The Reduction of SARS-CoV-2 RNA Concentration in the Presence of Sewer Biofilms

Wastewater surveillance has been widely used to track the prevalence of SARS-CoV-2 in communities. Although some studies have investigated the decay of SARS-CoV-2 RNA in wastewater, understanding about its fate during wastewater transport in real sewers is still limited. This study aims to assess the impact of sewer biofilms on the dynamics of SARS-CoV-2 RNA concentration in naturally contaminated real wastewater (raw influent wastewater without extra SARS-CoV-2 virus/gene seeding) using a simulated laboratory-scale sewer system. The results indicated that, with the sewer biofilms, a 90% concentration reduction of the SARS-CoV-2 RNA was observed within 2 h both in wastewater of gravity (GS, gravity-driven sewers) and rising main (RM, pressurized sewers) sewer reactors. In contrast, the 90% reduction time was 8–26 h in control reactors without biofilms. The concentration reduction of SARS-CoV-2 RNA in wastewater was significantly more in the presence of sewer biofilms. In addition, an accumulation of c.a. 260 and 110 genome copies/cm2 of the SARS-CoV-2 E gene was observed in the sewer biofilm samples from RM and GS reactors within 12 h, respectively. These results confirmed that the in-sewer concentration reduction of SARS-CoV-2 RNA in wastewater was likely caused by the partition to sewer biofilms. The need to investigate the in-sewer dynamic of SARS-CoV-2 RNA, such as the variation of RNA concentration in influent wastewater caused by biofilm attachment and detachment, was highlighted by the significantly enhanced reduction rate of SARS-CoV-2 RNA in wastewater of sewer biofilm reactors and the accumulation of SARS-CoV-2 RNA in sewer biofilms. Further research should be conducted to investigate the in-sewer transportation of SARS-CoV-2 and their RNA and evaluate the role of sewer biofilms in leading to underestimates of COVID-19 prevalence in communities.

THE RED FLAG OF EMERGENCY USE AUTHORIZATION (EUA)

The Emergency Use Authorization (EUA) policy, a representative biodefense policy, was legislated in the United States in 2001 based on lessons learned from Amerithrax, whereas Korea's EUA policy was based on lessons learned from the Middle East Respiratory Syndrome outbreak in 2015. Due to these divergent origins, the U.S. EUA's homeland security objectives were specialized to deal with highly pathogenic biological agents that could be exploited for bioterrorism, whereas the Korean EUA pursues disease containment purposes to strengthen mass-testing practices. During the early phase of the COVID-19 pandemic, the U.S. EUA revealed limitations in its integration with public health surveillance, laboratory partnerships, and insurance systems, which hampered the rapid expansion of testing capacities. Thereafter, once the limitations of the EUA were circumvented, the testing capacity of the United States began to catch up with that of South Korea, and later skyrocketed after solving these issues. (English) [ FROM AUTHOR] La política de autorización de uso de emergencia (EUA), una política representativa de biodefensa, se legisló en los Estados Unidos en 2001 en base a las lecciones aprendidas de Amerithrax, mientras que la política de EUA de Corea se basó en las lecciones aprendidas del brote del síndrome respiratorio de Oriente Medio (MERS) en 2015 Debido a estos orígenes divergentes, los objetivos de seguridad nacional de la EUA EUA se especializaron para tratar con agentes biológicos altamente patógenos que podrían explotarse para el bioterrorismo, mientras que la EUA coreana persigue propósitos de contención de enfermedades para fortalecer las prácticas de pruebas masivas. Durante la fase inicial de la pandemia de COVID-19, la EUA EUA reveló limitaciones en su integración con la vigilancia de la salud pública, las asociaciones de laboratorios y los sistemas de seguros, lo que obstaculizó la rápida expansión de las capacidades de prueba. A partir de entonces, una vez que se eludieron las limitaciones de la EUA, la capacidad de prueba de los Estados Unidos comenzó a alcanzar a la de Corea del Sur y luego se disparó después de resolver estos problemas. (Spanish) [ FROM AUTHOR] 美国在2001年根据炭疽攻击事件(Amerithrax)的经验教训制定了一项具有代表性的生物防卫政策，即紧急使用授权(EUA)政策，而韩国的EUA政策则基于2015年爆发的中东呼吸综合征(MERS)的经验教训。鉴于这些不同的起源，美国EUA的国土安全目标专门应对可能被用于生物恐怖主义的高致病性生物制剂，而韩国EUA则追求疾病遏制目的，以加强大规模检测实践。在2019冠状病毒病(COVID-19)大流行的早期阶段，美国EUA在与公共卫生监测、实验室合作伙伴关系和保险系统的整合方面存在局限性，这阻碍了检测能力的快速扩展。此后，当绕过EUA的限制后，美国的检测能力开始赶上韩国，并在解决这些问题后，检测能力直线上升。 (Chinese) [ FROM AUTHOR] Copyright of World Affairs is the property of Sage Publications Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Novel emm4 lineage associated with an upsurge in invasive group A streptococcal disease in the Netherlands, 2022.

Invasive group A streptococcal (iGAS) disease cases increased in the first half of 2022 in the Netherlands, with a remarkably high proportion of emm4 isolates. Whole-genome sequence analysis of 66 emm4 isolates, 40 isolates from the pre-coronavirus disease 2019 (COVID-19) pandemic period 2009-2019 and 26 contemporary isolates from 2022, identified a novel Streptococcus pyogenes lineage (M4NL22), which accounted for 85 % of emm4 iGAS cases in 2022. Surprisingly, we detected few isolates of the emm4 hypervirulent clone, which has replaced nearly all other emm4 in the USA and the UK. M4NL22 displayed genetic differences compared to other emm4 strains, although these were of unclear biological significance. In publicly available data, we identified a single Norwegian isolate belonging to M4NL22, which was sampled after the isolates from this study, possibly suggesting export of M4NL22 to Norway. In conclusion, our study identified a novel S. pyogenes emm4 lineage underlying an increase of iGAS disease in early 2022 in the Netherlands and the results have been promptly communicated to public health officials.

Misdiagnosis of Clostridioides difficile Infections by Standard-of-Care Specimen Collection and Testing among Hospitalized Adults, Louisville, Kentucky, USA, 2019-20201.

Although Clostridioides difficile infection (CDI) incidence is high in the United States, standard-of-care (SOC) stool collection and testing practices might result in incidence overestimation or underestimation. We conducted diarrhea surveillance among inpatients >50 years of age in Louisville, Kentucky, USA, during October 14, 2019-October 13, 2020; concurrent SOC stool collection and CDI testing occurred independently. A study CDI case was nucleic acid amplification test‒/cytotoxicity neutralization assay‒positive or nucleic acid amplification test‒positive stool in a patient with pseudomembranous colitis. Study incidence was adjusted for hospitalization share and specimen collection rate and, in a sensitivity analysis, for diarrhea cases without study testing. SOC hospitalized CDI incidence was 121/100,000 population/year; study incidence was 154/100,000 population/year and, in sensitivity analysis, 202/100,000 population/year. Of 75 SOC CDI cases, 12 (16.0%) were not study diagnosed; of 109 study CDI cases, 44 (40.4%) were not SOC diagnosed. CDI incidence estimates based on SOC CDI testing are probably underestimated.

COVID-19: Impact on Mental Health of Nursing Workers

The prolonged pandemic context by the new Coronavirus aggravated the physical and emotional strain of healthcare workers, negatively impacting mental health. The objectives of this study were to verify the prevalence of Mild Depression Disorder (MDD) and Mild Anxiety Disorder (MAD) and their associated factors. A cross-sectional study was conducted with nurses and nursing assistants from a private hospital in the city of Sao Paulo, Brazil. The sample consisted of 184 nursing workers, who answered a form using Google Forms (R), released by the social media group (WhatsApp (R)), restricted to employees and managers of the sectors. Demographic, occupational, clinical data, and indicators of MDD and MAD were obtained through the Hospital Anxiety and Depression Scale. Descriptive statistics and association tests between independent and dependent variables were used. There was a predominance of women (88%), in the role of nurse technicians and/or assistants (63.6%), and those who worked in specific units of patients with COVID-19 (58.7%). The prevalence of MDD was 43.5% (95% CI: 36.4% - 50.7%) and MAD was 46.2% (95% CI: 39.1% - 53.4%). There was a statistically significant association between MAD, age between 25 and 35 years (p=0.01) and hospital unit not specific for COVID-19 (p=0.04). The prevalence of mild depression and anxiety disorders was considered high. Mild anxiety disorder had a higher prevalence among younger workers and those working in units not specific to COVID-19.

International Law and Digital Disease Surveillance in Pandemics: On the Margins of Regulation

The COVID-19 pandemic elicited a surge in the use of digital tools to replace "classic” manual disease tracking and contact tracing across individuals. The main technical reason is based on the disease surveillance needs imposed by the magnitude of the spread of the SARS-CoV-2 virus since 2020, particularly how these needs overwhelmed governments around the world. Such developments led to stark variations across countries in terms of legal approaches towards the use of digital tools, including self-reporting software and mobile phone apps, for both disease tracking and contact tracing. Against this backdrop, in this article I highlight some of the normative challenges posed by the digitalization of disease surveillance, underscoring its almost non-existent regulation under international law. I look back at the historical emergence of the epidemiological principles underlying this procedure, by referring to John Snow's trailblazing work in cholera control. I emphasize how the COVID-19 pandemic prompted both technical and normative shifts related to the digitalization of these procedures. Furthermore, I refer to some of the overarching obstacles for deploying international law to tackle future tensions between the public health rationale for digitalized disease tracking and contact tracing, on the one hand, and normative concerns directly related to their legality, on the other hand. Lastly, I put forward conclusions in light of the current juncture of international health law reforms, and how they so far display limited potential to herald structural changes concerning the legality of the use of digital tools in disease surveillance.

Do Infrared Thermometers Hold Promise for an Effective Early Warning System for Emerging Respiratory Infectious Diseases?

BACKGROUND: Major respiratory infectious diseases, such as influenza, SARS-CoV, and SARS-CoV-2, have caused historic global pandemics with severe disease and economic burdens. Early warning and timely intervention are key to suppress such outbreaks. OBJECTIVE: We propose a theoretical framework for a community-based early warning (EWS) system that will proactively detect temperature abnormalities in the community based on a collective network of infrared thermometer-enabled smartphone devices. METHODS: We developed a framework for a community-based EWS and demonstrated its operation with a schematic flowchart. We emphasize the potential feasibility of the EWS and potential obstacles. RESULTS: Overall, the framework uses advanced artificial intelligence (AI) technology on cloud computing platforms to identify the probability of an outbreak in a timely manner. It hinges on the detection of geospatial temperature abnormalities in the community based on mass data collection, cloud-based computing and analysis, decision-making, and feedback. The EWS may be feasible for implementation considering its public acceptance, technical practicality, and value for money. However, it is important that the proposed framework work in parallel or in combination with other early warning mechanisms due to a relatively long initial model training process. CONCLUSIONS: The framework, if implemented, may provide an important tool for important decisions for early prevention and control of respiratory diseases for health stakeholders.

[Approval of CoronaVac in Brazil and Chile: some lessons on vaccine regulatory challengesA aprovação da CoronaVac no Brasil e no Chile: algumas lições sobre os desafios regulatórios de vacinas]. / La aprobación de CoronaVac en Brasil y Chile: algunas lecciones sobre los retos regulatorios de vacunas.

This analysis compares and systematizes some of the milestones (between December 2020 and October 2021) in the approval by Brazil and Chile of the CoronaVac vaccine made by the Chinese laboratory Sinovac, with regard to how the efficacy and immunogenicity of the vaccine was determined. To this end, a comprehensive analysis was conducted of official public documentation of the vaccine's approval in both countries; likewise, relevant technical articles on the subject, as well as dissemination and discussion in the media were considered. In both cases, a wide range of private and public actors expressed clearly competing interests in the measurement and dissemination of figures on the vaccine's efficacy. This reveals the challenges that middle-income countries face-and will continue to face-when certifying the quality of products in a pandemic period, and the need to institutionally strengthen regulatory authorities to ensure a sound and accurate evaluation of vaccine quality, in terms of safety and efficiency.

Esta análise compara e sistematiza alguns marcos da aprovação, no Brasil e no Chile, da vacina CoronaVac, do laboratório chinês Sinovac, de dezembro de 2020 a outubro de 2021, especificamente sobre como sua eficácia e imunogenicidade foram fundamentadas. Para tanto, foi realizada uma análise exaustiva da documentação pública oficial sobre a aprovação da vacina em ambos os países. Da mesma forma, foram considerados artigos técnicos pertinentes sobre o assunto, e divulgações e discussões realizadas na mídia. Em ambos os casos, uma disputa de interesses de uma ampla gama de atores privados e públicos em torno da medição e divulgação dos números referentes à eficácia foi claramente expressa. Isso permite visualizar os enormes desafios que os países de renda média enfrentam e enfrentarão para certificar a qualidade dos produtos em um contexto epidemiológico de pandemia e a necessidade de fortalecer institucionalmente as autoridades reguladoras para viabilizar uma avaliação íntegra e acertada da qualidade das vacinas em relação a sua segurança e eficiência.

[Geospatial models for SARS-CoV-2 outbreak control in Cartagena and Barranquilla, Colombia, 2020Modelos geoespaciais para controle de surtos de SARS-CoV-2 em Cartagena e Barranquilla, Colômbia, 2020]. / Modelos geoespaciales para control de brotes de SARS-CoV-2 en Cartagena y Barranquilla, Colombia, 2020.

Objective: Determine the temporal and spatial structure of the severe acute respiratory syndrome virus (SARS-CoV-2) that causes coronavirus disease (COVID-19), in the cities of Cartagena and Barranquilla, Colombia, in order to take necessary actions to support contact tracing. Methods: Cross-sectional ecological study with spatial analysis based on kernel densities of variables, including cases, mobile application alerts, population vulnerability, multidimensional poverty index; inverse distance weighted spatial interpolation of active cases; and, finally, the spatial superposition technique as a final result. The database of the National Institute of Health of the cities of Cartagena and Barranquilla and the Department of National Statistics was used. Results: The analysis identified an upward epidemiological trend in cases in the two cities, and determined the spatial direction of disease spread in neighborhoods, through spatial interpolation. Intervention areas were detected in 15 neighborhoods in Cartagena and 13 in Barranquilla, 50 meters around active cases with fewer than 21 days of evolution and by geographical risk layers, as a mechanism to stop the spread of COVID-19. Conclusions: Spatial analysis proved to be a useful complementary methodology for contact tracing, by determining temporal and spatial structure and providing necessary scientific evidence for the application of direct intervention measures, where necessary, to reduce the spread of SARS-CoV-2.

Objetivo: Determinar a estrutura temporal e espacial do vírus da síndrome respiratória aguda grave (SARS-CoV-2, na sigla em inglês), causador da doença pelo coronavírus de 2019 (COVID-19, na sigla em inglês), nas cidades de Cartagena e Barranquilla, visando a tomar ações necessárias que apoiem o rastreamento de contatos. Métodos: Estudo ecológico transversal que inclui análise espacial baseada em densidade de Kernel de variáveis como casos, alertas de um aplicativo móvel, vulnerabilidade populacional, índice de pobreza multidimensional, aplicação de interpolação espacial (IDW, na sigla em inglês) de casos ativos e, por último, aplicação da técnica de sobreposição espacial como resultado final. Foram utilizadas as bases de dados do Instituto Nacional de Saúde para as cidades de Cartagena e Barranquilla e do Departamento Nacional de Estatística. Resultados: A análise determinou o comportamento epidemiológico ascendente dos casos nas duas cidades e identificou a direção espacial de propagação da doença nos bairros, por meio de interpolação espacial. Foram detectadas áreas para intervenção em 15 bairros de Cartagena e 13 de Barranquilla, em 50 metros ao redor dos casos ativos com menos de 21 dias de evolução e de acordo com as camadas de risco geográfico, como mecanismo para impedir a propagação da COVID-19. Conclusões: A análise espacial permitiu determinar a estrutura temporal e espacial como uma metodologia complementar útil para o rastreamento de contatos, e forneceu a evidência científica necessária para a aplicação de medidas de intervenção direta, quando necessário, visando a reduzir o contágio pelo SARS-CoV-2.

ZOONOTIC DISEASES Can the transmission of pathogens between animals and humans be controlled?

After being associated with more than six million deaths so far, the Covid-19 pandemic is one of the worst diseases of animal origin known to date. Other zoonotic diseases such as severe acute respiratory syndrome (2002-2004, which mainly affected China), Middle East respiratory syndrome (2012, mainly affecting the Middle East), Ebola (2013-2016 in West Africa), and Rift Valley fever (from 2016 to the present) have also caused major disease outbreaks in recent decades. In addition, and especially in low-income countries, some zoonotic diseases such as tuberculosis and rabies are endemic and cause thousands of deaths. Of note, up to 60 % of known infectious diseases and 75 % of emerging infectious diseases have an animal origin and are responsible for public health problems and economic losses.

La COVID-19, una nueva cara con viejos contextos

Sin duda, la pandemia de la COVID-19 ha tocado la vida humana en materia de salud, economía, social, cultural, educación, turismo….el día a día, la convivencia. En todos ellos, la "incorporeidad” y la "tele-existencia” han sido el común denominador para dar continuidad a nuestras vidas. Žižek reflexiona sobre la "nueva normalidad”, (mejor dicho una "neo-realidad pandémica”). Describimos la vigilancia epidemiológica de la COVID-19 en México, con reflexiones de otros autores importantes y los errores. Por ejemplo, una situación contradictoria fue la creación de un sistema alternativo, paralelo y centralizado para la vigilancia epidemiológica de casos sospechosos de la COVID-19 en México;otro error fue comparar el SARS-CoV-2 con la última pandemia provocada por un virus respiratorio, la presencia de un brote epidémico de sarampión en varios estados al mismo tiempo, políticas de salud equivocadas (especialmente latinas). Esta pandemia debe servir de advertencia y orientar la conciencia y el legado de las generaciones posteriores.Alternate : Sem dúvida, a pandemia do COVID-19 tocou a vida humana em termos de saúde, economia, social, cultural, educação, turismo... dia a dia, convivência. Em todos eles, a "incorporeidade" e a "teleexistência" têm sido o denominador comum para dar continuidade às nossas vidas. Žižek reflete sobre a "nova normalidade” (antes uma "neo-realidade pandêmica”). Descrevemos a vigilância epidemiológica do COVID-19 no México, com reflexões de outros autores importantes e os erros. Por exemplo, uma situação contraditória foi a criação de um sistema alternativo, paralelo e centralizado para a vigilância epidemiológica de casos suspeitos de COVID-19 no México;outro erro foi comparar o SARS-CoV-2 com a última pandemia causada por um vírus respiratório, a presença de um surto epidêmico de sarampo em vários estados ao mesmo tempo, políticas de saúde erradas (especialmente latinos). Essa pandemia deve servir de alerta e orientar a consciência e o legado das gerações subsequentes.Alternate : Undoubtedly, the COVID-19 pandemic has affected people's lives in aspects related to health, the economy, society, culture, education, tourism, etc. Common to all these aspects is "incorporeity” and "tele-existence,” which lend a sense of continuity to our lives. Žižek raised the following question: "What in our system has failed, so much so that the catastrophe caught us completely off guard despite warnings by scientists?” We described the COVID-19 epidemiological surveillance in Mexico, with reflexions of other important authors and the mistakes. For example, a contradictory situation was the creation of an alternative, parallel and centralized system for the epidemiological surveillance of suspected cases of COVID-19 in Mexico;another mistake was to compare SARS-CoV-2 with last pandemic caused by a respiratory virus, epidemic outbreak of measles continued to be monitored in several states at the same time, wrong health policies (especially Latin). This pandemic should serve as a warning and guide the conscience and legacy of subsequent generations.

EPIVIGILA system and notifiable diseases: strength of data in epidemiological surveillance.

The epidemiological surveillance of communicable diseases, an essential function in public health, requires the management of clear, accurate and reliable information to achieve with a faster analysis of its results, early detection and its consequent timely response to events. In Chile, surveillance and control during the COVID-19 pandemic were successful to a large extent because the country had an integrated notification platform, the EPIVIGILA system, which was outstanding in proving its usefulness in this complex epidemiological context, among other efficient tools of new information technologies, due to the strength and diversity of the data it collects and thanks to the innovative essence of its conception. The objective of this study was to describe the architecture of the EPIVIGILA platform for notifiable diseases as a tool for public health surveillance and control in Chile.Copyright © 2023, Editorial Ciencias Medicas. All rights reserved.

A PRESCRIPTION FOR CALAMITY: WHY THE DEPARTMENT OF LABOR'S PHARMACY BENEFIT MANAGEMENT PROGRAM FALLS SHORT AS A SINGULAR SOLUTION TO THE U.S. OPIOID CRISIS

The purpose of this Note is to create a holistic solution for the U.S. Department of Labor to apply amidst the United States ongoing opioid crisis, which will serve to both prevent addiction before it can develop and treat existing cases of addiction. To this aim, this Note examines and analyzes the connections between the opioid crisis and another co-existing public health crisis, the COVID-19 pandemic, and the procurement procedures taken to resolve them. The argument is developed throughout three sections. First, this Note provides background information demonstrating the detrimental impact of opioid misuse and addiction, as well as the impact that COVID-19 in particular has had on rates of misuse and addiction in the United States. ally, this section introduces efforts taken to resolve the crisis, including the Department of Labors Pharmacy Benefit Management program, which is the subject of this Note. Second, this Note examines the Department of Labors Pharmacy Benefit Program, addressing the singularly preventative nature of the program, which fails to support a holistic solution. Additionally, this Note addresses concerns relating to the use of pharmacy benefit management services in general, particularly the cost-increasing nature of such mechanisms. In the final section, following an examination of the procurement procedure used to acquire COVID-19 vaccines, this Note proposes the application of a similar pharmaceutical procurement approach to combatting the opioid crisis. To conclude, this Note argues that by contracting with pharmaceutical companies to develop a safer and less addictive treatment plan, the Department of Labor would be able to prevent, as well as treat, opioid addiction.

Epidemiological surveillance and environmental hygiene, SARS-CoV-2 infection in the community, urban wastewater control in Cyprus, and water reuse

Background: Nowadays public health faces many challenges. Epidemiological surveillance and environmental hygiene and infection in community from SARS-CoV-2 along with its control in municipal wastewaters and reuse of water are amongst them. Epidemiology and environmental microbiology considers wastewater release of great importance. The purpose of this study is the detection and classification of COVID-19 infection in community wastewater and their removal by efficient functional processes. Methods and materials: A descriptive review of the published literature over the last 15-years in Greek and English was carried out via Medline, Scopus, and Google Scholar databases with the perspective of creating a research protocol. The study material consists of recent articles on the subject using keywords. Thus, the most effective techniques, wastewater-based epidemiology, and quantitative microbial risk assessment, for virus surveillance in wastewater are further analyzed. Results and contexts: The process and management of wastewater at a global level, is a high risk and a great challenge due to the huge amount of biomedical waste and wastewater that ends up in wastewater treatment plants. It may be an obstacle to human health, especially in the ongoing pandemic situation that must be evaluated in the operations of the plant in the environment along with the presence of other dangerous pathogenic microbes. Conclusions: It is vital the relationship between humanity and environment be reconsidered and more sustainable behavioural choices be encouraged. Scientific evidence pinpoints that the onset of new viral pathogens with a high epidemic-pandemic potential is often the result, complex, interactions among animals, individuals, and environment.

Clinical, epidemiological and virological findings of the first covid-19 outbreak in Medellín, Antioquia, Colombia / Hallazgos clínicos, epidemiológicos y virológicos del primer brote de covid-19 en Medellín, Antioquia, Colombia / Achados clínicos, epidemiológicos e virológicos do primeiro surto de covid-19 em Medellín, Antioquia, Colômbia

Resumen Objetivo: Caracterizar clínica, epidemiológica y virológicamente el primer brote de covid-19, a partir del caso primario en Medellín (Colombia), a través de las acciones de vigilancia y control epidemiológico realizadas para su contención. Metodología: Estudio descriptivo retrospectivo. Los casos secundarios se identificaron teniendo en cuenta la definición del protocolo del Instituto Nacional de Salud. La recolección de datos fue obtenida del Sistema de Vigilancia en Salud Pública, la investigación epidemiológica de campo, historia clínica y resultados de laboratorio. Se tuvieron en cuenta patrones clínicos de la enfermedad (signos y síntomas), componentes epidemiológicos (acciones de vigilancia y control de la transmisión) y virológicos (con el uso de la prueba diagnóstica para sars-CoV-2 y la evaluación de la recuperación virológica). La confirmación de los casos se hizo por técnica de detección diagnóstica de coronavirus Wuhan 2019 por Reverse Transcription Polymerase Chain Reaction - Real Time, protocolo Charité, Berlín, Alemania 2020, procesadas en e informadas por el Laboratorio Nacional de Referencia del Instituto Nacional de Salud. Resultados: El caso primario de Medellín ingresó al país el 2 de marzo de 2020, procedente de Madrid (España) y fue confirmado el 9 de marzo. Se identificaron 52 contactos estrechos en 9 conglomerados. Las acciones de vigilancia en salud pública permitieron identificar 5 casos relacionados en una fase temprana de la enfermedad. Conclusiones: La caracterización del caso primario en Medellín permitió identificar el primer brote de covid-19 y orientar las medidas de control epidemiológico, como aislamientos, tomas de muestras, seguimiento a contactos y búsquedas de casos secundarios.

Abstract Objective: To characterize clinically, epidemiologically and virologically the first outbreak of covid-19, from the primary case in Medellín (Colombia), through surveillance and epidemiological control carried out for its containment. Methodology: Retrospective descriptive study. Secondary cases are identified taking into account the definition of the protocol of the National Institute of Health. Data collection was obtained of the Public Health Surveillance System, research epidemiological field, medical history and results of laboratory. Clinical patterns of the disease (signs and symptoms), epidemiological components (transmission surveillance and control actions) and virological (with the use of the diagnostic test for sars-CoV-2 and the evaluation of virological recovery). The confirmation of the cases was done by the diagnostic detection technique of Wuhan coronavirus 2019 by reverse transcription polymerase Chain Reaction - Real Time, Charité protocol, Berlin, Germany 2020, processed in and reported by the National Laboratory of Reference of the National Institute of Health. Results: The Medellín's primary case entered the country on March 2, 2020, from Madrid (Spain) and was confirmed on March 9. 52 close contacts were identified in 9 clusters. The surveillance actions in public health made it possible to identify 5 related cases in an early phase of the disease. Conclusions: The characterization of the primary case in Medellín seek to identify the first outbreak of covid-19 and guide the epidemiological control measures, such as isolations, intakes of samples, follow-up contacts and case searches secondary.

Resumo Objetivo: Caracterizar clínica, epidemiológica e virologicamente o primeiro surto de covid-19, desde o caso primário em Medellín (Colômbia), por meio das ações de vigilância e controle epidemiológico realizadas para sua contenção. Metodologia: Estudo descritivo retrospectivo. Os casos secundários foram identificados tendo em consideração a definição do protocolo do National Institute of Health. A coleta de dados foi obtida junto ao Sistema Único de Vigilância em Saúde, pesquisa epidemiológica de campo, história clínica e resultados laboratoriais. Foram considerados os padrões clínicos da doença (sinais e sintomas), componentes epidemiológicos (ações de vigilância e controle da transmissão) e virológicos (com uso do teste diagnóstico para sars-CoV-2 e avaliação da recuperação virológica). A confirmação dos casos foi feita pela técnica de detecção diagnóstica de coronavírus Wuhan 2019 por Reação em Cadeia da Polimerase de Transcrição Reversa - Tempo Real, protocolo Charité, Berlim, Alemanha 2020, processada e relatada pelo Laboratório de Referência Nacional do Instituto Nacional de Saúde. Resultados: O caso primário de Medellín entrou no país em 2 de março de 2020, a partir de Madrid (Espanha) e foi confirmado em 9 de março. 52 contatos próximos foram identificados em 9 clusters. As ações de vigilância em saúde pública possibilitaram a identificação de 5 casos relacionados em fase inicial da doença. Conclusões: A caracterização do caso primário em Medellín permitiu identificar o primeiro surto de covid-19 e orientar medidas de controle epidemiológico, como isolamento, amostragem, acompanhamento de contatos e busca de casos secundários.

Wastewater Knows Pathogen Spread: Analysis of Residential Wastewater for Infectious Microorganisms including SARS-CoV-2.

BACKGROUND: We aimed to identify the genes of 35 pathogens, including viruses, bacteria, and protozoa that cause waterborne infectious diseases, and to assess the feasibility of a wastewater-based surveillance system. MATERIALS AND METHODS: Wastewater was aseptically sampled once a month from 2 sites. A total of 1 L of wastewater from each site underwent 0.2 µm filtration to generate the sample A. Subsequently, 200 ul of the filtered water was ultra-filtered and concentrated to generate the sample B, which was mixed with sample A in a 1:1 ratio. We performed a Filmarray® Gastrointestinal (GI) panel (BioFire Diagnnostics', Salt Lake City, UT, USA) test to simultaneously detect 13 enterobacteria, 5 enterovirus, and 4 protozoa. RNA was extracted to assess 18 types of viruses. RESULTS: Severe acute respiratory syndrome coronavirus 2 adenovirus, bocavirus, and rhinovirus was detected at both site. Norovirus GI/GII was continuously detected at both sites. Moreover, adenovirus, group A rotaviruses, and hepatitis A virus were frequently detected; however, hepatitis E virus was absent at either site. Campylobacter, enteroaggregative Escherichia coli, enterotoxigenic E. coli, Shiga toxin-producing E. coli, and Clostridioides difficile toxin A/B were detected at both sites. Giardia lamblia was also detected in both sites. CONCLUSION: We analyze multiple infectious disease pathogens under sample surveillance with incidence. Further in-depth studies on wastewater-based surveillance will be feasible and important.

The Early Detection of Fraudulent COVID-19 Products From Twitter Chatter: Data Set and Baseline Approach Using Anomaly Detection.

Background: Social media has served as a lucrative platform for spreading misinformation and for promoting fraudulent products for the treatment, testing, and prevention of COVID-19. This has resulted in the issuance of many warning letters by the US Food and Drug Administration (FDA). While social media continues to serve as the primary platform for the promotion of such fraudulent products, it also presents the opportunity to identify these products early by using effective social media mining methods. Objective: Our objectives were to (1) create a data set of fraudulent COVID-19 products that can be used for future research and (2) propose a method using data from Twitter for automatically detecting heavily promoted COVID-19 products early. Methods: We created a data set from FDA-issued warnings during the early months of the COVID-19 pandemic. We used natural language processing and time-series anomaly detection methods for automatically detecting fraudulent COVID-19 products early from Twitter. Our approach is based on the intuition that increases in the popularity of fraudulent products lead to corresponding anomalous increases in the volume of chatter regarding them. We compared the anomaly signal generation date for each product with the corresponding FDA letter issuance date. We also performed a brief manual analysis of chatter associated with 2 products to characterize their contents. Results: FDA warning issue dates ranged from March 6, 2020, to June 22, 2021, and 44 key phrases representing fraudulent products were included. From 577,872,350 posts made between February 19 and December 31, 2020, which are all publicly available, our unsupervised approach detected 34 out of 44 (77.3%) signals about fraudulent products earlier than the FDA letter issuance dates, and an additional 6 (13.6%) within a week following the corresponding FDA letters. Content analysis revealed misinformation, information, political, and conspiracy theories to be prominent topics. Conclusions: Our proposed method is simple, effective, easy to deploy, and does not require high-performance computing machinery unlike deep neural network-based methods. The method can be easily extended to other types of signal detection from social media data. The data set may be used for future research and the development of more advanced methods.

Active community search strategies for COVID-19 control.

Introduction: The active community search is widely used in field practice and allows to identify symptomatic people, criteria of risk of contagion, control of the virus, knowledge of the population at risk and, in addition, allows the analysis of the relationship of these factors with the increased risk of affecting health. However, it is difficult to find a consensus on this aspect. Objective(s): To identify active community search strategies that have an effect on the control of COVID-19. Method(s): A systematic search was conducted in the PubMed, Science Direct and LILACS databases, also in Google Scholar, Open Grey and PROSPERO, from December 2019 to January 2021. The selection criteria were previously defined with respect to the intervention and the research topic of the articles consulted. The protocol was sent for registration in the International Prospective Register of Systematic Reviews (PROSPERO). Registration number: CRD42020160617. Conclusion(s): Of the two identified strategies, the home visit of the medical team made up by students, professors and other health professionals stands out. It is necessary to take this result with caution because they are studies from the same country, although the importance of community participation in public health surveillance is reiterated.Copyright © 2022, Editorial Ciencias Medicas. All rights reserved.