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Chen J, Alifu X, Qi X, Zhang R, Chen L, Wang J, Yu Y. Estimating the health burden of foodborne gastroenteritis caused by non-typhoidal Salmonella enterica and Vibrio parahaemolyticus in Zhejiang province, China. RISK ANALYSIS : AN OFFICIAL PUBLICATION OF THE SOCIETY FOR RISK ANALYSIS 2024; 44:1176-1182. [PMID: 37648395 DOI: 10.1111/risa.14210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Revised: 08/04/2023] [Accepted: 08/09/2023] [Indexed: 09/01/2023]
Abstract
As acute gastrointestinal (AGI) disease patients only sometimes seek medical care or submit stool samples for testing, and laboratories cannot detect or identify the pathogen, most cases of foodborne gastroenteritis still need to be identified through public health monitoring. We conducted a population survey and sentinel hospital surveillance to determine the burden of foodborne gastroenteritis caused by non-typhoidal Salmonella enterica (NTS) and Vibrio parahaemolyticus infection, from July 2018 to June 2019 in Zhejiang province, China, and a model for calculating disease burden established. Using the burden of illness pyramid model, we estimated that there were 140.3 cases of NTS infection and 136.2 cases of V. parahaemolyticus infection. We estimated annual incidence per 100,000 population in Zhejiang province as 236 (95% confidence interval [CI] 208-267) and 206 (95% CI 155-232) cases for foodborne NTS and V. parahaemolyticus gastroenteritis, respectively. The results show that AGI caused by these two pathogens constitutes a substantial burden in the Zhejiang population. The health burden of AGI estimations caused by NTS and V. parahaemolyticus in this study can serve as a strategic framework to direct policy and intervention.
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Affiliation(s)
- Jiang Chen
- Department of Nutrition and Food Safety, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang, China
| | - Xialidan Alifu
- Department of Epidemiology & Health Statistics, School of Public Health, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Xiaojuan Qi
- Department of Nutrition and Food Safety, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang, China
| | - Ronghua Zhang
- Department of Nutrition and Food Safety, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang, China
| | - Lili Chen
- Department of Nutrition and Food Safety, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang, China
| | - Jikai Wang
- Department of Nutrition and Food Safety, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang, China
| | - Yunxian Yu
- Department of Epidemiology & Health Statistics, School of Public Health, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
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Saab ME, Vanier G, Sudlovenick E, Powell AL, Simonee J, Desmarais G, Muckle CA, Fairbrother JM, Daoust PY. Occurrence and antimicrobial resistance of Salmonella species and potentially pathogenic Escherichia coli in free-living seals of Canadian Atlantic and eastern Arctic waters. Zoonoses Public Health 2023; 70:542-554. [PMID: 37317052 DOI: 10.1111/zph.13064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 05/10/2023] [Accepted: 05/27/2023] [Indexed: 06/16/2023]
Abstract
Seal populations in Canadian waters provide sustenance to coastal communities. There is potential for pathogenic and/or antimicrobial-resistant bacteria to transfer to humans through inadvertent faecal contamination of seal products. The objective of this study was to investigate the occurrence and potential antimicrobial resistance of Salmonella spp., Escherichia coli and Listeria monocytogenes in faecal samples collected from grey seals (Halichoerus grypus) in the Gulf of St. Lawrence and from ringed seals (Pusa hispida) in Frobisher Bay and Eclipse Sound, Nunavut, Canada. Grey seals were harvested during commercial hunts or during scientific sampling; ringed seals were collected by Inuit hunters during subsistence harvests. Virulence genes defining pathogenic E. coli were identified by PCR, and antimicrobial susceptibility testing was performed on recovered isolates. In grey seals, E. coli was detected in 34/44 (77%) samples, and pathogenic E. coli (extraintestinal E. coli [ExPEC], enteropathogenic E. coli [EPEC] or ExPEC/EPEC) was detected in 13/44 (29%) samples. Non-susceptibility to beta-lactams and quinolones was observed in isolates from 18 grey seals. In ringed seals from Frobisher Bay, E. coli was detected in 4/45 (9%) samples; neither virulence genes nor antimicrobial resistance was detected in these isolates. In ringed seals from Eclipse Sound, E. coli was detected in 8/50 (16%) samples and pathogenic E. coli (ExPEC and ExPEC/EPEC) in 5/50 (10%) samples. One seal from Eclipse Sound had an E. coli isolate resistant to beta-lactams. A monophasic Salmonella Typhimurium was recovered from 8/50 (16%) seals from Eclipse Sound. All Salmonella isolates were resistant to ampicillin, streptomycin, sulfisoxazole and tetracycline. L. monocytogenes was not detected in any sample. These findings suggest that seals may act as important sentinel species and as reservoirs or vectors for antimicrobial-resistant and virulent E. coli and Salmonella species. Further characterization of these isolates would provide additional insights into the source and spread of antimicrobial resistance and virulence genes in these populations of free-living seals.
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Affiliation(s)
- Matthew E Saab
- Diagnostic Services, Atlantic Veterinary College, University of Prince Edward Island, Charlottetown, Prince Edward Island, Canada
| | - Ghyslaine Vanier
- WOAH Reference Laboratory for Escherichia coli, Faculté de médecine vétérinaire, Université de Montréal, Saint-Hyacinthe, Quebec, Canada
| | - Enooyaq Sudlovenick
- Department of Pathology and Microbiology, Atlantic Veterinary College, University of Prince Edward Island, Charlottetown, Prince Edward Island, Canada
| | - Ashley Lora Powell
- Diagnostic Services, Atlantic Veterinary College, University of Prince Edward Island, Charlottetown, Prince Edward Island, Canada
- Department of Pathology and Microbiology, Atlantic Veterinary College, University of Prince Edward Island, Charlottetown, Prince Edward Island, Canada
| | | | - Gabriel Desmarais
- WOAH Reference Laboratory for Escherichia coli, Faculté de médecine vétérinaire, Université de Montréal, Saint-Hyacinthe, Quebec, Canada
| | - Catherine Anne Muckle
- Department of Pathology and Microbiology, Atlantic Veterinary College, University of Prince Edward Island, Charlottetown, Prince Edward Island, Canada
| | - John Morris Fairbrother
- WOAH Reference Laboratory for Escherichia coli, Faculté de médecine vétérinaire, Université de Montréal, Saint-Hyacinthe, Quebec, Canada
| | - Pierre-Yves Daoust
- Department of Pathology and Microbiology, Atlantic Veterinary College, University of Prince Edward Island, Charlottetown, Prince Edward Island, Canada
- Canadian Wildlife Health Cooperative, Atlantic Veterinary College, University of Prince Edward Island, Charlottetown, Prince Edward Island, Canada
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Liu J, Luo B, Zhou Y, Ma X, Liang J, Sang X, Lyu L, Chen W, Fu P, Liu H, Zhen S, Wang C, Wu Y, Huang Q, Liang X, Bai G, Lan Z, Zhang S, Wu Y, Li N, Guo Y. Prevalence and distribution of acute gastrointestinal illness in the community of China: a population-based face-to-face survey, 2014-2015. BMC Public Health 2023; 23:836. [PMID: 37158857 PMCID: PMC10165855 DOI: 10.1186/s12889-023-15337-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 02/28/2023] [Indexed: 05/10/2023] Open
Abstract
BACKGROUND The true incidence of acute gastrointestinal illness in China is underrecognized by surveillance systems. The aims of this study were to estimate the incidence and prevalence of self-reported AGI in the community of China, and to investigate sociodemographic and epidemiological determinants of AGI. METHODS We conducted a 12-months cross-sectional population-based survey in eight provinces of China during 2014-2015. The survey determined the prevalence and incidence of acute gastrointestinal illness (AGI) in the total permanent resident population in China according to the census of the population in 2010. The random multilevel population sample was stratified by geographic, population, and socioeconomic status. We used a recommended case definition of AGI, with diarrhea (three loose or watery stools) and/or any vomiting in a four-week recall. A face-to-face survey was conducted by selecting the member in the household with the most recent birthday. RESULTS Among 56,704 sampled individuals, 948 (1,134 person-time) fulfilled the case definition; 98.5% reported diarrhea. This corresponds to 2.3% (95% CI:1.9%-2.8%) of an overall standardized four-week prevalence and 0.3 (95% CI: 0.23-0.34) episodes per person-year of annual adjusted incidence rate. There was no significant difference between males and females. The incidence rates were higher among urban residents, and in the spring and summer. In the whole study period, 50% of the cases sought medical care, of which 3.9% were hospitalized and 14.3% provided a biological sample for laboratory identification of the causative agent. Children aged 0-4 and young adults aged 15-24, people living in rural areas and people who traveled frequently had higher prevalence of AGI. CONCLUSION Results showed that AGI represents a substantial burden in China, and will contribute to the estimation of the global burden of AGI. Complemented with data on the etiologies of AGI, these estimates will form the basis to estimate the burden of foodborne diseases in China.
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Affiliation(s)
- Jikai Liu
- NHC Key Laboratory of Food Safety Risk Assessment, Food Safety Research Unit (2019RU4) of Chinese Academy of Medical Science, China National Center for Food Safety Risk Assessment, Beijing, China
| | - Baozhang Luo
- Shanghai Municipal Center for Disease Prevention and Control, Shanghai, China
| | - Yijing Zhou
- Jiangsu Provincial Center for Disease Prevention and Control, Nanjing, China
| | - Xiaochen Ma
- Beijing Center for Disease Prevention and Control, Beijing, China
| | - Junhua Liang
- Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
| | - Xianglai Sang
- Gansu Provincial Center for Disease Control and Prevention, Lanzhou, China
| | - Le Lyu
- Jilin Provincial Center for Disease Control and Prevention, Changchun, China
| | - Wen Chen
- Sichuan Provincial Center for Disease Control and Prevention, Chengdu, China
| | - Pengyu Fu
- Henan Provincial Center for Disease Control and Prevention, Zhengzhou, China
| | - Hong Liu
- Shanghai Municipal Center for Disease Prevention and Control, Shanghai, China
| | - Shiqi Zhen
- Jiangsu Provincial Center for Disease Prevention and Control, Nanjing, China
| | - Chao Wang
- Beijing Center for Disease Prevention and Control, Beijing, China
| | - Yangbo Wu
- Beijing Center for Disease Prevention and Control, Beijing, China
| | - Qiong Huang
- Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
| | - Xiaocheng Liang
- Gansu Provincial Center for Disease Control and Prevention, Lanzhou, China
| | - Guangda Bai
- Jilin Provincial Center for Disease Control and Prevention, Changchun, China
| | - Zhen Lan
- Sichuan Provincial Center for Disease Control and Prevention, Chengdu, China
| | - Shufang Zhang
- Henan Provincial Center for Disease Control and Prevention, Zhengzhou, China
| | - Yongning Wu
- NHC Key Laboratory of Food Safety Risk Assessment, Food Safety Research Unit (2019RU4) of Chinese Academy of Medical Science, China National Center for Food Safety Risk Assessment, Beijing, China
| | - Ning Li
- NHC Key Laboratory of Food Safety Risk Assessment, Food Safety Research Unit (2019RU4) of Chinese Academy of Medical Science, China National Center for Food Safety Risk Assessment, Beijing, China.
| | - Yunchang Guo
- NHC Key Laboratory of Food Safety Risk Assessment, Food Safety Research Unit (2019RU4) of Chinese Academy of Medical Science, China National Center for Food Safety Risk Assessment, Beijing, China.
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Schmidt MA, Groom HC, Rawlings AM, Mattison CP, Salas SB, Burke RM, Hallowell BD, Calderwood LE, Donald J, Balachandran N, Hall AJ. Incidence, Etiology, and Healthcare Utilization for Acute Gastroenteritis in the Community, United States. Emerg Infect Dis 2022; 28:2234-2242. [PMID: 36285882 PMCID: PMC9622243 DOI: 10.3201/eid2811.220247] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Knowledge of the epidemiology of sporadic acute gastroenteritis (AGE) in the United States is limited. During September 2016–September 2017, we surveyed Kaiser Permanente Northwest members in Oregon and Washington, USA, to collect data on the 30-day prevalence of dually defined AGE and diarrhea disease and related health-seeking behavior; from a subset of participants, we obtained a stool specimen. Using the iterative proportional fitting algorithm with raked weights, we generated AGE prevalence and annualized rate estimates. We detected norovirus, rotavirus, astrovirus, and sapovirus from submitted stool specimens through real-time quantitative reverse transcription PCR (qRT-PCR). We estimated a 30-day prevalence of 10.4% for AGE and 7.6% for diarrhea only; annual rates were 1.27 cases/person/year for AGE and 0.92 cases/person/year for diarrhea only. Of those with AGE, 19% sought medical care. Almost one quarter (22.4%) of stool specimens from those reporting AGE tested positive for ≥1 viral pathogen, compared with 8.2% from those without AGE.
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Ishaq S, Sadiq R, Chhipi-Shrestha G, Farooq S, Hewage K. Developing an Integrated "Regression-QMRA method" to Predict Public Health Risks of Low Impact Developments (LIDs) for Improved Planning. ENVIRONMENTAL MANAGEMENT 2022; 70:633-649. [PMID: 35543727 DOI: 10.1007/s00267-022-01657-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 04/25/2022] [Indexed: 06/14/2023]
Abstract
Worldwide Low Impact Developments (LIDs) are used for sustainable stormwater management; however, both the stormwater and LIDs carry microbial pathogens. The widespread development of LIDs is likely to increase human exposure to pathogens and risk of infection, leading to unexpected disease outbreaks in urban communities. The risk of infection from exposure to LIDs has been assessed via Quantitative Microbial Risk Assessment (QMRA) during the operation of these infrastructures; no effort is made to evaluate these risks during the planning phase of LID treatment train in urban communities. We developed a new integrated "Regression-QMRA method" by examining the relationship between pathogens' concentration and environmental variables. Applying of this methodology to a planned LID train shows that the predicted disease burden of diarrhea from Campylobacter is highest (i.e. 16.902 DALYs/1000 persons/yr) during landscape irrigation and playing on the LID train, followed by Giardia, Cryptosporidium, and Norovirus. These results illustrate that the risk of microbial infection can be predicted during the planning phase of LID treatment train. These predictions are of great value to municipalities and decision-makers to make informed decisions and ensure risk-based planning of stormwater systems before their development.
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Affiliation(s)
- Sadia Ishaq
- School of Engineering, University of British Columbia, Okanagan Campus, Kelowna, BC, V1V 1V7, Canada
| | - Rehan Sadiq
- School of Engineering, University of British Columbia, Okanagan Campus, Kelowna, BC, V1V 1V7, Canada.
| | - Gyan Chhipi-Shrestha
- School of Engineering, University of British Columbia, Okanagan Campus, Kelowna, BC, V1V 1V7, Canada
| | - Shaukat Farooq
- King Fahd University of Petroleum and Minerals (KFUPM), Dhahran, 31261, Saudi Arabia
| | - Kasun Hewage
- School of Engineering, University of British Columbia, Okanagan Campus, Kelowna, BC, V1V 1V7, Canada
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6
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Wang JK, He Y, Chen LL, Zhang HX, Qi XJ, Sun L, Zhang SF, Chen J, Zhang RH. A population-based survey of the prevalence of self-reported acute gastrointestinal illness in Zhejiang Province, China. PLoS One 2022; 17:e0268717. [PMID: 35584149 PMCID: PMC9116671 DOI: 10.1371/journal.pone.0268717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 05/05/2022] [Indexed: 11/19/2022] Open
Abstract
Acute gastrointestinal illness (AGI) is a prevalent public health concern worldwide. This study investigated the magnitude, distribution and burden of self-reported AGI among residents of Zhejiang Province, China. A face-to-face household survey was conducted using a multi-stage stratified random sampling method in 10 counties in Zhejiang Province between July 2018 and June 2019. In total, 12,021 participants were recruited. The prevalence of AGI 28 days after standardization was 1.8% (95% confidence interval (CI), 1.6–2.1), with an incidence rate of 0.24 episodes of AGI per person-year and an estimated 14 million cases of AGI in Zhejiang Province. Univariate and multivariable analyses showed a higher AGI prevalence among people who performed housework and were unemployed in summer and autumn among respondents living in western or northern cities (p < 0.05). More than 50% of AGI cases were attributed to the consumption of contaminated food. The disease burden caused by AGI in Zhejiang Province was approximately 975 million Chinses yuan (CNY). These results indicated that the disease burden of AGI in Zhejiang Province should be addressed and highlights the need for an improved active surveillance system of foodborne diseases to assess the impact of AGI on society and health.
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Affiliation(s)
- Ji-Kai Wang
- Department of Nutrition and Food Safety, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
| | - Yue He
- Department of Nutrition and Food Safety, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
| | - Li-Li Chen
- Department of Nutrition and Food Safety, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
| | - He-Xiang Zhang
- Department of Nutrition and Food Safety, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
| | - Xiao-Juan Qi
- Department of Nutrition and Food Safety, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
| | - Liang Sun
- Department of Nutrition and Food Safety, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
| | - Shuang-Feng Zhang
- Department of Nutrition and Food Safety, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
| | - Jiang Chen
- Department of Nutrition and Food Safety, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
| | - Rong-Hua Zhang
- Department of Nutrition and Food Safety, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, China
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7
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John P, Varga C, Cooke M, Majowicz SE. Incidence, Demographic, and Seasonal Risk Factors of Infections Caused by Five Major Enteric Pathogens, Ontario, Canada, 2010-2017. Foodborne Pathog Dis 2022; 19:248-258. [PMID: 35049363 DOI: 10.1089/fpd.2021.0034] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
In Canada, enteric infections cause significant health and economic burden. We evaluated the individual characteristics of laboratory-confirmed cases of Campylobacter spp. (n = 28,728), non-typhoidal Salmonella spp. (n = 22,640), Yersinia spp. (n = 1674), Verotoxin-producing Escherichia coli (VTEC; n = 1340), and Listeria monocytogenes (n = 471), reported between 2010 and 2017 inclusive, in Ontario, Canada (population ∼13,500,000). We calculated overall and pathogen-specific annual and mean incidence rates (IRs) for Ontario. We used multivariable Poisson and negative binomial regression models to estimate incidence rate ratios (IRRs) for years, seasons, age groups, and sexes, and we included two-way age and sex interaction terms in the models. Campylobacter and Salmonella infections had the highest IRs whereas Listeria infections had the lowest IRs. None of the infections showed long-term trends over the 8-year study period; however, rates of all five infections were elevated in the summer. More Salmonella, VTEC, and Listeria infections were linked to disease outbreaks than were Campylobacter and Yersinia infections. Overall, mean IRs of Campylobacter, Salmonella, Yersinia, and VTEC infections were highest in children 0-4 years old, whereas Listeria IRs peaked in adults 60 years and older. Higher mean IRs of Campylobacter were observed in males. No other differences by sex were statistically significant. The same mean rate was observed in both sexes for Listeria. Adjusting for all other factors, significant age- and sex-specific differences in IRs were observed in Campylobacter, Salmonella, and VTEC infection rates. No significant interactions of age and sex were found for Yersinia and Listeria infections. Future research should focus on the pathogen-specific socioeconomic, environmental, or agricultural risk factors that might be responsible for these infections.
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Affiliation(s)
- Patience John
- School of Public Health Sciences, Faculty of Health, University of Waterloo, Waterloo, Canada
| | - Csaba Varga
- School of Public Health Sciences, Faculty of Health, University of Waterloo, Waterloo, Canada.,Department of Pathobiology, College of Veterinary Medicine, University of Illinois at Urbana-Champaign, Urbana, Illinois, USA
| | - Martin Cooke
- School of Public Health Sciences, Faculty of Health, University of Waterloo, Waterloo, Canada.,Department of Sociology and Legal Studies, University of Waterloo, Waterloo, Canada
| | - Shannon E Majowicz
- School of Public Health Sciences, Faculty of Health, University of Waterloo, Waterloo, Canada
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8
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Lavallee S, Hynds PD, Brown RS, Schuster-Wallace C, Dickson-Anderson S, Di Pelino S, Egan R, Majury A. Examining influential drivers of private well users' perceptions in Ontario: A cross-sectional population study. THE SCIENCE OF THE TOTAL ENVIRONMENT 2021; 763:142952. [PMID: 33127160 DOI: 10.1016/j.scitotenv.2020.142952] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 09/23/2020] [Accepted: 10/06/2020] [Indexed: 06/11/2023]
Abstract
Private well users are responsible for managing and maintaining the quality of their drinking water source. Previous studies in Canada have reported low testing rates among well users, a cornerstone of well stewardship behaviours that can prevent the consumption of contaminated groundwater. To improve well stewardship, it is important to understand the interactions between, and the impacts of, various factors that may influence behaviours. Accordingly, the objective of the current study was to investigate the impact of socio-demographics, property characteristics, and experiences with well construction and acute gastrointestinal illness (AGI) (i.e., previous experiences) on levels of awareness, attitudes, risk perceptions, and beliefs (i.e., risk domains) among private well users in Ontario. A link to a province-wide online survey was circulated between May and August 2018 and novel "risk domain" scoring protocols were developed to classify and summarize response data. The survey was undertaken by 1228 respondents, of which 1030 completed the survey in full. Results indicate a low level of waterborne pathogen awareness, with 50.8% of respondents unaware of any groundwater associated pathogens. Respondents' geographic location, gender, and well type were significantly associated with well users' attitudes and perceptions of risk regarding their personal well water supply and the quality and quantity of local groundwater sources. Higher levels of awareness and lower risk perception scores (i.e., lower perceptions of risk) were associated with residential presence during well construction (p < 0.001 and p = 0.017, respectively). Previous case(s) of AGI within the respondent's household were significantly associated with negative attitudes towards their well water (p < 0.001) and higher risk perception scores (p = 0.025) with respect to the quantity of local groundwater sources. Results may be used to identify critical experiential control points (e.g., during well construction or after a physician confirmed AGI diagnosis) and develop improved risk management and communication strategies aimed at private well users.
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Affiliation(s)
- Sarah Lavallee
- School of Environmental Studies, Queen's University, Kingston, Ontario, Canada
| | - Paul D Hynds
- Technological University Dublin, Dublin, Ireland.
| | - R Stephen Brown
- School of Environmental Studies, Queen's University, Kingston, Ontario, Canada
| | - Corinne Schuster-Wallace
- Department of Geography and Planning, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | | | | | - Rylan Egan
- Department of Biology and Molecular Sciences, Queen's University, Kingston, Ontario, Canada
| | - Anna Majury
- School of Environmental Studies, Queen's University, Kingston, Ontario, Canada; Public Health Ontario, Kingston, Ontario, Canada.
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9
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Association of Ct Values from Real-Time PCR with Culture in Microbiological Clearance Samples for Shiga Toxin-Producing Escherichia coli (STEC). Microorganisms 2020; 8:microorganisms8111801. [PMID: 33207846 PMCID: PMC7698137 DOI: 10.3390/microorganisms8111801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 11/09/2020] [Accepted: 11/11/2020] [Indexed: 12/03/2022] Open
Abstract
Shiga toxin-producing Escherichia coli (STEC) are associated with acute gastroenteritis worldwide, which induces a high economic burden on both healthcare and individuals. Culture-independent diagnostic tests (CIDT) in frontline microbiology laboratories have been implemented in Alberta since 2019. The objectives of this study were to determine the association between gene detection and culture positivity over time using STEC microbiological clearance samples and also to establish the frequency of specimen submission. Both stx genes’ amplification by real-time PCR was performed with DNA extracted from stool samples using the easyMAG system. Stools were inoculated onto chromogenic agar for culture. An association between gene detection and culture positivity was found to be independent of which stx gene was present. CIDT can provide rapid reporting with less hands-on time and technical expertise. However, culture is still important for surveillance and early cluster detection. In addition, stool submissions could be reduced from daily to every 3–5 days until a sample is negative by culture.
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10
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Freedman SB, Xie J, Nettel-Aguirre A, Pang XL, Chui L, Williamson-Urquhart S, Schnadower D, Schuh S, Sherman PM, Lee BE, Gouin S, Farion KJ, Poonai N, Hurley KF, Qiu Y, Ghandi B, Lloyd C, Finkelstein Y. A randomized trial evaluating virus-specific effects of a combination probiotic in children with acute gastroenteritis. Nat Commun 2020; 11:2533. [PMID: 32439860 PMCID: PMC7242434 DOI: 10.1038/s41467-020-16308-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 04/25/2020] [Indexed: 01/11/2023] Open
Abstract
Gastroenteritis accounts for nearly 500,000 deaths in children younger than 5 years annually. Although probiotics have been touted as having the potential to expedite diarrhea resolution, recent clinical trials question their effectiveness. A potential explanation is a shift in pathogens following the introduction of a rotavirus vaccine. Here, we report the results of a multi-center, double-blind trial of 816 children with acute gastroenteritis who completed follow-up and provided multiple stool specimens. Participants were randomized to receive a probiotic containing Lactobacillus rhamnosus and Lactobacillus helveticus or placebo. We report no virus-specific beneficial effects attributable to the probiotic, either in reducing clinical symptoms or viral nucleic acid clearance from stool specimens collected up to 28 days following enrollment. We provide pathophysiological and microbiologic evidence to support the clinical findings and conclude that our data do not support routine probiotic administration to children with acute gastroenteritis, regardless of the infecting virus.
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Affiliation(s)
- Stephen B Freedman
- Alberta Children's Hospital Foundation Professor in Child Health and Wellness, Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, 28 Oki Drive NW, Calgary, AB, T3B 6A8, Canada.
| | - Jianling Xie
- Alberta Children's Hospital Foundation Professor in Child Health and Wellness, Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, 28 Oki Drive NW, Calgary, AB, T3B 6A8, Canada
| | - Alberto Nettel-Aguirre
- Alberta Children's Hospital Foundation Professor in Child Health and Wellness, Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, 28 Oki Drive NW, Calgary, AB, T3B 6A8, Canada
| | - Xiao-Li Pang
- University of Alberta, 116 St & 85 Ave., Edmonton, AB, T6G 2R3, Canada
| | - Linda Chui
- University of Alberta, 116 St & 85 Ave., Edmonton, AB, T6G 2R3, Canada
| | - Sarah Williamson-Urquhart
- Alberta Children's Hospital Foundation Professor in Child Health and Wellness, Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, 28 Oki Drive NW, Calgary, AB, T3B 6A8, Canada
| | - David Schnadower
- University of Cincinnati, 3333 Burnet Ave, Cincinnati, OH, UCA 45229, USA
| | - Suzanne Schuh
- University of Toronto, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
| | - Philip M Sherman
- University of Toronto, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
| | - Bonita E Lee
- University of Alberta, 116 St & 85 Ave., Edmonton, AB, T6G 2R3, Canada
| | - Serge Gouin
- Université de Montréal, 3175 Chemin de la Côte-Sainte-Catherine, Montréal, QC, H3T 1C5, Canada
| | - Ken J Farion
- University of Ottawa, 401 Smyth Rd, Ottawa, ON, K1H 8L1, Canada
| | - Naveen Poonai
- University of Western Ontario, 800 Commissioners Road E, London, ON, N6A 5W9, Canada
| | - Katrina F Hurley
- Dalhousie University, 5980 University Avenue, PO Box 9700, Halifax, NS, B3K 6R8, Canada
| | - Yuanyuan Qiu
- University of Alberta, 116 St & 85 Ave., Edmonton, AB, T6G 2R3, Canada
| | - Binal Ghandi
- University of Alberta, 116 St & 85 Ave., Edmonton, AB, T6G 2R3, Canada
| | - Colin Lloyd
- University of Alberta, 116 St & 85 Ave., Edmonton, AB, T6G 2R3, Canada
| | - Yaron Finkelstein
- University of Toronto, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
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11
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Abstract
Burden of disease analyses can quantify the relative impact of different exposures on population health outcomes. Gastroenteritis where the causative pathogen was not determined and respiratory illness resulting from exposure to opportunistic pathogens transmitted by water aerosols have not always been considered in waterborne burden of disease estimates. We estimated the disease burden attributable to nine enteric pathogens, unspecified pathogens leading to gastroenteritis, and three opportunistic pathogens leading primarily to respiratory illness, in Ontario, Canada (population ~14 million). Employing a burden of disease framework, we attributed a fraction of annual (year 2016) emergency department (ED) visits, hospitalisations and deaths to waterborne transmission. Attributable fractions were developed from the literature and clinical input, and unattributed disease counts were obtained using administrative data. Our Monte Carlo simulation reflected uncertainty in the inputs. The estimated mean annual attributable rates for waterborne diseases were (per 100 000 population): 69 ED visits, 12 hospitalisations and 0.52 deaths. The corresponding 5th–95th percentile estimates were (per 100 000 population): 13–158 ED visits, 5–22 hospitalisations and 0.29–0.83 deaths. The burden of disease due to unspecified pathogens dominated these rates: 99% for ED visits, 63% for hospitalisations and 40% for deaths. However, when a causative pathogen was specified, the majority of hospitalisations (83%) and deaths (97%) resulted from exposure to the opportunistic pathogens Legionella spp., non-tuberculous mycobacteria and Pseudomonas spp. The waterborne disease burden in Ontario indicates the importance of gastroenteritis not traced back to a particular pathogen and of opportunistic pathogens transmitted primarily through contact with water aerosols.
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12
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Soto JC, Barakat M, Drolet MJ, Gauvin D, Huot C. Waterborne outbreaks: a public health concern for rural municipalities with unchlorinated drinking water distribution systems. Canadian Journal of Public Health 2020; 111:433-442. [PMID: 32130716 DOI: 10.17269/s41997-020-00300-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 02/05/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVES The objective of this study is to describe an important waterborne outbreak of gastrointestinal illness observed in a rural municipality of Quebec. METHODS A population-based retrospective cohort study was conducted to identify risk factors associated with acute gastroenteritis. Indirect surveillance data were used to estimate the extent and the resolution of the epidemic. RESULTS The cohort consisted of 140 randomly selected individuals of whom 22 met the illness case definition (15.7% attack rate). The epidemic curve was similar to the evolution of antidiarrheal products sold by the only pharmacy in town and calls made to the Health Info Line. Bivariate analysis led to identifying five risk factors of gastrointestinal illness: consumption of municipal water, contact with someone with acute gastroenteritis (within and outside of the household), contact with a child in daycare, and being less than 35 years of age. Drinking municipal water had the highest risk ratio (RR = 24.31; 95% CI = 1.50-393.4). Drinking water from a private artesian well was a protective factor (RR = 0.28; 95% CI = 0.09-0.90). CONCLUSION This study highlighted that managing the risks associated with the consumption of untreated drinking water remains an important public health challenge, particularly in small rural municipalities vulnerable to climate variability.
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Affiliation(s)
- Julio C Soto
- Direction des risques biologiques et de la santé au travail, Institut national de santé publique du Québec, 190 Cremazie Est Boulevard, Montreal, Quebec, H2P 1E2, Canada.
| | - Mireille Barakat
- Direction des risques biologiques et de la santé au travail, Institut national de santé publique du Québec, 190 Cremazie Est Boulevard, Montreal, Quebec, H2P 1E2, Canada
| | - Marie-Josée Drolet
- Direction de santé publique, CISSS de Chaudière-Appalaches, 363 Route Cameron, Sainte-Marie, Quebec, G6E 3E2, Canada
| | - Denis Gauvin
- Direction de la santé environnementale et de la toxicologie, Institut national de santé publique du Québec, 2400 d'Estimauville Avenue, Quebec, Quebec, G1E 7G9, Canada
| | - Caroline Huot
- Direction de la santé environnementale et de la toxicologie, Institut national de santé publique du Québec, 2400 d'Estimauville Avenue, Quebec, Quebec, G1E 7G9, Canada
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13
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Tarr GAM, Chui L, Lee BE, Pang XL, Ali S, Nettel-Aguirre A, Vanderkooi OG, Berenger BM, Dickinson J, Tarr PI, Drews S, MacDonald J, Kim K, Freedman SB. Performance of Stool-testing Recommendations for Acute Gastroenteritis When Used to Identify Children With 9 Potential Bacterial Enteropathogens. Clin Infect Dis 2019; 69:1173-1182. [PMID: 30517612 PMCID: PMC7348586 DOI: 10.1093/cid/ciy1021] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 11/29/2018] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND The ability to identify bacterial pathogens that necessitate specific clinical management or public health action in children with acute gastroenteritis is crucial to patient care and public health. However, existing stool-testing guidelines offer inconsistent recommendations, and their performance characteristics are unknown. We evaluated 6 leading gastroenteritis guidelines (eg, those of the Centers for Disease Control and Prevention and Infectious Disease Society of America) that recommend when to test children's stool for bacterial enteropathogens. METHODS Via 2 emergency departments in Alberta, Canada, we enrolled 2447 children <18 years old who presented with ≥3 episodes of diarrhea and/or vomiting in a 24-hour period. All participants were tested for 9 bacterial enteropathogens: Aeromonas, Campylobacter, Escherichia coli O157, other Shiga toxin-producing E. coli, enterotoxigenic E. coli, Salmonella, Shigella, Vibrio, and Yersinia. Patient data gathered at the index visit were used to determine whether guidelines would recommend testing. Sensitivity and specificity to recommend testing for children with bacterial enteropathogens were calculated for each guideline. RESULTS Outcome data were available for 2391 (97.7%) participants, and 6% (144/2391) of participants tested positive for a bacterial enteropathogen. Guideline sensitivity ranged from 25.8% (95% confidence interval [CI] 18.7-33.0%) to 66.9% (95% CI 59.3-74.6%), and varied for individual pathogens. Guideline specificity for all bacterial enteropathogens ranged from 63.6% (95% CI 61.6-65.6%) to 96.5% (95% CI 95.7-97.2%). CONCLUSIONS No guideline provided optimally balanced performance. The most sensitive guidelines missed one-third of cases and would drastically increase testing volumes. The most specific guidelines missed almost 75% of cases.
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Affiliation(s)
- Gillian A M Tarr
- Department of Pediatrics, University of Calgary, University of Alberta and Alberta Provincial Laboratory for Public Health, Alberta, Canada
| | - Linda Chui
- Department of Laboratory Medicine and Pathology, University of Alberta and Alberta Provincial Laboratory for Public Health, Alberta, Canada
| | - Bonita E Lee
- Department of Pediatrics, Women and Children’s Health Research Institute, University of Alberta, Alberta, Canada
| | - Xiao-Li Pang
- Department of Laboratory Medicine and Pathology, University of Alberta and Alberta Provincial Laboratory for Public Health, Alberta, Canada
| | - Samina Ali
- Department of Pediatrics, Women and Children’s Health Research Institute, University of Alberta, Alberta, Canada
- Department of Emergency Medicine, Women and Children’s Health Research Institute, University of Alberta, Alberta, Canada
| | - Alberto Nettel-Aguirre
- Departments of Pediatrics and Community Health Sciences, University of Calgary, Alberta, Canada
| | - Otto G Vanderkooi
- Departments of Pediatrics, Microbiology, Immunology and Infectious Diseases, Pathology and Laboratory Medicine, and Community Health Sciences, Alberta Children’s Hospital Research Institute, Alberta, Canada
| | - Byron M Berenger
- Department of Pathology and Laboratory Medicine, University of Calgary, Alberta, Canada
- Alberta Provincial Laboratory for Public Health, Alberta, Canada
| | - James Dickinson
- Department of Family Medicine, University of Calgary, Alberta, Canada
| | - Phillip I Tarr
- Department of Pediatrics, Washington University in St. Louis School of Medicine, Missouri
| | - Steven Drews
- Department of Laboratory Medicine and Pathology, University of Alberta and Alberta Provincial Laboratory for Public Health, Alberta, Canada
| | - Judy MacDonald
- Alberta Health Services and Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Kelly Kim
- Department of Pediatrics, University of Calgary, University of Alberta and Alberta Provincial Laboratory for Public Health, Alberta, Canada
| | - Stephen B Freedman
- Sections of Pediatric Emergency Medicine and Gastroenterology, Department of Pediatrics, Alberta Children’s Hospital Research Institute, Cumming School of Medicine, University of Calgary, Alberta, Canada
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14
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Julien DA, Sargeant JM, Guy RA, Shapiro K, Imai RK, Bunce A, Sudlovenick E, Chen S, Li J, Harper SL. Prevalence and genetic characterization of Giardia spp. and Cryptosporidium spp. in dogs in Iqaluit, Nunavut, Canada. Zoonoses Public Health 2019; 66:813-825. [PMID: 31305029 DOI: 10.1111/zph.12628] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 06/13/2019] [Accepted: 06/16/2019] [Indexed: 12/31/2022]
Abstract
There are few epidemiologic studies on the role of dogs in zoonotic parasitic transmission in the Circumpolar North. The objectives of this study were to: (a) estimate the faecal prevalence of Giardia spp. and Cryptosporidium spp. in dogs; (b) investigate potential associations between the type of dog population and the faecal presence of Giardia spp. and Cryptosporidium spp.; and (c) describe the molecular characteristics of Giardia spp. and Cryptosporidium spp. in dogs in Iqaluit, Nunavut. We conducted two cross-sectional studies in July and September 2016. In July, the team collected daily faecal samples for 3 days from each of 20 sled dogs. In September, the team collected three faecal samples from each of 59 sled dogs, 111 samples from shelter dogs and 104 from community dogs. We analysed faecal samples for the presence of Giardia spp. and Cryptosporidium spp. using rapid immunoassay and flotation techniques. Polymerase chain reaction (PCR) and sequencing of target genes were performed on positive faecal samples. Overall, the faecal prevalence of at least one of the target parasites, when one faecal sample was chosen at random for all dogs, was 8.16% (CI: 5.52-11.92), and for Giardia spp. and Cryptosporidium spp., prevalence was 4.42% (CI: 2.58-7.49) and 6.12% (CI: 3.88-9.53), respectively. The odds of faecal Giardia spp. in sled dogs were significantly higher than those in shelter and community dogs (OR 10.19 [CI: 1.16-89.35]). Sequence analysis revealed that 6 faecal samples were Giardia intestinalis, zoonotic assemblage B (n = 2) and species-specific assemblages D (n = 3) and E (n = 1), and five faecal samples were Cryptosporidium canis. Giardia intestinalis is zoonotic; however, Cryptosporidium canis is rare in humans and, when present, usually occurs in immunosuppressed individuals. Dogs may be a potential source of zoonotic Giardia intestinalis assemblage B infections in residents in Iqaluit, Nunavut, Canada; however, the direction of transmission is unclear.
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Affiliation(s)
- Danielle A Julien
- Department of Population Medicine, Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada.,Centre for Public Health and Zoonoses, University of Guelph, Guelph, Ontario, Canada
| | - Jan M Sargeant
- Department of Population Medicine, Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada.,Centre for Public Health and Zoonoses, University of Guelph, Guelph, Ontario, Canada
| | - Rebecca A Guy
- National Microbiology Laboratory at the Public Health Agency of Canada, Guelph, Ontario, Canada
| | - Karen Shapiro
- Department of Population Medicine, Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada.,Department of Pathology, Microbiology & Immunology, School of Veterinary Medicine, University of California, Davis, California, USA
| | - Rachel K Imai
- Department of Pathobiology, Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada
| | - Anna Bunce
- Department of Population Medicine, Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada
| | - Enooyaq Sudlovenick
- Department of Pathology and Microbiology, Atlantic Veterinary College, Charlottetown, Prince Edward Island, Canada
| | - Shu Chen
- Laboratory Services Division, University of Guelph, Guelph, Ontario, Canada
| | - Jiping Li
- Laboratory Services Division, University of Guelph, Guelph, Ontario, Canada
| | - Sherilee L Harper
- Department of Population Medicine, Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada.,Centre for Public Health and Zoonoses, University of Guelph, Guelph, Ontario, Canada.,School of Public Health, University of Alberta, Edmonton, Alberta, Canada
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15
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Pang X, Qiu Y, Gao T, Zurawell R, Neumann NF, Craik S, Lee BE. Prevalence, levels and seasonal variations of human enteric viruses in six major rivers in Alberta, Canada. WATER RESEARCH 2019; 153:349-356. [PMID: 30743085 DOI: 10.1016/j.watres.2019.01.034] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 12/21/2018] [Accepted: 01/12/2019] [Indexed: 06/09/2023]
Abstract
The prevalence and seasonal variation of 7 viruses in 6 major rivers in Alberta were assessed using a combination of qPCR, cell culture and integrated cell culture with qPCR (ICC-qPCR). Water samples were collected monthly from rivers at different sites upstream and downstream of major urban centers. Seven viruses including rotavirus, adenovirus, astrovirus, norovirus, sapovirus, JC virus and enterovirus, were detected in at least one of the water samples at each site using qPCR. Rotavirus was most common with concentration ranging from 2.3 to 4.5 log10 genomic equivalent (GE) copies/L. Norovirus, sapovirus, astrovirus, adenoviruses and JC virus peaked during the winter (November to March). Viruses were most prevalent at the Bow River sampling site downstream of the City of Calgary, followed by the North Saskatchewan River site downstream of the City of Edmonton and the Red Deer River site downstream of the City of Red Deer. The detection rates and quantity of viruses had significant difference in the sampling sites between upstream and downstream of major urban centers (p < 0.001). 14% of the samples tested positive using viral culture indicating the presence of infectious viruses in river. Sequencing analysis identified human rotavirus in 75% of the samples collected from downstream versus 37% of the samples collected from upstream sites (p < 0.02). Multivariate binary regression showed that human activity in watersheds is a significant determinant of viruses in Alberta's Rivers. The discharge from wastewater treatment plants may be the possible sources of viral contamination. Seasonal coincidence of acute viral gastroenteritis outbreaks and monthly peak occurrence of enteric viruses in river water implies potential impact of waterborne viruses on human health.
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Affiliation(s)
- Xiaoli Pang
- Department of Laboratory Medicine and Pathology, University of Alberta, 116st & 85 Ave, Edmonton, AB, T6G 2R3, Canada; Provincial Laboratory for Public Health, 8440-112st, Edmonton, AB, T6G 2J2, Canada.
| | - Yuanyuan Qiu
- Department of Laboratory Medicine and Pathology, University of Alberta, 116st & 85 Ave, Edmonton, AB, T6G 2R3, Canada
| | - Tiejun Gao
- Department of Laboratory Medicine and Pathology, University of Alberta, 116st & 85 Ave, Edmonton, AB, T6G 2R3, Canada
| | - Ron Zurawell
- Environmental Monitoring and Science Division, Alberta Environment and Parks, Edmonton, AB, T5J 5C6, Canada
| | - Norman F Neumann
- School of Public Health, University of Alberta, 1405-87 Ave, Edmonton, AB, T6G 1C9, Canada
| | - Stephen Craik
- EPCOR Water, 9469 Rossdale Rd NW, Edmonton, AB, T5K 2E9, Canada
| | - Bonita E Lee
- Department of Paediatrics, University of Alberta, 1405-87 Ave, Edmonton, AB, T6G 1C9, Canada
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16
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Drudge C, Greco S, Kim J, Copes R. Estimated Annual Deaths, Hospitalizations, and Emergency Department and Physician Office Visits from Foodborne Illness in Ontario. Foodborne Pathog Dis 2018; 16:173-179. [PMID: 30511900 PMCID: PMC6434595 DOI: 10.1089/fpd.2018.2545] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Public Health Ontario is working to estimate the burden of disease from environmental hazards in Ontario, Canada. As part of this effort, we estimated deaths and health care utilization resulting from exposure to pathogens and toxic substances in food. We applied fractions for the proportion of illness attributable to foodborne transmission to the annual (2008–2012) counts of deaths, hospitalizations, emergency department (ED) visits, and physician office visits for 15 diseases (13 pathogen-specific diseases and 2 nonspecific syndromes) captured by administrative health data. Nonspecific gastroenteritis (causative agent unknown) was the dominant disease, accounting for 98% of ED visits, 94% of hospitalizations, and 88% of deaths annually attributed to the 15 diseases. We estimated that foodborne nonspecific gastroenteritis results in ∼137,000 physician office visits (1000/100,000 population), 40,000 ED visits (310/100,000), 6200 hospitalizations (47/100,000), and 59 deaths (0.45/100,000) in Ontario per year (mean estimates). Our results indicate that pathogen-specific approaches to foodborne disease surveillance can substantially underestimate the deaths and illness resulting from exposure to foodborne pathogens and other causes of foodborne illness.
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Affiliation(s)
| | - Susan Greco
- 1 Public Health Ontario, Toronto, Canada.,2 Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - JinHee Kim
- 1 Public Health Ontario, Toronto, Canada.,2 Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Ray Copes
- 1 Public Health Ontario, Toronto, Canada.,2 Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
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