Toxoplasmosis outbreak in São Paulo, Brazil: Epidemiology and visual outcome

ABSTRACT Purpose: To describe a 2019 acute toxoplasmosis outbreak in the city of São Paulo, Brazil, and to evaluate the laboratory serological profile for toxoplasmosis for three consecutive years. The ophthalmological manifestations of the patients involved in the outbreak were also studied. Methods: A cross-sectional descriptive study of a toxoplasmosis outbreak in São Paulo, Brazil, between February and May 2019. Epidemiological data were described, as were the observed ocular manifestations. As part of this study the number of patients with positive IgM toxoplasmosis serology was obtained from a large laboratory network (DASA) for three consecutive years, including the year of the outbreak (2018, 2019, 2020). Results: Eighty-three individuals were identified in the outbreak and two clusters were studied. The clinical picture of at least 77% of the patients, the epidemiological analysis, and the short incubation period (5-8 days) suggested contamination by oocysts. Serological laboratory data analysis revealed an increase of positive toxoplasmosis IgM in 2019 of 73% compared to the previous year. Ophthalmological examination revealed that at least 4.8% of the patients developed toxoplasmic retinochoroiditis, none of whom had been treated during the acute systemic disease. Conclusion: Our findings indicate vegetable contamination as the possible source of this outbreak, a high prevalence of toxoplasmosis in São Paulo during the outbreak period, and a drop in the number of tests during the COVID-19 pandemic. Retinochoroiditis was observed in at least 4.8% of the cases. We confirm the need to implement effective means for the prevention, diagnosis, and treatment of the disease. This may involve raising awareness among the population of the importance of vegetable hygiene, and improved quality control of food and water.

Efficacy of current vaccines against recently isolated foot and mouth disease virus type A South America (Venezuela) in Egypt 2022

Foot and mouth disease is a highly contagious viral disease that poses a significant economic threat to cloven-hoofed animals, including cattle and sheep. The emergence of a novel foot and mouth disease virus-A isolate, FMDV-A-Egy-AHRI-RL385-Ven-2022, in Egypt in 2022 has raised concerns about its potential impact on existing vaccination programs. Given that vaccination is a key strategy for foot and mouth disease virus control, the present study was aimed to assess the cross-protective efficacy of both local and imported inactivated vaccines against this new threat. Through challenge experiments and serum neutralization tests, we observed limited effectiveness of both vaccine types. The calculated r1-values at 28 days post-vaccination indicated a minimal immune response to FMDV-A-Egy-AHRI-RL385-Ven-2022 (0.176 and 0.175 for local and imported vaccines, respectively). Challenge experiments further confirmed these findings, revealing 0percent protection from the local vaccine and only 20percent rotection from imported vaccines by day 7 post-challenge. These results underscore the urgent need to update existing foot and mouth disease virus vaccines in Egypt by incorporating the newly circulating FMDV-A-Egy-AHRI-RL385-Ven-2022 strain. This proactive measure is crucial to prevent future outbreaks and ensure effective disease control(AU)

La fiebre aftosa es una enfermedad vírica muy contagiosa que supone una importante amenaza económica para los animales biungulados, entre ellos el ganado vacuno y ovino. La aparición de un nuevo aislado del virus A de la fiebre aftosa, el FMDV-A-Egy-AHRI-RL385-Ven-2022, en Egipto en 2022 ha suscitado preocupación por su posible impacto en los programas de vacunación existentes. Dado que la vacunación es una estrategia clave para el control del virus de la fiebre aftosa, el objetivo del presente estudio fue evaluar la eficacia protectora cruzada de las vacunas inactivadas locales e importadas frente a esta nueva amenaza. Mediante experimentos de desafío y pruebas de seroneutralización, observamos una eficacia limitada de ambos tipos de vacuna. Los valores r1 calculados a los 28 días posvacunación indicaron una respuesta inmunitaria mínima frente a FMDV-A-Egy-AHRI-RL385-Ven-2022 (0,176 y 0,175 para las vacunas local e importada, respectivamente). Los experimentos de provocación confirmaron aún más estos resultados, revelando un 0 por ciento de protección de la vacuna local y sólo un 20 por ciento de protección de las vacunas importadas al séptimo día después de la provocación. Estos resultados subrayan la urgente necesidad de actualizar las vacunas existentes contra el virus de la fiebre aftosa en Egipto incorporando la nueva cepa circulante FMDV-A-Egy-AHRI-RL385-Ven-2022. Esta medida proactiva es crucial para prevenir futuros brotes y garantizar un control eficaz de la enfermedad(AU)

Temporal and spatial analysis of over 7,000 measles cases outbreak from 2018 to 2019 in the Brazilian Amazon

ABSTRACT Objective: This study aimed to present a temporal and spatial analysis of the 2018 measles outbreak in Brazil, particularly in the metropolitan city of Manaus in the Amazon region, and further introduce a new tool for spatial analysis. Methods: We analyzed the geographical data of the residences of over 7,000 individuals with measles in Manaus during 2018 and 2019. Spatial and temporal analyses were conducted to characterize various aspects of the outbreak, including the onset and prevalence of symptoms, demographics, and vaccination status. A visualization tool was also constructed to display the geographical and temporal distribution of the reported measles cases. Results: Approximately 95% of the included participants had not received vaccination within the past decade. Heterogeneity was observed across all facets of the outbreak, including variations in the incubation period and symptom presentation. Age distribution exhibited two peaks, occurring at one year and 18 years of age, and the potential implications of this distribution on predictive analysis were discussed. Additionally, spatial analysis revealed that areas with the highest case densities tended to have the lowest standard of living. Conclusion: Understanding the spatial and temporal spread of measles outbreaks provides insights for decision-making regarding measures to mitigate future epidemics.

Brote de tinea capitis y otras micosis superficiales en una comunidad urbana de Medellín

Introducción. Las dermatofitosis son infecciones fúngicas superficiales de epitelios queratinizados. La tinea capitis es una de ellas y afecta a poblaciones escolares vulnerables. Carpinelo es un barrio del área periférica de Medellín con precarias condiciones socioeconómicas. Ante la sospecha de un brote de dermatofitosis, los afectados fueron evaluados. Objetivo. Evaluar clínica y microbiológicamente pacientes del barrio Carpinelo con sospecha de micosis cutáneas para determinar la presencia de un brote por dermatofitos. Materiales y métodos. Se llevó a cabo un estudio descriptivo, de corte longitudinal, con muestreo a conveniencia. Se hizo una búsqueda activa de casos en el Jardín Educativo Buen Comienzo de Carpinelo en niños de la institución y sus familiares. Se evaluaron clínicamente y se tomaron muestras de escamas y cabellos para exámenes directos y cultivos microbiológicos. Se analizó el perfil demográfico, clínico y micológico, con el programa estadístico SPSS™, versión 25. Resultados. Se estudiaron 57 pacientes, 47 eran menores de edad con una media de edad de seis años; se observó una proporción de hombres y mujeres de 2:1. Los pacientes con resultados positivos se diagnosticaron con tinea capitis (78,95 %), tinea faciei (15,79 %) y tinea corporis (10,52 %). El 75,43 % de los pacientes recibió tratamiento previo y de estos el 69,73 % fue con esteroides. El examen directo fue positivo en el 53,84 % y los cultivos en el 46,5 % de los casos. Los agentes aislados fueron: Microsporum canis (77,77 %), Trichophyton spp. (11,11 %), Trichophyton rubrum (5,55 %) y Malassezia spp. (5,55 %). Conclusión. Tinea capitis fue la presentación clínica más común y M. canis el dermatofito más frecuentemente aislado. Llamó la atención el uso de esteroides como primera y única opción del tratamiento empírico, lo cual resalta la importancia del diagnóstico microbiológico para proporcionar la terapia apropiada.

Introduction. Dermatophytoses are superficial fungal infections of the keratinized epithelium like tinea capitis. The latte mainly affects school-vulnerable populations. Carpinelo is a peripheral neighborhood in Medellín with poor socioeconomic conditions and where a suspected tinea capitis outbreak took place. Objective. To study and characterize, clinically and microbiologically, patients with suspected dermatophytosis in Carpinelo. Material and methods. We carried out a descriptive and longitudinal study with an active case search of tinea capitis in children and their relatives from the Jardín Educativo Buen Comienzo community in Carpinelo. Patients were clinically evaluated, and samples of scales and hair were taken to perform mycological studies with a 10 % potassium hydroxide and culture in Sabouraud and Mycosel agar. We analyzed the data with the statistical program SPSS™. 25 version. Results. Fifty-seven individuals were studied: 47 were children with a mean age of six years and a ratio of 2:1 male to female. Patients with confirmed diagnosis presented the following clinical forms: tinea capitis (78.95%), tinea faciei (15.79%) or tinea corporis (10.52%). Out of the total, 69.76% of the patients had previous treatment with steroids. The direct test was positive in 53.84% of the samples, and 46.15% had positive cultures. The isolated species were: Microsporum canis (77.77%), Trichophyton spp. (11.11%), Trichophyton rubrum (5.55%), and Malassezia spp. (5.55 %). Conclusion. Tinea capitis was the most common clinical form, and M. canis was the most frequently isolated species. The use of steroids as the first and only option for empiric treatment was worth of notice. The findings of this study point out the importance of microbiological diagnosis in choosing the best treatment for the patients.

Comportamiento de enfermedades vectoriales en una población manabita, Ecuador / Behavior of vector diseases in a Manabí population, Ecuador

Objetivo: Analizar el comportamiento de enfermedades vectoriales en una población manabita. Materiales y métodos: Se desarrolló bajo un tipo de investigación descriptiva de corte transversal y enfoque cuantitativo, con la utilización de un cuestionario como instrumento de recolección de datos. La muestra fueron 200 adultos del barrio San José de la parroquia Tarqui ­ Manta, de la provincia de Manabí ­ Ecuador. Resultados y conclusión: A través de esta investigación se pudo determinar que, de las 200 personas encuestadas, el 24% ha presentado alguna enfermedad vectorial, prevaleciendo el dengue con un 66.66%. Del 26% de familiares y conocidos de los encuestados que ha padecido enfermedades vectoriales, el 77.35% fue dengue. Generalmente, se presentan con síntomas que duran entre 1 a 3 días y sin mayores secuelas. La mayoría cuenta con servicios sanitarios óptimos y el 100% coincide que existen aguas estancadas en espacios públicos. Descriptores: Monitoreo epidemiológico; brotes de enfermedades; enfermedades endémicas. (Fuente: DeCS).

Objective: To analyze the behavior of vectorial diseases in a Manabi population. Materials and methods: It was developed under a type of descriptive cross-sectional research and quantitative approach with the use of a questionnaire as a data collection instrument. The sample consisted of 200 adults from the San José neighborhood of the Tarqui - Manta parish in the province of Manabí - Ecuador. Results and conclusion: Through this investigation it was possible to determine that of the 200 people surveyed, 24% have presented some vector disease, with dengue prevailing with 66.66%. Of the 26% of relatives and acquaintances of the respondents who have suffered vector-borne diseases, 77.35% were dengue. They usually present with symptoms that last between 1 to 3 days and without major sequelae. Most have optimal sanitary services and 100% agree that there is stagnant water in public spaces.

Outbreak report of SARS-CoV-2 infection by airborne transmission: Epidemiologic and molecular evidence / Reporte de un brote de infección por SARS-CoV-2 por transmisión aérea: evidencia epidemiológica y molecular

Introduction: It has been shown that the transmission of SARS-CoV-2 occurs mainly by air, and the risk of infection is greater in closed spaces. Objective: To describe the epidemiology, virology and molecular characterization of a COVID-19 outbreak at a closed vaccination point during the third wave of SARS-CoV-2 in Colombia. Materials and methods: Diagnostic tests, interviews, sampling, cell cultures and viral sequencing were carried out, the latter being molecular characterization and lineage identification. Results: Seven workers were positive for SARS-CoV-2; among these, 3 samples were analyzed, plus an additional sample belonging to the mother of the presumed index case; all samples were identified with lineage B.1.625, with a maximum of 2 nucleotides difference between them. Conclusions: Variant B.1.625 was identified as the cause of the COVID-19 outbreak, and a co-worker was also identified as the index case. Unexpectedly, attending a vaccination day became a risk factor for acquiring the infection.

Introducción. Se ha demostrado que la transmisión de SARS-CoV-2 se produce principalmente por vía aérea y el riesgo de infección es mayor en espacios cerrados con alta concentración de personas; este último factor se presentó en algunos de los puestos de vacunación de la ciudad de Medellín. Objetivo. Describir la epidemiología, virología y caracterización molecular de un brote de COVID-19 en un punto de vacunación cerrado durante la tercera ola de SARS-CoV-2 en Colombia. Materiales y métodos. Se realizaron test diagnósticos, entrevistas, toma de muestras, aislamiento viral y secuenciación genómica. Con esta última, se hizo la caracterización molecular y se identificó el linaje. Resultados. Siete trabajadores fueron positivos para SARS-CoV-2, y de estos, tres muestras fueron secuenciadas, más una muestra adicional perteneciente a la madre del presunto caso índice. Todas las muestras fueron identificadas con el linaje B.1.625, con un máximo de dos nucleótidos de diferencia entre ellas. Conclusiones. Se identificó la variante B.1.625 como la causante del brote de COVID-19, y también un compañero de trabajo fue identificado como el caso índice. De forma imprevista, asistir a una jornada de vacunación se convirtió en un factor de riesgo para adquirir la infección.

Mantenimiento del estatus de eliminación del sarampión en Colombia durante el control de brotes, 2019 / Maintaining measles elimination status in Colombia during outbreak control, 2019 / Manutenção do status de eliminação do sarampo na Colômbia durante o controle de surtos, 2019

RESUMEN Objetivo. Describir los brotes de sarampión generados por la múltiple importación de casos y las intervenciones de control. Métodos. Estudio descriptivo de brotes por múltiple importación de casos a Colombia entre 2018-2019. Se utilizaron las definiciones de caso, clasificación de fuente de infección, recolección de muestras biológicas, rastreo de casos sospechosos, identificación y seguimiento de contactos. El antecedente vacunal se obtuvo del carné o del sistema de información de Colombia. La nacionalidad se definió de acuerdo con el registro en el sistema de vigilancia en salud pública. Se empleó el sistema de comando de incidente con equipos de respuesta y planes de acción para controlar los brotes. Resultados. En marzo de 2018 se confirmó el primer caso de sarampión importado de Venezuela. La incidencia en 2018 fue 0,2 casos por 100 000 habitantes y en 2019 fue 0,3. La letalidad en 2019 fue de 0,4%. Se confirmaron 214 casos en población venezolana (91% sin antecedente vacunal). Se estudiaron 69 brotes sin vínculo epidemiológico. Se identificó el genotipo D8 linaje MVi/Hulu Langat.MYS/26.11. Se evitó la circulación endémica a través de intervenciones innovadoras tales como, la vigilancia y control de infecciones, notificación super inmediata, priorización de visitas de campo y criterios de niveles de riesgo de transmisión. Conclusiones. Colombia controló los brotes de sarampión que se presentaron por la importación de casos e impido la circulación endémica para conservar la certificación de la eliminación del virus de sarampión en el país.

ABSTRACT Objective. Describe measles outbreaks caused by importation of multiple cases, and the corresponding control interventions. Methods. Descriptive study of measles outbreaks caused by the importation of multiple cases to Colombia in 2018-2019. Case definitions, classification of source of infection, collection of biological specimens, searches for suspected cases, case identification, and contact tracing were employed. Vaccination records were obtained from vaccination cards or from the Colombian information system. Nationality was determined from records found in the public health surveillance system. The incident command system was used, and response teams and action plans were activated to control outbreaks. Results. In March 2018, the first case of measles imported from Venezuela was confirmed. Measles incidence in 2018 was 0.2 cases per 100 000 population, and it was 0.3 per 100 000 in 2019. The case fatality rate in 2019 was 0.4%. A total of 214 cases were confirmed in the Venezuelan population (91% with no vaccination history); and 69 outbreaks with no epidemiological link were studied. The MVi/Hulu Langat.MYS/26.11[D8] lineage was identified. Endemic circulation was prevented through innovative interventions such as infection surveillance and control, immediate notification, prioritization of field visits, and transmission risk level criteria. Conclusions. Colombia controlled measles outbreaks that resulted from imported cases, and it prevented endemic circulation, thereby maintaining certification of measles elimination in the country.

RESUMO Objetivo. Descrever os surtos de sarampo gerados por múltiplas importações de casos e as intervenções de controle. Métodos. Estudo descritivo de surtos devido a múltiplas importações de casos para a Colômbia entre 2018 e 2019. Foram utilizadas definições de caso, classificação da fonte de infecção, coleta de amostras biológicas, rastreamento de casos suspeitos, identificação e seguimento de contatos. O histórico de vacinação foi obtido do cartão de vacinação ou do sistema de informações da Colômbia. A nacionalidade foi definida de acordo com o registro no sistema de vigilância em saúde pública. O sistema de comando de incidentes foi usado, com equipes de resposta e planos de ação para controlar os surtos. Resultados. O primeiro caso de sarampo importado da Venezuela foi confirmado em março de 2018. Nesse ano, a incidência foi de 0,2 casos por 100 mil habitantes e, em 2019, de 0,3 casos por 100 mil habitantes. A taxa de letalidade em 2019 foi de 0,4%. Um total de 214 casos foi confirmado na população venezuelana (91% sem histórico de vacinação). Foram estudados 69 surtos sem vínculo epidemiológico. Foi identificado o genótipo D8, cepa MVi/Hulu Langat.MYS/26.11. A circulação endêmica foi evitada por meio de intervenções inovadoras, como vigilância e controle de infecções, notificação "superimediata", priorização de visitas de campo e critérios para níveis de risco de transmissão. Conclusões. A Colômbia controlou os surtos de sarampo decorrentes de casos importados e impediu a circulação endêmica a fim de manter a certificação da eliminação do vírus do sarampo no país.

COVID-19: perfil de trabalhadores brasileiros em uma companhia de mineração e a dinâmica dos casos comunitários / COVID-19: profile of Brazilian workers of a mining company and the dynamic of community cases

Resumo Objetivo: descrever o perfil de desfechos de COVID-19 em trabalhadores da mineração e a dinâmica dos casos nas unidades de mineração e seus respectivos municípios. Métodos: estudo de coorte e ecológico, com dados secundários clínico-epidemiológicos, sociodemográficos e ocupacionais de trabalhadores de mineradora multinacional no Brasil e de casos de COVID-19 nos cinco municípios onde as unidades estavam localizadas, de março de 2020 a abril de 2021. A incidência acumulada e média móvel (MM) de 7 dias dos casos foram calculadas e comparadas na unidade e respectivo município. Resultados: foram incluídos 17.523 trabalhadores; 88,4% eram do sexo masculino; e 22,6% tiveram pelo menos um resultado positivo. Os trabalhadores mais testados, com casos positivos, colocados em quarentena e com sintomas foram do sexo feminino, de meia-idade, morando e trabalhando no Rio de Janeiro, diretamente contratados pela mineradora, em turnos e ocupações de alto risco. Todas as unidades apresentaram uma incidência acumulada superior aos seus respectivos municípios. Três municípios apresentaram picos de COVID-19 com MM coincidindo com o aumento de casos entre trabalhadores de mineração. Conclusão: aproximadamente um quinto dos trabalhadores foram diagnosticados com COVID-19, e a distribuição temporal dos casos nas unidades de mineração foi semelhante àquela dos municípios onde estavam localizadas.

Abstract Objective: to describe the COVID-19 clinical outcomes profile from mining workers and the cases dynamic within the mining units and their respective municipalities. Methods: a cohort and ecological study using workers clinical-epidemiological, sociodemographic, and occupational secondary data of a multinational mining company, and of COVID-19 cases from five municipalities where the mining units were located, in Brazil, between March 2020 to April 2021. We calculated the cases cumulative incidence and the 7-day moving average (MA), and compared at the mining unit and respective municipality. Results: the study included 17,523 workers, 88.4% male, and 22.6% had at least one positive result for COVID-19. The workers most tested, with positive results, placed in quarantine, and with symptoms were female, middle-aged, living and working in Rio de Janeiro state, directly hired by the mining company, in shift-work, and in high-risk occupations. All mining units presented a cumulative incidence higher than their respective municipalities. Three municipalities showed peaks of COVID-19 with MA cases coinciding with an increase in cases among mining workers. Conclusion: approximately one-fifth of workers were diagnosed with COVID-19. The mining units had a similar temporal distribution of COVID-19 cases to the municipalities where they were located.

Investigação de surto de doença compatível com escorbuto em uma penitenciária masculina do Ceará, 2019-2020: um estudo de caso-controle / Investigation of an outbreak of disease compatible with scurvy in a male penitentiary in the state of Ceará, Brazil, 2019-2020: a case-control study / Investigación de un brote de enfermedad compatible con escorbuto en una penitenciaría masculina en el estado de Ceará, Brasil, 2019-2020: un estudio de casos y controlesInvestigação de surto

Objetivo: identificar ocorrência de surto compatível com escorbuto e fatores de exposição associados aos sinais/sintomas típicos de hipovitaminose, em penitenciária masculina, Ceará, Brasil, 2019-2020. Métodos: estudo de caso-controle populacional; foram utilizados registros clínicos e entrevistas com casos compatíveis - sinais/sintomas iniciados no período - e com controles; realizou-se análise multivariável. Resultados: 62 casos; idade média de 40,6 anos (DP = 10,8); principais sinais/sintomas foram edema e dor em membros inferiores (100,0%), dificuldade para deambular (91,9%), hematoma/equimose em membros inferiores (90,3%), febre (88,7%); identificou-se, como fator de exposição, média de idade > 40 anos (ORa = 1,10; IC95% 1,05;1,17; p-valor = 0,001); e como fatores protetores, trabalho (ORa = 0,11; IC95% 0,03;0,36; p-valor < 0,001) e participação em aulas (ORa = 0,21; IC95% 0,08;0,59; p-valor = 0,003) dentro da penitenciária. Conclusão: surto da penitenciária compatível com escorbuto pelos sinais/sintomas característicos, associados aos fatores identificados; recomendou-se oferta regular de dieta rica em vitamina C para todos os internos e acompanhamento clínico dos casos.

Objective: to identify the occurrence of an outbreak compatible with scurvy and exposure factors associated with typical signs/symptoms of hypovitaminosis that occurred in a male penitentiary in Ceará, Brazil between 2019-2020. Methods: this was a population-based case-control study; we used clinical records and interviews with compatible cases - based on sign/symptom onset during the study period - and with controls; we carried out multivariate analysis. Results: out of 62 cases, mean age was 40.6 years (SD = 10.8); main signs/symptoms were edema and pain in the lower limbs (100.0%), difficulty in walking (91.9%), hematoma/ecchymosis in the lower limbs (90.3%) and fever (88.7%); we identified being over 40 years old as an associated factor (aOR = 1.10; 95%CI 1.05;1.17; p-value = 0.001); and as protective factors: working (aOR = 0.11; 95%CI 0.03;0.36; p-value < 0.001) and taking part in classes (aOR = 0.21; 95%CI 0.08;0.59; p-value = 0.003) in the prison. Conclusion: we considered the penitentiary outbreak to be compatible with scurvy due to characteristic signs/symptoms, associated with the identified factors; we recommended regular provision of a diet rich in vitamin C to all male inmates and clinical follow-up of cases.

Objetivo: identificar la ocurrencia del brote compatible con escorbuto y los factores de exposición asociados con signos/síntomas típicos de hipovitaminosis que ocurrieron en una penitenciaría masculina en Ceará, Brasil entre 2019-2020. Métodos: estudio poblacional de casos y controles; se utilizaron historias clínicas y entrevistas con casos compatibles, con inicio de signos/síntomas durante el período de estudio, y controles; se realizó análisis multivariable. Resultados: de los 62 casos, edad media fue 40,6 años (DE = 10,8); principales signos/síntomas fueron edema y dolor en miembros inferiores (100,0%), dificultad para caminar (91,9%), hematoma/equimosis en miembros inferiores (90,3%) y fiebre (88,7%); la edad mayor de 40 años se identificó como factor asociado (ORa = 1,10; IC95% 1,05;1,17; p-valor = 0,001); y como factores protectores: trabajo (ORa = 0,11; IC95% 0,03;0,36; p-valor< 0,001) y participación en clases (ORa = 0,21; IC95% 0,08;0,59; p-valor = 0,003) dentro del centro penitenciario. Conclusión: el brote en centro penitenciario fue considerado compatible con escorbuto debido a los signos/síntomas característicos, asociados a los factores identificados; se recomendó oferta regular de dieta rica en vitamina C a todos los internos y seguimiento clínico de los casos.

Field investigation of a mumps outbreak and evaluation of vaccine effectiveness in a remote village school / 中国学校卫生

Objective@#To investigate the outbreak of mumps in a remote village school of Zhaoqing City, to evaluate and vaccine effectiveness ( VE ) of mumps containing vaccine (MuCV), so as to provide reference for the formulation of epidemic prevention and control strategies.@*Methods@#Through on site case investigations and interviews, case data and epidemic related epidemiological information were obtained. Descriptive and retrospective cohort studies were used to analyze the epidemic characteristics, explore risk factors, and evaluate the protective effect of vaccines.@*Results@#Totally 166 cases of mumps were found, and all of them were students. The total attack rate was 7.79% and the outbreak lasted for 60 days. The first case occurred on October 11th and the last case occurred on December 9th in 2018. Most of the cases aged from 10 to 13 years old, accounting for 66.27%. There were 96 male patients and 70 female patients, with no statistically significant sex difference in the incidence rate ( χ 2=2.40, P >0.05). Involving 28 classes, 11 of which had an incidence rate more than 10%, mainly distributed in grades 2, 4 and 6. There were statistically significant differences in incidence rates among different grades ( χ 2=96.89, P <0.01) and different floors ( χ 2=67.35, P < 0.01 ), with the third floor higher than the other floors. Twelve out of 58 boarding pupils were cases, and boarding pupils were 1.89 times higher in risk of contracting mumps than day students ( RR=1.89, 95%CI =1.10-3.23). Pupils without being given the shot of MuCV were higher in the infection rate than those having the shot ( χ 2=5.70, P <0.05), and the VE % was 35% (95% CI = 7%- 55%). The VE % of one dose was 34% (4%-54%), while the effectiveness of protection was declined with time ( χ 2 trend =6.53, P < 0.05). The effectiveness of vaccine almost diasappeared six years after the shot ( χ 2=1.12, P >0.05).@*Conclusion@#Delayed case report and isolation, low rate of receiving MuCV, and decreasing effectiveness of one shot MuCV are closely assocaited with the outbreak and ongoing spread of the epidemic.

Comprehensive evaluation of the epidemic warning and monitoring system for infectious disease aggregation in schools or daycare institutions with multi source data / 中国学校卫生

Objective@#To comprehensively evaluate the early warning monitoring system (WMS) for infectious disease aggregation in schools or daycare institutions with multisource data, to identify the advantages and disadvantages of the system, and to provide a basis for optimizing its warning function and exploring further integration of other data sources.@*Methods@#The infectious disease warning data from the Chinese infectious disease Automated alert and Response System(ARS), the Student Health Monitoring System (SHMS) in Foshan City, Guangdong Province, and WMS were collected from January 2021 to July 2023. The indicators such as sensitivity, specificity, Youden index, positive predictive value, early warning and median timeliness were used to comprehensively evaluate the early warning monitoring system.@*Results@#The ARS was not sensitive to common infectious disease warnings in schools or daycare institutions. The median timeliness of the SHMS and the WMS was 1 day. The sensitivity of SHMS and the WMS for early warning of hand foot mouth disease, infectious diarrhea, influenza like cases, chickenpox and other infectious diseases were more than 70%, while the sensitivity for novel coronavirus infection were only 10.42% and 64.58% . The Youden index and positive predictors of the WMS were both the highest.@*Conclusion@#The WMS can timely and effectively warn schools or daycare institutions of clustered epidemics, improve the positive predictive value, but the data sources are still insufficient, and it is necessary to continuously increase the data sources in future exploration to improve the warning ability.

Epidemiological and genetic characteristics of sapovirus clusters in Changzhou schools from 2019 to 2022 / 中国学校卫生

Objective@#To analyze the epidemiological characteristics and genetic characteristics of sapovirus (SaV) in a cluster of schools in Changzhou, so as to provide a reference for the treatment of clustered vomiting and diarrhea events in schools.@*Methods@#The epidemiological data and laboratory test data of sapovirus clusters in Changzhou from 2019 to 2022 were collected and analyzed. Partial VP1 genes of SaV positive samples were amplified and sequenced for phylogenetic analysis.@*Results@#A total of 8 cases of clusters of SaV epidemics were reported in Changzhou City from 2019 to 2022, with 118 reported cases. The total attack rate was 1.47%, and the median of the attack number was 15. There were 6 outbreaks in kindergartens and 2 outbreaks in primary schools, which were reported in the epidemic period from September to December. The main clinical manifestations were vomiting (113 cases, 95.76 %), abdominal pain (39 cases, 33.05%), and diarrhea (16 cases, 13.56%). Among the 8 outbreaks, 17 sample strains were successfully sequenced. 5 outbreaks were GII.3 , and the other 3 outbreaks were GI.1, GI .3 and GII.2. GI and GII were the main genotypes in this area, and GII .3 was the predominant strain.@*Conclusion@#SaV is an important pathogen in the clusters of vomiting and diarrhea in schools after the transmission of norovirus. Continuous surveillance of SaV should be carried out to further understand its epidemiological characteristics and genotype distribution, so as to provide scientific basis for the prevention and control of the epidemic in schools.

A 5-year follow up analysis of cases in a high school tuberculosis outbreak / 中国学校卫生

Objective@#To explore the effectiveness of preventive treatment for latent tuberculosis infection (LTBI) patients, so as to provide reference for the management and preventive treatment of clustered epidemic in schools.@*Methods@#Data came from the school tuberculosis outbreak of a boarding high school in Kaizhou District, Chongqing, which occurred between June 2017 and March 2018 among 2016 grade high school teachers and students for investigation and analysis. The total incidence, LTBI patients, and the incidence after preventive treatment for 5 years were followed up.@*Results@#A total of 34 cases of pulmonary tuberculosis from June 2017 to March 2018. A total of 1 357 individuals were screened for 6 concentrated contact screenings, with a confirmed tuberculosis rate of 2.43%, a tuberculosis skin test (TST) positive rate of 27.41%, and a strong TST positive rate of 7.39%. Among them, the confirmed tuberculosis rate and TST positive rate in the first case class were much higher than those in other classes, with statistically significant differences ( χ 2=286.30, 98.59, P ＜0.01). 88 cases of LTBI were found, with 31 cases receiving preventive treatment (35.23%), of which 28 completed preventive treatment (90.32%). After five years of follow-up, 73 cases of pulmonary tuberculosis were diagnosed in 2016 by the school senior high school, with a incidence rate of 0.98/10 2 (person/person years). Fifteen of the 88 LTBI patients were diagnosed with pulmonary tuberculosis, and the incidence rate was 3.33/10 2 (person/person years). The incidence rate of the preventive treatment group was 0.7/10 2 (person/person years)lower than that of the medical observation group 4.5/10 2 (person/person years), with a statistically significant difference ( χ 2=4.31, P ＜0.05).@*Conclusion@#The classes with higher TST positive rate and strong positive rate have higher incidence rate. Improving the preventive treatment rate of LTBI patients can effectively reduce the incidence rate of tuberculosis.

Association between Norovirus epidemics and school toilets design and management in Chengdu City / 中国学校卫生

Objective@#To analyze the relationship between the toilet design and sanitary condition of primary and secondary schools in Chengdu and the epidemic situation of Norovirus infection, so as to provide scientific references for school toilet design and Norovirus prevention and control.@*Methods@#A total of 78 cases of norovirus epidemics from 2019 to 2020 were included in this study. These epidemics happened in 78 schools and the causes were indicated as human-to-human transmission. The Chi square and Mann-Whitney U test were used to compare categorical and continuous data respectively. Unconditional binary Logistic regression was used to examine the multivariate associations.@*Results@#Most epidemics happened from October in 2019 to March in 2020(79.49%, 62 cases), in primary schools (71.79%, 56 cases) and in the center area (52.56%, 41 cases). The median of the case number in each epidemic was 10. Overall, 56 schools (71.79%) were equipped with toilets which were flushed independently, and 22 schools (28.21%) were equipped with toilets which were flushed uniformly. There were 27 schools (34.62%) that did not have enough water taps. Logistic regression analysis found that those with toilets flushed uniformly had a stronger epidemic, compared to the schools with toilets flushed independently( OR=5.53, 95%CI=1.63-18.76, P <0.05).@*Conclusion@#In order to prevent intestinal infectious diseases , it is suggested that schools should design or reconstruct independent flushing toilets with adequate faucets.

Analysis of epidemic characteristics of tuberculosis in schools in Shijiazhuang during 2011-2020 / 中国学校卫生

Objective@#To analyze the trend and characteristics of school tuberculosis epidemic in Shijiazhuang from 2011 to 2020, and to provide reference for school tuberculosis prevention and control.@*Methods@#Descriptive methods were used to analyze the epidemiological characteristics of tuberculosis among students and the epidemic situation of tuberculosis in schools in Shijiazhuang from 2011 to 2020. The χ 2 test and χ 2 trend test were used to analyze the characteristics and trend of school tuberculosis.@*Results@#A total of 4 896 cases of tuberculosis were registered among students in Shijiazhuang from 2011 to 2020. The average annual registered incidence rate of students was 24.69/100 000, and the difference in incidence rate was statistically significant ( χ 2=318.50, P <0.01) the overall registered incidence rate of tuberculosis among students in the past 10 years was on the rise ( χ 2 trend =87.79, P <0.01). Among the student cases, male accounted for 53.89%, female accounted for 46.11%. The age group of students aged >18 and above accounted for the largest proportion(50.35%), followed by the age group aged 16-18( 35.80 %). Most students cases occurred in April and September-November, with September the highest(12.03%). A total of 22 clustered outbreaks (174 cases) and the aggregate epidemic accounted for 3.55% of the total number of students with tuberculosis.@*Conclusion@#The prevention and control of tuberculosis epidemic in schools in Shijiazhuang should not be underestimated, and strengthen the supervision, management, publicity and education of students in key age groups to avoid clusters of outbreaks.

Analysis of an outbreak of influenza A in a primary school in Jing an District, Shanghai / 中国学校卫生

Objective@#To investigate the epidemiological data of an outbreak of influenza A in a primary school in Shanghai, to provide reference for targeted prevention and control measures.@*Methods@#A field epidemiological method was used to investigate and collect the data of influenza A outbreak in a primary school in Jing an District from November 8 to December 6, 2022, through on site follow up and telephone return visit to health teachers and cases. The distribution characteristics of the epidemic were analyzed by descriptive epidemiology.@*Results@#The first case developed symptoms of cough, sore throat, and fever on the morning of November 8th 2022, with a maximum body temperature of 38.6 ℃. Later, the clinical diagnosis was influenza A. The total number of influenza like cases reported in this outbreak is 99, including 92 students and 7 teachers. The total incidence rate was 9.45%. The clinical symptoms of all cases were fever, sore throat, and cough; 27 cases of influenza A were diagnosed by hospital rapid diagnostic reagents. The second grade students had the highest case incidence rate(24.46%), and there was a statistically significant difference in case incidence rates among students of different grades ( χ 2=48.28, P ＜0.01). The case incidence rate on the second floor was the highest (23.47%), and there was a statistically significant difference between the case incidence rates on different floors ( χ 2=52.38, P ＜ 0.01 ). Etiological testing showed that the influenza virus causing this outbreak was type A H3N2 virus.@*Conclusion@#This outbreak is a campus cluster outbreak caused by influenza A (H3N2) virus. The health and education departments should strengthen cooperation to effectively implement prevention and control measures of infectious diseases, and timely identify the source of infection and cut off the transmission route.

Epidemiological investigation of an outbreak of pertussis in a primary school in Rizhao / 中国学校卫生

Objective@#To investigate the epidemiological characteristics of a pertussis outbreak in a primary school in Rizhao City, so as to provide reference for the prevention and control strategy of pertussis.@*Methods@#The method of field epidemiological investigation was used to determine case definition for case search and case investigation,and the characteristics of the outbreak were comprehensively analyzed through descriptive epidemiological method.@*Results@#The outbreak lasted for 29 days from April 19 to May 17, 2022, with a total of 14 cases detected. All the cases were students aged 6-7 years from Class 2, Grade 1 in this primary school,including 6 boys and 8 girls. The attack rates of boys and girls were 30.00% and 34.78%, respectively. The time interval from onset to diagnosis of 14 cases ranged from 2 to 22 days, with a median of 10 days. All of them had received 4 doses of Diphtheria and Tetanus and acellular Pertussis(DTaP) combined vaccine, and the interval between the last vaccination and the onset of disease was 5-6 years. After isolated treatment, all the 14 sick students recovered, without severe or death cases.@*Conclusion@#The outbreak of pertussis in a primary school may be related to the decline in the effectiveness of pertussis vaccine protection over time, the lax implementation of a school registration and reporting system for sick absenteeism, and the poor sensitivity of existing pertussis surveillance systems.

Investigation of an acute gastroenteritis outbreak caused by Norovirus infection in a university / 中国学校卫生

Objective@#To investigate an acute gastroenteritis outbreak caused by Norovirus, and to provide evidence for effective school infectious outbreak prevention and control.@*Methods@#In March 2019, basic information of Huzhou Normal University and related data of cases were collected. Epidemiological characteristics were analyzed. Anal swabs of the 10 cases were collected for laboratory detection. Case definitions, specific detection criteria and procedures were based on the Diagnostic Criteria for Infectious Diarrhea (WS 271-2007) and the Technical Guidelines for the Investigation, Prevention and Control of Outbreaks of Norovirus Infection (2015 edition).@*Results@#During March 15 to March 20, a total of 13 (12 girls and 1 boy) confirmed cases were reported, all of them were from the same class, with the incidence rate being 25.00% (1/4) and 37.50% (12/32) in boys and girls, respectively. No significant sex difference was found ( χ 2=2.05， P >0.05). Anal swab specimens of 10 students were collected from laboratory were positive for Norovirus GII and have an identity of 100%.@*Conclusion@#The gastroenteritis outbreak was deduced to be attributed to GII Norovirus infection, which are likely caused by fecal contamination through person to person contact. It is suggested that schools should strengthen knowledge education on the prevention and control of infectious diseases and improve the protection awareness and ability of teachers and students to protect them.

Effectiveness and associated factors of varicella vaccination on school outbreaks / 中国学校卫生

Objective@#To evaluate the effectiveness of varicella vaccine in varicella outbreaks and to analyze the influencing factors, and to provide a reference for making the targeted prevention and controlling measures.@*Methods@#A total of 3 888 students with no history of varicella were selected from 2 schools with varicella outbreak in Guangdong Province in 2021, a retrospective cohort study was conducted by using questionnaire survey, rate ratio ( RR ) and vaccine effectiveness ( VE ) values were calculated and Logistic regression was uses to analyze the factors influencing the protective effect of varicella.@*Results@#There were 138 confirmed cases of varicella among the participants. There was no significant sex difference in the vaccination rate( χ 2=1.36, P =0.51), but there was significant difference in the vaccinattion rate of different age groups( χ 2=555.82, P <0.01). The overall protective effect of VarV was 66.94%(95% CI =56.17%-77.71%), and the protective effect of 2 doses of vaccine( VE = 90.02% , 95% CI =83.13%-96.90%) was higher than that of 1 dose( VE =49.40%, 95% CI =32.36%-66.44%)( χ 2=24.93, P < 0.01 ). The high fever rates in the vaccinated and unvaccinated groups were 7.69% and 25.81%, with significant difference( χ 2= 6.29 , P <0.05). The rates of moderate and severe skin lesions of vaccinated and unvaccinated groups was 20.00% and 50.00%, respectively, and the difference was statistically significant( χ 2=11.32, P <0.01). The protective effects of varicella vaccine against high fever and moderate to severe rash were 70.19%(95% CI =42.11%-98.27%) and 60.00%(95% CI =38.15%-81.85%). Stratified analysis showed that there were significant differences in different years of vaccination( χ 2=37.87, P <0.05), while there were no significant differences in age of vaccination and vaccine manufacturer ( P >0.05).@*Conclusion@#Varicella vaccination can prevent chickenpox infection and reduce the severity of the disease. However, the efficacy of varicella vaccine was affected by vaccination years. It is recommended to improve the vaccination coverage of varicella vaccine to prevent the outbreak of the epidemic.

Presence of SARS-CoV-2 in urban effluents in south-east Buenos Aires, Argentina, May 2020 to March 2022 / Presencia del SARS-CoV-2 en aguas residuales urbanas del sudeste de Buenos Aires, Argentina, de mayo del 2020 a marzo del 2022 / Presença de SARS-CoV-2 em águas residuais urbanas no sudeste de Buenos Aires, Argentina, de maio de 2020 a março de 2022

ABSTRACT Objectives. To implement and evaluate the use of wastewater sampling for detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in two coastal districts of Buenos Aires Province, Argentina. Methods. In General Pueyrredon district, 400 mL of wastewater samples were taken with an automatic sampler for 24 hours, while in Pinamar district, 20 L in total (2.2 L at 20-minute intervals) were taken. Samples were collected once a week. The samples were concentrated based on flocculation using polyaluminum chloride. RNA purification and target gene amplification and detection were performed using reverse transcription polymerase chain reaction for clinical diagnosis of human nasopharyngeal swabs. Results. In both districts, the presence of SARS-CoV-2 was detected in wastewater. In General Pueyrredon, SARS-CoV-2 was detected in epidemiological week 28, 2020, which was 20 days before the start of an increase in coronavirus virus disease 2019 (COVID-19) cases in the first wave (epidemiological week 31) and 9 weeks before the maximum number of laboratory-confirmed COVID-19 cases was recorded. In Pinamar district, the virus genome was detected in epidemiological week 51, 2020 but it was not possible to carry out the sampling again until epidemiological week 4, 2022, when viral circulation was again detected. Conclusions. It was possible to detect SARS-CoV-2 virus genome in wastewater, demonstrating the usefulness of the application of wastewater epidemiology for long-term SARS-CoV-2 detection and monitoring.

RESUMEN Objetivos. Aplicar y evaluar la utilización de muestreos de aguas residuales como método para la detección del coronavirus del síndrome respiratorio agudo severo de tipo 2 (SARS-CoV-2) en dos distritos costeros de la Provincia de Buenos Aires, Argentina. Métodos. Se utilizó un dispositivo de muestreo automático para tomar muestras de 400 mL de las aguas residuales de 24 horas en el distrito de General Pueyrredon, mientras que en el distrito de Pinamar se tomaron muestras de 2,2 L a intervalos de 20 minutos hasta un volumen total de 20 L. Los muestreos se realizaron una vez por semana. Las muestras se concentraron mediante floculación con policloruro de aluminio. La purificación del ARN y la amplificación y detección del gen diana se llevaron a cabo mediante la prueba de reacción en cadena de la polimerasa con retrotranscripción para el diagnóstico clínico a partir de hisopados nasofaríngeos. Resultados. Se observó la presencia de SARS-CoV-2 en las aguas residuales de ambos distritos. En General Pueyrredon, el SARS-CoV-2 se halló en la semana epidemiológica 28 del 2020, es decir, 20 días antes del inicio del aumento de casos de enfermedad por coronavirus 2019 (COVID-19) registrado en la primera ola (semana epidemiológica 31) y nueve semanas antes de que se alcanzara el número máximo de casos de COVID-19 con confirmación de laboratorio. En el distrito de Pinamar se detectó el genoma viral en la semana epidemiológica 51 del 2020, pero solo se pudo volver a realizar el muestreo en la semana epidemiológica 4 del 2022, en la que se volvió a detectar la circulación del virus. Conclusiones. Se pudo detectar el genoma del virus SARS-CoV-2 en aguas residuales, lo que muestra la utilidad de la aplicación de la epidemiología de aguas residuales como método para la detección y el seguimiento del SARS-CoV-2 a largo plazo.

RESUMO Objetivos. Implementar e avaliar o uso de amostragem de águas residuais na detecção do coronavírus da síndrome respiratória aguda grave 2 (SARS-CoV-2) em dois distritos costeiros da Província de Buenos Aires, Argentina. Métodos. No distrito de General Pueyrredon, amostras de 400 mL de águas residuais foram coletadas ao longo de 24 horas com um amostrador automático; já no distrito de Pinamar, foram coletados 20 L no total (2,2 L a intervalos de 20 minutos). As amostras foram coletadas uma vez por semana e concentradas por floculação com cloreto de polialumínio. A purificação do RNA e a amplificação e detecção de genes-alvo foram realizadas por meio de reação em cadeia da polimerase com transcrição reversa para diagnóstico clínico de esfregaços nasofaríngeos humanos. Resultados. Detectou-se presença de SARS-CoV-2 em águas residuais dos dois distritos. Em General Pueyrredon, o SARS-CoV-2 foi detectado na semana epidemiológica 28 de 2020, ou seja, 20 dias antes do início de um aumento no número de casos da doença provocada pelo coronavírus de 2019 (COVID-19) na primeira onda (semana epidemiológica 31) e 9 semanas antes de se registrar o número máximo de casos de COVID-19 confirmados em laboratório. No distrito de Pinamar, o genoma viral foi detectado na semana epidemiológica 51 de 2020, mas não foi possível realizar a amostragem novamente até a semana epidemiológica 4 de 2022, quando a circulação do vírus foi novamente constatada. Conclusões. Foi possível detectar o genoma do vírus SARS-CoV-2 em águas residuais, demonstrando a utilidade da aplicação da epidemiologia baseada em águas residuais para detectar e monitorar o SARS-CoV-2 em longo prazo.