Participants with higher levels of immunoglobulin G (IgG) anti-receptor binding domain (RBD) antibodies had lower rates of infection than those with the lowest levels. COVID-19 vaccines remained effective throughout the follow-up of this cohort of highly vaccinated HCWs. IgG anti-RBD antibody levels may be useful as correlates of protection for issues such as vaccine development and testing. There remains a need to increase the awareness among HCWs about the risk of contracting SARS-CoV-2 from contacts at a variety of venues.

Previously, we reported the persistence of the bacterial pathogen Neisseria meningitidis on fomites, indicating a potential route for environmental transmission. The current goal was to identify proteins that vary among strains of meningococci that have differing environmental survival. We carried out a proteomic analysis of two strains that differ in their potential for survival outside the host. The Group B epidemic strain NZ98/254 and Group W carriage strain H34 were cultured either at 36 °C, 5% CO2, and 95% relative humidity (RH) corresponding to host conditions in the nasopharynx, or at lower humidities of 22% or 30% RH at 30 °C, for which there was greater survival on fomites. For NZ98/254, the shift to lower RH and temperature was associated with increased abundance of proteins involved in metabolism, stress responses, and outer membrane components, including pili and porins. In contrast, H34 responded to lower RH by decreasing the abundance of multiple proteins, indicating that the lower viability of H34 may be linked to decreased capacity to mount core protective responses. The results provide a snapshot of bacterial proteins and metabolism that may be related to normal fitness, to the greater environmental persistence of NZ98/254 compared to H34, and potentially to differences in transmission and pathogenicity.

Early detection and active management of invasive group A Streptococcus (iGAS) infection outbreaks are essential. Here, we describe the changing epidemiology of outbreaks of iGAS in England between 2015 and 2019, a period of increasing incidence of iGAS infection. Data on iGAS infections were extracted from national public health management records and laboratory records. Outbreaks were described in size, duration, setting, and emm type. Overall, 194 outbreaks were identified, and reports increased each year, from 16 outbreaks in 2015 to 61 in 2019. The median outbreak size was 3 cases (n = 37; 19%), with 27% of outbreaks recording 4–10 cases (n = 53) and 7% recording more than 10 cases (n = 13). Outbreak duration ranged from 0 to 170 weeks (median 7). Settings of outbreaks changed over the study period, with increasing numbers observed in multiple settings. This study provides new insights into the changing burden of iGAS infection and outbreaks in England.

Human toxocariasis is a worldwide parasitic disease caused by zoonotic roundworms of the genus Toxocara, which can cause blindness and epilepsy. The aim of this study was to estimate the risk of food-borne transmission of Toxocara spp. to humans in the UK by developing mathematical models created in a Bayesian framework. Parameter estimation was based on published experimental studies and field data from southern England, with qPCR Cq values used as a measure of eggs in spinach portions and ELISA optical density data as an indirect measure of larvae in meat portions. The average human risk of Toxocara spp. infection, per portion consumed, was estimated as 0.016% (95% CI: 0.000–0.100%) for unwashed leafy vegetables and 0.172% (95% CI: 0.000–0.400%) for undercooked meat. The average proportion of meat portions estimated positive for Toxocara spp. larvae was 0.841% (95% CI: 0.300–1.400%), compared to 0.036% (95% CI: 0.000–0.200%) of spinach portions containing larvated Toxocara spp. eggs. Overall, the models estimated a low risk of infection with Toxocara spp. by consuming these foods. However, given the potentially severe human health consequences of toxocariasis, intervention strategies to reduce environmental contamination with Toxocara spp. eggs and correct food preparation are advised.

Temporal variability and methodological differences in data normalization, among other factors, complicate effective trend analysis of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) wastewater surveillance data and its alignment with coronavirus disease 2019 (COVID-19) clinical outcomes. As there is no consensus approach for these analyses yet, this study explored the use of piecewise linear trend analysis (joinpoint regression) to identify significant trends and trend turning points in SARS-CoV-2 RNA wastewater concentrations (normalized and non-normalized) and corresponding COVID-19 case rates in the greater Las Vegas metropolitan area (Nevada, USA) from mid-2020 to April 2023. The analysis period was stratified into three distinct phases based on temporal changes in testing protocols, vaccination availability, SARS-CoV-2 variant prevalence, and public health interventions. While other statistical methodologies may require fewer parameter specifications, joinpoint regression provided an interpretable framework for characterization and comparison of trends and trend turning points, revealing sewershed-specific variations in trend magnitude and timing that also aligned with known variant-driven waves. Week-level trend agreement corroborated previous findings demonstrating a close relationship between SARS-CoV-2 wastewater surveillance data and COVID-19 outcomes. These findings guide future applications of advanced statistical methodologies and support the continued integration of wastewater-based epidemiology as a complementary approach to traditional COVID-19 surveillance systems.

Leptospirosis in NZ has historically been associated with male workers in livestock industries; however, the disease epidemiology is changing. This study identified risk factors amid these shifts. Participants (95 cases:300 controls) were recruited nationwide between 22 July 2019 and 31 January 2022, and controls were frequency-matched by sex (90% male) and rurality (65% rural). Multivariable logistic regression models, adjusted for sex, rurality, age, and season—with one model additionally including occupational sector—identified risk factors including contact with dairy cattle (aOR 2.5; CI: 1.0–6.0), activities with beef cattle (aOR 3.0; 95% CI: 1.1–8.2), cleaning urine/faeces from yard surfaces (aOR 3.9; 95% CI: 1.5–10.3), uncovered cuts/scratches (aOR 4.6; 95% CI: 1.9–11.7), evidence of rodents (aOR 2.2; 95% CI: 1.0–5.0), and work water supply from multiple sources—especially creeks/streams (aOR 7.8; 95% CI: 1.5–45.1) or roof-collected rainwater (aOR 6.6; 95% CI: 1.4–33.7). When adjusted for occupational sector, risk factors remained significant except for contact with dairy cattle, and slaughter without gloves emerged as a risk (aOR 3.3; 95% CI: 0.9–12.9). This study highlights novel behavioural factors, such as uncovered cuts and inconsistent glove use, alongside environmental risks from rodents and natural water sources.

We describe an outbreak of Legionnaires’ disease linked to an exclusive cold-water source in a private residential setting in Yorkshire. The cold-water source was identified following microbiological testing of clinical and environmental samples. Legionella pneumophila was only detected in the cold-water system. Three cases were identified over the course of the outbreak: two confirmed and one probable. Conditions favourable to bacterial growth included system ‘dead legs’ and significant heat transfer to the cold-water system. We describe challenges in implementing control measures at the venue and highlight the importance of using enforcement powers, where necessary, to reduce risk.

Gastrointestinal infections significantly impact African low- and middle-income countries, although, accurate data on acute gastrointestinal illness (AGI) for all ages are lacking. This study aimed to describe the epidemiology of AGI in Ethiopia, Mozambique, Nigeria, and Tanzania. A population survey was conducted in one urban and one rural site per country, from 01 October 2020 to 30 September 2021, using web-based and face-to-face tools (n = 4417). The survey tool was adapted from high-income countries, ensuring comparability through an internationally recommended AGI case definition. Ethiopia had the highest AGI incidence (0.87 episodes per person-year), followed by Mozambique (0.58), Tanzania (0.41), and Nigeria (0.34). Age-standardized incidence was highest in Mozambique (1.46) and Ethiopia (1.25), compared to Tanzania (0.58) and Nigeria (0.33). The 4-week prevalence was 6.4% in Ethiopia and 4.3% in Mozambique, compared to 3.1% in Tanzania and 2.6% in Nigeria. AGI lasted an average of 5.3 days in Ethiopia and 3.0 to 3.4 days elsewhere. Children under five had 4.4 times higher AGI odds (95% CI: 2.8, 6.7) than those aged 15-59. The study provides empirical data on the incidence and demographic determinants of AGI in these four countries.

Post COVID-19 condition (PCC) refers to persistent symptoms occurring ≥12 weeks after COVID-19. This living systematic review (SR) assessed the impact of vaccination on PCC and vaccine safety among those with PCC, and was previously published with data up to December 2022. Searches were updated to 31 January 2024 and standard SR methodology was followed. Seventy-eight observational studies were included (47 new). There is moderate confidence that two doses pre-infection reduces the odds of PCC (pooled OR (pOR) 0.69, 95% CI 0.64–0.74, I2 = 35.16%). There is low confidence for remaining outcomes of one dose and three or more doses. A booster dose may further reduce the odds of PCC compared to only a primary series (pOR 0.85, 95% CI 0.74–0.98, I2 = 16.85%). Among children ≤18 years old, vaccination may not reduce the odds (pOR 0.79, 95% CI 0.56–1.11, I2 = 37.2%) of PCC. One study suggests that vaccination within 12 weeks post-infection may reduce the odds of PCC. For those with PCC, vaccination appears safe (four studies) and may reduce the odds of PCC persistence (pOR 0.73, 95% CI 0.57–0.92, I2 = 15.5%).