Prevalence of moderate or greater permanent childhood hearing impairment and effectiveness of targeted surveillance for babies who pass newborn hearing screening

OBJECTIVE

To assess the utility of targeted surveillance for the identification of moderate to profound PCHI in babies who pass newborn hearing screening in England and have risk factors.

DESIGN

Retrospective analysis.

STUDY SAMPLE

A total of 3,957,891 children born 01/04/2012-31/03/2018 in England.

RESULTS

A total of 7148 PCHI cases were identified (1.81 per 1,000 babies). 6,707 followed an immediate referral from the screen (1 per 16 referrals), 51 followed targeted surveillance referral (1 per 540 referrals) and 390 without a referral. Audiology uptake was higher following an immediate referral (96.7% overall, 77.2% within NHSP-defined timescales) than following targeted surveillance (63.8% overall, 51.1% within 52 weeks of birth). The screening was 94.5% sensitive overall, with similar sensitivities for each of the risk factors. General linearised logistic regression models identified syndrome as the risk factor with the highest odds ratio (14.08 for all babies, 22.19 for babies without immediate referral). Close family history of hearing loss was the next highest (10.93 for all babies, 12.29 for babies without immediate referral).

CONCLUSION

The evidence for a targeted surveillance programme, based on risk factors, for babies in England who pass the newborn screen is not strong.

Adaptive risk-based targeted surveillance for foreign animal diseases at the wildlife-livestock interface

Animal disease surveillance is an important component of the national veterinary infrastructure to protect animal agriculture and facilitates identification of foreign animal disease (FAD) introduction. Once introduced, pathogens shared among domestic and wild animals are especially challenging to manage due to the complex ecology of spillover and spillback. Thus, early identification of FAD in wildlife is critical to minimize outbreak severity and potential impacts on animal agriculture as well as potential impacts on wildlife and biodiversity. As a result, national surveillance and monitoring programs that include wildlife are becoming increasingly common. Designing surveillance systems in wildlife or, more importantly, at the interface of wildlife and domestic animals, is especially challenging because of the frequent lack of ecological and epidemiological data for wildlife species and technical challenges associated with a lack of non-invasive methodologies. To meet the increasing need for targeted FAD surveillance and to address gaps in existing wildlife surveillance systems, we developed an adaptive risk-based targeted surveillance approach that accounts for risks in source and recipient host populations. The approach is flexible, accounts for changing disease risks through time, can be scaled from local to national extents and permits the inclusion of quantitative data or when information is limited to expert opinion. We apply this adaptive risk-based surveillance framework to prioritize areas for surveillance in wild pigs in the United States with the objective of early detection of three diseases: classical swine fever, African swine fever and foot-and-mouth disease. We discuss our surveillance framework, its application to wild pigs and discuss the utility of this framework for surveillance of other host species and diseases.

Analysis of healthcare-associated infection in patients with pulmonary arterial hypertension associated with congenital heart disease in PICU: Evidence from a tertiary hospital in western China

OBJECTIVE

The present study intends to analyze the targeted surveillance and risk factors for healthcare-associated infection (HAI) in patients with pulmonary arterial hypertension associated with congenital heart disease (CHD-PAH) in a Pediatric intensive care unit (PICU), and provide basis for formulating relevant prevention and control measures of HAI.

METHODS

Children (≤14 years old) who were admitted to the PICU for ≥2 calendar days from January 2018 to December 2021 were included. Targeted surveillance of HAI was described.

RESULTS

A total of 7,828 patients in PICU were monitored, and the total hospitalization days of the patients were 36,174. 108 cases of HAI occurred, with a per-case infection rate of 1.38% and a per-thousand day infection rate of 2.99. 1,129 patients with CHD-PAH were included, among which the total hospitalization days were 1,483. In this subpopulation, 38 cases of HAI were diagnosed, with a per-case infection rate of 3.37% and a per-thousand day infection rate of 25.62. The main site of HAI was lower respiratory tract (43.51%), followed by blood infection (34.26%) and surgical site infection (9.26%). 36 strains of pathogenic bacteria were detected from patients with HAI. The top three pathogens with the highest detection rate were Klebsiella pneumoniae (6 episodes, 16.67%), Enterococcus faecium (6 episodes, 16.67%) and Acinetobacter baumannii (4 episodes, 11.11%). The incidence of VAP, CAUTI and CLABSI was 2.78, 0.08 and 1.66 per 1,000 catheter days respectively. Analysis revealed that patients with CHD-PAH were younger and prone to receive surgical corrections. CHD-PAH could significantly increase the length of ICU stay, ventilator days, times of central venous catheterization and central venous catheterization days. The choice of different central venous catheter types differed significantly between the two groups.

CONCLUSION

Patients with CHD-PAH are characterized with excessive central venous catheterization operations, prolonged indwelling time, and more types of catheterization, which are considered to be risk factors for HAI, thus increasing the length of hospital stay. The clinical etiology is mainly G-bacteria, which requires reasonable selection of antibiotics and strict aseptic operation. Limiting unnecessary invasive procedures is helpful for reducing the incidence of postoperative HAI in PICU.

Local Surveillance and Control of Raccoon Rabies Virus in Striped Skunks (Mephitis mephitis) in Southwestern New Brunswick, Canada

Targeted surveillance for raccoon rabies virus was conducted between February and May 2017, near Waweig, New Brunswick, Canada, in response to detection of a rabid striped skunk (Mephitis mephitis) on 8 February 2017. A total of six skunks, 11 raccoons (Procyon lotor), and two porcupines (Erethizon dorsatum) were live-trapped, euthanized, and tested for rabies virus antigens using the direct rapid immunohistochemical test. Of these, only two skunks tested positive for rabies. All three rabid skunks came from the same location, an abandoned barn used as a denning site. Four of five skunks removed from this barn were males. Feeding, aggression, extreme response to noise and light stimuli, and exposure to porcupine quills were observed in two rabid skunks. No additional cases of rabies in wildlife were detected in the area since 8 March 2017. A targeted surveillance approach that removed potentially infected wildlife followed by localized oral rabies vaccine distribution was implemented in this locality.

Accounting for spatially heterogeneous conditions in local-scale surveillance strategies: case study of the biosecurity insect pest, grape phylloxera (Daktulosphaira vitifoliae (Fitch))

BACKGROUND

Surveillance strategies are often standardized and completed on grid patterns to detect pest incursions quickly; however, it may be possible to improve surveillance through more targeted observation that accounts for landscape heterogeneity, dispersal and the habitat requirements of the invading organism. We simulated pest spread at a local scale, using grape phylloxera (Daktulosphaira vitifoliae (Fitch)) as a case study, and assessed the influence of incorporating spatial heterogeneity into surveillance compared with current, standard surveillance strategies.

RESULTS

Time to detection and spread within and beyond the vineyard were reduced by conducting surveys that target sampling effort in soil that is highly suitable for the invading pest in comparison with standard surveillance strategies. However, these outcomes were dependent on the virulence level of phylloxera because phylloxera is a complex pest with multiple genotypes that influence spread and detectability.

CONCLUSION

Targeting surveillance strategies based on local-scale spatial heterogeneity can decrease the time to detection without increasing the survey cost, and surveillance that targets highly suitable soil is the most efficient strategy for detecting new incursions. In addition, combining targeted surveillance strategies with buffer zones and hygiene procedures, and updating surveillance strategies as additional species information becomes available, will further decrease the risk of pest spread. © 2018 Society of Chemical Industry.

Could African swine fever and classical swine fever viruses enter into the United States via swine products carried in air passengers' luggage?

On average 8,000 pork derived products are annually confiscated by Customs and Border Protection at the United States (US) ports of entry such as international airports, harbours or mail offices. These swine products with unknown sanitary status could pose a risk for foreign animal diseases introduction into the US. This study aimed at analysing the risk of African swine fever virus (ASFV) and classical swine fever virus (CSFV) being introduced into the US through prohibited swine products carried by air passengers (PSPAP) and identifying locations and time periods at higher risk where and when preventive and mitigation measures should be implemented. Our results estimated that the risk for CSFV entry was seven times higher and further spread between US airports than for ASFV. Specifically, the overall mean annual probability of ASFV entry was estimated as 0.061 at 95% confidence interval (CI) [0.007, 0.216] while the probability of CSFV entry was estimated as 0.414 (95% CI [0.074, 1]). For both diseases, July and May were the months at highest risk for entry. For ASFV, the origin countries of those PSPAP that represented the highest risk (above 70% of the total risk) were Ghana, Cape Verde, Ethiopia and the Russian Federation, while for CSFV above 90% of the risk at origin was concentrated in the Dominican Republic and Cuba, followed by India, Colombia, Peru, Ecuador and China. These results could be used to implement and feed real time surveillance systems, which could potentially help customs to increase the detection rate of smuggled products, indicating when and where to look for them. Similarly, these systems could be adapted and implemented to other diseases improving the cost-effectiveness of the resources invested in preventing entrance of diseases via air passengers' luggage.

Prospective analysis of infectious disease surveillance data using syndromic information

In this paper, we describe a Bayesian hierarchical Poisson model for the prospective analysis of data for infectious diseases. The proposed model consists of two components. The first component describes the behavior of disease during nonepidemic periods and the second component represents the increase in disease counts due to the presence of an epidemic. A novelty of our model formulation is that the parameters describing the spread of epidemics are allowed to vary in both space and time. We also show how syndromic information can be incorporated into the model to provide a better description of the data and more accurate one-step-ahead forecasts. These real-time forecasts can be used to identify high-risk areas for outbreaks and, consequently, to develop efficient targeted surveillance. We apply the methodology to weekly emergency room discharges for acute bronchitis in South Carolina.