ABSTRACT
BACKGROUND: Whole-genome sequencing (WGS) of Mycobacterium tuberculosis allows rapid, accurate inferences about the sources, location and timing of transmission. However, in an era of heightened concern for personal privacy and science distrust, such inferences could result in unintended harm and undermine the public´s trust.METHODS: We held interdisciplinary stakeholder discussions and performed ethical analyses of real-world illustrative cases to identify principles that optimise benefit and mitigate harm of M. tuberculosis WGS-driven TB source investigations.RESULTS: The speed and precision with which real-time WGS can be used to associate M. tuberculosis strains with sensitive information has raised important concerns. While detailed understanding of transmission events could mitigate harm to vulnerable patients and communities when otherwise unfairly blamed for TB outbreaks, the precision of WGS can also identify transmission events resulting in social blame, fear, discrimination, individual or location stigma, and the use of defaming language by the public, politicians and scientists. Public health programmes should balance the need to safeguard privacy with public health goals, transparency and individual rights, including the right to know who infects whom or where.CONCLUSIONS: Ethical challenges raised by real-time WGS-driven TB source investigation requires public health authorities to move beyond their current legal mandate and embrace transparency, privacy and community engagement.
Subject(s)
Mycobacterium tuberculosis , Public Health , Tuberculosis , Humans , Administrative Personnel , Disease Outbreaks , Mycobacterium tuberculosis/genetics , Whole Genome Sequencing , Tuberculosis/epidemiology , Tuberculosis/microbiologyABSTRACT
Most guidelines recommend replacing endoscopic water bottles at least daily with newly sterilized or high-level disinfected water bottles. All these recommendations, however, are mainly based on expert opinions and outbreak reports. We tested the water quality from water bottles used in a gastrointestinal endoscopy unit where water bottles were used up to five days. The results show that the reuse of water bottles for more than one day is inadequate. The expert opinion in favour of changing water bottles daily rather than after five days is a sensible and safer option.
Subject(s)
Endoscopes/microbiology , Infection Control/methods , Water Microbiology , Cross Infection/prevention & controlABSTRACT
Data from three different data sources were compiled to estimate the presence of Coxiella burnetii in the Belgian Limburg province for both humans and livestock. First, serological data of all samples sent to the Belgian reference centre (20032010) for human Q fever were analysed, showing evidence for an acute Q fever infection in 15% of the cases. Second, a multi-centre prospective survey was conducted in Limburg in 2010 to detect undiagnosed human cases; evidence for a recent infection with Coxiella burnetii was found in three out of 100 patients from which clinicians suspected a Mycoplasma pneumoniae infection. Third, we analyzed data from the Belgian livestock screening program (20092010) which consisted of investigating all reported abortions, sampling tank milk, and serological screening of cattle. The results suggest an endemicity in the Limburgian livestock which seems to be especially high in cattle.
Subject(s)
Antibodies, Bacterial/blood , Coxiella burnetii/immunology , Q Fever/epidemiology , Q Fever/veterinary , Animals , Belgium/epidemiology , Cattle , Cattle Diseases/diagnosis , Cattle Diseases/epidemiology , Endemic Diseases , Humans , Prospective Studies , Serologic TestsABSTRACT
On 13 November 2009, the authorities of Flemish Brabant, Belgium, received an alert concerning a potential outbreak of Shigella sonnei at a public institution. A study was conducted to assess the extent, discover the source and to implement further measures. We performed a matched case-control study to test an association between shigellosis and canteen-food consumption. Water samples and food handlers' faecal samples were tested. The reference laboratory characterized the retrospectively collected Shigella specimens. We found 52 cases distributed over space (25/35 departments) and time (2 months). We found a matched odds ratio of 3·84 (95% confidence interval 1·02-14·44) for canteen-food consumption. A food handler had travelled to Morocco shortly before detection of the first laboratory-confirmed case. Water samples and food handlers' faecal samples tested negative for Shigella. Confirmed cases presented PFGE profiles, highly similar to archived isolates from Morocco. Foodborne transmission associated with the canteen was strongly suspected.
