Final Program and Abstracts - IMED | International Meeting on

2014
IMED
International Meeting
on E m e r g i n g D i s e a s e s
and
Surveillance
Co-sponsored by
ProMED-mail, the Program for Monitoring Emerging Diseases
EcoHealth Alliance
European Society of Clinical Microbiology and Infectious Diseases ( ESCMID)
HealthMap
Skoll Global Threats Fund (SGTF)
World Organisation for Animal Health (OIE )
Organized by the International Society for Infectious Diseases
FINAL PROGRAM
Table
ii
IMED 2014
of
C ontents
International Meeting on Emerging Diseases and Surveillance 2014
Welcome. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Committees. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
General Information. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
Floorplans | Hilton Vienna . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
Program-at-a-Glance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Scientific Program. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
Friday, October, 31, 2014. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
Saturday, November 1, 2014. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
Sunday, November 2, 2014 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
Monday, November 3, 2014. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
Poster Presentations I вЂў Saturday, November 1, 2014. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
Poster Presentations II вЂў Sunday, November 2, 2014. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28
Abstracts. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39
Friday, October 31, 2014
Session 01: MERS-CoV. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40
Session 02: In the Hot Zone: Ebola and MERS-CoV . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40
Session 03: 2014 West African Ebola Virus Outbreak Response . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41
Saturday, November 1, 2014
Session 04: West Nile Fever in the European Union. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42
Session 05: Rapid Diagnostics for Emerging Infectious Threats . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43
Session 06: Oral Presentations: Surveillance and Modeling of EID. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43
Session 07: Global Spread of Antibiotic Resistance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47
Session 08: Pathogen and Host Diversity. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48
Session 09: Ethics and Disease Surveillance. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49
Session 10: ProMED 20th Anniversary Symposium . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (no abstracts)
Session 11: Oral Presentations: Hot Topics in EID . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49
Sunday, November 2, 2014
Session 12: FAO of the UN: Tools for Animal Health. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53
Session 13: Health Care Associated Emerging Infections. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55
Session 14: Launching of the New OIE Global Wildlife Disease Reporting System. . . . . . . . . . . . . . . . . . . . . . . . 56
Session 15: Emerging Viral Threats . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56
Session 16: Things are Heating Up: EID and Climate Change. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57
Session 17: Pastoralism, Rural Communities and the Human Animal Health Interface. . . . . . . . . . . . . . . . . . . . . 58
Session 18: Oral Presentations: High-Consequence Viral Pathogens. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58
Monday, November 3, 2014
Session 19: One Health: From Research to Public Health. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62
Session 20: Oral Presentations: Emerging Respiratory Viruses. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63
Session 21: Changing Disease Landscapes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67
Poster Presentations. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68
Saturday, November 1, 2014
Session 22: Poster Presentations I. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68
Diseases of Animals. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68
Infections Related to Travel and Migration. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68
Influenza and Other Respiratory Infections. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69
Innovations in Diagnostic Tests for Emerging Diseases. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80
New Approaches to Outbreak Surveillance and Monitoring. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 84
New Pathogen Discovery. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93
Outbreak Response and Control . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 96
Public Communication of Outbreaks and Emerging Diseases. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105
Sociopolitical Factors in Disease Emergence. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 108
Vaccines and Emergence of Vaccine Preventable Diseases. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 110
Vectorborne Diseases. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 114
Sunday, November 2, 2014
Session 23: Poster Presentations I I. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 128
Antimicrobial Resistance. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 128
Bioterrorism and Biological Warfare. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 139
Climate Change and Ecological Factors in Disease Emergence. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 139
Diseases at the Interface of Humans, Wildlife and Other Animals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 140
Diseases of Animals. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 155
Ethical Issues in Emerging Diseases and Disease Surveillance. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 161
Foodborne and Waterborne Diseases. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 162
Infections of Public Health Significance. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 166
Outbreak Modeling. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 184
New Pathogen Discovery. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 186
Disclosures. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 187
Index of Authors and Co-Authors. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 189
Welcome
International Meeting on Emerging Diseases and Surveillance 2014
Welcome to the great city of Vienna and the fifth International Meeting on Emerging Diseases
and Surveillance, IMED 2014. Now established as a fixture for those whose work deals with
threats from infectious agents, IMED 2014 will once again bring leading scientists, clinicians and
policy makers together to present new knowledge and breakthroughs and discuss how to
discover, detect, understand, prevent and respond to outbreaks of emerging pathogens.
Since the last IMED, newly emerged diseases and outbreaks of familiar ones have continued to
challenge us and keep us vigilant. The unprecedented and tragic epidemic of Ebola virus disease
in West Africa has galvanized world attention and renewed our resolve to work toward answers
to this and future outbreaks. Many unanswered questions regarding the MERS coronavirus
outbreak in the Middle East remain. Diseases at the human-wildlife interface ranging from rabies
to plague to Nipah virus continue to draw our attention. Growing resistance by pathogens to all
types of therapeutic agents raise fundamental obstacles to our ability to respond to outbreaks
and pandemics. The threat of intentional use of biological agents for nefarious purposes remains
as real as ever.
Since its inception, IMED has been a summit that unifies our approach to pathogens in the
broadest ecological context. Drawing together human and veterinary health specialists, IMED
serves as a true One Health forum where those working in diverse specialties and diverse
regions can meet, discuss, present and challenge one another with findings and new ideas.
This year, over 600 abstracts were submitted. A selection of the best among these will be
presented in two poster sessions and four oral sessions.
A meeting of this scope could not occur without the help of many, and I particularly want
to thank our co-sponsors for making IMED possible: EcoHealth Alliance, the Skoll Global
Threats Fund (SGTF), the European Society of Clinical Microbiology and Infectious
Diseases (ESCMID), HealthMap, and the World Organisation for Animal Health (OIE). We also
acknowledge the generous technical contribution of the Food and Agriculture Organization of
the United Nations (FAO) and the support from Metabiota, the Vienna Convention Bureau, the
Mayor of Vienna and Austrian Airlines.
While pathogens emerge and mutate, our methodology for detection, surveillance, prevention,
control, and treatment also continue to evolve. New approaches to the uses of social media
and data mining, novel laboratory methods, rapid point-of-care diagnostics, risk communication,
political and societal responses to outbreaks have all seen innovation and change that will be
explored at IMED 2014.
Thank you for your participation.
Sincerely,
Larry MADOFF
Chair, Scientific Program Committee
Editor, ProMED-mail, International Society for Infectious Diseases
Boston, USA
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IMED 2014
C ommittees
International Meeting on Emerging Diseases and Surveillance 2014
Scientific Program Committee
Larry Madoff, Boston, MA, USA вЂ“ Chair
Jacques Acar, Paris, France
Daniel BeltrГЎn-Alcrudo, Rome, Italy
Timothy Brewer, Los Angeles, CA, USA
John Brownstein, Boston, MA, USA
Sidi Coulibaly, Ouagadougou, Burkina Faso
Onder Ergonul, Istanbul, Turkey
Elisabeth Erlacher-Vindel, Paris, France
Benson Estambale, Nairobi, Kenya
David Fisman, Toronto, Canada
Antoine Flahault, Paris, France
David Heymann, London, United Kingdom
Jim Hughes, Atlanta, GA, USA
Damien Joly, Nanaimo, BC, Canada
William Karesh, New York, NY, USA
Najwa Khuri-Bulos, Amman, Jordan
Keith Klugman, Seattle, WA, USA
Britta Lassmann, Boston, MA, USA
Daniel Lucey, Washington, DC, USA
Nina Marano, Nairobi, Kenya
Abla Mawadeku, Ottawa, Canada
Norbert Nowotny, Vienna, Austria
and Muscat, Oman
Philip Polgreen, Iowa City, IA, USA
Marjorie Pollack, New York, NY, USA
Natalia Psenichnaya, Rostov-on-Don,
Russian Federation
Arnon Shimshony, Jerusalem, Israel
Mark Smolinski, San Francisco,
CA, USA
Jaime Torres, Caracas, Venezuela
Jack Woodall, Rio de Janeiro, Brazil
Sustaining Sponsor
Metabiota
A for-profit company that develops systems to mitigate microbial threats. Specializing in
disease and pathogen detection, evaluation and response through the integration of field
and lab research with health data analytics. Metabiota has a demonstrated track record
in international collaboration, scientific and public health surveillance capacity-building,
and research with high public health impact. Focused on scientific leadership, community
health development and education, and exploratory research, Metabiota maintains
offices in San Francisco, CA, Washington, DC, and Guangzhou, China.
Co-Sponsors
ProMED-mail, the Program for Monitoring Emerging Diseases
EcoHealth Alliance
European Society of Clinical Microbiology and Infectious Diseases (ESCMID)
HealthMap
Skoll Global Threats Fund (SGTF)
World Organisation for Animal Health (OIE)
Technical Contributor
Food and Agriculture Organization of the United Nations ( FAO)
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IMED 2014
C ommittees
International Meeting on Emerging Diseases and Surveillance 2014
Cooperating Organizations
Austrian Agency for Health and Food Safety (AGES)
Austrian Federal Ministry of Health
Austrian Society for Infectious Diseases (Г–EGIT)
Austrian Society of Hygiene, Microbiology and Preventive Medicine (Г–GHMP)
Austrian Society of Tropical Medicine and Parasitology (Г–GTP)
CIRAD-INRA
EDENext
European Centre for Disease Prevention and Control (ECDC)
European Food Safety Authority (EFSA)
INMI (Istituto Nazionale per le Malattie Infettive "LAZZARO SPALLANZANI")
International Society for Infectious Diseases (ISID)
International Society for Disease Surveillance (ISDS)
University of Veterinary Medicine Vienna вЂ“ (Vetmeduni Vienna)
Contributors
Austrian Airlines
City of Vienna
International Society for Infectious Diseases (ISID)
Vienna Hilton Am Stadtpark
Vienna Convention Bureau
Exhibitors
Applied Maths
Austrian Airlines
Euroimmun
Food and Agriculture Organization of the United Nations (FAO)
International Society for Infectious Diseases (ISID)
We invite you to visit the Exibits in the
Pre-Function Area on the Ground Level.
Organizer & Conference Office
International Society for Infectious Diseases
9 Babcock Street, Unit 3, Brookline, MA 02446, USA
phone: (617) 277-0551 вЂў fax: (617) 278-9113
email: [email protected]
web: http://www.isid.org вЂў http://imed.isid.org
Exhibition Office
Media Plan
Freyung 6
1010 Vienna, Austria
Phone: (+43 1) 536 63 0
Fax: (+43 1) 535 60 16
Email: [email protected]
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IMED 2014
General Information
International Meeting on Emerging Diseases and Surveillance 2014
Opening Hours of the Registration and Information Desk
Friday, October 31, 2014
11:00 вЂ“19:00hrs
Saturday, November 1, 2014
08:00 вЂ“18:00hrs
Sunday, November 2, 2014
08:00 вЂ“18:00hrs
Monday, November 3, 2014
08:00 вЂ“12:00hrs
Congress Venue
Hilton Vienna вЂў Am Stadtpark вЂў 1030 Vienna вЂў Tel: +43 1 717 000 вЂў http://www.hilton.com
Registration Fees
Participants: EUR 505.00
Students: EUR 285.00
Social Program
The Welcome Reception will be held on Friday, October 31 from 17:30 to 19:00hrs
at the Hilton Hotel Vienna on the Gallery (Upper Level).
The MayorвЂ™s Reception will take place on Sunday, November 2 at 19:00hrs at the wine tavern
(Fuhrgassl Huber, Neustift am Walde). An invitation card is needed to gain access to this dinner.
The price is EUR 20,00 per person. Onsite registration is subject to availability. Buses will leave
at 19.00hrs from the Hilton Hotel (side entrance) and will return at approxmately 23.00hrs.
For both functions business attire is appropriate.
Badges
Please wear your name badge at all times during the conference in order to gain access to
the scientific program and all conference functions.
Internet Access
The Hilton provides free internet access in the main hotel lobby. WiFi access in the sleeping
rooms and conference area is available for a special conference fee if you present your IMED
name badge. Tickets can be purchased from the reception desk on the ground level
(EUR 10 for 24 hours).
IMED on
Social Media
Please tweet about IMED:
#IMED2014
Like our facebook page:
https://www.facebook.com/
IMED2014Vienna
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IMED 2014
CME
The IMED 2014 is accredited the European Accreditation Council for Continuing Medical Education (EACCME) to provide the following CME activity for medical specialists. The EACCME is
an institution of the European Union of Medical Specialists (UEMS), www.uems.net.
The IMED 2014 is designated for a maximum of, or up to 18 hours of European external CME
credits. Each medical specialist should claim only those hours of credit that he/she actually
spent in the educational activity.
Through an agreement between the European Union of Medical Specialists and the American
Medical Association, physicians may convert EACCME credits to an equivalent number of
AMA PRA Category 1 Credits.в„ў Information on the process to convert EACCME credit to
AMA credit can be found at www.ama-assn.org/go/internationalcme.
Live educational activities, occurring outside of Canada, recognized by the UEMS-EACCME for
ECMEC credits are deemed to be Accredited Group Learning Activities (Section 1) as defined
by the Maintenance of Certification Program of The Royal College of Physicians and Surgeons
of Canada.
RACE (Veterinary CE)
The American Association of Veterinary State Boards RACE committee has reviewed and
approved IMED 2014 as meeting the Standards adopted by the AAVSB, (maximum CME for
one veterinarian: 16.5). This course meets the requirements for hours of continuing education
in jurisdictions which recognize AAVSB RACE approval; however, participants should be aware
that some boards have limitations on the number of hours accepted in certain categories and/
or restrictions on certain methods of delivery.
All CME forms are included in the congress bag. Please complete and return forms to the ISID
after the conference is over as indicated on the form.
General Information
International Meeting on Emerging Diseases and Surveillance 2014
Poster Presentations
Poster presentations will be held on Saturday, November 1 and Sunday, November 2
from 11.45 to 13.15hrs. During this period all presenters must be available for
discussion at their posters.
Set-up for Poster Presentations I:
Saturday, November 1 from 08:00 to 10:30hrs
Removal: Saturday, November 1 from 16:30 to 18:00hrs
Set-up for Poster Presentations II:
Sunday, November 2 from 08:00 to 10:30hrs
Removal: Sunday, November 2 from 16:30 to 18:00hrs
Poster Areas (Upper Level)
Saturday, November 1, 2014 / Poster Presentations I
11:45вЂ“13:15
Room Bruckner/Mahler/Brahms / Upper Level:
Abstract Number Topic
22.001
Diseases of Animals
22.002 вЂ“ 22.004 Infections Related to Travel and Migration
22.005 вЂ“ 22.041 Influenza and Other Respiratory Infections
22.042 вЂ“ 22.056 Innovations in Diagnostic Tests for Emerging Diseases
22.057 вЂ“ 22.083 New Approaches to Outbreak Surveillance and Monitoring
22.084 вЂ“ 22.094 New Pathogen Discovery
22.095 вЂ“ 22.123 Outbreak Response and Control
22.124 вЂ“ 22.133 Public Communication of Outbreaks and Emerging Diseases
Klimt Ballroom I / Upper Level:
Abstract Number Topic
22.134 вЂ“ 22.138 Sociopolitical Factors in Disease Emergence
22.139 вЂ“ 22.152 Vaccines and Emergence of Vaccine Preventable Diseases
22.153 вЂ“ 22.193 Vectorborne Diseases
Sunday, November 2, 2014 / Poster Presentations II
11:45вЂ“13:15
Room Bruckner/Mahler/Brahms / Upper Level:
Abstract Number Topic
23.001 вЂ“ 23.037 Antimicrobial Resistance
23.038 Bioterrorism and Biological Warfare
23.039 вЂ“ 23.040 Climate Change and Ecological Factors in Disease Emergence
23.041 вЂ“ 23.088 Diseases at the Interface of Humans, Wildlife and Other Animals
23.089 вЂ“ 23.109 Diseases of Animals
23.110 вЂ“ 23.111 Ethical Issues in Emerging Diseases and Disease Surveillance
23.112 вЂ“ 23.126 Foodborne and Waterborne Diseases
Klimt Ballroom I / Upper Level:
Abstract Number Topic
23.127 вЂ“ 23.181 Infections of Public Health Significance
23.182 вЂ“ 23.186 Outbreak Modeling
23.187
New Pathogen Discovery
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IMED 2014
Floorplans
вЂў
Hilton A m Stadtpark Vienna
International Meeting on Emerging Diseases and Surveillance 2014
GROUND LEVEL
Park Congress
Pre-Function
Area
REGISTRATION
PLENARY
EXHIBITION
HALL
COFFEE
FIRST LEVEL
POSTERS
Mahler
Bruckner
Schonberg
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IMED 2014
Gallery
POSTERS
Gallery
Brahms
Gallery
BREAK-OUT SESSIONS
Klimt
Ballroom
1
Klimt
Ballroom
2&3
COFFEE
Program-at-a-Glance
International Meeting on Emerging Diseases and Surveillance 2014
Time Friday, October 31, 2014
Room
11:00вЂ“19:00
14:00вЂ“14:20
14:20вЂ“15:00
15:00вЂ“16:30
16:30вЂ“17:15
17:30вЂ“19:00
Registration and Information Desk
Welcome & Opening
Session I: Plenary Lecture: MERS-CoV Session 2: Plenary Session: In the Hot Zone: Ebola and MERS-CoV
Session 3: Plenary Lecture: Challenges and Controversies
in the 2014 West African Ebola Virus Outbreak Response
Welcome: Cocktail Reception
Foyer/Park Congress/Ground Level
Park Congress/Ground Level
Park Congress/Ground Level
Park Congress/Ground Level
Park Congress/Ground Level
Time Saturday, November 1, 2014
Room
3 Break-out Sessions:
08:30вЂ“09:30 Session 4: West Nile Fever in the European Union
09:30вЂ“10:30 Session 5: Rapid Diagnostics for Emerging Infecious Threats
08:30вЂ“10:30 Session 6: Oral Presentations: Surveillance and Modeling
of Emerging Infectious Diseases
10:30вЂ“11:00 Coffee Break
11:00вЂ“11:45 Session 7: Plenary Lecture: Global Spread of Antibiotic Resistance
11:45вЂ“13:15 Poster Presentations I (Session 22) 14:30вЂ“16:00 2 Break-out Sessions:
Session 8: Pathogen and Host Diversity
Session 9: Ethics and Disease Surveillance
16:00вЂ“16:30 Coffee Break
16:30вЂ“18:00 2 Break-out Sessions:
Session 10: ProMED 20th Anniversary Symposium
Session 11: Oral Presentations: Hot Topics in EID
Time Sunday, November 2, 2014
08:30вЂ“10:30 2 Break-out Sessions:
Session 12: FAO of the UN: Tools for Animal Health
Session 13: Health Care Associated Emerging Infections
10:30вЂ“11:00 Coffee Break
11:00вЂ“11:45 Session 14: Plenary Lecture: Launching of the New OIE
Global Wildlife Disease Reporting System
11:45вЂ“13:15 Poster Presentations II (Session 23)
14:30вЂ“16:00 2 Break-out Sessions:
Session 15: Emerging Viral Threats
Session 16: Things are Heating Up: EID and Climate Change
16:00вЂ“16:30 Coffee Break
16:30вЂ“18:00 2 Break-out Sessions:
Session 17: Pastoralism, Rural Communities and the Human
Animal Health Interface in East Africa
Session 18: Oral Presentations: High-Consequence Viral Pathogens
19:00вЂ“22:30 MayorвЂ™s Reception (Dinner)
Gallery/Upper Level
Park Congress/Ground Level
Park Congress/Ground Level
Klimt Ballroom 2&3/Upper Level
Ground Level and Upper Level
Park Congress/Ground Level
Bruckner/Mahler/Brahms/Upper Level
and Klimt Ballroom 1/Upper Level
Park Congress/Ground Level
Klimt Ballroom 2&3/Upper Level
Ground Level and Upper Level
Park Congress/Ground Level
Klimt Ballroom 2&3/Upper Level
Room
Park Congress/Ground Level
Klimt Ballroom 2&3/Upper Level
Ground Level and Upper Level
Park Congress/Ground Level
Bruckner/Mahler/Brahms/Upper Level
and Klimt Ballroom 1/Upper Level
Park Congress/Ground Level
Klimt Ballroom 2&3/Upper Level
Ground Level and Upper Level
Park Congress/Ground Level
Klimt Ballroom 2&3/Upper Level
Wine Tavern (Fuhrgassl Huber)
Time Monday, November 3, 2014
Room
08:30вЂ“10:30
10:30вЂ“11:00
11:00вЂ“11:45
2 Break-out Sessions:
Session 19: One Health: From Research to Public Health
Session 20: Oral Presentations: Emerging Respiratory Viruses
Coffee Break
Session 21: Plenary Lecture: Changing Disease Landscapes
Park Congress/Ground Level
Klimt Ballroom 2&3/Upper Level
Ground Level and Upper Level
Park Congress/Ground Level
The program is subject to changes!
7
IMED 2014
Scientific Program
FRIDAY вЂў October 31, 2014
International Meeting on Emerging Diseases and Surveillance 2014
Room: Park Congress
14:00вЂ“14:20
Ground Level
Friday, October 31, 2014
Welcome by the International Society for Infectious
Diseases (ISID)
Keith Klugman
Seattle, WA (USA)
FRIDAY
вЂў
October 31, 2014
Opening Session
Welcome to Vienna
Norbert Nowotny
Vienna (Austria)
Official Opening of the Conference
Sabine Oberhauser
Minister of Health, Austria
Vienna (Austria)
Welcome to IMED 2014
Larry Madoff
Boston, MA (USA)
Session 02
Plenar y Session
In the Hot Zone: Ebola and
MERS-CoV
Co-Chairs:William Karesh, USA
Oyewale Tomori, Nigeria
Room: Park Congress
15:00вЂ“16:30
Ground Level
Friday, October 31, 2014
02.001Why did the camel kiss the bat?
The ecology and animal origins of MERS-CoV
K. Olival
New York, NY (USA)
02.002Laboratory preparedness for
Ebola and MERS-CoV
M. Koopmans
Rotterdam (Netherlands)
02.003From the frontline of the Ebola crisis
H. de Clerck
Jette (Belgium)
Session 03
Plenar y Lecture
Challenges and Controversies in
the 2014 West African Ebola Virus
Outbreak Response
Chair: Jonathan Cohen, United Kingdom
Room: Park Congress
16:30вЂ“17:15
Ground Level
Friday, October 31, 2014
Session 01
Keynote Plenar y Lecture
MERS-CoV
03.001Challenges and controversies in the 2014 West
African Ebola virus outbreak response
A. Duse
Johannesburg (South Africa)
Chair: Norbert Nowotny, Austria
Welcome Cocktail Reception
Room: Park Congress
14:20вЂ“15:00
Ground Level
Friday, October 31, 2014
Gallery
Upper Level
01.001MERS-CoV
Z. Memish
Riyadh (Saudi Arabia)
8
IMED 2014
17:30вЂ“19:00
Friday, October 31, 2014
Scientific Program
SATURDAY вЂў November 1, 2014
International Meeting on Emerging Diseases and Surveillance 2014
Session 04
Session 06
Break-out Session
Oral Presentations
West Nile Fever in the European
Union: Challenges for Integrated
Surveillance and Control
Surveillance and Modeling of
Emerging Infectious Diseases
Co-Chairs:Celine Gossner, Sweden
Tom Yuill, USA
Room: Park Congress
08:30вЂ“09:30
Ground Level Saturday, November 1, 2014
Developed in collaboration with ECDC and EFSA
Session 05
Break-out Session
Rapid Diagnostics for
Emerging Infectious Threats
Co-Chairs:Giuseppe Cornaglia, Italy
Ron Dagan, Israel
Room: Park Congress
09:30вЂ“10:30
Ground Level Saturday, November 1, 2014
05.001Rapid diagnosis of MDR gram-negatives
G. Cornaglia
Verona (Italy)
05.002Rapid diagnosis of invasive mycosis
C. Lass-FlГ¶rl
Innsbruck (Austria)
05.003Mobilization of samples and biocontainment
laboratories for the diagnosis of risk group 4
agents in outbreak response
G. Ippolito
Rome (Italy)
Co-sponsored by ESCMID
06.002The worldвЂ™s first application of participatory
surveillance at a mass gathering: FIFA World Cup
2014, Brazil
W. Oliveira, G. S. Dimech, O. B. L. N. Leal-Neto,
M. Libel, M. Smolinski
BrasГlia (Brazil), Recife, Pernambuco (Brazil),
San Francisco, CA (USA)
06.003Communicable disease surveillance during the
2014 FIFA World Cup вЂ“ Rio de Janeiro State,
Brazil
X. Marincic, R. Chitale, A. Marty, R. De Santis,
Y. Aga, A. Chieppe
Miami, FL (USA), Silver Spring, MD (USA),
Rio de Janeiro (Brazil), Rotterdam (Netherlands)
November 1, 2014
04.003Integrated West Nile fever surveillance:
Experience of Italy
P. Calistri
Teramo (Italy)
06.001Making detection and response to all events
threatening human health faster: Guidance for
early warning and response with focus on
event-based surveillance
P. Nabeth, J. Guerra, Y. Bayugo, P. Barboza
Lyons (France)
вЂў
04.002Status of West Nile fever surveillance in animals
in the European Union
A. Gervelmeyer
Parma (Italy)
Room: Klimt Ballroom 2&3
08:30вЂ“10:30
Upper Level
Saturday, November 1, 2014
SATURDAY
04.001Status of West Nile fever surveillance in humans
in the European Union
L. Marrama Rakotoarivony
Stockholm (Sweden)
Co-Chairs:Timothy Brewer, USA
Natalia Pshenichnaya, Russian Federation
06.004Estimating illness incidence and investigating outbreaks using a multi-purpose population-based
reporting cohort in Sweden, 2013вЂ“2014
H. Merk, M. Edelstein, A. Wallensten
Solna (Sweden)
06.005Mapping of networks to detect priority zoonoses
in Jordan
E. Sorrell, S. Kornblet, N. Maswdeh, M. El
Azhari, R. Katz, J. Fischer
Washington, DC (USA), Amman (Jordan)
06.006A University driven approach to engaging communities in control of infectious diseases at the
human wildlife interface: Demonstration site
survey in Kilosa district, Tanzania
H. M. Amuguni, R. Mdegela, J. Killewo,
C. Rioux
North Grafton, MA (USA), Morogoro (Tanzania),
Dar-es-Salaam (Tanzania), Boston, MA (USA)
06.007Community-based disease surveillance using
mobile technology and the Red Cross/Red
Crescent volunteer network
A. McClelland
Petit Saconnex (Switzerland)
cancelled 9
IMED 2014
Scientific Program
SATURDAY вЂў November 1, 2014
International Meeting on Emerging Diseases and Surveillance 2014
06.008Local transmission networks of community and
hospital associated pathogens
G. Almogy, A. Bernevig, G. Almogy, A. E. Moses,
R. Nir-Paz
Tel Aviv (Israel), Princeton, NJ (USA), Jerusalem
(Israel)
06.009Developing a real-time syndromic surveillance system based on the monitoring of drug
purchases in pharmacies: The OpenHealth.fr
experience
P. GuГ©rin, V. Auvigne
Vannes (France), Angers (France)
SATURDAY
вЂў
November 1, 2014
06.010Design of optimal surveillance networkВ for
biosafety: A value of information model
M. Convertino
Minneapolis, MN (USA)
06.011Understanding the spatio-temporal risks for
bluetongue outbreaks across south India using
space-time Bayesian Poisson regression modelling
M. M. Chanda, D. J. Rogers, S. Carpenter, G.
Prasad, M. Gajendragad, B. V. Purse
Oxford (United Kingdom), Pirbirght (United
Kingdom), New Delhi (India), Bangalore (India),
Wallingford (United Kingdom)
06.012Rift Valley fever risk mapping and modelling in
Tanzania
C. Sindato, E. D. Karimuribo, J. Paweska, L. E.
Mboera, K. B. Stevens, G. Dautu, F. Kivaria, D. U.
Pfeiffer
Morogoro (Tanzania), Snadringham-Johannesburg,
Gauteng (South Africa), Dar es Salaam (Tanzania),
London (United Kingdom), Lusaka (Zambia)
Coffee Break
Ground Level
& Upper Level
10:30вЂ“11:00
Saturday, November 1, 2014
Session 07
Plenar y Lecture
Global Spread of
Antibiotic Resistance
Chair: Britta Lassmann, USA
Room: Park Congress
11:00вЂ“11:45
Ground Level Saturday, November 1, 2014
07.001Global spread of antibiotic resistance
R. Laxminarayan
New Delhi (India)
10
IMED 2014
Poster Presentations I (Session 22)
Saturday, November 1, 2014
11:45вЂ“13:15
Bruckner/Mahler/Brahms - Upper Level
and Klimt Ballroom 1 - Upper Level
Sessions 22.001вЂ“22.193 (see pages 17вЂ“27)
Session 08
Break-out Session
Pathogen and Host DiversityвЂ”
Are There Clues that Can
Help Us Prevent Emerging
Infectious Diseases?
Co-Chairs:Kevin Olival, USA
Jack Woodall, Brazil
Room: Park Congress
14:30вЂ“16:00
Ground Level Saturday, November 1, 2014
08.001Can host breadth and phylogeny portend viral
emergence?
K. Olival
New York, NY (USA)
08.002VirodiversityвЂ”How many viruses are out there?
S. J. Anthony
New York, NY (USA)
08.003Ebola, SARS, MERS, oh my, can we limit
outbreaks?
W. Karesh
New York, NY (USA)
08.004Wrap upвЂ”The big picture
P. Daszak
New York, NY (USA)
Co-Sponsored by EcoHealth Alliance
Session 09
Break-out Session
Ethics and Disease Surveillance
Co-Chairs:Effy Vayena, Switzerland
Rana Hajjeh, USA
Room: Klimt Ballroom 2&3
14:30вЂ“16:00
Upper Level
Saturday, November 1, 2014
09.001Disease surveillance in the era of big data
E. Vayena
Zurich (Switzerland)
09.002Guidelines for ethical disease surveillanceвЂ”
WHO perspective
A. Reis
Geneva (Switzerland)
Scientific Program
SATURDAY вЂў November 1, 2014
International Meeting on Emerging Diseases and Surveillance 2014
09.003Big dataвЂ”Healthy future?
Using big data for public health
S. Wallace
Leicester (United Kingdom)
Coffee Break
Ground Level
& Upper Level
16:00вЂ“16:30
Saturday, November 1, 2014
Session 10
Break-out Session
Co-Chairs:Stephen Morse, USA
Marjorie Pollack, USA
10.002Ending pandemics in our lifetime
M. Smolinski
San Francisco, CA (USA)
10.003Innovations in disease detection
J. Brownstein
Boston, MA (USA)
Round Table Discussion
Session 11
Oral Presentations
Hot Topics in Emerging Infectious Diseases
Co-Chairs:Hanna Nohynek, Finland
Jennifer Garland, USA
Room: Klimt Ballroom 2&3
16:30вЂ“18:00
Upper Level
Saturday, November 1, 2014
11.001Visceral Leishmaniasis and HIV co-infection in
Bihar, India: Long-term effectiveness and treatment outcomes with Liposomal Amphotericin B
(AmBisome)
T. Sunyoto, S. Burza, P. Sinha, R. Mahajan, J. van
Griensven, P. Das, M. Gonzalez Sanz
Delhi (India), Patna (India), Antwerp (Belgium),
London (United Kingdom)
11.002Past, present and future of Chagas disease in
Spain (1997вЂ“2011)вЂ”A descriptive study
Z. Herrador, E. Rivas, A. Gherasim, P. Aparicio,
A. Benito
Madrid (Spain), Tenerife (Spain)
11.006Re-emergence of brucellosis in domestic
ruminant animals of the Karamoja pastoral subregion in Uganda
D. B. Ndumu, P. Otto, R. Mwebe,
E. M. Namukose, K. J. N. Mugabi, J. Serrugga,
A. Kagirita, M. Bahati, C. Rutebarika, J. Zingeser
Entebbe (Uganda), Rome (Italy),
Kampala (Uganda)
November 1, 2014
10.00120 years of outbreak reporting
J. Woodall, S. Morse
Rio de Janeiro (Brazil), New York, NY (USA)
11.005Novel mycobacterial spp in the Serengeti
ecosystems: Potential implications for human
and animal health
B. Z. Katale, M. Matee, E. Mbugi,
M. Rweyemamu, P. D. Van Helden, R. M. Warren,
J. Keyyu, S. Kendall, H. Docrell, A. L. Michel
Dar es Salaam (Tanzania), Morogoro (Tanzania),
Tygerberg (South Africa), Arusha (Tanzania),
London (United Kingdom), Pretoria (South Africa)
вЂў
Room: Park Congress
16:30вЂ“18:00
Ground Level Saturday, November 1, 2014
11.004A pilot study evaluating the level of antimicrobial resistance in Salmonella and Campylobacter
isolated from poultry farms
T. Gaydos, S. Tilley, R. Berghaus, R. Singer,
C. Hofacre
Athens, GA (USA), St. Paul, MN (USA)
SATURDAY
ProMED 20th Anniversary
Symposium: Innovations in
Outbreak Detection
11.003Description and reporting of 303 probable neurocysticercosis cases identified by CT-brain scan
imaging and hospital record: A one year retrospective medical record review utilizing active
surveillance in a Southern California
community hospital
J. Garland, W. Robbins, C. Croker
Los Angeles, CA (USA)
11.007Invasive non-capsulated Haemophilus influenzae
in pregnancy and the newbornвЂ”An underrecognised pathogen
S. Collins, M. Ramsay, H. Campbell, S. Flynn,
N. Fry, D. Litt, M. Slack, S. Ladhani
London (United Kingdom)
11.008Cholera outbreak in a prison in
Port au Prince, Haiti, October 2013
W. Pierre, P. Dely, S. Corvil,
G. Suarez-Rangel
Delmas (Haiti), Bogota (Colombia)
11.009Above and beyond individual exposure:
Ward-level antibiotic prescribing is the principal
predictor of increased Clostridium difficile
infection risk
K. A. Brown, K. Valenta, D. Fisman, A. Simor,
N. Daneman
Salt Lake City, UT (USA), Montreal, QC (Canada),
Toronto, ON (Canada), 1 KingвЂ™s College Cir, ON
(Canada)
11
IMED 2014
Scientific Program
SUNDAY вЂў November 2, 2014
International Meeting on Emerging Diseases and Surveillance 2014
Session 12
Break-out Session
Food and Agriculture
Organization (FAO) of the UN:
Tools for Animal Health
Co-Chairs:Arnon Shimshony, Israel
Ulrich Herzog, Austria
SUNDAY
вЂў
November 2, 2014
Room: Park Congress
08:30вЂ“10:30
Ground Level
Sunday, November 2, 2014
12.001The progressive control pathway (PCP) for
transboundary animal diseases, a bottom-up
approach for disease control
E. Raizman
Rome (Italy)
12.002Global animal disease surveillance and
health information tools
J. Pinto
Rome (Italy)
12.003Tackling emergency diseases head on through
good emergency management practice (GEMP)
I. Douglas
Rome (Italy)
12.004Tools supporting laboratory capacities and
information sharing
F. Claes
Rome (Italy)
12.005Research tools supporting livestock development
and food security; Peste des petits ruminants as a
working example
W. Dundon
Vienna (Austria)
With a technical contribution from the Food and Agriculture
Organization (FAO) of the United Nations
Session 13
Break-out Session
Health Care Associated
Emerging Infections
Co-Chairs:Philip Polgreen, USA
Onder Ergonul, Turkey
Room: Klimt Ballroom 2&3
08:30вЂ“10:30
Upper Level
Sunday, November 2, 2014
13.001Contact networks and emerging infections
at local, national and global levels
P. Polgreen
Iowa (USA)
12
IMED 2014
13.002The role of biologic therapies in
emerging infections
J. W. Baddley
Birmingham, AL (USA)
13.003Emerging infections in transfusion and
transplantationвЂ”An under-recognized
mode of transmission
M. Kuehnert
Atlanta, GA (USA)
13.004Emerging medical device-related infections
around the world
D. K. Warren
Saint Louis (USA)
Coffee Break
Ground Level
& Upper Level
10:30вЂ“11:00
Sunday, November 2, 2014
Session 14
Plenar y Lecture
Launching of the New OIE Global
Wildlife Disease Reporting
System: WAHIS вЂ“ Wild
Chair: Jacques Acar, France
Room: Park Congress
11:00вЂ“11:45
Ground Level
Sunday, November 2, 2014
14.001Launching of the new OIE global wildlife
disease reporting system: World Animal Health
Information System (WAHIS)
P. Caceres
Paris (France)
Poster Presentations II (Session 23)
Saturday, November 1, 2014
11:45вЂ“13:15
Bruckner/Mahler/Brahms - Upper Level
and Klimt Ballroom 1 - Upper Level
Sessions 23.001вЂ“23.187 (see pages 28вЂ“38)
Session 15
Break-out Session
Emerging Viral Threats
Co-Chairs:Antoine Flahault, France
Sidi Coulibaly, Burkina Faso
Room: Park Congress
14:30вЂ“16:00
Ground Level
Sunday, November 2, 2014
15.001Ebola and its spread in West Africa
O. Tomori
Lagos (Nigeria)
Scientific Program
SUNDAY вЂў November 2, 2014
International Meeting on Emerging Diseases and Surveillance 2014
15.002Avian influenza studies at the human-animal
interface
M. Koopmans
Rotterdam (Netherlands)
15.003ChikungunyaвЂ™s entry into the Americas
A. Flahault
Paris (France)
Session 16
Break-out Session
Things Are Heating Up:
Emerging Infectious Diseases
and Climate Change
Co-Chairs:David Fisman, Canada
Keith Klugman, USA
Room: Klimt Ballroom 2&3
14:30вЂ“16:00
Upper Level
Sunday, November 2, 2014
16.001Indirect effects of climate on disease emergence:
Population stress and migration and emerging
infectious diseases
D. Fisman
Toronto, ON (Canada)
16.002Water, climate and disease emergence
A. Greer
Guelph, ON (Canada)
16:00вЂ“16:30
Sunday, November 2, 2014
Session 17
Break-out Session
Pastoralism, Rural Communities
and the Human Animal Health
Interface in East Africa
Co-Chairs:Bilal Butt, USA
Benson Estambale, Kenya
Room: Park Congress
16:30вЂ“18:00
Ground Level
Sunday, November 2, 2014
17.001Staying mobile, staying healthy: Pastoralism,
mobility, and human health in the drylands
of East Africa
B. Butt
Ann Arbor, MI (USA)
High-Consequence
Viral Pathogens
Co-Chairs:Larry Lutwick, USA
Keith Klugman, USA
Room: Klimt Ballroom 2&3
16:30вЂ“18:00
Upper Level
Sunday, November 2, 2014
18.001Ebola virus disease outbreak in Nigeria:
Lessons to learn
C. Althaus, S. Gsteiger, N. Low
Berne (Switzerland)
18.002Study of the impact of canine distemper and
rabies viruses on the red fox population in
Northern Italy trough a microsatellite analysis
outlining the population genetic structure
B. Zecchin, M. De Nardi, B. Crestanello,
P. Nouvellet, M. Babbucci, C. A. Donnelly,
C. Vernesi, A. Milani, P. De Benedictis, G. Cattoli
Legnaro, Padova (Italy), San Michele AllвЂ™adige
(Italy), London (United Kingdom)
18.003A surveillance of Ebola outbreak disease at
TГ©limГ©lГ©, Guinea Conakry 2014
J. M. V. Namahoro, S. Mehtar
Cape Town (South Africa)
18.004First deployment of the European mobile
laboratory in the course of the
Guinea Ebola outbreak
K. Stoecker, E. Fleischmann, S. Mely,
E. Newman, S. Meschi, B. Becker-Ziaja,
M. Gabriel, A. DiCaro, S. Gunther, R. WГ¶lfel
Munich (Germany), Lyons (France),
Porton Down (United Kingdom),
Rome (Italy), Hamburg (Germany)
18.005Ebola preparedness and response: The role
of a development organisation in Freetown,
Sierra Leone
S. Rokadiya, O. Johnson, P. Arkell, M. Lado,
C. Brown, G. Deen, E. Hanciles
Freetown (Sierra Leone)
November 2, 2014
Ground Level
& Upper Level
Oral Presentations
вЂў
Coffee Break
Session 18
SUNDAY
16.003Unraveling disease signatures in climate for the
improvement of disease prediction
X. Rodo
Barcelona (Spain)
17.002Reaching the fifth child: Operational challenges
for polio eradication among pastoralist
communities
V. Gammino
Atlanta, GA (USA)
17.003Control of zoonotic diseases: A route to poverty
alleviation among livestock-keeping communities
E. Fevre
Liverpool (United Kingdom)
17.004Integrated human and animal health surveillance
and services for remote rural communities
E. Schelling
Basel (Switzerland)
13
IMED 2014
Scientific Program
SUNDAY вЂў November 2, 2014
International Meeting on Emerging Diseases and Surveillance 2014
18.006Syndromic approach to diagnostics of febrile
travellers as a basis for surveillance of emerging
arboviral diseases
N. Cleton, J. Wagenaar, A. van der Eijk,
J. Reimerink, E. van Gorp, C. Reusken,
M. Koopmans
Bilthoven (Netherlands),
Rotterdam (Netherlands)
18.007Outbreak of Dengue fever in Dar es Salaam,
Tanzania during 2014: Preliminary results from
an outbreak investigation
F. Vairo, L. E. Mboera, P. De Nardo, N. Oriyo,
S. Meschi, E. Nicastri, A. Minha, S. Rumisha,
M. Malechela, G. Ippolito
Rome (Italy), Dar es Salaam (Tanzania),
Rome (Italy), Tanga (Tanzania)
SUNDAY
вЂў
November 2, 2014
18.008Epidemiology of West Nile virus and endemic
arboviruses in neurological disease in South
Africa: A One Health approach
M. Venter, J. Williams, C. van Eeden, S. van
Niekerk, V. Stivaktas, M. Pretorius, M. Rakgotho,
L. Braack, P. Almeida, R. Swanepoel
Pretoria (South Africa), Johannesburg
(South Africa), Lisboa (Portugal)
14
IMED 2014
18.009A strategy to estimate unknown viral diversity
in mammals
S. J. Anthony
New York, NY (USA)
18.010Foot and mouth disease epizootic in the Maghreb
(2014): Sequence of events and adopted strategy
A. Benkirane, A. Shimshony
Rabat (Morocco), Jerusalem (Israel)
MayorвЂ™s Reception
Sunday, November 2, 2014
19:00вЂ“23:00
Wine Tavern (Fuhrgassl Huber)
Buses will leave at 19.00hrs from the Hilton Hotel (side
entrance) and will return to the Hilton at approximately
23.00hrs
Scientific Program
MONDAY вЂў November 3, 2014
International Meeting on Emerging Diseases and Surveillance 2014
Session 19
Break-out Session
One Health: From Research to
Public Health
Co-Chairs:Thierry Lefrancois, France
Jan Clement, Belgium
Room: Park Congress
08:30вЂ“10:30
Ground Level
Monday, November 3, 2014
19.001State-space models, risk maps and public health:
One Health approach of hantavirus infections
K. Tersago
Antwerp (Belgium)
19.002From risk maps to risk alleviation in public
health: Examples for hantavirus and CCHF virus
infections
K. Dressel
Munich (Germany)
19.003One Health as an every-day work: Example of
Rift Valley fever in the animal and human health
network in South-western Indian Ocean
E. Cardinale
Ste. Clotilde (France)
19.004How to improve the practical implementation
of One Health?
E. Schelling
Basel (Switzerland)
Developed in collaboration with EDENext
Session 20
Oral Presentations
Emerging Respiratory Viruses
Co-Chairs:Tam Garland, USA
Nilufar Rakhmanova, Uzbekistan
Room: Klimt Ballroom 2&3
08:30вЂ“10:30
Upper Level
Monday, November 3, 2014
20.005Understanding the epidemiology of H5N1 and
H9N2 influenza virus outbreaks in Nepal
M. Akram, R. B. Dissanayake, K. S. Bisht, P.
Tshering, C. Shrestha, K. C. Thakuri, P. Manandhar,
S. P. Gautam, D. Castellan, M. S. Oberoi
Lalitpur (Nepal), Kathmandu (Nepal), Bangkok
(Thailand)
20.006 Surveillance for avian influenza in wild birds and
domestic poultry surrounding the wild birdвЂ™s
sanctuaries in Viet Nam, from March, 2009 to
October, 2012
T. L. Pham
Hanoi (Viet Nam)
cancelled
20.007Audience segmentation as a risk communication strategy for preventing complacency toward
highly pathogenic avian influenza
J. M. Kreslake, Y. Wahyuningrum, B. Safi,
M. E. Figueroa, D. Storey
Baltimore, MD (USA)
20.008Active surveillance of avian influenza A/H5
and H7 viruses at live bird markets in Vietnam,
2013вЂ“2014
D. T. Nguyen, T. N. Nguyen, T. L. To,
T. D. Nguyen
Hanoi (Viet Nam)
20.009What is the evidence for influenza transmission
aboard aircraftвЂ”A systematic review
C. Adlhoch, K. Leitmeyer
Stockholm (Sweden)
20.010Impact of national influenza vaccine campaign on
respiratory illness in Thailand, 2010вЂ“2011
P. Silaporn, S. Jiamsiri
Nonthaburi (Thailand)
November 3, 2014
20.011Selective pressure acting on influenza
neuraminidase gene: A complementary approach
for studying the emergence and evolution of antiviral drug resistance and reduced susceptibility
V. C. P. M. Correia, A. Abecasis,
H. Rebelo-de-Andrade
Lisbon (Portugal)
вЂў
20.002Detecting H5N1-HPAI virus variants in the
endemic situation: Developing an integrated
web-based, surveillance platform (вЂњIVM OnlineвЂќ)
P. A. Durr, N. Hartaningsih, H. Wibawa,
P. Pudjiatmoko, S. H. Irianingsih, R. Dharmawan, J.
McGrane, P. Selleck, M. Kim Torchetti,
W. Sastraningrat
Geelong (Australia), Jakarta (Indonesia), Wates
(Indonesia), Ames, IA (USA), Jimbaran (Indonesia)
20.004Avian influenza surveillance and pathogenic
potential assessment of animal influenza viruses
in Russia
K. Sharshov, M. Sivay, A. Glushchenko,
O. Kurskaya, M. Gulyaeva, A. Alekseev, A. Yurlov,
A. Shestopalov
Novosibirsk (Russian Federation)
MONDAY
20.001The distribution pattern of avian influenza
H5N1 viruses in the high transmission area
in Java, Indonesia
T. A. Garjito, J. Jastal, M. Mujiyanto,
W. Widoretno, Y. Udin
Salatiga (Indonesia), Donggala (Indonesia),
Jakarta (Indonesia)
20.003Survey for avian influenza A virus subtypes H5,
H9 and H7 in the live bird marketsвЂ™
environment in Bangladesh
P. K. Biswas, M. Giasuddin, B. K. Nath,
M. Z. Islam, N. C. Nath, M. Yamage
Chittagong (Bangladesh), Dhaka (Bangladesh)
15
IMED 2014
Scientific Program
MONDAY вЂў November 3, 2014
International Meeting on Emerging Diseases and Surveillance 2014
20.012Occupational exposure to dromedary camels is a
risk factor for infection with MERS-CoV:
A comparative serologic study
C. Reusken, E. Farag, B. Haagmans,
G.-J. Godeke, A. Ibrahim, S. Al Dhahiry, S. Raj,
K. Mohran, M. AlHajri, M. Koopmans
Rotterdam (Netherlands), Doha (Qatar),
Bilthoven (Netherlands)
20.013Experimental infection of dromedary camels with
Middle East respiratory syndrome coronavirus
T. Schountz, A. Malmlov, D. Adney, V. Brown,
E. De Wit, N. van Doremalen, S. Quackenbush,
V. Munster, R. Bowen
Fort Collins, CO (USA), Hamilton, MT (USA)
MONDAY
вЂў
November 3, 2014
20.014Detection of new genetic variants of
betacoronaviruses in endemic frugivorous
bats of Madagascar
J.-M. Heraud, N. Razanajatovo, L. Nomenjanahary,
D. Wilkinson, M.-M. Olive, J. Razafimanahaka,
S. Goodman, R. Jenkins, J. Jones
Antananarivo (Madagascar), Sainte Clotilde
(France), Chicago, IL (USA), Gwynedd (United
Kingdom)
16
IMED 2014
Coffee Break
Ground Level
& Upper Level
10:30вЂ“11:00
Monday, November 3, 2014
Session 21
Plenar y Lecture
Changing Disease Landscapes
Chair: Larry Madoff, USA
Room: Park Congress
11:00вЂ“11:45
Ground Level
Monday, November 3, 2014
21.001Changing disease landscapes: Using the
pressure-state-response model
J. Lubroth
Rome (Italy)
Poster Presentations I
SATURDAY вЂў November 1, 2014
International Meeting on Emerging Diseases and Surveillance 2014
Session 22
Poster Presentations I
Saturday, November 1, 2014
11:45вЂ“13:15
Bruckner/Mahler/Brahms вЂў Upper Level
Diseases of Animals
22.001Lumpy skin disease: Disease emergence, clinical
signs, complications and preliminary associated
economic losses in Jordan
S. M. Abutarbush
Al Ain (United Arab Emirates)
Infections Related to Travel and Migration
Influenza and Other Respiratory Infections
22.005Co-circulation of H7N9 virus with other HA
subtypes in live poultry markets
J. Li, J. Pan
Hangzhou (China)
22.006Simultaneous detection of 5 respiratory
bacteria by Seegene Anyplex II RB5 assay
W. L. Tan, K. X. L. Chan, K. S. Chan,
L. L. E. Oon
Singapore (Singapore)
22.007Ethnic disparities in healthcare use for
respiratory infections
S. Della Smirra, M. Campitelli, L. Rosella,
M. Chiu, N. Daneman, J. Smylie, J. Kwong
Toronto, ON (Canada)
22.008Predicting surges in influenza-like illness-related
emergency department visits using spatiotemporal models
L. J. Martin, Q. Liu, H. Dong, J. Talbot, Y. Yasui
Edmonton, AB (Canada)
22.012Sero-surveillance of Avian influenza A (H7N9) in
high risk provinces of Lao PDR
B. Douangngeun
Vientiane (PeopleвЂ™s Democratic Republic of Lao)
22.013Antiviral susceptibility and antigenic characterization among 2012вЂ“2013 seasonal influenza viruses
in UgandaвЂ”Implications for management and
pandemic responses
J. T. Kayiwa, T. Byaruhanga, B. Namagambo,
N. Owor, R. Chiizar, B. Bakamutumaho,
J. J. Lutwama
Entebbe (Uganda)
November 1, 2014
22.004Ten years tuberculosis trend in Gambella
Regional Hospital, South Western Ethiopia
G. A. Gulich, G. A. Chemidi, K. T. Tafese
Gambella (Ethiopia), Addis Ababa (Ethiopia)
22.011Healthcare seeking behavior for respiratory illness in a northern province of Vietnam
N. T. T. Yen, J. Patridge, N. H. Tuan, T. P. Nguyen,
N. B. Thuy, N. V. Thom, A. Luliano, D. T. Trang,
J. C. Kile, N. T. Hien
Hanoi (Viet Nam), Thai Binh (Viet Nam),
Atlanta, GA (USA)
вЂў
22.003International rotations: An initiative to educate
residents in tropical medicine and immigrant
health
P. Lichtenberger, S. Doblecki-Lewis
Miami, FL (USA)
22.010A systematic analysis of investments in influenza
awarded to UK institutions, 1997вЂ“2010
J. R. Fitchett, M. Head, R. Atun
London (United Kingdom), Boston, MA (USA)
SATURDAY
22.002Migrant women's health: Molecular epidemiology
of Human Papillomavirus (HPV) and Chlamydia
trachomatis infections
E. R. Frati, E. Fasoli, S. Bianchi, M. Martinelli,
D. Colzani, P. Olivani, E. Tanzi
Milan (Italy)
22.009Surveillance of respiratory and gastrointestinal
virus infection from adults and children in
Guangdong, China
D. Zhang, X. Zhu, L. Xu, Z. He, J. Wu, W. Wen,
Y. Hu, C. Lin, M. Li, K. Cao
Guangzhou (China)
22.014Fatal avian influenza A/H5N1 infection in a
36-week pregnant woman survived by her
newborn вЂ“ Soc Trang, Vietnam, 2012
T. V. Le, K. Ly, L. Nguyen, L. T. Phan,
N. M. Tran Minh
Ho Chi Minh City (Viet Nam), Hanoi (Viet Nam)
22.015Influenza as a cause of severe acute respiratory
infection at national and provincial hospitals
in Vietnam
T. P. Nguyen, N. T. T. Yen, N. B. Thuy, N. H. Tuan,
L. T. Q. Mai, T. N. Duong, J. Partridge, J. C. Kile,
D. T. Trang, N. T. Hien
Hanoi (Viet Nam)
22.016Severe acute respiratory infection in the North
of Vietnam: Burden, economic impact
N. T. T. Yen, N. B. Thuy, T. P. Nguyen, N. H. Tuan,
L. T. Q. Mai, T. N. Duong, D. T. Trang, J. Partridge,
J. C. Kile, N. T. Hien
Hanoi (Viet Nam)
22.017In vivo reassortment of avian and
swine influenza virus
K. Urbaniak, K. Kwit, A. Kowalczyk,
I. Markowska-Daniel
PuЕ‚awy (Poland)
17
IMED 2014
Poster Presentations I
SATURDAY вЂў November 1, 2014
International Meeting on Emerging Diseases and Surveillance 2014
22.018In vivo adaptation of avian influenza virus to pig
I. Markowska-Daniel, K. Urbaniak, K. Kwit,
M. Pomorska-MГіl, A. Kowalczyk
PuЕ‚awy (Poland)
22.019Detection and monitoring of outbreaks of
influenza-like illness using data of SOS MГ©decins
France 2006вЂ“2014
L. Toubiana, P. Guerin, P. Chansard, C. Demoor
Paris (France)
SATURDAY
вЂў
November 1, 2014
22.020Prevalence and distribution of avian influenza
A(H5N1) virus clade variants in live bird markets
of Vietnam, 2011вЂ“2013
D. T. Nguyen, J. E. Bryant, T. C. David, L. V. Nguyen,
K. Inui, L. T. Pham, L. Loth, T. Nguyen, Y. Jang,
T. L. To
Hanoi (Viet Nam), Atlanta, GA (USA)
22.021Serological evidence of influenza A viruses in bats
from Africa
G. S. Freidl, T. Binger, M. A. MГјller, E. de Bruin,
J. van Beek, V. M. Corman, A. Rasche, J. F. Drexler,
A. Sylverken, S. Oppong, Y. Adu-Sarkodie,
M. Tschapka, V. M. Cottontail, M. KnГ¶rnschild,
C. Drosten, M. Koopmans
Bilthoven/ Rotterdam (Netherlands), Bonn
(Germany), Kumasi (Ghana), Ulm (Germany)
22.022The international trade of chickens and increased
risk for introducing highly pathogenic avian
influenza A (H5N1) to previously uninfected
countries
J. M. Radin, J. Fowler
La Jolla, CA (USA)
22.023CAPA: Creating a network of investigators in
general practice for the characterisation and
management of acute community-acquired
pneumonia in France
L. Toubiana, H. Partouche, C. Buffel du Vaure,
V. Personne, A. Lorenzo, C. Ghasarossian,
P. Landais, S. Gilberg
Paris (France), NГ®mes (France)
22.024Serological surveillance of вЂњhumanвЂќ influenza virus
subtypes H1, H2, H3 among wild birds in Ukraine
B. Stegniy, D. Muzyka, M. Pantin-Jackwood,
M. Stegniy, V. Golovko, M. Mandygra, S. Doletskiy,
A. Gerilovych
Kharkiv (Ukraine), Athens, GA (USA),
Kiev (Ukraine)
18
IMED 2014
22.025Use of pseudotyped viruses for investigations
into vaccine efficacy, antigenic drift and vaccine
breakdown for equine influenza
R. Kinsley, J. Daly, A. Kliby, D. Elton, S. D. Scott,
N. Temperton
Chatham Maritime (United Kingdom),
Nottingham (United Kingdom), Newmarket
(United Kingdom)
22.026Low pathogenicity avian influenza virus (LPAIV)
chicken/England/4054/06 H7N3 replicates predominantly in olfactory epithelium in infected pigs
A. Nunez, B. Z. Londt, D. J. Hicks, I. H. Brown,
S. B. Brookes
Addlestone (United Kingdom)
22.027Replication potential of evolutionary distinct
H3N8 equine influenza viruses in swine cell lines
and respiratory explants
L. V. P. L. Patrono, C. Zanardello, F. Bonfante,
C. Terregino, I. Capua, P. R. Murcia
Legnaro (Italy), Glasgow (United Kingdom)
22.028Discordant correlation between serological
assays observed when measuring heterosubtypic
responses against avian influenza H5 and H7
viruses in unexposed individuals
E. Molesti, F. Ferrara, G. Lapini, E. Montomoli,
N. Temperton
Chatham Maritime (United Kingdom),
Siena (Italy)
22.029Vaccination of mice with plasmid DNA encoding
hemagglutinin from H5N1
P. A. Redkiewicz, A. Gora-Sochacka,
P. Kosson, A. Sirko
Warsaw (Poland)
22.030Prevalence and molecular characteristics of
respiratory viruses found in childrenвЂ™s with
respiratory tract infections in Eastern India
S. Kumar, S. Panda, N. K. Mohakud
Bhubaneswar (India)
22.031A preliminary study comparing trends in influenza-like illness and acute respiratory infection
consultations in general practice in-hours services
and out-of-hours services
C. Kearns, N. Gallagher, C. Nugent
Belfast (United Kingdom)
22.032Multiplex molecular diagnosis of viral acute
respiratory infections in Algiers, Algeria
H. Ziane, Z. Hanifa, F. Djennane, M. Bachtarzi,
S. Gourari, M. Tazir
Algiers (Algeria)
Poster Presentations I
SATURDAY вЂў November 1, 2014
International Meeting on Emerging Diseases and Surveillance 2014
22.033Impact of human enterovirus (hEV) and human
parechovirus (hPeV) infections in children в‰¤5
years with influenza-like illness (ILI) in Northern
Italy during 4 consecutive winter seasons
(2010/2011вЂ“2013/2014)
L. Bubba, L. Pellegrinelli, S. D. Discacciati,
A. Ranghiero, G. Anselmi, V. Primache, S. Binda,
A. Amendola, E. Pariani
Milan (Italy)
Innovations in Diagnostic Tests
for Emerging Diseases
22.034Molecular phylogeny and evolutionary dynamics
of influenza A(H1N1)09pdm NS1 gene
M. B. Valli, E. Giombini, C. Caglioti, P. Zaccaro,
S. Menzo, G. Ippolito, M. R. Capobianchi
Rome (Italy), Ancona (Italy)
22.043Validation of cyscope microscope, quantitative
buffy coat and rapid diagnostic kit for malaria
diagnosis among clinic attendees in Southwest
Nigeria
A. O. Ogunniyi, D. M. Dairo, H. DadaAdegbola, O. Ajumobi, O. Fawole, W. Oyibo
Abuja (Nigeria), Ibadan (Nigeria), Lagos (Nigeria)
22.038Evaluating the relationship of sex and age on the
influenza test result
J. K. Kigozi, J. T. Kayiwa, T. Byaruhanga, R. Chiza,
I. Nabukenya, B. Namagambo, B. Bakamutumaho,
J. J. Lutwama
Entebbe (Uganda)
22.039Variability of influenza clinical sample adequacy as
measured by rtPCR amplification of beta-actin
T. E. Bell, K. Felkins
Amarillo, TX (USA)
22.040Surveillance of influenza A exposure using noninvasive methods among industrial
pig farm workers and household members
in North Carolina
M. Nadimpalli, N. Pisanic, J. Stewart,
C. Heaney
Chapel Hill, NC (USA), Baltimore, MD (USA)
22.041The neglected burden of influenza in relation to
age, out-patients, hospitalized patients and the
economic impact in Uganda
T. Byaruhanga, J. T. Kayiwa, B. Namagambo,
R. Chiza, I. Nabukenya, N. Owor, J. J. Lutwama
Entebbe (Uganda)
November 1, 2014
22.037Early clinical management of SARI patients
improves outcomes and community outbreaks
B. Namagambo, J. T. Kayiwa, T. Byaruhanga,
R. Chiza, N. Owor, B. Bakamutumaho,
J. J. Lutwama, I. Nabukenya
Entebbe (Uganda), Kampala (Uganda)
22.045Rapid detection of nanotechnology based
diagnosis of rotavirus using silver nano-particles
probe
R. Kumar, G. Sahoo, K. Trivedi, R. Kumar,
K. Pandey, V. Ravidas, Y. Ansari, S. Parva,
R. Mansurri, P. Das
Patna (India), Patna (India)
вЂў
22.036Applying a risk based approach in surveillance
guidance for emerging respiratory pathogens
E. Wong, T. Mersereau, N. Khalil, M. Saboui
Ottawa, ON (Canada), Montreal, QC (Canada)
22.044Detection of ASF virus found in Georgia using
transmission electron microscope
N. Vepkhvadze, M. Kokhreidze, M.
Donduashvili, K. Goginashvili, R. Obiso, T. Tigilauri
Tbilisi (Georgia), Blacksburg, VA (USA)
SATURDAY
22.035Molecular basis of influenza virus survival
outside the host: Potential role of the
hemagglutinin protein
L. I. O. Sawoo, M. Feher, A. Dublineau, C. BatГ©jat,
I. Leclercq, J.-C. Manuguerra, J. Vanhomwegen
Paris (France)
22.042The role of conventional and real-time PCR in
determining the pneumococcal etiology of
complicated pneumonia cases
C. Silva-Costa, S. Aguiar, M. Pinho, M. Ramirez,
J. Melo-Cristino, P. Portuguese Group for
the Study of Streptococcal Infections
Lisbon (Portugal)
22.046Development of multiplex PCR for diagnosis of
tick-borne zoonoses
B. K. Mutai, J. Waitumbi
Kisumu (Kenya)
22.047Construction of chimeric arctic-like rabies virus
glycoproteins improves pseudotyped virus titre
to permit use in serological studies
E. Bentley, R. Ali, D. Horton, A. C. Banyard,
E. Wright
London (United Kingdom),
Surrey (United Kingdom)
22.048Detection of specific antibodies to Francisella
tularensis antigens to differentiate vaccine and
infection process
A. Gorbatov, P. SolovвЂ™ev, V. Firstova, E.
Baranova, E. Panfertsev, A. Mokrievich, N.
Pavlovich, N. Aronova, S. Biketov
Obolensk (Russian Federation), Rostov-on-Done
(Russian Federation)
22.049Multiplex molecular assay for diagnosis of multiple respiratory diseases of pigs in a single sample
P. Naraghi-Arani, C. Jaing, A. C. Carrillo,
J. Olivas, G. Anderson
Livermore, CA (USA), Manhattan, KS (USA)
19
IMED 2014
Poster Presentations I
SATURDAY вЂў November 1, 2014
International Meeting on Emerging Diseases and Surveillance 2014
22.050Validation of pyrazinamide susceptibility testing
of Mycobacterium tuberculosis by reverse
hybridization assay
V. Trangan, Y. Kondo, S. Foongladda
Bangkok (Thailand), Osaka (Japan)
22.058Development of a new antigen for screening
diagnostics of animal brucellosis
K. A. Khamdamov, R. G. Yaraev,
B. H. Kuvatov, S. A. Rahmatullaev
Samarkand (Uzbekistan)
22.051Role of matricellular proteins in systemic and
local immune response to Mycobacterium
tuberculosis infection
B. Shiratori, F. Hasibuan, A. Senoputra,
H. Chagan-Yasutan, B. Alisjahbana, T. Hattori
Sendai (Japan), Bandung (Indonesia)
22.059Typing of Yersinia pseudotuberculosis complex with
CRISPR analysis
K. Koskela, L. Mattinen, L. Kalin-MГ¤nttГ¤ri,
G. Vergnaud, O. GorgГ©, S. Nikkari, M. Skurnik
Helsinki (Finland), Orsay (France)
SATURDAY
вЂў
November 1, 2014
22.052Genetic structure of Candida glabrata isolates in
Sfax, Tunisia
A. Salma, A. Imen, S. Hayet, T. Houaida, F.
Cheikhrouhou, N. Sourour, A. Ayadi
Sfax (Tunisia)
22.053Multiplex evaluation of influenza neutralizing
antibodies with potential applicability to in-field
serological studies
E. Molesti, E. Wright, C. Terregino, R. Rahman,
G. Cattoli, N. Temperton
Chatham Maritime (United Kingdom), London
(United Kingdom), Legnaro (Italy)
22.054Genetic structure of Aspergillus flavus populations
in human and avian isolates
H. Ines, N. Sourour, F. Cheikhrouhou,
T. Houaida, S. Hayet, G. Raida, F. Makni,
R. StГ©phane, A. Ayadi
Sfax (Tunisia), Marseilles (France)
22.055ReLASVВ® Pan-Lassa Immunodiagnostics for the
detection of Lassa fever in West Africa
M. Boisen, A. Goba, L. Branco, O. Folarin,
P. Sabeti, E. Saphire, D. Asogun, C. Happi,
S. H. Kahn, R. Garry
Broomfield, CO (USA), Kenema (Sierra Leone),
Germantown, MD (USA), Lagos (Nigeria),
Cambridge, MA (USA), La Jolla, CA (USA), Irrua
(Nigeria), New Orleans, LA (USA)
22.056EUROIMMUN Dengue Virus NS1 ELISA is more
sensitive than PanbioВ® Dengue Early ELISA for
early detection of dengue virus infection
N. Ewers, S. SchГјtt, A. Kuhlencord, J. M.
Warnecke, K. Steinhagen, W. Schlumberger
Bielefeld (Germany), LГјbeck (Germany)
New Approaches to Outbreak Surveillance
and Monitoring
22.057Local perception and traditional practices to
cope with malaria risk affect related health policy
in the Logone Valley (Cameroon)
B. Marquis, J.-A. Ndione, O. Faye, M. Tsalefac
Dakar (Senegal), Yaounde (Cameroon)
20
IMED 2014
22.060Microbiological monitoring of shipsвЂ™ ballast water
in the South of the Russian Federation
S. Vodyanitskaya, N. Pshenichnaya
Rostov-on-Don (Russian Federation)
22.061The value of evidence from syndromic
surveillance
G. M. Andersson, C. Faverjon, F. Vial,
L. Legrand, A. Leblond
Uppsala (Sweden), Marcy lвЂ™Etoile (France),
Berne (Switzerland), Caen (France), Marcy
LвЂ™Etoile (France)
22.062Suite for Automated Global Electronic
bioSurveillance (SAGES) update: Re-engineering
software to improve ease of installation, use,
and sustainability
A. Katz, T. Campbell, G. Gorelick-Feldman,
J. Coberly, R. Wojcik, S. Patel, B. Feighner,
C. Perdue, S. Lewis
Laurel, MD (USA), Silver Spring, MD (USA)
22.063Using exterminator visits to characterize flea and
tick home infestationsвЂ”A novel way to assess
disease vectors at the human-environment
interface
G. Lamielle, K. Ehnert
Los Angeles, CA (USA)
22.064The Kombewa health and demographic
surveillance systems in rural Western Kenya
(Kombewa HDSS)
P. Sifuna, J. Cowden, A. Berhane, R. Coldren,
W. Otieno, M. Oyugi
Kisumu (Kenya)
22.065Combining semi logarithmic plotting and piecewise regression: A method to describe
complex temporal dynamics of epidemics and
to detect emerging patterns
V. Auvigne, F. Nicod, P. GuГ©rin, L. Toubiana
Angers (France), Vannes (France), Paris (France)
22.066Listeriosis Surveillance System: Enhanced model
in Lombardy region (Italy, 2006вЂ“2012)
E. Amato, S. Azzini, A. Piatti, M. M. Pontello
Milan (Italy)
22.067Monitoring Measles outbreak in Georgia in 2013
using different surveillance tools: EIDSS, ProMED
and WHO CISID
A. Ukharov, A. Burdakov, P. Imnadze,
N. Papelova, K. Sanadze, K. Zakhashvili
Overland Park, KS (USA), Tbilisi (Georgia)
Poster Presentations I
SATURDAY вЂў November 1, 2014
International Meeting on Emerging Diseases and Surveillance 2014
22.068Large-scale whole genome sequencing identifies country-wide spread of an emerging G9P[8]
rotavirus strain in Hungary, 2012
R. Doro, E. Mihalov-Kovacs, S. Marton, B. Laszlo,
J. Deak, F. Jakab, V. Martella, P. MolnГЎr, I. SГЎntha,
K. BГЎnyai
Budapest (Hungary), Debrecen (Hungary),
Szeged (Hungary), PГ©cs (Hungary), Bari (Italy),
Miskolc (Hungary)
22.069Influence of the electronic case report form for
multicentric studies in general practice in France
T. Poisson, H. Partouche, L. Toubiana
Paris (France)
22.073Multiplexed digital mRNA profiling of the inflammatory response in the West Nile Swiss Webster
mouse model
P. Naraghi-Arani, A. Freiberg, D. Beasley,
J. Pena, J. Plante, A. C. Carrillo, M. Labute,
K. Roberts, J. Smith, T. Juelic
Livermore, CA (USA), Galveston, TX (USA),
Chapel Hill, NC (USA)
22.074Predicting the potential for emerging infectious
disease: Engaging communities in species observations, data management, and the semantic web
M. McConnell, D. Pennington
Albuquerque, NM (USA), El Paso, TX (USA)
22.075Using a mobile short message-based disease
outbreak alert system to enhance disease
surveillance in Kenya
M. Toda, I. Njeru, S. O-Tipo, D. Kareko,
S. Inoue, M. Mwau, K. Morita
Nairobi (Kenya), Nagasaki (Japan)
22.076Double locus sequence typing (DLST), a
standardized and portable typing method for
epidemiological investigation of bacteria
K. Vranckx, P. Basset, D. S. Blanc, K. Janssens
Sint-Martens-Latem (Belgium), Lausanne
(Switzerland)
22.080Rabies surveillance in the combined joint operating areaвЂ”Afghanistan
H. Gobble, S. Stockwell, H. Gobble
Honolulu, HI (USA), Colorado Springs, CO
(USA)
22.081Improving public health and veterinary laboratory
testing quality and capacity in Cambodia
L. A. Perrone, V. Voeurng, S. Sek, S. Song,
D. Confer, R. Martin
Seattle, WA (USA), Phnom Penh (Cambodia)
November 1, 2014
22.072Research methods training for One Health
projects: Lessons learned in the Democratic
Republic of the Congo and Uganda
J. A. Steele, D. Saila-Ngita, T. Odoch,
H. M. Amuguni
North Grafton, MA (USA), Kampala (Uganda)
22.079Community health workers can effectively
implement disease surveillance of priority
diseases at village level in Kenya
E. M. Machache, J. Y. Carter, I. Njeru,
J. Mwitari
Nairobi (Kenya)
вЂў
22.071Application of a framework to assess cost and
performance of meningitis surveillance
N. A. Erondu, U. K Griffiths
London (United Kingdom)
22.078Crimean-Congo hemorrhagic fever infections
reported by Russian ProMED for the period of
2004вЂ“2014
B. Aslanov, N. Rakhmanova,
N. Pshenichnaya, V. Melnik
St. Petersburg (Russian Federation), Tashkent
(Uzbekistan), Rostov-on-Don (Russian
Federation), Donetsk (Ukraine)
SATURDAY
22.070Rabies veterinary laboratory capabilities in West
and the Central Africa
A. Angot, C. Bebay, Y. KaborГ©, G. Dauphin,
P. De Benedictis
Legnaro (Italy), Bamako (Mali), Rome (Italy)
22.077An automated analysis pipeline for whole
genome MLST data using BioNumericsВ®
K. De Bruyne, K. Vranckx, J. Goris, S. Valcke,
H. Pouseele, K. Janssens
Sint-Martens-Latem (Belgium)
22.082Implementing a professional development
program in clinical and public health laboratory
leadership and management
L. A. Perrone, E. Scott, L. Livingston,
C. Bradburn, A. McGee, S. Shotorbani,
D. Confer, A. Downer, A. Mokdad, R. Martin
Seattle, WA (USA)
22.083Risk of transfusion-transmitted Chikungunya
infection and efficacy of blood implementation
measures
H. Appassakij, C. Promwong, P. Rujirojindakul,
P. Khuntikij, K. Silpapojakul
Hat Yai (Thailand)
New Pathogen Discovery
22.084Identification of eight clades of novel singlestranded circular DNA viruses in pig feces
A. K. Cheung, T. F. F. Ng, K. M. Lager, D. P. Alt,
E. Delwart, R. M. Pogranichniy
Ames, IA (USA), San Francisco, CA (USA),
West Lafayette, IN (USA)
22.085A novel parvovirus from horse with polysynovitis
J. Wang, M. Yu, S. Valdeter, S. Walker, S. Riddell,
I. Broz, B. Meehan, D. Eagles, L.-F. Wang,
S. McCullough
Geelong (Australia)
21
IMED 2014
Poster Presentations I
SATURDAY вЂў November 1, 2014
International Meeting on Emerging Diseases and Surveillance 2014
22.086Saffold virus is able to productively infect primate
and rodent cell lines, and induces apoptosis on
these cells
Y. Xu, Q. Ng, C. B. L. Victorio, Y. J. Tan, K. B. Chua
Singapore (Singapore)
22.087Pathogen discovery and vaccine development for
emerging diseases
A. de Groof
Boxmeer (Netherlands)
SATURDAY
вЂў
November 1, 2014
22.088Small ssDNA viruses detected in domesticated
and wild animals by viral metagenomics
E. Feher, E. Kovacs, S. Marton, M. Balmann,
P. Pazar, G. Kemenesi, G. Lengyel, F. Jakab, K. Banyai
Budapest (Hungary), Pecs (Hungary)
22.089Candidate new rotavirus species detected in the
fecal virome of sheltered dog
E. Kovacs, S. Marton, S. L. Farkas, V. Martella,
K. Banyai
Budapest (Hungary), Bari (Italy)
22.090Genetic diversity and possible recombination
events in canine astroviruses
E. Kovacs, S. Marton, T. Tuboly, V. Martella,
K. Banyai
Budapest (Hungary), Bari (Italy)
22.091Molecular survey of bat-transmitted RNA viruses:
Discovering novel astroviruses, coronaviruses and
caliciviruses
G. Kemenesi, B. Dallos, T. GГ¶rfГ¶l, S. Boldogh,
P. EstГіk, A. Kutas, M. Oldal, V. Martella, K. BГЎnyai,
F. Jakab
PГ©cs (Hungary), Budapest (Hungary), JГіsvafЕ‘
(Hungary), Eger (Hungary), Bari (Italy)
22.092Discovery of a novel bovine enteric calicivirus,
KД±rklareli virus, in calves with enteritis in Turkey
F. Alkan, I. Karayel, C. Catella, L. Bodnar,
G. Lanave, K. BГЎnyai, N. Decaro, C. Buonavoglia,
V. Martella
Ankara (Turkey), Bari (Italy), Budapest (Hungary)
22.093Complete genome sequence of a new recombinant echovirus 25 strain isolated from a neonatal
patient with hand, foot and mouth disease complicating encephalitis in Beijing, China
Y. Meng, H. Li, J. Liang, Q. Wang, J. Zhang,
S. Liu, J. Cheng
Beijing (China)
22.094Increased detection of CrimeanвЂ“Congo hemorrhagic fever (CCHF) in Georgia (2009вЂ“2014)
N. Mamuchishvili, K. Zakhashvili,
G. Chakhunashvili, P. Imnadze, D. Echeverria
Tbilisi (Georgia), Seattle, WA (USA)
22
IMED 2014
Outbreak Response and Control
22.095Investigation of Ebola viral haemorrhagic fever
(VHF) outbreak in Luwero district Uganda,
2012вЂ“2013
E. N. Muwanguzi
Kampala (Uganda)
22.096Go big or go home: Impact of screening
coverage on syphilis infection dynamics
A. Tuite, D. Fisman
Toronto, ON (Canada)
22.097Genomic analysis of Legionella outbreaks:
Implications for outbreaksвЂ™ study and control
F. Gonzalez-Candelas, L. Sanchez-Buso,
I. Comas, G. Jorques, V. GarcГa-LГіpez de Meneses,
J. Calafat, F. Adrian, J. Fenollar, I. Escribano,
H. Vanaclocha
Paterna (Spain), Valencia (Spain), Alcoy (Spain)
22.098Adhering to infection control practices prevents
the transmission of MERS-CoV among health
care workers in a tertiary care institution, Riyadh,
Saudi Arabia
T. S. Butt, I. Koutlakis-Barron, S. AlJummah,
S. AlThawadi, S. AlMofada
Riyadh (Saudi Arabia)
22.099Signalling and risk assessment of emerging
zoonoses in the Netherlands
K. Maassen, J. van der Giessen,
A. van de Giessen
Bilthoven (Netherlands)
22.100Epidemiological monitoring of anthrax soil foci
in Kazakhstan
M. Orynbayev, A. M. Aikimbayev,
V. N. Sheyanov, G. A. Temiraliyeva, A. Tuleuov,
G. Omasheva
Gvardeisky (Kazakhstan), Almaty (Kazakhstan)
22.101A LegionnairesвЂ™ disease outbreak associated with
cooling towers in Warstein, Germany, August
2013
A. Maisa, A. Brockmann, F. Renken, C. Lueck, S.
Pleischl, M. Exner, I. Daniels-Haardt, A. Jurke
MГјnster (Germany), Soest (Germany), Dresden
(Germany), Bonn (Germany)
22.102Developing surveillance and situational
awareness of an emerging pathogen for the U.S.
military: Chikungunya
J. Writer, N. Darling, S. Harris, W. Corr,
R. Chitale
Silver Spring, MD (USA)
22.103Outbreak of pulmonary tuberculosis in
Cojutepeque military brigade, El Salvador,
July 2013
J. Santos
Santa Tecla (El Salvador)
Poster Presentations I
SATURDAY вЂў November 1, 2014
International Meeting on Emerging Diseases and Surveillance 2014
22.104Justified cholera vaccination trials in Uganda?
Large outbreaks in Namayingo and Moyo
Districts, 2014
I. Nabukenya, E. Namukose, G. Bwire, L. Lukwago,
F. Alingu, M. Malimbo, H. Mayinja, I. Makumbi
Kampala (Uganda), Tampa, FL (USA)
22.105Using a One Health approach to build the capacity of вЂњhot spot nationsвЂќ to respond to infectious
disease outbreaks: Overview of the USAID/
RESPOND project in Africa
H. M. Amuguni, D. Saila Ngita, L. Foan,
S. Tzipori
North Grafton, MA (USA), Kampala (Uganda)
22.109Epizootological investigation and laboratory
diagnostics of Classical Swine Fever outbreak in
Ukraine
S. Nychyk, M. Sytiuk, I. Halka, N. Hudz,
M. Peknii, V. Ukhovskii
Kiev (Ukraine)
22.110The characteristic of leptospirosis patients following major flood in Jakarta in early 2014
D. O. T. L. Handayani, I. Inggariwati
Jakarta (Indonesia)
22.111National Anti-Rabies Centre (CNAR) Centralized
structure for the surveillance and control of
rabies in Romania
I. Parvu, G. Coltan, S. Petrea, A. Streinu Cercel
Bucharest (Romania)
22.112Some epidmiological characteristics of tularemia
in the south-eastern part of Serbia
Z. VeliДЌkoviД‡, B. D. KociД‡, V. KostiД‡, N. K. RanciД‡
Л‡
Nice (Serbia)
22.113Cluster of invasive group-A-streptococcal infections centred around a primary school in the
Rotterdam-Rijnmond region in the Netherlands
in January and February 2012
H. Visser
Rotterdam (Netherlands)
22.117Preparedness to infectious outbreaks: An e-learning course for healthcare professionals based on
case histories
T. Saita, M. R. Valleto, M. Bellone, R. Villa,
C. Deligant, P. Dri
Milan, Outside North America (Italy)
22.118Epidemiology of acute watery diarrhea outbreak
and challenges of control вЂ“ Afar, Ethiopia, 2009
B. Beyene, M. Tumato, R. LUCe, F. Enquesilassie
Bahir Dar (Ethiopia), Hawasa (Ethiopia), Atlanata,
GE (USA), Addis Ababa (Ethiopia)
22.119Preparedness for public health emergencies:
Biggest hurdle in poor resource countries; a scan
lens in Uganda
A. Kagirita
Kampala (Uganda)
November 1, 2014
22.108Emerging dengue fever outbreak, Afar Region,
Ethiopia вЂ“ 2014
E. M. Sorassa, D. M. Abegaze, M. Mengesha,
J. Fogarty, A. Belachew, L. Boulanger,
A. Greenleaf, A. Bekele, D. Jima
Addis Ababa (Ethiopia)
22.116Measles outbreak investigation, Kindo Didaya
district-Southern region of Ethiopia, 2013
E. Z. Worku, H. Taame, Y. Mogessie, A. Bekele,
A. Worku
Addis Ababa (Ethiopia), Hawassa (Ethiopia)
вЂў
22.107Measles cluster at a tertiary care hospital in
SingaporeвЂ”An outbreak investigation
H. C. Chan, R. Sridhar, S. M. Chan, G. K. Goh,
G. Ciccone, R. T. P. V. Lin, S. Salmon,
I. Venkatachalam, P. A. Tambyah, D. A. Fisher
Singapore (Singapore)
22.115The changes of safety culture of the infectious
diagnostic sample handling in public health
laboratories
M. Shigematsu, M. Kigawa, S. Ando
Tokyo (Japan), Toyama (Japan)
SATURDAY
22.106Process evaluation of PakistanвЂ™s disease early
warning system
S. Zareen, S. M. Mursalin
Lahore (Pakistan), Islamabad (Pakistan)
22.114Impact of HIV/AIDS in the African military:
Approaches to integrating prevention in
care setting
F. Obuseh, J. Cline
Apo, AE (USA)
22.120Threat awareness and mitigation strategies for
potential epidemic Salmonella in the United
Kingdom
D. Mueller-Doblies, R. Horton, R. H. Davies
Addlestone (United Kingdom)
22.121Challenges in the management and control of
Lassa fever epidemic in resource limited setting
of South-East NigeriaвЂ”A situation study
U. S. Unigwe
Enugu (Nigeria)
22.122Control of a long standing community-wide
outbreak of cholera in a semi-urban district,
Atebubu-Amanten, Ghana: 2012
G. K. Kuma, J. Amankwa, E. Tinkorang, T. Letsa,
F. Iddrisah, M. J. Adjabeng, B. Azumah, S. O. Sackey,
J. A. Opintan, J. EL-Duah
Sunyani (Ghana), Accra (Ghana),
Dormaa (Ghana), Atebubu (Ghana)
22.123Outbreak of pneumonia for Pseudomonas
aeruginosa in the service of internal medicine
in a hospital of El Salvador, June 2013
A. MartГnez
Chalatenango (El Salvador)
23
IMED 2014
Poster Presentations I
SATURDAY вЂў November 1, 2014
International Meeting on Emerging Diseases and Surveillance 2014
Public Communication of Outbreaks
and Emerging Diseases
22.124Mining press articles about infectious diseases:
Swine flu, avian flu and the seasonal flu
E. Mayor
NeuchГўtel (Switzerland)
SATURDAY
вЂў
November 1, 2014
22.125Transforming the dynamics of Emerging Infectious
Disease (EID) communication: An innovative
integrative framework
A. Gesser-Edelsburg, N. Walter, Y. Shir-Raz,
E. Mordini, D. Dimitriou, M. S. Green
Haifa (Israel), Paris (France), Rome (Italy)
22.126Risk factors for Crimean-Congo hemorrhagic
fever among children with confirmed cases in
Southeastern Iran
B. Sharifi-Mood, M. Metanat, M. R. Sharifi
Zahedan (Iran), Zahedan (Iran)
22.127Does anticipated regret influence on willingness
to be vaccinated?
T. Kikkawa, M. Shigematsu
Tokyo (Japan)
22.128Novel norovirus recombinants detected in South
Africa
T. Y. Murray, J. Mans, M. B. Taylor
Pretoria (South Africa)
Poster Presentations I
Saturday, November 1, 2014
Klimt Ballroom I вЂў Upper Level
11:45вЂ“13:15
Sociopolitical Factors in Disease Emergence
22.134Comparison of Lyme disease risk perception
and management in different populations and
their experts
C. Aenishaenslin, P. Michel, A. Ravel, L. Gern
MontrГ©al, QC (Canada), NeuchГўtel (Switzerland)
22.135Registered nursesвЂ™ knowledge, attitudes and
practices regarding the spread of nosocomial
infections: The impact of organizational support
E. W. Kamunge, R. K. Parasher, T. Cahill,
G. Pinto-Zipp
Newark, NJ (USA), South Orange, NJ (USA)
22.136Legal and ethical complexity challenging global
health security: Sustainability of pathogen
surveillance
T. Makino
Tokyo (Japan)
22.129A short history of the contributions of One
Medicine and One Health in Norh America to
current concepts of emerging infectious diseases
P. Cowen, R. W. Currrier
Raleigh, NC (USA), Ames, IA (USA)
22.137Incidence infectious diseases of childhood
population before and after war in Bosnia and
Herzegovina in emergence
A. Bajraktarevic, L. Kumasin, E. Lokmic,
G. Todosijevic, Z. Begic, B. Djukic, A. Abduzaimovic,
S. Serdarevic
Sarajevo (Bosnia and Herzegovina), Tesanj
(Bosnia and Herzegovina)
22.130Transparent communications during infectious
disease outbreaks: The importance of social
media as a risk communication tool
M. Billingsley, M. Wroczynski
London (United Kingdom)
22.138Emergency transport: Not only a matter of time
G. Torrell VallespГn, A. FitГ©, A. Saidy,
A. Touray
Barcelona (Spain), Reus (Spain), Kuwonku
(Gambia)
22.131Middle East Respiratory Syndrome Coronavirus
infection among healthcare workers in a tertiary
care center inВ Saudi Arabia
M. A. Garbati, C. Syam, H. Alobida, M. Joseph,
A. M. Hakawi
Riyadh (Saudi Arabia)
22.132Rapid Semi-nested PCR for the identification of
Candida species in Candidasis
B. Sadeghi-Nejad, A. R. Samarbafzadeh,
M. Mehdinejad
Ahvaz (Iran)
22.133Full-length genome sequencing and analysis of 3
ZIKV strains on an Ion Torrent PGM sequencer
M. Vandenbogaert, V.-M. Cao-Lormeau,
L. Diancourt, J.-M. Thiberge, A. Sall, A. Kwasiborski,
D. Musso, P. DesprГЁs, J.-C. Manuguerra, V. Caro
Paris (France), Papeete вЂ“Tahiti, PolynГ©sie franГ§aise
(France), Dakar (Senegal)
24
IMED 2014
Vaccines and Emergence of Vaccine
Preventable Diseases
22.139In silico prediction of common epitopes in gp63
protein of pathogenic Leishmania species for
designing an epitope based DNA vaccine
P. S. Slathia, P. Sharma
Jammu (India)
22.140Immune responses induced byВ an alphavirus
replicon derived candidate vaccine against
Crimean-Congo haemorrhagic fever virus
F. Burt, R. Swanepoel, J. Paweska, M. Heise
Bloemfontein (South Africa), Pretoria (South
Africa), Sandringham (South Africa), North
Carolina (USA)
22.141DNA priming-protein boosting immunization regime based on L7/L12 and
TOmp31Brucellaantigens induces protective
immunity in BALB/c mice
M. Golshani, S. Rafati, A. Dashti, S. Bouzari
Tehran (Iran)
Poster Presentations I
SATURDAY вЂў November 1, 2014
International Meeting on Emerging Diseases and Surveillance 2014
22.142Progress towards measles elimination in
Singapore
H. J. A. Ho, C. Low, L. W. Ang
Singapore (Singapore)
22.143The introduction of the pneumococcal conjugate
vaccine into CameroonвЂ™s expanded programme
on immunization: Would every child be reached?
J. Njuma Libwea, M. Kobela, H. Nohynek
Tampere (Finland), Yaounde (Cameroon),
Helsinki (Finland)
22.144Antibody response to DNA vaccine against
H5N1 in broilers and layers chickens
A. Stachyra, A. Gora-Sochacka, A. Protasiuk,
A. Sirko
Warsaw (Poland)
22.148Protective effect of vaccination on mumps
complications: Analysis of the Czech national
surveillance data, 2007вЂ“2012
H. Orlikova, M. Maly, P. Lexova, H. Sebestova,
R. Limberkova, L. Jurzykowska, C. Benes, J. Kyncl
Prague (Czech Republic)
22.149Multiantigen T cell epitope-enriched leishmaniasis
vaccine
C. Juhls, LeishDNAvax Consortium, A. Freier
Berlin (Germany), London (United Kingdom)
22.150Epidemiological demographics of invasive
pneumococcal and Haemophilus influenza
diseases in JapanвЂ”First year assessment of
national surveillance
T. Makino, Y. Ohkusa
Tokyo (Japan)
22.151Immune response to hepatitis B vaccine in healthcare providers of an intensive care unit at a
teaching hospital in Guatemala City
I. Cazali, D. R. Erdmenger, L. OвЂ™Connell,
J. Guerra, A. E. Arana, I. Gudiel
Guatemala (Guatemala)
22.154Sero-study of rickettsial infections in young male
volunteers in Azerbaijan
E. Huseynova, C. Bautista, R. Rivard,
E. Garges, H. Dyson, A. Seyidov, N. Huseynov,
T. Ahmadkhanov, A. Richards, C. Farris
Baku (Azerbaijan), Silver Spring, MD (USA),
Frederick, MD (USA), Porton Down (United
Kingdom)
22.155Association of IL1B-31C/T and IL1RA variable
number of an 86-bp tandem repeat with
dengue shock syndrome in Thailand
A. Sa-ngasang, J. Ohashi, I. Naka,
S. Anantapreecha, P. Sawanpanyalert,
J. Patarapotikul
Nonthaburi (Thailand), Ibaraki (Japan),
Bangkok (Thailand)
November 1, 2014
22.147Economic model of rotavirus vaccination
programme incorporating excess risk of
intussusception in Singapore
A. Green, C.-F. Yung
Singapore (Singapore)
22.153Seroprevalence of arboviral infections in young
male volunteers in Azerbaijan
E. Huseynova, E. Garges, R. Rivard, A. Seyidov,
N. Huseynov, T. Ahmadkhanov, C. Bautista, A.
Debes, R. Woelfel, H. Dyson
Baku (Azerbaijan), Silver Spring, MD (USA),
Frederick, MD (USA), Munich (Germany),
Porton Down (United Kingdom)
вЂў
22.146Cross-protection evaluation of a lineage 1
West Nile virus inactivated vaccine against
natural infections from a virulent lineage 2
strain in horses
S. C. Chaintoutis, N. Diakakis,
M. Papanastassopoulou, G. Banos, C. I. Dovas
Thessaloniki (Greece)
Vectorborne Diseases
SATURDAY
22.145Increase in endemic Neisseria meningitidis capsular
group W ST-11 complex associated with severe
invasive disease in England and Wales
S. Ladhani, K. Beebeejaun, J. Lucidarme,
H. Campbell, S. Gray, E. Kaczmarski, M. Ramsay,
R. Borrow
London (United Kingdom), Manchester (United
Kingdom)
22.152Epidemiological, clinical and virological
supervision of the seasonal influenza in Tunisia:
Season 2013вЂ“2014
D. G. Kilani, N. Achour, S. Amin, M. A. Hadj
Kacem
Tunis (Tunisia)
22.156Severe fever with thrombocytopenia syndrome in
Miyazaki, Japan
T. Kawaguchi, M. Matsuda, I. Takajo,
A. Okayama
Miyazaki (Japan)
22.157Dengue virus non-structural protein 1 induces
vascular leakage through macrophage migration
inhibitory factor secretion and glycocalyx
degradation
T. M. Yeh, H.-R. Chen
Tainan (Taiwan, R.O.C.), Tainan (Taiwan, R.O.C.)
22.158Avian biodiversity and Usutu virus circulation in
Emilia-Romagna (Italy), 2010вЂ“2012
M. Calzolari, L. Fornasari, G. Calvi, R. Bellini,
P. Angelini, M. Dottori
Reggio Emilia (Italy), Parma (Italy), Crevalcore
(Italy), Bologna (Italy)
22.159Clinical profiles of dengue infection in a teaching
hospital of Sourthren province Sri Lanka
J. I. Abeynayake
Colombo (Sri Lanka)
25
IMED 2014
Poster Presentations I
SATURDAY вЂў November 1, 2014
International Meeting on Emerging Diseases and Surveillance 2014
22.160Human granulocytic anaplasmosis is an emerging
disease in South Korea: A 10-year study
J. Yi, K.-H. Kim, E. Y. Lee, M.-D. Oh
Busan (Republic of Korea), Seoul (Republic
of Korea)
SATURDAY
вЂў
November 1, 2014
22.161Old world vs. new world West Nile virus:
Is there any difference?
M. A. Jimenez-Clavero, E. Perez-Ramirez, F.
Llorente, J. Del Amo, N. Nowotny, R. Soriguer,
J. Figuerola
Valdeolmos (Spain), Vienna (Austria),
Seville (Spain)
22.162Use of doxycycline in dengue patients: A potential
alternative to a disease with no specific treatment
T. Fredeking, J. Zavala-Castro, P. GonzГЎlezMartinez, W. Moguel-Rodriguez, E. C. Sanchez,
M. J. Foster, F. A. Diaz-Quijano
Hurst, TX (USA), MГ©rida, YucatГЎn (Mexico),
Sao Paulo (Brazil)
22.163Serological detection of R. rickettsii in dengue
fever-negative samples in Nuevo Leon, Mexico
E. Jaramillo, E. Jaramillo-Reyna, J. Z. VillarrealPГ©rez, F. J. GarcГa-Elizondo, F. GonzГЎlez-AlanГs,
E. I. Galindo-Galindo, M. I. Tavitas-Aguilar,
S. P. Mora-Gloria, P. Carranza-Rosales,
C. B. Brito-LorГЎn
Guadalupe (Mexico), Monterrey (Mexico)
22.164Development of serological tools to detect
antibodies to zoonotic arboviruses in sera of
neurological disease cases of humans, livestock
and horses in southern Africa
T. Jooste, C. van Eeden, V. Stivaktas,
R. Swanepoel, M. Venter
Pretoria (South Africa)
22.165High seroprevalence of Borrelia miyamotoi
antibodies in forestry workers and individuals
suspected of human granulocytic anaplasmosis
in the Netherlands
S. Jahfari
Bilthoven (Netherlands)
22.166Complete genome sequence of the first
West Nile virus strain from Turkey
K. Ergunay, T. Bakonyi, N. Nowotny,
A. Ozkul
Ankara (Turkey), Vienna (Austria)
22.167Studies of vector competence of Italian Aedes
albopictus populations by experimental infections
with Chikungunya virus
C. Fortuna, M. E. Remoli, M. Di Luca,
F. Severini, L. Toma, E. Benedetti, P. Bucci,
M. G. Ciufolini, D. Boccolini, R. Romi
Rome (Italy)
26
IMED 2014
22.168Addressing the risk of dengue virus
transmission in developing country context:
The case of Dhaka, Bangladesh
P. Dhar-Chowdhury, C. E. Haque,
R. Lindsay, S. Hossian, M. Drebot
Winnipeg, MB (Canada)
22.169Modulation of cytokine activity by
tetracycline and doxycycline alters disease course
in experimental Ebola, Marburg and Lassa virus
infections
T. Fredeking, G. Ignatyev, A. Atrasheuskaya,
F. A. Diaz-Quijano
Hurst, TX (USA), Koltsovo (Russian Federation),
Sao Paulo (Brazil)
22.170A case control study of risk factors associated with dengue fever in Swat Valley, Khyber
Pakhtunkhwa, Pakistan
S. Ahmad, M. Chaudhry, H. B. Rashid, H. Ali,
M. Ahmad, M. H. Mushtaq
Lahore (Pakistan), Swat (Pakistan)
22.171Differential serodiagnosis of tick-borne virus
encephalitis (TBE) and West Nile fever (WNF)
in the South of Russia
S. Vodyanitskaya, L. Ermakova,
N. Pshenichnaya
Rostov-on-Don (Russian Federation)
22.172Toscana virus and Leishmania nucleic acids in
sandflies, Northern Cyprus
K. Ergunay, O. Erisoz Kasap, S. Orsten,
F. Gunay, E. Dincer, K. Oter, A. Ozkul, B. Alten
Ankara (Turkey), Mersin (Turkey),
Istanbul (Turkey)
22.173Seroprevalence and asymptomatic carriage of
Leishmania spp. in Austrian soldiers returning
from missions in the Lebanon, Syria and Bosnia
A. G. Obwaller, W. Poeppl, A. Graf-Langheinz,
G. Mooseder, A. Faas, J. Walochnik
Vienna (Austria)
22.174Identification of novel T cell epitopes on
Crimean-Congo haemorrhagic fever virus
and confirmation of long-lived memory T cell
responses
D. Goedhals, J. Paweska, F. Burt
Bloemfontein (South Africa), SandringhamJohannesburg (South Africa)
22.175Genetic marker tools for identifying tropical
human bed bugs and bat bugs: Leptocimex
inordinatus
R. Potiwat
Bangkok (Thailand)
22.176Potential animal reservoirs of Toscana virus and
co-infections with Leishmania infantum
E. Dincer, S. Gargari, A. Ozkul, K. Ergunay
Mersin (Turkey), Ankara (Turkey)
Poster Presentations I
SATURDAY вЂў November 1, 2014
International Meeting on Emerging Diseases and Surveillance 2014
22.177Detection of West Nile Virus from mosquito
Culex pipiens (fam: Culicidae) in Belgrade, Serbia
2012вЂ“2013
M. DjordjeviД‡, N. P. Stajkovic, B. PeЕЎiД‡
Belgrade (Serbia)
22.178Changing pattern of DENV serotypes in Vietnam
N. T. T. Thuy, F. Hasebe, K. Morira
Hanoi (Viet Nam), Nagasaki (Japan)
22.179Risk mapping of West Nile virus transmission
to humans in Spain
A. SГЎnchez GГіmez, M. J. Sierra,
M. Martinez-Aviles, E. Fernandez-Carrion,
J. M. Sanchez-Vizcaino, S. Santos, C. Amela
Madrid (Spain)
22.183Dengue in India: An epidemiological perspective
K. Baruah, P. K. Sen, A. Dhariwal
Dehli (India)
22.184Culex pipiens and Culex torrentium mosquitoes
from Germany have vector competence for
West Nile virus
M. Leggewie, M. Badusche, M. Rudolf, S. Jansen,
J. BГ¶rstler, K. Huber, A. KrГјger, J. Schmidt-Chanasit,
E. Tannich, S. C. Becker
Hamburg (Germany), Greifswald-Insel Riems
(Germany)
22.190Pathogenetic markers of severity in DF/DHF
A. Biswas, P. Sohal, K. Baruah, S. Sharma,
N. Wig, P. Aggarwal
New Delhi (India)
22.191Imported and autochthonous dengue in
PortugalвЂ”Three unusual years of experience
at the National Institute of Health
L. ZГ©-ZГ©, F. Amaro, H. C. OsГіrio, M. J. Alves
ГЃguas de Moura (Portugal)
November 1, 2014
22.182Epidemiology of tularaemia in South West
Germany 2001вЂ“2013
C. Wagner-Wiening, G. Pfaff, I. Boone
Stockholm (Sweden), Stuttgart (Germany),
Berlin (Germany)
22.189What is the role of asymptomatic carriers
in transmission of Gambiense human African
trypanosomiasis? Mathematical model of data
from North West Uganda
R. Oettle, F. Checchi, J. Edmunds
London (United Kingdom)
вЂў
22.181Putative new lineage of West Nile virus in the
mosquito Uranotaenia unguiculata
G. Kemenesi, M. Oldal, A. Kutas, B. Dallos,
F. FГ¶ldes, V. NГ©meth, P. Reiter, T. Bakonyi, K. BГЎnyai,
F. Jakab
PГ©cs (Hungary), Paris (France),
Budapest (Hungary)
22.188West Nile virus lineage 2 isolated from Culex
modestus mosquitoes in the Czech Republic,
2013: Expansion of the European West Nile
virus endemic area to the North?
I. Rudolf, T. Bakonyi, O. Sebesta, J. Mendel,
L. Betasova, H. Blazejova, K. Venclikova, P. Strakova,
N. Nowotny, Z. Hubalek
Brno (Czech Republic), Budapest (Hungary),
Vienna (Austria)
SATURDAY
22.180First molecular detection of human relapsing
fever spirochete Borrelia miyamotoi in Ixodes
ricinus from Portugal
M. Nunes, N. Lopes, T. Carreira, C. Maia,
A. P. G. Almeida, M. L. Veira
Lisbon (Portugal)
22.187Circulation of zoonotic arboviruses in equine
populations of Mallorca island
J. Vanhomwegen, J.-C. Manuguerra, C. Beck,
R. G. GarcГa, A. Figuerola, S. Lecollinet, M. LГіpezRoig, C. Rousseaux, J. Serra-Cobo
Paris (France), Maisons-Alfort (France),
Palma de Mallorca (Spain), Barcelona (Spain)
22.192Active surveillance for human plague in
Northwestern Uganda, 2008вЂ“2014
T. Apangu, S. Acayo, J. Kaggwa, L. Atiku,
J. Tendo, P. Anguzy, J. Wamala, I. Makumbi,
B. Yockey, E. Mbidde
Arua (Uganda), Kampala (Uganda),
Fort Collins, CO (USA), Entebbe (Uganda)
22.193Emergence of a dengue problem in IndiaвЂ”
A public health challenge
R. S. Sharma
Delhi (India)
22.185ArrГЎbida virus: First isolation of a phlebovirus in
sandflies in Portugal
F. Amaro, L. ZГ©-ZГ©, M.-J. Alves
ГЃguas de Moura (Portugal)
22.186Epidemiologic characteristics of severe
fever with thrombocytopenia syndrome in
South Korea, 2013
J. Shin, J. Kim, Y.-S. Park, D. Kwon, G.-R. Bae
Cheongju (Republic of Korea)
27
IMED 2014
Poster Presentations II
SUNDAY вЂў November 2, 2014
International Meeting on Emerging Diseases and Surveillance 2014
Session 23
Poster Presentations II
Sunday, November 2, 2014
11:45вЂ“13:15
Bruckner/Mahler/Brahms вЂў Upper Level
Antimicrobial Resistance
23.001Inhibitor-resistant beta-lactamases in
Enterobacteriaceae from Croatia
B. Bedenic, S. Jaman, V. Zujic-Atalic, J. Vranes
Zagreb (Croatia), Osijek (Croatia)
23.002High prevalence of faecal carriage of bla-SHV
type extended spectrum-ОІ-lactamases producing
Escherichia coli among healthcare workers
R. H. A. Bassyouni, S. Gaber, A. A. Wegdan
Fayoum (Egypt)
23.003Emergence of of vancomycin resistant
Staphylococcus aureus (VRSA) in Portugal
J. Melo-Cristino, A. FriГЈes, C. Resina,
V. Manuel, L. Lito, M. Ramirez
Lisbon (Portugal)
SUNDAY
вЂў
November 2, 2014
23.004Detection of antimicrobial resistance in selected
bacteria isolated from non-human primates at a
wildlife-human interface
B. A. Glover, A. O. Jenkins, M. vanVuuren
Pretoria (South Africa)
23.005Characterization of mutations conferring
resistance against first and second line drugs in
multidrug resistant isolates of Mycobacterium
tuberculosis from Mexico
R. Zenteno-Cuevas, O. Xochihua-Gonzalez,
B. Cuevas-Cordoba, R. MuГ±is-Salazar
Xalapa (Mexico), Veracruz (Mexico), Baja
California (Mexico)
23.006Methicillin resistant Staphylococcus aureus
multiple sites surveillance: A systematic review
J. Chipolombwe, E. TГ¶rГ¶k, J. Taljaard, G. Revathi,
P. S. Nyasulu
Mzuzu (Malawi), Cambridge (United Kingdom),
Cape Town (South Africa), Nairobi (Kenya),
Johannesburg (South Africa)
23.007Chromosome-mediated multidrug resistance in
Salmonella enterica serovar Typhi
Y.-S. Liao, T.-L. Lauderdale, D. C. Phung, H.
Watanabe, J.-C. Kuo, Y.-Y. Liu, P.-J. Wang, S.-Y. Liang,
C.-S. Chiou
Taichung City (Taiwan, R.O.C.), Zhunan (Taiwan,
R.O.C.), Hanoi (Viet Nam), Tokyo (Japan),
Taichung (Taiwan, R.O.C.)
28
IMED 2014
23.008ESKAPE bacteremia
R. GonГ§alves, D. Aguiar, J. TrГЄpa, R. Magano,
J. Cortez, H. Oliveira, J. Gamboa
Coimbra (Portugal)
23.009Investigating role of putative peptidoglycan
amidase, in biofilm formation and antimicrobial
resistance of Mycobacterium tuberculosis
A. Padhi, S. Mohanty, A. Sonawane
Bhubaneswar (India)
23.010Cefmetazole for bactermia caused by ESBLproducing Enterobacteriacae comparing with
carbapanems
T. Fukuchi, K. Iwata, G. Ohji
Hyogo (Japan)
23.011High antimicrobial resistance of urinary bacteria
isolated from long-term respiratory care wards
in a regional hospital in Taiwan
W.-C. Lin, K.-S. Liu
Yunlin County (Taiwan, R.O.C.)
23.012Determinants of isoniazid and rifampicin resistant
tuberculosis among suspected cases of Oromia
Region, Ethiopia, 2014
G. M. Misgana, N. H. Geda, G. J. Guto,
T. W. Abebe, M. S. Hassen
Adama (Ethiopia)
23.013Prospective case-control study of infections due
to carbapenem-resistant Enterobacteriacae
M. A. Garbati, H. Sakkijha, A. Abu-Shaheen
Riyadh (Saudi Arabia)
23.014Intestinal microflora in adults with acute
infectious diarrhea
N. Pshenichnaya, A. Aleshukina, A. Buslenko,
A. Juravlev, I. Aleshukina
Rostov-on-Don (Russian Federation), Moscow
(Russian Federation)
23.015Antibiotic resistanceвЂ”Challenges and
opportunities with bacteriophage and
lytic proteins
D. Trudil, M. Kutateladze
Reisterstown, MD (USA), Tbilisi (Georgia)
23.016Comparisons of drugs resistant results between
pulmonary and extra pulmonary tuberculosis in
lower northern of Thailand 2013
R. Khummin
Phitsanulok (Thailand)
23.017Reliability of Kirby-Bauer disk diffusion method
for detecting doripenem susceptibility in oxidase
positive non-fermenting gram negative bacilli
R. Misra, K. N. Prasad
Lucknow (India)
23.018Prevalence and detection of ampC
beta-lactamases in gram negative clinical
isolates & associated risk factors at a tertiary
care centre in northern India
R. Misra, K. N. Prasad
Lucknow (India)
Poster Presentations II
SUNDAY вЂў November 2, 2014
International Meeting on Emerging Diseases and Surveillance 2014
23.019ESBLs structure from KazakhstanвЂ™s enterobacteria
in the SMART study (2011вЂ“2013)
I. S. Azizov, D. Babenko, E. Zakharova,
A. Lavrinenko, N. Shambilova, E. Tishkanbayev
Karaganda (Kazakhstan)
23.020The analysis of resistance of M. tuberculosis to
drugs in Kazakstan (2010вЂ“2013)
D. Babenko, I. S. Azizov, N. Tabriz
Karaganda (Kazakhstan)
23.021Carbapenemase-producing Enterobacteriaceae in
a clinical hospital from Bucharest, Romania
D. Talapan, O. M. Dorobat, A. Streinu Cercel,
A. Rafila
Bucharest (Romania)
23.022Increase in Clostridium difficile mortality in the
United States, 1999вЂ“2011
V. N. Abdullatif, A. Noymer
Irvine, CA (USA)
23.023Efficacy of antibiotic combinations against
P. aeruginosa isolated from UTI in Northern
Jordan hospitals
Y. H. Tarazi
Irbid (Jordan)
23.024Antimicrobial resistance of fecal E. coli isolated
from cattle and pigs
M. Niculae, I. C. Mates, C. D. Sandru,
G. F. Brudasca, E. Pall, M. Spinu
Cluj (Romania), Bucharest (Romania)
23.028Understanding the mutations responsible for
carbapenem resistance in KPC-2
G. Cortina, P. Kasson
Charlottesville, VA (USA)
23.032Molecular characterization of methicillin-resistant
Staphylococcus aureus isolated from Makkah
hospitals
A. Asghar
Makkah (Saudi Arabia)
23.033Prevalence of opportunistic intestinal parasites
and drug resistance pattern of selected
diarrheogenic Enterobacteriaceae among
cotrimoxazole prophylaxis taking HIV seropositive individuals at St. PaulвЂ™s Teaching Hospital,
Addis Ababa
M. M. T. K. Kebede, M. M. T. K. Tadesse
Addis Ababa (Ethiopia)
23.034Detection of CTX-M-15 type of extended
spectrum beta lactamase producing Klebsiella
pneumoniae in Cairo University Hospitals in Egypt
R. H. Abd El-Aziz, M. Abd El-Halim,
A. El-Banna, A. El-Kholy
Cairo (Egypt)
23.035First identification of NDM-1 carbapenemase
from Klebsiella pneumoniae in Seychelles
J. T. Bibi, A. Michault
Victoria (Seychelles), St Pierre (France)
November 2, 2014
23.027Antimicrobial susceptibility and biofilm formation
by NT H. influenzae (NTHi) strains isolated from
Mexican patients
P. Gomez de Leon, T. Santander, F. J. DГaz,
F. QuiГ±ones, E. Sada
Mexico City, DF (Mexico)
23.031Recovery of Escherichia coli susceptibility to
cephalexin and co-trimoxasole due to changes in
ambulatory antibiotic consumption in Croatia
J. Vranes, V. Ticic, B. Bedenic, M. Anusic,
T. Marjan, A. Mlinaric-Djepina
Zagreb (Croatia)
вЂў
23.026Escherichia coli OXA-48 infection in a patient
with acute lymphoblastic leukaemia and potential
for spread in hospitalised patients
M. M. WrГіblewska, I. SeferyЕ„ska,
E. Lech-MaraЕ„da, K. Warzocha, M. Giemza,
E. Mik, A. Kuziak, D. Е»abicka, M. Gniadkowski,
W. Hryniewicz
Warsaw (Poland)
23.030Antibiogram, virulence genes markers and
biofilm formation of aeromonas species
recovered from cattle
I. H. Igbinosa, E. O. Igbinosa, A. I. Okoh
Pretoria (South Africa), Benin City (Nigeria),
Alice (South Africa)
SUNDAY
23.025It is a no-brainer: Never use fusidic acid alone!
A study from Alexandria, Egypt
A. Abouelfetouh, M. Naguib, M. Kassem,
M. El-Nakeeb
Alexandria (Egypt), Damanhour (Egypt)
23.029The changes of the levels of PFOR gene
expression between MZ-resistant and
MZ-susceptibility strains of G. intestinalis
R. Begaydarova, Y. Yukhnevich, D. Babenko,
S. Kaliyeva, I. S. Azizov
Karaganda (Kazakhstan)
23.036Magnitude of extended spectrum beta-lactamase
producing entrobacteriaceae among patients
admitted for bacterial infection in Adama Hospital
and clinical sample sent to Oromia Public Health
Laboratory, Adama, Ethiopia
G. M. Misgana, T. W. Abebe, G. J. Guto
Adama (Ethiopia)
23.037Drug resistance variants in chronic hepatitis B
Iranian patients under long term Lamivudine
treatment
S. R. Mohebbi, P. Azimzadeh, S. Mokhtari,
M. Khanyaghma, S. Kazemian, A. Sharifian,
M. R. Zali
Tehran (Iran)
29
IMED 2014
Poster Presentations II
SUNDAY вЂў November 2, 2014
International Meeting on Emerging Diseases and Surveillance 2014
Bioterrorism and Biological Warfare
23.038Biosecurity and the global maritime shipping
industry: An analysis of the current state of
surveillance metrics
J. Varco, M. J. Varco
Washington, DC (USA)
Climate Change and Ecological Factors
in Disease Emergence
23.039Genetic diversity of Aspergillus flavus and occurrence of aflatoxin contamination in stored maize
across three agro-ecological zones in Kenya
G. W. Gachara
Nairobi (Kenya)
23.040Climatic influences on seasonality associated with
influenza illness in Lao PDR, 2008вЂ“2011
P. Souliphone
Vientiane (PeopleвЂ™s Democratic Republic of Lao)
Diseases at the Interface of Humans,
Wildlife and Other Animals
SUNDAY
вЂў
November 2, 2014
23.041Molecular characterization of Echinococcus
granulosus from hydatid cysts isolated from
human and animals in Golestan Province,
North of Iran
M. Soosaraei
Gorgan (Iran)
23.042Escherichia fergusonii: An emerging multi-drug
resistant pathogen
B. A. Glover, A. O. Jenkins, M. vanVuuren
Pretoria (South Africa)
23.043Parapoxvirus infections in Turkey
T. C. Oguzoglu, A. Karakas, B. T. KoГ§,
S. Salar
Ankara (Turkey)
23.044Preventive vaccination against rabies and
necessity of oral vaccination of wildlife
L. Ninidze, R. Obiso
Tbilisi (Georgia), Blacksburg, VA (USA)
23.045Rabies prevention protocols and policies and
staff knowledge and training in animal shelters
in the United States
Z. N. Hedge
San Diego, CA (USA)
23.046Genetic analysis of West Nile Virus isolates from
different geographical regions in Kenya
L. Musila, A. Nyunja, H. Koka, R. Sang
Nairobi (Kenya)
23.047A вЂ�One HealthвЂ™ approach to the elimination
of rabies
E. Fogelberg, M. Kennedy, W. Gates
London (United Kingdom)
30
IMED 2014
23.048Molecular and microbiological detection of
Bartonella spp. bacteremia in cats
M. R. Drummond, P. P. V. D. P. Diniz, B. G.
Lania, D. M. R. Demolin, R. Gilioli, E. Breitschwerdt,
G. Vieira-Damiani, D. G. Scorpio, P. E. N. F. Velho
Sao Paulo (Brazil), Pomona, CA (USA), Raleigh,
NC (USA), Baltimore, MD (USA)
23.049Age-specific seriousness of avian influenza
A(H7N9) in the second-wave epidemic in China
E. H. Lau, P. Wu, J. Y. Wong, G. Freeman, J. T. Wu,
G. M. Leung, Y. Hongjie, B. J. Cowling
Hong Kong (China), Beijing (China)
23.050Do Costa Rican urban raccoon populations
pose a public health concern?
M. Baldi, G. Alvarado, E. Barquero, G. Hernadez,
C. Jimenez, M. Santoro, S. Hutter, S. Smith,
C. Walzer
Heredia (Costa Rica), San JosГЁ (Costa Rica),
Rome (Italy), Vienna (Austria)
23.051Prevalence of antibodies against influenza A/
H5N1 virus among live poultry market workers
in NorthernVietnam, 2011
M. T. Q. Le, D. Tham, D. N. Pham, N. S. Vu,
T. M. Luong, H. L. K. Nguyen, T. T. Le
Hanoi (Viet Nam)
23.052Phylogenetic characterization of Bocaviruses
infecting wild and captive living chimpanzees
K. Brozova, K. Hrazdilova, A. K. Piel,
F. A. Stewart, K. J. Petrzelkova, V. Celer
Brno (Czech Republic), Cambridge
(United Kingdom)
23.053Hantavirus in persons exposed to domestic and
wild rats in the UK: Results of a sero-prevalence
study
J. Duggan, R. Close, L. McCann, N. McCarthy,
T. Mannes, M. Keys, D. Wright, A. Walsh,
A. Charlett, T. Brooks
Salisbury (United Kingdom), Oxford
(United Kingdom), Bristol (United Kingdom),
London (United Kingdom)
23.054Bovine tuberculosis in pigs: A case of
Mycobacterium caprae infection
B. Amato, V. Di Marco Lo Presti, E. Gerace,
F. Mandanici, E. Biasibetti, M. B. Boniotti, L. Spuria,
F. Valenza, M. L. Pacciarini, M. T. Capucchio
Barcellona P.G. (Italy), Grugliasco (Italy),
Brescia (Italy)
23.055Features of epidemiology of Echinococcosus granulosus in the Southern Russia
L. Ermakova, N. Pshenichnaya, Y. Kirtanasov,
K. Bolatchiev, T. Tverdokhlebova
Rostov-on-Don (Russian Federation), Cherkessk
(Russian Federation)
Poster Presentations II
SUNDAY вЂў November 2, 2014
International Meeting on Emerging Diseases and Surveillance 2014
23.056Psittacosis associated with pet birdвЂ™s ownership:
A cause of public health concern
V. L. Ferreira, M. V. Silva, T. F. Raso
SГЈo Paulo (Brazil)
23.057Hepatitis E virus in the South of Spain:
Seroprevalence and acute infection in patients
with anormal transaminases levels
T. Perez-Gracia, F. Rivas, B. Suay, S. GarcГa-Valdivia,
F. Galan-Sanchez, M. Rodriguez-Iglesias
Valencia (Spain), Cadiz (Spain), Puerto Real
(Spain)
23.058The serum archive for emerging zoonosesвЂ”
A new national resource to inform public health
risk assessments for new and emerging animal
infections
K. Russell, B. Said, D. Brown, D. Morgan,
H. Kirkbride
London (United Kingdom)
23.059Seroprevalence of hepatitis E virus in wild boars
in Serbia
B. I. Kureljusic, B. SaviД‡, N. JezdimiroviД‡, Дђ.
CvetojeviД‡, J. Kureljusic, D. JakiД‡-DimiД‡,
O. RadanoviД‡, V. MiliД‡eviД‡, V. IvetiД‡
Belgrade (Serbia)
23.060Clinical analysis of Helicobacter cinaedi bacteremia
in patients with rheumatic diseases
I. Takajo, T. Kawaguchi, M. Matsuda, A. Okayama
Miyazaki (Japan)
23.064Coxiella burnetii infection in wild boars
(Sus scrofa)
S. Anastacio, C. Coelho, M. Pereira, M. M.
Vieira-Pinto, K. Sidi-Boumedine, G. J. da Silva
Coimbra, Coimbra (Portugal), Vila Real (Portugal),
Coimbra (Portugal), Sophia Antipolis (France)
23.065Pandemic influenza virus in pigs raised in
smallholder farms in Kenya, 2010вЂ“2012
P. M. Munyua, L. Mwasi, C. Onyango,
C. Cardona, L. Waiboci, K. Njenga, P. Kitala,
P. Nyaga, J. Mott
Nairobi (Kenya), Saint Paul, MN (USA)
23.069Highly pathogenic avian influenza in the occupational environment: Attitudinal and structural
determinants of behavior among commercial
poultry sector workers in Indonesia
J. M. Kreslake, Y. Wahyuningrum, B. Safi,
M. E. Figueroa, D. Storey
Baltimore, MD (USA)
23.070Assessing the risk of Mycobacterium bovis transmission from domestic cats to human contacts
C. OвЂ™Connor, A. Walsh, D. Morgan
London (United Kingdom)
23.071Zoonotic Bartonella species identified in wild
rodents in Cotonou, Benin
G. Bonnet, G. Houemenou, A. MartГn-Alonso,
E. Abreu-Yanes, I. Montoliu, B. Valladares,
C. Feliu, P. Foronda
Santa Cruz de Tenerife (Spain), Sart Tilman
(Belgium), Barcelona (Spain)
23.072Antiparasitic activity of bovine milk protein
lactoferrin on Toxoplasma gondii: An in vitro
and in vivo study
N. Anand
Chandigarh (India)
November 2, 2014
23.063The risk of import of potentially zoonotic and
multi resistant bacteria through import of
ornamental fish into the EU
N. Tafro, O. Stenvers, O. Haenen
Schiphol (Netherlands), Utrecht (Netherlands),
Wageningen (Netherlands)
23.068Canine rabies diagnosis from formalin fixed
paraffin embedded (FFPE) tissue
S. Beck, P. Gunawardena, D. Horton, D. J. Hicks,
D. A. Marston, A. Ortiz-Pelaez, A. R. Fooks,
A. Nunez
Addlestone (United Kingdom), Peradeniya
(Sri Lanka), Surrey (United Kingdom)
вЂў
23.062Novel point mutations in rpoB gene useful for
Brucella melitensis typing
S. AbuBakar, K.-K. Tan, Y.-C. Tan, K.-W. Lee,
W.-Y. Yee, L.-Y. Chang
Kuala Lumpur (Malaysia), Selangor (Malaysia)
23.067Rabies boosters: Serological follow-up of bat
workers in the United Kingdom
B. Said, H. Kirkbride, D. Horton, A. R. Fooks,
D. Morgan, D. Brown
London (United Kingdom), Surrey (United
Kingdom)
SUNDAY
23.061Molecular investigation of RNA viruses in bats
V. Nikolic, G. Stamenkovic, J. Jovanovic,
M. Paunovic, M. Stanojevic
Belgrade (Serbia)
23.066PRRS virus/Streptococcus suis co-infection in
nursery pig which have unstable status of PRRS
from farm in North-Eastern part of Thailand
S. Porntrakulpipat, J. Jiwakanon,
T. C. Nutravong, S. Angkititrakul
Khon Kaen (Thailand)
23.073Detection of Coxiella burnetii in rodents and
wild birds in Portugal
A. S. P. Santos, F. Amaro, A. C. Norte, P. Melo,
M. M. Santos-Silva, R. De Sousa, M. J. Alves,
M. S. Nuncio, F. Hagen, J. J. H. C. Tilburg
ГЃguas de Moura (Portugal), Coimbra (Portugal),
Lisbon (Portugal), Nijmegen (Netherlands)
31
IMED 2014
Poster Presentations II
SUNDAY вЂў November 2, 2014
International Meeting on Emerging Diseases and Surveillance 2014
23.074Lyophilisation of lentiviral pseudotypes for
the development and distribution of virus
neutralization assay kits for rabies, Marburg
and influenza viruses
S. D. Scott, S. Mather, E. Wright, N. Temperton
Chatham Maritime (United Kingdom), London
(United Kingdom)
23.083Qatar national response to MERS-CoV:
How has one health approach made a diference?
E. Farag, M. Al-Hajri, A. El-Sayed, F. AlHajri, K.
Mohran, H. Ghobashy1, C. Reusken, M. Koopmans
Doha (Qatar), Doha, Qatar (Qatar), Rotterdam
(Netherlands), Bilthoven/ Rotterdam
(Netherlands)
23.075Gastrointestinal helminthes of green-winged teal
(Anas crecca) from north Iran
M. R. Youssefi, H. Hosseini, M. T. Rahimi
Babol (Iran)
23.084Seroprevalence of Ngari and Bunyamwera
viruses in selected parts of North-Eastern and
Rift Valley regions of Kenya
R. C. Sang, C. O. Odhiambo, M. Venter,
R. Swanepoel
Nairobi (Kenya), Pretoria (South Africa)
23.076Facility based national rabies survey in Ethiopia
H. M. Hailu
Addis Ababa (Ethiopia)
23.077Contribution of molecular biology in the diagnosis of human and animal cryptosporidiosis
F. Cheikhrouhou, N. Sourour, T. Houaida,
G. Raida, S. Hayet, F. Makni, A. Ayadi
Sfax (Tunisia)
SUNDAY
вЂў
November 2, 2014
23.078Whole genome analysis of an explosively emerging human rotavirus G6P[6] in Cameroon
V. N. Ndze, M. Esona, E. A. Achidi, R. Doro,
S. L. Farkas, M. T. Obama-Abena, K. BГЎnyai
Yaounde (Cameroon), Atlanta, GA (USA),
Buea (Cameroon), Budapest (Hungary)
23.079Group A rotavirus in domesticated animals in
Cameroon
V. N. Ndze, M. Esona, E. A. Achidi,
M. T. Obama-Abena, K. Banyai
Yaounde (Cameroon), Atlanta, GA (USA),
Buea (Cameroon), Budapest (Hungary)
23.080Rodents as potencial reservoirs of vacciniavirus in
periurban area of Sao Paulo City, Brazil
L. H. Okuda, A. L. Arruda, C. Del Fava,
M. M. Fusuma, S. F. Souza, A. H. C. Nogueira,
E. De Stefano, E. M. Pituco, A. E. C. Campos
Sao Paulo (Brazil)
23.081HPAI H5N1 detection in illegally imported
captive birds from Bali at the Vienna
International Airport
S. Revilla-FernГЎndez, Z. BagГі, E. Wodak,
S. Richter, F. Schmoll
MГ¶dling (Austria)
23.082Outbreak of Chlamydia psittaci: Timely detection
and diagnostics in a wild bird rehabilitation centre
I. Goverse, N. Reedijk, I. Veldhuijzen, R. van
Gageldonk, O. Stenvers, F. Velkers, E. Heddema,
O. Pontesilli, A. Tjon-A-Tsien
Rotterdam (Netherlands), Bilthoven
(Netherlands), Utrecht (Netherlands),
Sittard-Geleen (Netherlands)
32
IMED 2014
23.085A clinical investigation into Brucella canis cases in
dogs in Alberta, Canada: Public health and animal
health implications
S. Checkley, C. McMillan, S. Chalhoub, S.
Neate, S. Cork, A. M. Rix, J. MacDonald, P. Buote
Calgary, AB (Canada), Edmonton, AB (Canada)
23.086Persisting West Nile virus infection in Kea
(Nestor notabilis)
T. Bakonyi, G. Gajdon, R. Schwing, W. Vogl,
A.-C. Habich, H. WeissenbГ¶ck, N. Nowotny
Vienna (Austria)
23.087Diagnosis of a severe parapoxvirus infection in
an Austrian sheep herd, in 2014
S. Richter, S. Revilla-FernГЎndez, Z. Bago,
M. Gonano, H. Weinberger, P. Schiefer,
M. del Fabro, F. Schmoll
MГ¶dling (Austria), Vienna (Austria)
23.088Nasal carriage of antibiotic-resistant
Staphylococcus aureus with multiple markers
of livestock-association among industrial pig
farmers and their household members in
eastern North Carolina
M. Nadimpalli, E. Pierce, N. Pisanic, J. Stewart,
C. Heaney
Chapel Hill, NC (USA), Baltimore, MD (USA)
Diseases of Animals
23.089Evaluation of thermal stability and inactivation of
peste des petits ruminants virus cultivated in cell
culture
A. Latif, A. Bin Zahur, R. Zahra, A. Ahmed,
R. Wasee ullah, U. Farooq
Islamabad (Pakistan)
23.090Is the control program for classical scrapie in
Finland (2006вЂ“2012) sufficient to show
negligible risk?
K. Schulman, J. KyyrГ¶, T. LyytikГ¤inen
Helsinki (Finland)
23.091Effects of community composition and
temperature on fungal pathogen epidemics
F. Al-Shorbaji, R. Gozlan, B. Roche,
R. Britton, D. Andreou
Bournemouth (United Kingdom),
Montpellier (France)
Poster Presentations II
SUNDAY вЂў November 2, 2014
International Meeting on Emerging Diseases and Surveillance 2014
23.101Identification of caliciviruses in cats with enteric
symptoms
V. Martella, C. Catella, L. Bodnar, G. Palermo,
G. Romito, G. Lanave, B. Di Martino,
D. Galante, M. A. Cafiero, C. Buonavoglia
Bari (Italy), Novara (Italy), Bologna (Italy),
Teramo (Italy), Foggia (Italy)
23.102Serological monitoring of leptospirosis in the
population of wild boars killed in the territory
of Ukraine
V. Ukhovskyi, S. Nychyk, M. Sytiuk,
V. Kulykova, I. Polupan, O. Stepna
Kiev (Ukraine)
23.103Reasons for a high rate of rabies in Ukraine
S. Nychyk, I. Polupan, A. Nikitova, M. Sytiuk,
V. Ukhovskyi
Kiev (Ukraine)
23.104Detection of influenza virus A from wild birds
in Kazakhstan
Z. Kydyrbayev, M. Orynbayev, A. Sansyzbay,
D. Suarez, J. Crawford, Z. Omarova, K. Tabynov
Kordaiskiy (Kazakhstan), Gvardeisky (Kazakhstan),
Athens, GA (USA), FPO, AE (Egypt)
23.105Molecular characterization of ovine herpesvirus
type 2 (ovhv-2) in Turkey
Y. Yildirim, S. Bilge Dagalp, V. Yilmaz, A. Faraji,
N. Coskun
Kars (Turkey), Ankara (Turkey)
November 2, 2014
23.107Horses naturally infected with Strongylidae and
Ascaridae: Evaluation of hematological and some
biochemical parameters
S. Z. Borozan, I. Bosnjak, S. Katic-Radivojevic,
S. Jovic, M. Krstic, S. Stojanovic
Belgrade (Serbia)
вЂў
23.106Detection and full-length genome characterization of feline kobuviruses identified from
diarrheic cats
B. Di Martino, F. Di Profio, I. Melegari,
F. Marsilio, V. Martella
Teramo (Italy), Bari (Italy)
SUNDAY
23.092Detection of virus genome on animal surfaces
and in litter in the course of outbreaks with
low-pathogenic Avian influenza
T. Homeier, T. Harder, Y. Gall, F. Conraths
Greifswald (Germany)
23.093Serological and virological investigation of
Maedi-Visna and caprine arthritis encephalitis
virus infections in sheep and goats in Erzurum
Province, Turkey
M. O. Timurkan, I. Sozdutmaz, H. AydД±n,
A. Kirbas, M. S. Aktas, Y. Ozkanlar
Erzurum (Turkey), Kayseri (Turkey)
23.094Tembusu-like flavivirus (PerakВ virus) as the
cause of neurological disease outbreaks in
young Pekin duck
G. Z. Homonnay, E. Walkone Kovacs, K. BГЎnyai,
M. Albert, E. Feher, T. MatГі, T. Tatar-Kis, V. Palya
Budapest (Hungary)
23.095D2R2: An evidence-based decision support tool
to aid prioritisation of animal health issues for
government funding
A. J. Frost, F. Gauntlett, J. Gibbens, H. Lester,
S. Wyllie
London (United Kingdom)
23.096Molecular detection of Dirofilaria repens in
shelter dogs from western Latvia
M. Kirjusina, A. Daukste, L. Bankovska,
R. Latvele, A. Krumina, I. Jahundovica
Daugavpils (Latvia), Riga (Latvia)
23.097Prevalence of equine herpesvirus infections in
foals with respiratory tract disease in a private
pension farm, Turkey
S. Bilge Dagalp, A. Faraji, V. S. Ataseven,
Z. BaЕџaran KarapД±nar, M. O. Timurkan, F. Dogan,
A. Ozkul, F. Alkan
Ankara (Turkey), Hatay (Turkey), Van (Turkey),
Erzurum, Erzurum (Turkey)
23.098Outbreaks of hemorrhagic syndrome by Bovine
Viral Diarrhoea Virus genotype 1 in Sicily (Italy):
Pathology and biomolecular investigations
V. Di Marco Lo Presti, V. Cannella, B. Amato,
E. Biasibetti, G. Purpari, A. Tomaselli, M. Vitale,
F. Antoci, A. Guercio, M. T. Capucchio
Barcellona (Italy), Palermo (Italy), Grugliasco
(Italy), Messina (Italy)
23.099Isolation and molecular characterization of a
bovine enterovirus from calves with diarrhea,
Turkey
F. Alkan, I. Karayel, G. Lanave, C. Buonavoglia,
K. BГЎnyai, V. Martella
Ankara (Turkey), Bari (Italy), Budapest (Hungary)
23.100Coxiella burnetii in dairy ruminant herds:
Informative value of BTM serological and
molecular analysis
S. Anastacio, N. Carolino, K. Sidi-Boumedine,
G. J. da Silva
Coimbra (Portugal), SantarГ©m (Portugal),
Sophia Antipolis (France)
23.108Mutations and phylogenetic analysis of the
equine influenza virus (H3N8) nucleoprotein
M. Boukharta, F. Zakham, N. Touil, M. Elharak,
M. M. Ennaji
Mohammedia (Morocco), Rabat (Morocco)
23.109A sheeppox outbreak in Morocco: Isolation and
identification of virus responsible for the new
clinical form of disease
K. Zro, F. Zakham, M. Melloul, E. El Fahime,
M. M. Ennaji
Mohammedia (Morocco), Rabat (Morocco)
33
IMED 2014
Poster Presentations II
SUNDAY вЂў November 2, 2014
International Meeting on Emerging Diseases and Surveillance 2014
Ethical Issues in Emerging Diseases and
Disease Surveillance
23.11065 years since the introduction of universal vaccination against pertussis in the Czech Republic:
Study and comparison of the Bordetella pertussis
strains isolated during the period 1964вЂ“2015 by
molecular biological methods
K. Fabianova, J. Zavadilova, D. Lzicarova,
M. Musilek, C. Benes, P. Krizova, B. Kriz
Prague (Czech Republic)
23.111Development of the biosafety and biosecurity
policy in National Scientific Center вЂњInstitute of
Experimental and Clinical Veterinary MedicineвЂќ
A. Gerilovych, B. Stegniy, M. Stegniy,
V. Golovko, I. Danylova
Kharkiv (Ukraine)
Foodborne and Waterborne Diseases
23.112Clinical manifestations and susceptibility testing
of Salmonella typhito ciprofloxacin, from the
second outbreak of typhoid fever in Songkhla
province of southern Thailand
S. Ruangchan
Songkhla (Thailand)
SUNDAY
вЂў
November 2, 2014
23.113Genomic identification of Anisakis simplex larvae
by PCR-RAPD
F. Kojima, S. Fujimoto
Fukuoka (Japan)
23.114Detection of Escherichia coli O157:H7 virulence
genes in isolates from beef, pork, water, human
and animal species in the North West province,
South Africa: Public health implications
C. N. Ateba, M. Mbewe
Mmabatho (South Africa), Polokwane
(South Africa)
23.115Response to Cryptosporidium waterborne
outbreaks in the United States and the United
Kingdom: Lessons learned from a comparative
analysis
M. J. Varco, J. Varco
Washington, DC (USA)
23.116Development of the multiplex PCR for detection
of the food-borne pathogens in feed-stuff raw
B. Stegniy, A. Gerilovych, I. Gerilovych,
A. Zavgorodnii, V. Arefiev
Kharkiv (Ukraine)
23.117An estimate of the seasonal variation of
pathogenic bacteria species around the
Danube river mouth
M. Spinu, E. Pall, M. Niculae, G. F. Brudasca,
C. D. Sandru
Cluj (Romania)
34
IMED 2014
23.118Thinking beyond Opisthorchis viverrini
infection for risk of cholangiocarcinoma in
the lower Mekong basin
J. A. Steele, C. Richter, P. Saenna, V. Stout,
P. Echaubard, B. A. Wilcox
North Grafton, MA (USA), Kunming (China),
Khon Kaen (Thailand), Sudbury, ON (Canada),
Bangkok (Thailand)
23.119Molecular identification, morphometrics and
geographical distribution of the sibling species
Anisakis simplex s. s., Anisakis pegreffii (Nematoda:
Anisakidae) in commonly consumed fish in Spain
X. Roca, E. BorrГ s, R. Fisa, I. Montoliu
Barcelona (Spain)
23.120Free living amoebae: Morphological and molecular identification in hospital water circuit
T. Houaida, D. Faten, S. Hayet, N. Sourour,
F. Cheikhrouhou, G. Raida, J. FaiГ§al, F. Makni,
H. Jamile, A. Ayadi
Sfax (Tunisia)
23.121Hepatitis E seroprevalence varies by age and
community in Southwest Germany
C. Wagner-Wiening, G. Pfaff, S. Brockmann,
J. <. <. Wenzel, P. Kimmig, I. Piechotowski
Stockholm (Sweden), Stuttgart (Germany),
Reutlingen (Germany), Regensburg (Germany)
23.122Outbreak of gastroenteritis by consumption
of seafood вЂњCevicheвЂќвЂ”Quetzaltenango,
Guatemala; July 2012
I. R. Samayoa Gramajo, J. Moir
Quetzaltenango (Guatemala)
23.123Human Bocavirus infection in children with
acute gastroenteritis in Tehran, Iran
P. Azimzadeh, S. Romani, S. Mokhtari,
S. R. Mohebbi, M. R. Zali
Tehran (Iran)
23.124Investigation of suspected choleraвЂ”
Quetzaltenango, Guatemala; October 2013
I. R. Samayoa Gramajo, J. Moir
Quetzaltenango (Guatemala)
23.125Environmental health surveillance as an important function of public health laboratories
S. Checkley, S. Fathima, N. Neumann, S. Mukhi
Calgary, AB (Canada), Edmonton, AB (Canada),
Winnipeg, MB (Canada)
23.126A One Health approach to food safety in Asia
D. Hall, Q. B. Le
Calgary, AB (Canada)
Poster Presentations II
SUNDAY вЂў November 2, 2014
International Meeting on Emerging Diseases and Surveillance 2014
Poster Presentations II
Sunday, November 2, 2014
Klimt Ballroom I вЂў Upper Level
11:45вЂ“13:15
Infections of Public Health Significance
23.127Evidence of Yersinia pestis DNA in rodents
in plague outbreak foci in Mbulu and Karatu
districts, northern Tanzania
M. H. Ziwa, B. M. HangвЂ™ombe, B. S. Kilonzo,
M. I. Matee
Dar es Salaam (Tanzania), Lusaka (Zambia),
Morogoro (Tanzania)
23.128Hantavirus seroprevalence among forestry
workers in Hungary
M. Oldal, V. NГ©meth, M. Madai, G. Kemenesi,
G. HorvГЎth, K. BГЎnyai, F. Jakab
PГ©cs (Hungary), Budapest (Hungary)
23.129Cellular immunity induced during HIV and
falciparum malaria co-infectionВ among pregnant
mothers and their babies
A. O. Micheal, A. I. Chiaka, A. O. Henrietta
Ibadan (Nigeria)
23.130A review estimating the number of cases and
number of deaths from MDR-TB among HIV/
AIDS around the globe
P. J. Cazeau
West Palm Beach, FL (USA)
23.134Utilization of malaria preventive services in pregnant women attending Public Health Facilities in
Oyo State, South-West Nigeria, 2013
O. T. Olugbade, O. Ajumobi, M. O. Anyanwu,
T. O. Ladipo, A. T. Olayinka, I. Ajayi
Abuja (Nigeria), Ibadan (Nigeria), Zaria (Nigeria)
23.135Clostridium difficile enteritisвЂ”Predictors for in
hospital fatal outcome
N. Ion Nedelcu, P. I. Calistru
Bucharest (Romania)
23.139Quality of care in DOTS centers under national
tuberculosis control programme in Dhaka City
T. Bulbul
Dhaka (Bangladesh)
23.140Fullerenpolyaminocapronic acid is effective against
Herpes simplex virus infection
N. N. Nosik, N. G. Kondrashina, I. K. Lyalina,
L. D. Rasnetzov
Moscow (Russian Federation), Nizhny Novgorod
(Russian Federation)
23.141Transient workers may be a sentinel population
for detection of emerging infectious diseases
C. S. Chelvi, I. Venkatachalam, R. Sridhar,
N. Oon Tek, F. Kelly, P. Hishamuddin, P. L. Lim,
P. A. Tambyah
Singapore (Singapore)
23.142Epidemiology of MRSA in cats in Wroclaw cityвЂ”
Cross sectional study
K. Bierowiec, K. PЕ‚oneczka-Janeczko, K. RypuЕ‚a
Wroclaw (Poland)
November 2, 2014
23.133Assessment of malaria treatment services to
patients under 5 years attending public health
facilities in Oyo State, South West Nigeria, 2013
O. T. Olugbade, M. O. Anyanwu, T. O. Ladipo,
O. Ajumobi, A. T. Olayinka, I. Ajayi
Abuja (Nigeria), Ibadan (Nigeria), Zaria (Nigeria)
23.138The effect of genetic polymorphisms on drugresistance and early treatment outcome in HIV
patients with primary TB in Eastern Siberia
O. Ogarkov, S. Zdanova, S. Heysell, E. Houpt,
E. Zorkaltseva, V. Sinkov, E. Savilov
Irkutsk (Russian Federation),
Charlottesville, VA (USA)
вЂў
23.132Risk factor analysis for bacteriologically confirmed pulmonary tuberculosis among US-bound
Bhutanese refugees and immigrants from Nepal
A. K. Mishra, K. Takahashi, R. M. Wali
Jhapa (Nepal), Kathmandu (Nepal)
23.137Co-circulation of three dengue serotypes in
Mogadishu, Somalia: Findings of an enhanced
hospital-based dengue surveillance system
H. Kyobe Bosa, L. Lukwago, J. Montgomery,
J. J. Lutwama, B. Fields
Mogadishu (Somalia), Kampala (Uganda),
Nairobi (Kenya), Entebbe (Uganda)
SUNDAY
23.131Prevalence of bacteriologically confirmed pulmonary tuberculosis from active case finding among
US-bound Bhutanese refugees and immigrants
from Nepal
A. K. Mishra, K. Takahashi, R. M. Wali
Jhapa (Nepal), Kathmandu (Nepal)
23.136Study of causative pathogens of respiratory infections prevalent in long-term inpatient facilities:
Examination at hospital wards housing patients
with severe motor and intellectual disabilities
S. Matsuda
Tohon (Japan)
23.143Group A streptococcal prosthetic joint
infectionвЂ”A thanskgiving offering: A rare
manifestation of a classical pathogen
L. Lutwick, D. Garg
Kalamazoo, MI (USA)
23.144Th17 cell response is active during Sporothrix
schenckii infection
L. S. Ferreira, A. C. GonГ§alves, D. C. G. Maia,
M. C. Polesi, I. Z. Carlos
Araraquara, (Brazil)
35
IMED 2014
Poster Presentations II
SUNDAY вЂў November 2, 2014
International Meeting on Emerging Diseases and Surveillance 2014
23.145Novel Enterovirus 71 (EV71) strains passaged
in murine NIH/3T3 cell successfully infect
cultured rodent cells
C. B. L. Victorio, Y. Xu, Q. Ng, K. B. Chua,
V. T. Chow
Singapore (Singapore)
23.146Amino acid substitution 51N->51I in the
protein relE (Rv1246c) correlated with drug
resistance distribution and phylogenetic
divergence into two groups among 110 strains of
Mycobacterium tuberculosis genotype Ural
by genome-sequencing
V. Sinkov, O. Ogarkov, S. Zdanova, S. Heysell
Irkutsk (Russian Federation),
Charlottesville, VA (USA)
23.147Characterisation and antibiotic resistance of
Staphylococcus aureus isolated from nasal swabs
from patients and healthcare workers at a
tertiary non-academic hospital in Nigeria
A. O. Adelowotan, M. M. Kock, M. M. Ehlers
Pretoria, Gauteng (South Africa)
SUNDAY
вЂў
November 2, 2014
23.148Infants born to HBV-infected mothersвЂ”Are they
fully protected after active-passive vaccination?
R. Komitova, M. Nesherova, M. Atanasova
Plovdiv (Bulgaria)
23.149Incidence of bacterial etiologies of acute diarrhea
among refugees in Dadaab refugee camp, Kenya,
2011вЂ“2013
M. O. Ope, A. Unshur, F. Oyier, S. A. Mowlid,
S. B. Ochieng, B. Owino, C. I. Okello, R. Nyoka,
N. Marano
Nairobi (Kenya), Dadaab (Kenya)
23.150Etiologies of undifferentiated febrile illness across
Kenya: Lots of malaria, salmonella and zoonosis
N. K. Nyakoe, M. Maraka, B. K. Mutai,
I. M. Bashir, G. Awinda, J. Nyataya, C. Masakhwe,
R. Coldren, J. Waitumbi
Kisumu (Kenya)
23.151Assessing communicable disease situation
using routine health information systems:
A case of Pakistan
S. M. Mursalin, S. Z. Zareen
Islamabad (Pakistan), Lahore (Pakistan)
23.152Revisiting the burden of typhoid fever in
low and middle income countries for policy
considerations
V. Mogasale
Seoul (Republic of Korea)
36
IMED 2014
23.153The KEMRI/USAMRU-Kenya laboratoryвЂ™s acute
febrille illness surveillance program: The need
to quantify the role of brucellosis and other
pathogens in febrile illnesses
S. L. Konongoi, R. Coldren, V. O. Ofula,
F. Eyase, R. Sang
Nairobi (Kenya), Kisumu (Kenya)
23.154Epidemiological and laboratory aspects of
advanced HIV-infection in the Chechen Republic
A. Agoshkov, N. Pshenichnaya,
H. Aidamirova, T. Shevchenko
Rostov-on-Don (Russian Federation),
Grozny (Russian Federation)
23.155Bartonella spp. bacteremia in blood donors from
Campinas, Brazil
L. H. U. Pitassi, P. P. V. D. P. Diniz, D. G. Scorpio,
M. R. Drummond, M. L. Barjas-Castro,
G. Vieira-Damiani, S. Sowy, E. Breitschwerdt,
W. Nicholson, P. E. N. F. Velho
Sao Paulo (Brazil), Pomona, CA (USA), Baltimore,
MD (USA), Campinas (Brazil), Raleigh, NC (USA),
Atlanta, GA (USA)
23.156Evaluation for effectiveness of rabies control
project 2009вЂ“2013: A case study of Mtwara
Region, Tanzania
E. P. Matoja, E. Mbunda, N. J. M. Malamsha,
S. Kimera, H. M. Msami
Mtwara (Tanzania), Dar es Salaam (Tanzania),
Morogoro (Tanzania)
23.157Moelcular and clinical surveillance of rotavirus
infection in children with acute gastroenteritis in
northern Italy (2007вЂ“2013)
L. Pellegrinelli, S. Binda, V. Primache, L. Bubba,
E. Pariani, A. Amendola, R. Delogu, G. Ianiro,
F. M. Ruggeri, L. Fiore
Milan (Italy), Rome (Italy)
23.158Intestinal infectious diseases among febrile hospitalized patients in ArmeniaвЂ”A retrospective
chart review
E. Zardaryan, L. Paronyan, Z. Gevorgyan,
V. Asoyan, H. Apresyan, A. Hovhannisyan,
T. Kuchuloria, R. Rivard, C. Bautista
Yerevan (Armenia), Tblisi (Georgia), Frederick,
MD (USA), Silver Spring, MD (USA)
23.159A retrospective chart review study to describe
the most common causes of febrile illnesses in
hospitalized patients in Armenia
L. Paronyan, E. Zardaryan, Z. Gevorgyan,
V. Asoyan, H. Apresyan, A. Hovhannisyan, T.
Kuchuloria, C. Bautista, R. Rivard
Yerevan (Armenia), Tblisi (Georgia), Silver Spring,
MD (USA), Frederick, MD (USA)
Poster Presentations II
SUNDAY вЂў November 2, 2014
International Meeting on Emerging Diseases and Surveillance 2014
23.160Chikungunya: Emergence of a debilitating virus
in Sint Maarten
S. Seng, B. G. Elliott, N. B. Esch, E. S. Fernandez,
B. Finkel, V. Asin-Oostburg, K. ShupeRicksecker
Cupecoy, St Maarten (Netherlands), Philipsburg,
St Maarten (Netherlands)
23.161Two cases of severe fever with thrombocytopenia syndrome with contrasting outcomes
J. S. Park, C.-J. Kim, T. S. Kim, K. U. Park,
H.-B. Kim, J. Song, E.-C. Kim
Seongnam-si, KK (Republic of Korea),
Seongnam-si (Republic of Korea),
Seoul (Republic of Korea)
23.162Molecular/epidemiological trends of the
norovirus GII.4 variant New Orleans 2009
in Italy 2009/2013
M. C. Medici, G. M. Giammanco, F. Tummolo,
S. De Grazia, F. Bonura, F. De Conto,
M. C. Arcangeletti, K. BГЎnyai, V. Martella,
A. Calderaro
Parma (Italy), Palermo (Italy), Budapest (Hungary),
Bari (Italy)
23.163The influence of consistency of not using shared
syringe to the risk HIV infection in the population
of injection drug users (IDUвЂ™s) in Jakarta in 2013
D. O. T. L. Handayani, I. Inggariwati, S. Ginting
Jakarta (Indonesia)
23.167Skin, lymph nodes and bonesвЂ”WhatвЂ™s the
disease?
R. M. Silva, M. C. M. P. P. Ferreira, R. GonГ§alves,
J. Vicente, D. Aguiar, L. Martins, A. Ferreira
Coimbra (Portugal), Porto (Portugal), Macedo de
Cavaleiros (Portugal), Lisbon (Portugal), Cumura
(Guinea-Bissau)
23.171Serological detection of dengue fever
re-emergence in Kenya: 2011вЂ“2014
S. L. Konongoi, R. Coldren, V. O. Ofula,
S. Owaka, F. Eyase, R. Sang
Nairobi (Kenya), Kisumu (Kenya)
23.172Sirt1-mediated synthesis of triglyceride by HCV
core protein in HepG2 cells
J. Wang, J. Cheng
Beijing (China)
23.173First identification of Burkholderia pseudomallei
in Seychelles
J. T. Bibi, J. Gedeon, A. Ibrahim, J. Rossouw,
A. von Gottberg, A. Bermingham
Victoria (Seychelles), Mahe (Seychelles),
Sandringham (South Africa), Johannesburg
(South Africa), London (United Kingdom)
23.174Circulating rotavirus in hospitalized pediatric
patients, with the predominance of G1P[8]
DS-1-like human rotavirus in Manado, Indonesia
A. F. C. Kalesaran, A. Thongprachum,
D. H. C. Pangemanan, S. Takanashi, S. Okitsu,
S. Hayakawa, S. M. Warouw, M. Mizuguchi,
H. Ushijima
Tokyo (Japan), Manado (Indonesia)
November 2, 2014
23.166Epidemiology, serotyping and identification of
universal vaccine candidates against Group A
Streptococcus of Indian origin by usingВ in silico
and proteomics approaches
A. K. Johri, M. Dua
New Delhi (India)
23.170Reverse vaccinology for vaccine development
against Group B Streptococcus which causes
high mortality in neonates
M. Dua, A. K. Johri
New Delhi (India)
вЂў
23.165Improvement in measles control in Oyo State,
South West Nigeria, between 2008 and 2012
A. O. Gbolahan, W. L. Abass, M. Gbadegesin,
P. B. Adewuyi
Ibadan (Nigeria), Abuja (Nigeria)
23.169Prevelance of Cryptosporidium and giardia
infection on HIV patient in Nepal
G. R. Pant, V. Pant, N. Pant, B. Khatiwada,
B. P. Bhattarai, R. K. Dangol
Kathmandu (Nepal), Kanchanpur (Nepal),
Makwanpur (Nepal), Lalitpur (Nepal)
SUNDAY
23.164Physician knowledge, attitudes and practice
regarding Chagas disease in U.S. areas of high
prevalence of T. cruzipositive serology in blood
donors
K. Doktor, S. Doblecki- Lewis, A. Chang, K. Snow,
P. Lichtenberger
Miami, FL (USA)
23.168National measles surveillance data analysis,
2005в€’2009, Ethiopia
B. Beyene, G. Gebrelibanose, D. Jima, R. LUCe
Bahir Dar (Ethiopia), Mekelle (Ethiopia), Addis
Ababa (Ethiopia), Atlanata, GE (USA)
23.175Livestock as potential reservoirs of
pathogenic leptospira in the periphery of
the city of SГЈo Paulo, Brazil
A. L. Arruda, L. H. Okuda, J. Ferreira,
V. Castro, S. Papini, E. Masi, A. E. C. Campos
Sao Paulo (Brazil)
23.176Two yearsвЂ™ experience of Toscana virus central
nervous system infections in a single center in
North-East Italy (2012вЂ“2013)
A. Mastroianni, S. Varani, M. P. Landini,
C. Cancellieri, V. Sambri, A. Pierro, S. Di Cesare,
G. Rossini, E. Briganti, F. Allegrini
ForlГ¬, (Italy), Bologna, (Italy), Bologna, (Italy)
37
IMED 2014
Poster Presentations II
SUNDAY вЂў November 2, 2014
International Meeting on Emerging Diseases and Surveillance 2014
23.177Sero prevalence and associated risk factors
of brucellosis in cattle in Pyawbwe Township,
middle part of Myanmar
T. T. Myaing, M. Y. Win, S. S. Wai, S. Bawn,
K. K. Moe, W. Y. Maung, L. L. Htun
Yangon (Myanmar), Nay Pyi Taw (Myanmar)
23.178Geotagging hepatitis A virus: A dynamic tool for
public health surveillance
R. De Sousa, H. Vennema, L. Verhoef, J. Sane,
A. Kroneman, M. Koopmans
Bilthoven (Netherlands), Rotterdam
(Netherlands)
23.179Surveillance of latent tuberculosis infection
among non-HIV immunocompromised patients
at a Brazilian reference hospital
P. Paulin, M. T. Garcia, G. D. J. Camargo, A.
T. Ferreira, R. N. Angerami, V. M. Sinkoc, R. S. B.
Stucchi, M. L. Moretti, M. R. Resende
Campinas (Brazil)
23.180About diagnostic importance of ELISA method
at herpetic infections in HIV infected patients
F. Saipov
Tashkent (Uzbekistan)
SUNDAY
вЂў
November 2, 2014
23.181Vertebral osteomyelitis and paraspinal abscess
among patients with brucellosis
B. Sharifi-Mood, M. Metanat, M. R. Sharifi,
S. M. Hashemi-Shahri
Zahedan (Iran), Zahedan (Iran)
38
IMED 2014
Outbreak Modeling
23.182Estimating the protective effect of case isolation:
A case study of smallpox
H. Nishiura, K. Ejima
Tokyo (Japan)
23.183Shifts in the force of dengue infection in Curacao
M. Limper, K. Thai, I. Gerstenbluth, A. Duits,
E. van Gorp
Rotterdam (Netherlands), Curacao
(Netherlands)
23.184The advantages and disadvantages of using mathematical modeling to develop strategies for the
control of livestock disease epidemics
T. J. Chiwome
Kwamhlanga (South Africa)
23.185Molecular spatiotemporal sequence analysis
reveals multiple introductions of the 2009
Influenza A/H1N1 pandemic virus into Africa
F. N. Nindo, G. W. Harkins, D. P. Martin
Cape Town (South Africa)
23.186Simulation of African swine fever
prevalence in the population of wild boars
S. Nychyk, M. Sytiuk, I. Halka, N. Hudz,
M. Peknii, V. Ukhovskii
Kiev (Ukraine)
New Pathogen Discovery
23.187Emerging phaeohyphomycoses among immunocompromised patients: Westerdykella dispersa as a
cause of angioinvasive infection in a neutropenic
pediatric cancer patient
P. K. Sue, G. Gurda, S. Zhang
Baltmiore, MD (USA)
A bstracts
International Meeting on Emerging Diseases and Surveillance 2014
Friday, October 31, 2014
Session 01: MERS-CoV. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40
Session 02: In the Hot Zone: Ebola and MERS-CoV . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40
Session 03: 2014 West African Ebola Virus Outbreak Response. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41
Saturday, November 1, 2014
Session 04: West Nile Fever in the European Union . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42
Session 05: Rapid Diagnostics for Emerging Infectious Threats . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43
Session 06: Oral Presentations: Surveillance and Modeling of EID. . . . . . . . . . . . . . . . . . . . . . . . . . . . 43
Session 07: Global Spread of Antibiotic Resistance. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47
Session 08: Pathogen and Host Diversity. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48
Session 09: Ethics and Disease Surveillance. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49
Session 10: ProMED 20th Anniversary Symposium . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (no abstracts)
Session 11: Oral Presentations: Hot Topics in EID. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49
Sunday, November 2, 2014
Session 12: FAO of the UN: Tools for Animal Health. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53
Session 13: Health Care Associated Emerging Infections. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55
Session 14: Launching of the New OIE Global Wildlife Disease Reporting System. . . . . . . . . . . . . . 56
Session 15: Emerging Viral Threats. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56
Session 16: Things are Heating Up: EID and Climate Change. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57
Session 17: Pastoralism, Rural Communities and the Human Animal Health Interface . . . . . . . . . . . 58
Session 18: Oral Presentations: High-Consequence Viral Pathogens . . . . . . . . . . . . . . . . . . . . . . . . . . 58
Monday, November 3, 2014
Session 19: One Health: From Research to Public Health. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62
Session 20: Oral Presentations: Emerging Respiratory Viruses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63
Session 21: Changing Disease Landscapes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67
Saturday, November 1, 2014
Session 22: Poster Presentations I. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68
Diseases of Animals. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68
Infections Related to Travel and Migration. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68
Influenza and Other Respiratory Infections. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69
Innovations in Diagnostic Tests for Emerging Diseases. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80
New Approaches to Outbreak Surveillance and Monitoring. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 84
New Pathogen Discovery. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93
Outbreak Response and Control. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 96
Public Communication of Outbreaks and Emerging Diseases . . . . . . . . . . . . . . . . . . . . . . . . . . . 105
Sociopolitical Factors in Disease Emergence. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 108
Vaccines and Emergence of Vaccine Preventable Diseases. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 110
Vectorborne Diseases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 114
Sunday, November 2, 2014
Session 23: Poster Presentations I I. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 128
Antimicrobial Resistance. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 128
Bioterrorism and Biological Warfare. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 139
Climate Change and Ecological Factors in Disease Emergence . . . . . . . . . . . . . . . . . . . . . . . . . . 139
Diseases at the Interface of Humans, Wildlife and Other Animals. . . . . . . . . . . . . . . . . . . . . . . . 140
Diseases of Animals. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 155
Ethical Issues in Emerging Diseases and Disease Surveillance. . . . . . . . . . . . . . . . . . . . . . . . . . . . 161
Foodborne and Waterborne Diseases. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 162
Infections of Public Health Significance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 166
Outbreak Modeling . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 184
New Pathogen Discovery. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 186
39
IMED 2014
A bstracts FRIDAY вЂў October 31, 2014
FRIDAY
вЂў
October 31, 2014
International Meeting on Emerging Diseases and Surveillance 2014
Session 01 (Plenary)
Session 02 (Plenary)
Keynote Plenary Lecture: MERS-CoV
In the Hot Zone: Ebola and MERS-CoV
Friday, October 31, 2014
Room: Park Congress
14:00вЂ“15:00
Friday, October 31, 2014
Room: Park Congress
15:00вЂ“16:30
01.001 MERS-CoV
02.001 Why did the camel kiss the bat? The ecology
Z. Memish
Ministry of Health, Riyadh, Saudi Arabia
The emergence of Middle East Respiratory Syndrome coronavirus
infection in 2012 had resulted in an increased concern of the spread of
the infection globally. The total global cases as of 30 September 2014
were 886 laboratory-confirmed cases officially reported to the World
Health Organization (WHO), including 352 (39.9%) deaths. Known
cases have been directly or indirectly linked to countries in the Arabian
peninsula. The epidemiologic features of MERS remain poorly defined.
Studies that have modeled the reproductive rate of MERS-CoV in
humans have been based on notified, clinically apparent cases and
auxiliary measurements, such as the viral evolutionary rate. However,
these studies have emphasized the need to reevaluate estimates of
reproductive rates through laboratory-based investigations of the
actual rate of transmission, including silent and subclinical infections.
Any unnoticed transmission of the virus in the population could explain
why newly identified index cases often cannot be linked to zoonotic
exposure. However, to date, the lack of approved serologic tools has
hindered in-depth investigation of rates of secondary transmission.
Humans can become infected within their communities and transmission can then be amplified in the healthcare setting. MERS-CoV infection had caused multiple healthcare associated outbreaks and resulted
in the transmission within families. Contact investigation among cases
shows a variable amount of spread among family members, hospitalized patients and healthcare workers. The rate of secondary transmission among household contacts of patients with MERS-CoV infection
has been proven to be extremely low at a rate of approximately 5%,
while the magnitude of transmission in Healthcare setting is difficult to
estimate and is dependent on compliance with recommended infection
control measures. So far, circulating virus strains remain similar under
continuous monitoring, with no genetic changes. Community onset
MERS-CoV cases continue to occur. Dromedary camels are currently
the most likely linked animal to human MERS-CoV cases. Serologic
tests showed significant infection in juvenile camel compared to adult
camels. The prospect for the control of MERS-CoV infection relies on
prompt identification of cases within healthcare facilities with the institution of the appropriate infection control measures. In addition, pointing
the exact route of transmission from camels to humans would further
add to the control measures of MERS-CoV infection.
40
IMED 2014
and animal origins of MERS-CoV
K. Olival
EcoHealth Alliance, New York, NY, USA
The purpose was to review the current state of knowledge regarding
the animal reservoirs, origins, and ecology of MERS-CoV. Middle East
Respiratory Syndrome coronavirus (MERS-CoV) is an emerging zoonotic disease with a high case fatality rate.
We review the current state of knowledge and peer-reviewed literature regarding MERS-CoV and its animal reservoirs, and present data
from field investigations, phylogenetic analyses, and camel trade.
In October 2012, we identified a fragment of nucleic acid identical
to MERS-CoV was detected in an Egyptian tomb bat (Taphozous perforatus) collected near the human index case in Southwestern Saudi
Arabia, and MERS-related CoVs have been found globally from an
array of bat species. Subsequently, MERS-CoV has been detected via
serology, PCR, and virus isolation in camels over a large geographic
range across the Middle East and Africa. Epidemiological and experimental studies have substantiated the link between human and camel
transmission, but salient questions about the origins, geographic
extent, and animal transmission of MERS-CoV remain.
There remain significant gaps in understanding the linkages of
MERS-CoV infections in bats, camels, and humans. An integrated вЂ�One
HealthвЂ™ framework to address these gaps and develop interventions to
prevent current and future spillover of MERS-CoV is needed.
A bstracts FRIDAY вЂў October 31, 2014
International Meeting on Emerging Diseases and Surveillance 2014
02.002 Laboratory preparedness for
Ebola and MERS-CoV
no abstract submitted by presenter
03.001 Challenges and controversies in the 2014 West
African Ebola virus outbreak response
October 31, 2014
02.003 From the frontline of the Ebola crisis
H. de Clerck
MГ©decins Sans FrontiГЁres, Jette, Belgium
Friday, October 31, 2014
Room: Park Congress
16:30вЂ“18:00
вЂў
The initial response to emerging infectious disease (EID) outbreaks
typically involves research laboratories with expertise in the specific
pathogen, as routine diagnostic laboratories generally lack the expertise to diagnose unusual pathogens. Routine patient care and diagnostics target the most common diseases, and pressures on healthcare
costs limit the ability for broader evaluation of a patient. Nevertheless,
the most likely scenario is that routine settings are the first to be
exposed to patients with a novel infectious disease, as the initial clinical presentation of most EID outbreaks is non-specific. In addition, as
soon as an outbreak expands, scaling up of response requires input
from and deployment of routine clinical laboratories, whereas more in
depth research can help provide basic understanding on sources of
introduction, modes of transmission, and level of control of an outbreak.
Therefore, optimal response to an EID outbreak requires planning for
these different tiers of the laboratory network, bearing in mind the need
for information and data sharing provisions, and sufficient understanding of strengths, weaknesses, and robustness of conclusions based on
laboratory work as well as clinical and epidemiological work. Based on
review of past outbreaks, we prepared a standardized preparedness
checklist, addressing the essential information that laboratory scientists
can bring to outbreak investigation teams, as well as critical information needed for interpretation of laboratory results in support of outbreak investigations. As an EID event by default means working with
unknowns, understanding data gaps and how those influence possible
decisions on intervention are a crucial aspect of EID preparedness.
Essential steps in laboratory preparedness will be discussed, using the
recent MERS CoV and Ebola outbreak as examples.
Challenges and Controversies in
the 2014 West African Ebola Virus
Outbreak Response
FRIDAY
M. Koopmans
Erasmus Medical Centre, Rotterdam, Netherlands
Session 03 (Plenary)
A. Duse
NHLS & University of Witwatersrand, Johannesburg, South Africa
Zoonotic infections are those that can be transmitted between animals
and humans. Approximately two-thirds of human infections are zoonoses and caused by microorganisms as diverse as viruses, bacteria,
fungi and parasites. Many of the pathogens causing zoonoses are
considered to be either emerging or novel agents. Health of humans is
inextricably linked to the health of animals and the environment. More
broadly, the environment not only encompasses physical, geographical, climatic, ecological, agricultural and veterinary dimensions, but
also the social, cultural, political and religious factors that influence
those human behaviors that shape it. Addressing the connections
between health and the environment requires an urgent expansion of
interdisciplinary collaborations and strong political and global will.Viral
hemorrhagic fever agents pose serious challenges to human health
due to the fact that: (i) Filovirus outbreaks are largely created by man
and driven by human behavior, (ii) there is significant nosocomial (hospital) amplification of disease, (iii) there is an associated high morbidity
and mortality, (iv) case management is difficult and, as yet, there are
no commercially available vaccines and therapeutic agents, (v) prevention of infections is fraught with difficulties, and (vi) infection prevention and control strategies can be frustratingly unsuccessful. The viral
hemorrhagic fevers (VHFs) of Africa provide an ideal illustration of the
interconnected nature of man, microbe and the environment. This presentation will focus on the complexity of the current 2014 West African
Ebola outbreak in which there has been multi-country involvement
(Guinea, Liberia and Sierra Leone) and is deemed to the largest Ebola
outbreak ever described. Challenges and controversies related to VHF
outbreak responses, infection prevention control decisions and social
mobilization will be contextualized and highlighted. Also discussed are
the challenges faced, and posed. by expatriate workforces in the West
African sub-region.
41
IMED 2014
A bstracts SATURDAY вЂў November 1, 2014
International Meeting on Emerging Diseases and Surveillance 2014
Session 04 (Invited Presentations)
West Nile Fever in the European Union:
Challenges for Integrated Surveillance
and Control
Saturday, November 1, 2014
Room: Park Congress
08:30вЂ“09:30
Break-out Session
04.001 Status of West Nile Fever surveillance in
humans in the European Union
SATURDAY
вЂў
November 1, 2014
L. Marrama Rakotoarivony
European Centre for Disease Pervention and Control, Stockholm,
Sweden
After the West Nile fever outbreak in Romania in 1996, rapid expansion of the disease in the USA from 1999 and evidence of transmission
through blood donations and organ transplantation in 2003, interest for
the disease increased in the European countries. A series of EU regulations for Blood safety and surveillance, were published. Following
the 2010 outbreak in Greece, the European Member States identified
an urgent need to timely monitor this disease in the region. In 2011,
the European Centre for Disease Prevention and Control started to
develop the вЂњWest Nile fever maps toolвЂќ in order to provide European
countries with timely updates of the spatial distribution of human cases
in Europe.
The tool covers 65 countries at a high spatial resolution level (NUTS3
or GAUL1). From 2011 to 2013, data were actively collected through
an event-based surveillance web-system, screening of official national
web sources and contacts with international networks and national official authorities. After data validation, static maps, table and synthesis
were published on ECDC website on a weekly basis during the transmission season (June-November). In 2014, a real time reporting system was implemented so that all Member States can report West Nile
fever cases directly into TESSy, the European Surveillance System for
human notifiable diseases. Connection of this database with a West
Nile specific atlas is currently under development. It will allow the publication of interactive maps and tables on ECDC website for the 2015
transmission season and onwards. The previous system based on
active data collection will be still maintained to collect data from non-EU
countries and will also be connected to interactive outputs. Since 2011,
available information about cases or infection in non-human hosts and
vectors has been provided in the weekly synthesis.
This information is already used by some countries to raise awareness in areas without human case reports and to adapt surveillance
activities. A systematic report of cases or infection in animals or vectors
through an effective surveillance system would allow collecting and
sharing at the EU level reliable data that would support surveillance
and response activities for both human and animal health. It would also
be an excellent example of the вЂњOne HealthвЂќ approach that could be
used for other diseases.
04.002 Status of West Nile fever surveillance in
animals in the European Union
A. Gervelmeyer
European Food Safety Authority, Parma, Italy
In the European Union (EU), clinical signs of West Nile fever (WNF) in
infected animals are mostly seen in horses (< 10% show neurological
disorders). European birds infected with West Nile virus seldom show
clinical symptoms and mortality is rare.
At EU level, WNF as a cause of equine encephalomyelitis is notifiable
in horses since January 2013, based on Council Directive 82/894/EEC,
although this obligation was in force in several EU countries before.
42
IMED 2014
In 2013, five countries, Bosnia and Herzegovina, Greece, Hungary, Italy
and Spain, reported 80 outbreaks of WNF in horses to the European
Commission.
Apart from reporting outbreaks of equine WNF encephalomyelitis
under Council Directive 82/894/EEC, European Member States (MS)
can report animal cases of WNF to the European Commission under
Directive 2003/99/EC on the monitoring of zoonoses and zoonotic
agents. The Directive foresees that in addition to a number of zoonoses
and zoonotic agents, for which monitoring is mandatory, others shall
be monitored if warranted by the epidemiological situation. In 2012 MS
agreed to start reporting WNF at EU level. In the first year of reporting,
13 countries reported data on animal cases of WNF. While not all MS
have a WNF monitoring system in place, some, like Italy and Greece,
have been operating systems involving active, passive and/or sentinel surveillance for several years. Most of the data reported in 2012
were from domestic solipeds (horses and donkeys) and birds, but data
from other animal species, such as cattle and farmed deer were also
included. Of the 11 MS reporting data on solipeds, only two, Germany
and Poland, did not have positive findings. However, no data on the
vaccination status of the tested animals has been provided. Four MS
provided data on testing of birds, of which two, Belgium and Germany,
did not find positive animals.
Currently, the European Center for Disease Prevention and Control
and the European Food Safety Authority strive to strengthen the collaboration between animal and human health sectors on WNF, to establish
more integrated surveillance of West Nile fever that would improve the
preparedness and response to WNF outbreaks in Europe.
04.003 Integrated West Nile Fever surveillance:
Experience of Italy
P. Calistri
Istituto Zooprofilattico sperimentale dellвЂ™Abruzzo e del Molise
вЂњG.CaporaleвЂќ, Teramo, Italy
The epidemiology of West Nile virus (WNV) is influenced by multiple
ecological factors and, therefore, integrated and comprehensive surveillance systems are needed for early detecting the infection and
activating consequent control actions.
In Italy since 2001 a national veterinary surveillance plan (VS) is in
place to identify the geographical areas at risk for re-introduction of the
WNV infection. This surveillance plan is coordinated by the National
Reference Centre for the study of Exotic Animal Diseases (CESME). It
is based on entomological monitoring and periodical serological testing
of birds and equines for WNV.
Following the first human cases detected in 2008, a human surveillance plan (HS) for the West Nile Neuroinvasive Disease (WNND)
was put in place and is coordinated by the Italian National Centre
for Epidemiology, Surveillance and Health Promotion of the Istituto
Superiore di SanitГ (CNESPS-ISS).
During the vector activity period (15 JuneвЂ“30 Nov) a data exchange
protocol is in place between VS and HS to jointly define and update the
map of the affected areas (provinces) on the basis of the WNV testing
in both VS and HS. Veterinary and human surveillances are, therefore,
linked each other and work as a chain reaction. Together with the animal and entomological monitoring, the surveillance of WNND human
cases allows to detect the virus circulation in a given geographical area
and to obtain an estimation of its magnitude through the systematic
detection of emerging clinical cases.
The data collected within the integrated human and veterinary information systems support the application of control measures for blood
transfusions and organ donations, preventing the transmission of the
disease among human population, thus allowing the evaluation of
planned actions and, if needed, their improvement or revision.
In conclusion, the Italian experience represents a good example of
collaboration among different sectors of public health (human, veterinary, entomologists and blood and organ donation authorities) in a вЂњone
healthвЂќ perspective. In case of zoonoses, such as WND, this approach
is of paramount importance for a better and holistic understanding of
the prevention of the diseases and the maintenance of both human and
animal health.
A bstracts SATURDAY вЂў November 1, 2014
International Meeting on Emerging Diseases and Surveillance 2014
Session 05 (Invited Presentations)
Session 06 (Oral Presentations)
Rapid Diagnostics for Emerging
Infectious Threats
Surveillance and Modeling of Emerging
Infectious Diseases
Saturday, November 1, 2014
Room: Park Congress
09:30вЂ“10:30
Saturday, November 1, 2014
Room: Klimt 2 & 3
08:30вЂ“10:30
Break-out Session
05.001 Rapid diagnosis of MDR gram-negatives
G. Cornaglia
University of Verona, Verona, Italy
no abstract submitted by presenter
threatening human health faster: Guidance for
early warning and response with focus on
event-based surveillance
P. Nabeth, J. Guerra, Y. Bayugo, P. Barboza
World Health Organization, Lyons, France
November 1, 2014
Purpose: The revised International Health Regulations (IHR[2005])
highlight the need for countries to reinforce surveillance and response
systems that aim to rapidly detect and respond to public health events.
Early warning and response (EWAR) is the organized mechanism to
detect as early as possible any public health event requiring rapid
investigation and response. As very limited guidance on implementation and management of EWAR exists, the World Health Organization
(WHO) has developed some guidance.
Methods & Materials: In 2013вЂ“2014, under WHO coordination,
three international and two regional consultations were held, a working group was constituted, and a guidance document entitled В«Early
detection, assessment and response to acute public health events:
Implementation of EWAR including EBSВ» was developed.
Results: The main channel that is usually used by EWAR is Indicator
based surveillance (IBS): this is the routine surveillance system process to collect regular data mainly from healthcare structures.
However, EWAR cannot be based solely on information provided by
the health system, and the usual IBS needs to be complemented with
ad hoc information on health events or risks which may represent a
potential acute risk to human health. The organized collection, monitoring, assessment and interpretation of this mainly unstructured information is called В« Event-Based SurveillanceВ» (EBS).
The process used by EWAR to detect public health events is referred
to as Epidemic Intelligence. It is made up of different steps: detection,
triage, verification, and risk assessment.
For EBS, as the information can be provided by very diverse sources,
detection should rely on mechanisms to be defined according to a
countryвЂ™s specificities; triage which consists of sorting data and information into the categories вЂњlikely to be relevantвЂќ or вЂњnot likely to be
relevantвЂќ for EWAR, is crucial to limit the unnecessary verification and
investigation of irrelevant signals.
The verification and risk assessment steps are similar whether for
EBS or IBS.
Conclusion: Implementation of EWAR requires several resources.
As the IHR(2005) prompt Member States to adopt an all hazard
approach, multisectoral partnership (sharing with other sectors than
human health) and political commitment are of upmost importance.
вЂў
Invasive fungal infections (IFI) are increasingly recognized and
are a primary cause of morbidity and mortality in immunocompromised patients. Fungal diseases are mostly opportunistic infections with a great variety of common and uncommon pathogens.
Laboratory methods for diagnosing IFI include microscopy, culture,
serology and histopathology. Conventional microbiologic and histological methods serve as the cornerstone for the definitive diagnosis
of invasive fungal infections. Direct microscopic examination of clinical
specimens is a first-line procedure in detecting fungal elements and is
rapid, useful, and cost-effective. Cultures yield the specific aetiological
agent and allow for susceptiВbility testing. All fungi obtained from sterile
sites should be identified to species level. Non-invasive diagnostic tests
for IFI include detection of antibodies, cell wall components and fungusspecific nucleic acids. The tests provide suppleВmental information for
the diagnosis of IFI. Most serological tests designed to detect specific
serum antibodies are ineffective as immunocompromised patientsвЂ™ lack
of a specific antibody response to infection. Detection of fungal cell wall
and cytoplasmic antigens in serum or other body fluids represent the
most direct means of providing a serologic diagnosis. Of great importance are the galactomannan (GM) immunoassay for the diagnosis
of invasive aspergillosis and the (13)-Гџ-D-glucan (BG) assay for the
diagnosis of infections caused by Aspergillus and Candida species or
others. Overall, the galactomannan test seems to be a highly specific
diagnostic tool (94% to 99%), even though sensitivity has ranged from
50% to 93% in patients with haematologic malignancy. Detection of
galactomannan in BAL fluid provides better evidence for aspergillosis than culture. BG is detectable in patientsвЂ™ serum during infection with Candida and Aspergillus species, Fusarium, Trichosporon,
Saccharomyces, and Acremonium. The absence of a positive test
result had a 100% negative predictive value, and the specificity of the
test was 90% for a single positive test result. Specificity increased
to 96% when 2 sequential positive results were required for a вЂњtruepositiveвЂќ test result. PCR has been studied in detail for candidemia and
invasive aspergillosis and clinical specimens include serum or whole
blood, and respiratory samples. DNA and RNA-based methods hold
promise for improved sensitivity and specificity, but these methods will
require extensive validation in clinical studies.
06.001 Making detection and response to all events
SATURDAY
05.002 Rapid diagnosis of invasive mycosis
C. Lass-FlГ¶rl
Innsbruck Medical University, Innsbruck, Austria
Break-out Session
05.003 Mobilization of samples and biocontainment
laboratories for the diagnosis of risk group 4
agents in outbreak response
G. Ippolito
National Institute fro Infectious Diseases вЂњL.SpallanzaniвЂќ, Rome, Italy
no abstract submitted by presenter
43
IMED 2014
A bstracts SATURDAY вЂў November 1, 2014
International Meeting on Emerging Diseases and Surveillance 2014
06.002 The worldвЂ™s first application of participatory
surveillance at a mass gathering: FIFA World
Cup 2014, Brazil
SATURDAY
вЂў
November 1, 2014
W. Oliveira1, G. S. Dimech2, O. B. L. N. Leal-Neto3, M. Libel4,
M. Smolinski4
1
Secretariat of Surveillance in Health, Ministry of Health, BrasГlia,
BrasГlia, Distrito Federal, Brazil, 2Ministry of Health Brazil, Brasilia, DF,
Brazil, 3Epitrack, Recife, Pernambuco, Brazil, 4Skoll Global Threats
Fund, San Francisco, CA, USA
Purpose: The 2014 FIFA World Cup is an event that increased the
risk of disease spread in Brazil. Participatory surveillance enhances the
early detection of infectious diseases through direct notification by the
population. Participatory surveillance was implemented at this mass
gathering event to potentially detect clusters of illness. The objective
was to detect possible changes in the epidemiological pattern of acute
disease events in 12 Brazilian host cities during the mass gathering
event of the 2014 FIFA World Cup.
Methods & Materials: A web-based and mobile application, вЂњHealthy
CupвЂќ, was developed as an open sourced tool to allow the public to selfreport on 10 symptoms during the World Cup over the period between
12 May to 13 July, 2014. Scenarios are built on three syndromes, respiratory, rash (exanthema) and diarrheal, aiming to identify public health
emergencies and their spatial distribution. The app uses gamefication
and provides useful information to the user to encourage engagement.
Results: The clinical-epidemiological characteristics of users and
features related to the use of the system for the duration of the study
will be presented. At the time of this abstract submission, the period
from 16 May to 09 July 2014, we observed 9,418 downloads, 7,275
users registration, 4,672 active users and 44,029 reports on their health
condition. Males were 52.7% of the participants; the median age was
30 (range 13вЂ“77 years old). Three hundred users were detected with
respiratory syndrome, 162 with diarrheal syndrome and 87 with rash
syndrome, but at no time, were clusters identified.
Conclusion: The Healthy Cup was a pioneering use of participatory
surveillance for mass gathering in Brazil. Confirming results from other
digital disease detection systems along with intensified surveillance
systems in use in Brazil, no clusters of illness were identified as serious health threats at the event. The participatory surveillance system
showed potential for use in other mass gathering events and routine
health services in the country. It is a promising tool for early detection of
health events, complementing existing traditional surveillance sources.
Engaging the public directly can strengthen the capacity to reduce the
magnitude of outbreaks during mass gathering events.
06.003 Communicable disease surveillance
during the 2014 FIFA World CupвЂ”
Rio de Janeiro State, Brazil
X. Marincic1, R. Chitale2, A. Marty3, R. De Santis4, Y. Aga5,
A. Chieppe6
1
University of Miami, Miami, FL, USA, 2Armed Forces Health
Surveillance Center, Silver Spring, MD, USA, 3Florida International
University, Miami, FL, USA, 4Secretaria de Estado de Saude, Rio de
Janeiro, Brazil, 5Erasmus MC University, Rotterdam, Netherlands,
6
Secretariat of State of Health of Rio de Janeiro, Rio de Janeiro, Brazil
Purpose: The Superintendencia de Vigilancia Epidemiologica e
Ambiental (SVEA) is part of the Secretaria de Estado de Saude do
Rio de Janeiro. Its mission is to plan, coordinate, assess, and support
epidemiological and environmental surveillance activities in the State of
Rio de Janeiro. It also provides technical support to health professionals in controlling illness and reporting health events, it therefore has
a major role in health surveillance during a вЂ�Mass GatheringвЂ™ such as
the 2014 FIFA World Cup. We provide a report of health surveillance
data gathered during the 2014 FIFA World Cup in the State of Rio de
Janeiro.
Methods & Materials: For this Mass Gathering, data collection
started one week before and will end one week after the 2014 FIFA
World Cup. Data was sent daily to Centro de InformaГ§Гµes EstratГ©gicas
44
IMED 2014
em VigilГўncia em SaГєde (CIEVS) and Centro Integrado de OperaГ§Гµes
Conjuntas da SaГєde (CIOCS) from local hospitals, Unidades de Pronto
Atendimento (UPA), Maracana Stadium medical points, and the FIFA
Fan Fest medical center. These data will be analyzed and events of
public health significance will be summarized.
Results: A total of 27 significant public health events were reported
and assessed. Of the 27 events, 24 cases were in attendees as follow:
3 confirmed cases (1 suspected) of imported malaria; 9 cases related
to violence;5 cases with suspected rabies exposure from animal bites;
3 cases potentially exposed to syphilis; 2 suspected dengue cases; 1
suspected typhoid fever case; and 1 person at risk of biological hazard
from a needle stick. Among non-attendees, there were 3 confirmed
cases of imported chikungunya.
Conclusion: In contrast to what was expected by national and
international authorities, communicable diseases did not have a major
public health impact in the State of Rio de Janeiro during the 2014 FIFA
World Cup. The surveillance system in place before the event coupled
with international awareness and preparation of travelers before coming to Brazil likely played an important role. These results reflect the
complete data collected during the approximately six week period that
included the 2014 FIFA World Cup.
06.004 Estimating illness incidence and investigating
outbreaks using a multi-purpose populationbased reporting cohort in Sweden, 2013вЂ“2014
H. Merk1, M. Edelstein2, A. Wallensten3
1
Public Health Agency of Sweden and Karolinska Institutet, Solna,
Sweden, 2Public Health Agency of Sweden and European Programme
for Intervention Epidemiology Training (EPIET), European Centre
for Disease prevention and Control (ECDC), Solna, Sweden, 3Public
Health Agency of Sweden and Uppsala University, Solna, Sweden
Purpose: Healthcare-based surveillance often does not allow estimation of population incidence of illness, and response rate among controls during outbreaks is generally low. Therefore in 2013, to improve
surveillance and preparedness, we set up a national cohort in Sweden
that reports online. The cohort enables population-based active surveillance of acute respiratory infections (ARI) and acute gastrointestinal
illness (AGI) and expedient control recruitment in outbreak investigations. We describe our multi-purpose cohort and report initial findings
from the ongoing 2013/2014 pilot study.
Methods & Materials: We selected individuals from the national population register, using stratified random sampling, and invited them by
post to join the cohort by registering on the study website. For surveillance purposes, participants receive a weekly e-mail encouraging them
to report online their health status for the previous week, including any
symptoms if ill. AGI and ARI reports are used to calculate incidence.
Participants reporting symptoms receive a follow-up questionnaire 3
weeks later.
As part of a national listeria outbreak investigation we also selected
participants from the cohort as controls based on age and sex.
Results: Of 34,842 invitees, 3,245 (9.3%) joined the cohort, of which
1,720 (53%) were female and 1,451 (45%) were children under 5. On
average 84.1% of participants submit a weekly report (range 11862850 reports). Between November 2013вЂ“June 2014, age-calibrated
incidences were 5/100 person-weeks for ARI and 0.9/100 personweeks for AGI. The weekly average response rate to the follow-up
questionnaire was 89.8%.
Of 186 cohort participants invited as controls, 108 (58%) responded
within 12 days of the e-mailed questionnaire.
Conclusion: We successfully recruited a population-based cohort to
report symptoms online on a weekly basis and enable rapid recruitment of controls for outbreak investigations. Although the recruitment
response rate was low, the high weekly reporting rate combined with
age-calibrated incidence estimates compatible with the published
literature suggest a functional surveillance system. Furthermore, the
response rate when recruiting controls was, in our experience, higher
and timelier than usual. Hence such a cohort may facilitate investigation of outbreaks. Overall, a multi-purpose cohort can be a valuable
instrument for surveillance and preparedness in countries with high
internet usage and complete population registers.
A bstracts SATURDAY вЂў November 1, 2014
International Meeting on Emerging Diseases and Surveillance 2014
06.005 Mapping of networks to detect priority
zoonoses in Jordan
E. Sorrell1, S. Kornblet1, N. Maswdeh2, M. El Azhari2, R. Katz1,
J. Fischer1
1
George Washington University Milken Institute of Public Health,
Washington, DC, USA, 2Jordan Ministry of Health, Amman, Jordan
H. M. Amuguni1, R. Mdegela2, J. Killewo3, C. Rioux4
1
Tufts University, North Grafton, MA, USA, 2Sokoine University of
Agriculture, Morogoro, Tanzania, United Republic of, 3Muhimbili
University of health and allied Sciences, Dar-es-Salaam, Tanzania,
United Republic of, 4Tufts University, Boston, MA, USA
Purpose: In light of increasing global population, disease emergence
and intensified encroachment on natural habitats, engaging communities in disease surveillance and emergency response activities is one
way to ensure that they are involved in the planning, implementation
and management of infectious diseases. In Africa through the One
Health Central and Eastern Africa network (OHCEA), universities have
developed local collaboration sites (One Health Demonstration Sites)
as centers for engaging the communities, local first responders, students and faculty to jointly identify and solve complex health problems
at the human-wildlife-livestock-interface.
Methods & Materials: In Tanzania, a baseline survey was done in
Kilosa district bordering Mikumi national park identified as a possible
location for a demonstration site. A multidisciplinary team led by faculty
and students from Sokoine and Muhimbili Universities in Tanzania and
Tufts University surveyed key stakeholders, assessing health related
activities, disease surveillance opportunities and practical interventions. A situational analysis was conducted and specific human health,
A. Kongelf, A. L. McClelland
Internatoinal Federation of the Red Cross and Red Crescent,
Petit Saconnex, Switzerland
Purpose: In epidemic response operations community-based cases
can go undocumented due to access barriers to facility based care,
poor communication channels and limited endogenous response
capacity. Developed nations continue to strengthen and improve electronic disease surveillance systems, however the parts of the world
most vulnerable to life threatening outbreaks still lack essential public
health infrastructure. Existing networks, are often inadequate during
rapidly evolving infectious disease epidemics.
Methods & Materials: In the cholera outbreak in Sierra Leone 2012,
the Sierra Leone Red Cross established 370 Oral Rehydration Points
(ORPs) for community-based cholera first aid. The rehydration points
were also valuable sources of information on the progress of the epidemic as they treated cases of cholera that did not attend the formal
Ministry of Health clinics, and therefore were not counted in the exiting
surveillance system. Data from 37 ORPs revealed that only 5 % of the
cases were referred to formal clinics.
Based on our experiences during the cholera outbreak in Sierra
Leone, the International Federation of Red Cross and Red Crescent
undertook a literature review on the use of mobile technology in community based disease surveillance. We have developed a system of
sms-based data collection, automated analysis, and report generation
that enables stakeholders to easily collect, assimilate, and act on disease surveillance information in real-time. The key innovation is the
linking of a large network of community based volunteers to software
solutions such as MAGPI, allowing real time and remote analysis of
data, and distribution of reports to support public health decisions.
Results: Recent field implementation in Haiti and South Sudan has
shown that the use of SMS data collectoin for disease survillance can
contribute to operational response during outbreaks and endemic
sceneriors and provides a signifcant prmiary data source for disease
survillance.
Conclusion: With its unique position with 17 million community based
volunteers worldwide, the Red Cross and Red Crescent Movement can
support not only in the emergency phase but also in epidemic prone
areas in support of their Ministries of Health if required, with valuable
data that can ensure early identification of outbreaks, allowing rapid
response and control measures.
November 1, 2014
communities in control of infectious diseases
at the human wildlife interface: Demonstration
site survey in Kilosa district, Tanzania
mobile technology and the Red Cross/Red
Crescent volunteer network
вЂў
06.006 A University driven approach to engaging
06.007 Community based disease surveillance using
SATURDAY
Background: Communication and coordination among national disease surveillance and response networks are vital in ensuring the
timely response to a public health event. Although systematic information-sharing between the human and animal health sectors can assist
with rapid detection and response to emerging infectious diseases,
resource constraints and other barriers often prevent efficient crosssector reporting. Our study aim was to determine whether resources
to develop one zoonotic disease network can be leveraged to build
sustainable One Health laboratory and surveillance networks for priority zoonoses.
Objective: In collaboration with the Field Epidemiology Training
Program (FETP) in Jordan we mapped the existing laboratory and
surveillance networks for detecting and reporting priority zoonotic
diseases to identify the nodes of communication, coordination, and
decision-making where health and veterinary sectors intersect, and to
identify priorities and gaps that limit information-sharing for action.
Methods & Materials: We selected three zoonotic diseases as case
studies: highly pathogenic avian influenza (HAPI) H5N1, rabies, and
brucellosis. Through meetings with government agencies and health
officials, and desk research, we mapped each system from the index
case through responseвЂ”including both surveillance and laboratory
networks, highlighting both areas of strength and those that would benefit from capacity-building resources.
Results: Our major findings indicate a strong desire and commitment
for multi-sectoral coordination in detection and response to zoonoses
across public health and veterinary sectors. Past zoonotic events have
shown that when political will and funding is available surveillance and
laboratory diagnostics are accurate and effective. Our analysis indicates that for Jordan the HPAI networks are well developed, coordinated, and effective in event identification, diagnosis and response and
suggests that current resources can be leveraged to expand national
avian influenza plans to all priority zoonoses.
Conclusion: Given the impact of zoonoses on public health this study
demonstrates how the HAPI model and programming can (and should)
be utilized for laboratory and surveillance One Health networks.
animal health, ecosystem challenges and impacts were identified such
as local human, livestock and wildlife diseases, habitat fragmentation,
edge effect, and biodiversity loss. Focus group discussions were held
with communities, local government and civil society officials.
Results: The Kilosa site is a constellation of villages, landscapes,
ethnic groups, domestic animals and wildlife. Together these entities
form natural, social and political ecosystems that are especially suited
for multidisciplinary collaboration, participatory research and joint
interventions. Villages surround the national park, closely interacting
with wild animals. Environmental issues such as flooding and internally
displaced communities are present. Ongoing conflict among pastoralists, farmers and national parks administration present opportunities for
community and government engagement, research and novel intervention systems. The region is strategically positioned in terms of cultural
resources and vulnerable populations as well as endemic or threatened
wildlife species. Rabies, Rift Valley fever, bovine tuberculosis, brucellosis and water borne zoonoses were identified by community members
as priority diseases that could be used to develop locally led surveillance, disease control and prevention programs.
Conclusion: The multifaceted issues identified presented opportunities for multidisciplinary investigation and intervention by community
members, government and the universities and engagement of all
stakeholders from the planning stages.
45
IMED 2014
A bstracts SATURDAY вЂў November 1, 2014
International Meeting on Emerging Diseases and Surveillance 2014
06.008 Local transmission networks of community
and hospital associated pathogens
SATURDAY
вЂў
November 1, 2014
G. Almogy1, A. Bernevig2, G. Almogy3, A. E. Moses3, R. Nir-Paz3
1
Flurensics Inc., Tel viv, Israel, 2Princeton U., Princeton, NJ, NJ, USA,
3
Hadassah Medical Center, Jerusalem, Israel
Purpose: Real-time understanding of how pathogens spread within a
community or a healthcare facility is pertinent for monitoring,infection
control and prevention measures. Obviously, automated real time data
analysis approach can improve decision-making processes, especially
in outbreaks, where rapid, accurate and comprehensive analysis is
critical. We propose that the dynamics of communicable diseases may
be viewed as the sum of multiple local transmission networks. We
explored the analytic and practical utility of applying computer simulations and signal analysis methodology to real-time pathogen data.
Methods & Materials: We used real pathogen data obtained from
the Hadassah Medical Centers (serving a population of ~1,000,000
people), including approximate home-address of patients, to preform
spatial-temporal analysis and simulate individual pathogen spread in
the entire Jerusalem area. Dataset contained 40,000 clinical test results
for 6 causing agents: three community diseases (Mycoplasma pneumoniae, Respiratory Syncytial Virus, Influenza Virus), and three health
care associated pathogens (Clostridium dificille, Carbapenem resistant Klebsiella pneumoniae and Methcillin resistant Staphylococcus
aureusвЂ“MRSA).
Results: We developed a signal-analysis terminology and methodology tailored for studying the real-time spread of pathogens, allowing
effective deconvolution of pathogen signals in space and time. By using
the patientsвЂ™ residence data and applying our algorithm, we were able
to eliminate the need for more than 30% of overall tests while maintaining ~100% of positive test results (i.e. saving 4000 tests per year
in one facility without lowering diagnostic capability). We were able to
predict the exact causative agent in the community in ~90% of cases.
Furthermore, we could predict and visualize the spread pattern of two
major community pathogens (figure).
Interestingly, we also identified via spatial-temporal-distributiondensity-analysis that MRSA occurrence in Jerusalem is probably
community-associated rather than health care associated.
Conclusion: We have created a methodology applicable to both
community and healthcare setting, based on spatial analysis of single
patient data in the context of local transmission networks. Our approach
enables cost-effective, real-time disease surveillance, epidemic spread
analysis, diagnostic assistance, and identification of disease hotspots
with an intuitive interface for both medical experts and researchers.
06.009 Developing a real-time syndromic surveillance
system based on the monitoring of drug
purchases in pharmacies: The OpenHealth.fr
experience
P. GuГ©rin1, V. Auvigne2
Celtipharm, Vannes, France, 2Ekipaj, Angers, France
1
Background: Data on the purchase of medicines in pharmacies by
patients are a source of information allowing the development ofrealtime вЂњbig dataвЂќ syndromic surveillance systems. The proof of concept
has been validated by numerous studies, but there are few examples
of operational implementation.
Objectives: Develop a syndromic surveillance system in operational
real time, from field data collection to the publication of monitoring indicators, develop the pilot indicators, develop innovative approaches to
spatio-temporal analysis and operate the system for at least six months.
Methods & Materials: The field network consists of 4,600 pharmacies located throughout France (21 % of French pharmacies).
They continuously transmit anonymous information on the sales of
medicines to a secure data treatment centre. The information includes
co-deliveries (multiple purchases by the same patient), the type of purchase (on prescription or over the counter) and the age of the patient
46
IMED 2014
(in case of purchase on prescription). Statistical processing algorithms
are run each night and the results are published before 8am the following morning onwww.OpenHealth.fr. The entire process is automated.
Open-source software (R and QGIS) is used.
The development of a new indicator includes the following steps:
defining the need, selecting the drug candidates based on expert opinion, developing the algorithm (choice of numerators and denominators,
weighting different types of drugs and type of purchase, choice of spatial and temporal smoothing parametersвЂ¦), validation by comparison
with existing data and development of publication interfaces.
Results: Six indicators, including two for the syndromic surveillance of infectious diseases (influenza-like illness, gastroenteritis)
were developed. They were validated by comparison with the French
Sentinelles Network. The update of the indicators was done in real
time (1 day release lag, daily time resolution) on a daily basis since
November 2013. The data can be freely downloaded (Open database
licence).
Conclusion: The developed methodology can be used to develop
a surveillance system for any syndrome. The only prerequisite is to
identify tracer drugs. The structure put in place will allow the development of indicators in a few days to allow a response to health crises.
The structure can also be duplicated in other countries.
06.010 Design of optimal surveillance network for
biosafety: a value of information model
M. Convertino
University of Minnesota, Minneapolis, MN, USA
Purpose: The model here proposed is explicitly based on a multiobjective optimization in which the value of information of reporting nodes
and the uncertainty related to outbreak source detection are maximized
and minimized, respectively. In order to test the model independently
of epidemiological, socio-environmental and biological features, we
consider three well-known epidemics with different geographic range,
pathogen features, and transmission routes. In this way we focus on
macro-linkages between patterns and process on networks that allows
to maximize detection via an optimally design surveillance.
Methods & Materials: The integrated model used in this paper consists in the following main sequential steps:
(1) Generation of potential surveillance networks within network
topologies;
(2) Model-based detection of onset/outbreak sources with uncertainty assigned to the reported outbreaks for all feasible surveillance
networks from (1); the determination of outbreak sources is performed
by minimizing the uncertainty in the effective distance estimations; and,
(3) Determination of the most informative surveillance network by
maximizing the VoI considering all combinations of feasible surveillance networks corresponding to potential reporting patterns.
Results: The results of the study hold when surveillance works for
any network topology. Here surveillance is seen as a function of the
network to contrast the spreading of infectious diseases. The random
surveillance design model, i.e. placing reporting nodes of outbreaks
randomly along the transmission network produces errors in the distance from the real outbreak sources. The ability of the maxVoI model
to detect outbreak sources with high accuracy and low surveillance
nodes is related to determination of the most meaningful nodes (in
terms of known information for describing outbreak patterns) via a portfolio model with Pareto optimization that explores all potential combinations of observers and corresponding outbreak information.
Conclusion: The design of optimal surveillance networks allows to
detect outbreak sources and paths correctly. Such detection is only
possible if information about outbreak вЂ�вЂ™fingerprintsвЂ™вЂ™, i.e reported outbreaks, is accurate and timely. We show that independently of system
scale and resolution, biological and socio-environmental dynamics the
вЂ�вЂ™unknownsвЂ™вЂ™ of epidemiological dynamics can be determined considering the same physics principles of reaction-diffusion processes and
information theory.
A bstracts SATURDAY вЂў November 1, 2014
International Meeting on Emerging Diseases and Surveillance 2014
06.011 Understanding the spatio-temporal risks for
bluetongue outbreaks across south India using
space-time Bayesian Poisson regression
modelling
M. M. Chanda1, D. J. Rogers1, S. Carpenter2, G. Prasad3,
M. Gajendragad4, B. V. Purse5
1
University of Oxford, Oxford, United Kingdom, 2Pirbright Institute,
Pirbirght, United Kingdom, 3ICAR, New Delhi, India, 4NIVEDI,
Bangalore, India, 5CEH, Wallingford, United Kingdom
Saturday, November 1, 2014
Room: Park Congress
11:00вЂ“11:45
November 1, 2014
modelling in Tanzania
C. Sindato1, E. D. Karimuribo1, J. Paweska2, L. E. Mboera3,
K. B. Stevens4, G. Dautu5, F. Kivaria6, D. U. Pfeiffer4
1
Sokoine University of Agriculture, Morogoro, Tanzania, United
Republic of, 2National Institute for Communicable Diseases of the
National Health Labolatory Service, Snadringham-Johannesburg,
Gauteng, South Africa, 3National Institute for Medical Research, Dar
es Salaam, Tanzania, United Republic of, 4Royal Veterinary College,
London, United Kingdom, 5University of Zambia, Lusaka, Zambia,
6
Food and Agriculture Organization of the United Nations, Dar es
Salaam, Tanzania, United Republic of
Global Spread of Antibiotic Resistance
вЂў
06.012 Rift Valley fever risk mapping and
Session 07 (Plenary)
SATURDAY
Background: Bluetongue virus (BTV), is an economically important,
midge-borne orbivus (family: Reoviridae)that causes disease in sheep
and cattle. In south India, small holder farmers are affected by bluetongue disease (BT) annually but severity varies dramatically between
years and farms. Temporal variability in numbers of outbreaks over
two decades has been linked to monsoon conditions, with warm wet
conditions in the preceding two months increasing outbreak numbers.
The contribution of diverse livestock hosts, vectors and land use types
found in south India to outbreak patterns is less well understood.
Objective: The objective of this analysis was to understand how
monsoon conditions interact with host and landscape factors to explain
spatio-temporal patterns of outbreaks in districts in south India over
over the last two decades and evaluate whether these relationships
can provide robust forecasts for disease management
Methods & Materials: The annual number of outbreaks in 61 districts (1992вЂ“2009) were related to land-cover, host availability (cattle,
buffalo, sheep and goat densities) and lagged climate predictors (temperature and precipitation) using a Bayesian generalised linear mixed
model with Poisson errors. Interacting structured and unstructured temporal and spatial random effects were used to account for spatial and
temporal autocorrelation and models were selected based on Deviance
information criteria. To evaluate out-of-fit predictive performance, the
data was divided into training (12 years) and test data (6 years).
Results: The best model combined climate, landover and host variables and unstructured spatial and temporal random effects and generate accurate predictions (r = 0.99 between observed and predicted
outbreaks). Annual BT outbreaks increased when maximum temperatures were high on average in the preceding year. More BT outbreaks
occurred in districts with (i) higher coverage of rainfed croplands, that
may support suitable breeding sites for biting midge vectors and (ii)
higher densities of goats and sheepвЂ”susceptible hosts for BT.
Conclusion: Combining host, landscape and climate predictors in
the same analytical framework vastly enhances our ability to predict
spatio-temporal patterns in vector-borne diseases in endemic situations. District level yearly forecasts could form part of an early warning
system for BT in India for planning of disease control measures.
Methods & Materials: A retrospective study was set to describe
the spatial and temporal pattern of RVF outbreaks using ArcGIS 10.
MaxEnt modelling was used to predict the current habitat suitability for
RVF occurrence. A cross-sectional serological study was carried out
in domestic ruminants in selected areas in Tanzania in order to validate the MaxEnt predictive algorithms. Multivariable logistic regression
model was used to analyze risk factors associated with RVFV activity
in the country.
Results: Between 1930 and 2007 a total of 10 outbreak waves were
reported with average inter-epidemic period (IEP) of 7.9 years (range=
3вЂ“17 years) in 47/120 of the districts in Tanzania. RVFV seroprevalence was higher in the areas predicted as high risk (37.8%, n= 487)
than the areas predicted as medium risk (22.4%, n= 482) and low risk
(16.7%, n = 466) (p < 0.001). RVF outbreaks were associated with
the eastern Rift Valley ecosystem (OR = 6.14, CI: 1.96, 19.28), soil
texture (clay [OR =8.76, CI: 2.52, 30.50], and loam [OR = 8.79, CI:
2.04, 37.82]), introduction of new domestic ruminants into the herd from
another district (OR = 3.92, CI: 2. 15, 7.15) and elevation of в‰¤1157
metres above sea level (OR = 1.82, CI: 1.27, 2.61).
Conclusion: The past RVF outbreaks and the risk of disease occurrence were distributed heterogeneously in Tanzania. The sequence
of outbreak waves, continuously cover more parts of the country.
Whenever infection has been introduced into an area, it is likely to be
involved in future outbreaks. The north-eastern and central parts of the
country have larger amount of suitable habitats for RVF occurrence
than the western and southern parts of the country. The findings can be
applied to guide targeted cost-effective RVF interventions.
07.001 Global spread of antibiotic resistance
R. Laxminarayan
Public Health Foundation of India-Center for Disease Dynamics,
Economics and Policy (USA), New Delhi, India
After many years as a side issue, antimicrobial resistance is moving to
centre stage, a move driven in large measure by the increasing global
prevalence of bacterial infections that are essentially untreatable. As
with other, highly mobile infectious diseases, antimicrobial resistance is
a shared global challenge affecting both the wealthiest and the poorest
of countries. In the high-income world, the consequences of resistance
are largely in the form of greater treatment costs while in the lowand middle-income world, the consequences are in terms of greater
morbidity and mortality. Here we review the most recent evidence of
global emergence and spread of resistance, the economic and health
consequences of the loss of antibiotic effectiveness, the benefits of
increasing access to effective antibiotics, and the appropriate balance
between investments in the conservation of existing antibiotics and
discovery of new antibiotics.
Background: Rift Valley fever (RVF) is an acute arthropod-borne viral
zoonotic disease. The hypothesis tested in this study was that, вЂњthe risk
of RVF occurrence is homogenously distributed throughout TanzaniaвЂќ.
Objectives: This study focused on mapping and modelling of
spatial and temporal pattern of RVF outbreaks, habitat suitability for
RVF occurrence, and potential risk factors associated with RVF virus
(RVFV) activity in Tanzania.
47
IMED 2014
A bstracts SATURDAY вЂў November 1, 2014
International Meeting on Emerging Diseases and Surveillance 2014
Session 08 (Invited Presentations)
Pathogen and Host DiversityвЂ”Are
There Clues that Can Help Us Prevent
Emerging Infectious Diseases?
Saturday, November 1, 2014
Room: Park Congress
14:30вЂ“16:00
Break-out Session
08.001 Can host breadth and phylogeny portend
viral emergence?
SATURDAY
вЂў
November 1, 2014
K. Olival
EcoHealth Alliance, New York, NY, USA
To better understand the underlying factors that affect host-range for
zoonotic viruses; and to test weather opportunity for contact or phylogenetic relatedness is a better predictor of zoonotic host potential.
We identified ~600 ICTV recognized viruses known to infect mammals, and through exhaustive literature searches over several years,
we compiled a comprehensive list of mammal host species for each
virus. We also collated and calculated other data specific to each speciesвЂ”taxonomy, geographic range, geographic overlap with humans
and other species, host traits, and phylogenetic distance to humans. To
assess phylogenetic distance among host species, we used two datasetsвЂ”the published mammal supertree and a cytochrome b maximum
likelihood tree. Using the number of viruses shared with humans as
a response variable, we used generalized additive models, to identify
significant host-specific predictor variables and to plot potentially nonlinear relationships with predictors.
We databased over 3000 host species-virus associations, including
750 species. The best model included phylogenetic distance to humans
(cytb), urban area overlap, median human population density within
a species host range, body mass, and measures of research bias.
Phylogenetic distance to humans was negatively related to number of
viruses shared, and the effect was stronger than our global measures
for opportunity for contact. We found a strong effect of research bias
suggesting that, with limits, the more we look the more viruses we find.
We also found a strong, almost exponential effect of total viral richness
for each host species on number shared. This also is likely capturing research bias, but may support the idea that the larger the pool of
pathogens, the more likely some are to jump.
We created the most comprehensive database of mammal-virus
associations to date, and identified several host-specific variables to
predict viral sharing. After controlling for research bias, we still found a
strong effect of host phylogeny on virus sharing and smaller affect using
our crude global measures of opportunity for contact with humans. Our
analysis is currently being used to better target viral discovery and zoonotic disease surveillance in mammals.
08.002 VirodiversityвЂ”How many viruses are out there?
S. J. Anthony
Columbia University, New York, NY, USA
Background: The majority of emerging zoonoses originate in wildlife
and many are caused by viruses. However there are no rigorous estimates of total viral diversity (here termed вЂ�virodiversityвЂ™) for any wildlife
species, despite the utility of this to future surveillance and control of
emerging zoonoses. Here we present a framework for the discovery of
novel viruses in wildlife and use it to make the first ever estimate of the
number of viruses that exist in a mammalian host, and the sampling
effort required to achieve it.
Methods: Here, we repeatedly sampled a mammalian wildlife host
known to harbor emerging zoonotic pathogens (the Indian Flying Fox,
Pteropus giganteus) and used PCR with degenerate viral family-level
primers to discover and analyze the occurrence patterns of viruses
48
IMED 2014
from nine viral families. We then adapted statistical techniques commonly used to estimate biodiversity in vertebrates and plants (E.g.
rarefaction, Chao2) to estimate the total viral richness in this species.
Results: A total of 55 viruses from seven viral families were detected
in P. giganteus. This included 11 paramyxoviruses, 14 adenoviruses,
13 herpesviruses, 2 bocaviruses, 8 astroviruses, 4 coronaviruses and
3 polyomaviruses. Of these, 50 were considered novel and several
were shown to be phylogenetically related to known human pathogens.
Analysis of the relative frequency of these viruses demonstrated reliably asymptotic behavior and estimated the total viral richness to be
58 viruses (limited to the viral families tested for). We used a simple
extrapolation to estimate there are a minimum of 320,000 mammalian
viruses awaiting discovery within these families (assuming all species
harbor a similar number of viruses, with minimal turnover between host
species), and estimate the cost of their discovery to be ~US$6.3 billion
(or ~US$1.4 billion for 85% of the total diversity).
Conclusions: Our work illustrates the power of using ecological
approaches to characterize virodiversity and estimate viral richness,
and can be considered part of a strategy to better target surveillance to
identify agents that pose zoonotic risks before they emerge in people.
As pathogens continue to emerge from wildlife, this estimate allows us
to put preliminary bounds around the potential size of the total вЂ�zoonotic
poolвЂ™, and facilitates a better understanding of where best to allocate
resources for the subsequent discovery of global viral diversity
08.003 Ebola, SARS, MERS oh my, can we limit
outbreaks?
W. Karesh
EcoHealth Alliance, New York, NY, USA
Nowhere in the world are the health impacts from both emerging and
endemic zoonotic diseases more important than in developing countries, where daily work and livelihoods are highly dependent on natural
resources. Most endemic diseases began as EIDвЂ™s at some point in
time and these diseases are now estimated to cause over one billion
cases of human disease annually. Many developing countries have
little to no capacity for diagnosis or detection of disease emergence
and early spread. With globalization and international travel, disease
movement is now rapid and the natural barriers to disease spread from
points of origin are becoming meaningless. Ebola virus disease, SARS,
and MERS illustrate the urgent need for improving early detection and
implementing strategies to reduce emergence in the first place.
While the linkages of human, animal, and environmental health is at
the heart of the One Health approach, an increasingly important prism
through which governments, NGOs, and practitioners view public
health, we still have three critically important challenges facing us: 1)
we need a broader and deeper knowledge of what underlies disease
emergence and spread, 2) we need to better target our surveillance
efforts to maximize available resources, and 3) we need to greatly
expand implementation of EID prevention strategies based on our state
of knowledge.
08.004 Wrap upвЂ”The big picture
P. Daszak
EcoHealth Alliance, New York, NY, USA
Despite scientific advances in virology, diagnostics and biotechnology,
we still are confronted regularly with new emerging infectious diseases.
Each new emerging pathogen appears to be unexpected, either in its
origins geographically or in the species it originated. At the same time,
the public perception of pandemic risk is of a crisis to be dealt with
after emergence, with efforts to predict or prevent their emergence
preliminary at best. In this symposium, we will hear about advances in
surveillance, viral ecology and host-virus evolution that begin to point a
a predictive approach to pandemics. They involve ways to better track
trends in disease emergence, analyze their underlying drivers, and use
ecological approaches to predict where, or from what species, the next
pandemic threat most likely will originate. In this wrap-up talk, I will
highlight some of these trends, and identify critical questions that need
to be addressed for pandemic prediction and prevention. In particular,
I will review a framework to target surveillance for novel pathogens,
identify where they are most likely to emerge and why, and find alternatives to the high risk behaviors that are accelerating their emergence.
A bstracts SATURDAY вЂў November 1, 2014
International Meeting on Emerging Diseases and Surveillance 2014
Session 09 (Invited Presentations)
Ethics and Disease Surveillance
Saturday, November 1, 2014
Room: Klimt 2 & 3
14:30вЂ“16:00
Break-out Session
09.001 Disease surveillance in the era of big data
E. Vayena
University of Zurich, Zurich, Switzerland
A. Reis
WHO, Geneva, Switzerland
Goals of the presentation:
вЂў To raise awareness for ethical issues in surveillance
вЂў To report on WHOвЂ™s project to develop guidelines on ethics and
surveillance
вЂў To solicit recommendations from the audience which will feed into
current policy-making in this area
Surveillance, often referred to as вЂњthe eyes of public health,вЂќ is one of
the most fundamental activities of public health. Surveillance can raise
multiple ethical and human rights issues, such as access to benefits,
confidentiality, informed consent, and concerns regarding stigma and
discrimination, for which appropriate national and international frameworks are required. Surveillance has also been at the center of controversy over the technical distinction between research, which requires
ethical oversight, and public health practice, whose limits are typically
a function of law, policy making, and public debate. There are also
important issues related to tissue sampling and sharing of specimen
and infectious agents (such as virus-sharing), as well as regarding the
use of electronic records and social media.
Remarkably, while there have been some efforts to craft surveillance
guidelines for specific diseases, WHO Member States currently lack a
comprehensive normative framework and specific guidelines on public health surveillance. In 2014 WHO launched a project to develop
WHO Guidelines on Ethical Issues in Public Health Surveillance. The
proposed document is intended to benefit public health surveillance
activities in all WHO Member States. It is more specifically targeted at
Ministries of Health and relevant public health agencies when designing public health surveillance policies and practices, as well as specific
disease programs and members of research ethics committees.
It will be important to receive feedback from participants in the IMED
conference, which will directly feed into the further development of
WHO guidelines.
Session 11 (Oral Presentations)
Hot Topics in Emerging Infectious
Diseases
Saturday, November 1, 2014
Room: Klimt 2 & 3
16:30вЂ“18:00
November 1, 2014
WHO perspective
Recent work conducted by the UK Nuffield Council on Bioethics
Working Party on Biological and Health Data has focused on the new
and potential developments in collecting, sharing and linking and
using human biological and health-related data arising from advances
in knowledge, technology, organisation and governance. вЂ�Big dataвЂ™ is
used in many facets of our everyday lives, including in public health
activities. Medical record data and administrative are collected, linked
and shared to search out indicators and incidences of health and disease, and to design and implement strategies to improve well-being.
Research studies, such as population-based research biobanks and
cohort studies, are combining participant health, life-style and environmental data with administrative and medical records to create detailed
and extensive datasets for access internationally. Although designed to
advance the common good, these uses of what might be sensitive personal data raise ethical and legal issues, such as around data security
and confidentiality. This talk will present the discussions of the Nuffield
Working Party, as well as that of others, on how big data is being used
to advance public health initiatives and the ethical questions that these
uses raise.
вЂў
09.002 Guidelines for ethical disease surveillanceвЂ”
public health
S. Wallace
University of Leicester, Leicester, United Kingdom
SATURDAY
The ever-expanding amounts of available data from social networks,
use of mobile applications etc., have created a valuable source of
health related information that should not remain untapped. However,
utilizing such data for the global public health good takes place in the
context of so-called вЂњbig dataвЂќ, a space charged with high expectations
and vexing ethical challenges. In this paper, I map these challenges
specifically looking at questions that arise in the uses of big data for
the purpose of disease surveillance. Three key ideas are highlighted:
the nexus of ethics and methodology referring to the methodological
challenges that the field is facing and their ethical implications; contextsensitivity referring to the distinct demands that the context of surveillance activities generate for those involved with digital surveillance; the
need for digital disease surveillance to secure its legitimacy as a public
health activity. I will highlight some aspects of these questions by referring to the recent Ebola outbreak in West Africa.
09.003 Big dataвЂ”Healthy future? Using big data for
Break-out Session
11.001 Visceral Leishmaniasis and HIV co-infection
in Bihar, India: Long-term effectiveness and
treatment outcomes with Liposomal
Amphotericin B (AmBisome)
T. Sunyoto1, S. Burza1, P. Sinha2, R. Mahajan1, J. van Griensven3,
P. Das2, M. Gonzalez Sanz4
1
Medecins Sans Frontieres, Delhi, India, 2Rajendra Memorial
Research Institute of Medical Sciences (ICMR), Patna, India, 3ITM,
Antwerp, Belgium, 4Royal London Hospital, London, United Kingdom
Purpose: Visceral Leishmaniasis (VL; also known as kala-azar)is
an ultimately fatal disease endemic in the Indian state of Bihar, while
HIV/AIDS is an emerging disease in this region.A 2011 observational
cohort study conducted in Bihar involving 55 VL/HIV co-infected
patients treated with 20вЂ“25mg/kg intravenous liposomal amphotericin
B (AmBisome) estimated an 85.5% probability of survival and a 26.5%
probability of VL relapse within 2 years. Here we report the long-term
field outcomes of a larger cohort of co-infected patients treated with this
regimen between 2007 and 2012.
Methods & Materials: Retrospective analysis of routine programme
data.
Results: Intravenous AmBisome (20-25 mg/kg) was administered to
159 VL/HIV co-infected patients (both primary infections and relapses)
in four or five doses of 5 mg/kg over 4вЂ“10 days. Test of cure was
not routinely performed.Initial cure was achieved in all discharged
patients.A total of 36 patients died during follow-up, including six who
died shortly after admission. Death occurred at a median of 11 weeks
(IQR 4-51) after starting VL treatment. Estimated mortality risk was
14.3% at six months, 22.4% at two years and 29.7% at four years after
49
IMED 2014
A bstracts SATURDAY вЂў November 1, 2014
International Meeting on Emerging Diseases and Surveillance 2014
treatment. Among the 153 patients discharged from the hospital, 26
cases of VL relapse were diagnosed during follow-up, occurring at a
median of 10 months (IQR 7вЂ“14) after discharge. After accounting for
competing risks, the estimated risk of relapse was 16.1% at one year,
20.4% at two years and 25.9% at four years. Low hemoglobin level and
concurrent infection with tuberculosis were independent risk factors
for mortality, while ART initiated shortly after admission for VL treatment was associated with a 64вЂ“66% reduced risk of mortality and 75%
reduced risk of relapse.
Conclusion: This is the largest cohort of HIV-VL co-infected patients
reported from the Indian subcontinent. Even after initial cure following treatment with AmBisome, these patients appear to have much
higher rates of VL relapse and mortality than patients not known to be
HIV-positive, although relapse rates appear to stabilize after 2 years.
These results extend the earlier findings that co-infected patients are
at increased risk of death and require a multidisciplinary approach for
long-term management.
SATURDAY
вЂў
November 1, 2014
11.002 Past, present and future of Chagas disease in
Spain (1997вЂ“2011)вЂ”A descriptive study
Z. Herrador1, E. Rivas2, A. Gherasim1, P. Aparicio1, A. Benito1
1
National Health Institute Carlos III, Madrid, Spain, 2University Hospital
of Tenerife, Tenerife, Spain
Purpose: After United States, Spain comes second in the list of countries receiving migrants from Latin America, being the European country with highest expected prevalence of Chagas disease. Since 2005
control measures regarding blood donation and organ transplants were
implemented at national level. Up to date, interventions targeting vertical transmission exists in 5 out of 17 autonomous regions. Moreover,
the prevalence of Chagas disease remains unknown as Chagas is not
a mandatory reporting disease.
Using hospitalizations records we aimed to describe Chagas disease temporal and geographical trends to identify and suggest future
improvements in its control in Spain.
Methods & Materials: We performed a retrospective descriptive
study using data provided by the National Surveillance System for
Hospital Data. Hospitalized patients with diagnosis of Chagas diseases
through the corresponding ICD-9-CM codes during a 15-year period
(1997вЂ“2011) were identified. The immigrant population from countries
endemics to Chagas obtained from the 1998вЂ“2011 census projection
was used as denominator. Temporal and geographical trends were
assessed and descriptive analysis was performed to characterize the
study population.
Results: 1.729 hospitalizations related to Chagas were recorded during the study period. Annual hospitalization rate varied from 18,0 during
1998-2004 to 224,8 per 100,000 inhabitants in 2005-2011. The rate of
hospitalization was significantly higher among women (74%) and aged
16-45 years (69,8%). Chagas without organic affection was the most
frequent diagnosis (75,3%). When comparing the two study periods,
we identified significant increase in hospitalization rate in all but one
autonomous region. The highest hospitalization rates increase were
registered in: the Basque Country (9.2 to 370/100,000), CataluГ±a (17.3
to 427/100,000), Comunidad Valenciana (21 to 414/100,000), Murcia
(18-320/100,000), AndalucГa (16 to 278/100,000) and Balearic Islands
(11 to 183/100,000).
Conclusion: The significant increase in hospitalization rates
observed during study period could be explained by the introduction
of control programs at national level targeting the horizontal transmission. Four out of the six regions with the highest increase have in
place some protocols for screening pregnant Latin American women.
Systematization and nationwide implementation of such protocols will
help improving Chagas disease information and control in Spain.
50
IMED 2014
11.003 Description and reporting of 303 probable
neurocysticercosis cases identified by CT-brain
scan imaging and hospital record: a one year
retrospective medical record review utilizing
active surveillance in a Southern California
community hospital
J. Garland1, W. Robbins2, C. Croker3
1
White Memorial Medical Center, Los Angeles, CA, USA, 2University
of California Los Angeles, Los Angeles, CA, USA, 3Los Angeles
County Department of Public Health, Los Angeles, CA, USA
Purpose: To investigate case reporting of probable neurocysticercosis (NCC) infection identified by CT brain scan reports and additional
epidemiological diagnostic criteria in the hospital medical record in a
community-based hospital in East Los Angeles during 2012.
Methods & Materials: Active surveillance was conducted utilizing
retrospective review of 7,363 CT brain scan reports and associated
patient medical records from January 1, 2012 to December 31, 2012.To
meet the case definition of probable NCC, a CT brain scan report must
describe evidence of lesions highly suggestive of NCC and the hospital
medical record must provide supporting epidemiological evidence as
defined by Del BruttoвЂ™s 2001 Diagnostic Criteria for NCC.
Results: Of the 7,363 CT brain scans reviewed, 303 (4.1%) showed
evidence of lesions highly suggestive of NCC and met additional
criteria for the diagnosis of a probable case based on the medical
record review. For this same time period (2012), Los Angeles County
Department of Public HealthвЂ™s Acute Communicable Disease Control
had one cysticercosis case reported in Los Angeles County; the case
was not submitted from the study site. The probable cases ranged in
age from 20 to 91 years with a mean age of 64.7 years. 235 (77.5%)
cases were born outside of the United States; 277 (91.4%) cases were
Hispanic ethnicity; 203 (66.9%) were female. Upon analysis of reporting radiologist for all scans, it was noted that nine of the ten radiologists
interpreting scans during the study period described evidence of NCC
on CT Brain scan reports. The reporting rate of positive NCC scans
read per radiologist ranged from 4.8% to 4.1% with an average reporting rate of positive scans at 4.3%. The radiologist that did not report any
evidence of lesions consistent with NCC on CT brain scans reviewed
248 scans or 3.3% (248/7,363) of total scans conducted during the
study period.
Conclusion: Neurocysticercosis is vastly under-reported at this
urban community hospital. Study findings suggest an important role
for active case surveillance. This study improves understanding of the
extent of NCC disease burden and under reporting in Los Angeles
County and provides evidence of the need for attention to conduct
active surveillance in hospitals to identify NCC.
11.004 A pilot study evaluating the level of
antimicrobial resistance in Salmonella and
Campylobacter isolated from poultry farms
T. Gaydos1, S. Tilley1, R. Berghaus1, R. Singer2, C. Hofacre1
1
University of Georgia, Athens, GA, USA, 2University of Minnesota,
St. Paul, MN, USA
Purpose: In the United States, monitoring antimicrobial resistance in
Salmonella and Campylobacter for poultry is done by collecting isolates
post-chill in the processing plant. The number of Salmonella isolates
collected using this method is too low to be statistically significant. To
evaluate the logistics and potential value of a pre-harvest component
for poultry monitoring, a pilot study was conducted by collecting samples from poultry houses during the week prior to processing.
Methods & Materials: During the course of the pilot study, boot sock
samples were collected from broiler and turkey industry collaborators.
Standard microbiological procedures were used to isolate Salmonella
and Campylobacter. The antimicrobial resistance profiles were determined by mean inhibitory concentration (MIC) using the Sensititre
NARMS Panel of Antimicrobials (ThermoВ®). The project plans to collect
1,400 samples from 350 different poultry farms from the United States.
Results: As of June 30th, 2014, 624 samples have been collected
from 156 different poultry farms. From the samples collect 37%
(232) were positive for Salmonella and 20% (123) were positive for
A bstracts SATURDAY вЂў November 1, 2014
International Meeting on Emerging Diseases and Surveillance 2014
Campylobacter. The most common isolated serotypes of Salmonella
were: Typhimurium (50), Schwarzengrund (22), Kentucky (22), enteritidis (11), and 1,4,5,12:i- (8). Of the isolates analyzed for antimicrobial resistance, 28% were resistant to no antimicrobials, 32% were
resistant to 1 antimicrobial, 13% were resistant to 2 antimicrobials, 9%
were resistant to 3 antimicrobials, 9% were resistant to 4 antimicrobials, and 8% were resistant to 5 or more antimicrobials. The most
common Campylobacter species isolated was jejuni (84%) followed by
coli (16%). Of the isolates analyzed for antimicrobial resistance 65%
were resistant to no antimicrobials, 19% to 1 antimicrobial, 13% to 2
antimicrobials, and 3% to more than 3 antimicrobials. Only 15% of
Campylobacter isolates were resistant to ciprofloxacin.
Conclusion: The majority of isolates collected in this trial were
resistant to 1 or fewer antimicrobials. The study has provided a useful
baseline for antimicrobial resistant organisms that are present on the
average poultry farm in the United States. The trend of the level of
antimicrobial resistance in human important pathogens is important to
aid in the judicious use of antimicrobials in both human and animal
treatment.
ecosystems: Potential implications for human
and animal health
Purpose: To determine the sero-prevalence of brucellosis in both
domestic ruminant animals and humans, on the basis of a One Health
framework, while identifying critical interventions for a disease prevention and control strategy. To present the survey findings in the domestic
animal population.
Methods & Materials: A multistage sampling design was used to
select the parishes within the districts and the dwellings of the groups of
livestock keepers referred as вЂ�manyattasвЂ™ within the parishes. The number of animals belonging to each group of livestock keepers (вЂ�manyattasвЂ™) were selected at random. The sample size was calculated using
the Survey Toolbox software, where the desired precision was set at
5% with an expected prevalence of 50%. A design effect (DE) of 2 was
used and sample size calculated at a 95% confidence level. A survey
analysis was done using the calculated sample size to determine the
number of parishes and the number of animals from each group of livestock keepers (вЂ�manyattaвЂ™); Consequently 6,594 animals (goats, sheep
and cattle were sampled from 57 parishes.
The serology of individual domestic ruminant animals was investigated using the cElisa brucella species antibody assay at the laboratory of the National Animal Disease Diagnostic and Epidemiology
Centre (NADDEC).
Results: This paper discusses the initial findings in the bovine,
caprine and ovine populations that respectively show 14.3%, 20.5%
and 10.9% brucella species antibody prevalence. The highest district
sero-prevalence was noted in caprine species, with Kaabong district
having the highest record of 39.4%. Sero-prevalence among the bovine
population ranged between 7.4% in Kotido district and 22.3% in Moroto
district. The ovine population showed lower prevalence to the disease
with the lowest record of 1.5% in Amudat district.
Conclusion: The study shows a resurgence of brucellosis in the
domestic ruminant populations of pastoral sub-region of Karamoja and
establishes baseline data on sero-prevalence in all 7 districts of the
sub-region for ease of future reference. Additionally, a strategic plan to
prevent and control brucellosis in these populations of the sub-region
and country at large has been laid down.
November 1, 2014
Purpose: Interspecies transmission of tuberculosis is of particular
concern, particularly in areas where human, livestock and wildlife
live in close proximity. The aim of this study was to determine species diversity of Mycobacterium tuberculosis complex MTBC) and its
public health significance at human-animal interface of the Serengeti
ecosystem, Tanzania.
Methods & Materials: DNA was extracted from Mycobacterium cultures obtained from sputum samples of 214 TB patients and tissues
of 606 animals (livestock and wildlife). Multiplex PCR was used to
differentiate Mycobacterium tuberculosis complex (MTBC) from nontuberculous mycobacterium (NTM) culture isolates. Spoligotyping and
Mycobacteria Interspersed Repetitive Units-Variable Tandem Repeats
(MIRU-VNTR) typing on 24 loci were performed on DNA isolates.
Results: Based on spoligotyping, three M. bovis strains were isolated
from wildlife all belonging to SB0133, while 2 novel strains of M. bovis
were identified in cattle and none from tuberculosis patients. M. bovis
isolates from wildlife had 96.8% and 45.2% spoligotype pattern agreement with novel strains namely SB2290 and SB2289 isolated in cattle.
Of the 24 MIRU-VNTR loci, QUB 11b showed the highest discrimination among the M. bovis strains.We found a diverse of M. tuberculosis
strains dominated by CAS 55 (25.7 %), T 52 (24.3%), LAM 38 (17.8%)
and EAI 25 (11.7%) families in TB patients. Other identified families
were unassigned (вЂ�named Serengeti strainsвЂ™) 25 (11.7%) and Beijing 8
(3.7%). The minority group that included Haarlem, X and S altogether
accounted for 11 (5.2%) of all genotypes. This study found Haarlem,
EAI_Somalia, LAM3 and S/convergent and X2 subfamilies which were
not reported previously in Tanzania.
Conclusion: This study reveals a large diversity of M. bovis and M.
tuberculosis strains in the Serengeti ecosystem, some of which were
novel. One of the novel strains of M. bovis isolated from cattle was
genetically linked to the SB0 133 isolated from buffaloes indicating
possible interspecies transmission of bovine tuberculosis (bTB) infections. The isolation of novel unassigned M. tuberculosis strains and
subfamilies that have not reported in Tanzania could have a public
health importance.
D. B. Ndumu1, P. Otto2, R. Mwebe1, E. M. Namukose3,
K. J. N. Mugabi4, J. Serrugga1, A. Kagirita5, M. Bahati1,
C. Rutebarika6, J. Zingeser2
1
National Animal Disease Diagnostic and Epidemiology Centre
(NADDEC), Ministry of Agriculture, Animal Industry and Fisheries
(MAAIF), Entebbe, Uganda, 2Food and Agriculture Organization
(FAO) of the United Nations (UN), Rome, Rome, Italy, 3Ministry
of Health, Kampala, Kampala, Uganda, 4Ministry of Agriculture,
Animal Industry and Fisheries, Entebbe, Wakiso, Uganda, 5Ministry
of Health, Kampala, Uganda, 6National Animal Disease Diagnostic
and Epidemiology Centre (NADDEC), Ministry of Agriculture, Animal
Industry and Fisheries (MAAIF), Entebbe, Wakiso, Uganda
вЂў
B. Z. Katale1, M. Matee1, E. Mbugi1, M. Rweyemamu2,
P. D. Van Helden3, R. M. Warren4, J. Keyyu5, S. Kendall6,
H. Docrell7, A. L. Michel8
1
Muhimbili University of Health and Allied Sciences, Dar es Salaam,
Tanzania, United Republic of, 2Southern African Centre for Infectious
Diseases Surveillance, Morogoro, Tanzania, United Republic of,
3
Stellenbosch University, Tygerberg, South Africa, 4Faculty of Health
Sciences, Tygerberg, South Africa, 5Tanzania Wildlife Research
Institute, Arusha, Tanzania, United Republic of, 6Royal Veterinary
College, London, United Kingdom, 7London School of Hygiene and
TRopical Medicine, London, United Kingdom, 8University of Pretoria,
Pretoria, South Africa
ruminant animals of the Karamoja pastoral
sub-region in Uganda
SATURDAY
11.005 Novel mycobacterial spp in the Serengeti
11.006 Re-emergence of brucellosis in domestic
11.007 Invasive non-capsulated Haemophilus
influenzae in pregnancy and the newbornвЂ”
An under-recognised pathogen
S. Collins, M. Ramsay, H. Campbell, S. Flynn, N. Fry, D. Litt,
M. Slack, S. Ladhani
Public Health England, London, United Kingdom
Purpose: Several studies have suggested an increased risk of invasive
non-typable H. influenzae (ntHi) disease among pregnant women and
newborn infants but none have been large enough to quantify the risk
or assess the outcome of such infections. Here we describe the demographic and clinical characteristics of maternal/neonatal ncHi disease.
Methods & Materials: Public Health England conducts enhanced
national surveillance of invasive ntHi disease in England and Wales.
Detailed clinical information was obtained for all laboratory-confirmed
cases among women aged 15-44 years and neonates under 48 hours
old during 2009-2012.
51
IMED 2014
A bstracts SATURDAY вЂў November 1, 2014
SATURDAY
вЂў
November 1, 2014
International Meeting on Emerging Diseases and Surveillance 2014
Results: Of 140 women diagnosed with ntHi, 72 (51.4%) were
pregnant and two had recently given birth (1.4%). Most women were
previously healthy (83.8%; 62/74) and presented with septicaemia
(67/74, 90.5%); all survived their infection. During the first 24 weeks
of pregnancy ntHi disease was associated with foetal loss at the time
of infection in all but three of 45 pregnancies. Of the 27 infections after
24 weeks gestations, two were stillbirths and 10 were born prematurely. The risk of pregnancy loss (60В·8/100) was 3-fold higher than the
background rate. Most (67.8%) babies were unwell at birth; although
only two had laboratory-confirmed invasive ntHi disease, most likely
because the mothers of the other infants had received antibiotics during labour
During the same period an additional 82 neonates, whoвЂ™s mothers
were not diagnosed with ntHi, were diagnosed with ntHi within the first
48 hours of life; 69 (84.1%) were born prematurely. Bacteraemia was
the most common presentation (53/82, 64.6%). Fourteen neonates
(16.7%) died within a week of infection.
Conclusion: This is the first study to characterise the burden of invasive ntHi disease in pregnancy and the newborn period. These finding
suggest that the true incidence of serious bacterial infections in the
neonatal period is likely to be higher than reported because of mothers receiving empiric antibiotics during labour. The severe outcomes
associated with invasive ntHi disease in pregnancy have not previously
been recognised and merits further investigation. This study also highlights the need for linking of maternal and perinatal data in order to
assess the true burden of disease in this vulnerable population.
11.008 Cholera outbreak in a prison in Port au Prince,
Haiti, October 2013
W. Pierre1, P. Dely2, S. Corvil1, G. Suarez-Rangel3
1
Directiion dвЂ™Epidemiologie de Laboratoire et de Recherche (DELR),
Delmas, Haiti, 2Direction dвЂ™Epidemiologie de Laboratoire et de
Recherche (DELR)/Ministere de la Sante Publique et de la Population
(MSPP), Delmas, Haiti, 3Tephinet, Bogota, Colombia
Purpose: The ongoing cholera epidemic in Haiti began in October
2010. Occasional suspected cases continue to be reported and clusters identified. On October 1, 2013, cases of profuse diarrhea consistent with cholera were reported at 30 prisoners in the 10 cells of the
high prison for male in Haiti. We hypothesized that the water in the
prison could be the transmission route.
The purpose is to confirm the diagnosis, identify risk factors
associated with infection, in order to inform prevention and control
measures.
Methods & Materials: We conducted a matched case-control (1:2)
study. Suspected cases were any prisoner with >3 episodes in 24h of
acute watery diarrhea, with or without vomiting between October 1 and
15, 2013. Controls were prisoners without diarrhea in the previous 6
months, matched by cell with the cases. We collected stool samples
from selected cases for culture, and samples of several sources of
drinking water for coliforms and residual chlorine assays. We collected
demographics, food history, water use, hygiene and clinical characteristics by semi-structured survey. We used EpiInfo3.5.3 for analysis. We
calculated frequencies, means, paired (pOR) and adjusted Odds Ratio
(aOR) with 95% confidence interval (CI 95%).
Results: We enrolled 32 cases and 64 controls. The attack rate was
0.7% (30/4200) with no deaths. Mean age for was 28 years (range:
18вЂ“48) and 32 years (20вЂ“58) for cases and controls, respectively. All
(6) stool samples were Vibrio cholera Ogawa 01- positive. Fecal coliforms were found in 2 water samples. Consumption of untreated (nonchlorinated) drinking water (pOR=5.7, 95%CI=1.7вЂ“24.9); unwashed
fruits and vegetables (pOR=7.8; 95%CI=2.1вЂ“44.4), not washing hands
before eating (pOR=12.2; 95%CI=2.7вЂ“11.4) or after using latrines
(pOR=8.7; 95%CI=3.35вЂ“24.6) were significantly associated with illness. On logistic regression only not washing hands before eating was
significant (aOR=8.75; 95%CI=3.4вЂ“24.6).
52
IMED 2014
Conclusion: Poor sanitary practices and drinking untreated water
were risk factors associated with cholera infection. We could not conduct laboratory testing on all cases or foods, but met CDC attribution
criteria. We recommended improving prison water and sanitary conditions, and educating prisoners on proper hand washing technique,
resulting in no new cases after October 8, 2013.
11.009 Above and beyond individual exposure:
Ward-level antibiotic prescribing is the
principal predictor of increased Clostridium
difficile infection risk
K. A. Brown1, K. Valenta2, D. Fisman3, A. Simor4, N. Daneman5
University of Utah, Salt Lake City, UT, USA, 2McGill University,
Montreal, QC, Canada, 3University of Toronto, Toronto, Canada,
4
University of Toronto, 1 KingвЂ™s College Cir, ON, Canada, 5Sunnybrook
Health Sciences Center, Toronto, ON, Canada
1
Purpose: Recent research on Clostridium difficile transmission suggests that exposure to spores from symptomatic patients may not completely explain hospital-acquired infections. Antibiotic exposure has
been shown to be a primary risk factor for not only C. difficile infection
(CDI), but also for asymptomatic colonization with C. difficile. In this
study, we sought to discern the relative impacts of individual-level and
ward-level antibiotic exposure on patient risk.
Methods & Materials: A cohort study design was used to assess
the association of antibiotic exposure with the incidence of CDI among
patients admitted to Sunnybrook hospital, a large acute care teaching
hospital located in Toronto, Canada. The source cohort consisted of
all patients over 18 years old, without a previous CDI diagnosis, and
hospitalized in an acute care ward at Sunnybrook hospital in a period
spanning June 1, 2010 to May 31, 2012 (n= 34,119).
Results: Across wards, patients received antibiotics for 22% to 58%
of days. We found that ward-level prescribing was strongly associated
with increased CDI risk. Based on weighted linear regression, each
10% increase in ward-level ABx prescribing was associated with a
3.9 per 1,000 patient-days (95% CI 2.1 to 5.6, p < 0.001) increase
in CDI incidence and explained 56% of ward level variation in CDI
rates (Figure). In multilevel Poisson analyses controlling for time since
admission, age, individual-level antibiotic receipt, previous hospitalizations, infection pressure, and ICU admission, ward-level antibiotic
prescribing was the strongest predictor of CDI risk. Each 10% increase
in ward-level ABx prescribing was associated with a 36% increase in
risk (RR = 1.36, 95% CI: 1.16 to 1.59).
Conclusion: Although many studies have considered the impact of
individual-level risk factors on CDI, we find that ward-level antibiotic
prescribing better explains CDI risk, and this suggests that asymptomatic colonized patients may be driving infection spread. This research
has major implications for infection control, hospital hygiene, and antimicrobial stewardship.
A bstracts SUNDAY вЂў November 2, 2014
International Meeting on Emerging Diseases and Surveillance 2014
Session 12 (Invited Presentations)
Food and Agriculture Organization
(FAO) of the UN: Tools for Animal
Health
Sunday, November 2, 2014
Room: Park Congress
08:30вЂ“10:30
Break-out Session
12.001 The progressive control pathway (PCP) for
transboundary animal diseases, a bottom-up
approach for disease control
E. Raizman
Food and Agriculture Organization of the United Nation, Rome, Italy
Animal diseases impact livestock production and farming systems,
people and livelihoods. Recent outbreaks due to diseases such as
foot-and-mouth disease (FMD), H7N9 and contagious bovine pleuropneumonia (CBPP) globally has had unprecedented consequences
in terms of impact. The impact of FMD in endemic regions on four
November 2, 2014
health information tools
J. Pinto
FAO, Rome, Italy
вЂў
12.002 Global animal disease surveillance and
SUNDAY
The Progressive Control Pathway (PCP) is the approach developed by
FAO for classifying country progress in foot and mouth disease (FMD)
risk management. In this approach there are criteria for classifying a
countryвЂ™s position along a series of stages from zero (uncontrolled,
disease present, no action being taken, no investments for prevention or control) to stage five (free without vaccination, investment into
prevention, detection, and emergency preparedness is considerable).
It has lead to a tool that can be applied to measure (and communicate) country progress within regional roadmaps, and aims at assisting
countries along a pathway and the activities to be implemented based
on risk management, covering a series of stages before they could
apply for recognition of disease freedom by the World Organisation
for Animal Health (OIE). The PCP-FMD approach is considered a joint
tool with the OIE, with countries able to submit to this organization
recognition of their national plan for endorsement, which serves as an
incentive for further progress and linked with the critical competencies
established with the OIE Performance of Veterinary Services pathway.
The Progressive Control Pathway approach(es) recognises that differences in risk of infection occur between (and within) infected countries,
that countries (or provinces, governorates, or states) are at different
stages in managing the risk of infection. The PCP is not a top down prescribed approach rather a method that applies a risk reduction approach
in which each infected country is encouraged to develop national
risk reduction strategies that are supportive to the regional effort.
A similar approach with a roadmap of 4 stages was developed by FAO for
progressive control of brucellosis and rabies. This roadmap was based
upon information from extensive research and practical experience in the
field in many countries over many years. The feasibility of this roadmap is
being tested in some affected countries in Central Asia and Middle East.
FAO and OIE have embarked into the formulation of a Global Strategy
adopting a 3 phased strategic approach that should eventually lead
countries to eradicate PPR. The 3 phase approach will correspond to 4
different implementation stages. Phase 1 would focus on gaining better
epidemiological understanding of PPR and its socio-economic impact.
Phase 2 would constitute the framework for addressing control and
eradication measures. Finally phase 3 will correspond to the post-eradication of PPR where countries should be able to provide evidence of
absence to obtain official recognition of freedom by the OIE. In terms of
implementation this corresponds to stage 4 of the stepwise approach.
continents has been estimated at US$6.5 to 21 billion, whilst outbreaks
in FMD free countries and zones cause losses of >US$1.5 billion a year
(Knight-Jones and Rushton, 2013). The H7N9 strain of avian influenza
emergence in China has been estimated to be USD 6.5 billion (Chinese
Agriculture Ministry estimates, 2013) over the course of two years, the
annual cost of the bacterial disease, contagious bovine pleuropneumonia (CBPP) in Africa, is estimated at USD 61.4 Million per year (Tambi
et al. 2006).
Global Animal disease surveillance and reporting systems are notably
weak in developing countries due to limited resources,technical capacities and weak surveillance infrastructures. Additionally, official disease
reporting is limited to specific priority diseases or project related. The
lack of incentives for famers and communities to report animal disease
problems impact the amount, quality (e.g. sensitivity) and timeliness of
disease reporting at multiple levels. In addition to this, surveillance at
the animal/human interface is often neglected and absent. The consequences of the above mentioned weakness/limitations impact early
warning and effective risk management. FAO provides policy advice
to countries on how to prevent, control or eradicate animal diseases.
FAO supports member countries in use and development of new
approaches for disease surveillance tools and innovative approaches
to assist member countries to improve national surveillance and disease intelligence capacities through a number of approaches.
FAO has been leading the development of mobile devices to enhance
disease surveillance such as SMS Gateways for Avian Influenza in
Bangladesh, Digital Pen Technology in Africa and EMA-i. Bangladesh
conducts active Highly Pathogenic Avian Influenza (HPAI) surveillance
in 260 out of 487 sub-districts as part of an USAID funded FAO project. Community Animal Health Workers (CAHW), Veterinary Surgeons
Livestock Officers are using the Short Message Service (SMS) for
sending and receiving SMS messages between computers and mobile
phone to collect data and report on disease and death in poultry. Digital
pen technologies (DPT) in Countries in Africa to report transboundary
animal diseases of priority. In 2006 FAO introduced the Digital Pen
Technology (DPT) into southern Africa as an innovative way of collecting and sending animal disease surveillance data from remote areas
in the field to the Central Epidemiology Units for analysis and decision
making. FAO also has developed an Event Mobile Application (EMAi) for data collection and real-time disease reporting. EMA-i has been
piloted in 2013 in Uganda with the objective to support the veterinary
services to improve the existing disease reporting system In Indonesia,
teams trained in Participatory Disease Surveillance and Response
(PDSR) method use a two-step process to diagnose HPAI based on
clinical case definition and rapid antigen detection test. The advantage
of this methodology is rapid field diagnosis to enable timely outbreak
response.
FAO has also been involved in supporting national capacity building in surveillance through the field veterinary epidemiology training
(FETPV-FETP) in Asia and Africa.
At global level, FAO, OIE, WHO have been coordinating since 2006
efforts through the implementation of the Global Early Warning System
for Transboundary Animal Diseases, includes zoonoses (GLEWS+).
GLEWS+ builds on existing event-based surveillance systems, global
health information platforms (FAO EMPRES-i, OIE WAHIS and WHO)
to confidentially track and verify relevant events and provides a framework with global reach to enable the convening and pooling of expertise, data, functional networks, operational systems and stakeholders
with the ultimate goal of enhancing inter-organizational coordination
and supporting member countries in the detection, prevention and control of threats to health and the food chain through cross-sectoral and
multidisciplinary partnership.
Linking veterinary epidemiology and laboratory networks to gather
and share disease and non disease data, linking outbreak information
with data related to the pathogen characteristics can help in describing
epidemiological and genetic dynamics in a spatial and temporal context.
Strengthening existing national or regional networks promotes rapid
detection, information sharing, and harmonization of methodologies
and development of strategies for disease control (to better consider
trans-border threats) and builds trust among neighbours. Technical
53
IMED 2014
A bstracts SUNDAY вЂў November 2, 2014
International Meeting on Emerging Diseases and Surveillance 2014
networks that bring together institutions across the globe, including
FAO Reference Centres in veterinary epidemiology, risk analysis,
bioinformatics or epidemic intelligence. Cross sectoral collaboration,
platforms and databases (including disease and non-disease data),
multidisciplinary approaches, tools and partnerships are prerequisites
for improving global disease surveillance at all levels and conducting
adequate disease intelligence, risk assessment that support effectively
disease prevention.
12.003 Tackling emergency diseases head on through
good emergency management practice (GEMP)
SUNDAY
вЂў
November 2, 2014
I. Douglas
FAO, Crisis Management Centre-Animal Health (CMC-AH),
Rome, Italy
With increasing frequency, authorities are called upon to deal with
emergency animal disease outbreaks. An effective response is critical
to reducing the impacts of transboundary animal diseases. In many
developing countries, food security depends on a rapid and solid
response.
The Food and Agriculture Organization of the United Nations (FAO)
has long recognized that countries need to prepare themselves
for emergency diseases. вЂњGood Emergency Management Practice
(GEMP)вЂќ is one important tool, developed by FAO to support its member countries.
GEMP is an umbrella term that encompasses an evolving package of
useful tools. Countries can adapt these tools to better assist their own
needs regarding preparedness and response.
At the core of GEMP is a manual вЂњThe Essentials (A guide to preparing for animal health emergencies)вЂќ. This publication, in a little over a
hundred pages, emphasizes that вЂњpreparedness planningвЂќ is vital to
establish the key approaches that are generic, and that more specific
вЂњcontingency planningвЂќ is a natural and critical follow-on. A вЂњpreparedness planвЂќ will equip those who are responsible for response to establish an agreed, multi-disciplinary mode of approach that can adapt to
a wide range of emergency needs. A more focused вЂњcontingency planвЂќ
can outline specific strategies needed for specific threats.
While a useful reference manual, FAO believes that it can be used
by countries, and regions, to facilitate a planning process that enables
countries to develop their own mechanisms for response to animal
disease outbreaks. FAO is rolling out three-day introductory courses,
designed for key animal health operatives. To date, seven multi-country
or regional courses and four country-specific course have been completed, involving over 200 participants.
The manual has been endorsed by a wide range of country and international animal health agencies and presents a global standard for best
practice in relatively straight-forward language.
вЂњThe EssentialsвЂќ is currently available in English, French, and
Spanish, and Arabic, Chinese and Russian translations will soon be
completed.
вЂњGEMP EssentialsвЂќ manual online:http://www.fao.org/docrep/014/
ba0137e/ba0137e00.pdf
12.004 Tools supporting laboratory capacities and
information sharing
G. Dauphin
Food and Agriculture Organization of the United Nations, Rome, Italy
Laboratory capacities and tools for information sharing have to be
constantly supported. To help laboratories assess their capacities
and functionalities, FAO has developed a Laboratory Mapping Tool
that addresses 108 critical points in the laboratory. This standardized
tool was applied on a yearly (or more) basis by FAO in around 30
laboratories in Asia and Africa and enabled laboratories to monitor their
strengths and weaknesses and identify priorities for action. This information has also been aggregated at regional level to generate regional
overviews and inform about regional needs. Laboratory skills can be
54
IMED 2014
supported by various trainings; today training tools include distancelearning. Databases can also support laboratory capacities and information sharing. For instance, sequence databases customized for a
given pathogen makes the upload of sequences to the public domain
easier for users and provides them with adapted analytical tools for
sequence analysis and phylogeny. Furthermore the influenza genetic
module developed within the global animal disease information system
(EMPRES-i) integrates sequence data from OpenFlu, database for
influenza isolates and epidemiological data related to influenza events.
This tool helps better sharing and integration of information from the
laboratory and from the field for better monitoring of influenza viruses
(genetic mutations and geographical dispersion over time) and detection of those strains that represent or potentially represent significant
threat to humans or animals. EMPRES-i functionalities have also
been expanded with a mobile application for field real-time reporting
(EMA-i) by animal health workers or field veterinarians. These field
data can then be linked to laboratory results through a linkage between
a Laboratory Information Management System and EMA-i. Another
example is the ten Indonesian animal health laboratories which now
share their raw laboratory influenza data for the national monitoring of
influenza viruses in poultry through a shared database (IVM Online)
where joint analysis is conducted with raw data from various sources.
Lastly, strengthening of laboratory capacities and information sharing
has shown to be highly supported through global, regional and national
networks. Regional support/leading laboratories have been designated
in various regions of the world and have great roles to play in supporting capacities of other laboratories in the region. In conclusion, laboratory capacities and information sharing need constant evolution and
can be supported by various tools, such as assessment tools, distance
learning tools, and also databases, networks, approaches or policies.
12.005 Research tools supporting livestock
development and food security: Peste des
petits ruminants as a working example
W. Dundon
International Atomic Energy Agency (IAEA), Vienna, Austria
Peste des petits ruminants (PPR) is a highly infectious transboundary
animal disease caused by the PPR virus (PPRV) that affects mainly
sheep, goats and small wild ruminants. With morbidity and mortality
rates that can be as high as 70вЂ“80%, PPR is classified within the group
of animal diseases that are notifiable to the OIE (World Organization for
Animal Health). Sheep and particularly goats contribute considerably
to the household and cash income and nutrition of small farmers in
many countries so the control of a disease such as PPR is considered
an essential element in the fight for global food security and poverty
alleviation. It is for this reason that PPR is presently being considered
as the next animal disease for global eradication.
The Joint FAO/IAEA Division is supporting the major drive by FAO
to control and eliminate PPR from its Member States (MS), and has
spent many years developing and validating diagnostic and vaccine
technologies. Access to infected animal tissues from outbreaks in MS
has allowed for the development and optimization of a number of tools
and procedures in the fight against this important disease. In addition,
on-going molecular epidemiological studies and full genome sequencing are providing a clearer understanding of the genetic influences on
PPRV spreading dynamics, host specificity, viral pathogenicity and
transmission.
This presentation will include the current status of research and development based efforts within the Joint FAO/IAEA Division and discuss
(1) the development of novel serological diagnostic tools for the identification of PPRV (2) cell lines for the improved isolation of PPRV from
diagnostic samples (3) multiplex assays for the detection of respiratory
disease in small ruminants including PPRV (4) full genome sequencing
by standard and NGS techniques, (5) the monitoring of PPRV circulation within MS through molecular epidemiological approaches.
A bstracts SUNDAY вЂў November 2, 2014
International Meeting on Emerging Diseases and Surveillance 2014
Session 13 (Invited Presentations)
Health Care Associated Emerging
Infections
Sunday, November 2, 2014
Room: Klimt 2 & 3
08:30вЂ“10:30
Break-out Session
13.001 Contact networks and emerging infections at
local, national and global levels
P. Polgreen
University of Iowa, Iowa, USA
Healthcare settings frequently bring patients, both with and without
infectious diseases, into close contact with one another. Even patients
in different rooms, units and clinics often share the same healthcare
workers: seemingly disconnected patients can be connected through
healthcare workers. Furthermore, patients frequently travel both within
a hospital and among hospitals, increasing the opportunities for noninfected patients to come into contact with infected patients. This is
true regardless of the route by which infectious diseases are spread,
e.g., contact, droplet, respiratory. Thus, healthcare facilities вЂ“hospitals as well as outpatient clinicsвЂ”present a unique environment for
the potential spread of infectious diseases, both emerging and nonemerging. This presentation will focus on examples of how the process
of healthcare delivery has contributed to the spread of emerging infections around the world. Specifically, we will focus on different types
of infections and healthcare-associated contact networks. Finally, we
will discuss interventions to prevent the spread of emerging infectious
diseases that consider contact networks in healthcare settings.
13.002 The role of biologic therapies in emerging
M. Kuehnert
CDC, Atlanta, GA, USA
13.004 Emerging medical device-related infections
around the world
D. K. Warren
Washington University School of Medicine, Saint Louis, USA
November 2, 2014
All medical products of human origin, including blood, solid organs,
cells, and other tissues, can transmit infection from donors to recipients. Despite low risk, the number of infections transmitted through
blood and blood products may be greatest because of the number of
transfusions performed, with over 20 million units received in the United
States alone. However, despite only 28,000 U.S. solid organ transplants annually, transplant transmission clusters are more frequently
reported and notable, as recipients are more susceptible to complications of donor-derived infection because of immunosuppression.
The US Centers for Disease Control and Prevention has investigated
an increasing number of donor-derived infection clusters among transfusion and transplant recipients. Parasites, bacteria, and viruses have
been transmitted from infected donors, resulting in illness and death in
recipients. In some cases, as with HIV and hepatitis B and C, recognition of the risk of transmission has resulted in changes in screening
donors for these agents, making transfusions and transplants substantially safer. However, relatively very few pathogens are screened using
laboratory testing, instead relying on epidemiologic risk assessment.
Many infected donors who are the source of these transfusion- and
transplant-associated clusters are asymptomatic, making screening
triggered by signs or symptoms difficult. Transfusion- and transplanttransmitted infections may be challenging to diagnose. Several recent
cases of transfusion- and transplant-associated encephalitis, including
West Nile virus, rabies virus, lymphocytic choriomeningitis virus, and
Balamuthia mandrillaris amebae, highlight the challenges associated
with detection of clusters of donor-derived illness.
Particularly for transplant, in many of the clusters, identification of
the etiology was complicated by delayed diagnosis due to the rarity
of the disease, geographic distance separating transplant recipients,
and lack of prompt recognition. On a worldwide level, вЂњtransplant tourismвЂќ may further complicate recognition. Traceability and international
notification networks on possible threats (e.g., WHO NOTIFY project)
are essential. Establishment of surveillance systems to detect illness
among recipients, including communication among physicians, donor
organizations, and public health authorities, may enable rapid discovery and investigation of disease clusters. These clusters highlight the
need for greater awareness among clinicians, pathologists, and public
health workers, and for better communication networks about emerging
threats.
вЂў
The number of patients receiving immunosuppressive agents has
increased over the past decade and is expected to increase substantially in the near future. Biologic immunosuppressive therapies, such
as tumor necrosis factor-alpha (TNF-О±) inhibitors, represent important
treatment advances for patients with malignancy, autoimmune inflammatory diseases and other conditions. Although these drugs have
revolutionized the treatment of malignancies and inflammatory and
rheumatologic disorders, there is an important safety issue: a potential
increased risk of infection caused by a broad spectrum of organisms.
Besides an increased risk of traditional infections such as pneumonia, sepsis and urinary tract infections, there are descriptions among
biologic-treated patients of increased risk of opportunistic and emerging infections, including tuberculosis, systemic mycoses, legionellosis,
progressive multifocal encephalopathy and leishmaniasis. This presentation will review our current understanding of infectious risk in the
setting biologic therapies and will provide an update of the immune
system targets and potential infectious complications of established
and emerging biologic therapies.
transplantationвЂ”An under-recognized
mode of transmission
SUNDAY
infections
J. W. Baddley
UAB School of Medicine, Birmingham, AL, USA
13.003 Emerging infections in transfusion and
Healthcare-associated infections are one the most frequent adverse
events in the delivery of care. These infections are often associated
with the use of medical devices, such as urinary and intravascular
catheters, and result in significant morbidity and mortality. We will
review the global epidemiology of common device-related infections,
including intravascular catheter-associated bloodstream infection,
catheter-associated urinary tract infections, and ventilator associated
pneumonia. We will examine the impact of prevention efforts on these
infections. We will also discuss the re-use of medical devices intended
for single use, including syringes, hemodialysis filters and implantable
cardiac devices, and infection.
55
IMED 2014
A bstracts SUNDAY вЂў November 2, 2014
International Meeting on Emerging Diseases and Surveillance 2014
Session 14 (Plenary)
Session 15 (Invited Presentation)s
Launching of the New OIE Global
Wildlife Disease Reporting System:
WAHISвЂ“Wild
Emerging Viral Threats
Sunday, November 2, 2014
Room: Park Congress
11:00вЂ“11:45
14.001 Launching of the new OIE global wildlife
disease reporting system: World Animal Health
Information System (WAHIS)
SUNDAY
вЂў
November 2, 2014
P. Caceres
OIE, Paris, France
The World Animal Health Information System (WAHIS) is an internetbased computer system, launched in 2006, that processes data on
OIE-Listed animal diseases in domestic animals and wildlife with
the purpose of sharing information, reported by National Veterinary
Services, with the international community. Currently, 180 OIE Member
Countries have an obligation to provide animal disease information to
the OIE on the 119 OIE Listed diseases on a six-monthly basis through
WAHIS, additionally, 15 non-Member Countries voluntarily contribute to
sharing animal health status.
Moreover OIE Member Countries have to notify information on
exceptional epidemiological events related to OIE-Listed diseases as
well as emerging diseases (such as newly discovered Middle East
Respiratory Syndrome Coronavirus [MERSвЂђCoV]) within 24 hours after
confirmation. From 1 January 2014 up to 30 July 2014, a total of 506
immediate notification/follow-up reports were submitted by Member
and non-Member Countries.
From 2009, to adapt to the situation created by recent animal health
crises, WAHIS was tailored to make it possible to differentiate disease
status between domestic animals and wildlife. One of the aims was to
encourage countries to notify diseases detected in wildlife while avoiding unjustified adverse trade consequences. Another reason was to
better understand epidemiological risks.
In parallel, the OIE had started collecting information on wildlife
specific diseases that had not met OIEвЂ™s criteria to be listed. In 2014,
data on 53 infectious and non-infectious diseases affecting wildlife
is voluntarily provided by OIE Member Countries on an annual basis
and publicly available on a new web platform, WAHIS-Wild Interface,
launched in December 2013. These diseases to be monitored in
wildlife have been selected by OIEвЂ™s experts due to their importance
for human health (e.g. infection with Hantavirus), domestic animals
(e.g. ovine herpesvirus 2 causing malignant catarrhal fever in sheep),
environmental integrity and biodiversity (e.g. Infection with Geomyces
destructans also known as white nose syndrome). In addition, WAHISWild contributes in strengthening the epidemiological knowledge of
diseases. For example, information on subtypes H5 and H7 of low
pathogenic avian influenza virus in poultry is mandatorily reported
through WAHIS, while complementary information on cases in wildlife involving all subtypes can be voluntarily reported and viewed on
WAHIS-Wild Interface.
This presentation will briefly introduce WAHIS and wildlife disease
reporting system as well as WAHIS-Wild Interface. It will be explained
how both systems can be utilised as complementary tools to provide
early warning to protect animal and public health, as well as to better
understand the epidemiology of various pathogens.
56
IMED 2014
Sunday, November 2, 2014
Room: Park Congress
14:30вЂ“16:00
Break-out Session
15.001 Ebola and its spread in West Africa
O. Tomori
RedeemerвЂ™s University, Lagos, Nigeria
Ebola virus disease, a hideous infection with fatalities as high as
90%, is caused by Ebola virus of the filoviridae family. It is transmitted
through direct contact with the blood, body fluids and tissues of infected
persons. Transmission can also occur by handling sick or dead infected
wild animals (chimpanzees, fruit bats etc). Since there is no vaccine
or specific drugs for treatment, patients receive general supportive
therapy,
The first outbreaks occurred simultaneously in 1976 in Sudan and
DR Congo. There are five distinct species of the genus Ebolavirus:
(Ebola-Zaire, Ebola-Sudan, Reston Tai Forest and Bundibugyo). Apart
from Tai Forest and Reston viruses, all other Ebola virus species have
been associated with large outbreaks of Ebola disease in Central and
East Africa, principally in Zaire, Sudan, Democratic Republic of Congo,
Republic of Congo, Gabon and Uganda.
The first report of Ebola virus human infection in West Africa was in
1994, in an ethnologist infected with the Ebola-Tai Forest virus strain,
while conducting a necropsy on a wild chimpanzee in Tai Forest Ivory
Coast. Late in 2013, an Ebola outbreak caused by Ebola-Zaire virus
strain occurred in Guinea, spreading to Liberia and Sierra Leone. The
West African Ebola outbreak is currently the most severe of reported
outbreaks in Africa. As at July 20 2014, a total of 1,093 cases and 660
deaths have been reported. On 20th July 2014, a Liberian citizen on a
flight originating from Monrovia was admitted into a private hospital on
arrival in Lagos, Nigeria; he four days later with a diagnosis infection
caused by Ebola-Zaire virus strain.
The severity of the 2014 Ebola virus outbreak in West Africa is
attributed to several factors: poor disease surveillance and monitoring
break down of infection control precautions in health facilities, noncompliance with aspects of the International Health Regulations (IHR)
by countries and demonstrated ignorance and lack of awareness of the
disease by residents of affected communities. Important lessons from
the 2014 West African Ebola outbreak should be useful in controlling
future epidemics of infectious diseases.
15.002 Avian influenza studies at the
human-animal interface
M. Koopmans
Erasmus Medical Centre, Rotterdam, Netherlands
Influenza viruses remain among the top emerging disease threats,
given their widespread presence in wild birds, and the proven capability
of crossing the species barrier. The list of avian influenza viruses that
may infect humans is growing, with the notable emergence of H7N9
influenza viruses in China since 2013 as the most prominent recent
example. While the total number of recognized human cases is limited
globally, each animal influenza virus infection in a person is considered a public health threat, as the influenza pandemics of the last 100
years all have emerged from the animal world. Science falls short in
predicting which animal influenza viruses may develop into pandemic
influenza viruses, and it is clear that many factors may influence this.
Currently, humans are the sentinels for detection of transmission
potential, a situation that is far from ideal. The history of avian influenza
outbreaks affecting humans in the past decade has drawn attention to
the importance of studies at the human animal interface, and development of new technologies may help strengthening and targeting surveillance efforts to hotspots for disease emergence. This may involve
both serological and molecular surveillance, ideally integrated across
A bstracts SUNDAY вЂў November 2, 2014
International Meeting on Emerging Diseases and Surveillance 2014
the medical and veterinary domains. Our research program focuses on
development of methods and approaches to enhance emerging disease preparedness, and to develop novel approaches to surveillance
at the human-animal interface.
15.003 ChikungunyaвЂ™s entry into the Americas
A. Flahault
Ecole des Hautes Etudes de Sante Publique, Paris, France
Sunday, November 2, 2014
Room: Klimt 2 & 3
14:30вЂ“16:00
Break-out Session
16.001 Indirect effects of climate on disease
emergence: Population stress and migration
and emerging infectious diseases
D. Fisman
University of Toronto, Toronto, Canada
Our planet is undergoing rapid environmental change as a result of
human activities. Profound changes are occurring in global climate as
a result of greenhouse gas accumulation, and these changes in turn
will affect precipitation patterns, temperatures, abundance of water for
human consumption and agriculture, and sea level rise. All of these
changes will impact human populations profoundly, and are projected
The environment in which we live is changing at a rate that is unprecedented. For pathogens with environmental reservoirs such as water,
climate change impacts such as warming temperatures, and changing
precipitation patterns resulting in more extreme weather events can
significantly alter the risk of disease occurrence in both humans and
animals. This presentation will highlight how the use of both traditional
and novel epidemiological modeling techniques can contribute to our
understanding of the environmental drivers of waterborne disease
risks. Drawing on both human and veterinary examples from across
North America, we will describe environmental drivers of acute gastrointestinal illness (AGI) as well as the implications of these findings
for understanding disease dynamics under climate warming scenarios.
Identifying the potential impact of warmer temperatures, increased
precipitation, and extreme weather events on the burden of different
water-borne pathogens will begin to provide evidence to allow for a
more nuanced understanding of the potential direction and magnitude
of changes that may occur. This improved understanding will allow us
to identify the best strategies for allocating appropriate resources to
surveillance, and disease prevention activities in the future.
16.003 Unraveling disease signatures in climate for
the improvement of disease prediction
X. Rodo
Institut CatalГ de CiГЁncies del Clima (IC3), Barcelona, Spain
Assessing the role of climate variability and its changes on the incidence of infectious diseases globally, implies being able to understand
the effects of climate dynamics at regional-to-local scales. Progress in
climate models has been considerable over the last few decades and
despite some important uncertainties, several model intercomparison
exercises highlight that substantial consensus exists on both the direction and magnitude of the changes to occur over the next few decades.
Understanding regional climate dynamics and how both vector populations and human societies integrate these forcing, becomes key when
extrapolation to other settings and time scales is attempted. The latter being particularly true at the light of both short-term and long-term
immune responses to infection. The process leading to a proper integration of climate information demands first the accurate identification
of disease signatures on potential extrinsic predictors of disease, a task
for which statistical approaches, which efficiently shape and constrain
those regions and timescales, are required. The ulterior development
of effective population disease models will therefore require a tradeoff
among the paucity of data available, the understanding of disease
epidemiology and a proper integration of the nonlinearities in disease
dynamics within the selected modeling framework. Prediction capacity
will therefore not necessarily improve with model complexity.
Examples will be shown for a wide range of diseases, ranging from
waterborne diseases to vector borne diseases having or not a zoonotic
intermediate host and ultimately up to diseases recently seen to be
windborne.
November 2, 2014
Things Are Heating Up: Emerging
Infectious Diseases and Climate Change
A. Greer
University of Guelph, Guelph, ON, Canada
вЂў
Session 16 (Invited Presentations)
16.002 Water, climate and disease emergence
SUNDAY
Chikungunya is an arbovirosis (CHIKV) transmitted by the mosquitoes
Aedes aegypti and Aedes albopictus. There are three CHIK genotypes:
East-Central-South African (ECSA), West African and Asian lineages.
The ECSA genotype has been associated with major epidemics in the
Indian Ocean in 2005вЂ“2006, with spread towards India in 2006-2009
and then to Southeast Asia and Pacific Islands, causing a total of more
than 2 million cases. Since October 2013, an outbreak of Asian CHIKV
occurred on the island of St. Martin in the Caribbean sea. It is not
yet known from where this strain came to this French island. Within
the nine following months transmission spread intensely, in numerous other Caribbean islands and in French Guyana, causing around
500,000 suspected cases (including about 6,000 laboratory-confirmed
cases). Autochthonous transmission was confirmed in 89% of cases.
Although we donвЂ™t have yet a deep knowledge and experience from
the Asian lineage of CHIKV, what we have learned from the ECSA lineage is its high attack rate during epidemics (range from 40% in La
RГ©union to 75% in Lamu and Mombasa, Kenya), and the low proportion of asymptomatic cases (7 to 28%). CHIKV infections are mostly
mild, with acute fever and arthralgia. Most of patients recover within
one week, although a small proportion may experience debilitating
arthralgia and fatigue for a couple of months or even years. Very rare
severe complications have been seen, particularly in new born infants
infected during delivery. No animal reservoir has been identified. Both
Aedes types are competent vectors, although Aedes aegypti has been
recognised as the predominant vector for the Asian genotype CHIKV.
Economic burden from CHIKV has been calculated at La RГ©union, and
can be substantial, particularly in touristic areas.
Epidemiological profile of CHIKV infections seems to follow the traces
of dengue viruses, which are transmitted by the same vectors. It is
therefore highly predictable that CHIKV will spread to the Americas, as
dengue fever did. It is noteworthy however that CHIKV did not cause
(yet) large outbreaks in temperate zones, but only limited number of
autochthonous transmissions. There is no reason why CHIKV would not
continue its progression, when globalization is fostering the process, and
accelerating its pace. It is time to look actively for specific drugs and vaccines effective against these frequent and sometimes severe infections
which have the potential to spread all over the world rapidly.
to cause large-scale migration both due to loss of habitat (e.g., because
farmland ceases to be arable, or due to loss of costal areas via sealevel rise), and due to resultant conflict. Much work has been done to
date on the potential changes in infectious disease ecology that could
result from, and that is already occurring as a result of, climate change,
but less has been written about the impact that complex climatic feedbacks on human populations could have on the spread and emergence
of infectious diseases. In this talk, I will draw on basic principles of
infectious disease dynamics, as well as historical examples, to highlight
how crises in human mobility and relocation that result from climate
change could contribute to disease emergence. I will focus in particular
on issues related to movement of human populations into erstwhile
wilderness areas, the effects of refugee camps and transit centers
on amplification of infectious disease outbreaks, and the interaction
between conflict, climate change and disease emergence.
57
IMED 2014
A bstracts SUNDAY вЂў November 2, 2014
International Meeting on Emerging Diseases and Surveillance 2014
Session 17 (Invited Presentations)
Pastoralism, Rural Communities and
the Human Animal Health Interface in
East Africa
Sunday, November 2, 2014
Room: Park Congress
16:30вЂ“18:00
Break-out Session
17.001 Staying mobile, staying healthy: Pastoralism,
mobility, and human health in the drylands of
East Africa
SUNDAY
вЂў
November 2, 2014
B. Butt
University of Michigan, Ann Arbor, MI, USA
Livestock keeping pastoralists who live in dryland regions of East Africa
rely on macro- and micro-mobility in order to sustain their livelihood
systems. Dominant narratives of pastoral mobility have suggested that
pastoralists tend to move вЂњhaphazardlyвЂќ and across wide spaces in
search of water and forage, with little nuance surrounding the reasons
for mobility. New empirical evidence suggests that pastoral mobilities
are the result of synergies between social, ecological, economic, and
political fluctuations, which change rapidly across time and space.
Yet despite this new evidence, dominant narratives of mobility have
persisted and hampered efforts to prevent and treat pastoralists for
emerging infectious diseases such as Q Fever, Rift Valley Fever,
Trypanosomiasis, and East Coast Fever. This is because existing
health care facilities do not adequately reflect, both in their physical
location and their social access, the complex realities of pastoral mobility in an era of changing climate, ecology, and politics. Additionally,
there remain social and economic stigmas, regardless of proximity to
healthcare, which limit pastoralistsвЂ™ abilities to meaningfully engage
with health care practitioners and reduce susceptibility to or prevent
emerging infectious diseases. In this paper we describe a new conceptual approach to understand why pastoralists remain vulnerable to
emerging infectious diseases, by relying on the lens of pastoral mobility. We present preliminary empirical data on the disjuncture between
health care access and delivery and the everyday rhythms of pastoral
mobility. We argue prevention and treatment of emerging infectious
diseases can be more effective if the physical location of health care
facilities and the services that they provide is coupled with a more
detailed understanding of pastoral mobility. To demonstrate this claim,
we present spatially explicit data on the GPS based locations of forage,
water, market and trading centers, herders, livestock, and health care
providers as they move around a dryland landscape in Kenya. This
evidence clarifies how access to healthcare is mediated by space and
time and across changing ecologies and politics. This new conceptual
approach provides the potential to bridge gaps in our understanding of
why pastoralists in drylands remain susceptible to emerging infectious
diseases.
17.002 Reaching the fifth child: Operational
challenges for polio eradication among
pastoralist communities
V. Gammino
US Centers for Disease Control and Prevention, Atlanta, GA, USA
Since its inception in 1988, the Global Polio Eradication Initiative (GPEI)
has consistently employed four key operational strategies to eradicate
wild poliovirus: surveillance for acute flaccid paralysis (AFP), routine
immunization (RI), вЂњmop-upвЂќ campaigns after an outbreak, and supplemental immunization activities (SIAs). In the absence of adequate
RI, SIAs are relied upon to maintain population immunity, thus their
58
IMED 2014
effectiveness is critical to eradication efforts. The logistics involved to
implement these strategies can be daunting, however, in the presence
of limited or out-of-date census data, a highly mobile target population or insecurity that can impede vaccine delivery during SIAs. Mobile
populations, including pastoralists, may often live beyond the reach of
established health care systems that are designed to serve sedentary
populations. As a result, these groups may have limited perceptions of
disease risk for low prevalence diseases such as polio, are frequently
under-immunized and can be systematically excluded from disease
surveillance measures. This is of particular concern within the context
of GPEI, as communities with under-immunized children can serve as
reservoirs for poliovirus, and unwittingly contribute to the continued disease transmission. In this presentation, we will provide an overview of
the operational challenges, preliminary research findings and borrowing methods from epidemiology, geographic information systems, and
anthropology, present potential вЂњpoints of convergenceвЂќ and solutions
to strengthen current GPEI strategies and thereby improve service provision to these populations.
17.003 Control of zoonotic diseases: A route to
poverty alleviation among livestock-keeping
communities
E. Fevre
University of Liverpool, Liverpool, United Kingdom
no abstract submitted by presenter
17.004 Integrated human and animal health
surveillance and services for remote rural
communities
E. Schelling
Swiss Tropcial and Public Health Institute, Basel, Switzerland
no abstract submitted by presenter
Session 18 (Oral Presentations)
High-Consequence Viral Pathogens
Sunday, November 2, 2014
Room: Klimt 2 & 3
16:30вЂ“18:00
Break-out Session
18.001 Ebola virus disease outbreak in Nigeria:
Lessons to learn
C. Althaus, S. Gsteiger, N. Low
University of Bern, Berne, Switzerland
Purpose: International travel has already spread Ebola virus disease (EVD) to major West African cities as part of the unprecedented
epidemic that started in Guinea. An infected airline passenger who
arrived in Nigeria on July 20, 2014 caused outbreaks in Lagos and
Port Harcourt. By September 13, there were 21 reported EVD cases
including 8 deaths. We quantified the impact of early control measures
in preventing further spread of EVD in Nigeria and calculated the risk
that a single undetected case will cause a new outbreak.
Methods & Materials: We extended our EVD transmission model
(Althaus, PLOS Curr, 2014 Sept 2) and applied it to data of the outbreak in Nigeria reported by the World Health Organization (WHO).
Results: We estimated the basic reproduction number R0=5.4 (95%
confidence interval [CI]: 4.2-6.8). We also found that the reported control interventions including case isolation, contact tracing and surveillance were successful in reducing the reproduction number below unity
15 days (95% CI: 10вЂ“21 days) after the death of the index case. Using
the estimated value of R0 in Nigeria, we calculated that the risk of an
outbreak from a single undetected case was 81% (95% CI: 76вЂ“85%).
A bstracts SUNDAY вЂў November 2, 2014
International Meeting on Emerging Diseases and Surveillance 2014
Conclusion: R0 in Nigeria was substantially higher than in Guinea,
Sierra Leone and Liberia. This shows the large number of contacts
at risk of infection when EVD is introduced through air travel. Cities
at the highest risk of imported cases should have strong surveillance
at airports and the capacity to implement intensive control measures.
18.002 Study of the impact of canine distemper and
rabies viruses on the red fox population in
Northern Italy trough a microsatellite analysis
outlining the population genetic structure
B. Zecchin1, M. De Nardi1, B. Crestanello2, P. Nouvellet3,
M. Babbucci4, C. A. Donnelly3, C. Vernesi2, A. Milani1,
P. De Benedictis1, G. Cattoli1
1
Istituto Zooprofilattico Sperimentale delle Venezie, Legnaro, Padova,
Italy, 2Fondazione Edmund Mach, San Michele AllвЂ™adige, Trento, Italy,
3
Imperial College London, London, United Kingdom, 4University of
Padova, Legnaro, Padova, Italy
K. Stoecker1, E. Fleischmann1, S. Mely2, E. Newman3, S. Meschi4,
B. Becker-Ziaja5, M. Gabriel5, A. DiCaro6, S. Gunther7, R. WГ¶lfel1
1
Bundeswehr Institute of Microbiology, Munich, Germany, 2Laboratoire
P4 INSERMвЂ“Jean MГ©rieux, Lyons, France, 3Public Health Engalnd,
Porton Down, United Kingdom, 4National Institute for Infectious
DiseasesвЂќL.SpallanzaniвЂќ, Rome, Italy, 5Bernhard-Nocht-Institute
for Tropical Medicine, Hamburg, Germany, 6National Institute for
Infectious Diseases Lazzaro Spallanzani, Rome, Italy, 7Bernhard
notch Institute of Tropical medicine, Hamburg, Hamburg, Germany
Purpose: Over the last 30 years Filovirus outbreaks repeatedly
occurred in the sub-Saharan African region. However, until recently
the western African sub-region was spared from this burden. On the
10th of March 2014 local health authorities in GuГ©ckГ©dou and Macenta,
Guinea, reported the outbreak of a deadly disease characterized by
severe diarrhea, fever and vomiting.
Methods & Materials: After confirmation of an Ebola Zaire strain as
the causative agent of the disease, the Global Outbreak and Response
Network of the World Health Organisation (GOARN/WHO) asked
the European Mobile Laboratory (EMLab) Consortium on the 23rd of
March to support the outbreak response mission by the deployment
of the EMLab. Three days later the lab equipment was deployed,
accompanied by a team of the EMLab consortium. Upon arrival at the
MГ©decins Sans FrontiГЁres isolation ward in GuГ©ckГ©dou, the epicentre
of the outbreak, the lab was set into operational readiness, and started
to run diagnostic tests on patient samples.
Results: Since then, more than 600 samples have been analysed
and five team rotations took place (as of end of June). Here, we introduce the concept of the EMLab, which has been developed at the
Bundeswehr Institute of Microbiology. Furthermore, lessons learned so
far from this first deployment of the EMLab, including logistics, laboratory concept, differential diagnosis, case load, establishment of transmission chain and daily routine will be presented.
Conclusion: The EMLab consortium consists of partners from
the Bernhard-Nocht-Institute, Bundeswehr Institute of Microbiology,
Instituto Nazionale per le Malattie Infettive, Irrua-Specialist-TeachingHospital, National Institute for Medical Research Dar es Salam, Public
health England, Institute of Virology Marburg, Laboratoire P4 INSERM,
Robert Koch Institute and Spiez Laboratory.
November 2, 2014
TГ©limГ©lГ©, Guinea Conakry 2014
J. M. V. Namahoro, S. Mehtar
Stellenbosch University, Cape Town, South Africa
laboratory in the course of the Guinea
Ebola outbreak
вЂў
18.003 A surveillance of Ebola outbreak disease at
18.004 First deployment of the European mobile
SUNDAY
Purpose: In 2006 northern Italy was affected by an outbreak of canine
distemper virus (CDV), which is still circulating in the red fox population.
From 2008 to the beginning of 2011, the rabies virus was introduced in
the same area from the Balkan region.
The objective of this research is to study the genetic and spatial
structure of the fox population in northern Italy, where rabies and CDV
were circulating with similar temporal and spatial patterns; as well, we
explored the association between these infections and the genetic
characteristics of the fox population.
Methods & Materials: We investigated the results of the microsatellite analysis of 379 samples of foxes collected from the regions affected
by rabies and distemper infections. A panel of 21microsatellite markers
was selected and we examined the genetic and spatial structure of the
red fox population with a Bayesian clustering analysis implemented in
Structure 2.3.3 and Geneland 4.0.2. We further explored the susceptibility of the identified fox sub-groups either to rabies or to CDV infection
through a matched case-control study.
Results: The study area included three regions of north
easternItaly(Friuli-Venezia-Giulia,Veneto, Trentino-Alto-Adige) in which
we identified 4 distinct sub-populations. The population structure likely
reflects the presence of artificial and environmental barriers able to
reduce the movement patterns of foxes; therefore, from a geographical
point of view, sub-populations are partially segregated. As a result of
the case control study we had indications that one of the four subpopulations was more susceptible to rabies and less to CDV, while
another turned out to be less concerned by rabies and more by CDV.
Conclusion: By analyzing the genetic structure of the red fox population, we found evidence for a spatial segregation able to influence the
spread of CDV and rabies viruses. However, to better understand the
dynamics of both diseases we have to take into account a multiplicity
of factors: the ecological features of the red fox population, the presence of migrants, the land use and the presence of environmental and
artificial barriers. This will allow improvement of diseases surveillance,
control, preparedness and intervention.
Results: 118 exposed persons were observed for 21 days and 25
persons among them develop the Ebola outbreak disease, 9 died. The
attack rate of Ebola outbreak disease equals to at TГ©limГ©lГ© and the
mortality was 9 died out of 25 infected (36%). The female are more
infected than the men (57% and 43%). The infection risk increases in
adult generation. The funeral preparation of death from Ebola virus was
the transmission risk factor of Ebola outbreak.
Conclusion: To control the Ebola outbreak disease, additional strategies such as involving community leaders in response efforts are used
to alleviate concerns of hesitant and fearful population so that healthcare workers can care for patients in treatment centers and thorough
contact tracing can be performed. Enhancing communication across
borders with respect to disease surveillance will assist in the control
and prevention of more cases in this Ebola virus disease outbreak.
Purpose: The purpose of this study was to describe the trend of transmission risk of Ebola outbreak disease in community of TГ©limГ©lГ© in
Guinea Conakry.
To identify the contacts of ill or deceased persons and tracking the
contacts daily for the entire incubation period of 21 days
Methods & Materials: A descriptive study design and audit form was
used to collect the data. Two criteria were considered: being close to
the patients with Ebola outbreak disease more than 12 hours and participation in unsafe burial practices. All exposed were under observation for 21 days after being exposed(1,4-6)
59
IMED 2014
A bstracts SUNDAY вЂў November 2, 2014
International Meeting on Emerging Diseases and Surveillance 2014
18.005 Ebola preparedness and response:
The role of a development organization
in Freetown, Sierra Leone
SUNDAY
вЂў
November 2, 2014
S. Rokadiya, O. Johnson, P. Arkell, M. Lado, C. Brown, G. Deen,
E. Hanciles
KingвЂ™s Health Partners, Freetown, Sierra Leone
Purpose: Since May 2014, Sierra Leone has experienced its first
Ebola virus disease (EVD) outbreak.KingвЂ™s Sierra Leone Partnership
(KSLP), an initiative of KingвЂ™s Health Partners in London, focuses
on health system strengthening through a long-term health partnership with Connaught Hospital, where they have an in-country team.
Traditionally, humanitarian organisations dominate emergency
response. However, KSLP were invited immediately to join the national
Ebola case management committee and taskforce at the Ministry of
Health and Sanitation (MoHS), to assist with nationwide preparedness
and response planning.
Methods & Materials: Initially, KSLP were asked to advise
Connaught on modifying international guidelines to develop a Hospital
Preparedness Plan, which was disseminated nationally, and assist
in training healthcare staff. Nationally, we assisted by contacting all
Western Area hospitals were to assess whether they had an equipped
isolation unit, received the national operational plan, and had trained
staff. We also conducted site inspections of isolation units nationwide.
Results: We helped Connaught set up a well-equipped isolation unit;
provided training for staff including screening, disease management,
and use of personal protective equipment (PPE). We defined staff key
roles and provided clinical assistance with suspected patients.
Progressively, weвЂ™ve had less involvement in clinical management
with an Ebola lead at Connaught, supported by KSLP. Our communication and site visits helped identify areas of weakness and distribute appropriate information and equipment. We also identified and
addressed ethical dilemmas both clinically for suspected patients and
for us, as an organisation.
Conclusion: Development organisations such as KSLP are well
placed to respond rapidly to specific scenarios in emergency response
due to their knowledge of local health-systems and their relationship
with key partners. This experience has augmented our close working
relationship with local partners and MoHS. We believe that a wellequipped, technically and clinically proficient development organisation
can play a key role in humanitarian emergencies.
18.006 Syndromic approach to diagnostics of febrile
travellers as a basis for surveillance of
emerging arboviral diseases
N. Cleton1, J. Wagenaar2, A. van der Eijk3, J. Reimerink4,
E. van Gorp5, C. Reusken5, M. Koopmans6
1
National Institute for Public Health and the Environment, Bilthoven,
Netherlands, 2ErasmusMC, Rotterdam, Netherlands, 3Erasmus
University Medical Centre, Rotterdam, Netherlands, 4National Institute
for Public Health and the Environment RIVM, Bilthoven, Netherlands,
5
Erasmus Medical Center, Rotterdam, Netherlands, 6Erasmus Medical
Centre, Rotterdam, Netherlands
Purpose: Emerging diseases with global public health impact have
stressed global health surveillance in recent decades. Many display
overlapping symptoms and geographical distribution, complicating
early warning. Local diagnostic databases can support international
surveillance activities in a wide range of diseases. Through a retrospective database and serological analysis of all arboviral diagnostic
requests in the Netherlands from 2009-2013 we assessed the potential
for syndromic diagnostic algorithms that enhance the ability to detect
emerging infections.
Methods & Materials: Patients were divided according to clinical
syndromes, travel history and diagnostic results. Based on literature
review, diagnostic flow charts and diagnostic serological multiplex
protein arrays were created using a combination of syndrome and
60
IMED 2014
geographical distribution in relation to virus group and probability of
infection. These results were compared to diagnostics requested by
physicians to identify possible gaps when using physician indexed
approach.
Results: Data for 26,511 samples (8126 patients) was analyzed.
25% of patients had both travel history and clinical history included in
their diagnostic request and <0.1% had reported vaccination history.
DENV was the most performed diagnostic test (84% of patients) followed by CHIKV (20%) and WNV (6%) of which respectively 20%, 18%
and 3% tested positive. The largest proportion of patients returned from
Southeast Asia (34%), followed by the Caribbean and South America.
The most prominent symptoms were febrile disease (83%), arthralgia
(19%) and rash (10%). Patients presenting with rash and hemorrhagic
symptoms were more often DENV positive (odds ratio 1.7 and 2.3).
Presenting arthralgia, arthritis or respiratory symptoms reduced probability (odds ratio 0.7 and 0.5). DENV was consistently tested when
indicated from the diagnostic algorithm. This was not the case in 44%
of patients with symptoms indicative of CHIKV infection.
Conclusion: Returning travelers on which arboviral diagnostics are
performed present frequently with febrile illness, sometimes with some
additional symptoms. While travel destination and syndrome could
be used to triage for diagnostics, this is not consistently done for all
patients for whom this is indicated. This points at an important gap
in case finding and stresses the need for syndromic based diagnostic
algorithms and matching laboratory methods to identify all relevant
(emerging) infections.
18.007 Outbreak of Dengue fever in Dar es Salaam,
Tanzania during 2014: preliminary results
from an outbreak investigation
F. Vairo1, L. E. Mboera2, P. De Nardo3, N. Oriyo2, S. Meschi4,
E. Nicastri5, A. Minha6, S. Rumisha2, M. Malechela2, G. Ippolito7
1
National institute for Infectious Diseases вЂњL.SpallanzaniвЂќ, Rome, Italy,
2
National Institute for Medical Research, Dar es Salaam, Tanzania,
United Republic of, 3National Institute for Infectious Diseases INMI
вЂњL.SpallanzaniвЂќ, Rome, Please Select, Italy, 4National Institute for
Infectious DiseasesвЂќL.SpallanzaniвЂќ, Rome, Italy, 5National Institute for
Infectious Diseases вЂњL.SpallanzaniвЂќ, Rome, Italy, 6National Institute
for Medical Research, Tanga, Tanzania, United Republic of, 7National
Institute fro Infectious Diseases вЂњL.SpallanzaniвЂќ, Rome, Italy
Purpose: From 2010, seasonal outbreaks of dengue have been
reported in Dar es Salaam, Tanzania. In February 2014 a report from
PROMED mail showed the increasing occurrence of dengue cases.
As early May 2014 there were over 300 confirmed cases of dengue
fever in Dar es Salaam. An outbreak investigation was carried out.
Preliminary data on risk factors and clinical presentation are reported.
Methods & Materials: The survey was conducted, during June 2014
in seven selected sites in the three districts of Dar es Salaam. Patients
with febrile illness of less than 7 days were tested dengue by rapid
test (DRT) for the presence of antigen and antibodies. Demographic,
environmental and clinical data were collected from the patient through
a structured interview. Acute dengue fever (DF) has been defined as
Antigen and/or IgM positivity at DRT.
Results: We enrolled 483 patients with fever. DRT showed positive
results in 110 (22.8%) subjects. Among these, 101 (20.9%) patients
had DF. Among the enrolled patients, 9 (1.9%) patients were positive
for IgG only. Among the DF patients, 30 (29.7%) subjects had IgG. The
incidence of malaria was 35.2% overall and 20.8% among DF patients.
In the clinical presentation only joint and muscle pain were strongly
associated with the presence of DF (p <0.001). Dengue warning signs
were present in 42 patients (41.6%). Three patients had severe dengue
(1 had hemorrhagic manifestations and 2 shock; among these, one had
IgG positive). No deaths were observed. Thirty-four patients (33.7%)
were admitted.
Conclusion: The incidence of DF was high. Compared to previous studies in Zanzibar, the prevalence of past infection is very low
as shown by the IgG positivity. The high incidence of coinfection with
malaria during epidemic underlines the need to simultaneously test
all febrile patients for dengue and malaria. The non-specific clinical
A bstracts SUNDAY вЂў November 2, 2014
International Meeting on Emerging Diseases and Surveillance 2014
presentation of DF make the diagnosis harder in malaria endemic
countries. High proportion of patients showed warning signs, three
patients had diagnosis of severe dengue, 29.7% acute patients were
positive for IgG suggesting more than one serotype could be circulating. ELISA, PCR and viral sequencing are ongoing.
18.008
Epidemiology of West Nile virus and endemic
arboviruses in neurological disease in South
Africa: A One Health approach
M. Venter1, J. Williams2, C. van Eeden2, S. van Niekerk3, V. Stivaktas2,
M. Pretorius2, M. Rakgotho2, L. Braack2, P. Almeida4, R. Swanepoel2
1
US-Centres for Disease Control and Prevention, Pretoria, South
Africa, 2University of Pretoria, Pretoria, South Africa, 3Roche,
Johannesburg, South Africa, 4Universidade Nova de Lisboa, Lisboa,
Portugal, Portugal
Purpose: The majority of emerging zoonoses originate in wildlife and
many are caused by viruses. However there are no rigorous estimates
of total viral diversity for any wildlife species, despite the utility of this
to future surveillance and control of emerging zoonoses. Here we
present a framework for the discovery of novel viruses in wildlife and
use it to make the first estimate of the number of viruses that exist in a
mammalian host, as well as the sampling effort required to achieve it.
Methods & Materials: We repeatedly sampled a mammalian host
known to harbor zoonotic pathogens (the Indian Flying Fox, Pteropus
A. Benkirane1, A. Shimshony2
Department of Pathology & VPH, Rabat, Morocco,
2
Hebrew University of Jerusalem, Jerusalem, Israel
1
Purpose: This paper describes the spatial and temporal sequence
of events for the 2014 foot and mouth disease (FMD) outbreak in the
Maghreb after 14 years of disease freedom, and analyzes the adopted
control measures in affected Tunisia and Algeria, as well as preventive
measures underway in neighboring Morocco, a country presently at
high risk of contamination.
Methods & Materials: Information used to this end was collected
through OIE weekly bulletins, FAO global information system, personal
contacts with senior veterinarians, reports from the local press, as
well as data directly obtained from a vaccine producer and from two
international FMD reference laboratories ; all have been published in
ProMED-mail and ProMED-MENAвЂ™s postings.
Results: FMDV serotype O (topotype ME-SA, lineage Ind-2001d)
was officially notified from Libya in April 2013. Apparently, no contingency plans were consequently prepared by other North African countries at risk. In previous years, mass annual FMD vaccinations were
applied in Tunisia (large & small ruminants) and Algeria (cattle only),
using a bivalent A & O vaccine, the latter of the West African Lineage;
coverage was partial. When both were hit in 2014, they reacted essentially through animal movement control, some culling of diseased and
slaughtering of in-contact animals, and mass vaccination campaigns.
Initially, FMDV vaccine strains O1 Manisa and O BFS were used ; both
have been found poorly matching the circulating strain. As a result,
the outbreak continued to spread rapidly in Tunisia (since April) and
in Algeria (since July), eventually affecting vast territories within both
countries.
Morocco has opted, in 2007, for the cessation of FMD vaccination
with the aim of applying for the OIE status of вЂњfree country without vaccinationвЂќ. When the disease flared up in Tunisia, two million doses of a
serotype O vaccine composed of strains O1 Manisa and O-3036 were
ordered, a preventive vaccination campaign launched in August 2014.
In September, Tunisia and Algeria started using new vaccines based on
strain O-TUR-05-9 which, similarly to O-3036, matches the field strain.
Conclusion: Hopefully this will limit the spread of FMD in the two
affected countries and minimize the losses likely to result from a possible contamination of the Moroccan ruminant population, of which only
cattle are being vaccinated.
November 2, 2014
in mammals
S. J. Anthony
Columbia University, New York, NY, USA
Maghreb (2014): Sequence of events and
adopted strategy
вЂў
18.009 A strategy to estimate unknown viral diversity
18.010 Foot and mouth disease epizootic in the
SUNDAY
Background: West Nile virus (WNV) is endemic to South Africa but
underreported as neurological pathogen. To investigate WNV and other
arboviruses with zoonotic potential, a One Health approach was used
since 2008 to trace virus activity, seasonality, molecular epidemiology,
disease potential and vectors involved.
Methods & Materials: Country-wide surveillance for acute neurological disease/fevers in horses was initiated in 2008. From 2010
postmortem specimens from fatal neurological cases in wildlife and
livestock were also accepted. Mosquito vectors were trapped monthly
since 2012 in 4 sites in Gauteng and Limpopo where horse and wildlife cases occurred. Specimens from humans with acute neurological
disease were collected at 3 hospitals in Gauteng in 2008-2009 and
since 2012. Sera from 127 healthy veterinarians from across the country were screened for WNV and Shunivirus (2012). Acute specimens
were screened by Flavi- and alphavirus genus specific PCRs followed
by specific realtime-PCRs for WNV, Wesselsbron, Sindbis, Middelburg,
Shuni, equine encephalosis (EEV); WNV IgM ELISA and positive cases
sequenced. Neutralization assays was used to define sero-prevalence.
Results: WNV was detected annually in 1-17% of 609 horses (91%
neurological and 36% fatal) (2008-2013). All PCR positive cases
were lineage 2 except one fatal lineage 1 case. Other viruses identified by RTPCR in neurological horse cases include Middelburg(7%)
Sindbisvirus(1%), Shunivirus(1.7%), Equine encephalosis(9%) and
Wesselsbronvirus(0.3%). 15/169 brain or spinal cord specimens from
other species tested positive for Sindbis (2); Shunivirus (4), WNV(2);
Middelburg (6) and EEV(1) representing 5/23 rhinoceros, 3/15 warthog,
1/28 Cape Buffalo, 1/6 crocodiles, 2/2 giraffe and 2/37 bovine. Cases
were distributed across the country from February-June. Mosquito
abundance peaked in February-April and is being screened. In hospitalized humans with neurological diseases, WNV was confirmed in
3.6% of 206 cases while 17% had neutralizing antibodies (2008-2009).
WNV (7.9%) and Shunivirus(4%) antibodies were detected in 127
healthy veterinarians across the country in 2012. Serological screening
for the other viruses is in process.
Conclusion: WNV lineage 2 was associated with severe disease in
horses and humans in South Africa, across the country, predominated
in late summer. Other endemic arboviruses with zoonotic potential contribute to neurological disease in several animal species and should be
investigations in humans.
giganteus) and used PCR with degenerate viral family-level primers to
discover viruses from nine viral families. We then adapted statistical
techniques commonly used to estimate biodiversity in vertebrates and
plants (rarefaction, Chao2) to estimate the total viral richness in this
species.
Results: A total of 55 viruses from seven viral families were detected.
This included 11 paramyxoviruses, 14 adenoviruses, 13 herpesviruses,
2 bocaviruses, 8 astroviruses, 4 coronaviruses and 3 polyomaviruses.
Of these, 50 were considered novel and several were shown to be
phylogenetically related to known human pathogens. Analysis of the
relative frequency of these viruses produced reliably asymptotic behavior and estimated the total viral richness to be 58 viruses (limited to
the viral families tested for). We then used a simple extrapolation to
estimate there are a minimum of 320,000 mammalian viruses awaiting
discovery within these families and estimated the cost of their discovery
to be ~US$6.3 billion (or ~US$1.4 billion for 85% of the total diversity).
Conclusion: Our work illustrates the power of using ecological
approaches to characterize viral diversity and estimate viral richness,
and can be considered part of a strategy to better target surveillance to
identify agents that pose zoonotic risks before they emerge in people.
As pathogens continue to emerge from wildlife, this estimate allows us
to put preliminary bounds around the potential size of the total вЂ�zoonotic
poolвЂ™, and facilitates a better understanding of where best to allocate
resources for the subsequent discovery of global viral diversity
61
IMED 2014
A bstracts MONDAY вЂў November 3, 2014
International Meeting on Emerging Diseases and Surveillance 2014
Session 19 (Invited Presentations)
One Health Approach
Monday, November 3, 2014
Room: Park Congress
08:30вЂ“10:30
Break-out Session
19.001 State-space models, risk maps and
public health: One-health approach of
hantavirus infections
K. Tersago
University of Antwerp, Antwerp, Belgium
Purpose: Predictive frameworks for wild zoonotic infection occurrence
are needed for proper risk assessment of environmental changes and
targeted prevention strategies. Puumala virus (PUUV) is the most
common hantavirus in Europe, is specifically hosted by bank voles
(Myodes glareolus) and causes a form of haemorrhagic fever with renal
syndrome in humans, called nephropathia epidemica (NE). In the last
decade, intermittent epidemic foci of NE have changed significantly
in size and frequency in Western Europe. Consequently, within the
EDENext project, a multidisciplinary approach was used to build and
evaluate the potential of climate and land use variables in predicting
occurrence of NE epidemics throughout the Western-European region
in space and time. Hence, allowing the construction of risk maps and
visualize detailed NE risk foci in the coming year.
Methods and Materials: Geo-referenced NE case data between
2004 and 2010 linked to high resolution spatial polygons from Belgium,
France, Germany and The Netherlands were used to construct a NE
model dataset. Potential explanatory variables (climate, land use and
remote sensing derivatives) were selected based on a literature study
and previous modelling work. The final parameter selection was done
by a bootstrapped mixed model approach and a geo-statistical spacetime Poisson model was used for prediction of NE relative risk in each
of the polygons of our study region. Model evaluation was based on an
out-of-sample dataset from 2011 and 2012.
Results: A purely climate-based model frame was selected to predict
the regionwide space-time trend in NE occurrence best. Beech occurrence was selected as the most dominant purely spatial determinant of
NE occurrence. Our model frame enables forecasting NE relative risk
in the coming year throughout the Western-European region with high
specificity (96%) and moderate sensitivity (60%). Predictions improve
further when correcting for risk overestimation in years directly following local high NE outbreaks.
Conclusion: This study is one of few examples of applied forecasting
of zoonotic disease emergence, based only on environmental triggers,
that could aid targeted prevention measures over a vast region.
MONDAY
вЂў
November 3, 2014
19.002 From risk maps to risk alleviation in public
health: Examples for hantavirus and CCHF
virus infections
K. Dressel
sine-Institut gGmbH, Munich, Germany
Understanding the biology, epidemiology and public perception of
zoonotic disease (and its emergence and mitigation) within the context
of a One Health approach is needed to ensure all appropriate factors
are taken into account. Close collaboration between disciplines and
institutions is necessary to tackle the challenges for Public Health
and its task to inform the public in a way that will enhance compliance
and will help to protect or at least mitigate the risks for the public from
vector-borne diseases in endemic areas. Drawing from ongoing work
within the EDENext FP7 project вЂ�Biology and control of vector-borne
62
IMED 2014
infections in EuropeвЂ™ (www.edenext.eu) this talk will explore the challenges, rewards, limitations and potential methods for joining forces
between modelling and social science with the purpose of producing
more reliable and accessible alert maps for Public Health and for the
design of health communication strategies for the public.
Findings of a comparative study, based on qualitative, explorative data
acquired by focus group research and conducted within the EU-funded
project EDENext will be presented. In this approach we have produced
alert maps (prevalence maps) and used them within the group discussion with people living in endemic areas of five countries. We have
analysed public risk perception and information expectations of people
potentially affected by the Crimean Congo Hemorrhagic Fever Virus
(CCHF) in the Republic of Macedonia and Turkey and affected regions
of the Hantavirus in Germany, France and Finland. Results show considerable differences how people perceive provided alert maps and
how they actually would use the material or how they evaluate the
usability of these risk maps. These findings should not only be used
for the improvement of future design of models; it should be also used
to inform One Health practitioners on important conclusions to draw for
improved Public Health communication strategies by using alert maps.
19.003 One Health as an every-day work: Example of
Rift Valley fever in the animal and human health
network in South-western Indian ocean
E. Cardinale
CIRAD, Ste Clotilde, France
Rift Valley fever (RVF) is a mosquito-borne zoonotic infection caused
by a Phlebovirus. This virus can be maintained in the environment by
an enzootic cycle involving wild and domestic ruminants and mosquitoes. In domestic ruminants, RVFV causes mass abortions and high
neonatal mortality. Humans are accidental hosts: infection is acquired
when handling infected animals or contact. In Madagascar RVF epidemics occurred in 2008 and 2009 in several regions with 418 severe
suspected human cases, including 59 confirmations and 7 deaths. The
goal of this study was to investigate the RVFV spread in ruminants
during these latest events taking into account environmental conditions
and livestock trade and try to deduce the potential risks of infection for
the human population in this country.
Thus, monthly collections of recorded cattle and small ruminant
movements were organized all over Madagascar in 2010 in primary
and secondary markets and slaughterhouses and data were analyzed
by social network analysis (SNA). To asses RVFV seroprevalence,
blood was taken from 3,438 cattle, 227 sheep and 762 goats and sera
were tested with commercial ELISA kits. Several remotely-sensed
environmental data spanning from 2005 to 2008 were collected from
different repositories, and their values were computed for the area covering each municipality. Human population data in 2010 was retrieved
from international databases. We used a logistic regression model to
check the associations between ruminant seroprevalence and environmental and ruminant-trade variables. We derived the RVFV infection
risk for humans from previous serological studies in humans correlated
with the density and predicted seroprevalence of ruminants in each
municipality. Such research studies are not only led in Madagascar but
also in the Comoros archipelago, within the new SEGA вЂњOne HealthвЂќ
network. This first-generation RVFV risk model will be further refined
using both environmental and public-health data. Output of the model
will be shared with the surveillance network and will serve to focus a
combine human-animal surveillance and improve intersectoral emergency response.
19.004 How to improve the practical implementation
of One Health?
E. Schelling
Swiss Tropcial and Public Health Institute, Basel, Switzerland
no abstract submitted by presenter
A bstracts MONDAY вЂў November 3, 2014
International Meeting on Emerging Diseases and Surveillance 2014
Session 20 (Oral Presentations)
Emerging Respiratory Viruses
Monday, November 3, 2014
Room: Klimt 2 & 3
08:30вЂ“10:30
Break-out Session
20.001 20.001The distribution pattern of avian
influenza H5N1 viruses in the high transmission
area in Java, Indonesia
T. A. Garjito1, J. Jastal2, M. Mujiyanto3, W. Widoretno4, Y. Udin2
1
Institute of Vector and reservoir control research and development,
Salatiga, Central Java, Indonesia, 2Vector Borne Diseases research
and development unit donggala, Donggala, Central SUlawesi,
Indonesia, 3Vector borne diseases research and development unit
donggala, Donggala, Central SUlawesi, Indonesia, 4Ministry of Health
Republic of Indonesia, Jakarta, Indonesia
Purpose: Indonesia has became a country with highest confirmed
human case of highly pathogenic avian influenza A H5N1 virus (HPAIV)
in Indonesia. As of Juli 2014, Ministry of Health Indonesia reported
197 confirmed human cases of infection with Highly Pathogenic Avian
Influenza (HPAI) H5N1 virus from Indonesia. Of these 165 died (CFR
: 83.67 %). By the end of June 2014, a total of 51 H5N1 positive confirmed cases occured in Jakarta, 51 cases in West Java and 31 cases
in Banten provinces. The aim of this study was to investigate the transmission pattern of highly pathogenic avian influenza virus (HPAI) H5N1
in the highest transmission area in this area using molecular analysis
and geographical information system.
Methods & Materials: To analyze the transmission pattern, spatial
modelling carried out to analyze and predict the pattern of transmission. Molecular analysis was also conducted to identify the virus population and genetic relationship between cases and outbreak of H5N1
virus in both of human and poultry that important for spatial analysis.
Results: The distribution of positive confirmed HPAI H5N1 cases
have the dispersal movement to west and east with spesific pattern that
leads to the northwest and southeast. We have only used spatial data
based on molecular information from the H5N1 cases in both of human
and poultry with spesific clade 2.1.3. There is no relationship between
the population density and the case distribution.
Conclusion: This study demonstrated the possibility of HPAI
H5N1 transmission is still ongoing in this region with spesific pattern.
Strengthening early warning system to anticipate the possibility of outbreaks of HPAI H5N1 in humans in the region becomes very urgent
and important.
20.002 Detecting H5N1-HPAI virus variants in
the endemic situation: developing an
integrated web-based, surveillance
platform (вЂњIVM OnlineвЂќ)
H9 and H7 in the live bird marketsвЂ™ environment
in Bangladesh
P. K. Biswas1, M. Giasuddin2, B. K. Nath1, M. Z. Islam1, N. C. Nath3,
M. Yamage3
1
Chittagong Veterinary and Animal Sciences University, Chittagong,
Bangladesh, 2National Reference Laboratory for Avian Influenza,
Dhaka, Bangladesh, 3FAO, Dhaka, Bangladesh
November 3, 2014
Purpose: A very little is known on the circulation of avian influenza A virus (AIV) subtypes in the live bird marketsвЂ™ environment in
Bangladesh, one of the badly-struck countries with highly pathogenic
avian influenza (HPAI) H5N1. To assess the circulation of AIV, particularly its three important zoonotic subtypes: HPAI H5, LPAI H9 and H7
in live bird marketsвЂ™ environment, we conducted a survey in two phases
on randomly selected 32 live bird markets (LBM) in Dhaka, the capital
city and in Chittagong, the second largest city.
Methods & Materials: In the first phase, four kinds of LBM environmental samples: market floor, poultry stall floor, poultry holding
case and slaughter area of each of the selected LBM were sampled
monthly once (but twice in August) during the period of JulyвЂ“December,
2012, except for October. In the second phase, the same four kinds
of samples plus water used for meat processing were sampled, again
monthly once for a period of five monthsвЂ”from September, 2013 to
January, 2014. Each investigated sample from a selected material
was a pooled one comprising samples/swabs from five places. The
collected samples were investigated following the standard procedures
practiced by the National Reference Laboratory for Avian Influenza
(NRL-AI) based in Savar, Dhaka. Using the recommended primer sets
and probes, wherever applicable, real-time or conventional reverse
transcription PCR were done to screen at first the Matrix (M) gene of
AIV followed by the H5, H9 and H7 genes.
Results: The results showed that, in the first phase, 13.5% (95%
confidence interval [CI] 9.4%вЂ“19.2%) LBM in their в‰Ґ 1 environmental
samples were positive with AIV, 9.4% (95% CI 5.9%вЂ“14.4%) with H5
and only 1.6% (95% CI 0.3%вЂ“4.7%) with H9. In the second phase,
19.4% (95% CI 14.0%вЂ“26.2%), 1.3% (95% CI 0.05%вЂ“4.7%) and 7.5%
(95% CI 4.2%вЂ“12.8%) LBM in their в‰Ґ 1 environmental samples were
positive with AIV, H5 and H9, respectively, but none with H7. The HA
cleavage site of the isolates belonging to the subtype H5 in the second
phase had the amino acid motif RRRKKR*GLF.
Conclusion: H5N1 and H9N2 are seemingly circulating in LBM environment in Bangladesh.
вЂў
Background: Since 2003, the highly pathogenic avian influenza
virus subtype H5N1 (HPAI-H5N1) has been endemic in poultry flocks
in Indonesia. As from July 2005, it also caused sporadic disease in
humans, with Indonesia having the highest cumulative total of cases
worldwide. Through the use of vaccination, the disease has been
largely controlled in poultry flocks, but there is an ongoing need to
monitor antigenic drift in response to this vaccination, as well as detecting novel incursions.
Objective: To develop a surveillance system based on the Indonesian
Ministry of AgricultureвЂ™s (MoA) regional veterinary laboratory network
to antigenically and genetically characterize isolates from outbreaks of
HPAI-H5N1.
20.003 Survey for avian influenza A virus subtypes H5,
MONDAY
P. A. Durr1, N. Hartaningsih2, H. Wibawa3, P. Pudjiatmoko4,
S. H. Irianingsih3, R. Dharmawan3, J. McGrane2, P. Selleck5,
M. Kim Torchetti6, W. Sastraningrat7
1
Australian Animal Health Laboratory, Geelong, Victoria, Australia,
2
FAO, Jakarta, Indonesia, 3DGLAHS, Wates, Indonesia, 4DGLAHS,
Jakarta, Indonesia, 5CSIRO, Geelong, Australia, 6USDA, Ames, IA,
USA, 7Udayana University, Jimbaran, Indonesia
Methods & Materials: Since 2010, a partnership project between
FAO and the Indonesian MoA has been developing a formal approach
to monitor HPAI-H5N1 virus, the вЂњInfluenza Virus MonitoringвЂќ or вЂњIVMвЂќ
network. This вЂњmolecular surveillanceвЂќ system has successfully implemented the laboratory protocols for the antigenic and genetic characterisation of H5N1 isolates. In the past year, work has focused on
developing a robust data management platform (вЂњIVM OnlineвЂќ) as well
as defining governance structures for the network.
Results: The IVM network has successfully undertaken antigenic
screening for over 750 HPAI-H5N1 isolates. A particular success of
the network was the recognition of a new incursion of clade вЂњ2.3.2.1вЂќ
virus with distinct epidemiological and clinical features. The web-based
system (вЂњIVM OnlineвЂќ) stores all the test data, as well as the sequence
data. IVM Online uses a mix of custom written programs and third-party
modules to provide advanced bioinformatics tools, which enable fully
replicable analyses. A quality control (QC) module plots the time series
of the positive controls (вЂњLevey-Jennings chartsвЂќ), and thereby detects
potentially sub-standard runs. The IVM Online application is written
using open-source programming languages and only uses freeware
third party tools, thus avoiding any costly overheads in its maintenance.
Conclusion: The Indonesian IVM network (including IVM Online) is
successful example of developing an advanced molecular surveillance
system. As such, it has potential relevance for other countries seeking
to establish laboratory networks to monitor avian influenza and other
pathogens.
63
IMED 2014
A bstracts MONDAY вЂў November 3, 2014
International Meeting on Emerging Diseases and Surveillance 2014
20.004 Avian influenza surveillance and pathogenic
potential assessment of animal influenza
viruses in Russia
K. Sharshov1, M. Sivay1, A. Glushchenko1, O. Kurskaya 1,
M. Gulyaeva2, A. Alekseev1, A. Yurlov3, A. Shestopalov1
1
Research Center of Clinical and Experimental Medicine, Novosibirsk,
Russian Federation, 2Novosibirsk University, Novosibirsk, Russian
Federation, 3 Institute of Systematics and Ecology of Animals,
Novosibirsk, Russian Federation
Purpose: Recent outbreaks of an avian-origin H5N8, H6N1, H7N9
influenza virus raise concern of the emergence of novel reassortant
viruses in Eurasia and the potential threat to the human population.
Avian influenza virus (AIV) surveillance and pathogenecity assesment
are important tasks prior the fundamental study and using these data in
practice. The study was aimed for collecting specific data on different
AIV distribution and biodiversity, comparing to the data from other part
of the world and filling the gap in Global Influenza Surveillance Network
in Russia.
Methods & Materials: The specimens were tested for AIV by standard methods. AIVs were isolated and studied by standard virological
and molecular-biological methods according to WHO and OIE manuals. Cell cultures and mice model were used.
Results: The report focuses on some epidemiological, pathogenic
and evolutionary aspects of AIVs including H5N1 isolated in Northern
Eurasia, russia in the last decade. During surveillance for AIV in
Northern Eurasia (Russia, Mongolia, Kazakhstan) more than 10000
samples from wild birds were collected. More than 300 AIVs were isolated and 25 different subtypes were detected. All the isolated viruses
belong to low pathogenic except the H5N1 virus. Moreover, we isolated
some rare subtypes including H1N2, H8N8, H13N8, H10N7, H15N4,
H16N3, LPAI H5N1. Some of them have not been detected in Russia
earlier or elsewhere (according to databases). The biological properties
of these viruses were studied. Phylogenetic analysis of different genes
shows close relationship of Russian viruses with strains from different
European, African, Asian countries and from Australia. We found some
reassortment events between animal viruses; evolutionary trends are
discussed. The report contains more detailed comparative virological,
molecular, pathogenic characteristics of viruses. Some molecularepidemiological aspects are discussed.
Conclusion: We showed circulation of different AIV including HPAI
H5N1 among wild birds and mammals in the natural ecosystems of
Northern Eurasia. Our study confirms the significant role of AIV surveillance in Russia for the Global Influenza Surveillance Network. The
results demonstrate the need for ongoing surveillance to detect new
pathogenic variants of animal influenza viruses. We suggest increasing
efforts of AIV surveillance in discovered вЂњhotspotsвЂќ in Northern Eurasia.
20.005 Understanding the epidemiology of H5N1 and
MONDAY
вЂў
November 3, 2014
H9N2 influenza virus outbreaks in Nepal
M. Akram1, R. B. Dissanayake1, K. S. Bisht1, P. Tshering1,
C. Shrestha2, K. C. Thakuri2, P. Manandhar2, S. P. Gautam2,
D. Castellan3, M. S. Oberoi1
1
Food and Agriculture Organization of the United Nations, Lalitpur,
Nepal, 2Department of Livestock Services, Kathmandu, Nepal, 3Food
and Agriculture Organization of the United Nations, Bangkok, Thailand
Background: The first outbreaks of highly pathogenic avian influenza (HPAI) H5N1 (clade 2.2) and H9N2 were officially reported
in Nepal in early 2009 and early 2010, respectively. The first report
of H5N1clade 2.3.2.1a in South Asia was reported in January 2010.
Objective : To conduct a retrospective study of laboratory data including description and preliminary analysis of spatial, temporal and population factors related to the distribution and spread of avian influenza
H5N1 and H9N2 subtypes in Nepal between 2010 and 2012.
Methods & Materials: A secondary data analysis was conducted of
laboratory data from 2010 to 2012 related to H5N1 and H9N2. Two
hundred and ninety-eight laboratory submissions were analysed and
64
IMED 2014
confirmed by RT-PCR at the Central Veterinary Laboratory in Nepal
and an international reference laboratory. Spatial, temporal and population distributions are described and analysed.
Results: The analysis of retrospective data indicated that the frequency of reported avian influenza events increased by 355% from
51 in 2010 to 232 in 2012. Commercial broilers and layers constituted
about 71.5% (n=213) of total AI events while backyard chicken and
ducks constituted about 20.8% (n=62) of AI events. Sixty eight per
cent (n=203) of the events were only related to H9N2 virus and 29.8%
(n=89) were typed as H5N1 virus subtype. Three events (1%) were
found to have concurrent infection with both H5N1 and H9N2 virus
subtypes occurred in 2011. H5N1events were reported mainly during
the first and fourth quarters of the year between 2010 and 2012 while
H9N2 events were reported diffusely in all four quarters particularly in
the latter half of 2011 and 2012. The highest number of H5N1events
(between 16 and 32 events per year) concentrated in five districts while
only two of those same districts reported H9N2 events.
Conclusion: The majority of avian influenza events verified during the study period were attributable to H9N2 virus. The spatial and
temporal distribution of reported H5N1 and H9N2 events differed with
reference to year of onset of reporting and the temporal distribution,
suggesting unique reporting and transmission characteristics of H5N1
and H9N2 events.
20.006 Surveillance for avian influenza in wild birds
and domestic poultry surrounding the wild
birdвЂ™s sanctuaries in Viet Nam, from March,
2009 to October, 2012
T. L. PHam
Department of Animal Health, Hanoi, Viet Nam
Purpose: To understand avian influenza (AI) in wild birds as well as
in domestic birds in backyard farms and live-poultry markets (LPMs)
located surrounding the wild birdвЂ™s sanctuaries in Viet Nam, DAH with
the support from the OIE/Japan Trust Fund Project on Strengthening
HPAI Control in Asia conducted a surveillance programme for AI from
March, 2009 to October, 2012.
Methods & Materials: In total, 583 wild birds classified in 95 different
species, 203 environmental specimens and 5,025 poultry (including
3,697 ducks, 933 Muscovy ducks, 8 geese and 387 chickens) surrounding the wild birdвЂ™s sanctuary areas in three Southern provinces
and one Northern province of Viet Nam were examined on AI viruses
(AIV). At the same time of sampling, a survey of Knowledge, Attitude
and Practices (KAP) with 215 questionnaires was undertaken to 110
backyard farm owners and 105 vendors of the LPMs.
The samples were tested by Real-time RT-PCR in Viet Nam then
were analyzed in depth at OIE Reference Laboratory for HPAI in Japan,
Hokkaido University. Data were entered into an Excel-database at DAH
and were imported into SPSS 11.5 software for statistical analysis and
descriptions. ArcGIS 9.3 and spatial database of Viet Nam were used
for mapping.
Results: The results showed that there was not any AIV detected
in all wild birds sampled and in environmental samples, vice versus,
at least 19 different sub-types of AIV including two sub-types of highly
pathogenic avian influenza (HPAI) H5N1 and H5N2 were identified in
poultry surrounding the wild birdвЂ™s sanctuaries.
Conclusion: Poor practices of poultry grazing at backyard farms,
of bird trading at LPMs together with HPAI viruses circulating among
poultry population would be risky to human health. Moreover, because
multiple subtypes of AIV were widely circulating in LPMs and genetic
reassortment is known to occur frequently in domestic ducks, there is a
potential threat that novel influenza viruses may emerge.
In order to break HPAI virus circulation among poultry and to progressively reduce the risk of H5N1 in Viet Nam, more and special attention
to the poultry marketing systems including LPMs should be taken in
consideration.
A bstracts MONDAY вЂў November 3, 2014
International Meeting on Emerging Diseases and Surveillance 2014
20.007 20.007Audience segmentation as a risk
communication strategy for preventing
complacency toward highly pathogenic avian influenza
J. M. Kreslake, Y. Wahyuningrum, B. Safi, M. E. Figueroa, D. Storey
Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
Purpose: Risk perception (RP) and self-efficacy (SE) are predictors
of behavior in pandemic outbreaks, but research on their relevance is
limited in populations with routine exposure. Highly pathogenic avian
influenza (H5N1) is endemic among poultry in Indonesia and human
mortality is relatively high. Previous research found paradoxical associations between these predictors and behavioral outcomes, suggesting complacency and overconfidence. This study examines differences
in behaviors among population segments defined by interactions
between attitudinal predictors to inform targeted risk communication.
Methods & Materials: Cluster analysis was conducted on a 2009
population-based Indonesian household survey (n=2,413). Attitudinal
clusters were defined by mean RP and SE scores: responsive (highRP/high-SE); proactive (low-RP/high-SE); avoidant (high-RP/low-SE);
indifferent (low-RP/low-SE). Multilevel regression analyses (reference
group: responsives) were used. Outcomes: risk (poultry roaming
around home, mingling with livestock) and protective behaviors (soap
use during food preparation, safe disposal of poultry waste, reporting
poultry deaths). Predictors: attitudinal group membership, controlling
for age, wealth and education (SES), knowledge, district-level interventions, and district. High-incidence districts were excluded to focus on
behaviors amid H5N1 background prevalence.
Results: Indifferents were the largest cluster (41.2%), followed by
proactives (27.2%), avoidants (22.1%), and responsives (9.6%).
Avoidants were poorer (r=-0.33, p=0.01) than the highest-SES group
(responsives). Odds of poultry roaming were lower among proactives (OR:0.51, p=0.002) and indifferents (OR:0.65, p=0.04) than
responsives. Compared to responsives, clusters had: greater odds
of livestock mingling (proactive OR:9.55, p=0.02; avoidant OR:14.77,
p=0.02; indifferent OR:6.99, p=0.04), lower odds of safe poultry waste
disposal (proactive OR:0.49, p=0.03; avoidant OR:0.40, p=0.01; indifferent OR:0.50, p=0.03), lower odds of reporting (proactive OR:0.20,
p=0.03; avoidant OR:0.20, p=0.03; indifferent OR:0.06, p<0.001), and
less soap use (proactive r=-0.41, p=0.01; avoidant r=-0.40, p=0.01;
indifferent r=-0.50, p<0.001).
Conclusion: Behavioral outcomes were best among individuals with
high RP and high SE. Targeted communication should be designed
to improve both RP and SE in the indifferent majority. Proactives are
vulnerable to overconfidence; despite high SE, behavioral outcomes
were poorer than indifferents. Responsives and avoidants accurately
perceive high-risk environments, but avoidants demonstrate fewer
protective behaviors; their lower SE may be attributable to fewer
resources. Structural interventions are recommended to complement
risk communication to populations with low SE and low socioeconomic
status.
20.008 20.008Active surveillance of avian influenza A/
H5 and H7 viruses at live bird markets in
Vietnam, 2013вЂ“2014
aboard aircraftвЂ”A systematic review
C. Adlhoch, K. Leitmeyer
European Centre for Disease Prevention and Control, Stockholm,
Sweden
November 3, 2014
Purpose: Air travel has been shown to contribute to the spread of
influenza through infected passengers and potentially through in-flight
transmission. Contact tracing (CT) after exposure to influenza is not
performed systematically. A systematic literature review of published
investigations was performed to evaluate the evidence for influenza
transmission aboard aircraft as a basis for deciding whether to trace
contacts.
Methods & Materials: Two databases (EMBASE, PubMed) were
screened for publications on the transmission of influenza virus on
aircraft. Studies investigating on-board influenza transmission from
passengers and/or crew to passengers and/or crew were included.
Relevant data of each publication were systematically and independently extracted by the two authors. Points were awarded to studies
that limited the potential for both recall and selection bias. Points were
deducted for studies failing to control for confounders like other possible exposure before and/or after the flight.
Results: Independent review of 402 retrieved articles yielded 14 articles providing evidence of on-board transmission of influenza viruses.
The majority (11/14) of these studies described potential transmission
of the pandemic influenza A(H1N1)pdm09 during the initial phase of
the pandemic in 2009. Overall, the evidence for on-board influenza
transmission in the reviewed literature was of limited quality; the level
of evidence in most studies was medium or low. Overall 68/163 (42%)
identified secondary cases were sitting in the same or within two rows
ahead and behind the index. When limiting this analysis to influenza
A(H1N1)pdm09 confirmed cases only, the ratio was higher (21/30,
70%).
Conclusion: There might be a higher risk for influenza transmission
in close proximity, but up to 60% of the cases would not have been
identified when restricting CT. Therefore the objective for CT e.g. containment needs to be clearly identified. The analysed studies showed
discrepancies in the case definition and ascertainment, CT strategies using a restricted or comprehensive approach, timeliness and
completeness of follow-up as well as the investigation of alternative
exposures after possible on-board exposure to influenza. These limitations made a comparison of the studies and outcomes challenging.
A standardised procedure for initiating, conducting and summarizing
contact tracing would be helpful for evidence-based assessment of the
risk for transmission aboard aircraft.
вЂў
Purpose: Vietnam is affected by avian influenza (AI) A/H5N1 viruses
in both poultry and human cases since 2003. On 31/3/2013, China
reported the first human infection with novel influenza A strain (H7N9),
and as 4/6/2014 the number of cases reported to WHO reached 448
including 156 deaths. Vietnam shares land border with China and then
exposes to a risk of H7N9 virus incursion. Therefore, two active surveillance programs were put in place (1) to monitor circulation of A/H5N1
viruses and (2) to monitor a possible influenza A/H7N9 incursion from
China.
Methods & Materials: Surveillance program for A/H5N1 was conducted from 10/2013-02/2014 in 147 live bird markets (LBMs) in 44
out of 63 provinces. 13,000 oropharyngeal swabs were collected from
ducks and tested for flu A, H5 and N1 viruses using rRT-PCR.
20.009 What is the evidence for influenza transmission
MONDAY
D. T. Nguyen1, T. N. Nguyen2, T. L. To1, T. D. Nguyen1
1
National Center for Veterinary Diagnosis, Hanoi, Viet Nam,
2
Epidemiology Division, Hanoi, Viet Nam
For H7N9, 60 markets were selected in nine northern provinces of
high risk and sampled weekly from 12/2013 to 03/2014. 64,390 oropharyngeal swabs taken from chickens were tested for influenza type A
and H7N9 viruses using rRT-PCR.
Results: From 10/2012 to 9/2013, 147 LBMs were surveyed with
5.68% of 40,000 samples positive to H5N1. From 11/2013 to 02/2014,
5.89% of about 13,000 samples showed positive to H5N1.
For the A/H7N9 surveillance, there were 2,188 pooled samples were
flu A positive (17.0%), but none of these samples were positive to H7N9.
Overall, Influenza type A virus was detected in 42/60 LBMs (70.0%).
Conclusion: The evidence that H5N1 viruses are present indicates
a threat to poultry populations and human health. The surveysвЂ™ data
provide a basis for adjusting prevention/controlling policy for AI caused
by A/H5N1 viruses.
Although, H7N9 has not been detected in poultry, large number of
tested samples were positive with influenza type A virus. Continued
surveillance of H7N9 in poultry at LBMs is critical to timely response.
Overall, prevalence of influenza A was detected in both active surveillances. Additionally, China recently reported influenza non-H5 subtypes such as H10N8. Hence active surveillance will help provide a
comprehensive approach towards more efficient disease control and
prevention for poultry and humans with a better preparation to control
new introduction of other non-H5 subtypes into Vietnam.
65
IMED 2014
A bstracts MONDAY вЂў November 3, 2014
International Meeting on Emerging Diseases and Surveillance 2014
20.010 Impact of national influenza vaccine campaign
on respiratory illness in Thailand, 2010-2011
P. Silaporn1, S. Jiamsiri2
1
International communicable disease control section, Nonthaburi,
Thailand, 2Expanded Program on Immunization section, Nonthaburi,
Thailand
Purpose: To determine the efficacy of influenza vaccine on outpatient
visit and hospitalization related to influenza like illness (ILI), influenza,
pneumonia of all causes and pneumonia due to influenza among high
risk population in Thailand.
Methods & Materials: This retrospective cohort study compared the
incidence rate of ILI, influenza, pneumonia of all causes and pneumonia due to influenza among vaccinated and non-vaccinated high risk
population. Vaccination status was defined according to the influenza
vaccination registration in 2010 and the incidence rate of ILI, influenza,
pneumonia of all causes and pneumonia due to influenza were determined using the national administrative data from the National Health
Security Office during 2010вЂ“2011 and calculated into incidence rate
ratio, 95% confidence interval and vaccine efficacy.
Results: There were 2,244,594 high risk individuals according to
the influenza vaccination registration. 1,370,373 (61.1%) were unvaccinated and 874,221 (38.9%) were vaccinated in 2010. Influenza vaccine efficacy in preventing ILI was 56% (IRR=0.44[95% CI=0.44-0.45]),
but there was no significance reduction of outpatient visit related to
influenza infection, pneumonia of all causes and pneumonia due to
influenza infection. Influenza vaccine efficacy in preventing hospitalization related to ILI, pneumonia of all causes and pneumonia due
to influenza infection were 25% (IRR=0.75[95%CI=0.71-0.78]), 38%
(IRR=0.62[95%CI=0.54-0.72]) and 32% (IRR=0.68 [95%CI=0.530.86]), respectively. Interestingly, there is no significant reduction of
hospitalization related to influenza infection, however, among children
age 6 months to 2 years, the vaccine efficacy in preventing hospitalization due to influenza was 60% (IRR=0.40[95%CI=0.13-0.96]).
Conclusion: Influenza vaccine efficacy in preventing hospitalization
related to pneumonia, ILI and pneumonia related to influenza in high
risk population were 25.0%, 38.0% and 32.0%, respectively. However,
children age 6 months to 2 year demonstrated 60% vaccine efficacy in
preventing influenza hospitalization.
20.011 Selective pressure acting on influenza
neuraminidase gene: a complementary
approach for studying the emergence and
evolution of antiviral drug resistance and
reduced susceptibility
MONDAY
вЂў
November 3, 2014
V. C. P. M. Correia1, A. Abecasis2, H. Rebelo-de-Andrade1
1
Instituto Nacional de SaГєde Dr. Ricardo Jorge, Lisbon, Portugal,
2
Instituto de Higiene e Medicina Tropical, Universidade Nova de
Lisboa, Lisbon, Portugal
Purpose: The repertoire of influenza antivirals is currently very limited,
making resistance a serious public health threat. Neuraminidase inhibitors (NAIs) oseltamivir and zanamivir are presently the only effective
antiviral drugs available worldwide for influenza management, targeting
neuraminidase (NA) protein that is under both antiviral and antibody
selective pressure (SP).
Aim: To investigate the SP acting on the NA of seasonal (A(H3N2),
A(H1N1), B-Yamagata, B-Victoria) and pandemic (A(H1N1)pdm09)
influenza viruses. It comprises two main objectives:(1) to evaluate the
contribution of positive SP (PSP) for the emergence of NAIs resistance
(R) or reduced susceptibility (RS); and (2) to determine the impact of
NAIs introduction into clinic and wide use during 2009 pandemic in the
SP acting on influenza NA.
Methods & Materials: Large-datasets of NA sequences were constructed using sequences from GISAID and NCBI Databases and from
viruses circulating in Portugal. Analyses of seasonal epidemics were
performed in the total dataset and in three temporal sub-datasets:(1)
before NAIs clinic introduction (1999); (2)before pandemic oseltamivir
wide use (2009); and (3) from 2009 to date. Regarding A(H1N1)pdm09,
66
IMED 2014
a total dataset and 2 sub-datasets split according to the end of the
pandemic period(10/08/2010) were studied. Maximum-likelihood phylogenetic trees were inferred in PhyML3.0, after performing sequence
alignment by ClustalW in MEGA5 and determining the best-fit model in
jModelTest. SP analysis were performed in HyPhy, including estimation
of global dN/dS, estimation of site-specific dN/dS and identification of
positively selected sites by SLAC and FEL methods, and differential
selection analysis according to time, using a significance level of в‰¤0.05.
Results: Preliminary analysis revealed the occurrence of PSP on
position 275 (R oseltamivir) of A(H1N1) seasonal NA after 1999 but
not from 2009 onwards. The site 151 (RS oseltamivir and zanamivir)
of A(H3N2) NA showed to be under PSP since 1999. A(H1N1)pdm09
post-pandemic results cause some concern since PSP was found on
positions 247 (RS oseltamivir) and 275. Influenza B SP and differential
selection results are now being obtained.
Conclusion: This study may contribute for understanding the role of
selective pressure in NAIs resistance and reduced susceptibility and
may detect potential risks of emergency of resistant viruses.
20.012 Occupational exposure to dromedary camels
is a risk factor for infection with MERS-CoV:
A comparative serologic study
C. Reusken1, E. Farag2, B. Haagmans1, G.-J. Godeke3, A. Ibrahim4,
S. Al Dhahiry5, S. Raj1, K. Mohran6, M. AlHAjri2, M. Koopmans7
1
Erasmus Medical Center, Rotterdam, Netherlands, 2Supreme Council
of Health, Doha, Qatar, 3National Institute for Public Health and the
Environment, Bilthoven, Netherlands, 4Leawaina camel hospital,
Doha, Qatar, 5Hamad Medical Center, Doha, Qatar, 6Ministry of the
Environment, Doha, Qatar, 7Erasmus Medical Centre, Rotterdam,
Netherlands
Purpose: There is growing evidence that dromedary camels (Camelus
dromedarius) are a reservoir for human infections with Middle East
respiratory Syndrome coronavirus (MERS-CoV). Although camels are
suspected to be the primary source of infection for humans, the routes
of direct or indirect zoonotic transmission are yet unknown. The majority of primary cases do not report contact with animals and one of the
major issues to be resolved is whether, and to what extent, asymptomatic or mildly diseased individuals contribute to the spread of the
virus. Here, we describe a comparative serologic investigation in Qatar,
among healthy people with daily, occupational exposure to dromedary
camels and healthy people who do not have contact with camels.
Methods & Materials: Serum samples from nine different human
cohorts were analysed for the presence of antibodies against MERSCoV, SARS-CoV or HCoV-OC43 spike domain 1 by protein micro-array
technology. Individuals in five cohorts had no contact with camels
(n=242), while individuals in four cohorts had daily and intensive
occupational exposure to camels (n=290). Confirmatory testing was
performed by plaque reduction neutralization (PRNT) for MERS-CoV.
Results: None of the sera from the non-camel contact cohorts showed
reactivity with MERS-CoV S1 while serum samples from 20 persons
in the camel-contact cohorts reacted with the MERS-CoV antigen on
the protein micro-array. Regardless whether there was occupational
contact with camels or not, all cohorts showed a high seropositivity
for HCoV-OC43, ranging between 93 and 100%. None of the serum
samples reacted with SARS-CoV antigen. The micro-array results for
MERS-CoV S1 were confirmed by PRNT.
Conclusion: Our results demonstrate that occupational exposure to
dromedary camels is a risk factor for MERS-CoV infection.
20.013 Experimental infection of dromedary camels
with Middle East respiratory syndrome
coronavirus
T. Schountz1, A. Malmlov1, D. Adney1, V. Brown1, E. De Wit2,
N. van Doremalen2, S. Quackenbush1, V. Munster2, R. Bowen1
1
Colorado State University, Fort Collins, CO, USA, 2Rocky Mountain
Laboratories NIAID, Hamilton, MT, USA
Purpose: Middle East respiratory syndrome coronavirus (MERS-CoV)
emerged in 2012 and has caused more than 800 cases of disease with
a fatality rate of more than 30%. It is thought the disease has an inflammatory immunopathologic component, similar to what is observed
A bstracts MONDAY вЂў November 3, 2014
International Meeting on Emerging Diseases and Surveillance 2014
in severe acute respiratory syndrome. Recent work has shown that
human monocyte-derived dendritic cells (DC) are productively infected
by MERS-CoV and these cells express many inflammatory cytokine
genes, including Ifna, Cxcl10, Ccl2 and Ccl5. Although the virus likely
originated in bats, serological, virological and molecular evidence
suggests it is naturally hosted by dromedary camels (Camelus dromedarius) without causing significant disease.
Methods & Materials: Camels were intranasally and intratracheally inoculated with MERS-CoV to determine susceptibility, pathology,
host response and virus dynamics. Bone marrow-derived dendritic
cells were generated to examine MERS-CoV effects on antiviral gene
expression.
Results: Each camel had nasal discharges and mild fevers for several days. Infectious virus was recovered only from the upper respiratory tract and for the first seven days; however, viral RNA was detected
for several weeks in oral and nasal swabs. Virus was not detected in
other tissues and histopathology was unremarkable, suggesting infection was confined to the upper respiratory tract. Camels held past 28
days seroconverted by ELISA to nucleoprotein. UV-inactivated MERSCoV induced robust expression of several antiviral genes in camel dendritic cells; however, infectious MERS-CoV repressed the expression
of Cxcl10, Ifna, Tbk1 and Ikbke, but not Rigi or Mda5, suggesting the
impact on this pathway occurs prior to IFN gene expression and IFNRО±
signaling. Despite this activity, and in contrast to human DC, camel DC
failed to support replication of MERS-CoV.
Conclusion: Together, these data indicate that camels are susceptible to MERS-CoV, but they only develop mild disease and may
remain persistently infected for several weeks. These features support
the hypothesis that camels are a reservoir host of MERS-CoV. We also
identifed several important differences in human and camel dendritic
cell responses to MERS-CoV that may account for the differential outcomes of infection. These differences may also play an important role
in the ecology of MERS-CoV circulation in camel populations.
20.014 Detection of new genetic variants of
betacoronaviruses in endemic frugivorous
bats of Madagascar
J.-M. Heraud1, N. Razanajatovo1, L. Nomenjanahary1, D. Wilkinson2,
M.-M. Olive1, J. Razafimanahaka3, S. Goodman4, R. Jenkins5,
J. Jones5
1
Institut Pasteur of Madagascar, Antananarivo, Madagascar, 2Centre
de Recherche et de Veille sur les Maladies Emergentes dans lвЂ™Ocean
Indien (CRVOI), Sainte Clotilde, France, 3Madagasikara Voakajy,
Antananarivo, Madagascar, 4Field Museum of Natural History,
Chicago, il, USA, 5Bangor University, Gwynedd, United Kingdom
Session 21 (Plenary)
Changing Disease Landscapes
Monday, November 3, 2014
Room: Park Congress
11:00вЂ“11:45
21.001 Changing disease landscapes: Using the
pressure-state-response model
J. Lubroth
FAO, Rome, Italy
Threats of animal origin are increasing as a result of ongoing societal developments that alter and shape global disease landscapes.
Population growth escalates, the globe becomes more interconnected
through traffic of people, goods, and animals or their products, fluctuations in climate become more common, encroachment into sylvatic disease cycles mesh with compounding urban expansion and agriculture
intensification, and in the face of continuous proliferation of poverty,
accesses to goods and medical services (human or veterinary) is often
weak. The joint outcome of these pressures is the intensified contact
between humans, wildlife, and domestic animals and sharing of their
microbes, resulting in emergence, spread and persistence of infectious diseases (a degraded вЂ�stateвЂ™). Disease burdens are increasingly
caused by infectious disease agents that flare up in an existing reservoir, spill over into other vulnerable species, invade new geographic
areas, or gain new traits such as virulence or antimicrobial resistance
through genetic evolution. These disease burdens contribute to the
vicious cycle of rural and urban poverty. Livestock health is the weakest link in our global health chain, and disease drivers in livestock as
well as wildlife are having increasing impacts on humans. Over 70
percent of human diseases originate in animals, and our expanding
human population inhabits more wildernesses while becoming ever
more reliant on animals for food. With regard to the pressures and
the state of livestock and global health, diseases must be addressed
at its source, particularly in animals. A sustainable response requires
decision makers inside and outside the medical community to identify
the drivers of the pressures and reduce the ominous state we find ourselves. Approaches that capture and apply the One Health mind set
are of utmost importance to effectively manage disease risks emanating from the complex interactions between humans, animals and their
environment. This integrated and interdisciplinary approach is required
to develop policies that are sensitive to the natural resource base, conservation and to promote sustainable livestock production to meet the
needs food production that demands more animal foodstuffs to feed the
world of 9.6 billion by 2050.
MONDAY
вЂў
November 3, 2014
Purpose: Bats are amongst the natural reservoirs of many coronaviruses (CoVs) of which some can lead to severe infection in human.
To date no CoVs has been identified in endemic bats of Madagascar.
Methods & Materials: We sampled frugivorous bats in four different
areas of Madagascar: Anjohibe, Anosibe AnвЂ™Ala, Menabe and Toliara
based on known accessible colonies of roosting bats and sites where
bats are frequently hunted and eaten by people. Specimen were tested
for the presence of coronavirus using RT-PCR that target the RdRp
gene. Phylogenetic analysis were performed from a 440 bp fragment
of the RdRp gene previously cleaned and aligned with reference
sequence collected from a literature search.
Results: We analyzed fecal and throat swabs from 351 frugivorous
bats belonging to three species captured in four different regions of
Madagascar. We detected 14 coronaviruses from two endemic bats
species, of which 13 strains were isolated from Pteropus rufus and one
strain isolated from Eidolon dupreanum, giving an overall prevalence of
4.5%. Phylogenetic analysis revealed that the Malagasy strains belong
to the genus Betacoronavirus but form three distinct clusters, which
seem to represent previously undescribed genetic lineages.
Molecular dating analyses estimated the most recent common ancestor (MRCA) dates for coronavirus for all Malagasy strains at 1074 years
ago, while the separation of Malagasy strains from SARS virus strains
was estimated to have occurred 1769 years ago.
Conclusion: Our findings suggest that CoVs, which circulate in
frugivorous bats of Madagascar, potentially pose a spillover risk to
human populations especially for individuals that hunt and consume
infected bats.
Overlaying in a temporal sense the estimated emergence period of
Coronavirus genetic lineages occurring on Madagascar with apparent
African affinity, and the dispersal biogeographical history of the three
Malagasy fruit bat species, it can be presumed that they colonized
Madagascar before the emergence of virus group. To date the mechanism of dispersal of coronavirus in Madagascar is unknown. One of
our hypothesis is that another bat specy might play a role in pathogen
dispersal across the Mozambique Channel.
67
IMED 2014
Poster Presentations I
SATURDAY вЂў November 1, 2014
International Meeting on Emerging Diseases and Surveillance 2014
Session 22
Poster Presentations I
Saturday, November 1, 2014
Room: Bruckner/Mahler/Brahms вЂў Upper Level
11:45вЂ“13:15
Diseases of Animals
22.001 Lumpy skin disease: disease emergence,
clinical signs, complications and preliminary
associated economic losses in Jordan
SATURDAY
вЂў
November 1, 2014
S. M. Abutarbush
College of Food and Agriculture, Al Ain, United Arab Emirates
Background: Lumpy skin disease (LSD) is a vector borne,
viral disease of cattle. It is endemic in parts of Africa and currently is emerging in different parts of the Middle East.
Objective: The objectives of this study are to report the emergence of
LSD in Jordan and associated clinical signs, complications and preliminary economic losses.
Methods & Materials: Methods: Two adult dairy cattle developed
clinical signs suggestive of LSD and were confirmed as positive by
PCR. The 2 cases were in Irbid governorate, on the Jordanian border
of Israel and Syria (Figure 1). The disease spread rapidly to all the districts of Irbid governorate. During the month following the emergence
of the disease, epidemiological data were collected from the affected
region.
Results: Results: Forty one dairy cattle holdings were surveyed. The
morbidity rate ranged from 3 to 100%, (Mean = 35.1%, SD В±28.5%).
The mortality rate ranged from 0 to 20%, (Mean = 1.3%, SD В±4.4%).
The case fatality rate ranged from 0 to 100%, (Mean = 6.2%, SD
В±22%). The overall morbidity rate was 26%, mortality rate 1.9%, and
case fatality rate 7.5%. Skin nodules (Figure 2-3), anorexia, decreased
milk production, and decreased body weight were common clinical
signs, while mastitis and myiasis were seen as complications in a
few affected animals. Decreased body weight ranged from 0 to 80%,
(Mean = 23.1%, SD В±15.7%). Decreased milk production ranged from
0 to 100%, (Mean = 51.5%, SD В±22.2%). Affected cattle were treated
accordingly and the cost of treatment ranged from 0 to 84.3 British
Pound/animal, (Mean = 27.9 GBP, SD В±22.5 GBP).
Conclusion: Conclusion: LSD continues to spread through the
Middle East region and poses a serious threat to the rest of Asia and
Europe. International collaboration and communication is warranted to
prevent the further spread of the disease to the rest of Asia and Europe.
Infections Related to Travel and Migration
22.002 Migrant womenвЂ™s health: molecular
epidemiology of Human Papillomavirus (HPV)
and Chlamydia trachomatis (Ct) infections
E. R. Frati1, E. Fasoli1, S. Bianchi1, M. Martinelli1, D. Colzani1,
P. Olivani2, E. Tanzi1
1
University of Milan, Milan, Italy, 2Naga Centre Onlus, Milan, Italy
Purpose: Nowadays, we live in an era of the greatest human mobility
recorded in history and almost half of all migrants are women. One
of the major public health problems in this high-risk population are
Sexually Transmitted Infections (STIs). STIs surveillance in migrant
women is determined both by the real need to know their spread in
the population and to avoid serious consequences and relevant costs
related to the healthcare system. This study aimed at evaluating the
molecular epidemiology of two STIs, Human Papillomavirus (HPV) and
Chlamydia trachomatis (Ct), in undocumented immigrant women in
Milan.
68
IMED 2014
Methods & Materials: 537 urine samples were collected from immigrant women (median age 36 years; range: 18вЂ“65) attending the Naga
Centre (http://www.naga.it) in Milan between June 2012-December
2013 and not involved in the national cervical cancer screening or in
routine gynecological visits. Informed consent was obtained from all
participants. Socio-demographic and sexual-behavioural patterns were
collected by a questionnaire. HPV and Ct DNA were detected using
PCR assays that amplify an ORF L1 segment and a cryptic plasmid
segment, respectively.
Results: Out of 757 undocumented migrant women enrolled,
537 participated in the study (acceptability rate: 71%). The women
belonged to 39 different nationalities and 22.5% were immigrants from
<1-year. Most of the women came from South-America (43.4%) and
Eastern-Europe (30.7%). Over 65% of them were married/had a stable
partner, were not using contraception and had at least one pregnancy.
The prevalence rates of HPV and Ct infections were 24.2% and 7.8%,
respectively. Moreover, 66.1% of HPV infections was sustained by
HR-types. All STIs-positive women were recalled and referred to indepth investigation and/or therapeutic treatment.
Conclusion: These data indicate that undocumented migrant
women living in Milan are very willing to get educational information
and counseling interventions on sexual health issues, given the high
acceptability to participate in the study bypassing barriers to access to
healthcare facilities. A urine-based test seems to increase the вЂњscreening uptakeвЂќ among women at increased risk of STIs. In addition, these
data improve the epidemiological surveillance of HPV and Ct infections
in women unlikely to seek healthcare services and allow to understand
their patterns of sexual-risk behavior.
22.003 International rotations: an initiative to
educate residents in tropical medicine
and immigrant health
P. Lichtenberger1, S. Doblecki-Lewis2
1
University of Miami Miller School of Medicine, Miami, FL, USA,
2
University of Miami, Miami, FL, USA
Purpose: The Division of Infectious Diseases in partnership with the
Department of Medicine at the University of Miami/Jackson Memorial
Hospital has developed a working relationship with the Universidad
del Valle and the CIDEIM in Cali, Colombia to develop a bi-directional
exchange program in Tropical Medicine.
Methods & Materials: Rotation objectives include develop skills
for cultural and social sensitivity to one of the minority communities
in South Florida, development of clinical skills for effective prevention,
diagnosis and treatment tropical diseases, exposure to an alternate
healthcare system/culture and improvement Spanish language skills,
to allow participants to increase their clinical skills for the diagnosis
and treatment of infectious and tropical diseases in areas with limited
resources and to prepare and encourage individuals to pursue a career
in global and tropical medicine.
Results: Seven trainees from University of Miami/Jackson Memorial
Hospital had experienced a 2вЂ“4 week ACGME/GME approved elective
rotation offered to Internal Medicine Residents, Infectious Diseases
Fellows and Global Health Residents within the year 2013вЂ“2014 at the
Hospital Universitario del Valle (HUV), and CIDEIM a private research
unit dedicated to the management and research on Leishmania,
syphilis, and vector control. All residents were funded from Medicine
Department and Global health resources. Trainees were exposed
to cases of Malaria, dengue, Leishmania, Leprosy, Leptospirosis,
Endemic Mycosis, Parasitosis among others. They interacted with
patients, other physicians and prepared clinical presentations in
Spanish. No safety or health issues happened during their rotation stay.
Conclusion: This rotation help trainees develop skills for the management and preventionof tropical diseases as well as educational exposure to different healthcare models and fluency in medical Spanish. It
is also intended to act as a cultural exchange, allowing participants to
gain an understanding of how medicine is practiced in resource poor
environments as well as other health issue that may affect developing
countries. With the success of exchanges the Department of Infectious
diseases is looking to continue to expand its sites and also fortify the
relationship with countries of high immigration rates in the US like
Colombia, Central America and Brazil, developing a robust curriculum
and facilitating the educational exchange from trainees from the other
countries in the US.
Poster Presentations I
SATURDAY вЂў November 1, 2014
International Meeting on Emerging Diseases and Surveillance 2014
22.004 Ten years tuberculosis trend in Gambella
Regional Hospital, South Western Ethiopia
G. A. Gulich1, G. A. Chemidi2, K. T. Tafese3
1
Mettu university, Gambella, Gambella, Ethiopia, 2Addis Ababa
University,, Addis Ababa, shewa, Ethiopia, 3Armawerhansen institute,
Addis Ababa, shewa, Ethiopia
subtypes in live poultry markets
J. Li, J. Pan
Hangzhou Center for Disease Control and Prevention, Hangzhou,
China
Purpose: Avian influenza virus (AIV) H5N1, H7N9 and H9N2 have
been extensively studied due to its ability to cause contagious respiratory disease in both humans and animals with potentially fatal outcomes. However, вЂњwhich subtype of AIV might play a key role in the
next pandemicвЂќ is highly questionable, since the broad range of AIVs.
In this study, all subtypes of AIVs were investigated for Hemagglutinin
(HA) gene in the specimens collected from live poultry markets (LPMs)
and live poultry farms (LPFs).
Methods & Materials: Real-time RT-PCR was performed to identify
specimen positive for each HA subtype of a total of 457 environmental
and animal swab specimens collected from 36 LPMs and 5 LPFs of 14
districts cover the whole city from June 2013 to February 2014, while
Hangzhou had a total of 30 human infection cases confirmed during the
second wave of H7N9 epidemic in January/February 2014.
Results: AIVs were continually detected in both summer and winter
seasons with peaks of 41.94% (13/31) and 60.89% (151/248), respectively. The LPMs were heavily contaminated by AIVs, notably higher
than that in LPFs (П‡2 = 45.57, P < 0.01). All HA subtypes, with the
exception of H8 and H12 to H16, were detected in specimens from
the LPMs of Hangzhou. AIVs of subtypes H7, H9, H6 and H5 were
detected most frequently from the specimens related to chickens (poultry swabs and feces, smear specimens from the surface of cages, etc.);
H1, H2, H3 and H4 less frequently; and H10 and H11 only sporadically.
Be differ from that, H6, H2, H9 and H5 make up four of the most commonly recognized subtypes in samples correlated with domestic ducks.
H1, H2, H3, H4, H5, H6, H7 and H9 co-circulated over than two months
in LPMs, creating the opportunity for genetic mixing.
Conclusion: LPMs carrying fomites can become a predominant
infection source for both poultry flocks and human contacted. Our
finding suggest that, besides H5, H7 and H9, the risk caused by AIVs
Purpose: To evaluate the performance of Seegene Anyplex II RB5
assay, a qualitative in vitro diagnostic test that allows the simultaneous
detection of Chlamydophila pneumoniae, Mycoplasma pneumoniae,
Legionella pneumophila, Bordetella pertussis, and Bordetella parapertussis from respiratory samples. Rapid and accurate identification of
these causative agents is a key component for establishment of proper
diagnosis, facilitation of early treatment, and easing of public health
concerns. Classical microbiological identification techniques, however,
cannot provide an efficient means of diagnosis, because most of these
organisms grow either slowly or not at all in culture, leading to delay in
detection and diagnosis.
Methods & Materials: The Anyplex II RB5 assay is based on
TOCETM (Tagging Oligonucleotide Cleavage Extension) technology
which makes it possible to detect multi-pathogens in a single fluorescence channel on real-time PCR instruments. A total of 63 samples
were tested, 42 were external quality assurance program samples, 6
were isolates from ATCC and NCTC Bacteriology Collection, and 15
were clinical specimens.
Results: 34 positive PCR were obtained, 5 with Bordetella parapertussis, 6 with Bordetella pertussis, 8 with Mycoplasma pneumoniae, 5
with Chlamydophila pneumoniae and 10 with Legionella pneumophila.
Sensitivity and specificity of the assay was determined to be 97.1% and
100% respectively.
Conclusion: This study shows the overall good performance of the
assay for the rapid diagnosis of multifaceted atypical pneumonia.
November 1, 2014
22.005 Co-circulation of H7N9 virus with other HA
bacteria by Seegene Anyplex II RB5 assay
W. L. Tan, K. X. L. Chan, K. S. Chan, L. L. E. Oon
Singapore General Hospital, Singapore, Singapore
вЂў
Influenza and Other Respiratory Infections
22.006 Simultaneous detection of 5 respiratory
SATURDAY
Purpose: Tuberculosis (TB) is a chronic infectious disease mainly
caused by Mycobacterium tuberculosis (MTBC). It is one of the major
health problems in Ethiopia, across the nation. According to World
Health Organization 2009 report the status of TB in Gambella Region
was the highest from all the Ethiopian Regions, with the notification
rate of (new and relapse) 261-421/100, 000. We, therefore, carried out
this study to investigate the trend of TB in Gambella Regional Hospital
Southwest Ethiopia.
Methods & Materials: Methods: The study was conducted at the
Gambella Regional Hospital, South Western Ethiopia. Retrospectively
the medical records of all TB patients registered from 1st January 2003
to 14th November 2012 were assessed.
Results: The results of the study revealed that there were 4300
TB cases registered in the ten years duration in Gambella Regional
Hospital. Males consist the highest percentage 2430 (56.51%). Out
of 4300 TB cases registered 1045 (24.30%) had Extra pulmonary TB
(EPTB) and 3255 (75.70%) suffered from pulmonary TB (PTB) (П‡2=31.
14; p<0.001). From 3255 registered PTB cases, smear positive PTB
accounted for 1368 (31.81%) of the cases. The age groups 15-44 took
the highest percentage among the patients 2918 (67.86%). Only 1444
patients were knew their HIV status out of these 423 (29.29%) were
HIV positives. The trend in TB registered cases of all forms of TB was
gradually declining in the ten years.
Conclusion: The retrospective study showed that TB problem in the
study area was not at the level to be undermined. Hence, TB control
program should give attention to the control of TB in Gambella Region.
of other subtypes, including H6, H10, H2, H3, H4, etc., should not be
underestimated. Therefore, from a public health standpoint, extensive
surveillance of avian influenza virus is recommended.
22.007 22.007Ethnic disparities in healthcare use for
respiratory infections
S. Della Smirra1, M. Campitelli2, L. Rosella3, M. Chiu2, N. Daneman4,
J. Smylie5, J. Kwong2
1
University of Toronto, Toronto, ON, Canada, 2Institute for Clinical
Evaluative Sciences, Toronto, ON, Canada, 3University of Ontario,
Toronto, ON, Canada, 4Sunnybrook Health Sciences Center, Toronto,
ON, Canada, 5St. MichaelвЂ™s Hospital, Toronto, ON, Canada
Purpose: Previous studies suggest that ethnic disparities exist for
infectious diseases. However, it is unknown if this holds true in Canada
with universal healthcare access and a diverse ethnic population. We
aimed to examine the association between ethnicity and healthcare use
for respiratory infections, and whether ethnic disparities differ between
healthcare settings.
Methods & Materials: We conducted a retrospective cohort study
with up to 16 years of follow-up (1996 through 2012) of 156,161 population health survey respondents in Ontario, Canada. We included individuals aged 12 years or older whose data could be successfully linked
to health administrative data. The outcome comprised upper respiratory infections, acute bronchitis, and pneumonia stratified by healthcare setting (hospitalizations, emergency department [ED] visits, and
physician office visits). The exposure of interest was ethnicity, of which
twelve distinct groups were captured. We used multivariable Poisson
regression models using person-week of exposure as the offset term.
The final models were adjusted for demographics, socioeconomic
status, lifestyle factors, comorbidities, immigrant effects, health status,
and healthcare utilization.
Results: Differences in baseline characteristics between ethnic
groups were notable. The incidence of healthcare encounters for respiratory infections was higher for most ethnic groups than the White group
for physician office visits, but the opposite was observed for ED visits
and hospitalizations. This pattern largely persisted after multivariable
adjustment. The most prominent example was the South Asian group,
69
IMED 2014
Poster Presentations I
SATURDAY вЂў November 1, 2014
International Meeting on Emerging Diseases and Surveillance 2014
who were more likely to have a physician office visit for respiratory
infection compared to the White group (rate ratio=1.64; 95%CI 1.561.72), but were less likely to have an ED visit (RR=0.57; 95%CI 0.490.65) or a hospitalization (RR=0.58; 95%CI 0.41-0.82). The Aboriginal
population was unique, with an increased likelihood of ED visits for RIs
(RR=1.43; 95%CI 1.30-1.56) compared to Whites.
Conclusion: We observed marked variations in healthcare utilization
for respiratory infections between ethnic groups and across healthcare
settings. This may be attributed to differences in disease burden, but
appears more likely to relate to patterns of healthcare access between
ethnic groups. These differences might inform the development of
ethno-culturally appropriate interventions to improve outcomes.
22.008 Predicting surges in influenza-like illness-
related emergency department visits using
spatio-temporal models
SATURDAY
вЂў
November 1, 2014
L. J. Martin1, Q. Liu1, H. Dong1, J. Talbot2, Y. Yasui1
1
University of Alberta, Edmonton, AB, Canada, 2Government of
Alberta, Edmonton, AB, Canada
Purpose: Influenza-like illness (ILI) creates substantial burdens on the
healthcare system, including surges in emergency department (ED)
visit volumes during seasonal influenza epidemics and pandemics.
However, the timing and magnitude of these surges are not commonly
forecasted. Advanced warning of these increases can inform public
health decision-making aimed at managing an epidemic and mitigating pressure on EDs, including the opening of influenza assessment
centres (IACs). Our objective was to predict surges in ILI-related ED
visit volumes to inform public health decision-making during influenza
epidemics.
Methods & Materials: We analyzed ILI-related ED visits for
Edmonton, Alberta residents over ten years to develop (2004вЂ“2008,
training data) and test (2008вЂ“2014, testing data) spatio-temporal prediction models. We used Poisson regression with ILI-related visits as
the outcome; log transformed age- and area-specific population as
the offset; age, neighborhood, Christmas holidays, weekday, and day
of the year as main effects; and included hypothesized main effect
interactions. We incorporated prediction residuals over 14 days and
predicted volume three days ahead. To evaluate model effectiveness,
we defined a peak as a day with в‰Ґ36 visits and examined area under
the ROC curve (AUC) and the frequency with which predicted volumes
were within 30% of observed volumes. Additionally, we investigated the
value of including ILI-related telehealth call data.
Results: The most effective model for seasonal influenza incorporated linear regression of mean residuals from the model with fixed
effects and an offset of the prediction residual on the most recent day
(i.e., three days prior). For influenza seasons in 2008вЂ“2014, AUC
values ranged from 0.83 to 0.91 and predicted volumes were within
30% of observed volumes for 64вЂ“82% of the 266 peak days. However,
during the 2009 H1N1 pandemic period, using the observed visit volume three days ahead of time as a prediction value outperformed the
timeliness of our models. Telehealth calls did not improve predictions.
Conclusion: For seasonal influenza epidemics of varying severity,
our prediction models provide advanced warning of ILI-related ED
volume increases. This information may assist in public health decision-making regarding opening an IAC. However, during influenza pandemics such as H1N1 in 2009, other approaches appear necessary.
22.009 Surveillance of respiratory and gastrointestinal
virus infection from adults and children in
Guangdong, China
D. Zhang1, X. Zhu2, L. Xu2, Z. He2, J. Wu2, W. Wen2, Y. Hu2, C. Lin2,
M. Li2, K. Cao2
1
School of Public Health, Sun Yat-sen University, Guangzhou,
Guangdong, China, 2Zhongshan School of Medicine, Sun Yat-sen
University, Guangzhou, China
Purpose: To determine the respiratory viruses among children and
adults with respiratory tract infections and gastrointestinal viruses
70
IMED 2014
infection among children with diarrhea in Guangdong, China.
Methods & Materials: Seven respiratory viruses (influenza A (FluA),
respiratory syncytial virus (RSV), parainfluenza virus (PIV), adenovirus
(ADV), human metapneumovirus hMPV), human coronavirus (HCoV),
human bocavirus (HBoV) were detected by PCR/RT-PCR from nasopharyngeal swaps, and major five enteric viruses (human rotavirus
Group A, B and C, enteric adenovirus, norovirus, sapovirus and human
astrovirus) and human bocavirus were investigated by real time PCR
from fecal specimens collected from children visiting general hospitals
with complaints of diarrhea.
Results: FluA were detected in18.50%, RSV in 7.82%, PIV in 3.47%,
ADV in 3.47%, hMPV in 2.24%, HCoV in2.47% and HBoV in1.27%
specimens. Co-infection occurred in 3.39% of nasopharyngeal swaps
specimens and was more prevalent among males, inpatients, children,
and persons <14 years of age. Human rotaviruses were the most prevalent and were detected 22.9%, enteric adenovirus in 6.7%, human
astrovirus in 3.4%, sapovirus in 1.3% and norovirus in 0.8% and human
bocavirus in 1.5% fecal samples. Co-infections were found in 3.7% of
specimens with 23.5% of the human bocavirus positive specimens coinfected with another enteric virus.
Conclusion: This study indicates that RSV was the most prevalent
viral infection for children, and FluA was the most prominent viral infection for adults. Human rotavirus and enteric adenovirus were most frequently detected in children with diarrhea. HBoV was the most common
pathogen, tending to co-infect with other respiratory and gastrointestinal viruses.
22.010 A systematic analysis of investments in
influenza awarded to UK institutions,
1997вЂ“2010
J. R. Fitchett1, M. Head2, R. Atun3
1
KingвЂ™s College London, London, United Kingdom, 2Infectious Disease
Research Network, London, United Kingdom, 3Harvard School of
Public Health, Boston, MA, USA
Purpose: Influenza causes a significant disease burden globally. We
describe the investments awarded to UK institutions for influenza
research and outline potential funding gaps in this portfolio.
Methods & Materials: We sourced data from major public and philanthropic funding sources for infection research for 1997вЂ“2010. We
systematically analysed each study and allocated them to disease
categories including respiratory infectious disease and influenza. We
described studies by type of science (pre-clinical; clinical trials; product
development; implementation research), and identified the most prominent funders.
Results: Respiratory infectious disease research received ВЈ419
million across 1192 studies. Influenza received ВЈ80.0 million (19.1%
of all respiratory infection research) across 141 studies (11.8%). The
mean award was ВЈ567 823 (SD ВЈ818 009), and median award ВЈ299
988 (IQR ВЈ159 841-656 509); these were higher than all other respiratory pathogens or diseases. The highest contributing investor was the
Medical Research Council (ВЈ42.4 million, 53% of influenza funding).
The proportional change in influenza funding between 1997вЂ“2004 and
2005вЂ“2010 is an increase of 42% (going from ВЈ29.2 million to ВЈ50.8
million). Immunology and vaccinology studies accounted for ВЈ35.7 million (44.6% of all influenza research).
By type of science along the R&D value chain, ВЈ57.9 million (72%)
was for pre-clinical studies. There were just 5 studies in phase I-III trials
and 5 in product development research. Implementation research was
a focus of 16% of the funding.
Using the Global Burden of Disease 2010 figures for disabilityadjusted life years (DALYs), the total research investment for influenza
over this time period equates to ВЈ4.16 per DALY. This is higher than
equivalent measures for tuberculosis, pneumonia, measles, diphtheria
and respiratory syncytial virus.
Conclusion: Compared to burdens imposed by other respiratory
disease areas, influenza has been relatively well funded over this time
period, in terms of awards to UK institutions. There were relatively few
studies on antivirals, diagnostics and influenza in the context of global
health, and there are areas that may warrant greater future research
investment (alongside implementation and surveillance services).
The lack of private sector information leaves a notable data gap that
we urge needs to be redressed.
Poster Presentations I
SATURDAY вЂў November 1, 2014
International Meeting on Emerging Diseases and Surveillance 2014
22.011 Healthcare seeking behavior for respiratory
illness in a northern province of Vietnam
N. T. T. Yen1, J. Patridge2, N. H. Tuan1, T. P. Nguyen1, N. B. Thuy1,
N. V. Thom3, A. Luliano4, D. T. Trang2, J. C. Kile2, N. T. Hien1
1
National Institute of Hygiene and Epidemiology, Ha noi, Viet Nam,
2
U.S. Centers for Disease Control and Prevention, Hanoi, Vietnam,
Hanoi, Viet Nam, 3Thai Binh Provinvial Preventive Medicine Center,
Thai Binh, Viet Nam, 4Centers for Disease Control & Prevention,
Atlanta, GA, USA
Background: Since March 2013, human cases of avian influenza A
(H7N9) have been detected in China and H7N9 is low pathogenic for
poultry but is high pathogenic for humans. Lao PDR has not yet been
affected by this new subtype of avian influenza. However, poultry and
humans are still at risk because Lao PDR shares a border with China
and people and poultry frequently across the border resulting in an
increased risk of spread of the virus across the border. The preliminary
sero-surveillance is crucial to elucidate the circulation of the influenza
A(H7N9) in poultry population in Lao PDR.
Objectives: To identify the hot spot of influenza A(H7N9) in asymptomatic poultry for further virological surveillance.
Methods & Materials: Methods:
Site selection for the surveillance was based on the Information
obtained from the study on the poultry value chain. Phongsaly,
Bounneua and Nhot Ou District of Phongsaly Province, Louangnamtha
and Sing District of Loungtnamtha Province, and Xay District of
J. T. Kayiwa, T. Byaruhanga, B. Namagambo, N. Owor, R. Chiizar,
B. Bakamutumaho, J. J. Lutwama
Uganda Virus Reseacrh Institute, Entebbe, Uganda
Purpose: To characterize and assess the susceptibility of influenza
viruses to neuraminadase inhibitors oseltamivir and zanamivir.
Methods & Materials: Specimens shipped to the WHO collaborating center, CDC Influenza Division, Atlanta, were regrown to a larger
volume with sufficient titer. Hemagglutination inhibition (HI) tests were
performed with a panel of post infection ferret antisera for detailed antigenic characterization. Also a functional neuramindase inhibition (NI)
assay and genetic analysis were performed to assess susceptibility of
the viruses to neuraminidase inhibitors oseltamivir and zanamivir. In
addition a subset of viruses were selected for sequence analysis (HA,
NA and M genes for type A viruses and HA, NA and NS genes for
type B viruses). Real-time RT PCR assay was used to determine the
influenza type/subtype of specimens which were unable to regrow or
grow to sufficient titers.
Results: 56 nasal- and oral-pharyngeal specimens collected from
February, 2012 to December, 2012, were shipped to CDC-Atlanta.
Upon testing, 12 specimens were negative by PCR for influenza, 2
specimens were a mixture of A(H3) and B by real time RT-PCR. 6 were
influenza B by HI test, of which 3 belonged to B/Victoria/2/87-lineage
and were antigenically similar to B/Brisbane/60/2008 virus. 3 were
B/Yamagata lineage viruses and all were antigenically similar to B/
Wisconsin/01/2010. All 6 B viruses tested were sensitive to the antiviral
drugs oseltamivir and zanamivir. Sequence and phylogenetic analysis
of the HA, NA and NS genes of one influenza B virus related it to reference vaccine strain B/Brisbane/60/2008 of Victoria lineage in clade 1A.
Seventeen H3N2 viruses which were HI tested were antigenically similar to A/Victoria/361/2012 virus, which was the H3 component of the
2012-2013 influenza vaccine for the Northern Hemisphere and 2013
influenza season for the Southern Hemisphere. All 17 H3N2 viruses
were sensitive to oseltamivir and zanamivir. Phylogenetic analysis of
the HA genes of two H3N2 viruses showed them to belong to group
3C or 3B.
Conclusion: Influenza viruses were antigenically similar to the recommended WHO trivalent influenza vaccines for the 2012-2013 season of the Northern Hemisphere and all were sensitive to oseltamivir
and zanamivir.
November 1, 2014
in high risk provinces of Lao PDR
B. Douangngeun, Bounlom Douangngeun, Chintana Chanthavisouk,
Phouvong Phommachanh, Vatthana Theppangna, Bounheuang
Kounnavong, Sithong Phiphakkhavong
The National Animal Health Laboratory, Vientiane, Lao, PeopleвЂ™s
Democratic Republic of
characterization among 2012вЂ“2013 seasonal
influenza viruses in UgandaвЂ”Implications for
management and pandemic responses
вЂў
22.012 Sero-surveillance of Avian influenza A (H7N9)
22.013 Antiviral susceptibility and antigenic
SATURDAY
Purpose: In Vietnam, the influenza sentinel surveillance system captures only consulting cases, limiting understanding of burden of disease in the community. We conducted a survey to identify self-reported
cases of influenza-like illness (ILI) and severe acute respiratory infection (SARI) to describe healthcare utilization to better estimate the
burden of influenza-associated illness.
Methods & Materials: A cross-sectional survey was conducted in
urban and rural areas of Thai Binh Province in northern Vietnam. A
two-stage cluster sample was used to select households. Standardized
questionnaires were used to screen households for episodes of selfreported ILI in the previous month and SARI in the previous 12 monthsand health seeking behavior for each episode.
Results: During May 2013, we surveyed 2100 households and 6760
residents, including 1470 rural households and 4666 residents in Kien
Xuong District and 630 urban households and 2094 residents in Thai
Binh City. Overall, we identified 582 (8.6%, 95% CI: 6.3-10.9) episodes
of self-reported ILI and 121 (1.8%, 95% CI: 1.2-2.4) episodes of selfreported SARI cases. Proportions of both self-reported ILI and SARI
were significantly (p< 0.05) lower in Thai Binh City than in Kien Xuong
District. Overall, the proportion of participants that reported seeking
healthcare outside the home for an ILI episode was 89.0% (95% CI:
84.4-93.5). Only 18.2% (95% CI: 10.0-26.5) of household members
with a self-reported ILI episode reported seeking healthcare at the ILI
sentinel surveillance site. Similarly, the estimated proportion of SARI
cases that seek healthcare at a SARI burden study site was 24.9%.
Conclusion: In both urban and rural communities of Thai Binh
Province the vast majority of cases with self-reported respiratory illness, as captured by ILI, sought healthcare outside the home. However,
less than 1/5 of self-reported ILI cases presented to a national ILI
surveillance sentinel site. Similarly, for SARI we estimated that only
1/4 of cases seek healthcare at a SARI burden study site. National
sentinel surveillance and facility-based research studies that depend
upon healthcare seeking behavior of the populations they serve will
significantly underestimate burden of influenza-associated disease in
Vietnam. Adjustment for healthcare utilization practices will improve the
ability to accurately estimate incidence of influenza in the community.
Oudomxay Province were chosen for surveillance. Asymptomatic
chickens from backyards and semi-commercial farms were selected
for sampling. From January to March 2014, serum sampling has been
conducted once a month and submitted to the National Animal Health
Laboratory for testing. The serum samples were screened by ELISA
for Flu A. Positive samples were submitted for further testing against
H7 and N9.
Results: Overall, ~ 20% (129/657 sera) test positive. While sample
sizes are moderately low, it appears that semi-commercial farms in
Louangnamtha and Oudomxay Provinces have the highest rates of
seropositive poultry at 95% and 45% respectively.
Conclusion: The result obtained from this preliminary sero-surveillance indicated the circulation of avian influenza A virus in the poultry
population in the high risk areas. Further tests are required to determine the presence of H7 and N9 in the FluA ELISA positive tested sera
to support further virological surveillance. Continue keeping vigilance
for avian influenza A (H7N9) is of great benefit in preventing the virus
incursion.
71
IMED 2014
Poster Presentations I
SATURDAY вЂў November 1, 2014
International Meeting on Emerging Diseases and Surveillance 2014
22.014 Fatal avian influenza A/H5N1 infection in a
36-week pregnant woman survived by her
newborn вЂ“ Soc Trang, Vietnam, 2012
T. V. Le1, K. Ly2, L. Nguyen3, L. T. Phan4, N. M. Tran Minh5
WHO, Ho Chi Minh City, Viet Nam, 2Pasteur Institute, Ho Chi Minh
City, Viet Nam, 3Pasteur Institute, Ho Chi Minh City, Viet Nam,
4
Pasteur Institute, Ho Chi Minh, Viet Nam, 5World Health Organization,
Hanoi, Viet Nam
SATURDAY
вЂў
November 1, 2014
1
Purpose: Reports of prenant women infected with avian influenza A/
H5N1 are rare. Previous studies showed that A/H5N1 virus can penetrate the placental barrier and infect the fetus. Of six reported cases,
four died and the two survivors had a spontaneous abortion. We report
a clinical case and outcome of a 36-week pregnant woman infected
with A/H5N1 and her newborn in Soc Trang province, Viet Nam, in
January 2012.
Methods & Materials: Epidemiological, veterinary and laboratory
investigations were conducted. Clinical manifestations, progress, treatment and outcome of the case-patient and her newborn were collected
from medical records. Human tracheal aspirate, throat swab and serum
specimens were tested for influenza A/H5N1, A/H3N1, A/H1N1, A/
H1N1/09 and B by reverse-transcriptase (RT)-PCR, real tiem RT-PCR
and genome sequencing. Poultry throat and rectal swabs were tested
by PCR and virus isolation.
Results: The case-patient developed fever on 22 January, was hospitalized on 25 January and died on 28 January. Clinical manifestation
showed typical characteristics of avian influenza A/H5N1 infection with
rapid progressive severve pneumonia. Her tracheal aspirate sample
was positive for influenza A/H5N1 belonging to clade 1.1 virus. The
newborn baby was delivered by caesarean section on 25 January. She
had low birth weight, early onset pneumonia, but fully recovered and
was discharged on 10 Febuary. Her throat swabs and paired serum
samples tested negative for influenza A/H5N1. The mother had slaughtered sick poultry in the week before illness onset and the same clade
virus was detected in patientвЂ™s poultry samples.
Conclusion: This was the first documented case of a live birth from a
severely ill pregnant woman infected influenza A/H5N1. Further studies
are needed to better understand the transmission of influenza A/H5N1
virus in human.
22.015 Influenza as a cause of severe acute respiratory
infection at national and provincial hospitals
in Vietnam
T. P. Nguyen1, N. T. T. Yen1, N. B. Thuy1, N. H. Tuan1, L. T. Q. Mai1,
T. N. Duong1, J. Partridge2, J. C. Kile2, D. T. Trang2, N. T. Hien1
1
National Institute of Hygiene and Epidemiology, Ha noi, Viet Nam,
2
U.S. Centers for Disease Control and Prevention, Hanoi, Vietnam,
Hanoi, Viet Nam
Purpose: In response to potential public health threats from influenza,
since 2011 VietnamвЂ™s National Influenza Surveillance System has been
conducting SARI surveillance to enhance information on severe hospitalized cases of influenza disease. Our objective was to determine the
burden of influenza as a cause of SARI, by gender and age.
Methods & Materials: Patients who were hospitalized for fever and
cough or sore throat with onset within 7 days of presentation were
enrolled at 4 select hospitals in four regions of Vietnam. The demographic and clinical data, and one respiratory specimen were collected.
Specimens were tested by reverse-transcription polymerase chain
reaction for influenza at 4 reference regional laboratories in Vietnam.
Results: From March 2011 to April 2013, a total of 2,803 SARI
patients were enrolled. The age ranged from <1 year to 102 years old,
with a median age of 16 years (IQR 1 -34 years). Of 2,803 enrolled
patients, 1381 (49.3%) were children <16 years old and 1450 (69.6%)
were male. Overall, 282 (10%) of SARI patients were positive for
influenza virus by RT-PCR. Positive rates by age group were 41/764
(5.4%), 35/533 (6.6%), 5/69 (7.2%), 155/980 (15.8%), 22/216 (10.2%)
and 24/241 (10%) in 0 to < 2 years, 2 to < 5 years, 5 to < 15 years, 15
to < 50 years, 50 to < 65 and >= 65 years old respectively. Of these,
72
IMED 2014
141(50%) B, 82 (29.1%) A/H3N2 and 58 (20.6%) A/H1N1pdm09.
Among the influenza positive patients, there were 41 (14.5%) hospitalized in an ICU. Underlying health conditions were reported by 35
(12.4%) influenza positive patients, and included at least one condition,
such as smoking, lung disease (such as asthma), diabetes, liver disease, heart disease, hypertension, neurologic disease, kidney disease,
pregnancy.
Conclusion: Influenza virus infection was a significant cause of SARI
in hospitalized patients and it remains a burden to the healthcare system as well as a burden to the patient and family. Additional studies
may allow for better understanding of risk factors related to infection
and disease progression, including why some cases present as the
more severe SARI form, and to investigate the contribution of other
pathogens to SARI burden.
22.016 Severe acute respiratory infection in the North
of Vietnam: burden, economic impact
N. T. T. Yen1, N. B. Thuy1, T. P. Nguyen1, N. H. Tuan1, L. T. Q. Mai1,
T. N. Duong1, D. T. Trang2, J. Partridge2, J. C. Kile2, N. T. Hien1
1
National Institute of Hygiene and Epidemiology, Ha noi, Viet Nam,
2
U.S. Centers for Disease Control and Prevention, Hanoi, Vietnam,
Hanoi, Viet Nam
Purpose: The burden of disease, economic impact and health care
utilization related to influenza viruses is not well described for severe
acute respiratory infection (SARI) patients in Vietnam. Our study proposes to describe the burden of human influenza illness in terms of
morbidity, mortality, socioeconomic impact and understand health care
utilization at hospitals in Thai Binh province, North of Vietnam
Methods & Materials: A modified WHO case definition of SARI
was used. Adults and children meeting the definition were enrolled at
three hospitals (Provincial hospital, a Pediatric hospital and a District
Hospital) in Thai Binh, North of Vietnam. For each patient, the direct
and indirect costs, work days lost and school absenteeism associated
with hospitalization and influenza treatment, a nasal or throat swab
were collected for influenza virus detection by real-time reverse transcription polymerase chain reaction at National Influenza Centre
Results: From January 2013 through December 2013, of 23,411
hospitalized patients at enrolled hospitals in Thai Binh, 7,833 (30%)
were identified as SARI. Of 1295 SARI cases tested, 229 (18%) were
positive for influenza viruses, including pA/H1N1 2009 (39.3%), A/
H3N2 (32.3%), B (26.2%), co-infection of A/H3 & B (1.3%) and coinfection of pA/H1N1 09 & B (0.9%). Both normal and low white blood
cell counts were found in influenza related SARI patients. Of influenza
related SARI patients, 13.4% required treatment in ICU. There were
two SARI deaths positive with influenza B among tweleves SARI
deaths at the three hospitals. The median hospital stay was seven days
(IQR 6-10). Of 1,295 survey respondents, 3 (<1%) reported receiving
an influenza vaccination during the past 12 months. Socioeconomic
impact included direct and indirect costs per patient of 4,595,00 VND
($US 230), an average of 10 work days lost and 6 school days lost, and
care giver 11 days lost
Conclusion: We found the most frequent influenza viruses identified
were pA/H1N1 2009, A/H3N2 and B. A low rate of influenza vaccination
was found in the study population. The costs due to SARI case hospitalization are important to patients with limited resources (per capita
monthly income = 5,451,000 VND ($US 270), even for only one week
of the treatment
22.017 In vivo reassortment of avian and swine
influenza virus
K. Urbaniak, K. Kwit, A. Kowalczyk, I. Markowska-Daniel
National Veterinary Research Institute, PuЕ‚awy, Poland
Purpose: A genetic reassortment of influenza virus is an important
mechanism for overcome the species barrier. Therefore the objective
of this study was to determine the percentage reassortants and their
genetic constellation after co-infection of pigs with 2 strains of different
subtype and origin. The differences between isolates from the upper
and the lower respiratory tract were also studied.
Poster Presentations I
SATURDAY вЂў November 1, 2014
International Meeting on Emerging Diseases and Surveillance 2014
Purpose: Pigs are considered important intermediate hosts in which
avian influenza viruses (AIV) adapt to mammals before they transmit
to humans. However, the exact role of pigs in this process is unclear.
Therefore the objective of this study was to determine the factors influencing the efficiency of AIV adaptation to pigs.
Methods & Materials: 25 serial passages of AIV (A/duck/Bavaria/77,
H1N1) in pigs were performed. In total 70 influenza virus-naГЇve, 6-8
weeks old pigs were used. Pigs were i.n. inoculated with positive respiratory tract tissue homogenates of euthanized pigs from the previous
passage. The sentinel pigs were introduced to the force infected animals
when the virus shedding was evidenced. The pigs were daily checked
of body temperature and swabbing. At DPI 4 they were euthanized.
The respiratory tract tissues were checked by RRT-PCR (M gene) and
all positive samples were used for virus isolation. The sequence of
genome of the original AIV was compared with the obtained isolates.
Results: Both, force infected and sentinel pigs do not demonstrate
typical clinical symptoms of acute influenza. The virus shedding was
detected at passages: p8, p15, p19, p20, p23 and p24. The most
frequent positive results were evidenced in middle right lobe and
in trachea, however, from p19 most of tested tissues were positive.
So we confirm that AIV shows tropism to the lower respiratory tract.
Additionally, majority of organ samples of sentinels from p19, p23 and
p24 were PCR positive. Several mutations in HA (S159R/S, K180E,
E204D, G239E, G411S), NA (I30L, V34I, L127M, A131T, N364S), M1
(M248I), M2 (C19Y) and NP (I63M, R132K) genes were evidenced.
Conclusion: Based on our results we can state that adaptation of
AIV to the pig is possible but under experimental conditions the effective transmission of pig-adapted AIV between pigs does not occur. This
suggest that the barrier between birds and pigs is much stronger than
previously assumed and the role and risk of the pig in the emergence of
novel influenza viruses in the human population is probably lower that
previously assumed.
*This work is supported by FLUPIG Project No 258084 founded by
EC FP7.
L. Toubiana1, P. Guerin2, P. Chansard2, C. Demoor2
INSERM ; UPMC : UniversitГ© Pierre et Marie Curie-Paris 6, Paris,
France, 2SMF, Paris, France
1
Purpose: Established in 1966, SOS MГ©decins France (SMF) is an
umbrella organisation of 64 associations throughout France, covering
60% of the French population. A partnership was signed with INSERM
in 2012 in order develop an information system (SIS_READ) dedicated
to epidemiological research, with automatic and independent diagnostic data collection using records of general practitioners. Over 18 million
medical acts have been recorded over a 9-year period. On average,
7,000 acts (consolidated over 3 days) are aggregated at national level
every day.
Objective: Set up an observatory of the spatiotemporal evolution of
influenza-like illness and the early detection of epidemics using SMF
data.
Methods & Materials: We used the SIS-READ data stream for
estimating the incidence of the diagnosis вЂњinfluenza-like illnessвЂќ. The
Serfling method was used to detect the epidemic. The interpolated map
was generated by the Krigeage method.
Results: Over the past 4 years, the average weekly participation is 951
general practitioners (GPs), i.e. 1.6% of all GPs in France. 54,514 cases
of influenza-like illness were described in 2012 and 82,006 cases in
2013. The estimated incidences are very similar to those released by the
Institute for Public Health (InVS). According to InVS sources, the 20132014 influenza epidemic started in the 5th week of 2014. Using SMF
data, the epidemic threshold was exceeded during week 52 in 2013.
Conclusion: Given the collection method used by SMF, the stability
and the temporal resolution, the independence of disease (all acts are
automatically recorded in real time) and the spatial representativeness
of the SMF network, the estimation of incidence is more reliable and
more accurate than the currently used sources of reference. The epidemic was detected several weeks earlier.
November 1, 2014
to pig
I. Markowska-Daniel, K. Urbaniak, K. Kwit, M. Pomorska-MГіl,
A. Kowalczyk
National Veterinary Research Institute, PuЕ‚awy, Poland
influenza-like illness using data of SOS
MГ©decins France 2006-2014
вЂў
22.018 In vivo adaptation of avian influenza virus
22.019 Detection and monitoring of outbreaks of
SATURDAY
Methods & Materials: Six pigs were i.n. inoculated with sw/
Gent/172/08 (H3N2) and A/Duck/Italy/1447/05 (H1N1) viruses to
examine the likelihood of genetic reassortment in the pig. At 2 DPI, 6
sentinel pigs were introduced. Swabbing and body temperature check
were executed daily. At 4 DPI/DPC three infected and sentinel piglets
were euthanized and samples from the respiratory tract were checked
by RRT-PCR (M gene). Blood samples for an HI test were collected
at 14, 21 and 28 DPI/DPC. All positive samples were used for plaque
purification and virus isolation. The genetic analysis of isolated viruses
was performed with use of different molecular methods (PCR, RT-PCR,
PCR-RPLF).
Results: Virus shedding was detected from 1 to 6 DPI/DPC in the
infected and sentinel pigs. From samples positive in the RRT-PCR in
total, 207 and 40 isolates from tissue and swab samples were obtained,
respectively. In both cases most of them were isolate from sentinel
pigs. For most of isolates differentiation between all H3N2 and H1N1
genes were done. All viruses from tissue were H3N2, whereas 37.5%
(15 isolates) from swabs were H1N1 subtype. All H1N1 viruses were
isolate from sentinels, which were also infected with H3N2 subtype. Up
to now no reassortant was detected. All collected sera were seronegative for H1N1 and were seropositive for H3N2.
Conclusion: Based on the results we can state that for the reassortment to occur co-infection of pig with two or more influenza virus must
take place. However the reassortment is a very complex process and
different factors may influence on its occurrence. Under experimental
conditions we did not succeeded to achieve the reassortation between
H1N1 and H3N2 viruses of different origin.
*This work is supported by FLUPIG Project No 258084 founded by
EC FP7.
22.020 Prevalence and distribution of avian influenza
A(H5N1) virus clade variants in live bird
markets of Vietnam, 2011вЂ“2013
D. T. Nguyen1, J. E. Bryant2, T. C. David3, L. V. Nguyen4, K. Inui1,
L. T. Pham4, L. Loth5, T. Nguyen1, Y. Jang3, T. L. To1
1
National Center for Veterinary Diagnosis, Hanoi, Viet Nam, 2Oxford
University Clinical Research Unit and Wellcome Trust, Hanoi, Viet
Nam, 3Influenza Division, Atlanta, GA, USA, 4Epidemiology Division,
Hanoi, Viet Nam, 5ECTAD Programme, Hanoi, Viet Nam
Purpose: Active surveillance for avian influenza (AI) viruses in poultry
sold at live bird markets (LBMs) was conducted in 44 of 63 provinces
throughout Vietnam over two periods from September 2011 to February
2012 and October 2012 to June 2013. The study objectives were to
assess the prevalence of avian influenza type A, H5 and H5N1 subtype
viruses and characterize the geographical and temporal distribution of
H5N1 virus genetic variants across the country.
Methods & Materials: Monthly sampling was conducted in 394 LBMs
located in 372 communes. A total of 9,790 oropharyngeal swabs from
poultry were screened for influenza A virus by real-time RT-PCR. Virus
isolation was attempted on all positive samples in embryonated chicken
eggs and the HA1 region of each H5 virus isolate was sequenced
Results: Market prevalence of H5 subtype virus was 32.2% (127/394)
over the cumulative 15 months of surveillance. Phylogenetic analyses
indicated that clade 1.1 viruses persisted in the south, whereas three
genetically distinct subgroups of clade 2.3.2.1 were found simultaneously in northern, central and southern Vietnam. Clade 2.3.2.1c viruses
first appeared in July 2012 and spread rapidly to the center and south
of Vietnam in late 2012, where they were predominant among clade
2.3.2.1 viruses and were detected in both active LBM surveillance and
poultry outbreaks.
73
IMED 2014
Poster Presentations I
SATURDAY вЂў November 1, 2014
International Meeting on Emerging Diseases and Surveillance 2014
Conclusion: Given the overlapping geographic distribution of clade
variants and the antigenic divergence previously described for these
clades, current AI poultry vaccines used in Vietnam may require bivalent formulations containing representatives of both clade 1.1 and clade
2.3.2.1 viruses.
22.021 Serological evidence of influenza A viruses in
bats from Africa
SATURDAY
вЂў
November 1, 2014
G. S. Freidl1, T. Binger2, M. A. MГјller2, E. de Bruin1, J. van Beek1,
V. M. Corman2, A. Rasche2, J. F. Drexler2, A. Sylverken3, S. Oppong3,
Y. Adu-Sarkodie3, M. Tschapka4, V. M. Cottontail4, M. KnГ¶rnschild4,
C. Drosten2, M. Koopmans1
1
National Institute for Public Health and the Environment/Erasmus
Medical Center, Bilthoven/Rotterdam, Netherlands, 2University of
Bonn Medical Centre, Bonn, Germany, 3Kumasi Collaborative Center
for Tropical Medicine/Kwame Nkrumah University of Science and
Technology, Kumasi, Ghana, 4University of Ulm, Ulm, Germany
Purpose: Bats are known natural hosts for a range of zoonotic viruses
such as Marburg, Ebola, Rabies, Nipah, Hendra, as well as for various
Corona- and Paramyxoviruses. In 2009/10, researchers discovered
RNA of two novel influenza virus subtypesвЂ”H17N10 and H18N11вЂ”in
Central and South American fruit bats. Although the newly discovered
bat influenza virus genome diverged significantly from previously
known influenza viruses, evidence suggests that conditions are met to
reassort with human influenza viruses in human cells. The identification
of bats as possible additional reservoir for influenza A viruses raises
questions about the role of this mammalian taxon in influenza A virus
ecology and possible public health relevance.
Methods & Materials: As molecular testing can be limited by a
short time window in which the virus is detectable, serological testing
provides information about past infections and virus spread in populations, after the virus has been cleared. This study aimed at screening
serum from 101 frugivorous bats (Eidolon helvum) sampled in 2009/10
in Ghana, for the presence of antibodies against the complete panel
of influenza A haemagglutinin (HA) types ranging from H1 to H18 by
means of a protein microarray platform. This technique enables simultaneous serological testing against multiple recombinant HA-types in
5Вµl of serum.
Results: Preliminary results indicate serological evidence against
avian influenza virus HA-type H9 in 21% of the animals screened, with
somewhat cross-reactivity to phylogenetically more closely related
HA-types H8 and H12.
Conclusion: To our knowledge, this is the first report of serological
evidence of influenza A viruses other than H17 and H18 in bats. As
avian influenza subtype H9 is associated with human infections, the
implications of our findings from a public health context remain to be
investigated.
22.022 The international trade of chickens and
increased risk for introducing highly
pathogenic avian influenza A (H5N1) to
previously uninfected countries
J. M. Radin1, J. Fowler2
1
aJoint Doctoral Program in Public Health (Epidemiology), San Diego
State University/University of California, San Diego, La Jolla, CA,
USA, 2Univeristy of California, San Diego, La Jolla, CA, USA
Purpose: Every year billions of chickens are shipped thousands of
miles around the globe in order to meet the ever increasing demands
for this cheap and nutritious protein source. Unfortunately, transporting chickens internationally can potentially increase the chance for
introducing zoonotic viruses, such as avian influenza A (H5N1) to new,
uninfected countries and regions. The global spread of this virus is
especially worrisome due to its devastating economic impact, its zoonotic nature, and high case fatality rate in both poultry and humans.
Aim: To determine if poultry outbreaks of highly pathogenic H5N1
have been influenced by the magnitude of poultry imported from
infected countries. The role of different poultry species, including ducks
and turkeys, were also examined.
74
IMED 2014
Methods & Materials: A retrospective analysis of poultry trading
data from the Food and AgricultureвЂ™s FAOSTAT database and poultry
outbreaks recorded by the WHO were collected from 2003 to 2011. A
Generalized Estimating Equation (GEE) model was used to assess the
risk of infection in a country with the quantity of chickens imported from
countries experiencing at least one poultry H5N1 case during that year.
Results: This study found significant and positive interaction
between quantity of chickens traded and H5N1 poultry infection in the
exporting country, in both the non-adjusted (p=0.0013) and adjusted
model (p=0.0005). For every 1,000 chickens imported from an infected
country, the odds of infection in the importing country increased by 1.3,
when adjusting for year, population in the importing country, and population in the exporting country. The trade of ducks and turkeys was not
significantly associated with increased risk.
Conclusion: These findings show that reducing or halting trade from
countries experiencing H5N1 poultry cases can greatly reduce the risk
of introducing the virus to previously uninfected countries. These findings may also have important implications for preventing the spread of
similar emerging avian influenza virus subtypes, such as H7N9.
22.023 CAPA: Creating a network of investigators in
general practice for the characterisation and
management of acute community-acquired
pneumonia in France
L. Toubiana1, H. Partouche2, C. Buffel du Vaure2, V. Personne2,
A. Lorenzo2, C. Ghasarossian2, P. Landais3, S. Gilberg2
1
INSERM ; UPMC : UniversitГ© Pierre et Marie Curie-Paris 6, Paris,
France, 2UniversitГ© Paris Descartes, Paris, France, 3CHU NГ®mes,
NГ®mes, France
Purpose: The French National College of Teachers in General Practice
(CNGE) and the French National Institute of Health and Medical
Research (Inserm) have joined forces to develop a prospective,
multi-centric study to describe acute community-acquired pneumonia
(CAP). The inclusion of approximately 1,000 cases within one year was
required. As CAPs are relatively rare, a large network of investigators
needed to be created, which would be demographically representative
of the population of general practitioners practicing in mainland France.
Given the limited financial resources for this study, the вЂњall-electronicвЂќ
option was chosen.
This approach for a study of this magnitude was a first, and a real
challenge.
Methods & Materials: The MetaSurv generator of the Inserm allowed
creating an ubiquitous information platform dedicated to the study. It
included a multi-phase electronic form containing over 1,000 variables
with consistency check allowing an unlimited number of follow-up visits.
The platform, accessible via the Internet, allowed the creation of
a network of nearly 500 operational investigators in less than three
weeks.
Management functions of the system allowed real-time monitoring of
the participation of investigators and patient enrolment. Reports for the
attention of the investigators containing enrolment evolution charts and
maps were posted online regularly.
Results: The observatory worked without interruption between
September 2011 and July 2012. A total of 425 GPs enrolled 912
patients aged over 18 years showing one or more signs suggestive
of CAP. The first statistical analyses allowed the publication of several
important communications.
Conclusion: The technological choice made in this study has demonstrated its effectiveness from all points of view compared to the conventional alternative. The network was up and running in record time
and the participation was constant throughout the study period. The
real-time follow-up and the online management of the study is a major
asset, both from the viewpoint of quality of the collected data and of the
overall cost reduction.
Poster Presentations I
SATURDAY вЂў November 1, 2014
International Meeting on Emerging Diseases and Surveillance 2014
22.024 Serological surveillance of вЂњhumanвЂќ influenza
virus subtypes H1, H2, H3 among wild birds
in Ukraine
B. Stegniy1, D. Muzyka2, M. Pantin-Jackwood3, M. Stegniy1,
V. Golovko4, M. Mandygra5, S. Doletskiy5, A. Gerilovych1
1
NSC IECVM, Kharkiv, Ukraine, 2National Science Center Institute
of Experimental and Clinical Veterinary Medicine, Kharkiv, Ukraine,
3
Southeast Poultry Research Laboratory, Athens, GA, USA, 4KhDZVA,
Kharkiv, Ukraine, 5NAAS, Kiev, Ukraine
R. Kinsley1, J. Daly2, A. Kliby3, D. Elton3, S. D. Scott1, N. Temperton4
1
University of Kent, Chatham Maritime, Kent, United Kingdom,
2
University of Nottingham, Nottingham, United Kingdom, 3Animal
Health Trust, Newmarket, United Kingdom, 4University of Kent,
Chatham Maritime, United Kingdom
Purpose: Standard assays used for assessing equine influenza
vaccine efficacy (i.e. haemagglutination inhibition and single radial
haemolysis) do not measure antibody neutralisation of virus. On the
other hand, pseudotype viruses (PVs) provide a flexible tool to conduct
neutralisation testing, and to investigate the effect of specific antigenic
mutations on vaccine effectiveness. We next began an investigation
into haemagglutinin (HA) antigenic drift mutations that lead to vaccine
breakdown and a subsequent epidemic amongst horses across Europe
including the UK. There were approximately 30 amino acid differences
between the A/equine/Newmarket/79 vaccine strain and the A/equine/
Sussex/89 outbreak strain. Three of these mutations are located within
regions of the HA that appear to correspond to major epitopes previously identified in human influenza.
Objective: was to generate equine influenza-pseudotyped lentiviruses for use to develop a PV antibody neutralisation assay (PVNA),
and compare with the Single Radial Haemolysis (SRH) standard influenza antibody assay used for surveillance and vaccine assessment.
The PVNA was then used to investigate the potential role of the three
mutations mentioned in the vaccine breakdown.
Methods & Materials: Equine influenza pseudotyped lentiviruses
were produced by co-transfection of HEK293T cells with four plasmids
expressing the following genes; HIV gag-pol, firefly luciferase reporter,
influenza surface haemagglutinin (HA) glycoprotein and TMPRSS2
protease (for HA cleavage). Pseudotype particles were then harvested
and used to develop a 96-well plate luminescence assay for measuring neutralising antibody levels in serum samples from vaccinated and
naГЇve equines. Specific single mutations were introduced into the HAs
of A/equine/Newmarket/79 vaccine strain and the A/equine/Sussex/89
outbreak strain PVs and PVNAs conducted using Newmarket/79- and
Sussex/89-specific antisera.
A. Nunez, B. Z. Londt, D. J. Hicks, I. H. Brown, S. B. Brookes
Animal Health and Veterinary Laboratories Agency, Addlestone,
Surrey, United Kingdom
Purpose: Pigs are considered potentially important mixing vessels for
a range of influenza viruses, as they possess both avian (О±2-3) and
mammalian (О±2-6) sialic acid viral receptors. In this study we evaluated
the susceptibility and the pathogenesis of a LPAIV in pigs.
Methods & Materials: Fourteen 6-week-old pigs were challenged
intranasally with A/chicken/England/4054/06 H7N3 LPAIV and killed in
pairs at 3, 4, 5, 7, 12 and 19 days post infection (dpi). At post mortem,
samples from the respiratory tract, draining lymph nodes and brain
were collected, fixed in buffered formalin and routinely processed for
histopathology. Influenza A nucleoprotein and sialic acid receptors
were detected by immunohistochemistry.
Results: No clinical signs were observed during the course of
infection. Virus antigen was detected in the olfactory epithelium of all
animals killed from 3-12 dpi. Only one of the animals, killed at 4 dpi,
showed minimal virus antigen in bronchiolar epithelial cells and alveolar macrophages, associated with a mild bronchointerstitial pneumonia.
Virus antigen was also observed in the olfactory nerves, but not in the
olfactory bulb, of one of the animals killed at 7 dpi. Distribution of mammalian influenza virus receptors was widespread throughout the respiratory system, but avian influenza virus receptors were only abundant
in the olfactory epithelium, bronchioles and alveoli.
Conclusion: LPAIV A/chicken/England/4054/06 H7N3 infection in
pigs resulted in a subclinical presentation, with viral replication in olfactory epithelium associated with a high prevalence of avian influenza
virus receptors.
November 1, 2014
into vaccine efficacy, antigenic drift and
vaccine breakdown for equine influenza
chicken/England/4054/06 H7N3 replicates
predominantly in olfactory epithelium in
infected pigs
вЂў
22.025 Use of pseudotyped viruses for investigations
22.026 Low pathogenicity avian influenza virus (LPAIV)
SATURDAY
Purpose: To perform serological surveillance of H1, H2, H3 influenza
viruses in wild birds of various environmental groups in Ukraine
Methods & Materials: Monitoring of circulating influenza virus of H1,
H2, H3 subtypes were conducted in 2006вЂ“2012 in different regions of
Ukraine. By hemagglutination inhibition we studied 946 wild birds of
44 species. All studies were performed as recommended by the OIE.
Results: 6.06% of Dunlin, 5.88% of Grey Plover, 14.28 % of Curlew
Sandpiper, 40% of Broad-billed Sandpiper in 2006, 15.38 % of Mute
Swan in 2008 and 6.97% of mallards in 2011 had antibodies to H1 influenza virus in serum. Also, antibodies were found in egg yolks of Song
Thrush, Blackbird, Jay in 2006, 3.22вЂ“4.16 % of mallard yolks in 2009.
Antibodies to H2 AIV in serum were found in 2006, 2009, 2011 at
13.04%, 1.61%, 1.55 -3.04% of mallards respectively, while in egg
yolks in 2006 at Song Thrush, Great Tit, Slender-billed Gull and egg
yolks of mallards (12.5%).
Antibodies to H3 AIV were found in 2006 at egg yolks of Yellowlegged Gull (23.07%), in 2007 in yolks of Coot (33.3%) and Grey Plover
(14.28%), in 2008 at yolks of Common Tern, in 2009 at blood serum of
mallards (12.90%).
Conclusion: Obtained data demonstrate that sufficiently wide circulation of вЂњhumanвЂќ H1, H2, H3 subtypes of influenza viruses in wild
waterfowl, that could potentially create risks for human infection.
Results: The pseudotype virus neutralisation assay (PVNA) was
clearly able to differentiate between the vaccinated and naГЇve populations, and demonstrated a good correlation (r=0.65) with the SRH
assay. Results also showed that specific single amino acid mutations in
putative major epitope sites altered the ability of the sera to neutralise
the PVs, indicating their importance in vaccine protection.
Conclusion: Equine influenza pseudotyped lentiviruses can be used
in antibody neutralisation assays to distinguish between vaccinated
and naГЇve equines and for investigation into the role of specific haemagglutinin mutations in vaccine breakdown.
22.027 Replication potential of evolutionary distinct
H3N8 equine influenza viruses in swine cell
lines and respiratory explants
L. V. P. L. Patrono1, C. Zanardello2, F. Bonfante2, C. Terregino2,
I. Capua2, P. R. Murcia3
1
University of Padua/Istituto Zooprofilattico Sperimentale delle
Venezie, Legnaro (PD), Italy, 2Istituto Zooprofilattico Sperimentale
delle Venezie, Legnaro (PD), Italy, 3MRC-University of Glasgow
Centre for Virus Research, Glasgow, United Kingdom
Purpose: In early 2000вЂ™s an equine influenza virus (EIV) of the H3N8
subtype crossed the species barrier and established in dogs as canine
influenza virus. Moreover, between 2004вЂ“2006, H3N8 viruses closely
related to EIV were detected in pigs in China, and recently, EIV H3N8
has been isolated from camels in Mongolia. To understand nature
of host range determinants of Influenza A viruses, is fundamental to
study influenza pathogenesis at the site of infection. Swine respiratory
explants constitute a unique model to study the dynamics of influenza
virus infection in the target tissues of the natural host.
Aim: To assess and compare the replication potential of evolutionary distinct H3N8 equine influenza viruses in pig cells and respiratory
explants.
Methods & Materials: Newborn Pig Trachea (NPTr) and Newborn
Swine Kidney (NSK) cell lines were infected at a MOI of 0.001 with various EIV isolates spanning from 1963 to 2003. Triplicate samples of the
75
IMED 2014
Poster Presentations I
SATURDAY вЂў November 1, 2014
International Meeting on Emerging Diseases and Surveillance 2014
SATURDAY
вЂў
November 1, 2014
supernatants were collected at different time points for virus quantification. Six to eight week-old piglets (n=6) were used to collect explants
of the upper and lower respiratory tract. Explants were infected in
triplicate with 200 PFU of EIVs. Infection phenotypes evaluated by
virus titres, histological lesions and immunostaining were determined
at different time points.
Results: All EIVs tested replicated in swine cell lines whereas in
organ explants only вЂњoldвЂќ EIVs were able to replicate. Viral loads were
higher in the lower than in the upper respiratory tract. In agreement with
this finding, histological damage and viral antigen were not detected in
nasal mucosa nor tracheas but commonly observed in the lungs.
Conclusion: Our ex vivo system has proven to be more selective
than the in vitro for screening the replication potential of EIVs in the
pig host. Moreover, we describe the phenotype of infection of equine
influenza in swine explants highlighting a tropism for the lower respiratory tract. Our preliminary data show that EIVs progressively lost their
ability to replicate in swine explants along their evolutionary history,
suggesting that evolutionary determinants play an important role on
EIV host range.
22.028 Discordant correlation between
serological assays observed when
measuring heterosubtypic responses
against avian influenza H5 and H7 viruses
in unexposed individuals
E. Molesti1, F. Ferrara1, G. Lapini2, E. Montomoli2, N. Temperton1
1
University of Kent, Chatham Maritime, United Kingdom, 2University of
Siena, Sienna, Italy
Purpose: The human population is constantly exposed to multiple
influenza A subtypes due to zoonotic spillover and rapid viral evolution
driven by intrinsic error-prone replication and immunological pressure.
In this context, antibody responses directed against the HA protein are
of importance since they have been shown to correlate with protective immunity. Serological techniques, detecting these responses, play
a critical role for influenza surveillance, vaccine development, and
assessment. As the recent human pandemics and avian influenza
outbreaks have demonstrated, there is an urgent need to be better prepared to assess the contribution of the antibody response to protection
against newly emerged viruses and to evaluate the extent of preexisting heterosubtypic immunity in populations.
Methods & Materials: SRH, HI, MN and pp-NT were used in a comparative serology approach to deliniate the humoral response against
avian viruses in human sera.
Results: In this study, 68 serum samples collected from the Italian
population between 1992 and 2007 were found to be positive for antibodies against H5N1 as determined by single radial hemolysis (SRH),
but most were negative when evaluated using haemagglutination inhibition (HI) and microneutralisation (MN) assays.
Conclusion: As a result of these discordant serological findings, the
increased sensitivity of lentiviral pseudotypes was exploited in pseudotype-based neutralisation (pp-NT) assays and the results obtained
provide further insight into the complex nature of humoral immunity
against influenza A viruses.
22.029 Vaccination of mice with plasmid DNA encoding
hemagglutinin from H5N1
P. A. Redkiewicz1, A. Gora-Sochacka1, P. Kosson2, A. Sirko1
1
Institute of Biochemistry and Biophysics, Warsaw, Poland,
2
Mossakowski Medical Research Centre, Warsaw, Poland
Purpose: Recombinant DNA vaccine based on the sequence of H5
HA from H5N1 strain of HPAIV was prepared. Sequence manipulation
included deletion of the proteolytic cleavage site, codon usage optimization and cloning into a commercially available expression vector.
Further study was focused on the enhancement of immunogenicity of
76
IMED 2014
HA DNA vaccines by modification of the coding sequence and using
various adjuvants. Variants of the plasmids containing unmodified and
modified sequence encoding HA were prepared and tested in mice
along with three different adjuvants.
Methods & Materials: 4вЂ“6 week old BALB/c mice were immunized
twice intramuscularly in the quadriceps muscle at two weeks intervals
with either 50 Ојg or 10 Ојg of plasmid DNA along with adjuvant 1, 2 or
3. At three time points: (i) two weeks after the prime dose, (ii) one week
after the boost dose and (iii) two weeks after the boost dose the blood
samples were collected and sera were prepared. Four weeks after the
priming mice were scarified and spleens were isolated. HA-specific
IgG titers in sera samples were determined by indirect ELISA. The
proliferation ability of murine splenocytes stimulated with commercial
hemagglutinin H5 from A/Bar-headed Goose/Qinghai/12/05 H5N1
strain was determined using CellTiter 96В® AQueous One Solution Cell
Proliferation Assay (MTS).
Results: The results show that both vaccine doses (50 Вµg and 10
Ојg) of the tested plasmids elicited HA-specific IgG antibody response.
However, the level of the response depended on the sequence variant, the dose and the adjuvant. Additionally, the study of splenocytes
proliferation confirmed that the tested vaccines elicited the T-cell proliferative responses.
Acknowledgments:This work was supported by Innovative Economy
Program, Grant No. WND-POIG.01.01.02-00-007/08.
22.030 Prevalence and molecular characteristics of
respiratory viruses found in childrenвЂ™s with
respiratory tract infections in Eastern India
S. Kumar1, S. Panda1, N. K. Mohakud2
1
KIIT University, Bhubaneswar, Odisha, India, 2KIMS, KIIT University,
Bhubaneswar, Odisha, India
Purpose: Acute respiratory tract infections (ARTIs) are a major cause
of morbidity and mortality in children both in developed and developing
countries. In the last few decades, a wide range of respiratory viruses,
including human respiratory syncytial virus (hRSV), human metapneumovirus (hMPV), influenza A and B viruses, parainfluenza viruses
(PIVs), rhinovirus (HRV), have been repeatedly detected in acute lower
respiratory tract infections (LRTI) in children. Role of these respiratory
viruses in ARTIs among children has not been well established in India.
Our work represents a complete profiling of respiratory viruses circulating in eastern India.
Methods & Materials: Total 260 nasal and nasopharyngeal swabs
were collected (2012вЂ“2014) from patients suspected of ARTIs. All
these samples were subjected to multiplex RT-PCR for detection of
respiratory viruses. The demographic characteristics, viral prevalence,
age distribution, seasonal distribution, and pathogen spectrum of the
patients with ARTIs were analyzed. hMPV positive samples were
subjected to partial sequencing of F gene (571 ntвЂ“977 nt) using ABI
PRISM BigDye termination reaction. N-J algorithm was implemented
for phylogenetic analysis using MEGA 6.06 to calculate the percentage
of nucleotide identity and genetic divergence between hMPV isolates.
Results: 74/260 (27.69%) sample were found positive for any respiratory virus (Influenza, Parainfluenza virus (PIV), Human respiratory
syncytial virus (hRSV), Human metapneumovirus (hMPV) or human
rhinovirus (HRV). HRV was the major etiological agent (18.85%), followed by hRSV (4.61%), hMPV (3.85%), PIV (2.31%), and Influenza
(1.54%). Co-infection of hMPV with hRSV, PIV, HRV and Influenza was
observed in 2, 1, 1 and 1 cases respectively. In phylogenetic analysis,
the present hMPV isolates clustered with hMPV subgroup A2.
Conclusion: The characterisation and epidemiological investigation
of respiratory viruses at molecular level is very important. The present study adds to our knowledge of the epidemiology characteristics of
these common respiratory viruses among patients with ARTIs in eastern India. It provides a useful insight into the circulation of prevalent
strains and helps in the understanding of illness attributable to these
respiratory viruses.
Poster Presentations I
SATURDAY вЂў November 1, 2014
International Meeting on Emerging Diseases and Surveillance 2014
22.031 A preliminary study comparing trends in
influenza-like illness and acute respiratory
infection consultations in general practice
in-hours services and out-of-hours services
C. Kearns, N. Gallagher, C. Nugent
Public Health Agency, Belfast, United Kingdom
Purpose: Rapid and accurate identification of the causative agent
among potential bacterial and viral pathogens is essential for the management of acute respiratory infections.
Methods & Materials: To evaluate the prospective utility of multiplex
PCR assay in diagnosis of viral respiratory infections, a panel of 54
respiratory samples collected from children (n=47) and adults (n=7)
with severe bronchiolitis (n=24) or pneumonia (n=30), were analyzed
by the Seegene SeeplexВ® RV12 system. The study was conducted in 5
centers from February to April 2011.
Results: Of 54 cases, 36 (66.6%) were positive by RV12 multiplex
PCR. Viruses identified were: Respiratory Syncytial Virus (RSV, n=
26) with RSV B (n=23) and RSV A (n=3), followed by Human Rhino
Virus (n=7), Adenovirus (n=7), Influenza virus A (n=6), Influenza virus
B (n=2), Coronavirus: OC43/229E/NL63 (n=3), Human Parinfluenza
virus (n=2) and Human Metapneumovirus (n=1). In 20 cases (37%),
viruses were the only etiology reported. However, viral coinfection
(identification of more than 1 virus) was noted in 17 cases (31.5%), and
association with bacterial etiology was identified in 16 cases (29.6%),
mostly with S.pneumoniae (n=10). In 18 cases (33.3%) no viral etiology
has been identified, and 11 cases (20.4%) remained without etiological
diagnosis.
Conclusion: Multiplex molecular testing has improved the ability of
clinical laboratories to diagnose respiratory virus infections. As a result,
following the adoption of these tests, clinical laboratories will provide
much on the treatment of respiratory infections and detect emerging
viruses.
Purpose: Influenza-like illness (ILI) can cause excess pediatric morbidity during winter season. An ILI case is defined by abrupt onset of fever
(>38ЛљC), one or more respiratory symptoms (non-productive cough,
sore throat, or rhinitis), and one or more systemic symptoms (myalgia,
headache, or severe malaise). ILI is considered to be a valid proxy of
influenza activity, and up to 30вЂ“40% of children develop ILI during each
influenza season. Influenzaviruses are considered the main cause of
ILI, however other respiratory viruses-generally not included among
common pathogens under investigation-can be involved, such as
human enterovirus (hEV) and human parechovirus (hPeV)
This study aimed at investigating the impact of hEV and hPeV infections in children в‰¤5 years with ILI during 4 consecutive winter seasons
(from 2010/2011 to 2013/2014) in Lombardy (Northern Italy).
Methods & Materials: During the study period, throat-swabs were
collected from 312 children в‰¤5 years (48.4% females) with ILI by sentinel practitioners in the framework of the Italian influenza surveillance
network InfluNet. Nucleic acids were extracted from each sample by a
commercial method (Invitek) and two one-step real-time RT-multiplexPCRs were carried out to detect influenzaviruses type A/B and hEV/
hPeV.
Results: 46.1% (144/312) of samples were positive to influenzavirus
detection (70.8% type A); the median age of these outpatients was 4
years (IQR: 1 year); hEVs were detected in 9% (28/312) of children
(median age: 2 years; IQR: 3 years), and hPeV in 3.5% (11/312) of ILI
cases (median age: 1 year; IQR: 1 year). 11.1% (16/144) of influenzavirus-positive samples resulted positive also to hEV or hPeV detection
(6.9% and 4.2%, respectively). No hEV/hPeV co-infections were identified. Among influenzavirus-negative samples, 10.7% (18/168) were
positive to hEV and 3% (5/168) to hPeV.
Conclusion: During the study period, 46% of ILI cases were laboratory-confirmed influenzaviruses infections. Unexpectedly, the impact
of hEV and hPeV infections in children в‰¤5 yearswas 9% and 3.5%,
respectively. HPeV was mainly detected in children в‰¤3 years. HPeV
and hEV were identified either as single infection or as co-infection.
Further investigations will allow to ascertain the hEV and hPeV genotypes circulating in the community, particularly among children.
November 1, 2014
respiratory infections in Algiers, Algeria
H. Ziane, Z. Hanifa, F. Djennane, M. Bachtarzi, S. Gourari, M. Tazir
Service de microbiologie, Algiers, Algeria
L. Bubba, L. Pellegrinelli, S. D. Discacciati, A. Ranghiero, G. Anselmi,
V. Primache, S. Binda, A. Amendola, E. Pariani
University of Milan, Milan, Italy
вЂў
22.032 Multiplex molecular diagnosis of viral acute
parechovirus (hPeV) infections in children в‰¤5
years with influenza-like illness (ILI) in Northern
Italy during 4 consecutive winter seasons
(2010/2011вЂ“2013/2014)
SATURDAY
Purpose: A variety of data sources collated annually by the Public
Health Agency provide information on respiratory disease and timing of
activity. Influenza-like illness (ILI) and acute respiratory infection (ARI)
consultations in primary care were obtained by automated extraction,
from all general practitioners in-hours and out-of-hours (OOH) services
across Northern Ireland. The OOH service may provide an earlier indication of activity than in-hours service as it is operational for longer
periods. We examined ILI and ARI trends in GP in-hours and OOH over
a three year period.
Methods & Materials: Weekly aggregate data on ILI and ARI consultations, stratified by age-group were extracted from both services
for the years 2010/11, 2011/12 and 2012/13. Differences in peak activity periods were observed using longitudinal graphs and proportional
estimates.
Results: The peak week for ILI activity was one week earlier in the
OOH than the in-hours service in two of the three years. In contrast
the peak week of activity for ARI was one week later in the OOH than
the in-hours service. ILI consultations were a much lower proportion of
all in-hour and OOH consultations (1%) than ARI consultations (15%).
Conclusion: This preliminary study suggests that OOH services
may provide a slightly earlier indication of ILI activity than the in-hours
service. Conversely, indicators for ARI appear earlier in the in-hours
service, possibly due to the age-groups accessing these services. The
low proportion of consultations due to ILI may indicate the effectiveness
of the public health message to remain at home when ILI is suspected
22.033 Impact of human enterovirus (hEV) and human
22.034 Molecular phylogeny and evolutionary
dynamics of influenza A(H1N1)09pdm NS1 gene
M. B. Valli1, E. Giombini2, C. Caglioti3, P. Zaccaro3, S. Menzo4,
G. Ippolito5, M. R. Capobianchi6
1
National Institute for Infectious Diseases вЂњL. SpallanzaniвЂќ, Rome, IT,
Italy, 2National Institute for Infectious Diseases вЂњL.SpallanzaniвЂќ, Rome,
Italy, 3National Institute for Infectious Diseases вЂњL. SpallanzaniвЂќ,
Rome, Italy, 4Marche Polithecnic University, Ancona, Italy, 5National
Institute fro Infectious Diseases вЂњL.SpallanzaniвЂќ, Rome, Italy, 6National
Institute for Infectious Diseases, Rome, Italy
Purpose: Following its jump to human population, swine-origin pandemic influenza A virus (H1N1) experienced fast evolutionary rates and
strong selection pressure, diverging early into two different clusters.
Despite these findings strongly suggest that the relevant evolutionary
steps to adapt to humans occurred at the beginning of the pandemic,
many aspects of its adaptation and the subsequent evolutionary trends
of the virus remain obscure. In this study the dynamics of genetic variations of NS1 protein, which plays a crucial role in viral replication aswell-as in host adaptation, has been investigated
Methods & Materials: Nucleic acid extracted by nasopharyngeal
swabs has been amplified with RT-PCR in house to obtained full-lenght
77
IMED 2014
Poster Presentations I
SATURDAY вЂў November 1, 2014
SATURDAY
вЂў
November 1, 2014
International Meeting on Emerging Diseases and Surveillance 2014
NS1 sequences and than sequenced by a modified Sanger method.
The Phylogenetic analisys was performed using MEGA 5 package (NJ)
and the selective pressure was computed using the Nei and Gojobori
substitution model (with the Jukes-Cantor correction)
Results: The NS1 variants isolated in Rome were examined
and compared to worldwide sequences downloaded from GISAID
Database. The phylogenetic tree of 2009 and 2013 Rome-sequences
revealed a significant (bootstrap 1000) segregation of the two groups in
well separated clades. The selective pressure analysis on NS1 and HA
demonstrated that dN/dS ratio of NS1 and HA was highest in 2009, than
its value progressively decreased from 0.456 (2009) to 0.092 (2013) in
NS1 gene whereas it started to increase in HA gene since 2011
Conclusion: Our study reveals that NS1 was generally subjected
to a growing purifying selection during the course of seasonal epidemics, whereas its variability has increased, mainly in synonymous
substitutions, in a typical genetic radiation pattern. NS and HA show
discrepant evolution: from 2009 to 2011 both genes displayed growing
purifying selection, while in 2012 and 2013 selective pressure on HA
started growing again. This demonstrates that after initial adaptation to
humans for both genes, neutralizing antibodies in the human population subjected HA to continuous pressure through seasonal epidemics, while NS has reached optimal adaptation to the new host. The
evolutionary dynamics of NS1 gene obtained in this study provides
new insight into the epidemiology of influenza, which is crucial for its
surveillance and control.
22.035 Molecular basis of influenza virus survival
outside the host: Potential role of the
hemagglutinin protein
L. I. O. Sawoo1, M. Feher1, A. Dublineau2, C. BatГ©jat1, I. Leclercq1,
J.-C. Manuguerra1, J. Vanhomwegen1
1
Institut Pasteur, Paris, France, 2Insitut Pasteur, Paris, France
Purpose: Of the viruses belonging to the family Orthomyxoviridae,
influenza A virus (IAV) is the most predominant cause of morbidity
and mortality in humans through yearly epidemics and pandemics.
Pandemic threats with new IAVs such as the H1N1 (2009) pandemic
virus (H1N1pdm), have stimulated numerous studies on their transmission mechanism. However, knowledge on how environmental factors
may impact IAV persistence is still rudimentary. We have previously
shown that IAV can persist in water and on surfaces for extended periods of time and that susceptibility of the virus to a given temperature or
salinity was not due to genomic degradation. Our findings suggested
that external structures of IAVs, particularly the surface glycoprotein
Hemagglutinin (HA) which could play a role in virus survival. To identify
molecular determinants involved in IAV survival outside the host, we
used influenza pseudotypes based on lentiviral vectors expressing a
luciferase reporter gene.
Methods & Materials: Pseudotypes produced with HA genes of
H1N1pdm and pre-pandemic H1N1 strains were generated and subjected to various environmental parameters such as different salinities
and temperatures over time. Luciferase expression was measured after
MDCK cells transduction to evaluate influenza pseudotypes integrity.
Results: No differences were observed between H1N1pdm and seasonal H1N1 pseudotypes at low salinities at a given temperature, as
shown with their viral counterparts. However, increasing temperatures
and salinities had a strong negative effect on the survival of the H1N1
pseudotypes, with a higher impact on pre-pandemic H1N1 pseudotypes. After intermolecular comparison of both viruses on the HA gene,
several key-point mutations were targeted and 10 different pseudotyped mutants were studied for their persistence in water. Recombinant
viruses bearing those mutations will also be tested in order to confirm
the results.
Conclusion: Influenza pseudotypes provided reliable assays to
study the loss of viability of IAV outside the host, and allowed the identification of amino-acids that are potentially involved in IAV survival.
78
IMED 2014
22.036 Applying a risk based approach in surveillance
guidance for emerging respiratory pathogens
E. Wong1, T. Mersereau1, N. Khalil2, M. Saboui1
1
Public Health Agency of Canada, Ottawa, ON, Canada, 2Public
Health Agency of Canada, Montreal, QC, Canada
Purpose: Internationally, a number of health organizations have
adopted a risk based approach to ensure the public health response
is appropriate to risk posed by an emerging pathogen (including novel
influenza strains). As surveillance is important in understanding novel
diseases and informing effective action, guidance must identify the key
elements needed to contribute to risk assessment.
Objective: To apply a risk based approach to surveillance that serves
the public and public health in a meaningful way and to support planning activities in Canada.
Methods & Materials: An environmental scan was conducted to
review national and international risk based surveillance guidance
documents. Committees with representatives from different areas of
expertise were created and/or consulted to identify assumptions and
operational limitations when setting surveillance objectives and recommended activities for different disease transmission scenarios.
Results: Using scenarios that considered the evolution of disease
characteristics (e.g. increasing capacity for human-to-human transmission and geographic origin/spread), key considerations were
identifiedby individuals with a broad range of expertise (laboratory,
epidemiology, public health, and zoonosis) to develop guidance,
objectives and recommendations for emerging respiratory pathogens
(including pandemic influenza). Factors that were affected by these
considerations included the public health response goals (containment
vs. mitigation), surveillance activities (collection of case-level or aggregate data, outbreak investigations), laboratory testing procedures,
and need for special studies. Existing infrastructure was recognized
as being vital in the surveillance of emerging respiratory pathogens.
These findings were applied in surveillance guidance for the Middle
East Respiratory Syndrome Coronavirus and avian influenza A(H7N9).
The need for a formal assessment tool was also recognized and a risk
assessment framework is under development.
Conclusion: Collaborative discussions allowed for the communication of expectations and limitations among public health authorities,
laboratory scientists and clinicians when faced with a public health
threat. Given the unknown nature of the epidemiology of an emerging
respiratory pathogen, a risk-based approach to surveillance establishes guidance that is flexible and responsive for an evolving situation.
22.037 Early clinical management of SARI patients
improves outcomes and community outbreaks
B. Namagambo1, J. T. Kayiwa1, T. Byaruhanga1, R. Chiza2, N. Owor1,
B. Bakamutumaho1, J. J. Lutwama1, I. Nabukenya3
1
Uganda Virus Reseacrh Institute, Entebbe, Uganda, 2Uganda Virus
Research Institute, Kampala, Uganda, 3Uganda Virus Research
Institute, Entebbe, Uganda
Purpose: There have been several incidents of severe respiratory
infectious diseases in Uganda for the last five years; these include
the 2009 Pandemic Influenza commonly known as вЂњSWINE FLUвЂќ,
Seasonal Influenza A(H1N1), Influenza A(H3N2) and Influenza B.
These Acute Respiratory Infections pose a substantial risk for humans
due to their extremely high potential to spread from person-to-person
hence these infections can produce worse outcomes. Events of these
severe acute respiratory infections have demonstrated the importance
of strengthening Case management systems that include patient follow
up to help in detection of new viruses and provide information to assess
the impact on the population being investigated for better operational
preparedness plans.
Objectives: To assess incidence of outcomes and incidence of complications in SARI patients.
Methods & Materials: Nasopharyngeal and oropharyngeal specimens were collected from Patients between the age в‰Ґ 2 months with an
acute respiratory infection presenting history of fever or measured fever
Poster Presentations I
SATURDAY вЂў November 1, 2014
International Meeting on Emerging Diseases and Surveillance 2014
(в‰Ґ 38 В°C, 100.4 В°F) and cough; AND suspicion of pulmonary parenchymal disease (e.g. pneumonia or RTI), based on clinical evidence of
consolidation: WITH symptom onset within 10 days were followed up
from in five hospitals of Mbarara, Entebbe, Arua, Tororo and FortPortal;
from date of admission up to the time they leave the hospital. Samples
were tested for influenza A and B with real-time reverse-transcription
polymerase chain reaction, and subtyped for seasonal A/H1, A/H3, A/
H5, and 2009 pandemic influenza A (pH1N1).
Results: Out of the 3,576 SARI admissions, 1,572 patients were
put under the SARI clinical/case management system; 4,404(93%)
were discharged after full recovery, 29(2%) death, 81(5%) runaway
and 6(0%) were transferred when conditions worsened. The minimum
length of stay on admission was 10day. Although 172/4404 (3.9%) were
positive for influenza, no patient was confirmed dead for Influenza.
Conclusion: Case management programmes improve clinical outcomes, patient satisfaction, improve patient follow up, and ensure
patients acquire right medication with in a minimum time.
22.038 Evaluating the relationship of sex and age on
adequacy as measured by rtPCR amplification
of beta-actin
T. E. Bell, K. Felkins
Texas Tech University Health Science Center, Amarillo,
Amarillo, TX, USA
Purpose: Influenza diagnosis is hampered by imperfect diagnostic
tools. Clinical mimicry of influenza with other respiratory pathogens
limits clinical accuracy for influenza diagnosis. Rapid antigen testing
has less than ideal sensitivity, and polymerase chain reaction (PCR)
remains relatively expensive and not universally available. These
limitations may be magnified during influenza outbreaks, when public
health decisions affecting whole populations are reliant on accurate
and predictable results. Although antigen testing remains the mainstay
non-invasive methods among industrial pig
farm workers and household members in
North Carolina
M. Nadimpalli1, N. Pisanic2, J. Stewart1, C. Heaney2
1
University of North Carolina at Chapel Hill, Chapel Hill, NC, USA,
2
Johns Hopkins Bloomberg School of Public Health, Baltimore, MD,
USA
November 1, 2014
22.039 Variability of influenza clinical sample
22.040 Surveillance of influenza A exposure using
вЂў
Purpose: There is limited data available from Africa on Population at
risk for Influenza. Influenza is a major cause of morbidity and mortality
in the world (Martin et a,l 2013). Severe outcomes of Influenza illness
among individuals have been reported. Sex and age have been independent factors of causing influenza (Martin et al, 2013). Since there is
limited data available in African countries about the impact of Influenza,
our study evaluated the association of age and sex on influenza results.
Methods & Materials: We established a sentinel surveillance system
for influenza in five hospitals and outpatient clinics respectively and
other identified areas of outbreaks in four distinct geographical regions
of Uganda (northern, eastern western and central), using standard
case definitions for influenza like illness (ILI). Nasopharyngeal and
oropharyngeal specimens were collected from January 2012 through
June 2014 from 2474 non-smoking patients with ILI above 18 years
and tested for influenza A and B with real-time reverse-transcription
polymerase chain reaction, and subtyped for seasonal A/H1, A/H3, A/
H5, and 2009 pandemic influenza A (pH1N1). Data analysis was done
using Chi square which involved the comparing of sex and different age
ranges of the patients.
Results: Out of the 2474 people tested for influenza, 1228 were
males and 1246 females. 328 tested positive for Influenza while 2146
were negative. 12 patients were aged >45 years and 2462 were
below 45 years. On analysis, sex was not statistically significant when
compared with the influenza results (p =0.25). Also age groups was
not statistically significant when compared with the influenza results.
(p=0.181).
Conclusion: Sex and Age groups are not associated or related with
the Influenza test results.
SATURDAY
the influenza test result
J. K. Kigozi, J. T. Kayiwa, T. Byaruhanga, R. Chiza, I. Nabukenya,
B. Namagambo, B. Bakamutumaho, J. J. Lutwama
Uganda Virus Research Institute, Entebbe, Uganda
for outpatient laboratory detection of influenza, the successful identification of influenza is dependent on the volume of antigen collected
during sampling. The purpose of this study was to evaluate the variability of nasal clinical sampling adequacy based on Beta-actin quantity
in influenza samples.
Methods & Materials: Beta-actin DNA is a housekeeping gene that
has been used as a proxy measure of epithelial cells in nasal sampling.
For our study, we analyzed data from 48 clinical influenza samples
with beta-actin control data collected and analyzed between 2009 and
2011. All samples were influenza positive by rt-PCR utilizing a commercially available detection kit (PrimerDesign, UK) on an ABI7500
PCR platform. The kit incorporates beta-actin as an internal control.
Samples were collected by trained research staff or clinical nursing
staff. Samples were run in triplicate and included in final analysis if
there was less than 10% variability between runs.
Results: Data for 48 samples were available for analysis. Patients
ranged in age from 9 months to 78 years. The average number of
cycles required for B-actin detection was 29.9 (range 25.5вЂ“36.9, std
dev 2.77). There was no significant difference in beta-actin quantity
relative to patient age or year of collection and analysis.
Conclusion: There was significant variability in influenza sampling
adequacy in this study. We demonstrated an eleven-fold difference
in beta-actin between the lowest and highest quantity samples. The
standard deviation of cycles for rt PCR detection equates to more
than an order of magnitude difference within one standard deviation.
Incorporation of intra-sample beta-actin controls in antigen tests may
be one way to improve diagnostic accuracy of these tests and control
for sampling variability.
Purpose: Workers at confined animal feeding operations (CAFOs)
may be exposed to reassortant influenza A viruses. There is a growing
need for influenza A surveillance in eastern North Carolina, where pig
CAFOs are concentrated and poultry CAFOs are rapidly proliferating.
However, influenza A surveillance among CAFO workers is difficult
in the U.S. due to trouble recruiting workers, who often fear retribution from their employers; and invasive sampling methods, which can
reduce study participation and retention. New approaches are needed
to investigate the emergence of novel influenza A viruses among CAFO
workers in the U.S.
Aim: To examine baseline prevalence of influenza A among industrial
pig farmers and their household members enrolled in a four-month,
repeated measures study of influenza A exposure and infection.
Methods & Materials: In collaboration with the Rural Empowerment
Association for Community Help (REACH), a community organization
based in eastern North Carolina, we enrolled a convenience sample
of industrial pig farmers and their household members from October,
2013 to February, 2014. Baseline nasal swabs and questionnaires
assessing influenza A symptoms were collected from each participant
upon enrollment. Community organizers from REACH collected biweekly nasal samples and questionnaires from participants for the next
four months. RT-qPCR was used to quantify and subtype influenza A
virus RNA present in each baseline sample.
Results: 183 baseline nasal swabs were collected from 102 workers,
27 adult household members, and 54 minors. Retention of participants
was high; 87% (159/183) contributed all time points and 95% (174/183)
contributed at least 8/9. Eight percent of participants (15/183) were
positive for influenza A at baseline, including 10 workers, two adult
household members, and three minors. Subtyping revealed presumptive pandemic swine H1N1 influenza A virus among one worker at
baseline.
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Poster Presentations I
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International Meeting on Emerging Diseases and Surveillance 2014
Conclusion: Influenza A surveillance studies of CAFO workers in
the U.S. are possible when non-invasive methods are used, and when
researchers collaborate with community groups who have the trust
of participants. Our findings suggest industrial pig farmers and their
household members are exposed to influenza A, including pandemic
strains. Further research is required to determine whether CAFOs are
the source of exposure to these strains.
22.041 The neglected burden of influenza in relation to
age, out-patients, hospitalized patients and the
economic impact in Uganda
SATURDAY
вЂў
November 1, 2014
T. Byaruhanga1, J. T. Kayiwa1, B. Namagambo1, R. Chiza2,
I. Nabukenya2, N. Owor1, J. J. Lutwama1
1
Uganda Virus Reseacrh Institute, Entebbe, Uganda,
2
Uganda Virus Research Institute, Entebbe, Uganda
Purpose: we investigated the burden of Influenza on age, hospitalized and out-patients, and the economic impact of disease. The burden
of Influenza goes unnoticed year round in Uganda without profound
intervention by government. World Health Organization emphasized
assessing the severity of Influenza virus in hospitalized patients and
assess its impact as a nosocomial infection. In communities, the risk of
spread of influenza from one individual to another is high stressing the
importance of maintaining surveillance activities and the introduction of
the Influenza vaccine in the country.
Methods & Materials: Demographic and clinical data, together with
nasal pharyngeal and or throat swabs were collected from enrolled
patients using two case definitions; influenza-like illness (ILI) for outpatients and severe acute respiratory infection (SARI) for hospitalized
patients for a period from January 2012 to December 2013. Samples
were screened at National Influenza Center (NIC)/Uganda Virus
Research Institute (UVRI) for influenza A and B virus using Real Time
rtPCR. Data were statistically analyzed using SPSS. The impact was
assessed by evaluating the number of days lost from school at hospital among school attending children and the economic loss caused
through medication. The medical cost for drugs prescribed to patients
was calculated and converted from Uganda Shillings to the US dollars
rate of 2680:1 respectively for the year 2014.
Results: A total of 4758 specimens from enrolled patients were
tested for ILI and SARI on Real Time PCR. 1913 (40%) were hospitalized SARI patients and 2845 (60%) were ILI out-patients. 505 (10.6%)
patients were SARI and ILI positive for influenza; with 367 (73%) ILI
and 138 (27%) SARI. The results showed that in out-patients (ILI),
there was an almost twice more likelihood to have Influenza (OR 1.905,
95% CI: 1.552-2.338) than hospitalized patients (SARI) and this was
statistically significant (p 0.001). Children <17 years lost an average of
3 school days in hospital and total of 2372.35$ spent on all positive ILI
and SARI patients.
Conclusion: More out patients are infected with influenza than hospitalized patients. There is need to allocate more resources towards
combatting Influenza in the country.
Innovations in Diagnostic Tests
for Emerging Diseases
22.042 The role of conventional and real-time PCR in
determining the pneumococcal etiology of
complicated pneumonia cases
C. Silva-Costa, S. Aguiar, M. Pinho, M. Ramirez, J. Melo-Cristino,
P. Portuguese Group for the Study of Streptococcal Infections
Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
Purpose: Streptococcus pneumoniae is a major cause of pneumonia,
including complicated cases, such as those associated with empyema
or pleural effusion. However, the etiology of complicated pneumonia
is frequently not established, given the low microbiological yield of the
specimens by traditional methods. This possibly under-estimates the
contribution of pneumococci to the burden of diseased and may introduce a bias in the determined serotype prevalence. The aim of this
80
IMED 2014
study was to enhance the detection of pneumococci in pleural fluid of
children and adolescents (< 18yrs), in Portugal (from May 2009 to May
2013), using two PCR approaches and to compare their effectiveness.
Methods & Materials: The pediatric departments of 30 hospitals
were asked to report and submit samples of all cases of pneumonia
with empyema or pleural effusion with a suspected pneumococcal
etiology. The serotype of the isolated pneumococci was determined
by Quellung. Total DNA of culture negative samples was extracted, followed by conventional (end-point) or real-time PCR (RT-PCR) analysis
targeting the lytA and cpsA genes. Amplification of specific capsular
genes by conventional PCR was used to identify the serotype in culture
negative samples.
Results: A total of 105 complicated pneumonia cases were identified.
Isolation of S. pneumoniae was possible in 14 pleural fluid samples
(13%). In the remaining 91 culture negative cases, pneumococci were
identified in 70 samples (77%), of which 27 samples (30%) by both
conventional and RT-PCR and in an additional 43 samples (47%) by
RT-PCR only. The main capsular serotypes identified among the available isolates were: serotype 1 (n=6) and 3 (n=5). Identification of the
serotype by conventional PCR for the culture negative cases was possible in 25 samples. Again in these cases, a pronounced dominance of
serotypes 1 (n=7) and 3 (n=9) was found.
Conclusion: The detection of pneumococcal DNA by PCR greatly
enhances the identification of pneumococci in pleural fluid. RT-PCR
offers a significant enhancement relative to conventional PCR and
culture (51% of pneumococcal positive samples were identified by
RT-PCR only). Serotypes 1 and 3 are the major causes of complicated
pediatric pneumonia cases in Portugal (accounting for 70% of cases).
22.043 Validation of cyscope microscope,
quantitative buffy coat and rapid diagnostic
kit for malaria diagnosis among clinic
attendees in Southwest Nigeria
A. O. Ogunniyi1, D. M. Dairo2, H. Dada-Adegbola3, O. Ajumobi4,
O. Fawole5, W. Oyibo6
1
Nigeria Field Epidemiology and Laboratory Training Program, Abuja,
FCT, Nigeria, 2University of Ibadan, Ibadan, OYO, Nigeria, 3University
College Hospital, Ibadan, OYO, Nigeria, 4Nigerian Field Epidemiology
and Laboratory Training Programme, Abuja, FCT Abuja, Nigeria,
5
University of Ibadan, Ibadan, Nigeria, 6University of Lagos, Lagos,
LAG, Nigeria
Purpose: The unavailability of accurate, rapid, reliable and costeffective diagnostic instruments compels many laboratories to depend
on the labour-intensive and time-consuming light microscopy for diagnosis. Alternative instruments like Cyscope fluorescent microscope
(Cyscope), Quantitative Buffy Coat fluorescent microscope (QBC) and
CareStartв„ў Rapid diagnostic kit (CareStartв„ў) with the potential to
address these challenges have been developed but their validity and
cost effectiveness have not been determined in Nigeria, an endemic
and resource limited setting. This study was designed to validate these
instruments and assess their comparative cost-effectiveness.
Methods & Materials: Blood samples collected from 502 patients who
were systematically randomly selected from 1800 patients at three hospitals in southwestern Nigeria, were tested for malaria parasites using
the diagnostic tools mentioned above, with Light Microscopy as the gold
standard. For each instrument, sensitivity, specificity, positive predictive
value (PVP), negative predictive value (NPV), turn around time and costper-hour of use were assessed. Statistical analysis included McNemar
chi-square and Kappa statistics at 0.05 significance level.
Results: Malaria prevalence in the samples was 19.5%
(CareStartв„ў), 21.7% (light microscopy), 30.7% (Cyscope) and 32.7%
(QBC) respectively. Sensitivity of the instruments compared with
light microscopy was 76% (CareStartв„ў), 95% (Cyscope) and 98.1%
(QBC) while specificity was 85.5% (QBC), 87.3% (Cyscope) and 96%
(CareStartв„ў). PPV for the instruments was 65.2% (QBC), 67.5%
(Cyscope), and 84.7% (CareStartв„ў) with NPV of 93.6% (CareStartв„ў),
98.6% (Cyscope) and 99.4% (QBC). Inter instrument agreement index,
Kappa value (Ka) were 0.71 [(OR=28.5; CI=7.54вЂ“241.01) (QBC)],
0.72 [(OR=10.0; CI= 4.01вЂ“32.13) (Cyscope)] and 0.75 [(OR=0.6; CI=
0.3вЂ“1.13) (CareStartв„ў)]. Average cost per hour of use for the instruments was $2.04 (Cyscope), $5.61 (RDT), $5.89 (QBC) and $10.77
Poster Presentations I
SATURDAY вЂў November 1, 2014
International Meeting on Emerging Diseases and Surveillance 2014
(light microscopy). The turnaround time per result output was 5minutes
(Cyscope), 10minutes (QBC), 20minutes (CareStartв„ў) and 45 minutes
(light microscopy).
Conclusion: Cyscope fluorescent microscopy was found to be
comparatively accurate, rapid and most cost-effective for malaria diagnosis in this resource-limited setting and is therefore recommended
for routine diagnosis for control and elimination of malaria.
22.044 Detection of ASF virus found in Georgia using
transmission electron microscope
N. Vepkhvadze1, M. Kokhreidze1, M. Donduashvili1, K. Goginashvili1,
R. Obiso2, T. Tigilauri1
1
Laboratory for the Ministry of Agriculture, Tbilisi, Georgia, 2Attimo
R&D, Blacksburg, VA, USA
R. Kumar1, G. Sahoo1, K. Trivedi1, R. Kumar1, K. Pandey2,
V. Ravidas2, Y. Ansari3, S. Parva1, R. Mansurri4, P. Das2
1
rmrims, Patna, Bihar, India, 2rmrims, Patna, India, 3Niper, Patna,
Bihar, India, 4niper, Patna, Bihar, India
Purpose: Rotavirus A, which accounts for more than 90% of rotavirus
gastroenteritis in humans, is endemic worldwide. Each year rotavirus
causes millions of cases of diarrhoea in developing countries, almost
2 million resulting in hospitalisation and an estimated 611,000 resulting
in death. Definitive diagnosis of Rotavirus A typically relies on virus
isolation, antigen detection, serological response, or PCR, and each of
these methods is generally time- or cost-prohibitive, thus, they are not
often appropriate for clinical diagnosis.The development of a simple,
rapid, and sensitive method for quantitative detection of Rotavirus
A virus using dynamic light scattering (DLS) Transmission Electron
Microscope (TEM) and Silver nanoparticle labels.
Methods & Materials: Rotavirus specific antibodies are conjugated
to Silver nanoparticles, and aggregation of the silver nanoparticles
probes is induced upon addition of the target virus. DLS is used to measure the extent of aggregation and the mean hydrodynamic diameter is
Purpose: Ticks are important vectors of zoonoses that include rickettsioses, Q-fever, anaplasmosis, babesiosis and lyme disease among
others. These diseases cause febrile illnesses that are usually outside
the differential diagnosis radar of clinicians. Here we describe development of a multiplex PCR for diagnosis of 8 tick-borne zoonoses.
Methods & Materials: Two multiplex PCR methods that can simultaneously detect four pathogens each were developed. Taqman primers and probe sequences were selected from published literature and
base calling specificity confirmed from sequences available in the NCBI
Genbank. Reporter dyes for the probes were selected to allow multiplexing of four targets. Each of the primers/probe set was optimized in
a singleplex assay for each pathogen and then multiplexed into a one
tube assay of four pathogens. Sensitivity and specificity of the assays
was tested using serially diluted control DNA in a singleplex and multiplex formats. Human samples from patients with undifferentiated febrile
illness were tested to evaluate performance of the multiplex assays on
clinical samples.
Results: The primers and probes sets for four targets that worked
at the same conditions were pooled together. Assay one comprised
primers and probes for detection of Coxiella burnetii, Anaplasma
phagocytophilum, Borrelia burgdorferi and Ehrlichia chaffeensis. Assay
two comprised primers and probes for detection of Rickettsia, Babesia,
Bartonella, and Borrelia spp. The assay dynamics of the tests (lower
and upper limit of detection) were comparable when the assays were
performed in singleplex or multiplex formats. The primers and probes
were specific to their targets whether performed in a singleplex or
multiplex assay. On 1100 human samples, the assays have identified
the following infections: 4% Rickettsiae, 5% cases of Q-fever, 2% A.
phagocytophilum cases, 1% cases of E. chaffeensis, and 1% cases
of Borrelia.
Conclusion: Two multiplex PCR assays for detection of important
tick borne zoonoses were developed. The test will be very useful for
cataloguing tick-borne infections in Kenya.
November 1, 2014
diagnosis of rotavirus using silver
nanoparticles probe
tick-borne zoonoses
B. K. Mutai1, J. Waitumbi2
1
Walter Reed Project-Kisumu/Kenya Medical Research Institute,
Kisumu, Kenya, 2Walter Reed Project/Kenya Medical Research
Institute-Kisumu, Kisumu, Kenya
вЂў
22.045 Rapid detection of nanotechnology based
22.046 Development of multiplex PCR for diagnosis of
SATURDAY
Purpose: African Swine Fever virus (ASFv) is the causative agent of
African Swine Fever. ASFv is a large double-stranded DNA virus that
replicates in the cytoplasm of infected cells and is the only member
of the Asfaviridae family. ASFv infects domestic pigs, warthogs and
bush pigs, as well as soft ticks. This infection is characterized by a
high morbidity and mortality rate (>95%). In 2007, several regions in
Georgia were affected by massive porcine mortality. The LMA utilizes
both ELISA and PCR techniques in the detection of ASF. A total of 415
samples out of 2,964 samples tested positive (2007-2010). Some of
those samples were sent to the PIADC for study.
Methods & Materials: The PIADC evaluated 20 ASFv positive samples. The study used Virus visualization by HAD reactionвЂ”all Georgian
virus isolates (twenty) were grown in Primary Swine Macrophage
Cultures (PSMC). Virus stocks were produced and titrated in PSMC.
Virus genomic areas were sequenced in all isolates. Sequenced viruses
were fragmented by CD2 and 9GL in the Virus genome in order to define
the similarity of virus strains circulating within the regions of Georgia.
A cytopathic effect (cell rounding and appearance of refractive bodies)
occurs in at least 50% of cells. Primary porcine macrophage cell cultures
were infected by a pathogenic ASFv isolate and examined 24 hours post
infection, prepared three (3) samples for comparison a) mock-infected,
b) infected and c) infected cells with RBC (Red-Blood-Cells). Then, we
prepared and stained samples with 1% Toluidine blue and tested the
stained cells using a Transmission Electron Microscope (TEM).
Results: In the case of virus detection, samples were placed on
Nickel and Copper Electron Microscope grids and examined using the
Hithachi electron microscope (EM). The microphage of the ASF virus
was detected with high magnification (>10,000). We observed ASFvinfected macrophage with a cytoplasmic Virus Factory (VF) adjacent to
the Nucleus (N) and recruiting mitochondria (M).
Conclusion: TEM is expensive and cannot be afforded by many
laboratories. For the first time, we had the opportunity to study the
vГrus-molecular epidemiology of ASF using the TEM.
correlated to virus concentration. Additional TEM characterization has
been done are provided as further support for the interpretation of the
DLS calibration.
Results: The effects of nanoparticle concentration and size on the
analytical performance of the assay were systematically investigated.
It was determined that decreasing the silver nanoparticles probe concentration improves the detection limit while the effect of changing the
silver nanoparticle size is minimal.
Conclusion: This work not only extends the application of a DLSbased assay to the detection of viruses, it elucidates inherent properties of this approach which make it better suited for virus detection in
comparison to smaller analyte targets such as DNA and proteins. This
assay could be easily implemented in most laboratories for a wide variety of pathogens. Unconjugated silver and antibodies are commercially
available and cost effective.
22.047 Construction of chimeric arctic-like rabies virus
glycoproteins improves pseudotyped virus titre
to permit use in serological studies
E. Bentley1, R. Ali2, D. Horton3, A. C. Banyard 4, E. Wright 1
1
University of Westminster (Viral Pseudotype Unit-Fitzrovia), London,
United Kingdom, 2University of Westminster, London, United Kingdom,
3
University of Surrey, Surrey, United Kingdom, 4Animal Health and
Veterinary Laboratories Agency, Surrey, United Kingdom
Background: The Arctic-like rabies viruses (AL RABV) constitute a
lineage of RABV circulating in the Middle East and Asia with distinct
antigenic and genetic characteristics. As with all lyssaviruses, AL RABV
81
IMED 2014
Poster Presentations I
SATURDAY вЂў November 1, 2014
SATURDAY
вЂў
November 1, 2014
International Meeting on Emerging Diseases and Surveillance 2014
cause an invariably fatal disease of mammals with zoonotic implications. A RABV glycoprotein (G) lentiviral pseudotyped virus (PV) has
shown to be a highly sensitive and specific surrogate to live virus in
neutralisation assays. However, using wildtype AL RABV G failed to
generate infectious PV.
Objective: To generate AL RABV PV with chimeric G and compare
titres achieved with PVs bearing wildtype G. Undertake serology studies to determine the efficacy of current vaccines and antivirals against
this RABV subset.
Methods & Materials: Chimeras were constructed by splicing the
ecto- and transmembrane domains of four AL RABV G strains with the
cytoplasmic domains of vesicular stomatitis virus (VSV) G or RABV
challenge virus standard-11 (CVS-11) G. PV generation followed a
three plasmid transfection protocol and neutralisation assays (IC100)
were undertaken using a panel of sera.
Results: Comparison of PV expressing wildtype or chimeric G
revealed chimeric AL RABV with a VSV G cytoplasmic domain significantly increased PV titres (22-2200 fold). When comparing wildtype
and VSV G based chimeric G PVs the latter showed neutralisation
occurred within a single doubling serum dilution. AL RABV chimeric PV
were neutralised by a range of the serum samples tested.
Conclusion: Infectious PV titre is effectively improved for AL RABV
through the generation of chimeric G with a VSV G cytoplasmic
domain. Comparison of chimeric and wildtype G PV shows switching
the cytoplasmic domain does not affect the neutralisation profile. AL
RABV are neutralised by responses to existing vaccines and therapeutics. On-going serological studies will fully evaluate the efficacy of
current vaccines and antivirals against these viruses.
22.048 Detection of specific antibodies to Francisella
tularensis antigens to differentiates vaccine
and infection process
A. Gorbatov1, P. SolovвЂ™ev1, V. Firstova1, E. Baranova1, E. Panfertsev1,
A. Mokrievich 1, N. Pavlovich2, N. Aronova2, S. Biketov1
1
SRCAMB, Obolensk, Russian Federation, 2Anti-plague research
institution, Rostov -on -Done, Russian Federation
Purpose: Tularemia diagnostics in human is based mainly on detection of specific antibodies (Ab) to F.tularensis(Ft). However, it may be
difficult to diagnose tularemia infection in vaccinated humans because
they have positive reaction in serological tests which based on LPS
of vaccine strain of F.tularensis(TLV). Previously we observed that
animals infected by F.tularensis holarctica strains generated antibodies to LPS F.novicida.The purpose of this work was to evaluate the
serodiagnosis tests in rapid lateral flow (LF) format constructed with
LPS Ft, LPS F.novicida and FTT-1696 antigens.
Methods & Materials: Methods. LPS Ft, LPS F.novicida or FTT-1696
antigens were adsorbed to test line of each test. Sera obtained from
rabbits immunized with TLV or challenged with Ft holarctica or Ft mediasiatica 30 days ago was used. Human sera obtained from vaccinated
with TLV or donors after recovery from Ft holarctica also were analyzed.
Data of LFests were confirmed in dot-blot, Western-blot and ELISA.
Results: Results. Ab to LPS Ft were found in all sera, obtained from
tularemia recovered rabbits and humans, and only in 30% of sera were
detected Ab to LPS F.novicida. Abs to LPS Ft and F.novicida were found
in all serum, obtained from rabbit challenged with Ft mediasiatica. Ab
to FTT-1696 were found in 70% of tularemia recovered human serum
and in all serum obtained from rabbit challenged with Ft holarctica or Ft
mediasiatica.Ab to LPS F.novicida were not found in all sera obtained
from human or rabbits immunized with TLV. Ab to LPS Ft and FTT-1696
were found in 80% and 30%, respectively, in human sera vaccinated
with TLV.
Conclusion: Conclusion. Simultaneous detections of Ab to LPS Ft
and LPS F.novicida get opportunity to differentiate Ab response during vaccine and infection tularemia processes. Sera from vaccinated
people and rabbits contain only antibodies to LPS Ft. Antibodies to
FTT-1696 proteins could be found only in serum with high antibody
titers to F.tularensis and could not differentiate vaccine and infection
tularemia processes.
82
IMED 2014
22.049 Multiplex molecular assay for diagnosis of
multiple respiratory diseases of pigs in a
single sample
P. Naraghi-Arani1, C. Jaing1, A. C. Carrillo2, J. Olivas2, G. Anderson3
1
Lawrence Livemore National Laboratory, Livermore, CA, USA,
2
Lawrence Livermore National Laboratory, Livermore, CA, USA,
3
Kansas State University, Manhattan, KS, USA
Purpose: To develop a multiplex molecular diagnostic assay that can
be used to simultaneously detect and differentiate between multiple
respiratory pathogens of swine from oral fluids. The assay is to be used
for diagnosis of commonly occuring pathogens of pigs and includes
assays for foreign animal diseases in order to enable rapid, highthroughput surveillance during outbreaks of ASF and CSF.
Methods & Materials: A multiplex molecular assay using multiplex
RT-PCR followed by hybridization to probe-coupled beads and
analysis on the Luminex MagPix instrument has been developed.
Results: The assay enables detection and differentiation of 4 bacterial (M. hyponeumoniae, A.pleuropneumoniae, H.parasuis, and S.suis)
and 6 viral pathogens (PRRS, Flu, PCV2, Pseudorabies Virus, ASF,
CSF) with no cross-reactivity to clinical and genetic near-neighbor
organisms. In addition to endemic diseases, the assay is able to detect
and differentiate between African Swine Fever and Classical Swine
Fever. The 25-plex assay has sensitivity of 1000 infectious units or less
per ml of porcine oral fluid.For Influenza detection, an LOD of 200 infectious units per ml has been demonstrated.
Conclusion: The assay is expected to be of utility in clinical diagnosis of important endemic diseases as well as surveillance for FADs
22.050 Validation of pyrazinamide susceptibility
testing of Mycobacterium tuberculosisby
reverse hybridization assay
V. Trangan1, Y. Kondo2, S. Foongladda1
1
Mahidol University, Bangkok, Thailand, 2Nipro Corporation, Osaka,
Japan
Purpose: Pyrazinamide (PZA) is a first-line drug for tuberculosis treatment. Pyrazinamide resistance has a correlation with mutation in pncA
gene of M. tuberculosis that encoded for pyrazinamidase to get the
active pyrazinoic acid. The objective of this work was to evaluate the
line probe assay (LiPA) kit which includes 47 probes cover the entire
pncA gene of wild-type to detect PZA resistance.
Methods & Materials: A total of 92 clinical isolates of multidrugresistant M. tuberculosis (MDR-TB, n = 78) and M. bovis BCG (n = 14)
were tested with the LiPA kit. Among these isolates, 48 were previously
found to be resistant to PZA by the BACTEC MGIT 960. The results
obtained were compared with DNA sequencing and MGIT method.
Results: LiPA was 93.5% concordance to sequencing results with a
sensitivity and specificity of 87.0% and 100%, respectively. All 6 discrepancies attributed to heterogeneous of mutant pncA gene mix with
wild-type that were revealed by sequencing. All M. bovis BCG strains
was detected by probe number 16 of C-to-G point mutation at codon 59.
Sequencing of pncA was concordant to initial MGIT for 76/92 isolates
(82.6%). After retesting, MGIT method showed reproducibility of 84.8%
with shifting of 7 resistant to susceptible and 7 susceptible to resistant.
Afterward, MGIT and sequencing results was 97.8% concordance. Two
strains of PZA resistance by MGIT did not show any mutation on pncA
gene by both LiPA and sequencing.
Conclusion: The results of LiPA kits were good correlation with
pncA sequencing. The LiPA is a rapid and reliable test for the detection of pncA gene mutation and is good predicator for PZA resistance,
because MGIT can be hampered by false results. The limitation of the
LiPA test is mix population of sequences.
Poster Presentations I
SATURDAY вЂў November 1, 2014
International Meeting on Emerging Diseases and Surveillance 2014
22.051 Role of matricellular proteins in systemic and
local immune response to Mycobacterium
tuberculosis infection
B. Shiratori1, F. Hasibuan2, A. Senoputra2, H. Chagan-Yasutan1,
B. Alisjahbana2, T. Hattori1
1
Tohoku University, Sendai, Japan, 2Universitas Padjadjaran,
Bandung, Indonesia
Purpose: Candida glabrata has emerged as an important nosocomial
pathogen, yet little is known about its epidemiology. Aims: we aimed
to identify possible variation in the population structure of C.glabrata
isolates by polymorphic markers analysis from hospitalized and non
hospitalized patients.
Methods & Materials: Two populations of isolates were considered
in our study. The first included 108 isolates from in-patients. The second
population was collected from the out-patients and contain 24 isolates
from vaginal site and three isolates from buccal site.
Results: A total of 135 Candida glabrata isolates were typed using
polymorphic markers. Multilocus analyses resulted in the delineation
of 52 genotypes. We allowed the identification of 8 new alleles and 25
new genotypes. Five genotypes G14, G42, G20, G15 and G35 were the
most frequent and represented 54.8% of the entire population. These
genotypes were identified in all studied isolation sites except buccal
site which were unique. Three genotypes G42, G14 and G20 predominated in both invasive and non-invasive population and in hospitalized
and non hospitalized. Moreover, the genotype G35 was absent in outpopulation (vaginal and buccal samples) and four patients (among 7
patients) infected with genotype G35 were hospitalized in the same
intensive care unit and period.
Conclusion: We can conclude that very little differentiation exists
between both hospitalized and non hospitalized patients and invasive
and colonizing population. Endogenous flore of the host was the main
source of infection but inter-patient transfers can be also exist but still
quite common and canвЂ™t be in important factor in the transmission of
this yeast in our hospital.
Purpose: The increased number of outbreaks of H5 and H7 LPAI and
HPAI viruses in poultry has major public and animal health implications.
The continuous rapid evolution of these subtypes and the emergence
of new variants influence the ability to undertake effective surveillance.
Retroviral pseudotypes bearing influenza haemagglutinin (HA) and
neuraminidase (NA) envelope glycoproteins represent a flexible platform for sensitive, readily standardized influenza serological assays.
We describe a multiplex assay for the study of neutralizing antibodies
that are directed against both influenza H5 and H7 HA. This assay
permits the measurement of neutralizing antibody responses against
two antigenically distinct HAs in the same serum/plasma sample thus
increasing the amount and quality of serological data that can be
acquired from valuable sera.
Methods & Materials: Sera obtained from chickens vaccinated
with a monovalent H5N2 vaccine, chickens vaccinated with a bivalent
H7N1/H5N9 vaccine, or turkeys naturally infected with an H7N3 virus
were evaluated in the pseudotype assay (simple and multiplex format).
Results: The results obtained using the pseudotype-based assays
correlated strongly with data obtained by HI assay. We show that pseudotypes are highly stable under basic cold-chain storage conditions
and following multiple rounds of freeze-thaw.
Conclusion: We propose that this robust assay may have practical
utility for in-field serosurveillance and vaccine studies in resourcelimited regions worldwide.
November 1, 2014
in Sfax, Tunisia
A. Salma, A. Imen, S. Hayet, T. Houaida, F. Cheikhrouhou,
N. Sourour, A. Ayadi
Laboratory of Parasitology Mycology, Sfax, Tunisia
E. Molesti1, E. Wright 2, C. Terregino3, R. Rahman1, G. Cattoli4,
N. Temperton1
1
University of Kent, Chatham Maritime, United Kingdom, 2University
of Westminster, London, United Kingdom, 3Istituto Zooprofilattico
Sperimentale delle Venezie-IZSVe, Legnaro (PD), Italy, 4Istituto
Zooprofilattico Sperimentale delle Venezie, Legnaro, Padova, Italy
вЂў
22.052 Genetic structure of Candida glabrata isolates
antibodies with potential applicability to in-field
serological studies
SATURDAY
Purpose: Matricellular proteins (MP), such as osteopontin (OPN),
galectin-9 (gal-9) and tenascin-C (TN-C) are expressed upon physiological processes, but also during infection, inflammation, or tumorigenesis. We studied plasma MP levels as potential markers of tuberculosis
(TB) activity.
Methods & Materials: Plasma levels of MP and other biomarkers
were measured by ELISA and Luminex assay in 16 TB cases, 66 LTBI
individuals and 35 healthy individuals. Granulomatous disease biopsies were examined for gal-9.
Results: Levels of OPN and TN-C was higher in active TB patients
compared to healthy individuals (HC) and latently infected individuals
(LTBI). Moreover LTBI had higher OPN level compared to HC. No significant difference of gal-9 levels was found among groups. Studied
MP correlated with each other in TB group, but not in LTBI and HC
groups. In TB group, plasma MP levels also correlated with G-CSF and
IL-6, and high OPN and TN-C levels were associated with neutrophilia
and lymphocytopenia. To investigate the role of gal-9 in TB infection,
we studied the expression of gal-9 in TB granuloma and compared
its expression to other granulomatous diseases. Positive gal-9 staining
was observed only in TB granuloma, but not in sarcoidosis and
CrohnвЂ™s disease granulomas. Intracellular gal-9 was detected inside
of the TB granuloma encapsulated by fibrotic tissue. To investigate
whether gal-9 plays role in granuloma necrosis, we performed in vitro
apoptotic and necrotic assays. Gal-9 showed dose dependent apoptotic and necrotic effect on Jurkat, and ED 40515(-) cells.
Conclusion: We propose that OPN and TN-C levels may serve as
a good markers to monitor TB disease severity. For the first time, we
showed the localization of gal-9 in TB granuloma and suggest that
gal-9 is one of the factors involved in granuloma necrosis.
22.053 Multiplex evaluation of influenza neutralizing
22.054 Genetic structure of Aspergillus flavus
populations in human and avian isolates
H. Ines1, N. Sourour1, F. Cheikhrouhou1, T. Houaida1, S. Hayet1,
G. Raida1, F. Makni1, R. StГ©phane2, A. Ayadi1
1
Laboratory of Parasitology Mycology, Sfax, Tunisia, 2Laboratory of
Parasitology Mycology, Marseilles, France
Purpose: Aspergillus flavus is the second leading cause of allergic,
invasive, and colonizing fungal diseases in humans, and also the second most frequent organism associated with avian infections. Currently,
it is not known whether there is a link between the environmental
isolates and/or human isolates of A. flavus and those responsible for
aspergillosis in birds.
Methods & Materials: Microsatellite typing was used to analyze 29 A.
flavus clinical and environmental avian isolates and 63 human clinical
isolates collected from patients with a variety of aspergillosis diseases.
Results: The combination of all six markers yielded 77 different genotypes with a 0.98 D value. A. flavus genotypes obtained from avian
isolates were compared with those obtained from human clinical and
environmental samples. The standardized indices of association IA and
rBarD were significantly different from zero (pвЂ‰<вЂ‰0.01), suggesting a prevailing clonal reproduction. There was high genetic diversity between
the hospital and poultry environments of A. flavus isolates. The human
environmental population was significantly differentiated from environmental and clinical avian populations (FstвЂ‰>вЂ‰0.25). The avian clinical
subpopulation exchanged few strains with the environmental human
(NmвЂ‰=вЂ‰7.24) and avian (Nm =вЂ‰6.60) populations. The minimum spanning tree analysis identified three A. flavus genotype clusters that were
highly structured according to the isolation source (pвЂ‰<вЂ‰10-4).
Conclusion: The present study describes a specific population structure of human environmental Aspergillus flavus isolates which was
clearly distinct from environmental and clinical avian populations.
Further studies are needed in order to better understand the epidemiology of A. flavus at a wider geographical scale and in particular situations, such as in hospitals or avian farms, where invasive aspergillosis
(IA) outbreaks occur.
83
IMED 2014
Poster Presentations I
SATURDAY вЂў November 1, 2014
International Meeting on Emerging Diseases and Surveillance 2014
22.055 ReLASVВ® Pan-Lassa Immunodiagnostics for the
detection of Lassa fever in West Africa
SATURDAY
вЂў
November 1, 2014
M. Boisen1, A. Goba2, L. Branco3, O. Folarin4, P. Sabeti5, E. Saphire6,
D. Asogun7, C. Happi4, S. H. Kahn2, R. Garry8
1
Corgenix Inc., Broomfield, CO, USA, 2Kenema Government Hospital,
Kenema, Sierra leone, 3Zalgen LLC, Germantown, MD, USA,
4
Redeemer University, Lagos, Nigeria, 5Broad Institute, Cambridge,
MA, USA, 6Scripps Research Institute, La Jolla, CA, USA, 7Irrua
Specialist Teaching Hospital, Irrua, Nigeria, 8Tulane University, New
Orleans, LA, USA
Purpose: Lassa fever is a severe viral illness endemic to west Africa
which can progress to hemorrhagic fever with high mortality. The Viral
Hemorrhagic Fever Consortium (VHFC.org) has developed Pan-Lassa
immunoassays to detect Lassa fever in austere laboratory environments. These new prototypes utilize reagents specific for three variants
of Lassa virus (LASV) nucleoprotein (NP) that represent the strains
of LASV currently circulating in Nigeria and Sierra Leone. The prototypes that were evaluated include ReLASVВ® Pan-Lassa Antigen Rapid
Diagnostic Test (RDT), Antigen ELISA, and IgG/IgM ELISA Tests. The
aim of this study was to establish immunoassay clinical effectiveness in
Nigeria and Sierra Leone.
Methods & Materials: ReLASVВ® Pan-Lassa immunoassays were
developed using recombinant LASV NP and affinity purified LASV
NP specific rabbit polyclonal antibody. Testing was performed using
banked and fresh serum samples from Irrura Specialist Teaching
Hospital, Irrura, Nigeria and Kenema Government Hospital, Kenema,
Sierra Leone. Samples from suspected cases or contacts were
screened using the Pan-Lassa Antigen RDT followed by Pan-Lassa
ELISA testing for NP antigen, IgM, and IgG reactivity. Some antibody
positive samples received endpoint titer testing of multiple samples
to demonstrate conversion from NP+ to IgM+ or seroconversion from
IgM+ to IgG+ (class-switching). For confirmation of LF, RT-PCR testing
was repeated on freshly extracted viral RNA.
Results: The final clinical performance dataset consisted of 32
Nigerian, 92 Sierra Leone. Using a combined diagnostic algorithm (Ag+
and/or IgM+), the Pan-Lassa diagnostics demonstrated Sensitivity
of 94% and Specificity of 86%. Positive Predictive Value (PPV) was
83.6% but this includes 7 of 9 false-positive samples that were in
fact IgG+/PCR- which would indicate these patients were post-acute
or LF convalescent. Removing these 7 cases increases the PPV to
96% vs RT-PCR. Performance on Nigerian and Sierra Leone samples
showed no significant difference for Sensitivity or Specificity between
LF endemic countries.
Conclusion: The ReLASVВ® Pan-Lassa prototypes successfully
detected Lassa fever in suspected cases in Nigeria and Sierra Leone.
Using the combined diagnostic results algorithm, this suite of tests
detected 94% of PCR confirmed LF cases and represent a viable LF
screening method for laboratories in LF endemic countries.
22.056 EUROIMMUN Dengue Virus NS1 ELISA is more
sensitive than PanbioВ® Dengue Early ELISA for
early detection of dengue virus infection
N. Ewers1, S. SchГјtt2, A. Kuhlencord 1, J. M. Warnecke2,
K. Steinhagen2, W. Schlumberger2
1
MVZ DIAMEDIS GmbH, Bielefeld, Germany, 2Euroimmun AG,
LГјbeck, Germany
Purpose: Dengue fever is a potentially life-threatening viral disease
caused by dengue virus (DENV). For early infection diagnosis, serological detection of DENV nonstructural glycoprotein 1 (NS1) is the
most suitable method.
Objective: We evaluated the performance of the EUROIMMUN
Dengue Virus NS1 ELISA in comparison to the well-established
PanbioВ® Dengue Early ELISA.
Methods & Materials: 413 routine serum samples from patients
with suspected DENV infection were tested by both NS1 ELISA capture assays. Divergent results were further analyzed using different
serology-based methods.
84
IMED 2014
Results: Comparison of the two NS1 capture ELISAs led to an overall correlation of 91%.
PanbioВ® Dengue Early ELISA
n=413
positive
EUROIMMUN
Dengue Virus
NS1
ELISA
borderline
negative
positive
76
2b
8b
borderline
0
0
1
negative
1a
0
325
a Follow-up samples from this patient showed no seroconversion, clearly
indicating no active DENV infection.
b Additional serological analyses indicated a potentially active DENV infection
in all 10 cases.
In 11 sera with dissimilar outcome, correctness of EUROIMMUN
Dengue Virus NS1 results could be confirmed by additional serological
testing.
Conclusion: The EUROIMMUN Dengue Virus NS1 ELISA is 9%
more sensitive than the PanBioВ® ELISA and thus ideally suited for
screening patients with suspected acute DENV infection.
New Approaches to Outbreak Surveillance
and Monitoring
22.057 Local perception and traditional practices to
cope with malaria risk affect related health
policy in the Logone Valley (Cameroon)
B. Marquis1, J.-A. Ndione2, O. Faye3, M. Tsalefac4
UniversitГ© Cheikh Anta Diop, Dakar, Senegal, 2Centre de Suivi
Ecologique, Dakar, Senegal, 3UniversitГ© Cheikh Anta Diop/Ecole
Doctorale Eau, QualitГ© et Usages de lвЂ™Eau, Dakar, Senegal, 4The
University of Yaounde I, Yaounde, Cameroon
1
Purpose: Malaria, a highly environmental dependent disease remains
a major concern for public health in the sahelian Logone Valley.
Therefore, improving the health policy requires a holistic assessment
of environmental factors that influence the malaria seasonal outbreaks.
None of the studies carried out in this area focuses on local perception,
knowledge and traditional practices. Consequently, the question that
needs to be addressed is how inhabitants perceive and try to cope
with malaria risk there. The objective of this study is to examine the
relevance of existing malaria risk-related local perception on the management strategies in the Logone Valley.
Methods & Materials: The study was conducted during the period
from 15th March to 30th May 2013, in the Health district of Yagoua,
Mayo-Danay Division in the Far-North Region of Cameroon. The study
included a structured questionnaire about malaria-related information
administered to households, 3 in-depth interviews, 3 group discussions, field visits and picture assignment.
Results: The results revealed that 40% respondents ended up
school in primary level, 15%. Most of them (87%) were familiar with the
main symptoms of malaria. 45% responded that mosquito bite causes
malaria while the remaining proportion (65%) indicated that the disease
transmission is related to various environmental factors. 50% new quinine. 35% were found consulting traditional healers for the treatment
and a similar percentage of the respondents declared using tradition
medicine in addition to cure malaria. The outside sleeping habit was
found in almost 70% of the population mainly in hot season (between
March and June). Only 13% had knowledge on insecticide impregnated
bednets.
Conclusion: The findings indicate that a well designed Health educational program would be an important step in increasing community
participation in environmental management for malaria control in the
Logone valley. The National Malaria Control Program (NMCP) could
benefit from this ecohealth approach to produce desired outcomes in
malaria control.
Poster Presentations I
SATURDAY вЂў November 1, 2014
International Meeting on Emerging Diseases and Surveillance 2014
22.058 Development of a new antigen for screening
diagnostics of animal brucellosis
K. A. Khamdamov, R. G. Yaraev, B. H. Kuvatov, S. A. Rahmatullaev
Veterinary Research Institute, Samarkand, UZ, Uzbekistan
Purpose: CRISPR-Cas (clustered regularly interspaced short palindromic repeat вЂ“CRISPR-associated proteins) adaptive immune system
is responsible for developing immunity against invading foreign mobile
genetic elements such as plasmids and bacteriophages in prokaryotes. CRISPR loci are constructed from a chain of ca. 30 bp repeated
sequences (direct repeats, DR). In between DRs are unique spacer
sequences, which originate mostly from conjugative plasmids or phage
genomes. The spacer setup of the CRISPR loci is specific and reflects
the evolutionary history of the bacterium. Our aim was to generate a
comprehensive CRISPR database for typing Y. pseudotuberculosis
strains and to evaluate their potential phylogenetic relationships with
Y. pestis.
Methods & Materials: More than 300 Yersinia strains were studied,
including 201 Y. pestis, 120 Y. pseudotuberculosis, ten Y. similis and
four Y. wautersii strains.
Results: Altogether 1902 different spacer sequences were identified
from the three CRISPR genomic loci. A Small fraction of these spacer
sequences found matching sequences in the databases, these mostly
being of prophage origin.
Conclusion: Our results revealed major differences among the spacers of Y. pseudotuberculosis complex strains. This method may be useful for forensic applications and outbreak monitoring; however, this will
require the generation of an extensive reference database. Our results
Purpose: In 2012 Russian Federation joined the International
Convention for the Control and Management of ShipsвЂ™ Ballast Water
and Sediments, 2004, developed within the scope of activities of the
International Maritime Organization. For realization of the Convention
rules it is necessary to organize collection and analysis of ballast water
samples in Russian ports.
Methods & Materials: The standard for ballast water quality on ships,
which are required to manage their ballast, stipulates discharge concentrations of indicator microbes, including: toxigenic Vibrio cholerae (O1
and O139)вЂ”less than 1 colony forming unit (CFU) per 100 ml and less
than 1 CFU per 1 g (raw weight) of zooplankton samples; Escherichia
coliвЂ”less than 250 CFU per 100 ml, intestinal EnterococciвЂ”less than
100 CFU per 100 ml.
Results: Since 2010 the Rostov Anti-Plague Institute was carrying
out investigations of ballast water from international sea traffic in the
Azov sea basin for detection of human pathogenic vibrios. During the
study period different sampling methods were approbated, ship routes
with isolation of V. cholerae non-O1/non-O139 were analyzed, the
algorithm was developed for preventive measures in case of detection
of cholera causative agents, which were nРѕt recorded so far.
In 2012 the potential of molecular proteomic mass-spectrometry was
used in investigations. Bacterial identification with the help of MALDITOF mass-spectrometry presents an addition to standard methods of
detection. Though the Bruker database lacks profiles of cholera etiological agents, we managed to gain some experience of identification,
using the commercial Biotyper database for ship ballast monitoring in
2012-2013.
Conclusion: The monitoring results showed evidence of possible importation into the Azov sea basin of Vibrio species. The use
of MALDI-TOF mass-spectrometry improved informational value of
the study, increased spectrum and rate of bacteriological findings. The
ongoing investigations would contribute to realization of the Convention
rules on the territory of Russian Federation.
November 1, 2014
complex with CRISPR analysis
K. Koskela1, L. Mattinen2, L. Kalin-MГ¤nttГ¤ri1, G. Vergnaud3,
O. GorgГ©3, S. Nikkari1, M. Skurnik2
1
The Finnish Defence Forces, Helsinki, Finland, 2University of
Helsinki, Helsinki, Finland, 3UniversitГ© Paris-Sud, Orsay, France
water in the South of the Russian Federation
S. Vodyanitskaya, N. Pshenichnaya
Rostov State Medical University, Rostov-on-Don, Russian Federation
вЂў
22.059 Typing of Yersinia pseudotuberculosis
22.060 Microbiological monitoring of shipsвЂ™ ballast
SATURDAY
Purpose: Brucellosis is a zoonotic disease that causes human suffering and great economic loss. When implemented, the control of this
disease is usually based on vaccination, serological testing, and culling. In regions where brucellosis is widely spread, mass epidemiological screening tests are one of the most effective means for controlling
this dangerous disease. In the USA, a rapid method called the Card
test has been developed for the diagnosis of bovine brucellosis. Rose
Bengal Antigen imported from Russia to Uzbekistan is made of Brucella
abortus19 strain. Our research was devoted to the development of a
new antigen that possesses more specificity and agglutinability (more
agglutinable) compared to the antigens of vaccine strain 19.
Methods & Materials: We tested vaccine strain Brucella abortus
104M as an antigen for Rose Bengal Test due to its high agglutination properties and ability to grow quickly, which is important for the
industrial manufacture of antigen. Three day-old Brucella culture was
inactivated at 800C and then in a 0.5% phenol solution at pH 3.75 and
then tested for activity and specificity.
Results: Activity of a new brucellosis antigen was verified using 40
serum samples of cattle, experimentally infected by brucellosis. Results
showed that experimentally infected animalsвЂ™ serum reacted with the
new antigen as a large-grained agglutinate, and that this antigen was
as active as brucellosis antigen of Russian origin. The specificity of
the brucellosis antigen was tested on 407 cattle serum, including; 30
samples of animals vaccinated against emphysematous carbuncle,
50 samplesвЂ”against anthrax, 30 samplesвЂ”against tuberculosis,
15 samplesвЂ”against foot and mouth disease, 40 samplesвЂ”against
leptospirosis, as well as 20 samplesвЂ”calves up to 2 month age (free
of brucellosis), 162 samplesвЂ”healthy cattle of private households,
and 60 samplesвЂ”3вЂ“6 month age calves before vaccination. Results
showed that the brucellosis antigen developed in the Uzbek Research
Institute of Veterinary gave negative results with serum of various animal groups.
Conclusion: These results testified to the great promise of using this
new antigen for mass animal screening in regions where brucellosis is
widely spread.
suggest that Y. pestis has lived protected or secluded life and it probably has not encountered many foreign transforming DNAs. Apparently
in the life cycle of Y. pestis there have been rare instances where it
has been exposed to other bacteria or bacteriophages. Therefore, a
relatively low number of spacers are present in Y. pestis compared to
Y. pseudotuberculosis.
22.061 The value of evidence from syndromic
surveillance
G. M. Andersson1, C. Faverjon2, F. Vial3, L. Legrand4, A. Leblond5
1
National Veterinary Institute (SVA), Uppsala, Sweden, 2VetagroSup,
Marcy lвЂ™Etoile, France, 3Vetsuisse FakultГ¤t, Berne, Switzerland,
4
Normandie Universite, Caen, France, 5Vetagrosup and INRA UR346,
Marcy LвЂ™Etoile, France
Background: In syndromic surveillance, an aberration detection
algorithm typically alerts when the observed counts from some epidemiological indicator[FV1] exceed a threshold value. However,
such, binary result can be difficult to combine with other knowledge.
The art of presenting scientific evidence to decision makers has been
more extensively studied in forensic sciences in which legal certainty
requires statements that clearly specify how strong the evidence for/
against an hypothesis is and how the expert reached that conclusion.
Forensic evidence is evaluated using likelihood ratios in the framework
of Bayesian hypothesis testing. The central concept is the value of evidence (V), the likelihood ratio for the observed results given the main
hypothesis and the alternative hypothesis.
Objective: To demonstrate how the value of evidence concept may
be incorporated into a decision support system to calibrate the output
from syndromic surveillance systems for the purpuse of warning and
informed decision making.
85
IMED 2014
Poster Presentations I
SATURDAY вЂў November 1, 2014
International Meeting on Emerging Diseases and Surveillance 2014
SATURDAY
вЂў
November 1, 2014
Methods & Materials: The predicted distribution of reported cases in
a non-outbreak situation and the expected distribution of cases during
an outbreak are exploited to calculate the likelihood ratio for observing
n cases given no outbreak over the likelihood for the same number of
cases given an ongoing outbreak. The concept is demonstrated using
data on horses presenting nervous and respiratory symptoms.
Results: Weekly counts on nervous and respiratory syndromes [FV1]
from 2006 to2010 were fitted to alternative regression models based on
Poisson and Negative Binomial distributions respectively. The counts
from historical outbreaks of West Nile Virus and New Influenza were
fitted to a NB model. Using different scenarios we demonstrate how V
may be translated to verbal statements or combined with estimates of
risk of introduction (Pprior) and costs of different outcomes to estimate
the utility of a decision. By lowering action threshold at high risk seasons the sensitivity is increased without loosing specificity.
Conclusion: The value of evidence concept is a promising approach
for presenting results from syndromic surveillance. The approach is
in concordance with the risk analysis framework by offering explicit
separation of assumptions (Pprior), value of evidence (V), criteria for
decisions and a transparency of how the evidence is evaluated.
22.062 Suite for Automated Global Electronic
bioSurveillance (SAGES) update:
Re-engineering software to improve ease
of installation, use, and sustainability
A. Katz1, T. Campbell1, G. Gorelick-Feldman1, J. Coberly1, R. Wojcik1,
S. Patel1, B. Feighner1, C. Perdue2, S. Lewis1
1
Johns Hopkins University Applied Physics Laboratory, Laurel, MD,
USA, 2US Armed Forces Health Surveillance Center, Silver Spring,
MD, USA
Purpose: SAGES is a collection of open source software tools for electronic disease surveillance in resource-limited settings. The SAGES
architecture uses mobile and web-based methods to collect structured
data from SMS, Wi-Fi, and Internet connected devices. The primary
data analysis tool, OpenESSENCE, provides a web-based interface
supporting data analysis, visualization, and reporting. SAGES tools are
now in use in several countries on three continents, with several more
installations planned.
This presentation describes the SAGES collection of tools and the
on-going re-engineering effort to improve ease of installation, configuration, and use. We describe challenges encountered when designing
tools for use in resource-limited settings, including downstream effects
of decisions made at the projectвЂ™s inception. Particular attention will be
paid to the trade-offs between designing individual, customized systems (requiring heavy technical support) versus generic вЂ�80% solutionвЂ™
systems that are closer to functioning вЂ�out of the box.вЂ™
Methods & Materials: The past five years have seen significant
advancements in open source software, technological approaches to
data management, and our understanding of the issues involved with
deploying SAGES systems. All of these advancements called for a reengineering effort to improve our SAGES tools. Additionally, while our
intitial engagement strategy of customized installation was successful, it required significant external technical support during installation
and configuration of the SAGES tools. After surveying the technical
landscape for solutions that met our new technical requirements, we
re-engineered several SAGES tools.
Results: Our re-engineering effort has resulted in SAGES tools
which are easier to install, configure, and use. Users now have significantly enhanced web and mobile interfaces, with greater flexibility
when querying the data and generating analysis products. The result
is an improved вЂ�out of the boxвЂ™ capability while still allowing advanced
developers to enhance or customize SAGES systems.
Conclusion: The SAGES project is intended to enhance electronic
disease surveillance capacity in resource-limited settings around the
world. We have re-engineered our SAGES tools with an eye toward
ease of installation and use, with an ultimate goal of creating a selfsustaining SAGES users community. We believe the SAGES tools
facilitate local and regional disease surveillance, regional public health
collaborations, and increased WHO IHR 2005 compliance.
86
IMED 2014
22.063 Using exterminator visits to characterize
flea and tick home infestationsвЂ”A novel way
to assess disease vectors at the humanenvironment interface
G. Lamielle, K. Ehnert
County of Los Angeles, Department of Public Health, Los Angeles,
CA, USA
Purpose: Complete control and management of vector-borne diseases
such as endemic typhus can be challenging due to the persistence of
vectors in the environment, and information on the local distribution
of fleas and ticks is often limtied. By using an under-utilized resource,
local exterminator data, we aim to assess the geographic and temporal patterns of home infestations with fleas and ticks in Los Angeles
County.
Methods & Materials: To our knowledge, using local exterminators
data to evaluate home infestations with fleas and ticks has never been
done before. Exterminators were contacted by the Veterinary Public
Health (VPH) program to collect data about home flea and tick infestations, consisting of: initial visit date, zip code and vector species (flea
vs. tick). Temporal and geographical analysis was performed using
ArcGIS and Epi-Info 7.
Results: The initial results of this on-going study yielded a higher
number of home visits for flea infestations than originally anticipated.
Flea infestations also showed a highly seasonal pattern, whereas tick
infestations appeared more randomly distributed in time.
Conclusion: This project represents a new strategy for surveillance
of vectors in close proximity to humans, and therefore with a higher
potential of disease transmission. This information may be used by
public health departments to conduct targeted educational outreach for
flea and tick prevention, thus reducing the role of companion animals
in the transmission of zoonoses carried by fleas and ticks. In addition,
the results may help local veterinarians advocate for the year-round
use of pet ectoparasite preventives by their clients, further reducing
local disease risk.
22.064 The Kombewa health and demographic
surveillance systems in rural Western Kenya
(Kombewa HDSS)
P. Sifuna, J. Cowden, A. Berhane, R. Coldren, W. Otieno, M. Oyugi
Usamru-k, Kisumu, Kenya
Purpose: The Kombewa Health and Demographic Surveillance
System (HDSS) established by the U.S. Army Medical Research Unit
вЂ“Kenya (USAMRU-K) in rural Western Kenya, is a registration system
designed to track the evolving health status, demographics and health
threats of the catchment population over time. A dynamic cohort of
141,956 residents drawn from 34,718 households forms the HDSS
surveillance population.
Methods & Materials: The core of the HDSS consists of biannual
household visits to register new or outgoing residents and record any
vital demographic changes (births, deaths, or pregnancies) that have
occurred in the interim. A standard verbal autopsy technique is applied
by the program to determine probable cause of registered deaths. A
short questionnaire on illnesses and health-seeking behavior in the
two weeks before the study enumeration visit is included in the HDSS
surveys to obtain data on prevalence of syndromes at household level.
The program is currently developing capability to link hospital data with
the HDSS so that clustering of various diseases presenting to hospital
(inpatient or outpatient) can be better identified.
Results: Under-five mortality rate for the area is estimated at 118
deaths/1000 live births. Using the household morbidity data, we have
estimated the prevalence of malaria in the study area at 184/1,000
residents/year and prevalence of convulsions among children under
the age of five years at 15/1, 000 children under the age of five per
year. The Kombewa HDSS has successfully supported recruitment
and retention activities for several research studies nested within it,
including the concluded phase 3 randomized, controlled trial of RTS,S/
AS01 malaria vaccine. Published results have shown that the vaccine
reduces episodes of both clinical and severe malaria in children 5 to 17
months of age by approximately 50%.
Poster Presentations I
SATURDAY вЂў November 1, 2014
International Meeting on Emerging Diseases and Surveillance 2014
Conclusion: The HDSS is an important surveillance platform for
determining disease burden (the population size is known, so there
is a denominator against which to measure indicators and diseases of
interest). All houses are GPS-mapped, so individuals in the study area
have an вЂњaddressвЂќ for use in case of an outbreak. The Kombewa HDSS
encourages sharing of data under approved collaborations for ethically
approved activities.
22.065 Combining semi logarithmic plotting and
piecewise regression: a method to describe
complex temporal dynamics of epidemics
and to detect emerging patterns
V. Auvigne1, F. Nicod1, P. GuГ©rin2, L. Toubiana3
Ekipaj, Angers, France, 2Celtipharm, Vannes, France, 3INSERM ;
UPMC : UniversitГ© Pierre et Marie Curie-Paris 6, Paris, France
1
Purpose: Invasive listeriosis is a rare, life-threatening foodborne
disease. Most industrialized countries have developed surveillance
system for listeriosis since 1987. European surveillance system are
passive, in particular in Italy the notification of listeriosis has been mandatory since 1990. In Lombardy region (about 10 million inhabitants,
17% of Italian popolation), the national mandatory notification system
of listeriosis since 2005 has been integrated with a laboratory-based
network involving voluntary referral of human isolates and standardized data-sheet (demographic, clinical and microbiological data) to the
Regional Reference Centre-RRC (University of Milan).
A. Ukharov1, A. Burdakov1, P. Imnadze2, N. Papelova3, K. Sanadze2,
K. Zakhashvili2
1
Black & Veatch, Overland Park, KS, USA, 2National Center for
Disease Control and Public Health of Georgia, Tbilisi, Georgia,
3
Black & Veatch, Tbilisi, Georgia
November 1, 2014
model in Lombardy region (Italy, 2006вЂ“2012)
E. Amato1, S. Azzini1, A. Piatti2, M. M. Pontello1
1
University of Milan, Milan, MI, Italy, 2Regione Lombardia, Milan, Italy
using different surveillance tools: EIDSS,
ProMED and WHO CISID
вЂў
22.066 Listeriosis Surveillance System: enhanced
22.067 Monitoring Measles outbreak in Georgia in 2013
SATURDAY
Background: One of the purposes of monitoring seasonal epidemics,
such as influenza, is to detect the emergence of atypical epidemic patterns. This detection requires describing dynamics of epidemics. The
dynamics are usually described by the dates of crossing the epidemic
threshold, the peak level and the time above threshold. However, these
criteria do not allow the description of dynamics during an entire year.
Objective: Developing a method allowing the description of complex
temporal dynamics of seasonal infectious patterns using a minimum of
variables, as well as the early detection of atypical emerging patterns.
Methods & Materials: The method is based on the fact that the semilogarithmic plotting of the ascending phase of an epidemicвЂ”when the
increase in the number of cases is exponentialвЂ”becomes linear.
After semi-logarithmic plotting, daily time series are broken into segments by piecewise regression. Coordinates (time and incidence) of
the breakpoints and the slope (a) of each segment are then determined.
The daily transmission rate (Rq) equals a +1. The method is applied to
the daily series of the incidence of influenza-like-illness in France, from
July 2010 to June 2014, published on www.OpenHealth.fr.
Results: Each of the four yearly cycles, from July 1st to March 30th,
is modelled in 5 to 8 log-linear segments. From July to mid-November,
the dynamics of the four years are similar, with a low-intensity epidemic
phase from mid-August to end September, preceded and followed by
phases of stability or slight decline in incidence. Regarding the period
from mid November to end March, the four years can be divided
into two subgroups. Years 2010/2011 and 2011/2012 have only one
ascending phase (Rq 1.07 and 1.11) starting mid-November and ending at the incidence peak (5 February and 7 January). The two other
years (2011/2012 and 2013/2014) show two rapidly ascending phases
(Rq 1.06 to 1.11) interspersed by a slowly ascending phase (Rq 1.01
and 1.02).
Conclusion: A real-time method is proposed for the detection of a
possible emerging pattern, before it passes the epidemic threshold.
This requires a monitoring system able to estimate low incidences with
accuracy.
Aim: To evaluate the efficiency of the two surveillance system
(MAINF and RRC) and carry out a comparison of regional data with
the Italian and European data in the same period by the Annual Report
EFSA/ECDC.
Methods & Materials: All detected cases, from the two surveillance
system in the period 2006-2012, were analyzed using the personal data
as variable of linkage. Therefore, it was possible to realize a database
that collects the reported cases by MAINF and/or RRC.
Results: In the period under study (2006-2012), 355 cases of listeriosis have been reported to MAINF surveillance system while 202
isolates were sent from hospital laboratories to RRC. The comparison
of the two databases detects a total of 427 listeriosis cases, including 53% of cases notified only to MAINF system, 16% of the isolates
detected only by RRC and 31% of cases recognized by both surveillance sources. The trend of the two indipendent sources (MAINF and
RRC) is equivalent (Figure 1). Based on notification data the average
annual incidence rate is 0.53/105 and the incidence rises to 0.63/105
considering the observed cases by both sources. This data are significantly higher than the Italian notification rate (0.17/105) and more
aligned with the European notification rate (0.33/105).
Conclusion: Although there are certainly differences in eating habits
between different Italian region, the observed difference in listeriosis
incidence is primarily due to the different sensitivity of surveillance
also with regard to the mandatory notification system. The integrated
surveillance system (MAINF and RRC) may represent an extensible
model for other Italian regions.
Purpose: Georgia encountered a big measles outbreak in 2013: over
7000 cases with a few deaths were observed. Crude incidence per 1
million populations from Jan 13 till Dec 13 reached 1829.9. Measles
cases were tracked by the 92-node surveillance network in Georgia
with the Electronic Integrated Disease Surveillance System (EIDSS),
an open source tool developed to improve national disease surveillance providing a secure way to collect, share and analyze data within
One Health approach. Other early warning and disease monitoring
tools also traced this outbreak. Evaluate EIDSS, ProMED and WHO
CISID tools for monitoringmeasles outbreak in Georgia in 2013 based
on a retrospective analysis of the available data.
Methods & Materials: Data from EIDSS, ProMED (English and
Russian domains) and WHO CISID systems was analyzed and compared with official numbers provided by the National Center for Disease
Control and Public Health of Georgia. Evaluation was done by the
following criteria:
1) Outbreak detection delay between the outbreak discovering and
appearance of the warning in a tool.
2) Number of reports published.
3) Total number of reported cases.
4) Reports regularity.
5) Average report publication delay between official epi report and its
publication in a tool.
6) Divergence of reports from official numbers.
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International Meeting on Emerging Diseases and Surveillance 2014
Results: Criteria
EIDSS
CISID
ProMED -EN
ProMED -RU
Outbreak Detection
Delay (in days)
1
50
3
22
Number of Reports
170
7
4
4
Total Number of Cases
7477
7477
3150
3787
Reports Regularity
Daily
Monthly
Sporadically
Sporadically
Average Report
Publication Delay
(in days)
4.46
>30
8
2.2
Average Report
Divergence from
Official Numbers
None
None
46%
20%
Conclusion: EIDSS demonstrated strong results in each category
providing good early warning and disease monitoring capabilities
including data quality and reporting consistency. ProMED results
depend on language: Russian version shows small average reporting
delay, but it is slow in initial outbreak detection; English version delivers
the initial warning fast but has big lags in the follow up reports. ProMED
suffers from inconsistency and reports quality on both languages. WHO
CISID guarantees official reporting numbers but features the longest
delay.
22.068 Large-scale whole genome sequencing
identifies country-wide spread of an emerging
G9P[8] rotavirus strain in Hungary, 2012
R. Doro1, E. Mihalov-Kovacs1, S. Marton1, B. Laszlo2, J. Deak3,
F. Jakab4, V. Martella5, P. MolnГЎr6, I. SГЎntha7, K. BГЎnyai1
1
Hungarian Academy of Sciences, Centre for Agricultural Research,
Budapest, Hungary, 2Department of Medical Microbiology, Medical
and Health Science Center, University of Debrecen, Debrecen,
Hungary, 3University of Szeged, Szeged, Hungary, 4University of
PГ©cs, PГ©cs, Baranya, Hungary, 5Department of Animal Health and
Wellbeing, University of Bari, Bari, Italy, 6Szent LГЎszlГі Hospital for
Infectious Diseases, Budapest, Hungary, 7Hungarian National Public
Health and Medical Officer Service, Miskolc, Hungary
Purpose: Two vaccines, the monovalent Rotarix and the pentavalent
RotaTeq, have been available in >100 countries worldwide for about
eight years to reduce RVA associated disease burden. Both vaccines
have shown marked safety and efficacy profile in pre licensure clinical
trials as well as in ongoing national immunizations programs. With the
availability of vaccines, many countries continued or started rotavirus
surveillance to monitor the fluctuation of strains and document any
potential vaccine associated events, including possible selection of
heterotypic strain(s), spread of vaccine strain to non-vaccinated persons, reassortment between vaccine and field strains, or, reversion of
the attenuated phenotype. In this study the distribution of rotavirus G
and P types having circulated during 2012 in Hungary is reported. In
addition, nucleotide sequencing and phylogenetic analyses of near full
length genomes of >100 strains was performed to gain a deeper insight
into the molecular epidemiology and evolution of co-circulating strains
and to monitor if vaccine derived strains or reassortants have been in
circulation in the community.
Methods & Materials: In routine strain characterization, the VP7 and
VP4 genes were amplified using published oligonucleotide primers.
Amplicons were direct-sequenced in both directions on an ABI3100
equipment. Deep sequencing was carried out using the Ion Torrent
PGM equipment. Sequence and phylogenetic analyses were carried
out using freely available computer programs.
Results: In 2012, the Hungarian rotavirus surveillance network
identified an increase in the prevalence of G9P[8] strains across the
country. This genotype combination predominated in seven out of
nine study sites (detection rates, 45%-83%). In addition to G9P[8]s,
epidemiologically major strains included genotypes G1P[8] (34.2%),
G2P[4] (13.5%), and G4P[8] (7.4%), whereas unusual and rare strains
were G3P[8] (1%), G2P[8] (0.5%), G1P[4] (0.2%), G3P[4] (0.2%), and
G3P[9] (0.2%). Genomic analysis of 125 Hungarian human rotaviruses
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identified nine major genotype constellations and uncovered both intraand intergenogroup reassortment events in circulating strains. The
conserved genomic constellation of medically important genotypes
suggested the clonal spread of the re-emerging G9P[8] genotype and
several co-circulating strains (e.g. G1P[8] and G2P[4]) during 2012.
Conclusion: This study indicates the robustness of whole genome
sequencing in routine rotavirus strain surveillance.
22.069 Influence of the electronic case report form
for multicentric studies in general practice
in France
T. Poisson1, H. Partouche1, L. Toubiana2
1
UniversitГ© Paris Descartes, Paris, France, 2INSERM ; UPMC :
UniversitГ© Pierre et Marie Curie-Paris 6, Paris, France
Purpose: As part of a large prospective multicentre study describing
the acute community-acquired pneumopathies treated in general practice, an ancillary study was performed.
Objective: To identify the role of the electronic case report form
(eCRF) among the determinants of inclusion of patients by investigating general practitioners.
Methods & Materials: A platform independent from that of the main
study was developed. 425 investigators enrolled in the main study were
invited to participate by interactive e-mail with simplified validation. In
less than three weeks, a specific eCRF allowed to collect the motivation
to participate, the difficulties encountered to include patients, opinions
and practices regarding the main study.
Results: 336 investigators (79 %) responded to the survey.235
doctors had included at least one patient. 101 doctors had included
none. The variables associated with inclusions are: having already participated in a study with an eCRF (p< 0.001); feeling supported by the
clinical study supervisor (p< 0.001); being motivated by participation in
a GP network; receiving remuneration. The barriers that were identified
are: lack of time; lack of training; lack of cases encountered.
Conclusion: The ease of use of an eCRF and knowledge of the existence of вЂњhuman assistanceвЂќ are the essential factors for participating
in fully electronic clinical studies. This information should be taken into
account when developing research protocols, in particular in general
practice, where the variables are collected вЂњduring the consultationвЂќ.
22.070 Rabies veterinary aboratory capabilities in
West and the Central Africa
A. Angot1, C. Bebay2, Y. KaborГ©2, G. Dauphin3, P. De
Benedictis1
1
FAO Reference Centre for Rabies, Istituto Zooprofilattico
Sperimentale delle Venezie, Viale dellвЂ™UniversitГ 10, 35020 Legnaro
(PD), Italy, 2FAO Emergency Centre for Transboundary Diseases
for West and central Africa, Bamako, Mali, 3Food and Agriculture
Organization of the United Nations, 00153 Rome, Italy
Purpose: Updated data on the human mortality from canine rabies
shows that about 70,000 people die worldwide each year. Africa is
the second most affected continent, with 31,329 annual deaths, the
domestic dog being the main reservoir of the virus [A. Anderson and
S.A Shwiff.,2013]. About 99% of human cases are ascribable to a dog
bite. However, the epidemiological data and laboratory confirmatory
cases are rare. The burden and the impact of the disease are not well
known, and this contributes to considering rabies a low priority issue.
Being rabies endemic in most West and Central African countries, in
2010 a rabies subnetwork was created in the region to pinpoint the
actual animal rabies diagnostic capabilities, and to finally improve the
data available on animal rabies cases in the 23 member countries.
Methods & Materials: Three questionnaires were submitted in 2011вЂ“
2012 to all the national veterinary laboratories with the aim of recognizing the priority gaps in rabies diagnosis, which needed to be bridged.
The collected data were supplemented with information resulted from
support activities carried out in the region between 2013вЂ“2014.
Results: Twelve out of 23 laboratories declared not to carry out any
diagnostic activity for rabies while eleven laboratories carry out rabies
diagnosis on a routine basis. The total number of samples collected
in 9 out of the 11 laboratories performing rabies diagnosis between
Poster Presentations I
SATURDAY вЂў November 1, 2014
International Meeting on Emerging Diseases and Surveillance 2014
2011вЂ“2012 is of 1.66 sample per million of estimated inhabitants.
These data reveal failure in the number of suspect samples submitted
to and analyzed by veterinary laboratories in the region, due to dearth
in reagents and proficiency.
Conclusion: The lack of reagents/material and capacity building
are the crucial issues preventing an improvement in animal rabies
diagnosis. In 2013 key equipments/reagent and training sessions
were provided by UN-FAO thanks to the IDENTIFY project (USAID).
These efforts allowed the detection in September 2013 of a rabies outbreak, for the first time in Congo. The successful outcome achieved in
Brazzaville clearly shows that an improvement in the diagnosis of the
disease is indeed possible in all the member countries.
22.071 Application of a framework to assess cost and
performance of meningitis surveillance
N. A. Erondu, U. K Griffiths
London School of Hygiene and Tropical Medicine, London, United
Kingdom
J. A. Steele1, D. Saila-Ngita1, T. Odoch2, H. M. Amuguni3
Tufts University Cummings School of Veterinary Medicine, North
Grafton, MA, USA, 2Makerere University, Kampala, Uganda,
3
Tufts University, North Grafton, MA, USA
1
Purpose: University members of the One Health Central and East
Africa (OHCEA) network from the DRC and Uganda identified training in research methods as a priority for advancement of their One
November 1, 2014
projects: lessons learned in the Democratic
Republic of the Congo and Uganda
вЂў
22.072 Research methods training for One Health
22.073 Multiplexed digital mRNA profiling of the
SATURDAY
Purpose: Serogroup A meningococcal (NmA), has historically
accounted for approximately 85% of all meningitis cases in the African
meningitis belt. Since 2009, mass campaigns with a new conjugate
vaccine, MenAfriVac,В® have been conducted targeting 1-29 year olds.
The long term health impact of MenAfriVacВ® can only be determined by
strong disease surveillance. The objective of this study was to evaluate
the performance and estimate the costs of meningitis surveillance in
Chad and determine resources needed for implementing an improved
surveillance strategy.
Methods & Materials: A questionnaire was designed to measure
core surveillance function (detect, report, analysis, feedback, investigation, and response), and support activity (training, supervision,
communication, and co-ordination) performance. Interviews were conducted with 51 participants in seven districts. Participants represented
health facilities, district, regional, and national surveillance offices, and
district and national laboratories. Resource utilization data according
to surveillance activities was also included in interviews and collected
from other sources, including financial records of the Ministry of Health
and international partners. Identified needs were combined with international standards and guidelines to develop an optimal operational
surveillance standard with associated costs.
Results: A lack of adequate resources and missing standard procedures for meningitis surveillance was reported at the sub-national
health levels. Nine percent of specimens were sent to the national
laboratory for confirmation and four percent of probable meningitis
cases had a known outcome reported. One district laboratory had not
been able to conduct any analysis of cerebrospinal fluid due to lack of
supplies. Three of the districts reported zero meningitis cases in 2012.
In the other four districts, reported cases varied between 43 and 232,
equivalent to between 11 and 89 per 100,000 populations.
In facilities with no detected cases, resources spent on surveillance
were marginal. Costs per detected cases amounted to US$ 49. Costs
of lumbar puncture comprised 43% and laboratory analysis 41% of total
costs.
Conclusion: Investments are needed across the system in Chad
and other African meningitis belt countries. A systematic approach that
assesses performance gaps and the associated costs can provide a
more sustainable solution for ideal integrated disease surveillance.
Health research capacity. A research methods course was designed to
effectively train students and researchers and to identify gaps related
to One Health research training for future curriculum and capacity
development.
Methods & Materials: An intensive research methods short-course
was designed by faculty at Tufts University with OHCEA partners at
the University of Kinshasa and University of Lubumbashi in the DRC
and Makerere University in Uganda. The course was designed with
minimum lecture time and an emphasis on active learning to guide participants through the research process at an intermediate level, given
that most target participants had completed basic research methods
training. Participants were evaluated based on presentation of either
their own proposed research or a hypothetical project.
Results: Thirty junior faculty from each of the universities in the
DRC attended the course and used the applied training to develop
their own research project proposals. Twelve students in the Masters
in Veterinary Preventive Medicine (MVPM) program attended the
course at Makerere University and used the training to develop a
hypothetical research project related to their One Health field attachments. All participants made positive progress; however, many of the
faculty participants in the DRC lacked the assumed previous training
and benefitted from more detailed instruction in the basics of research
methods. Students in the MVPM program had immediately preceding
coursework related to One Health research and statistical methods and
were well prepared for the level and pace of training.
Conclusion: Active learning for research methods training, in which
participants develop their own project and present their plan to an audience, proved to be an effective method for an intensive short-course.
Implementation of the course in this project revealed that thorough
understanding of participant background is necessary to effectively
design the course and also revealed gaps in research methods content
and teaching methods that can guide future curriculum development for
One Health research capacity at these institutions.
inflammatory response in the West Nile Swiss
Webster mouse model
P. Naraghi-Arani1, A. Freiberg2, D. Beasley2, J. Pena1, J. Plante3,
A. C. Carrillo4, M. Labute1, K. Roberts2, J. Smith2, T. Juelic2
1
Lawrence Livemore National Laboratory, Livermore, CA, USA,
2
University of Texas Medical Branch, Galveston, TX, USA, 3University
of North Carolina Chapel Hill, Chapel Hill, NC, USA, 4Lawrence
Livermore National Laboratory, Livermore, CA, USA
Purpose: The ability to track changes in gene expression following
viral infection is paramount to understanding viral pathogenesis. This
study was undertaken to evaluate the nCounter,В® a high throughput
digital gene expression system, as a means to better understand West
Nile virus (WNV) dissemination and the inflammatory response against
WNV in the outbred Swiss Webster (SW) mouse model over the course
of infection.
Methods & Materials: The nCounterВ® Mouse Inflammation gene
expression kit containing 179 inflammation related genes was used to
analyze gene expression changes in multiple tissues over a nine day
course of infection in SW mice following intraperitoneal injection with
WNV. Protein expression levels for a subset of these cytokine/chemokine genes were determined using a multiplex protein detection system
(BioPlex) and comparisons of protein/RNA expression levels made.
Results: Expression analysis of spleen, lung, liver, kidney and brain
of SW mice infected with WNV revealed that Cxcl10 and Il12b are differentially expressed in all tissues tested except kidney. Data stratification
of positively confirmed infected (WNV [+]) versus non-infected (WNV
(-) tissues allowed differentiation of the systemic inflammatory gene
response from tissue-specific responses arising from WNV infection.
Significant (p<0.05) decrease in C3ar1 was found in WNV (-) spleen.
Il23a was significantly upregulated, while Il10rb was down-regulated
in WNV (-) lung. Il3 and Mbl2 were down-regulated in WNV (-) liver. In
WNV (+) livers, Stat1, Tlr2, chemokines Cxcl1, Cxcl3, Cxcl9, Cxcl10,
cytokines Il6, Il18, cytokine-related gene Il1r and cytokine agonist Ilrn
were significantly upregulated. In WNV (-) brain tissues, Csf2 and
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Poster Presentations I
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International Meeting on Emerging Diseases and Surveillance 2014
Cxcl10 were significantly upregulated. Similar gene and protein expression kinetics were found for Ccl2, Ccl3, Ccl4 and Ccl5 and correlated
with the presence of infectious virus.
Conclusion: The utility of the nCounterВ® platform for rapid identification of gene expression changes in SW mice associated with WNV
infection was demonstrated.
22.074 Predicting the potential for emerging infectious
disease: Engaging communities in species
observations, data management, and the
semantic web
SATURDAY
вЂў
November 1, 2014
M. McConnell1, D. Pennington2
1
University of New Mexico, Albuquerque, NM, USA, 2University of
Texas at El Paso, El Paso, TX, USA
Purpose: Biosurveillance of emerging diseases from wildlife hosts creates challenges that require interdisciplinary collaborations. Historically,
a вЂњmono-cultureвЂќ approach to disease research prevented effective
infectious disease research, because discipline-specific disease indicators often do not transcend to other disciplinary concepts. Founded
in 2010, the Geospatial Epidemiology Research Network (GERN)
advances new approaches to zoonotic infectious diseases by bringing
together experts with common interests to utilize emerging technologies to their fullest advantage.
Methods & Materials: GERN initially identified ChagasвЂ™ Disease
as a potential challenge to the public health of New Mexico residents.
ChagasвЂ™ Disease, caused by the parasite Trypanosoma cruzi and vectored through triatomine bugs, is a primary example of a neglected disease yet remains poorly understood in the southwestern United States.
A pilot study conducted in 2011 re-confirmed the existence of Triatoma
and T. cruzi in New Mexico. Community collection efforts during Spring/
Summer of 2013 yielded Triatoma specimens from local dwellings and
peridomestic areas. Traditional analyses are forthcoming, yet new tools
are critical to next generation disease research and outreach.
Results: New methods and tools for improving our understanding of
emerging diseases such as Chagas are rapidly evolving across disciplines and institutions. Enabling the diffusion of innovations within and
across communities in our information-rich society remains challenging,
especially for researchers searching for new techniques that transcend
to complementary disciplines. The Virtual Learning Commons (VLC), to
be released in 2014, will standardize processes, support researchers,
and potentially facilitate the collection of critical information in disease
research. The VLC utilizes next generation Web approaches (a.k.a.
Semantic Web) enabling easier discovery of relevant methods and
tools, along with advanced data visualization: who created the methods, who is using them, where they are being used, and other pertinent
information for a particular application.
Conclusion: The VLC will enable disease researchers and decision
makers to more easily integrate surveillance strategies with new analytical approaches. This interdisciplinary approach toward translational
infectious disease research will be critical as more infectious diseases
emerge. By expanding parameters from different disciplines through
technologies, effective public health outreach programs may be created
to reduce potential risk of exposure and maintain health populations.
22.075 Using a mobile short message-based disease
outbreak alert system to enhance disease
surveillance in Kenya
M. Toda1, I. Njeru2, S. O-Tipo2, D. Kareko2, S. Inoue1, M. Mwau3,
K. Morita4
1
Nagasaki University, Nairobi, Kenya, 2Ministry of Health, Nairobi,
Kenya, 3Kenya Medical Research Institute, Nairobi, Kenya, 4Nagasaki
University, Nagasaki, Japan
Purpose: The Ministry of Health (MOH) in Kenya conducts surveillance for priority diseases, conditions and events within the Integrated
Disease Surveillance and Response (IDSR) strategy. This entails
detection and timely notification of select priority diseases, conditions
and events by health facilities. While an electronic web-based system
90
IMED 2014
had been developed for weekly reporting, there still existed a gap in
appropriate technology for immediate notification.
The MOH in partnership with the JICA-JST SATREPS project developed a mobile short message service (SMS)-based disease outbreak
alert system (mSOS) as an early warning system to enhance realtime notification, coordination, preparedness, and response to priority
diseases, events and conditions within the IDSR strategy. Using formatted SMS clinicians at health facilities would notify multiple levels
simultaneously.
Methods & Materials: A 6-month pilot implementation was conducted in Busia and Kajiado counties between November 2013 and
April 2014. An endline survey was conducted in June 2014 to assess
IDSR and mSOS reporting systems using mixed method (qualitative
and quantitative) research.
Results: The pilot consisted of 127 health facilities. Fifty-eight
(45.7%) health facility in-charges were asked to use mSOS (formatted SMS) and IDSR reporting (paper-based and or unformatted SMS)
systems to notify suspected priority diseases to the next level, and 69
(54.3%) were asked to continue their routine IDSR reporting. Over 400
alert notification messages were sent through mSOS, which consisted
of mostly suspected measles and dysentery cases. A total of 43 incharges used mSOS. Among those who used mSOS (43 out of 58
health facilities selected), 39 (90.7%) in-charges said mSOS was easy
to use and that mSOS was helpful in reducing reporting challenges.
Thirty (69.8%) in-charges felt mSOS was helpful in triggering response
action. Forty-one (95.4%) in-charges felt mSOS shortened time
required to send notification to the next level. However, twelve (27.9%)
in-charges experienced network challenges. Forty-two (97.7%) incharges felt mSOS should be rolled-out nationally.
Conclusion: The pilot implementation provided proof that mSOS
would be effective in enhancing surveillance. However, infrastructural
challenges in the country may hinder full benefits of the system. Further
analyses on qualitative data may provide insights into components that
need to be addressed.
22.076 Double locus sequence typing (DLST), a
standardized and portable typing method for
epidemiological investigation of bacteria
K. Vranckx1, P. Basset2, D. S. Blanc2, K. Janssens1
Applied Maths NV, Sint-Martens-Latem, Belgium, 2University Hospital
of Lausanne, Lausanne, Switzerland
1
Purpose: Sequence-based typing methods are more and more finding
their way in the epidemiological and clinical setting; replacing the time
consuming and laborious gold standard PFGE (pulsed field electrophoresis). While whole genome sequencing is becoming more available
for these settings, it is still too expensive for most routine clinical and
epidemiological microbiology laboratories. As the price and analysis
time continue to go down, this will likely be solved in the near future.
For many labs however, there is an immediate need for a quick, unambiguous and cheap technique to monitor outbreaks and nosocomial
infections.
Methods & Materials: For this purpose, we developed a typing
scheme based on the single strand sequencing of two highly polymorphic loci, double locus sequence typing (DLST). Currently, two
schemes have been set up and validated, one for Staphylococcus
aureus and the other for Pseudomonas aeruginosa. A third one for
Clostridium difficile is in development.
Results: In comparison with multi locus sequence typing (MLST),
the throughput of DLST is substantially higher while the use of highly
polymorphic regions resulted in a similar (for P.aeruginosa) or higher
(for S.aureus) discriminatory power. Sequences can be compared to a
central BioNumericsВ® Server database through the website www.dlst.
org. Fasta, text files or raw chromatograms can be submitted to obtain
allele numbers at both loci. Alleles that are not present in the database
can be assigned a new allele automatically for registered users upon
submission of a high quality chromatogram. The trace files are stored
in the database together with the contact details of the submitting lab to
allow manual curation. All labs with access to a sequencer and internet
are able to use these schemes.
Conclusion: Unambiguous, standardized and definitive typing
results are obtained quickly and can be incorporated in databases at
local or international level for surveillance purposes.
Poster Presentations I
SATURDAY вЂў November 1, 2014
International Meeting on Emerging Diseases and Surveillance 2014
22.077 An automated analysis pipeline for whole
genome MLST data using BioNumericsВ®
K. De Bruyne, K. Vranckx, J. Goris, S. Valcke, H. Pouseele,
K. Janssens
Applied Maths NV, Sint-Martens-Latem, Belgium
B. Aslanov1, N. Rakhmanova2, N. Pshenichnaya3, V. Melnik4
North-Western State Medical Academy, St. Petersburg, Russian
Federation, 2ProMED-mail, Tashkent, Uzbekistan, 3Rostov State
Medical University, Rostov-on-Don, Russian Federation, 4Donetsk
Medical University, Donetsk, Ukraine
1
Purpose: Several Former Soviet Union (FSU) countries have annual
cases of Crimean-Congo hemorrhagic fever (CCHF). Russian ProMEDmail (http://promedmail.org/ru) is one of ProMEDвЂ™s regional networks
that offers Russian language reports on emerging infection outbreaks
relevant to 15 FSU countries. We have reviewed Russian ProMED
(ProMED-RUS) to assess epidemiologic situation on CCHF for the past
10 years in the territory of FSU based on available ProMED data.
Methods & Materials: We used CCHF as the keyword to search
reports in ProMED-RUS posted from 2004-2014. Comments by the
moderators to complement the information provided in the outbreak
itself were also reviewed.
Results: According to ProMED-RUS, CCHF cases were recorded in 4
countries (Russia, Kazakhstan, Georgia, and Tajikistan). The southern
part of Russia (Stavropol, Rostov, Volgograd and Astrakhan regions,
and Kalmikiya, Ingushetiya, Dagestan, Karachaevo-Cherkessia republics) has the highest prevalence of CCHF over the past 10 years with
1177 total cases, 37 fatal cases, 125 average annual cases, 4 lethal
cases, and over 3% case fatality rate (CFR). The highest number of
cases in Russia were registered in the period of 2006вЂ“2008, which
coincides with official Russian MOH statistics. Beginning in 2009,
the incidence rate decreased, averaging 70 registered cases. In
Kazakhstan, ProMED-RUS has been reporting on CCHF cases since
2008, with the highest number of cases reached in 2009 in the southern
part of the country along with Jambyl and Kizilorda regions. Up until
2013 63 total cases and 13 fatal cases were registered with a CFR of
24%. In Tajikistan, ProMED-RUS reported 5 cases in 2009 with 3 lethal
cases and a CFR of 60%. Georgia reported in ProMED-RUS one case
in 2012 and 5 cases in 2014 with 2 lethal cases (CFR 40%). CCHF
starts in April, peaks between May-June, and decreases in August. The
majority of cases are due to tick bites. However, Kazakhstan (2009),
E. M. Machache1, J. Y. Carter1, I. Njeru2, J. Mwitari3
Amref Health Africa-Headquaters, Nairobi, Nairobi, Kenya, 2Divison
of Disease Surveillance and Response, Nairobi, Kenya, 3Ministry of
Health, Nairobi, Nairobi, Kenya
1
Purpose: In 2009, the Ministry of Health, Kenya, in collaboration
with Amref Health Africa, established a pilot project to introduce a
Community Based Disease Surveillance (CBDS) system into three
districts in Kenya. The project aimed to provide Community Health
Workers (CHWs) with the capacity and means to identify, refer and
report patients with suspected priority conditions, according to the
national Integrated Disease Surveillance and Response (IDSR) strategy, to local health facilities for diagnosis and management
Methods & Materials: A national project steering team was created
comprising senior officers from the Units of Disease Surveillance,
Outbreak and Response; and Community Health Services, and Amref
Health Africa. Criteria for selection of pilot districts included high burden of communicable diseases and areas with established community
structures. Priority diseases were grouped into major conditions with
simplified lay case definitions. Data collection, referral and reporting
tools were developed, using a paper-based system. District Health
Management Teams (DHMTs) and Community Health Extension
Workers (CHEWs) received refresher training on principles of IDSR
and the CBDS system; who in turn trained CHWs and health care personnel at the link health facilities.
Results: Three districts in Kenya participated in the CBDS pilot project. A total of 64 CHEWs from 32 Community Health Units (CHUs) and
1600 CHWs were trained. Data will be presented on reporting rate of
CHWs, total number of cases referred and attendance rate at health
facilities; and number of suspected priority conditions reported by type,
since the project start.
Conclusion: The project has established clear pathways for early
detection of suspected priority conditions, and referral and reporting
between different levels of the health system, starting from village level.
With adequate support and supervision, CHWs can play a critical role
in detecting suspected priority diseases and outbreak surveillance
within their local communities. The reporting system complements the
passive, facility-based IDSR surveillance and management system for
priority diseases and outbreaks; however establishing a CBDS system
requires major resource inputs
November 1, 2014
reported by Russian ProMED for the period of
2004вЂ“2014
implement disease surveillance of priority
diseases at village level in Kenya
вЂў
22.078 Crimean-Congo hemorrhagic fever infections
22.079 Community health workers can effectively
SATURDAY
Purpose: For many years, Sanger sequencing-based multilocus
sequence typing (MLST) has been one of the standards in bacterial
typing, characterizing isolates by looking at a set of housekeeping
genes (loci). As next-generation sequencing is increasingly replacing
Sanger sequencing, Вconventional MLST can be extended to whole
genome MLST (wgMLST), incorporating many more loci and thus providing higher resolution.
The bioinformatics behind this approach exceeds the capabilities of
many routine surveillance labs. We aim to make this technique available to labs with neither the expertise nor the hardware to implement
this technique.
Methods & Materials: The wgMLST platform we present, consists
of a user-friendly point and click interface based on BioNumericsВ® 7.5,
combined with a scalable, high-throughput calculation infrastructure
for sample processing. An internal nomenclature is used for qualitycontrolled automated allele naming. Next to the pan-genomic wgMLST
scheme, different subsets of loci can be defined such as MLST, rMLST,
eMLST, core loci...
Results: As an illustration, we will focus on the Listeria scheme. This
scheme contains 3436 loci over the 4 lineages, of which around 68%,
i.e. 2345 loci can be counted among the core genome (= present in all
lineages). 19% of the loci are lineage-specific and around 4% of the
loci are multi-allelic.
Conclusion: The BioNumericsВ® 7.5 software (Applied Maths NV)
offers a powerful platform for biologists where wgMLST schemes can
be defined, automatically curated, analyzed and compared with historical data such as MLST, PFGEвЂ¦
Tajikistan (2009), and Russia (2011) registered 3 nosocomial clusters
among healthcare workers due to inadequate infection control with 5,
7, and 9 cases respectively.
Conclusion: ProMED-RUSвЂ™ reports of outbreaks and particularly
comments from experts provide useful information for emerging infection case reporting, analysis, and comparison in the territory of FSU
22.080 Rabies surveillance in the combined joint
operating area вЂ“ Afghanistan
H. Gobble1, S. Stockwell2, H. Gobble1
1
US Army, Honolulu, HI, USA, 2US Army, Colorado Springs, CO, USA
Purpose: Military Expeditionary and Special Operations Forces are
often operating in remote regions where infectious disease prevalence
is not available for all disease. This is true for the rabies virus in particular. A rabid bench-top Rabies test was used to establish local rabies
prevalence in animals euthanatized, as part of vector control procedures, on United States and Coalition bases in Afghanistan.
Methods & Materials: Animals captured on Coalition Bases were
presented to veterinary services for humane euthanasia. The 438th
Medical Detachment teams maintained a tissue bank of frozen brainstems collected from these animals as a way to ensure that if a bite
report was made identifying a previously euthanized animal, tissue
was available to test. These samples were tested with the BIONOTEвЂ™s
Anigen Rapid Rabies Ag Test Kit, a chromatographic immunoassay for
the qualitative detection of Rabies virus antigen.
91
IMED 2014
Poster Presentations I
SATURDAY вЂў November 1, 2014
International Meeting on Emerging Diseases and Surveillance 2014
SATURDAY
вЂў
November 1, 2014
Results: A total of 130 samples were tested from 7 different sites.
There were a total of 103 felines, 3 jackals, 21 canines, and 3 fox
samples tested (Table 1). 129 tests negative test results and 1 positive
in a canine.
Conclusion: An accurate understanding of the prevalence and risk
is key to making wise command decisions and utilizing limited medical
and human capital to its fullest. In countries where domestic and feral
dog populations are not regularly vaccinated for rabies, they are the
primary reservoir of the disease. These dogs represent both the solution and the problem to the risk factor. The key to reduce the incidence
and therefore the threat of rabies is to vaccinate the dogs. When this
is not done, either due to instability or will the assumption is made that
all dogs are rabid and therefore treated as such. This sets up a vicious
cycle that neither protects man or animal. The disease surveillance
efforts conducted here by the US. Army Veterinary Corps provide enormous scientific real world data from which to make wise decisions now
and for years to come at very little expense. This data indicates that the
rabies virus is less prevalent in the animal populations of Afghanistan
than previously reported.
22.081 Improving public health and veterinary
laboratory testing quality and capacity in
Cambodia
L. A. Perrone1, V. Voeurng2, S. Sek2, S. Song2, D. Confer1, R. Martin1
1
International Training and Education Center for Health, Seattle, wa,
USA, 2International Training and Education Center for Health, Phnom
Penh, Cambodia
Purpose: Functional laboratory systems are increasingly being recognized as a keystone of effective biosurveillance, biosecurity and
sustainable health programs. Specifically, diagnostic laboratories significantly contribute to disease detection, patient care, disease surveillance and outbreak investigations. Inaccuracies in diagnostic testing
can lead to potentially devastating outcomes for patient, public and veterinary health, surveillance data, and can ultimately affect health policy.
The WHO and signatories of the International Health Regulations
acknowledge the importance of quality laboratory testing and the need
to develop sustainable laboratories in countries in which many of the
вЂњhot-spotsвЂќ for emerging infectious diseases exist. Capacity and capability of such testing remains inadequate in resource-limited countries
and many geographically strategic nations including Cambodia are
ill-prepared.
Laboratories need adequate human resources who understand
quality management practices, can utilize the laboratoryвЂ™s resources
effectively and maximize the laboratoryвЂ™s capacity to detect diseases
of public health concern. Laboratories also need effective leaders who
have the skills to advocate for resources in a fluctuating health care
environment.
Methods & Materials: Working with the WHO, the Cambodian
Ministry of Health and the US Centers for Disease Control, we
are implementing a laboratory and clinical mentoring program to
strengthen the quality and capacity of infectious disease diagnosis and
surveillance in national and provincial laboratories across Cambodia.
I-TECH is working in 4 provincial hospital laboratories (Takeo, Kampot,
Kampong Cham, Svay Rieng), the National Center for Tuberculosis
and Leprosy Control, the National Veterinary Research Institute, and
2 hospital laboratories (Preah Kossamak, National Pediatric Hospital)
in Phnom Penh to provide training to staff on quality management and
quality systems implementation. In addition to testing capacity, quality indicators such as proficiency testing results, turnaround time, and
surveys from clinical staff are also being evaluated.
This work builds on laboratory capacity assessment data from 22
hospital laboratories across Cambodia collected in early 2014 by other
WHO-sponsored organizations. Following a gap analysis of the data,
individual quality improvement implementation plans were developed
for our 8 target laboratories. Laboratory quality is monitored closely
on site and progress towards meeting international standards are
measured.
Results: This work is currently in progress however our approach
and initial findings will be presented here.
92
IMED 2014
22.082 Implementing a professional development
program in clinical and public health laboratory
leadership and management
L. A. Perrone1, E. Scott1, L. Livingston2, C. Bradburn1, A. McGee1,
S. Shotorbani1, D. Confer1, A. Downer1, A. Mokdad3, R. Martin1
1
University of Washington, Seattle, wa, USA, 2Interactive Outcomes,
Seattle, WA, USA, 3Institute for Health Metrics and Evaluation,
Seattle, WA, USA
Purpose: Laboratories are an essential component in the WHOвЂ™s
Integrated Framework Model for Health Systems and accurate laboratory testing is essential to provide evidence for disease diagnosis
and treatment, for surveillance activities, and establishing disease
prevalence. The WHO and signatories of the International Health
Regulations acknowledge the importance of quality laboratory testing
and the need to develop laboratories in resource-limited countries in
which many of the вЂњhot-spotsвЂќ for emerging infectious diseases exist.
Capacity and capability of such testing remains limited in many geographically strategic nations. Laboratories need leaders who can utilize
resources effectively, maximize the laboratoryвЂ™s capacity to diagnose
disease and have the skills to advocate for laboratories in a fluctuating
health care environment. To address this need we developed an inservice professional development program for senior health laboratory
directors and managers.
Methods & Materials: Working together with the WHO Regional
Office for the Eastern Mediterranean, I-TECH solicited over 65 nominations of candidates from 10 Ministries of Health. Up to 3 participants
were chosen per country and paired with a senior mentor for the duration of the program.
The 9 month program was delivered through 2 in-person meetings
and a series of 4 distance-learning courses via an online learning platform. The coursework addressed key competencies such as: testing
quality, laboratory systems, leadership and management, analysis and
communication of laboratory information, law and regulation of laboratory practice, and appropriate utilization of diagnostic technology. The
curriculum was also bolstered by weekly online community discussion
boards. Participants also completed a capstone project during the program that addressed an issue related to improving their laboratoryвЂ™s
operations. The program was piloted in 2014 and included 17 participants and 11 mentors from 10 countries across the Middle East.
Results: We found that the in-person meetings were crucial to build
rapport amongst our participants and mentors and provided a strong
foundation for them as an online community throughout the program.
Timely support by faculty and active involvement from the mentors was
important for participant morale. Over 80% of the participants completed the program successfully.
Conclusion: In-service and online professional development programs can be effective interventions to improve laboratory operations
and network linkages regionally.
22.083 Risk of transfusion-transmitted Chikungunya
infection and efficacy of blood implementation
measures
H. Appassakij, C. Promwong, P. Rujirojindakul, P. Khuntikij,
K. Silpapojakul
Prince of Songkla University, Hat Yai, Thailand
Purpose: A вЂ�real-timeвЂ™ chikungunya fever (CHIKF)-related symptoms
observation-based strategy was implemented during the 2009 epidemic in Songkhla Province, southernThailand to mitigate transfusionassociated CHIKF. 11 of 13,202 (0.08%) blood donations suggestive of
CHIKF-contamination were deterred from blood transfusion. To date,
no published data on actual transfusion-transmitted CHIKF to recipients has been reported. This study estimated transfusion-transmitted
CHIKF through the blood transfusion chain and the efficacy of blood
safety implementation measures.
Methods & Materials: A web-based tool named the вЂњEuropean
Up-Front Risk Assessment ToolвЂќ (EUFRAT; http://eufrattool.ecdc.
europa.eu) was used to estimate the risk of transfusion-transmitted
CHIKF using the published data and transfusion practices from the
2009 CHIKF epidemic in Songkhla Province, southern Thailand.
Poster Presentations I
SATURDAY вЂў November 1, 2014
International Meeting on Emerging Diseases and Surveillance 2014
Results: The mean and maximal weekly risk of viraemic donations
during the entire epidemic period were estimated to be from 5.1 (95%
confidence interval (CI); 0.7-9.5) to 26.5 (95% CI; 16.4-36.6) per
100,000, respectively. This meant that the mean and maximal potential
risk of total transfusion-transmitted CHIKF to recipients receiving all
infective products from packed red blood cells, plasma, and platelets, in
the absence of blood safety measures, were estimated from 58.7 (95%
CI; 43.7-73.7) to 312.3 (95% CI; 277.7-346.9) per 100,000. Based on
percentage of transfusion-transmitted risk reduction calculated in the
EUFRAT model, the estimates suggested that implementation measures-based on CHIKF-related symptoms observation or screening for
CHIKV RNA could be used independently or in a combination to effectively minimize the risk of transfusion-transmitted CHIKV in recipients.
Alternatively, pre-donation screening for donors at risk in combination
with either CHIKF-related symptoms observation or screening for RNA
detection-based strategies would be expected to be effective and practical preventive strategies.
Conclusion: This study confirms that prompt blood screening measures can effectively reduce the risk of transfusion-transmitted CHIKF
and maintain blood safety supply during an outbreak.
22.084 Identification of eight clades of novel singlestranded circular DNA viruses in pig feces
November 1, 2014
Background: Because of the serious shortage of organs from human
donors, xenotransplantation has become a valuable alternative.
Provided that the genetic incompatibility is overcome, pig organs are
considered a good match in size and shape for their human counterparts. However, unknown pathogens, including viruses not harmful in
the animal, may pose risks to the organ recipient.
Objective: Identification of the circular replication initiator protein
(Rep)-encoding single-stranded DNA (CRESS-DNA) viruses in swine
feces.
Methods & Materials: The chimpanzee stool-associated circular
viruses (ChiSCV)-related nucleotide sequences identified using viral
pyrosequencing were used to design primers for PCR. DNA amplification employing converging primers were used to confirm the presence
of contig sequences in the sample and diverging primers to amplify and
clone the complete circular viral genomes. The Rep-related sequences
were aligned by MAFFT and used to generate a Bayesian interference
phylogenetic tree.
Results: Metagenomic analysis of fecal samples collected from
diarrheal swine was conducted. Complete nucleotide sequences of 18
novel genomes were cloned and determined. Each genome encodes
two putative major open reading frames (ORFs): ORF1 encodes a Rep
involved in rolling-circle DNA replication and ORF2 encodes a capsid
protein. Thus, these new viruses belong to the group of CRESS-DNA
genomes, which includes Circoviridae, Gemininviridae, Nanoviridae
and other unclassified circular genomes.
In this study, phylogenetic analysis revealed that sixteen genomes are
in a monophyletic clade with porcine stool-associated virus (PoSCV)
previously described, but are divergent enough to be further classified
into to six distinct virus clades. One virus shares Rep homology with fur
seal stool-associated virus and the other belongs to a unique clade with
no known counterparts.
Conclusion: The development of metagenomics has revolutionized
virus discovery leading to the identification of many new viruses. The
impact of this technology is exemplified by the breadth of CRESS-DNA
viruses detected in a diverse range of organisms including swine. This
work showed that the fecal virome of swine exhibits a very diverse set
of viruses.
Purpose: To identify and characterize a novel parvovirus from a diseases outbreak in horses.
Methods & Materials: Whole blood, lymph node and joint fluid from
a horse with polysynovitis were used for the study. Virus isolation was
conducted on lymph node and joint fluid using equine embryonic kidney
cells and Vero cells. Nucleic acid extracted from partially purified original samples was used for next generation sequencing (NGS) using 454
GS FLX system (Roche) and MiSeq system (Illumina), respectively. A
qRT-PCR assay was later developed for the specific detection of newly
identified virus based on NGS results.
Results: No viral pathogen was isolated following 3 passages on
each of the two cell lines. 51,820 and 32,451 sequence reads were
generated from blood and lymph node samples, respectively, by 454
sequencing. The sequences were assembled into 574 and 679 large
contigs, respectively. BLASTN analysis at the nucleotide level showed
no sequence identity to any of the known viruses in GenBank. A
protein-based BLASTX search resulted in 13 contigs showing best protein sequence identity to chipmunk parvovirus and various degree of
sequence identity to several other members of genus Erythroparvovirus,
in the family Parvoviridae, including human parvovirus B19. The fulllength genome sequence (5,538 bp) of the virus was obtained following subsequent re-sequencing using MiSeq system. Genetic analysis
demonstrated that the virus is distinct from all known parvoviruses.
The viral genome has 55.7%, 52.1%, and 50.5% nucleotide identity
to chipmunk parvovirus, bovine parvovirus 3, human parvovirus B19,
respectively. Application of a qRT-PCR developed based on the newly
identified virus resulted in detection of the virus from other horses that
had similar clinical symptoms in the affected farm.
Conclusion: A novel parvovirus has been identified from horses with
polysynovitis using NGS analysis. The novel virus represents a distinct
genetic lineage from all existing parvoviruses. To our knowledge, this is
the first demonstration of parvovirus in horses with disease syndrome.
The presence of the virus in site-appropriate samples from affected
individuals and the similarity of clinical findings to those of humans
infected with parvovirus B19 suggest that the virus is likely the causative agent of the disease.
вЂў
A. K. Cheung1, T. F. F. Ng2, K. M. Lager1, D. P. Alt1, E. Delwart2,
R. M. Pogranichniy3
1
National Animal Disease Center, USDA, Agricultural Research
Service, Ames, IA, USA, 2University of California at San Francisco,
San Francisco, CA, USA, 3Purdue University College of Veterinary
Medicine, West Lafayette, IN, USA
polysynovitis
J. Wang, M. Yu, S. Valdeter, S. Walker, S. Riddell, I. Broz, B. Meehan,
D. Eagles, L.-F. Wang, S. McCullough
Australian Animal Health Laboratory, Geelong, Australia
SATURDAY
New Pathogen Discovery
22.085 A novel parvovirus from horse with
22.086 Saffold virus is able to productively infect
primate and rodent cell lines, and induces
apoptosis on these cells
Y. Xu1, Q. Ng1, C. B. L. Victorio1, Y. J. Tan2, K. B. Chua1
1
Temasek Life Sciences Laboratory, Singapore, Singapore,
2
National University of Singapore, Singapore, Singapore
Purpose: Saffold virus (SAFV), a newly discovered human cardiovirus
of the Picornaviridae family, causes widespread infection among children as shown by previous seroprevalence studies. Prior to the discovery of Saffold virus (SAFV), viruses belonging to the Cardiovirus genus
under the family Picornaviridae, were only known to infect mammals
other than humans. However, characteristics of SAFV, such as host
range and cytopathogenicity, remain largely unknown.
This study is designed to determine the host cell range of SAFV and
its cytopathogenicity.
Methods & Materials: Available mammalian cell lines in the
laboratory were screened for productive SAFV infection by a laboratory-adapted SAFV of genotype 3. The susceptible cell lines were subsequently subjected to cellular study to assess the kinetics of cell death
and virus growth. Following which, a series of cellular studies, such
as DNA laddering analysis, Apo-One Fluorometric assay, and Western
Blot, were performed in infected cell lines to determine the forms of cell
death and pathways involved.
93
IMED 2014
Poster Presentations I
SATURDAY вЂў November 1, 2014
International Meeting on Emerging Diseases and Surveillance 2014
Results: Five of the eight tested cell lines (Neuro2A, CHO-K1,
NIH/3T3, Vero and HEp-2) were found to be susceptible. The time
frame for SAFV to cause full lytic cytopathic effect (CPE) of these permissible cells and the resultant endpoint virus titer differed for each
cell type. HEp-2 exhibited the shortest time frame to reach full CPE
compared to the others. All infected cell lines produced high virus titer
at 72 hours post infection. Besides causing lytic cell death, SAFV also
induced host cells to undergo apoptotic cell death through both extrinsic and intrinsic pathways though the apoptotic events in HEp-2 cells
appeared to have been blocked between the early and late stages.
Conclusion: In conclusion, laboratory-adapted SAFV is able to productively infect a number of mammalian cell lines and induce apoptosis
in the infected host cells but the apoptotic activities in HEp-2 cells are
blocked before the end stage.
22.087 Pathogen discovery and vaccine development
for emerging diseases
SATURDAY
вЂў
November 1, 2014
A. de Groof
MSD Animal Health, Boxmeer, Netherlands
Purpose: Outbreaks of infectious diseases in animals and fish for food
production continue to be threats for animal health, human health,
and food security. The identification of the causative agents involved
in emerging diseases, and the development of efficacious vaccines
against these diseases, are therefore highly desired. Identification of an
unknown infectious agent requires specialized techniques, especially
when a novel virus is considered.
Methods & Materials: Nowadays, next generation sequencing platforms combined with viral purification and library preparations provide
and excellent method to identify viruses of which the genome composition is unknown. The VIDISCA method (Virus discovery cDNA-AFLP)
is one of the library preparation methods which have been successfully
applied to identify novel viruses.
Results: In the study presented here, the VIDISCA technology combined with Roche-454 next generation sequencing was used to identify a previously unknown virus that causes a long-known disease in
commercially kept tropical fish for food production. Subsequently, the
near complete genome sequence was obtained, the virus was cultured
in vitro, KochвЂ™s postulates were fulfilled and three candidate vaccines
were developed which all provided efficacious protection against disease. All this was accomplished in 20 months.
Conclusion: Our integrated approach shows that vaccine development against unknown pathogens can greatly benefit from novel
molecular genetic techniques for virus identification.
pigeon disease syndrome. In a number of cases the obtained genome
sequences showed significant sequence differences from reference
genome sequences deposited in the GenBank (e.g., 77% nt identity
with gyrovirus 3; 90% nt identity with gyrovirus 4; 75-92% nt identity
with different types of circovirus-like viruses) and thus may represent
novel genotypes or virus species within the respective virus families.
Conclusion: Our study indicates the robustness of the virus metagenomics methodology to detect novel circoviruses and circovirus-like
agents in specimens of domesticated and feral animal species. The
significance of these findings from the viewpoint of veterinary medicine
needs further investigations.
22.089 Candidate new rotavirus species detected in
the fecal virome of sheltered dog
E. Kovacs1, S. Marton1, S. L. Farkas1, V. Martella2, K. Banyai1
1
Hungarian Academy of Sciences, Centre for Agricultural Research,
Budapest, Hungary, 2Department of Animal Health and Wellbeing,
University of Bari, Bari, Italy
Purpose: Rotaviruses (RVs) are classified within the genus Rotavirus,
family Reoviridae. The 9th report of ICTV has listed five virus species
(designated Rotavirus A to E), but with the availability of new sequence
information, an additional three species, Rotavirus G to H, have been
proposed. Species demarcation criteria include serological crossreactivity, sequence similarity values and host range.
Methods & Materials: In this study we report a diverse rotavirus
strain identified by deep sequencing of the fecal virome of a suckling
dog.
Results: Sequence and phylogenetic analysis of the genes encoding structural proteins revealed a low genetic relatedness between the
strain 135/2012 and those being representatives of their respective
virus species. The greatest aa similarities were seen when compared
with the type strains of candidate species Rotavirus H. The VP1, VP2,
VP3, VP4, VP6 and VP7 proteins shared 57%, 44%, 41%, 40%, 46%,
and 28%, although the length of the VP4 protein aligning between the
two candidate species was relatively short (50%). The 46% aa identity
within the VP6 gene was comparable to similarity values obtained for
other species (range, RVA, 27%; RVB, 38%) and was below the 53%
aa cutoff value proposed recently for differentiation of RV species.
Conclusion: Analysis of the structural genes strongly suggests that
the identified RV strain may be the representative of a novel RV species. The availability of full length structural genes will permit further
investigations to uncover the host range and any potential public health
implications of this unusual rotavirus.
22.088 Small ssDNA viruses detected in domesticated
22.090 Genetic diversity and possible recombination
E. Feher1, E. Kovacs1, S. Marton1, M. Balmann1, P. Pazar2,
G. Kemenesi3, G. Lengyel4, F. Jakab3, K. Banyai1
1
Hungarian Academy of Sciences, Centre for Agricultural Research,
Budapest, Hungary, 2Szent Istvan University, Budapest, Hungary,
3
University of Pecs, Pecs, Hungary, 4Dr. GyГ¶rgy RadГі Military Medical
Centre, Hungarian Defence Forces, Budapest, Hungary
E. Kovacs1, S. Marton1, T. Tuboly2, V. Martella3, K. Banyai1
1
Hungarian Academy of Sciences, Centre for Agricultural Research,
Budapest, Hungary, 2Szent IstvГЎn University, Faculty of Veterinary
Science, Budapest, Hungary, 3Department of Animal Health and
Wellbeing, University of Bari, Bari, Italy
and wild animals by viral metagenomics
Purpose: Small ssDNA viruses of the Circoviridae and Anelloviridae
family are widely distributed. In our study fecal and organ samples of
healthy and diseased domesticated and wild animals were investigated
by high-throughput sequencing by using an Ion Torrent PGM platform.
Methods & Materials: Sequence data generated by viral metagenomics were used to obtain the whole genomes with the adaptation of
back-to-back primed PCR and traditional sequencing.
Results: With this approach, six whole genomic sequences of new
type gyroviruses (human gyrovirus, avian gyrovirus 2, gyrovirus 3 and
4) were described in fecal samples of ferrets with spleen and lymph
node enlargement. Identification and determination of different circoviral or circovirus-like sequences in the fecal specimens of rabbit,
swine and different European bat species was carried out by the same
approach. We also identified traces of the recently described pigeon
torque teno virus in liver samples of pigeons suffering from young
94
IMED 2014
events in canine astroviruses
Purpose: Dogs are among the most popular companion animals in
Hungary and in other countries all around the world. These animals
are in close contact with humans, other pets and wild-living animals.
Viral infections of dogs manifest frequently as gastrointestinal symptoms that could also affect the environment thus dogs and also other
susceptible organisms. Furthermore, virus infections of dogs may have
implications on human health.
Methods & Materials: In this study healthy and diarrheic fecal specimens were collected during 2012 in Hungary from 51 sheltered dogs
and subjected to viral metagenomics on an Ion Torrent PGM platform.
Results: A large variety of enteric viruses were identified, including
rotaviruses, kobuviruses, noroviruses, picodicistroviruses, bocaviruses, parvoviruses, and astroviruses. Most typically, partial genomic
sequences were obtained for the identified viruses. To further study
the genomic structure of canine astroviruses, the sequence output
was multiplied in repeated sequencing runs. As a result, the coding
sequences of five canine astrovirus strains were determined.
Poster Presentations I
SATURDAY вЂў November 1, 2014
International Meeting on Emerging Diseases and Surveillance 2014
The five, near-full length Hungarian astrovirus genomic sequences
shared 74вЂ“96% nt identity with each other and 80вЂ“97% nt identity with
the overlapping regions of the reference sequences deposited in the
GenBank. Phylogenetic analysis divided canine astroviruses into four
lineages based on the gene sequence coding for the capsid protein.
Simplot analysis identified potential recombination events between two
pairs of strains, bc41 and bc14 and bc23 and bc14, localizing the crossing points in the capsid region.
Conclusion: Our study is the first to describe the coding region of
canine astroviruses and shows a great diversity among co-circulating
strains.
22.091 Molecular survey of bat-transmitted RNA
viruses: discovering novel astroviruses,
coronaviruses and caliciviruses
KД±rklareli virus, in calves with enteritis in Turkey
F. Alkan1, I. Karayel1, C. Catella2, L. Bodnar2, G. Lanave2, K. BГЎnyai3,
N. Decaro2, C. Buonavoglia2, V. Martella2
1
Ankara University Veterinary Faculty, Ankara, Turkey, 2Department
of Veterinary Medicine, University Aldo Moro of Bari, Bari, Italy,
3
Veterinary Medical Research Institute, Budapest, Hungary
Purpose: In cattle, caliciviruses of at least three distinct genera
(Nebovirus, Norovirus and Vesivirus) have been detected but only
neboviruses and noroviruses have been associated with enteric replication and with enteric signs, on the basis of either experimental infections or observational studies. In this study it is reported the molcular
characterization of novel bovine enteric calicivirus from calves with
diarrhea.
recombinant echovirus 25 strain isolated
from a neonatal patient with hand, foot and
mouth disease complicating encephalitis in
Beijing, China
November 1, 2014
22.092 Discovery of a novel bovine enteric calicivirus,
22.093 Complete genome sequence of a new
вЂў
Purpose: With over 1250 species, bats represent the most widespread
mammalian order worldwide. Emerging infectious diseases pose a significant threat to human and animal welfare. Moreover, anthropogenic
activities, such as urbanization and destruction of natural bat habitats
are increasing interactions between bats, humans, and livestock.
Methods & Materials: We investigated the occurrence and genetic
diversity of bat RNA viruses in Hungary. Bat faecal samples were
collected from different geographic areas of Hungary and screened
for RNA viruses of six distinct virus families (AstrovirusesвЂ”AstV,
CoronavirusesвЂ”CoV,
CalicivirusesвЂ”CalV,
LyssavirusesвЂ”LysV,
OrthoreovirusesвЂ”OrthV, ParamyxovirusesвЂ”ParmV, RotavirusesвЂ”
RotV) with different sets of consensus primer pairs.
Results: A total of 447 bat faecal samples were collected in 2012 and
2013 from 45 sampling sites across Hungary. Twenty-four out of the 28
known Hungarian bat species were sampled and tested in this study.
Novel strains of AstVs, CoVs and novel CalVs were detected, while
LyssV-, OrthV-, ParmV- and RotV were not identified in the samples.
The overall prevalence of AstVs in bats was 6.93% (95% confidence
interval [CI] 4.854, 9.571). Out of the 24 bat species tested, AstVs
were identified in the following eight species: Miniopterus schreibersii,
Myotis bechsteinii, Myotis daubentonii, Myotis emarginatus, Myotis
nattereri, Nyctalus noctula, Pipistrellus pygmaeus and Plecotus auritus. CoV RNA was detected in seven bat species: Myotis daubentonii,
Myotis myotis, Myotis nattereri, Pipistrellus pygmaeus, Rhinolophus
euryale, Rhinolophus ferrumequinum and Rhinolophus hipposideros.
The prevalence of bat CoV among the sampled bats was 1.79% (95%,
CI 0.849, 3.348). Novel bat CalVs were detected in three bat species,
namely Myotis daubentonii, Myotis alcathoe and Eptesicus serotinus.
The prevalence of BtCalV among the sampled bats was 0.67% (95%,
CI 0.189, 1.780).
Conclusion: As the main results of this study, i) we have successfully
confirmed SARS-related CoVs in bats, ii) we have described new bat
species harbouring AstVs in Europe and iii) first time we found new
species of CalVs in bats.
SATURDAY
G. Kemenesi1, B. Dallos1, T. GГ¶rfГ¶l2, S. Boldogh3, P. EstГіk4, A. Kutas1,
M. Oldal1, V. Martella5, K. BГЎnyai6, F. Jakab1
1
University of PГ©cs, PГ©cs, Hungary, 2Hungarian Natural History
Museum, Budapest, Hungary, 3Aggtelek National Park, JГіsvafЕ‘,
Hungary, 4EszterhГЎzy KГЎroly College, Eger, Hungary, 5Department of
Animal Health and Wellbeing, University of Bari, Bari, Italy, 6Veterinary
Medical Research Institute, Budapest, Hungary
Methods & Materials: In 2012, an outbreak of enteritis occurred in
KД±rklareli, Thrace, Turkey. Faecal samples were tested and found positive for either group A rotavirus or coronavirus. Also, all the analyzed
animals tested positive for Cryptosporidium spp. Interestingly, upon
electron microscopy observation, small round viruses(SRVs) could be
observed in the stools. Also the virus was identified by RT-PCR with
consensus primers and sequence analysis.
Results: By RT-PCR with consensus primers and sequence analysis, the SRVs were characterized as caliciviruses, with limited homology(<65% nucleotide[nt] identity) in a short(300nt) fragment of the
RNA-dependent RNA-polymerase, to the bovine calicivirus (Nebovirus)
prototype strain NB. By combining RT-PCRs with a primer walking
strategy, 5вЂ™ and 3вЂ™RACE protocols and next generation sequencing
semiconductor technology, the complete genome of the novel calicivirus, named KД±rklareli virus, was determined. The genome was 7484nt
long with a 57nt-long 5вЂ™UTR, and a 80nt-long 3вЂ™UTR. Two ORFs, of
6581nt (ORF1) and 657nt (ORF2) in length, were mapped. ORF1 contained the replicative proteins and, at the 3вЂ™ end, the 1629nt-long (542
amino acids,aa) capsid region, with a potential cleavage site between
the non-structural proteins and the capsid protein. In the full length
VP1, KД±rklareli virus displayed less than 60%nt and 43%aa identity to
other bovine caliciviruses. A distinctive feature, with respect to other
bovine neboviruses, was found in the genome organization, as there
was a 1-nt overlap between ORF1 and ORF2, while members of the
Nebovirus genus have a 1-nt interval between the two ORFs.
Conclusion: In conclusion, we identified a novel bovine calicivirus,
distantly related to other bovine enteric caliciviruses, and with a distinctive genome organization. Information on the epidemiological and
patho-biological features of KД±rklareli virus needs to be gathered, in
order to assess the relevance of this novel enteric virus in the bovine
species.
Y. Meng, H. Li, J. Liang, Q. Wang, J. Zhang, S. Liu, J. Cheng
Institutes of Infectious Diseases, Beijing Ditan Hospital, Capital
Medical University, Beijing, China
Purpose: Echovirus 25 is a member of human enterovirus B, which
is unfrequent in HFMDs, but it often causes aseptic meningitis. By
now, only three strains have been sequenced completely in the NCBI.
To know more about its gene structure, evolution, and virulence,we
sequenced a novel E25 strain of china completely.
Methods & Materials: Viral RNA was extracted from 140 Ојl of throat
swabs of the HFMD patient hospitalized in the Division of Pediatrics,
Beijing Ditan Hospital.Reverse transcription (RT) was performed with 5
Ојl RNA to synthesize cDNA.Partial VP1 region was amplified to find out
it belongs to E25.Then we designed the specific primers for sequencing the complete genome of the strain.The phylogenetic tree based on
VP1 section was drawn by MEGA 6.0. Simplot and similar bootscan
analyses was used to find recombination.
Results: The complete genome consists of 7429 nucleotides, including an 6585-nt open reading frame. The phylogenetic dendrogram
based on VP1 gene regions showed that our strain was located in the
novel subgroup D4 with other E25 strains of China. Both Simplot and
similar bootscan analyses of the genome revealed that E25/2010/CHN/
BJ was a probable progeny of recombination of the E25 strain and
Coxsackievirus B3 (CVB3) strain.
Conclusion: We sequenced the complete genome of an E25
strain successfully, which is the fourth report of the whole genome
sequence of the E25 strain prevalent in the world, and the first one
inBeijing,China. The whole genome consists of 7429 nucleotides,
encoding a 2194-amino-acid polyprotein, which is identical to the other
three. The Phylogeny based on VP1 showed that our strain E25/2010/
CHN/BJ was located in the novel subgenogroup D4, along with the
other E25 strains prevalent inChinain recent years. Phylogenetic
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International Meeting on Emerging Diseases and Surveillance 2014
analysis based on full-length genome revealed that E25/2010/CHN/
BJ was a possible progeny of recombination of E25 strain HN-2 (or
E25SD2010CHN) and CVB3 Beijing0811(or CVB3 Fuyang19), but itвЂ™s
the first report of recombination between E25 and CVB3 inthe world.
The complete genome sequence of E25/2010/CHN/BJ strain was
deposited in the NCBI GenBank database under accession number
KJ957190.
22.094 Increased detection of CrimeanвЂ“Congo
hemorrhagic fever (CCHF) in Georgia
(2009вЂ“2014)
SATURDAY
вЂў
November 1, 2014
N. Mamuchishvili1, K. Zakhashvili2, G. Chakhunashvili1, P. Imnadze3,
D. Echeverria4
1
NCDC, Tbilisi, Georgia, 2National Center for Disease Control and
Public Health of Georgia, Tbilisi, Georgia, 3National Center for
Disease Control and Public Health, Tbilisi, Georgia, 4University of
Washington, Seattle, WA, USA
Purpose: Crimean Congo hemorrhagic fever is a febrile disease caused
by the CCHF virus and transmitted by ticks and contact fluids from
infected hiumans or animals. CCHF is an emerging disease in Georgia.
The first laboratory case was diagnosed in 2009 in Tbilisi. Since then,
cases have increased with a case-fatality rate of 8%. Similar to Turkey,
the CCHF virus (genus Nairovirus, family Bunyaviridae) is transmitted
to humans by bites of infected ticks from the genus Hyalomma. In this
study, we describe 25 patients from different Georgian regions who
were admitted to the Tbilisi infectious disease hospital between 2009
and 2014. This study represents the first study where CCHF incidence
rates are described in Georgia.
Methods & Materials: The introduction of an Electronic Integrated
Disease Surveillance System in 2007 permits case-based analyses.
Clinicians adhere to a clearly defined case definition, which requires
laboratory confirmation based on positive PCR and ELISA test results
accompanied by symptoms of high fever, nausea, vomiting, abdominal
pain, elevated enzymes, pancytopenia. Petechia and hemorrhagic subcutaneous bleeding.
Results: Twenty-five lab confirmed cases were reported in 9 women
and 16 men. The majority were <45 years of age (range=19-77). Cases
increased from single reports in 2009 and 2012 to 13 cases in 2013.
There have been 10 cases to date in 2014. In order of importance,
cases were elevated in 7 villages near Kashuri (n=12, incidence rate
= 1.92/100,000) and 2 villages near Apsindza (n=3, incidence rate =
2.27/100,000). The remaining villages incurred fewer cases in Borjomi
(n=3, incidence rate = 0.95), Khaspi (n=2, incidence rate = 0.38), Tbilisi
(n=2, incidence rate = 0.08), with 1 case from Mtsxeta (incidence rate =
0.17), Gori (incidence rate =0.21), and Marneuli (incidence rate = 0.23).
The mortality rate was 2/25 or 8%.
Conclusion: Laboratory results are consistent with other CCHF case
series reported in Turkey. Recent training in laboratory diagnostics
and intensive training in clinical recognition of CCHF disease among
regional family doctors account for the increased reporting of cases.
Proposed CCHF prevention programs in Kashuri and Aspindza with the
goal of scaling up prevention to all high risk regions in Georgia.
Outbreak Response and Control
22.095 Investigation of Ebola viral haemorrhagic
fever (VHF) outbreak in Luwero district
Uganda, 2012/13
E. N. Muwanguzi
Ministry of Health, Kampala, Uganda
Purpose: The main objective of the investigation was to confirm the
outbreak and institute response and control measures.
Methods & Materials: Investigations involved specimen collection
and analysis and epidemiologic case-based investigations using the
surveillance case definition. The team also conducted investigations
on the possible index case and worked with Village Health Teams for
contact tracing.
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IMED 2014
Results: The putative index case was a motor cycle rider who is
reported to have transported an Ebola patient to the hospital. Of the
33 reported cases, 7 met the suspected case definition, and 6(18.2%)
were confirmed positive for the Ebola of Sudan type (SEBOV) virus
species and 1(3.0%) was classified as a probable case. The remaining 26(78.8%) were confirmed negative for the Ebola of Sudan type
(SEBOV)virus species. The Case Fatality Rate (CFR) for the outbreak
was 4/7(57.1%). The most affected village was Kakute and the most
affected age group was 20-30years.
Conclusion: The investigation confirmed the outbreak to be due to
Ebola of Sudan type (SEBOV)virus. Response and control measures
were established that enabled the outbreak to be controlled without
spreading beyond the villages of the index cluster.
22.096 Go big or go home: impact of screening
coverage on syphilis infection dynamics
A. Tuite1, D. Fisman2
1
University of Toronto, Toronto, ON, Canada, 2University of Toronto,
Toronto, Canada
Purpose: Syphilis has reemerged as a significant public health problem
in many high-income countries, with outbreaks focused in urban men
who have sex with men (MSM). In many jurisdictions these outbreaks
are ongoing, despite intensification of efforts to screen and treat at-risk
individuals. We sought to understand how population-level coverage of
asymptomatic screening impacts the ability to control syphilis transmission during an outbreak.
Methods & Materials: We developed a risk-structured dynamic compartmental mathematical model of syphilis transmission in a population
of sexually active MSM. Parameters were derived from the biomedical
literature and by model calibration. We assumed a baseline level of
treatment of early (primary, secondary, and early latent) syphilis cases
due to seeking medical care for symptoms or referral via partner notification in all scenarios. We evaluated the impact of the level of annual
population-wide screening (0-90% coverage) on incidence of early
syphilis at endemic equilibrium. Assumptions around immunity following treatment, sexual mixing, and screening frequency were tested in
sensitivity analyses.
Results: The relationship between screening coverage and equilibrium
syphilis incidence displayed an inverted U-shape relationship, with peak
equilibrium incidence occurring with 40% screening coverage (Figure).
In the base case, 75% of the population needed to be screened annually for local elimination (incidence <1 case per 100,000 population).
Results were qualitatively similar in the face of differing programmatic,
behavioural, and natural history assumptions, although the screening thresholds for local elimination differed. Results were particularly
sensitive to screening frequency; with 6- or 3-monthly screening, the
population coverage required to achieve local elimination was reduced
to 50% or 30%, respectively.
Conclusion: Screening has the potential to control syphilis outbreaks.
However, when coverage is suboptimal, screening may ultimately
result in the establishment of higher equilibrium infection incidence
than that observed in the absence of the intervention.
22.097 Genomic analysis of Legionella outbreaks:
implications for outbreaksвЂ™ study and control
F. Gonzalez-Candelas1, L. Sanchez-Buso2, I. Comas2, G. Jorques3,
V. GarcГa-LГіpez de Meneses 3, J. Calafat3, F. Adrian3, J. Fenollar3,
I. Escribano4, H. Vanaclocha5
1
University of Valencia-FISABIO Salud Publica, Paterna, Spain,
2
FISABIO Salud Publica, Valencia, Spain, 3Direccion General de
Salud PГєblica, Alcoy, Spain, 4Hospital Virgen de los Lirios, Alcoy,
Spain, 5Direccion General de Salud PГєblica, Valencia, Spain
Purpose: Genome sequencing of pathogens is becoming a routine
method for outbreak investigations and surveillance programs. The
Gram-negative Legionella pneumophila is a strictly environmental,
opportunistic pathogen and the main cause of LegionnaireвЂ™s disease
and Pontiac fever. As for most environmental bacteria, our knowledge
at the genome level of this pathogen is still very limited. During the
1999-2010 period, 18 legionellosis outbreaks were recorded in the city
of Alcoy (Alicante province, Spain).
Poster Presentations I
SATURDAY вЂў November 1, 2014
International Meeting on Emerging Diseases and Surveillance 2014
T. S. Butt, I. Koutlakis-Barron, S. AlJummah, S. AlThawadi,
S. AlMofada
King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi
Arabia
Purpose: Transmission of Middle East Respiratory Syndrome
Coronavirus (MERS-CoV) among Health Care Workers (HCWs) and
patients has been clearly documented. A mortality rate of approximately 30% poses a significant risk to exposed individuals. It is not
conclusive whether adhering to basic Infection control (IC) practices
alone is sufficient to prevent the transmission of MERS-CoV. We propose that Advanced IC Measures incorporated at an institutional level,
in conjunction with the Basic Measures is necessary to reduce the risk
of transmission during an epidemic.
A retrospective observational study of combined Basic and Advanced
IC Measures implemented since the initial discovery of MERS-CoV
was conducted to determine effectiveness in preventing transmission
to HCWs.
Methods & Materials: Basic IC measures include standard and
transmission based precautions that include hand and environmental
hygiene, designated patient placement, prompt institution of isolation precautions, proper quality, type and use of Personal Protective
Equipment (PPE). Advanced IC measures include daily administrative
rounds to review adequacy of strategies, IC risk assessment, patient
screening for symptoms, high-particulate mask fit-testing, interdepartmental collaboration, epidemic-plan implementation, stock piling of
critical supplies, Emergency Department contingency plan, appropriate ordering, collection, transportation and analysis of specimens, full
PPE use including high-particulate mask during advanced airway management, isolation flagging on electronic medical records, IC on-call,
MERS-CoV testing for inter-hospital transfers, effective staff education
and communication.
Results: Total of 511 real time PCR MERS-CoV tests performed.
HCW with post-unprotected exposure: 107 resulting in zero cases.
Patients tested: 404 resulting in 11 positive cases. 73% positive cases
were male, with an average age of 56.5 years (range: 19-84). Potential
HCW Exposure Days (patient presentation to cure or expired): 281
days. Patient mean duration of infectivity: 25.5 days (range: 6-58). Allcause mortality: 45% (5 of 11). Mortality directly related to MERS-CoV
infection: 27% (3 of 11).
zoonoses in the Netherlands
K. Maassen, J. van der Giessen, A. van de Giessen
National Institute for Public Health and the Environment, Bilthoven,
Netherlands
Purpose: In the last decade, The Netherlands has encountered some
outbreaks related to (emerging) zoonoses. After the avian influenza
outbreak in 2003 causing conjunctivitis amongst cullers and the emergence of livestock associated MRSA in 2004, the worldвЂ™s largest outbreak of Q fever among people took place. These events emphasized
the need for a more systematic approach of sharing and assessing
signals for (emerging) zoonotic infections.
Methods & Materials: A zoonoses risk analysis structure was developed and implemented consisting of several steps covering signaling,
response (including up scaling), outbreak management and decisionmaking at the governmental level. Important is that at each stage in all
teams experts from both human and veterinary health are involved. In
the вЂ�signaling forum zoonosesвЂ™ a risk assessment is performed on the
zoonotic signals that are brought in by the participants. This signaling
forum is the basis of the structure with regular meetings every month. If
necessary, ad hoc meetings can be organized in case of an urgent signal. Experts from the key veterinary institutes (Animal Health Service,
Central Veterinary Institute, Faculty of Veterinary Medicine, Dutch
Wildlife and Health Center), the Netherlands Food and Consumer
Product Safety Authority, the Community Health Services and the
National Institute for Public Health and the Environment assess the risk
and determine whether a follow-up action is desired.
Results: An integrated human-veterinary risk analysis structure has
been developed and implemented in order to improve early warning
and control of emerging zoonoses in The Netherlands.
Conclusion: In this example of a One Health strategy next to the
actual assessment of signals, the signaling forum strengthens the
relationship, collaboration and communication between the human and
veterinary health partners in The Netherlands, also key factors in the
joint battle against emerging zoonoses
November 1, 2014
the transmission of MERS-CoV among health
care workers in a tertiary care institution,
Riyadh, Saudi Arabia
22.099 Signalling and risk assessment of emerging
вЂў
22.098 Adhering to infection control practices prevents
Conclusion: Adhering to a combination of Basic and Advanced IC
measures prevented the transmission of MERS-CoV to HCWs at a
Tertiary Care Institution, Riyadh, Saudi Arabia.
SATURDAY
Methods & Materials: We analyzed 69 clinical and environmental
isolates of L. pneumophila collected during the investigation of 13 of
those outbreaks. Most (n=45) samples corresponded to a specific
Sequence Type (ST578) almost endemic to this area and frequently
found in clinical samples of Legionellosis patients. The samples were
sequenced using the SOLiD 5500XL platform to an average coverage
of 90X. Mapping and subsequent variant calling and filtering were performed to obtain aligned pseudo-genomes.
Results: The analysis of ST578 strains involved in the same outbreak showed overlapping levels of variability (range 6-1,760 SNPs
in a core of 3,046,296 bp) to those observed between strains from
different outbreaks (range 5-1,807 bp), thus revealing that some of
these outbreaks have not been caused by a single bacterial clone. Our
results also showed that recombination is the main force introducing
variability in the ST578 clade (>98%), with at least 16 events mapped
on 5 different branches of the phylogeny in a 20-year period. These
events increased more than 10-fold the per-branch substitution rates
compared to those obtained only from mutation.
Conclusion: In conclusion, L. pneumophila strains involved in
ST578 outbreaks in Alcoy do not show a clonal relationship even
after removing the effects of recombination from the analyses. These
results suggest that Legionella outbreaks can be more complex than
previously considered on the basis of sequence typing and that this
methodology can be misleading when the complete genomic diversity
is not considered. In these cases, deep genome sequencing can unveil
the actual relationships between clinical and environmental strains during outbreak investigations and contribute to their control. A distinction
between physical and biological sources of outbreaks might also help
in this respect.
22.100 Epidemiological monitoring of anthrax soil foci
in Kazakhstan
M. Orynbayev1, A. M. Aikimbayev2, V. N. Sheyanov3,
G. A. Temiraliyeva4, A. Tuleuov5, G. Omasheva5
1
Research Institute for Biological Safety Problems, Gvardeisky,
Kazakhstan, 2Scientific Practical Center for Sanitary Epidemiological
Expertise, Almaty, Kazakhstan, 3Scientific and Practical Center
for Sanitary Epidemiological Expertise and Monitoring, Almaty,
Kazakhstan, 4Scientific Practical Center for Sanitary Epidemiological
Expertise, Almaty, Kazakhstan, 5Scientific and Practical Center for
Sanitary Epidemiological Expertise, Almaty, Kazakhstan
Purpose: Anthrax has established niches in Kazakhstan, and this continues to pose a threat to animal and human health. There is a historic
heritage of more than 1,930 old anthrax cattle graves that are subject to
continuous monitoring. Veterinary and sanitary services should develop
control methods of historical anthrax points and anthrax soil foci.
Methods & Materials: Retrospective cohort analysis, bacteriological
methods, GIS, and PCR-based surveillance.
Results: The 2010 outbreak in the Pavlodar region serves as an
example for the long-term persistence of Bacillus anthracis spores
in the soil. This area had been considered safe for 40 years. Other
examples: animals got infected when grazing at the archaeological
excavation site in Zhambyl region in 2004. In 2009, infection of animals
was reported in association with construction trenches for a gas pipeline in the West Kazakhstan region. In 2011, a PCR-confirmed case of
anthrax associated with excavation work occurred in an area of East
Kazakhstan region, which was registered as an anthrax stationary
point. The results indicated the standard qualitative analytical method
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IMED 2014
Poster Presentations I
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International Meeting on Emerging Diseases and Surveillance 2014
of detecting Bacillus anthracis spores in the soil is not enough effective.
Conclusion: The soil of pasture and sick cattle burial grounds may
become a factor in the spread of pathogens of various diseases.
The causative agent of anthrax can be dangerous for an indefinitely
long period of time. After nutrients and water reach the layer where
spores are present, germination occurs, vegetative growth becomes
possible, and then, re-sporulation may occur again. This cycle of recloning maintains and restores the pathogenic properties of spores.
The more sensitive methods of anthrax spores detection in soil should
be investigated.
The researches were carried out with the support of the US
Department of Energy (US-DOE) through ISTC to determine the epidemic potential of soil anthrax foci.
22.101 A LegionnairesвЂ™ disease outbreak associated
SATURDAY
вЂў
November 1, 2014
with cooling towers in Warstein, Germany,
August 2013
A. Maisa1, A. Brockmann2, F. Renken2, C. Lueck3, S. Pleischl4,
M. Exner4, I. Daniels-Haardt1, A. Jurke1
1
NRW Centre for Health, MГјnster, Germany, 2Public Health
Department Soest, Soest, Germany, 3Institute for Medical
Microbiology and Hygiene, Dresden, Germany, 4Institute for Hygiene
and Public Health, Bonn, Germany
Background: Between the 1st of August and 6th of September 2013
an unusual cluster of patients with LegionnairesвЂ™ disease (LD) of
unknown aetiology in Warstein was notified to the public health authorities in Soest, North Rhine-Westphalia, Germany. An investigation team
comprised of professionals with different expertise was formed to control the outbreak.
Objective: Potential sources were inspected, sampled and shut
down. A case-control study was conducted to identify possible sources
of infection.
Methods & Materials: Methods: Cases and controls completed a
questionnaire or were interviewed by phone using random digit dialling. Laboratory investigation was performed at the national consultant
laboratory. Odds ratio (OR), 95% confidence interval (CI) and p-values
were calculated by logistic regression (SPSS).
Results: Results: According to German case definition the outbreak consisted of 159 reported suspected cases of LD including 78
laboratory-confirmed cases and 2 fatalities. Legionella pneumophila,
serogroup 1, subtype Knoxville, sequence type 345, could be identified as the epidemic strain. Applying the European case definition, this
outbreak included 77 laboratory-confirmed cases and 1 fatality only.
Cases were 19 to 94 years old (median of 63 years) and 64% were
male. The case fatality rate was 1.28%, whilst 91% of cases were
hospitalised and 17% of those needed intensive care. Further analysis
involved 75 age- and sex-matched laboratory-confirmed cases and
controls, respectively. In univariable analysis cases were almost five
times more likely to smoke than controls (OR 4.81; 95% CI 2.33-9.93;
p<0.0001). Furthermore cases were two times more likely to live in a 3
km distance around one identified infection source than controls (OR
2.14; 95% CI 1.09-4.20; p<0.027).
Conclusion: Conclusion: This is the largest outbreak of LD in
Germany to date; however the case fatality rate was low compared
to previous outbreaks throughout Europe. Due to a series of uncommon events, this outbreak was most likely caused by multiple sources
involving industrial cooling towers. Quick epidemiological assessment,
source tracing and shutting down potential sources as well as rapid
laboratory testing and early treatment are necessary to reduce morbidity and mortality. Maintenance of cooling towers must be reliable to
prevent such LD-outbreaks in the future.
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IMED 2014
22.102 Developing surveillance and situational
awareness of an emerging pathogen for
the U.S. military: Chikungunya
J. Writer, N. Darling, S. Harris, W. Corr, R. Chitale
Armed Forces Health Surveillance Center, Silver Spring, MD, USA
Purpose: AFHSCвЂ™s Division of Integrated Biosurveillance, established
in April 2012, provides U.S. Department of Defense (DoD) decisionmakers regular communication and consultation on timely, relevant, and
actionable biosurveillance data and information. In December 2013,
France reported two cases of autochthonous chikungunya on Saint
MartinвЂ”the first autochthonous cases in the Western Hemisphere.
While U.S. military personnel have operated in chikungunya endemic
countries, the emergence of the disease in the Caribbean has the
potential to significantly increase the risk to DoD personnel. The need
to understand how this could affect the U.S. military was immediately
recognized and DoD leadership has been requiring regular updates on
this emerging disease.
Methods & Materials: A broad range of websites are scanned daily
for pertinent information on chikungunya to track trends and intensity of disease spread. An analysis of the impact of chikungunya on
military personnel going back to the Vietnam War was undertaken. We
developed a preliminary model based on chikungunya importation into
France and Australia to predict cases in DoD personnel. Regular interaction with other U.S. government agencies (USG) supplies additional
information.
Results: Regular вЂ�Surveillance SummariesвЂ™ as well as disease-specific laboratory and surveillance guidance are published and distributed
to a U.S. military list serve numbering more than 500 persons and the
USG numbering over 40 persons. These publications provide readers
with information and analysis of specific relevance to DoD populations.
They include background information on cases; affected locations;
transmission modes; diagnostic capability within DoD; and vaccine/
treatment efforts initiated by PAHO, MOHs, USG, and industry. The
preliminary model yielded broad estimates of annual cases (0 to 624)
related to the Caribbean outbreak.
Conclusion: The integration of timely, verified information and data
in published products for ongoing surveillance and situational awareness of an emerging disease has led to enhanced communication,
more comprehensive and better knowledge of internal and external
disease-related activities, and improved synchronization of biosurveillance efforts across DoD. Characterizing the past impact of chikungunya has proven more difficult as it is not a reportable disease in the
DoD and has no specific ICD-9 code. The modeling of chikungunya
incidence in service members requires further refinement.
22.103 Outbreak of pulmonary tuberculosis in
Cojutepeque military brigade, El Salvador,
July 2013
J. Santos
Ministry of Health El Salvador, Santa Tecla, El Salvador
Objectives: 1) Identify etiologic agent, 2) Describe characteristics of
inffected people, 3) Identify risk factors associated with the infection,
and 4) Recommend measures for prevention and control.
Methods & Materials: We made a descripcion of case series.
Screening to 80 military personnel of the brigade was performed with
three sputum smears and X-ray of the chest. Beside HIV tests were
taken at the positive cases, which are also made interview, investigating demographic, clinical, laboratory and risk factors data. Frecuencies,
percentages and rates were calculated using an Excel worksheet. The
rates were calculated for each of the five military bedrooms (called A,
B, C, D and E).
Results: It was identified the Mycobacterium as the etiologic agent.
The affected people were all male, and 19 years old. All of them came
from a rural area. The main risk factor that we found was the overcrowding, beside to be a contact of a pulmonary tuberculosis case.
Attack rate was 18.75% in bedroom C. The index case was identified
and two secundary cases, with and exposure period of 59 days. The
Poster Presentations I
SATURDAY вЂў November 1, 2014
International Meeting on Emerging Diseases and Surveillance 2014
index case was contact of a Pulmonary Tuberculosis case at his home.
Only the index case presented symptoms: cough, fever and weight loss
for more than 15 days.The other two cases had cough since two days
duration.
Conclusion: We found a rate of pulmonary tuberculosis 526 times
higher than the national rate. It was also 12.5 times higher than that
found in other studies in closed populations such as school facilities. As
a result of the investigation we could stop the outbreak, cure cases and
to intoduce tests for pulmonary tuberculosis screening for all incoming soldiers. This is the firs time that an outbreak of tuberculosis is
described in a military instalation in El Salvador. The health personnel
in military brigades has begun the procces of training and continuing
education.
22.104 Justified cholera vaccination trials in Uganda?
Large outbreaks in Namayingo and Moyo
Districts, 2014
capacity of вЂњhot spot nationsвЂќ to respond to
infectious disease outbreaks: overview of the
USAID/RESPOND project in Africa
H. M. Amuguni1, D. Saila Ngita1, L. Foan2, S. Tzipori3
1
Tufts University, North Grafton, MA, USA, 2USAID, Kampala,
Uganda, 3Tufts University Cummings School of Veterinary Medicine,
North Grafton, MA, USA
Purpose: Infectious diseases are emerging from wildlife and livestock
with greater frequency in areas with limited resources for disease
prevention and control. Responding effectively requires coordination
November 1, 2014
22.105 Using a One Health approach to build the
вЂў
Background: Over the past seven years, Uganda has reported a cholera outbreak annually. Cholera vaccine trials are in advanced stages
and Uganda has been considered a candidate. On 23rd April 2014,
cholera was reported in Obongi county, Moyo district, West Nile. Four
weeks later, another cholera outbreak started on 15th May 2014 in
Namayingo district, Eastern Uganda.
Purpose: To establish the extent of the cholera outbreak in Moyo and
Namayingo districts and to assess the risk factors in the affected areas.
Methods & Materials: A national multidisciplinary team supported
investigations, surveillance, case management and infection control
as well as social mobilization to curb the spread. Contact tracing, line
listing, active case search and investigation were conducted. Data was
analysed in Epiinfo 6.0.
Results: Laboratory confirmation of Vibrio cholera 01 Inaba was
obtained from Central Public Health Laboratories for both outbreaks.
Up to 84 cases, 4 deaths in Obongi county, Moyo district (Attack Rate
108.7 cases per 100,000 people, Case Fatality Rate 4.7%) and 86
cases, 2 deaths (AR 189.5, CFR 2.3%) from Mutumba Sub-county,
Namayingo district were recorded. In Moyo, average age of 22.3 years
and 60% (n=64) female cases were recorded compared to mean age
of 18.4 years and 58% (n=86) females in Namayingo. All patients
responded well to antibiotics and fluid therapy at Obongi Health Centre
IV and Mutumba HCIII where cholera treatment centres (CTC) were set
up. All deaths occured in the community, none of the referred patients
died. Both outbreaks occurred in fishing communities where poor hand
washing practices in Moyo; low latrine coverage (46%) and use, poor
access to safe drinking water and poor hygiene/sanitation practices in
Namayingo were risk factors. There was prompt case detection, referral, good case management and effective infection control at the CTC.
Conclusion: Vaccine trial introduction may reduce incidence of cholera outbreaks in Uganda but this should be harnessed with improved
access to water, latrine coverage and hygiene practices.
SATURDAY
I. Nabukenya1, E. Namukose2, G. Bwire 2, L. Lukwago2, F. Alingu3, M.
Malimbo4, H. Mayinja2, I. Makumbi2
1
Ministry of Health, Kampala, 284, Uganda, 2Ministry of Health,
Kampala, Uganda, 3University of San Florida, Tampa, FL, USA,
4
Uganda Ministry of Health, Kampala, Uganda
with a diversity of professions and stakeholders in both human, animal
health, social and environmental sciences. The USAID RESPOND
project was part of multi-year multi-project effort to pre-empt or combat
at their source, the first stages of zoonotic diseases that pose significant threats to human health. It focused on eight countries in Africa:
Kenya, Uganda, Tanzania, Rwanda, Ethiopia, Cameroon, Democratic
Republic of Congo and Gabon, areas considered вЂњhot spotsвЂќ for emerging and re-emerging infectious diseases.
Methods & Materials: RESPOND used a one health approach to
improve countries capacities to prepare and respond to emerging
diseases. RESPOND reinforced and supported existing public health
services by developing the skills of a wide range of professionals with
multidisciplinary applied training and experience in animal, human and
environmental health threats, while simultaneously strengthening the
institutions that provided the training. It leveraged established relationships with key international and national frontline organizations to
build sustainable response capacity. The project provided training to
enable partners to prepare and respond to outbreaks, enhanced their
capacity to plan and conduct investigations, improved cross-sectoral
linkages across multiple disciplines to support a coordinated response
and introduced technologies that improve surveillance and outbreak
investigation.
Results: A multidisciplinary field based epidemiology graduate
program serving six countries was started at Makerere University.
Government and private sectors were engaged in training programs
such as risk analysis, participatory epidemiology, gender in emerging
pandemics, outbreak investigation and emerging zoonotic disease
integrative training to broaden and train the community of frontline
responders. Seven schools of public health and veterinary medicine
reviewed and mapped their curricula to integrate One Health competencies. Demonstration sites connected communities, universities and
government counterparts and nine institutions were linked into TUSK,
an open source software that creates, manages, and delivers technology to support and enhance health sciences education.
Conclusion: Over the past 5 years, RESPOND has strengthened
training and support to universities, governments, and civil society
using One Health approaches to improve their capacity to respond to
outbreaks and diseases of zoonotic origin.
22.106 Process evaluation of PakistanвЂ™s disease early
warning system
S. Zareen1, S. M. Mursalin2
1
Federal Research and Training Centre, Lahore, Pakistan, 2National
Health Management and Information System Pakistan, Islamabad,
Pakistan
Background: In the last decade, Pakistan has experienced a number
of natural and manmade calamities that caused massive human and
economic damage. Of these the earthquake of 2005 was a big disaster
claiming around 100,000 deaths in affected areas. That led to emergence of first National Disease Early Warning System (DEWS). Since
then it has progressed to a stage to cater more than 107 million (57%)
population of the country.
Purpose: To assess if this system is meeting the intended objectives mainly timely detection and response of epidemics. It also aims at
formulating recommendations for its effective functioning and scale up
in yet uncovered districts.
Methods & Materials: In this study, both quantitative cum qualitative approach were used to collect the intended information during
and after devastating floods in July, 2010. The districts were ranked
into 3 categories (top, middle and lowest) according to the number of
alerts produced. Thus 15 districts and their 37 health facilities (HFs)
out of 45 potential sampling frames were selected by simple random
sampling for data collection. The study also included semi-structured
questionnaire and unstructured interview of 46 DEWS Managers and
field workers.
Results: DEWS is operative in 2762 HFs. About 2/5 of the visited HFs
had received one day training on DEWS since July, 2010. Whereas, 3/4
of the sampled HFs are visited by DEWS staff at least once a month
99
IMED 2014
Poster Presentations I
SATURDAY вЂў November 1, 2014
International Meeting on Emerging Diseases and Surveillance 2014
with more frequency of visits to the larger hospitals. DEWS case definitions were displayed at 59.5% of the HFs only. The case definition of
Cholera was less specific. DEWS weekly reporting forms were available at 91.9% HFs and only 8.1% HFs visited have received DEWS
weekly bulletin. The barriers identified for lack of HFs participation in
DEWs are; lack of communication and training, insecurity and lack of
incentives for staff.
Conclusion: By and large DEWS is meeting its objective of timely
detection of epidemics and response generation. There is need for
capacity building and closed follow-up as per standard operation procedures evolved. There is also a need for accelerated use of innovative
ICT for its promotion.
22.107 Measles cluster at a tertiary care hospital in
SATURDAY
вЂў
November 1, 2014
SingaporeвЂ”An outbreak investigation
H. C. Chan1, R. Sridhar2, S. M. Chan3, G. K. Goh3, G. Ciccone3,
R. T. P. V. Lin2, S. Salmon3, I. Venkatachalam3, P. A. Tambyah3,
D. A. Fisher1
1
NUH, Singapore, Singapore, 2National University Health Systems,
Singapore, Singapore, 3National University Health System, Singapore,
Singapore
Purpose: 2014 saw a global resurgence of measles, with 15000 cases
in the Philippines. Singapore noted an increase, with 23 of 72 cases in
2014 to date reporting travel to the Philippines. The National University
Hospital (NUH) also noted nosocomial measles transmission.
Methods & Materials: NUH is a 1000 bed tertiary hospital with
routine laboratory surveillance for infectious diseases of public health
significance. Measles diagnoses were confirmed by polymerase-chain
reaction and genotyping. Contact tracing was based on congruence
of time, place and activity. Susceptibility was assessed through IgG
testing (в‰¤250 mIU/mL indicated susceptibility) and vaccination history. Non-immune contacts were offered measles, mumps and rubella
(MMR) vaccine or intravenous immunoglobulin if pregnant or immunocompromised. Patient details were obtained from hospital records and
interviews. Contacts were risk assessed by the Occupational Health
Clinic.
Results: Of 4 cases identified in the pediatric department from
25-February to 21-March 2014, 3 were inpatients and 1, a healthcare
worker (HCW). Case 1, a 17 year old boy with leukaemia, was transferred from the Philippines. Measles was confirmed on D18 of admission, with B3 genotype. He died of severe necrotizing pneumonia.
Case 2, a 5 month old boy with biliary atresia, was symptomatic on
D19 of admission. Case 3, an 8 month old boy, presented with measles
10 days post-discharge. Case 4, a 39 year old paediatrician, was a
contact of cases 1 and 2. Cases 2, 3 and 4 were of D9 genotype,
each with symptom onset within 2 days. The 353 contacts were: 189
(53.5%) HCW, 162 (45.9%) patients, 2 (0.6%) visitors. The HCW were:
89 (47.1%) doctors, 78 (41.3%) nurses, 22 (11.6%) other staff. Of 150
HCW tested, 9 had inadequate immunity by enzyme immunoassay
(EIA) but found to be immune by plaque reduction neutralization test
(PRNT). 6 received booster MMR, 2 declined, and 1 deferred due to
pregnancy.
Conclusion: The genotypic and epidemiological data is suggestive
of an unidentified index as the source of this measles outbreak instead
of Case 1. Secondary transmission was averted due to high herd
immunity, prompt immunization, and administration of immunoglobulin
to high risk, non-immune persons. Ongoing surveillance and vigilance
is essential with the evolving global measles epidemic.
100
IMED 2014
22.108 Emerging dengue fever outbreak, Afar Region,
Ethiopia вЂ“ 2014
E. M. Sorassa1, D. M. Abegaze2, M. Mengesha1, J. Fogarty 3,
A. Belachew 4, L. Boulanger5, A. Greenleaf6, A. Bekele1, D. Jima7
1
Ethiopian Public Health Institute, Addis Ababa, Ethiopia, 2Addis
Ababa Health Bureau, Addis Ababa, Ethiopia, 3University of New
Mexico, Albuquerque, NM, Addis Ababa, Ethiopia, 4Addis Ababa
University, Addis Ababa, Ethiopia, 5Center for Disease Control
and Prevention, Addis Ababa, Ethiopia, 6Allan Rosen field Global
Health fellow, Addis Ababa, Ethiopia, 7Ethiopian Health and Nutrition
Research Institute, Addis Ababa, Addis Ababa, Ethiopia
Purpose: Dengue fever is a mosquito born viral disease. In the past
nine months, 11,609 cases of Dengue fever have been reported in
Ethiopia. Previous to September 2013, there had been no reported
Dengue outbreaks. On 03 April 2014, we received report of an increase
of acute febrile illness (AFI) negative for malaria from Adaar District,
Afar Region, Ethiopia. A team was deployed to the district to confirm
the existence of the outbreak, identify the etiology, source, risk factors
and to implement intervention measures.
Methods & Materials: We conducted a descriptive study followed by
unmatched case-control study (60 case and 120 controls). A suspected
case was defined as any person with AFI (fever, severe headache and/
or diarrhea) with a negative malaria test from 19 March to 30 April, 2014.
Controls were neighbors of cases without signs and symptoms of the
disease. We collected 39 blood specimens for laboratory confirmation.
Results: There were 708 AFI cases with no deaths. The crude attack
rate (AR) was 12,048 per100, 000 population and the highest AR was
among people 15-44 (AR=17,472 per 100,000) years of age. The subsequent analytic study determined that factors associated with illness
were having an AFI patient in the household (OR: 2.3: 95% CI: 1.2-4.4)
and wearing short pants and a t-shirt (OR: 3.6: 95% CI: 1.2-11.1). Of
the fourteen specimens that were ELISA tested at national laboratory in
Addis Ababa, nine (64%) were positive for Dengue fever.
Conclusion: We confirmed the third Dengue fever outbreak in
Ethiopia since September 2013. However, it is the first reported Dengue
fever in Afar Region. Dengue is an emerging public health problem
in Ethiopia. We recommended enhanced surveillance for Dengue in
Ethiopia in order to improve case detection, diagnosis, and to provide
timely intervention.
22.109 Epizootological investigation and laboratory
diagnostics of Classical Swine Fever outbreak
in Ukraine
S. Nychyk, M. Sytiuk, I. Halka, N. Hudz, M. Peknii, V. Ukhovskii
Institute of Veterinary Medicine of the NAAS, Kiev, Ukraine
Purpose: Classical Swine Fever (CSF) is a dangerous transborder disease of domesticated and wild pigs. During the last 3 years CSF was
registered in Russia, Belorussia, Lithuania and Ukraine. The last CSF
outbreak was registered in Ukraine in July-August 2003 in a private
household in Khotiv village, Kiev-Sviatoshyno district of Kyiv.
The goal of this work was to present the results of epizootological
study and laboratory diagnostics of CSF in Ukraine.
Methods & Materials: Investigation was conducted at the place of
outbreak. Clinical picture and pathoanotomical changes were documented during external examination and autopsy of the animals. White
blood cells were counted and viral antigens in samples from the spleen
lymph nodes were detected via fluorescent antibody method.
There were 1 bore, 2 breeding sows older than 1 year, 7 yelts and 20
piglets 2 months old in the household. Animals were kept in 3 separate
sheds 5-10 meters apart. Animals were fed with the leftovers from the
different canteens and concentrated feedstuff.
Results: Animals were not vaccinated against CSF. 1 breeding
sow, a boar, and 5 yelts died. It was found during the study that not
disinfected leftovers were the source of CSF virus. During the clinical studies 2 yelts demonstrated no appetite, depression, dystaxia,
Poster Presentations I
SATURDAY вЂў November 1, 2014
International Meeting on Emerging Diseases and Surveillance 2014
nosebleeding, hemorrhages on the abdominal wall and high body temperature 40.1-41.1ВєРЎ. During the autopsy, hemorrhagic inflammation of
submandibular lymph nodules, hemorrhaging in epiglottis, hemorrhagic
infraction of spleen, and diffused hemorrhage in urocyst were found.
Laboratory methods confirmed CSF via the detection of lymphocytopenia and presence of antibodies to the virus in the spleen and lymph
nodes samples.
Conclusion: All above studies confirmed the diagnosis of CSF in
pigs. Recommended to conduct educational outreach on the dangers
of food waste use for animals that was not decontaminated by the
local veterinaries. Also to enhance the pig product import control into
Ukraine.
22.110 The characteristic of leptospirosis patients
following major flood in Jakarta in early 2014
D. O. T. L. Handayani, I. Inggariwati
Health Department, Jakarta Metropolitan City Government, Jakarta,
Indonesia
I. Parvu1, G. Coltan2, S. Petrea2, A. Streinu Cercel2
1
National Institute fir Infectious diseases вЂњProf. Dr. Matei BalsвЂќ,
Bucharest, Romania, 2National Institute for Infectious Diseases вЂњProf.
Dr. Matei BalИ™вЂќ, Bucharest, Romania
Purpose: In Romania, human and animal rabies still represents a
very important issue for public health, our country being on the 6-th
place among European countries concerning animal rabies and is one
of the few countries with indigenous human rabies. In Romania, two
structures exist for the surveillance and control of RabiesвЂ”the human
network and the veterinary one. Giving the fact that communication
between these two networks was poor, whenever an accurate evaluation on Rabies cases in Romania was needed, the data was incomplete.
November 1, 2014
structure for the surveillance and control of
rabies in Romania
tularemia in the south-eastern part of Serbia
Z. VeliДЌkoviД‡1, B. D. KociД‡1, V. KostiД‡2, N. K. RanДЌiД‡3
1
Institute for public health, Nice, Serbia, 2Clinic for Infectious Disease,
Clinical Center NiЕЎ, Nice, Serbia, 3Institut za javno zdravlje NiЕЎ, Nice,
Serbia
вЂў
22.111 National Anti-Rabies Centre (CNAR) Centralized
22.112 Some epidmiological characteristics of
SATURDAY
Purpose: In early 2014, Jakarta suffered from major flood, covering
for nearly 30% of Jakarta. Water level were varied between 10 to 150
centimeters. The rise of Leptospirosis cases were noticed through
hospital based surveillance system and followed by field investigation.
The objectives of our study were to understand the characteristics of
leptospirosis patients in Jakarta.
Methods & Materials: Information of leptospirosis patients were collected from in-patient which is reported through Hospital based surveillance system. Patients were probable leptospirosis cases, diagnosis
was made by rapid diagnostic test conducted at each hospital. Cases
were then followed up by team of Surveillance Officer.
Results: The outbreak period of leptospirosis in Jakarta was between
the 3rd to 12th week in 2014. Total leptospirosis patients reported
from Hospital were 105 cases with 18 death (case fatality rate 18%).
Majority of case was male (70%). There were differences in patients
age group based on their gender. In female group the highest proportion of patients was in the age group of 41вЂ“50 years old (48%). In male
group the highest proportion of patients was in the age group of 31вЂ“40
years old (27%), followed by 51вЂ“60 years old (22%) and 41вЂ“50 years
old (20%). Patient symptoms were fever (91%), malaise (66%), headache and myalgia (42%), jaundice (38%), calf tenderness (18%) and
conjunctival suffusion (15%). At the average, patients were admitted to
hospital at th 6th day after onset of symptom. Average of patients had
history of visiting physician twice due to their illness before hospital
admission. Potential occupational risk factors known were lay workers
(33%), housewives (21%), etc. Most of cases (76%) were flood victims,
others had history of contacted with flood due to their activities.
Conclusion: Leptospirosis is one of health problem in Jakarta especially following major flood. Overall, male in the age group of 31вЂ“50 year
old were at the highest risk of suffering from leptospires. Differences of
patients distribution based on their gender possibly due to their activities, while female usually stay at flood victims shelters, male were more
likely to be more active and exposed by flood.
Following the initiative of the National Institute for Infectious Diseases
вЂњProf. Dr. Matei BalИ™вЂќ, the Ministry of Health approved the creation of
CNAR within the Institute.
Objectives: Completing the missing links in communication between
the human and veterinary anti-rabies surveillance structures, by creating a National structure that collects and manages all the data regarding Rabies in Romania. Compiling and transmitting immediate reports
to territorial human anti-rabies centers.
Methods & Materials: CNAR was created within INBI вЂњ Matei BalИ™вЂќ
because the Institute had already experienced a similar action in the
surveillance of HIV cases across the Romanian territory. Furthermore,
the Bucharest Anti-Rabies Centre already existed within the structure
of the Institute and had the highest number of presentations from
patients with bite wounds from either domestic or wild animals (12.000/
year). In order to create CNAR, the Bucharest Anti-Rabies Centre kept
itвЂ™s previous location, but was transformed into a territorial anti-rabies
department. In addition, a logistics department was created with the
purpose to collect, centralize and forward national data on rabies.
Results: By elaborating and forwarding accurate and immediate
reports between the two structures we managed to achieve major
improvement in medical attitude on rabies which lead to a better management of patients with bite wounds in Romania and a significant
decrease in post-exposure prophylaxis costs.
Conclusion: Human rabies, a disease which always leads to death,
can only be prevented by controlling animal rabies outbreaks and by
reporting new cases to human anti-rabies centers, in order to obtain
proper, accurate and rapid medical response. CNAR is likely to be
the key structure created in order to significantly improve all of these
actions.
Purpose: The aim of the paper was to present main characteristics of
two outbreaks of tularemia.
Methods & Materials: Epidemiologic and environmental investigations were conducted to identify sources of infection, modes of transmission, and household risk factors. Retrospective epidemiological
study was done.
Results: The study involved 34 patients, 18 women (52.9%) and
16 (47.1%) men. The age ranged from 10 to 75. The great number of
cases were from the age group 60-65. The most of the patients were
from villages 27 (87.1%), and only 4 (12.9%) were from a city. The
high number of patients were housewives or engaged in agriculture.
23 patients were hospitalized in Clinic for Infectious diseases in the
city of NiЕЎ. The patients having complaints of fever, malaise, chills and
shivering, painful sore throat with swollen tonsils and enlarged cervical
lymph nodes were affected and the patients were different in all cases.
The sera from all patients were analysed for the presence of F. tularensis antibodies using a microagglutination assay. Overall 14 sera of all
analysed, (bouth from the first and second outbreak) showed antibody
titres of 1/1280 and/or more (in two patients from the second outbreak
was 1/15120) against F. tularensis. The first cases appeared during
1999 and the leading clinical symptom was lymphadenopathia and all
sick perons had it. 24 (77,4%) patients had temperature higher than 38
degrees and 21 (22.6%) had pain in the throat. The outbreak in 1999
was registered only in villages surrounding Sokobanja and the next
year the new cases were noted in whole Nishava District. The most
frequent clinical form of tularemia in the second outbreak was tonsiloglandular. Only one patient had ulcero-glandular form of tularemia. The
leading symptom was pain in the throat followed by exudates. Enlarged
lymph cervical glands were noted in all patients.
Conclusion: The current report suggests that tularemia exists in
south-eastern part of Serbia.
101
IMED 2014
Poster Presentations I
SATURDAY вЂў November 1, 2014
International Meeting on Emerging Diseases and Surveillance 2014
22.113 Cluster of invasive group-A-streptococcal
infections centred around a primary school in
the Rotterdam-Rijnmond region in the
Netherlands in January and February 2012
SATURDAY
вЂў
November 1, 2014
H. Visser
Municipal Public Health Service Rotterdam-Rijnmond, Rotterdam,
Netherlands
Purpose: This is a case report describing a community outbreak of
invasive group A streptococcus in a municipality in the Rotterdam area.
The outbreak appeared to be centred on an urban primary school,
strongly suggested by the fact that two of the cases had no other epidemiological link other than that their respective son and daughter were
in the same primary school class. The relative risk contracting invasive GAS disease is higher in household contacts. If non-household
contacts also have a higher relative risk is unknown. In this outbreak
we look into this difference between (non)household contacts. Do we
need to broaden the indication of prophylactically treatment of close
contacts?
Methods & Materials: Diagnoses from the index-patients were
retrieved from the treating physician. In order to identify the contacts of
the patients, the Municipal Public Health Service (MPHS) contacted all
index-patients by telephone. Contact tracing was intensified to investigate if we faced an outbreak, for early detection and treatment of possible GAS infections and stop transmission. Clinical specimens were
obtained and processed by clinical microbiology laboratories according
to routine procedures.
Results: A total of 42 contacts were identified. Eleven contacts
(26%) were sampled before treatment. Four contacts were defined
as household contacts, seven contacts were close contacts. None of
the household contacts sampled tested positive, seven non-household
contacts were sampled of which three tested positive for the GAS strain
found in three of the index patients. Four out of seven index patients
were cultured and tested positive. Three out of seven non-household
contacts tested positive for the same strain. This outbreak strain was
determined to be a non-mucoid group A streptococcus, T3, Emm3.1
possessing the gene for exotoxin A.
Conclusion: To stop transmission and prevent severe illness, we
would advice to broaden the indication of prophylaxis in outbreak settings such as described here. We also would consider to treat persons
that have been in contact with a person in the period before death.
These people can be considered as household contacts. iGAS infections have a high mortality rate, so careful consideration for prescribing
prophylaxis is needed.
22.114 Impact of HIV/AIDS in the African military:
approaches to integrating prevention in
care setting
F. Obuseh, J. Cline
USAFE/AFAFRICA, Apo, AE, USA
Introduction: Reports and data have shown that Sub Saharan Africa
bears the brunt of the AIDS pandemic. Numerous studies estimated
an average HIV prevalence of over 6% among military personnel. The
HIV sentinel surveys indicate that the seroprevalence rate varies by
region from 3.1 to 15%. Although prevalence and AIDS-related mortality began to decline in Sub Saharan Africa, sentinel data shows that
HIV prevalence is on the rise among uniformed services.
Purpose: To highlight the impact of HIV in the military to the general
population, the importance of integrating prevention with military environment into comprehensive clinical care HIV/AIDS, to establish the
minimum package of services and to explore ways to implement this
package.
Methods & Materials: Methods: The methodology evaluates existing
programs through extensive literature review. Presenter will present an
overview of the impact of HIV in the military and how to effectively manage the problem.
Results: The presentation will be followed by discussion concluding
102
IMED 2014
with recommendations for strengthening and increasing capacity to
deal with HIV/AIDS among uniformed services. Presentation will show
an understanding to the risk factors, surveillance, epidemics of HIV,
and effects of HIV & AIDS in the African military, It will provide a forum
for thinking through strategies to achieve HIV/AIDS prevention, prevention of sexual transmission of HIV, Opportunities to mitigation of
the impact of the disease, capacity building for program sustainability,
share African military experience with HIV/AIDS prevention activities.
Conclusion: Discussion/conclusion: HIV/AIDS is one of the leading
causes of death on the continent and has been identified вЂњthe greatest
threat to development, stability, and securityвЂќ. The rate of infection in
some African security forces is believed to be high, raising concerns
that those forces being unable to deploy when needed and co-infection
through interaction with civilian population, spouses, and especially
individuals in sex trade. Outcome of presentation would initiate discussion around issues of HIV/AIDS prevention, care, and managing the
impact of HIV on the African military.
22.115 The changes of safety culture of the infectious
diagnostic sample handling in public health
laboratories
M. Shigematsu1, M. Kigawa2, S. Ando1
1
National Institute of Infectious Diseases, Tokyo, Japan, 2University of
Toyama, Toyama, Japan
Purpose: Multiple guideline changes and logistical support were implemented to public health laboratories during the last decade trying to
meet global requirements of Biosafety and Biosecurity. Coincided with
global recession, all laboratories struggled to meet all the requests. The
study analyzed readily available multiple surveys carried out during the
period to illustrate how well they responded to changes and what are
the obstacles they still face.
Methods & Materials: Multiple surveys were carried out to the same
public health laboratories in 2003, 2004, 2005, 2007 and 2012. The
surveys were done to serve different purposes but some questions
were remarkably similar. Stratified by the similar questions and none
similar questions, we analyzed the factors influenced in implementation
of the new biosafety at the institution using SPSS.
Results: The surveys were targeted to public health laboratories in
Japan. Although the overall number of the laboratories varies a little
by year, response rate was hundred percent with follow-up calls and
letters in all cases. The preparation of in-house guidelines and manuals for infectious pathogen and samples handling, the guidance for
exposure incidents and the establishment of the in-house biosafety
committee were increased overtime. Health monitoring improvement
such as free vaccination offer struggled to increase may be because of
the extra cost on top of routine health checkup provided. Slow progress
observed with the education and training part where the demand of
tools and train-the-trainer session increase being noticed. Transport of
the infectious substances were one of the targeted area of improvement as preparedness for pandemic and emergency of highly infectious
diseases. Knowledge gain and practice improvement were observed
from the survey. The size of the institution by number of workers and
budgetary size of hosting city or the prefecture did affect the progress.
Also, the rotation period of the personnel clearly affected the outcome.
Conclusion: Inevitable personnel turn over by regular rotation of the
position in public health sector influences as much as the financial support availability in the case of biosafety. Repeated and regular training
is the one most important elements to improve biosafety in such area.
22.116 Measles outbreak investigation, Kindo Didaya
district-Southern region of Ethiopia, 2013
E. Z. Worku1, H. Taame1, Y. Mogessie2, A. Bekele3, A. Worku4
1
Ethiopian Public Health Institute, Addis Ababa, Ethiopia, 2Southern
Nation and Nationalites People Regional Health Bureau, Hawassa,
Ethiopia, 3Ethiopian Public Health Agency, Addis Ababa, Ethiopia,
4
Addis Ababa University, Addis Ababa, Ethiopia
Purpose: Measles is a highly contagious disease and remains the leading cause of childhood morbidity and mortality in the world. In Ethiopia
measles accounts four percent of childhood mortality. On October 2,
Poster Presentations I
SATURDAY вЂў November 1, 2014
International Meeting on Emerging Diseases and Surveillance 2014
22.117 Preparedness to infectious outbreaks: an
Purpose: TELL ME is an EU funded Collaborative Project, which aims
to provide evidence-based models, tools and guidance for improved
risk communication during infectious disease outbreaks. The purpose
of the research was to develop an interactive, online learning course
about risk communication in case of infectious disease outbreaks that
can be used across all EU countries. A survey of healthcare professionals across Europe and the US, revealed that during the A(H1N1)
pandemic in 2009 there was a considerable lack of reliable information
to convey to people and insufficient tools and guidance for handling
the publicвЂ™s doubts and fears, especially in relation to vaccination. An
online course for health care professionals could provide consistent
information and convey it simultaneously all over Europe.
Methods & Materials: The following approach was used for the
development of the e-learning course:
1) Analysis of usability, width of adoption, languages and scalability of
open source e-Learning Management Systems.
2) Analysis of e-learning models aimed at healthcare professionals.
3) Validation and evaluation of the course by healthcare professionals
across the EU.
Results: Our analysis revealed that the best open source platform for
this purpose was Moodle 2.7 release.
A formal review of scientific literature showed that case histories were
the most effective model for a course aimed to healthcare professionals. Case histories drag education into daily clinical activity testing its
practical application in real life.
A prototype online course for primary care staff has been developed
and will be tested by a range of healthcare professionals from the EU
in the coming months. It will be freely available in English across all
EU countries via the TELL ME website (http://www.tellmeproject.eu/
content/d33-proptotype-online-course-primary-care-staff).
Conclusion: The availability of an interactive, online course about
risk communication in case of infectious disease outbreaks will facilitate homogeneous training for healthcare professionals, improving
their knowledge, skills and preparedness.
B. Beyene1, M. Tumato2, R. LUCe3, F. Enquesilassie4
Amhara Regional state Health Bureau, Bahir Dar, Ethiopia, 2SNNPR
Health Bureau, Hawasa, Ethiopia, 3CDC, Atlanata, GE, USA, 4Addis
Ababa University, Addis Ababa, Ethiopia
1
Purpose: The aim was to rapidly investigate the outbreak epidemiologically and guiding response activities in the affected districts of Afar
from AprilвЂ“June 2009.
Methods & Materials: A line list and case register log book of the
districts were reviewed as per the world health organization case
definition. 31 cases and 23 controls were interviewed with a structured
questionnaire. A checklist also applied to observe case treatment centers and investor camps. Stool and drinking water samples were also
collected, transported and examined as per standard microbiologic
procedures. Then analysis was done using EPi Info version 3.5.1.
Results: A total of 1,076 cases and 48 deaths were reviewed with
an attack rate of 0.9% and a case fatality rate of 4.4%. 87.8% (945) of
cases were males. Hand washing after latrine usage was protective
of illness (OR = 0.13, p= 0.03) while unsanitary latrine (OR = 10.5,
P-value= 0.001), contact with a case (OR = 200, P-value= 0.001) and
visiting a place which has similar illness (OR=33.6, P=0.001) shown
statistically significant association. Vibrio cholera 01 serotype Inaba
and Escherichia coli were isolated from 89 % (9) of stool and100 % (4)
of water samples respectively.
Conclusion: V. cholera 01 serotype Inaba was confirmed as etiologic agent in all districts. Drinking untreated water, close contact with
a case, not practicing hand washing and unsanitary latrines were likely
determinants for this outbreak. Therefore, provision of safe drinking
water supply and raising community awareness about hygienic practices to control diarrheal disease is necessary.
November 1, 2014
T. Saita, M. R. Valleto, M. Bellone, R. Villa, C. Deligant, P. Dri
Zadig-on behalf of Tell Me, Milan, Outside North America, Italy
outbreak and challenges of controlвЂ”Afar,
Ethiopia, 2009
вЂў
e-learning course for healthcare professionals
based on case histories
22.118 Epidemiology of acute watery diarrhea
SATURDAY
2013, an outbreak of measles was reported from Southern Nation and
Nationalities People Regional Health Bureau of Kindo Didaya district
that affected 591 people. We investigated to describe the outbreak and
to assess risk factors and recommend prevention and control measure.
Methods & Materials: We reviewed national surveillance data also
conducted unmatched case control study (1:2). A measles case was
defined as illness characterized by fever, rash, and either cough,
coryza or conjunctivitis. Controls were individuals who had no clinical
signs of measles and were randomly selected from the same communities where cases were identified. Risk factors were assessed using
logistic regression.
Results: A total of 50 cases and 100 controls were enrolled in the
study.The mean age for cases were 8.4 years while for controls were
8.6 years old. 90% of the cases were children below the age of 15 years
old. A total of eight deaths with case fatality rate of 1.4% were attributed
to this outbreak. Not being vaccinated (OR=6.62; CI: 2.29-19.10), and
having contact with suspected or confirmed cases (OR=12.6; CI: 3.5239.62) was associated with contracting measles.
Conclusion: Being unvaccinated and having contact with suspected
and confirmed case was precipitated measles outbreak in kindo Didaya
district. Based on our finding we recommended strengthening routine
measles immunization and health education in the district.
22.119 Preparedness for public health emergencies:
biggest hurdle in poor resource countries; a
scan lens in Uganda
A. Kagirita
Ministry of Health, Kampala, Uganda
Purpose: Uganda Implements both IDSR and IHR concepts to address
the question of threat to global public health security and trade caused
by emerging and re-emerging diseases including PHEIC and call for
strengthening of national capacities for surveillance and response
using a well coordinated preparedness mechanism. Public health
emergency preparedness refers to steps taken in advance of outbreaks
or public health events so that response is quick and essential supplies
and equipment are available for immediate action. Uganda has been hit
and contained several emerging and re-emerging infectious diseases
including Yellow fever, Ebola, Murburg, Ziika fever, HPA influenza,
meningitis, cholera etcetera and devastating conditions like Nodding
diseases with remarkable and internationally recognised response and
containment. However, the question remains whether this performance
has been attributed to high levels of preparedness.
Aim: Analyzing the Public health threats preparedness levels in
respect to successes and challenges in effective control of emerging
and re-emerging infectious public health threats in Uganda.
Methods & Materials: A cross sectional and purposive descriptive
study was conducted in more than 50% districts of Uganda targeting
response committes. other information sources included key informats
and the health and humanitarian assistance organisations that have
supported public health emergency response. structured questionnaires and interviews were conducted. This study only focused on
the main preparedness areas; like availability of : Human resources
for deployment, functional response committees (rapid response team
and epidemic preparedness committee), emergency response plan,
emergency funds, stockplies of drugs and protective gears, MOU with
Non governmnetal organisations and training of staff on IDSR and IHR
103
IMED 2014
Poster Presentations I
SATURDAY вЂў November 1, 2014
International Meeting on Emerging Diseases and Surveillance 2014
Results: Preliminary analysis of collected data indicate better performance in public health response is not proportional to levels of preparedness but rather attributed to other factors like staff attitudes and
is immensely affected by poor prioritisation and funding.
Conclusion: Uganda has had remarkable performance to public
health emergency response evienced by recent effective control of
emerging and re-emerging infectious diseases. UgandaвЂ™s response
capacity needs to be integrated and focused to institutional strengthening rather than individualistic efforts
22.120 Threat awareness and mitigation strategies
for potential epidemic Salmonella in the
United Kingdom
SATURDAY
вЂў
November 1, 2014
D. Mueller-Doblies, R. Horton, R. H. Davies
AHVLA, Addlestone, United Kingdom
Purpose: Over the past few years, several Salmonella serovars of
public health significance have been circulating in EU member states,
posing a risk to the British poultry industry and potentially having an
impact on human salmonellosis risk. Some of those serovars are a
potential threat because of their multidrug resistance, whereas others
have the potential to become established in poultry production units
where they might be difficult to eliminate because of special environmental persistence properties.
Methods & Materials: Three examples of recent Salmonella outbreak situations in the UK and how they were dealt with successfully
are shown in this presentation.
Results: A multi-country outbreak of nalidixic acid resistant S.
Stanley, the source of which seems to be the turkey production chain,
has been ongoing in Europe since 2011. PFGE analysis of S. Stanley
isolates from different livestock species in the UK showed that the UK
strains are different from the epidemic strain circulating in other EU
member states.
Multidrug-resistant S. Infantis has become a problem in several EU
member states over the past few years, with the main reservoir being
the broiler production chain. The persistence of this serovar in broiler
houses and the high invasiveness in human patients make it a potential threat to public health. An outbreak in a UK broiler company was
quickly contained due to early detection and strict intervention measures being applied.
Multidrug-resistant S. Paratyphi B variant Java was isolated from two
unrelated broiler farms in the UK. The ability of this strain to become
established in broiler houses and the difficulty in eliminating contamination from poultry houses triggered a strict control programme on the
affected farms and the infection was thereby contained and was not
carried over into subsequent crops.
Conclusion: These examples show the importance of scanning surveillance, early detection and intervention to ensure that Salmonella
strains, which may be present in other EU member states, do not
become established the UK. A good working relationship between
policy makers, the surveillance network and the poultry industry has
proved to be a particular strength of the Salmonella control programme
in the UK.
22.121 Challenges in the management and control of
Lassa fever epidemic in resource limited
setting of South-East NigeriaвЂ”A situation study
U. S. Unigwe
University of Nigeria Teaching Hospital, Enugu, Enugu, Nigeria
Purpose: The Lassa fever virus discovered in Lassa town in the Northeast region of Nigeria in 1969 has increased in prevalence and endemicity over the past four and half decades. Though Lassa has occurred
in about 22 of the 37 states in the country, only 6 states have been
established as endemic. In the South-east region of Nigeria comprising 5 states, only Ebonyi state is established as endemic for Lassa
virus with epidemics occurring at more frequent intervals and losing its
seasonal variation.
104
IMED 2014
Methods & Materials: The most recent episode occurred in the
month of May 2014 in Ebonyi state and was subsequently exported
to the neighbouring Enugu state. Blood samples of ill health staff and
close contacts to index case were collected and tested in different diagnostic centres. Other tests as surrogate markers- LFT, CBC, Urinalysis
and Prothrombin time/INR were assayed for contacts without suggestive symptoms. This epidemic highlighted the various challenges in
managing Lassa fever epidemics in resource limited settings.
Results: It established poor infection prevention and control measures with attendant high risk of infection to Medical and health workers
(25 were clinically ill from the exposure). Morbid fear of Lassa fever
among health workers in the tertiary institutions and grossly inadequate/absent drugs (Ribavirin) and Personal Protective Equipments
(PPEs) complicated management of ill staff. In the absence of specially
trained staff, the ill staff had to be transferred to the only treatment centre in the country located 300 km away. Questionable political will has
delayed the establishment of more diagnostic and treatment centres.
The variability in positive results for Lassa virus in the two diagnostic
centres in the country (0 and 8 samples) compared to 19 samples in
a diagnostic laboratory in Nagasaki University questions the sensitivity
and specificity of our diagnostic centres for Lassa virus and undermines
management of ill patients.
Conclusion: There is need to establish more treatment and diagnostic centres in each of the endemic states, train dedicated staff and
improve quality of diagnostic processes. Establishing effective infection
prevention and control procedures and insisting on its implementation
is necessary to prevent the high transmission of infection to hospital
staff.
22.122 Control of a long standing community-wide
outbreak of cholera in a semi-urban district,
Atebubu-Amanten, Ghana: 2012
G. K. Kuma1, J. Amankwa2, E. Tinkorang3, T. Letsa3, F. Iddrisah4, M. J.
Adjabeng2, B. Azumah5, S. O. Sackey6, J. A. Opintan7, J. EL-Duah1
1
Regional Hospital, Sunyani-B/A, Sunyani, Ghana, 2Ghana Health
Service, Accra, Ghana, 3Ghana Health Service, Sunyani, Ghana,
4
Ghana Health Service, Dormaa, Ghana, 5Ghana Health Service,
Atebubu, Ghana, 6University of Ghana School of Public Health, Accra,
Ghana, 7University of Ghana Medical School, Accra, Ghana
Purpose: On June 4th 2012, the Atebubu-Amanten District (AAD)
and Brong Ahafo Regional Health Directorate (BARHD) notified the
National Disease Surveillance (NDS)-Accra, of a long standing diarrhoea outbreak in AAD which had spread to surrounding communities.
A multi-task team was constituted to investigate the extent of outbreak, identify cause and source of infection, individuals at risk, and
enhance control and preventive measures
Methods & Materials: We conducted a descriptive study in which
we reviewed medical records and surveillance data from health facilities, interviewed health officials and opinion leaders at AAD, conducted
environmental assessment and collected water and stool samples for
laboratory investigations. A suspected cholera-case was any person
with acute watery diarrhoea with or without vomiting in AAD, from 20th
March to 15th July 2013. A case-patient was a suspected case from
who V. cholera O1 has been isolated. We embarked on active case
searches, treatment and community education. We analysed data by
person, place and time using Epi Info version 3.3.1
Results: A total of 157 cases were recorded with attack rate of
1.6/1000 population and 7/157 deaths (CFR-4.5%). 17 of 26 communities were affected. Of all the cases 82(52.2%) were females. Mean age
was 23.9 В±22.3 (Range:4months-95yrs). Age-group mostly affected
was 0-4yrs, 44/157(28.0%). Index case occurred on 3rd April 2012,
and epidemic curve showed a peak of cases, 39(24.8%) in the 21st
epidemiological week (between 20-27th June). Average incubation
period was estimated to be 3days (Range: 1-7days). We observed
that Dam Y, located in the main Atebubu township, where most of the
cases 42/157(26.8%) occurred, was exposed to open gutters and
broken sewerages. Vibrio cholera O1 ogawa was isolated from case
patients, but non from sampled water bodies. Isolates were resistance
to all antibiotics tested except tetracycline and ciprofloxacin. A total of
67 contacts were given Tetracycline prophylaxis
Poster Presentations I
SATURDAY вЂў November 1, 2014
International Meeting on Emerging Diseases and Surveillance 2014
Conclusion: Vibrio cholera O1 ogawa was responsible for the prolonged propagated outbreak of cholera in AAD which was suspected
to emanate from Dam Y. Female children were mostly affected. Our
treatment of cases, contacts, health education, recommendation of
boiling drinking water and chlorination of Dam Y helped in the control
of the outbreak
22.123 Outbreak of pneumonia for Pseudomonas
aeruginosa in the service of internal medicine
in a hospital of El Salvador, June 2013
A. MartГnez
Hospital Nacional de Chalatenango, El Salvador, Chalatenango,
El Salvador
swine flu, avian flu and the seasonal flu
E. Mayor
University of NeuchГўtel, NeuchГўtel, Switzerland
Purpose: In this contribution, we examine the press coverage of the
H1N1 A(2009) pdm influenza virus, the H1N5 avian flu virus and the
common/seasonal flu viruses. We ask several questions, including: Are
there lexical patterns that organize the data, allowing to recognize the
strand discussed from the lexicon ? How does the depiction of emerging infectious diseases differ from the coverage of the seasonal flu
generally ? Are the swine and avian flu depicted differently ?
Methods & Materials: From the archives of two prominent newspapers (the New York Times and the Guardian), we retrieved two
thousand articles that contained the term вЂ�fluвЂ™ in their title. The articles
A. Gesser-Edelsburg1, N. Walter1, Y. Shir-Raz1, E. Mordini2,
D. Dimitriou3, M. S. Green1
1
University of Haifa, Haifa, Israel, 2Responsible Technology SAS,
Paris, France, 3Zadig Communication, information and Education in
Science, Rome, Italy
Purpose: This EID communication integrative framework asks how to
incorporate notions of two-way communication, uncertainty and transparency; and how to harness the potential of social media. It is aimed
mainly at local-level health organizations, which often lack adequate
вЂњmapsвЂќ for EID communication.
Methods & Materials: Building upon existing textbooks of outbreak
communication, and identifying gaps and misconceptions of pandemic
communication campaigns, it suggest that in order to succeed we need
to adopt a multilayered public health perspective that is aware of technological, cultural and social changes.
Results: We propose a theory-driven framework incorporating key
components from culture and communication studies into the wider
context of the communication process (public sphere, segmentation,
mass media, social media, opinion leaders, research and stakeholders). Each component is discussed separately, and then amalgamated
into one communication integrative framework, emphasizing its unique
position in the dynamical nature of public health crises.
Conclusion: The significance of the proposed risk communication
framework is that it integrates relevant concepts and theories with a
practical approach. The contribution of this framework is that it can be
adapted to many specific risk situations through simulations in which
the ideas can be developed into concrete plans.
November 1, 2014
22.124 Mining press articles about infectious diseases:
Infectious Disease (EID) communication:
An innovative integrative framework
вЂў
Public Communication of Outbreaks
and Emerging Diseases
22.125 Transforming the dynamics of Emerging
SATURDAY
Background: Among healthcare-associated infections, Pseudomona
aeruginosa pneumonia(PAP) is particularly important. In June 2013,
the medicine service of a general hospital with capacity of 100 beds,
22 of which become of internal medicine reported PAP cases for the
first time.
Objectives: We aimed to confirm a PAP outbreak,to determine
patient and healthcare characteristics associated with infection, and to
identify outbreak source and mode of transmission.
Methods & Materials: We conducted a case series among internal
medicine admissions with pneumonia during June 2013. Suspected
cases were admissions with respiratory illness; confirmed cases were
suspected cases with P.aeruginosa isolated from respiratory secretion
cultures. We collected person, place and time data through medical
chart reviews. We used a Microsoft Excel database to compile data and
calculate central tendency and dispersion measures. We inspected
nursing and respiratory care areas, and reviewed disinfection procedures of reused respiratory therapy materials. We collected samples
from surfaces and materials from medicine service, emergency and
respiratory care areas for cultivation. We compared antibiotic-resistance profiles of P.aeruginosa isolates.
Results: We identified 21 suspected cases; seven were confirmed,
for a 33% (7/21) attack rate. The first case presented on June 6 at
22. Within 72 hours, there were three additional cases. Male: female
ratio was 1:6. For the cases mean age was 69 years (range: 54вЂ“87).
No case developed complications or died. P.aeruginosa isolates were
susceptible to ciprofloxacin, with identical antibiotic-resistance profiles. Cases received IV ciprofloxacin, with a bacterial sensibility of
the 100%, resulting in cure. All 12 surface samples were negative for
P.aeruginosa. Disinfection procedures of respiratory therapy materials
didnot comply with standards, relying on a powdered-soap wash. The
container used to wash respiratory therapy materials was also used for
cleaning patients with diabetic foot. We found nasal cannulas that were
humid and inadequately-bagged.
Conclusion: We documented a limited, non-lethal outbreak of PAP,
probably transmitted by inadequate disinfection practices throughout the medicine service. Clonality of P.aeruginosa isolates was not
assessed, but suggested by antibiotic-resistance patterns. We recommended discarding used respiratory therapy materials, limiting reuse of
equipment to only those suitable for reuse by washing and disinfection.
spanned over 30 years, (from January 1980 to May 2013). Included
articles featured the word вЂ�fluвЂ™ in their title. We produced the term/document matrix using tf-idf as a measure, after tokenization, top-word filtering stemming and pruning.
Results: We present descriptive analyses which display the frequency of mentions of each strain monthly and yearly. Logistic regressions in which the strain discussed is regressed on the tf-idf measure
of each term simultaneously, show that the lexicon for discussing the
different strains is partly specialized, but also overlapping. Association
rules further explore these relationships.
Conclusion: The main interest of this contribution is to understand the
differences and similarities in the press coverage of flu-type emerging
diseases, and the seasonal flu. The media communicate about the different flu strands is specialized to some extent, but part of the lexicon
is common between the strands. Implications regarding the automatic
classification of articles will be discussed.
22.126 Risk factors for Crimean-Cong0 hemorrhagic
fever among children with confirmed cases in
Southeastern Iran
B. Sharifi-Mood1, M. Metanat2, M. R. Sharifi3
Infectious diseases and tropical medicine reasearch center,Zahedan
university of medicacl sciences, Zahedan, Iran, Islamic Republic of,
2
Infectious Diseases and Tropical Medicine Research Center,Zahedan
University of Medical Sciences, Zahedan, Iran S&B, Iran, Islamic
Republic of, 3Zahedan University of Medical Sciences, Zahedan,
Iran&SB, Iran, Islamic Republic of
1
Purpose: Crimean-Congo hemorrhagic fever (CCHF) is a tick-borne
disease caused by the arbovirus which is a member of the nairovirus
genus and can transmit to human by several routes.Tick bite is one of
the most important way and in endemic areas,animal holder,slaughter
houses, livestock worker and farmer are at risk for CCHF.Health care
staff also are at risk through unprotected contact with infectious blood
and other infected body fluids.This study was conducted to evaluate
the routes of transmission among children with confirmed CCHF in
Southeastern Iran
105
IMED 2014
Poster Presentations I
SATURDAY вЂў November 1, 2014
International Meeting on Emerging Diseases and Surveillance 2014
Methods & Materials: In this cross-sectional study,we reviewd
all patient,s files with age less than nineteen years who admitted to
our hospital (Boo-ali hospital,zahedan,Southeastern Iran) betwwen
1991вЂ“4014
Results: Among 39 children and adolescens with CCHF(28
male,11female with age range 4.5 to 18 years) animal contact was
the most common route for acquistion of disease (21%).Tick living are
(14%),contact with fresh slaughtered meat (11%) and tick bite (3%)
were other routes for transmission.
Conclusion: We conclude although,Prevalence of CCHF is less than
adults among children but, they can acquire infection by same routes
which adults can infect, and animal contact is more important among
children.
22.127 Does anticipated regret influence on
willingness to be vaccinated?
SATURDAY
вЂў
November 1, 2014
T. Kikkawa1, M. Shigematsu2
1
Keio University, Tokyo, Japan, 2National Institute of Infectious
Diseases, Tokyo, Japan
Purpose: The purpose of the study was to explore how вЂњanticipated
regretвЂќ of being vaccinated and unvaccinated will influence on willingness to be vaccinated. The precedent psychological study by Connolly
& Reb (2003 and 2010) presented that the anticipating regrets merely
does affect decisions to be vaccinated. We focused on the types of
anticipated regrets related to the decision of vaccination and evaluated
the effect of information given about the vaccination.
Methods & Materials: Online survey was carried out from 20th to
22nd February, 2014 to readily available registered panel. A total of
1017 (521 male, 496 female), age from17 to 85 years, participated in
the survey. First, participants were asked to anticipate regret, asked to
read a brief information of a fictitious vaccine, and then asked to fill the
questionnaire including evaluation of the explanation of vaccine, expectation to vaccination, regret and demographic variables. The study was
3x2x2 between-subject design of following three factorials: 1) Content
of anticipated regret such as anticipating regret of suffering from the
disease without vaccination (RSDV), adverse effects of vaccination
(RSAEV), and no regret anticipated (Control); 2) Personal relevance
such as being vaccinated for themselves or to protect children;3) Order
of the information given, positive information first or the negative first.
The ANOVA was used for analysis with all of the dependent variables.
Results: Main findings are two-fold. First, participants of RSAEV and
Control evaluated importance of vaccination less than those of RSDV
(M=2.12, 2.23, 2.33, respectively; 5-point Likert type scale). Second,
participants of RSAEV and Control showed greater reluctance to be
vaccinated than RSDV (M=2.91, 2.85, 2.49, respectively). Participants
who read negative information first showed greater willingness to be
vaccinated, and are more reluctant to be vaccinated for children.
Conclusion: The content of anticipated regret affected attitudes
toward vaccination. Interestingly, those who DO NOT anticipate regret
(control) took similar attitudes as RSAEV. This result suggests that
people would spontaneously think about the regret of side effects
occurrence at vaccination and be aversive in real events. It is extremely
important to offer more information about the disease impact on health
if contracted without vaccination in effective order.
22.128 Novel norovirus recombinants detected in
South Africa
T. Y. Murray, J. Mans, M. B. Taylor
University of Pretoria, Pretoria, South Africa
Purpose: Noroviruses (NoVs) are the leading cause of viral gastroenteritis worldwide. Recombination frequently occurs within and between
NoV genotypes, particularly at the conserved ORF1/2 junction between
the polymerase and capsid genes. Recombinants have been implicated in sporadic cases, outbreaks and pandemics of NoV. There is
a lack of data on NoV recombinants in Africa and therefore, the aim of
this study was to investigate the presence and diversity of norovirus
recombinants in South Africa (SA).
106
IMED 2014
Methods & Materials: From 2010 to 2013, NoV GII strains from
positive stool specimens were selected for further genotypic characterisation. Genotypes were assigned based on partial polymerase and
capsid nucleotide sequences. If discordant genotypes were detected in
a single specimen, amplification of the polymerase/capsid region spanning the ORF1/2 junction was used to confirm the recombinant type.
SimPlot, maximum Chi-squared and phylogenetic analyses were used
to confirm the breakpoints of recombination.
Results: During the four-year period, eleven NoV recombinants types
were identified in SA. All recombinants had a breakpoint in the region of
the ORF1/2 junction (P<0.05). The majority (9/11) were intergenotype
recombinants, but two intragenotype GII.4 recombinants were also
characterised. Three combinations represented novel recombinants
namely GII.P not assigned (NA)/GII.3, GII.P4 New Orleans 2009/GII.4
NA and GII.P16/GII.17. Several widely reported recombinants that
were also identified included GII.P21/GII.2, GII.P21/GII.3, GII.Pe/GII.4
Sydney 2012 and GII.Pg/GII.12. Other recombinants that were identified and to date, have a reportedly restricted geographic distribution,
included GII.Pg/GII.1, GII.Pe/GII.4 Osaka 2007, GII.P4 New Orleans/
GII.4 Sydney 2012 and GII.P7/GII.6. This is the first report of the GII.P4
New Orleans/GII.4 Sydney 2012 recombinant in Africa.
Conclusion: Over the past four years, remarkably diverse NoV
recombinants have been circulating in SA. Pandemic strains such as
the GII.Pe/GII.4 Sydney 2012 recombinant co-circulated with novel and
emerging recombinant strains. Combined polymerase- and capsidbased NoV genotyping is essential to determine the true diversity and
global prevalence of these viruses.
22.129 A short history of the contributions of One
Medicine and One Health in North America to
current concepts of Emerging Infectious
Diseases
P. Cowen1, R. W. Currrier2
1
North Carolina State University, Raleigh, NC, USA, 2Iowa State
University, Ames, IA, USA
Purpose: One clear idea that stands out when examining the history of
One Medicine and One Health is that, at times, a One Health perspective dominates the landscape of medical advancements and in other
historical periods a large void can emerge between the disciplines that
often naturally contribute to One Health discoveries. Tragically, the idea
of One Health can virtually be lost in certain epochs. The reasons for
this ebb and flow of One Health concept are examined over specific
periods of North American history. The purpose of this purpose of this
paper is to sketch out key contribution of individuals to One Health and
the understanding of Emerging Diseases, starting with Revolutionary
War through the Post World War II period.
Methods & Materials: Beginning with Benjamin Rush, M.D. the lectures, writings, and accomplishments of several physicians, microbiologists, virologists and veterinarians are examined. Individuals or groups
included in this history include Benjamin Rush, contributors to the earliest editions of the American Journal of Public Health, Theodore Smith,
Daniel Elmer Salmon, William Osler, K.F. Meyer, Richard Shope, James
H. Steele and Calvin W. Schwabe (who coined the term One Medicine).
Results: A summary of major contributions to and understanding
of One Health and its impact on Emerging Disease for each of the
individuals mentioned characterize the dominant conceptual paradigm
governing One Health over historical time periods dating back to the
middle of 18th century.
Conclusion: Approximately once a century we lose a firm grip on the
basics of the One Health approach at which time people of visionary
stature bring it back to prominence in order to address key societal
challenges such as the presence or threat of an Emerging Diseases.
This historical examination of the waxing and waning of One Health
activities highlights the fact that the fundamental idea of One Health
is tremendously resilient. One Health bounces back because it is relevant. No matter how out of fashion One Health may be, when intractable problems come up One Health is reinvented or reinvigorated, as
Steele and Schwabe have done for us.
Poster Presentations I
SATURDAY вЂў November 1, 2014
International Meeting on Emerging Diseases and Surveillance 2014
22.130 Transparent communications during infectious
disease outbreaks: the importance of social
media as a risk communication tool
M. Billingsley, M. Wroczynski
BMJ-on behalf of Tell Me Project, London, Outside North America,
United Kingdom
M. A. Garbati1, C. Syam2, H. Alobida2, M. Joseph2, A. M. Hakawi2
King Fahad Medical City, Riyadh, Riyadh, Saudi Arabia, 2King Fahad
Medical City, Riyadh, Saudi Arabia
1
Purpose: To describe the socio-demographic, clinical characteristics
and outcome of infection due to Middle East Respiratory Syndrome
Corona virus (MERS CoV) among healthcare workers in King Fahad
Medical City, Riyadh, Saudi Arabia.
Methods & Materials: This is a retrospective chart review of healthcare workers infected with MERS CoV from April, 2014 to June 2014.
The institutional review board (IRB) of KFMC approved the study.
Nasopharyngeal and throat swab and, where available, tracheal-aspirate, or bronchoalveolar-lavage specimen were obtained and placed in
a viral transport medium (Vircell). Samples were subjected to real-time
reverse-transcriptaseвЂ“polymerase-chain-reaction (RT-PCR) amplification of consensus viral RNA targets (upE and ORF1b) to detect MERS
CoV. Routine tests for bacterial and viral co-infections were negative.
Results: During the outbreak, 23 staff members were infected.
Seventy per cent were female nurses with no chronic medical
Number
Percentage (%)
Gender
Male
Female
5
18
22
78
Age group (years)
20-29
30-39
40-49
в‰Ґ50
3
13
4
3
13
57
17
13
Job category
Nurses
Respiratory therapist
Pharmacist
Radiology technician
18
3
1
1
78
13
4
4
Nationality
Saudi
Non Saudi
0
23
0
100
Job location
Critical care
Emergency room
Medical wards
Pharmacy
Radiology
4
8
9
1
1
18
35
39
4
4
November 1, 2014
virus infection among healthcare workers in
a tertiary care center in Saudi Arabia
Characteristic
вЂў
22.131 Middle East Respiratory Syndrome Corona
Table 1: Socio-demographic characteristics of MERS CoV cases
at KFMC
SATURDAY
Purpose: To explore use of social media as a risk communications
tool for encouraging a culture of sharing and collaboration and analyse
how this has manifested in previous emergencies to help spread public
health messages; to highlight the benefits of using social media as a
risk communication tool, identify potential challenges for integration
into formal communication strategies; identify best practice guidelines
on how organisations involved in crisis communication can build, maintain and assert a presence on social media.
Methods & Materials: Qualitative literature search including analysis of: 1) Social media during epidemics, specifically Facebook and
Twitter; 2) Global audience interacting and sharing information using
social media; 3) Role of social media in keeping up to date with developing news; 4) How user-generated content contributes to a collective
body of information during a crisis; 5) Role of social media in spreading
misinformation and validating or discrediting rumour; and 6) Extent to
which social media encourages pro-social behavior.
We also conducted surveys and carried out scenario based testing
of members of the NHS Social Media (@nhssm) Twitter community
regarding the integration of social media in communications strategies.
Results: We identified best practice principles, which can be applied
when planning social media communications before and during infectious disease outbreaks, including ten golden rules for risk communication. Research has contributed to the development of guidance
documents and tools to enable health communicators at decision making level, who are responsible for drafting and delivering communication strategies in outbreak situations, to develop appropriate messages.
Conclusion: Social media can facilitate the process of open dialogue, democratic and transparent exchange and cross referencing of
knowledge across multiple platforms during public health crises. It is
important for organisations involved in risk communication to monitor
and have a stake in these exchanges in order to build social capital,
track public opinion and provide a consistent source of accurate information that helps the public make informed decisions and interpret risk.
Social media has generally been used inconsistently by health agencies. To ensure social media platforms are harnessed to their fullest
potential, organisations should do more to monitor and analyse sentiment and messages that users share to help formulate relevant, timely
and transparent outbreak communications.
problems. Staff members from critical areas were mainly affected (table
1) and 74% had fever at presentation. Respiratory, gastrointestinal, and
articular features were prominent (table 2). Fifteen (65%) cases got
admitted, 5 to the intensive care unit (ICU). Those with mild disease
were isolated at home or to a designated charity building. Mean length
of stay was 9 days (5вЂ“17) and 10 days (3вЂ“19) for those admitted and
isolated cases respectively. The mean period of infectivity was 10 days
(6вЂ“21). Treatment was mainly supportive. Only one patient died, while
96% recovered.
Table 2: Clinical characteristics of MERS CoV cases at KFMC
Presentation
Number
Percentage (%)
Respiratory
Sore throat
Runny nose
Cough
Shortness of breath
Chest pain
Wheezing
5
2
14
2
1
1
20.8
8.3
58.3
8.3
4.2
4.2
Gastrointestinal
Abdominal pain
Nausea/Vomiting
Diarrhea
6
10
9
24
40
36
Conclusion: MERS CoV infection among the elderly with chronic
medical conditions was associated with significant morbidity and mortality. Earlier reports have suggested human-to-human transmission,
though unsustained. Thus raising the possibility of airborne transmission. The secondary cases being less severe. If promptly identified,
implementation of strict infection control measures can decrease the
risk of nosocomial transmission from mild and asymptomatic cases.
22.132 Rapid Semi-nested PCR for the identification of
Candida species in Candidasis
B. Sadeghi-Nejad1, A. R. Samarbafzadeh2, M. Mehdinejad3
1
Abadan School of Medicine Sciences, Ahvaz, Iran, Islamic Republic
of, 2Ahvaz Jundishapur University of Medical Sciences, Ahvaz, IR.
Iran, Ahvaz, Iran, Islamic Republic of, 3Ahvaz Jundishapur University
of Medical Sciences (AJUMS), Ahvaz, Iran, Islamic Republic of
Purpose: The incidence of candidiasis caused by Candida species has
been increased in immunocompromised, cancer patients. In current
surveysemi-nested PCR (sn-PCR) as rapid identification for detection
of the species of Candida sp. specially Candida albicans were carried
out in 65 clinical isolates.
107
IMED 2014
Poster Presentations I
SATURDAY вЂў November 1, 2014
SATURDAY
вЂў
November 1, 2014
International Meeting on Emerging Diseases and Surveillance 2014
Methods & Materials: We carried out phenotypic characterization
including germ tube test, temperature tolerance, clamidoconidia production, CHROMagar Candida and semi-nested PCR using universal
and species-specific primers for detection of Candida species on the
culture of clinical isolates. By using universal primers, carried out the
amplification of the 3вЂ™ end of 5.8S ribosomal DNA (rDNA) and the 5вЂ™
end of 28S rDNA, including the internal transcribed spacer 2 (ITS2),
production 350 to 410-bp fragments from the four Candida species,
such as Candida albicans, Candida tropicalis, Candida glabrata, and
Candida parapsilosis.
Results: By phenotypic identification system 60 (92.3 c%) yeasts isolates were identified including, Candida albicans (n = 33), Candida glabrata (n = 14), Candida tropicalis (n = 11) and Candida parapsilosis (n
=2) and five isolates were mixed culture. By the semi-nested PCR, 63
(96.6 %) isolates were identified. Candida albicans (n = 37), Candida
glabrata (n = 11), Candida tropicalis (n = 14) and C. parapsilosis (n =
1) and the species of two isolates could not be identified. The survey of
semi-nested for specific identification of Candida species of 65 clinical
Candida isolates revealed 70.3% resultsagreement with PCR.
Conclusion: The semi-nested in this survey was specific and more
sensitive than phenotypic characterizationfor the detection of Candida
albicans in candidal vulvovaginitis.
22.133 Full-length genome sequencing and
analysis of 3 ZIKV strains on an Ion Torrent
PGM sequencer
M. Vandenbogaert1, V.-M. Cao-Lormeau2, L. Diancourt1,
J.-M. Thiberge1, A. Sall3, A. Kwasiborski1, D. Musso2, P. DesprГЁs1,
J.-C. Manuguerra 1, V. Caro1
1
Institut Pasteur, Paris, France, 2Insitut Louis MalardГ©, Papeete-Tahiti,
PolynГ©sie franГ§aise, France, 3Institut Pasteur de Dakar, Dakar, Senegal
Purpose: Zika virus (ZIKV), an emerging arbovirus, was first isolated
in 1947. In October 2013, French Polynesia (FP), South Pacific, suffered the largest ZIKV outbreak ever reported, with subsequent ZIKV
outbreaks in 2014 in the Pacific region. No severe diseases resulting
from ZIKV infection had previously been reported but, during the FP
outbreak, severe neurological complications have been described.
There is limited information about the genotype circulating in the country causing such conditions, and its potential to acquire varying competence to host-adaptation. Therefore, establishment of alert systems
and promotion of awareness in the case of ZIKV epidemics is necessary to anticipate the emergence of new or more virulent viral strains.
Both the lack of data on this pathogen and its rapid emergence stress
the necessity for more comprehensive genetics-driven studies in order
to measure the ability and potential to host-adaptation of the virus,
and to elaborate whether severe neurological manifestations may be
associated to recent infection by ZIKV.
Methods & Materials: Viral RNA was extracted from infected cell
culture supernatants following nonspecific amplification (Whole
Transcription Amplification). The full-length genome of three ZIKV
strains was obtained by High Throughput Sequencing (HTS), using an
Ion Torrent PGM.
Results: We successfully sequenced the full genome of three ZIKV
virus strains, one from the FP outbreak, and the 2 others from former
African isolates (1980 and 1991). Data analysis for the FP strain
revealed low variability compared to a genome recently added to public
databases, corresponding to a French imported case from FP, with the
exception of a number of variable sites, evidencing genomic microevolution during outbreaks. Phylogenetic reconstruction confirms the
samples clustered with respectively Asian and African genotypes.
Conclusion: We obtained genomic sequences for the newer Asia
genotype FP ZIKV isolate, in addition to the 2 former Africa-genotype
isolates, which will be committed to the scientific community, the
analysis of which underlined the importance of genetic surveillance to
emerging epidemic viral strains.
108
IMED 2014
Session 22 continued
Poster Presentations I
Saturday, November 1, 2014
Room: Klimt Ballroom I вЂў Upper Level
11:45вЂ“13:15
Sociopolitical Factors in Disease Emergence
22.134 Comparison of Lyme disease risk perception
and management in different populations and
their experts
C. Aenishaenslin1, P. Michel2, A. Ravel1, L. Gern3
UniversitГ© de MontrГ©al, MontrГ©al, QC, Canada, 2Public Health
Agency of Canada, MontrГ©al, QC, Canada, 3UniversitГ© de NeuchГўtel,
NeuchГўtel, Switzerland
1
Purpose: Endemic for several decades in many temperate countries,
Lyme disease (LD) is emerging in Canada. In the last decade, decision
aid tools for LD management have focused on risk quantification in
ecological systems. But the populationвЂ™s knowledge and perceptions
of risk are also important determinants of the success of prevention
strategies.
Aim: To describe and compare the knowledge, risk perceptions,
preventive behaviors and social acceptability of vector control interventions for LD, as well as their determinants, within and between populations and experts from two different regions: one Swiss region where
LD is endemic for more than 30 years (NeuchГўtel), and one Canadian
region, where the disease has been emerging for 6 years (MontГ©rГ©gie).
Methods & Materials: A quantitative analysis of a web-based survey
involving 814 participants along with focus groups composed of citizens and of experts was conducted in both study regions. The results
are interpreted for each region, with a comparative analysis between
them.
Results: The comparative analysis showed very different trends in
knowledge level, risk perceptions and behaviors between both regions.
In MontГ©rГ©gie, 22% perceived themselves as being at high or very high
risk of contracting LD vs. 53% in NeuchГўtel, but a higher percentage
of participants from this region believe that personal protection is easy
(74% vs. 54% in MontГ©rГ©gie). Different predictors of risk perception
were identified for both regions. Concerning predictors of preventive
behaviors, in NeuchГўtel, exposure and knowledge were the strongest
identified predictors, while risk perception was more strongly associated with behaviors in MontГ©rГ©gie. Most dimensions of risk perceptions
were different between populations and their regional experts. Social
acceptability of different vector control interventions was higher in
MontГ©rГ©gie.
Conclusion: The results of this study illustrate that population
perceptions, knowledge, behaviors and acceptability of interventions
toward the same disease can be different, presumably according to
the emerging or endemic status of the disease, to previous public
health actions and to other characteristics of the local context. Thus,
the effectiveness of potential preventive strategies are not universal but
context-dependent. Decision-makers ought to consider this context in
their choice of public health actions.
22.135 Registered nursesвЂ™ knowledge, attitudes and
practices regarding the spread of nosocomial
infections: the impact of organizational support
E. W. Kamunge1, R. K. Parasher2, T. Cahill2, G. Pinto-Zipp2
1
Essex County College, Newark, NJ, USA, 2Seton Hall University,
South Orange, NJ, USA
Purpose: Nosocomial infections (NIs) are new localized or systemic
infections that develop in patients receiving medical care in a hospital or other healthcare facilities. The infections are not incubating or
present during a patientвЂ™s admission into the healthcare facility and are
Poster Presentations I
SATURDAY вЂў November 1, 2014
International Meeting on Emerging Diseases and Surveillance 2014
T. Makino
National Institute of Infectious Diseases, Tokyo, Tokyo, Japan
Purpose: After SARS in 2003, global health community has committed
the transparent sharing of any emerging outbreaks. This momentum
crystalized the revision of International Health Regulations (IHR) in
2005, which now binds member states to notify any potential public
health emergencies within 24 hours to World Health Organization
(WHO). In the extension of this global disease surveillance mechanism,
pathogen surveillance and genome information sharing play key roles
for both risk assessment and development of medical countermeasures. However, question still lies in whether benefits of surveillance
are equitably shared by the member states. This research aims to
analyze the intersection of different values and norms regarding the
pathogen sharing and benefit sharing.
Methods & Materials: WHOвЂ™s Influenza A(H5N1) sample sharing dispute was chosen for the case analysis. Materials were official
documents and press releases of WHO, and witnesses of experts and
national delegates engaged in the dispute. Stakeholder analysis was
conducted to contrast the argument between developed and developing nations on the viewpoints of security and equity. Policy analysis
applied the existing international legal framework and ethical codes to
examine the legitimacy of both sides.
Results: Developed nations were for sample sharing, recognizing the
benefit of sample sharing as the preparedness and prompt response
to be beneficial to the global community. IHR and rights for security
supported the recognition of efficient sample sharing as the key for
immediate response to any potential pandemic. Developing nations, in
contrast, were hesitant to share pathogens unless equitable attribution
of benefit to the originating nations was guaranteed. Convention of the
Biological Diversity (CBD) and rights for healthcare access supported
the recognition of biological sample collection as the biopiracy, in which
situation revenues of diagnostics and vaccines were monopolized by
pharmaceutical industries mostly located in developed nations.
population before and after war in Bosnia and
Heryegovina in emergence
A. Bajraktarevic1, L. Kumasin1, E. Lokmic1, G. Todosijevic2, Z. Begic3,
B. Djukic4, A. Abduzaimovic5, S. Serdarevic6
1
Public Health Institution Sarajevo-Department for preschool children,
Sarajevo, Bosnia and Herzegovina, 2Clinical medical Center,
Sarajevo, Bosnia and Herzegovina, 3Pediatrics Clinic, Sarajevo,
Bosnia and Herzegovina, 4First medical aid, Sarajevo, Bosnia and
Herzegovina, 5Private laboratory, Tesanj, Bosnia and Herzegovina,
6
Public Healt Institution of Bosnia and Herzegovina, Sarajevo, Bosnia
and Herzegovina
Background: The importance of social factors as causes of infectious
disease has been well established. The decrease in emergence of morbidity and mortality with increasing socioeconomic position is one of the
most consistent relationships in pediatrics and epidemiology.
Objective: Our intent and purpose of this paper is to compare the
incidence of childhood diseases and infectious diseases in different
periods before and after the war in the period of a quarter century in
Bosnia and Herzegovina with similar GPD and poor social and economic situation completely changed by the political situation.
Methods & Materials: Infectious disease outcomes, including infectious aetiologies of chronic conditions, accounted for 77 reviews but in
Bosnia and Herzegovina we have only two articles about infectious diseases and social conditions before the war 1992/1995. In this article we
compared the incidence of infectious diseases in children and overall
morbidity now and 25 years ago on the basis of data of public institutes
for health care.
Results: We found no significant differences in the incidence of infectious diseases in children today 2013 years and 25 years ago in 1989.
The structure of the disease paediatrics occupied the annual level of
about 5 percent and for other infectious diseases of about a quarter
of the total number without counting the ordinary sore throat, colds,
bronchitis and other common short-term viral diseases. The specific
structure of intestinal infectious disease and tick-borne disease showed
differences It is also now more tick-borne diseases and less intestinal
infectious diseases.
Conclusion: Historical social and political transitions may have
shaped trends in infectious disease research. Changes in the political situation has not significantly affected the incidence of infectious
diseases in the child population as a bad social situation has not drastically changed given the worsening economic situation before the war
and now twenty years after the war.
November 1, 2014
global health security: sustainability of
pathogen surveillance
22.137 Incidence infectious diseases of childhood
вЂў
22.136 Legal and ethical complexity challenging
Conclusion: Different legal frameworks and ethical values justified
each side. Equitable sharing of benefit should be ensured for global
health security by practical operation of disease surveillance, which
can be supplemented by the voluntary international aid by private sector and non-governmental organizations. Public health community is
now encouraged to step outside and get engaged in the fora of diplomacy and economics.
SATURDAY
identified at least forty-eight to seventy-two hours following the patientвЂ™s
admission. Episodes of NIs are recognized in hospitalized patients
world-wide and are prevalent in all age groups. They are caused by
pathogens such as bacteria, viruses and parasites present in the
air, surfaces or equipment and are often transmitted by indirect and
direct contact. Some of the pathogens are resistant to antimicrobial
agents. The burdens of NIs include prolonged duration of hospitalization for patients resulting in increased costs of healthcare and deaths.
Implementation of safe patient care activities is the role of healthcare
practitioners such as physicians, dental health care workers and nurses.
Therefore these healthcare workers should be familiar with practices to
prevent the spread of NIs. It has been documented in the literature that
at the time of graduation from their professional education, healthcare
professionals have sufficient knowledge to practice patient safety and
infection control guidelines. However, the evidence suggests otherwise
since a cadre of healthcare workers including nurses are implicated
in the transmission of nosocomial infections. This enigma prompts an
exploration for plausible contributory factors that could be implicated
in the spread of nosocomial infections. With nurses having the most
contacts with patients; understanding of their knowledge, attitudes and
practice patterns, and an examination of the impact of organizational
support may provide one approach by which this health care issue
would be addressed.
Methods & Materials: This exploratory, cross-sectional and descriptive study was conducted using on-line survey responses from 352
registered nurses (RNs). Data was analyzed with descriptive and inferential non-parametric statistics.
Results: The participants demonstrated high levels of knowledge,
adherence to recommended guidelines of infection control practices,
and positive attitudes. Analysis of data also indicated significant associations between organizational support and RNsвЂ™ knowledge, attitudes
and practices.
Conclusion: Findings in this study suggest that nursing education,
concerted efforts of infection control and organizational support play
pivotal roles toward reducing the spread of NIs.
22.138 Emergency transport:
Not only a matter of time
G. Torrell VallespГn1, A. FitГ©2, A. Saidy3, A. Touray4
1
CAPI Baix-a-mar Consorci de Servei a les Persones, Barcelona,
Spain, 2FUNCA (Reus), Independent Personnel for this publication,
Reus, Spain, 3Ministry of Health and Social Welfare, Kuwonku,
Gambia, 4AssociaciГі per al Desenvolupament Kuwonku, Kuwonku,
Gambia
Purpose: Some of the major health challenges facing The Gambia
today include malaria, maternal and infant mortality, acute respiratory
infections, diarrhoea and pneumonia. The Gambia has only 5 hospitals
and a relatively centralized non coordinated health system. Lots of
efforts are invested to study and improve the maternal and new-born
emergency care, including the analysis of the delay in health care.
Aim: To describe and to analyse the emergency transport in rural
Gambia
109
IMED 2014
Poster Presentations I
SATURDAY вЂў November 1, 2014
SATURDAY
вЂў
November 1, 2014
International Meeting on Emerging Diseases and Surveillance 2014
Methods & Materials: Using the conceptual model of вЂњthree delays
in maternal careвЂќ and the social determinants of health we describe
the system of emergency transport in the Upper River Region of rural
Gambia by direct observation during a period of a month in a primary
health centre in Kuwonku.
Results:
1st delay: Making the decision to go to the health centre
вЂў Socioeconomic and political context: distance to the health centre
typology of health system (payment), subsistence economy,
believes (acceptance of illness and death), difficulties in understanding the severity of the situation
вЂў Core elements of inequity: Age (old/new-born/young), Gender
(man/woman), role in the family (mother, father, son, daughter),
ethnics (Fula, Mandinka)
вЂў Material Resources: subsistence economy, lack of money.
2nd delay: Delay in reaching the health centre and the place of
referral
вЂў Socioeconomic and political context: Poor roads (not paved),
crossing river (schedules, money), high price of fuel, systematic
police road controls, schedules of public transport.
вЂў Core elements of inequity: age, gender, ethnics
вЂў Material Resources: access to the money, access to fuel, existence
of a suitable vehicle
3rd delay: Delay in receiving appropriate health care when arriving.
вЂў Socioeconomic and political context: lack of hospitals in rural
territories
вЂў Core elements of inequity: age, gender, rural
вЂў Material Resources: medical equipment (oxygen, shortage of
essential drugs and technical diagnoses), continuous electricity
source.
Conclusion: We have observed different cases of referrals during
this period. Time to afford the money for the ride, non existence of
paved roads and the need to cross the river are three of the main difficulties for the emergency transport in rural Gambia.
Vaccines and Emergence of
Vaccine Preventable Diseases
22.139 In silico prediction of common epitopes in gp63
protein of pathogenic Leishmania species for
designing an epitope based DNA vaccine
P. S. Slathia, P. Sharma
Shri Mata Vaishno Devi University, Jammu, J&K, India
Background: Leishmaniasis is a neglected tropical disease that
affects about 350 million individuals worldwide. The causative agent
Leishmania sp., is a protozoan parasite having a relatively simple life
cycle with two principal stages: the flagellated mobile promastigote living in the gut of the sand fly vector and the intracellular amastigote
within phagolysosomal vesicles of the vertebrate host macrophage.
The Leishmania surface protease gp63 has been shown to induce
immunity and currently DNA vaccines based on it are under trials. In the
current study we have tried to find out epitopic sequences that are conserved across Leishmania species for designing a common vaccine.
Objective: To study gp63 protein sequences for finding out the conserved regions. To predict conserved epitopes and design a rational
concept based DNA vaccine in silico.
Methods & Materials: 395 protein sequences of gp63 of Leishmania
species viz. Leishmania donovani donovani, Leishmania donovani,
Leishmania guyanensis, Leishmania infantum, Leishmania major
strain friedlin, Leishmania braziliensis mhom/br/75/m2904, Leishmania
infantum jpcm5, Leishmania major and Leishmania mexicana mhom/
gt/2001/u1103 having protein length from 550 to 650 were collected
from NCBI. These sequences were subjected to multiple sequence
alignment using ClustalOmega. The conserved fragments of в‰Ґ9-mers
were chosen for T-cell epitope prediction. NetMHCPan, NetMHCIIPan,
CTLPred, IEDB Analysis, BCPREDS servers were used for T-cell
110
IMED 2014
and B cell epitope prediction. Self epitopes were removed by BLAST
analysis. The predicted epitopes were joined in tandem separately. For
analyzing IgE epitopes AlgPred server was used. The epitopic peptides
so obtained were reverse translated using human codons and conceptually cloned into pBI-CMV1 vector.
Results: Multiple sequence alignment and variability masking studies revealed the presence of six conserved sequences that were used
for epitope prediction. Four epitopes for Class I MHC and three each
for Class II MHC and B cell were predicted. No similarity to human proteins and no allergenic sequences were found. The reverse translated
sequences were cloned into Multiple Cloning Site of vector.
Conclusion: The vector construct generated could work as immunogenic DNA vaccine for all the pathogenic species of Leishmania. The
results need to be validated by experimental studies and use of different adjuvants could further enhance immunogenicity.
22.140 Immune responses induced by an alphavirus
replicon derived candidate vaccine against
Crimean-Congo haemorrhagic fever virus
F. Burt1, R. Swanepoel2, J. Paweska3, M. Heise4
UFS/NHLS, Bloemfontein, South Africa, 2University of Pretoria,
Pretoria, South Africa, 3Special Pathogens Unit National Institute for
Communicable Diseases of the National Health Laboratory Service,
Sandringham, South Africa, 4The University of North Carolina, North
Carolina, NC, USA
1
Purpose: Crimean-Congo haemorrhagic fever virus (CCHFV) is a
tick borne virus that causes severe haemorrhagic fever with fatalities.
The recent emergence of CCHFV in several countries in the Balkans
and re-emergence in south-western regions of the Russian Federation
after an extended absence raises concerns that this virus could
expand its current geographic distribution and establish new endemic
foci. Currently there is no vaccine and the pathogenesis of the virus
is not well understood. The immune correlates of protection are not
well understood hence investigating immune responses to specific
viral proteins contributes to our knowledge on possible mechanisms
of protection.
Methods & Materials: A replicon-based vector derived from Sindbis
alphavirus was developed which expresses CCHFV glycoproteins. A
mouse model was used to characterize humoral immune responses.
Groups of mice were immunized with a Sindbis based replicon vaccine
expressing the Gn and Gc of CCHFV. Control groups of mice received
mock vaccine. All groups received booster doses. Serum samples were
collected and tested for antibody responses. Mouse spleens were harvested and splenocyte cultures were stimulated with CCHFV antigen
or conconalavin A as the control. IgG antibody titers against Gc were
determined by indirect immunofluorescent antibody (IFA) tests using
commercially available antigen slides prepared with cells tranfected
with plasmid expressing CCHF Gc. Isotyping was performed using antimouse IgG1, IgG2a and IgG2b FITC conjugates. Interferon gamma,
tumour necrosis factors, interleukin (IL) -2, IL-4, IL-6 and IL-10 levels
in stimulated splenocyte culture media were determined using ELISA.
Results: Antibody against CCHFV was detected in all mice using
IFA, with titers ranging from 8 to>128. IgG1 and IgG2a responses were
detected with a lower IgG2b. Cytokine profiling of antigen-stimulated
splenocyte culture supernatants indicated elevated levels of interferon
gamma and IL-2, two cytokines known to be involved in Th-1 type cellular responses.
Conclusion: CCHFV glycoproteins are likely responsible for recognition of receptor sites on susceptible cells and consequently cell tropism
and pathogenicity of the virus in humans. The Sindbis virus based
replicon vectors efficiently expressed the CCHFV glycoproteins and
induced strong detectable humoral immune responses and cell mediated immune responses against CCHFV in mice.
Poster Presentations I
SATURDAY вЂў November 1, 2014
International Meeting on Emerging Diseases and Surveillance 2014
22.141 DNA primingвЂ”Protein boosting immunization
regime based on L7/L12 and
TOmp31Brucellaantigens induces protective
immunity in BALB/c mice
M. Golshani1, S. Rafati1, A. Dashti2, S. Bouzari2
1
Pasteur Institute of Iran, Tehran, Iran, Islamic Republic of, 2Pasteur
Institute of iran, Tehran, Iran, Islamic Republic of
H. J. A. Ho1, C. Low2, L. W. Ang2
1
Tan Tock Seng Hospital, Singapore, Singapore, 2Ministry of Health
Singapore, Singapore, Singapore
Purpose: We describe the epidemiological trends of measles in
Singapore to assess its progress towards measles elimination and to
identify gaps in fulfilling the World Health Organisation (WHO) Western
Pacific Regional Office (WPRO) regional measles elimination criteria.
Methods & Materials: Epidemiological data on measles maintained
by the Communicable Disease Division, Ministry of Health from 1981
to 2012 were collated and analysed. Data on measles vaccination
coverage were obtained from the National Immunisation Registry and
School Health Services, Health Promotion Board. To assess the changing levels of herd immunity of the population, the findings of periodic
seroepidemiological surveys on measles were traced and reviewed.
Results: With the successful implementation of the National
Childhood Immunisation Programme using the monovalent measles
vaccine, the disease incidence declined from 88.5 cases per 100,000
in 1984 to 6.9 per 100,000 in 1991. A вЂ�catch-upвЂ™ vaccination programme
using the trivalent measles, mumps and rubella (MMR) vaccine was
conducted in 1997, followed by the introduction of the 2-dose vaccination schedule in January 1998 to curb the resurgences in 1992, 1993
and 1997. This led to a sharp decline in incidence to 2.9 per 100,000
in 1998. Measles vaccination coverage was maintained at 95% for the
first dose and between 92-94% for the second dose. In children aged
1-17 years, 83.1% were seropositive for measles IgG antibodies in
2008-2010, while more than 95% of adults were seropositive. Sporadic
cases with very few clusters of two or more cases continued to occur
among unvaccinated population, in particular children below 4 years of
age. The predominant measles virus genotype, D9, is being replaced
by B3 and G3 genotypes endemic in other countries.
Conclusion: Singapore is making good progress towards the elimination of endemic measles. To protect young children with two doses
of MMR vaccine by 2 years of age, recent amendments have been
made to the measles immunisation schedule. A targeted multi-pronged
strategy is required for further reduction of measles incidence.
Purpose: This study was purposed to describe the knowledge, attitude
and practices (KAP) of parents/guardians on pneumonia and immunisations/EPI vaccines; identify predictive parental socio-economic/
demographic characteristics that of good knowledge on pneumonia
infections and EPI vaccines. Finally, the study described health center
personnel perceptions about immunisations.
Methods & Materials: The WHOвЂ™s immunisation coverage cluster
survey design was used, involving parents/guardians (n=205) of children aged 0-59 months and health centre personnel (n=13) directly
concerned with vaccination activities between July-September 2010
in two health districts in Yaounde, Cameroon. The response rate was
79.3%. Descriptive statistics and multivariate logistic models were used
to analyse the parental/guardian data while the health personnel data
was only analysed descriptively using SPSS version 17.0.
Results: Only 19% of the parents/guardians were aware of the availability of the PCV. Logistic modelling identified important associations
between parental socio-economic/demographic factors and good
knowledge on pneumonia disease burden and prevention.
Conclusion: According to parents/guardians, a concise message
through mass sensitisation/out-reach campaigns on the dangers of
pneumonia and urgent need for prevention is primordial, if the PCV is
to reach every child.
22.144 Antibody response to DNA vaccine against
November 1, 2014
in Singapore
J. Njuma Libwea1, M. Kobela2, H. Nohynek3
University of Tampere School of Health Sciences, Tampere, Finland,
2
Expanded Programme on Immunisations, Cameroon, Yaounde,
Cameroon, 3National Institute for Health and Welfare (THL), Helsinki,
Finland
1
вЂў
22.142 Progress towards measles elimination
conjugate vaccine into CameroonвЂ™s expanded
programme on immunization: Would every
child be reached?
SATURDAY
Purpose: Brucellosis is the most common bacterial zoonotic disease
worldwide and no vaccine is available for the prevention of human brucellosis. In humans, brucellosis is mostly caused by Brucella melitensis
and Brucella abortus. TheOmp31 and L7/L12 are immunodominant
and protective antigens conserved in human Brucella pathogens. The
aim of this study was to evaluate the immunogenicity and protective
efficacy of a L7/L12-truncated Omp31 vaccine candidate administered
as DNA priming-protein boosting immunization regime.
Methods & Materials: Bioinformatic tools were used to design the
truncated Omp31 and L7/L12- TOmp31 fusion protein. The humoral/
cellular immune response and protection levels against challenge with
wild B.melitensis and B.abortus were evaluated in vaccine immunized
mice and control groups.
Results: Vaccination of BALB/c mice with the DNA priming/Protein
boosting immunization regime provided the significant protection level
against both B.melitenisis and B.abortus remarkably compatible to the
vaccine positive control groups.Moreover, L7/L12-TOmp31 elicited a
strong specific IgG response with shift to Th1 response (higher IgG2a
titers) and significant IFN-gamma/IL2 production and T-cell proliferation
was also observed. The Th1 oriented response persisted for 12 weeks
after final immunization.
Conclusion: rL7/L12-TOmp31 could be a new potential candidate
for the development of a prime-boost vaccine regime against B. melitensis and B.abortus.
22.143 The introduction of the pneumococcal
H5N1 in broilers and layers chickens
A. Stachyra, A. Gora-Sochacka, A. Protasiuk, A. Sirko
Institute of Biochemistry and Biophysics, Warsaw, Poland
Purpose: Avian Influenza virus brings continuous threat of new outbreaks among human and domestic animals populations, which stimulate research in new methods of prevention and control of the disease.
One of the promising new technology, proven to work well against
influenza, is DNA vaccination, which is implemented by our group.
Chickens are the most popular domestic poultry species and they have
great economical importance. Different breeds of different types are
distinguished in many levels like body weight, life span, metabolism
or immunological potential. Since there are not many data comparing
immunological differences between broiler and laying chickens which
are definitely economically most important chicken types, vaccination
studies using H5N1 DNA experimental vaccine were performed.
Methods & Materials: Chicken were immunized with plasmid DNA
complexed with liposomal carrier for improvement of uptake by host
cells. Hemagglutinin gene with optimized nucleotide sequence from
H5N1 highly pathogenic strain (clade 2.2) was the basis of the vaccine.
Chickens were divided into several groups which received either single
or two-doses of vaccine in different schedules. Blood samples were
collected in several time points and the dynamics of humoral response
to the DNA vaccine was followed. The anti-HA IgY level were measured
in chicken serum using optimized ELISA test procedure and HI assay.
Results: The results showed high efficacy of our DNA composition,
which induced strong humoral responses levels, when two doses
of vaccine were applied. They also indicated some differences in
immune responses of broilers and layers chicken types when induced
by H5-DNA vaccine, which to our knowledge, were never compared
before.
Conclusion: Our study sheds more light on chickenвЂ™s immunological
system and broaden immunization methods against influenza virus.
Acknowledgments of financial support: This work was
supported by Innovative Economy Program, Grant No.
WND-POIG.01.01.02-00-007/08
111
IMED 2014
Poster Presentations I
SATURDAY вЂў November 1, 2014
International Meeting on Emerging Diseases and Surveillance 2014
22.145 Increase in endemic Neisseria meningitidis
capsular group W ST-11 complex associated
with severe invasive disease in England
and Wales
SATURDAY
вЂў
November 1, 2014
S. Ladhani1, K. Beebeejaun1, J. Lucidarme2, H. Campbell1, S. Gray2,
E. Kaczmarski2, M. Ramsay1, R. Borrow2
1
Public Health England, London, United Kingdom, 2Public Health
England, Manchester, United Kingdom
Purpose: To describe the epidemiology, clinical characteristics and
outcome of laboratory-confirmed invasive meningococcal capsular
group W (MenW) disease in England and Wales.
Methods & Materials: Prospective, enhanced national surveillance
of laboratory-confirmed invasive meningococcal disease with questionnaire follow-up of cases and whole genome sequence analysis of clinical isolates. Study included patients with laboratory-confirmed invasive
MenW disease in England and Wales.
The main outcome measrures were trends in MenW disease incidence during July 2002-May 2013; association between age, infecting
strain, risk factors, clinical presentation, intensive care requirement and
outcome among cases diagnosed during July 2010вЂ“June 2013.
Results: Invasive MenW disease has increased year-on-year from
2009/10 because of rapid expansion of a single endemic clone belonging to the ST-11 complex (cc11). In 2013/14, MenW was responsible
for 15% of all invasive meningococcal disease. All but one of the recent
MenW cc11 isolates were very closely-related, consistent with recent
clonal expansion. Initially, cc11 cases were observed in adults but
subsequently detected across all age-groups. Clinical follow-up of all
129 MenW cases diagnosed during the 2010/11-2012/13 epidemiological years revealed that most cases were previously healthy (n=105,
81%) and, while the majority presented with meningitis (n=21, 16%),
septicaemia (n=16, 12%) or both (n=63, 49%), a quarter had atypical presentations including pneumonia (n=15, 12%), septic arthritis
(n=9, 7%) and epiglottitis/supraglottitis (n=5, 4%). Forty-eight (37%)
required intensive care and meningococcal-related case-fatality was
12% (n=15). There was no association between infecting strain, clinical
disease or outcome.
Conclusion: The recent increase in invasive MenW disease has
been associated with rapid endemic expansion of a single clone
belonging to cc11. Although there were no differences in clinical characteristics or outcome between this and other clones, MenW disease
in general was associated with severe disease with unusual clinical
presentations, high rates of intensive care admissions and high case
fatality. The rapid increase in MenW cc11 will require careful monitoring
in the coming years.
22.146 Cross-protection evaluation of a lineage 1
West Nile virus inactivated vaccine against
natural infections from a virulent lineage 2
strain in horses
S. C. Chaintoutis, N. Diakakis, M. Papanastassopoulou, G. Banos,
C. I. Dovas
Aristotle University of Thessaloniki, Thessaloniki, Greece
Purpose: Lineage 2 West Nile virus (WNV) strains are associated with
encephalitis outbreaks in humans and horses in Africa, Central Europe,
Italy and Greece. In 2010, West Nile fever occurred in Northern Greece
with 17 confirmed horse cases, attributed to вЂњNea Santa-Greece-2010вЂќ
lineage 2 strain, which eventually became endemic. Currently, all the
commercially available horse vaccines (inactivated, recombinant, and
DNA vaccines) are being developed and evaluated for the protection
they offer, using lineage 1 strains. On the other hand, results regarding
their efficacy against lineage 2 infections in horses, especially under
field conditions are lacking. This study was conducted to evaluate
the capability of an inactivated lineage 1 vaccine (Equip WNV, Zoetis
Inc.) to provide cross-protection against natural infections of the highly
pathogenic вЂњNea Santa-Greece-2010вЂќ WNV-lineage 2 strain.
112
IMED 2014
Methods & Materials: In total 185 WNV-seronegative horses in
Thessaloniki, Greece were selected during two consecutive years
(2011-2012). The 140 were immunized with the aforementioned vaccine and 45 were used for control purposes. The horses were being
examined for presence of neurological signs compatible with WNVinfection. Blood serum samples were taken at specific time-points.
MAC-ELISA (detection of WNV-specific IgM antibodies) was used
for the confirmation of the diagnosis in horses with clinical signs. The
neutralizing antibody titers of the vaccinated horses against the вЂњNea
Santa-Greece-2010вЂќ lineage 2 strain and the вЂњPaAn001/FranceвЂќ lineage 1 strain, were also determined.
Results: WNV enzootic circulation was observed during the study,
as evidenced by testing of the control horses (serology), as well as by
testing sentinel birds (serology and sequencing of WNV) residing in
proximity to the study area. Neurological signs were detected in 3 control animals and diagnosis was confirmed by MAC-ELISA. Оќo clinical
signs related to WNV disease were observed in any of the vaccinated
animals. Neutralizing antibody titers against both WNV strains, in the
immunized horses, ranged between 1:40 and 1:320, one month after
the double primovaccination. The protective titers were maintained until
the annual booster, where a strong anamnestic humoral response was
observed.
Conclusion: вЂњEquip WNVвЂќ is capable to offer cross-protection in
horses, against natural infections of lineage 2 WNV strains under field
conditions.
22.147 Economic model of rotavirus vaccination
programme incorporating excess risk of
intussusception in Singapore
A. Green1, C.-F. Yung2
National University Hospital Systems Residency, Singapore,
Singapore, 2Tan Tock Seng Hospital, Singapore, Singapore
1
Purpose: The rotavirus vaccine is available in Singapore on a private
basis which achieves coverage of only about 15%. In view of increasing
demands on health infrastructure especially hospital bed pressures, we
evaluated the potential impact and cost-effectiveness of rotavirus vaccination if it were incorporated into a national vaccination programme
achieving 90% coverage.
Methods & Materials: Analysis was conducted through a Markov
model that followed two cohorts of children from birth to 5 years of age
with differing rotavirus vaccination coverage (15% vs 90%). Principal
model inputs included data on rotavirus disease burden, full market
value vaccine cost, coverage rates, efficacy, and burden of excess
intussusception attributable to rotavirus vaccination. The model estimated the effect of vaccination on outpatient/hospitalization utilisation,
cost as well as Disability-Adjusted Life Year (DALY).
Results: Within 5 years after implementation, increasing vaccination
coverage from 15% to 90% would prevent 1,561 more hospitalizations
and 9,177 outpatient visits due to rotavirus infection among children
<5 years. This equates to approximately US$1 million of medical costs
being averted. Furthermore, 90% vaccination coverage would reduce
the DALY across the cohort by approximately half. The programme
would be cost effective with an incremental cost per DALY averted
of ~US$31,000 despite our estimated 5 excess intussusception. If
all the excess intussusception cases resulted in death, the cost per
DALY averted would rise to ~US$120,000, but still remain cost effective based on accepted WHO guidelines at 3x gross domestic product
(GDP) per capita (Singapore GDP in 2012, $51000).
Conclusion: A national rotavirus vaccination programme is cost
effective in helping to alleviate health service utilisation resulting from
the burden of rotavirus gastroenteritis even at full market vaccine
costs. Our model demonstrated that recent identification of excess
intussusception attributable to rotavirus vaccine would not have a significant impact on overall cost effectiveness of a rotavirus vaccination
programme. However, apart from financial considerations, monitoring
and public communication of excess risk remain crucial in maintaining
confidence in vaccines.
Poster Presentations I
SATURDAY вЂў November 1, 2014
International Meeting on Emerging Diseases and Surveillance 2014
22.148 Protective effect of vaccination on mumps
complications: analysis of the Czech national
surveillance data, 2007вЂ“2012
H. Orlikova, M. Maly, P. Lexova, H. Sebestova, R. Limberkova,
L. Jurzykowska, C. Benes, J. Kyncl
National Institute of Public Health, Prague, Czech Republic
Purpose: Leishmaniases are neglected protozoal diseases that
severely affect large populations in tropical and subtropical regions
worldwide. Treatment options are limited due to variations in efficacy,
toxicity and high costs of the available drugs, and increasing drugresistance. Effective preventative measures are not available. A vaccine is needed for prevention, control and elimination of leishmaniasis
in endemic regions. Ideally, such a vaccine should be immunogenic in
populations of different genetic backgrounds and efficacious against
the various Leishmania species.
Methods & Materials: We present preclinical data of a multiantigen
T cell epitope-enriched DNA vaccine against leishmaniasis [1]. The
vaccine antigens were selected as conserved in various Leishmania
species, different endemic regions, and over time.
T. Makino, Y. Ohkusa
National Institute of Infectious Diseases, Tokyo, Tokyo, Japan
Purpose: Japanese Immunization Program (JIP) decided to include
Haemophilus Influenza Type B vaccine and Conjugated Pneumococcal
Vaccine into its children routine schedule in 2013 April. According to
this, Japanese National Epidemiological Surveillance of Infectious
Diseases (NESID) was also modified to include Invasive Haemophilus
Influenza Diseases (IHD) and Invasive Pneumococcal Diseases (IPD)
at the same time. These agents in adults are associated with pneumonia, which has become the third biggest largest cause of death among
Japanese entire population. Our study tried to illustrate the demographics of these infections in Japan, using the notifications in the first year
of surveillance.
Methods & Materials: Case data were collected from the NESID
database notified between April 1st 2013 and March 31 2014, including patientsвЂ™ age, sex, signs and symptoms, and vaccination history.
Disease types are defined as follows: Bacteremia (pathogens detected
from either blood by culture or PCR, excluding), Meningitis (bacteremia
with symptoms of neck spasticity or meningeal signs, or cerebral spinal
fluid (CSF) positive by culture or PCR), and Pneumonia (bacteremia
with symptom of pneumonia, excluding Meningitis). National population
data as of the end of March 2013 was used to estimate the morbidity.
Results: 1,481 cases of IPD and 159 cases of IHD were reported.
Incident rates were the highest among children-under-5 followed by
senior of 65 and more. Case fatality rates of IPD were highest among
senior (10%) and lowest among children-under-5 (0.3%), while IHD
had as high fatality rate among children-under-15 as among senior
(8%). Bacteremia prevailed more among children, while pneumonia
among senior for both IPD and IHD. IPD has increased proportion of
Meningitis among young adult. Regarding seasonality, incident rate
had major peak in spring (April and May) for children, while senior had
two peaks of both spring and winter. Vaccination history was collected
almost 70% of adolescent cases (under 15 years old).
Conclusion: This analysis first illustrated the nationally notified
cases of IPD and IHD throughout a year. Because doctors are mandated to report cases within seven days, national surveillance data has
limitation on prognosis. Few serotypings limit evaluation of the vaccine
effectiveness. Following survey should examine the impact of national
vaccination policy.
November 1, 2014
leishmaniasis vaccine
C. Juhls1, LeishDNAvax Consortium2, A. Freier3
1
Mologen AG, Berlin, Germany, 2London School of Hygiene
and Tropical Medicine, London, United Kingdom, 3CharitГ©UniversitГ¤tsmedizin Berlin, Berlin, Germany
pneumococcal and Haemophilus influenza
diseases in JapanвЂ”First year assessment of
national surveillance
вЂў
22.149 Multiantigen T cell epitope-enriched
22.150 Epidemiological demographics of invasive
SATURDAY
Background: In the Czech Republic mandatory mumps vaccination
with two doses was introduced in 1987. Despite the high 98% vaccination coverage the routine surveillance reporting detects mumps
outbreaks. Moreover, mumps and complications (mainly orchitis,
meningitis and pancreatitis) and hospital admission affect both, unvaccinated but also vaccinated individuals. We assessed the effect of vaccination on complications and hospitalizations among mumps cases.
Objective: We compared the effect of mumps vaccination on complications and hospitalization need among unvaccinated and vaccinated
mumps cases reported to the Czech national surveillance system
between 2007вЂ“2012.
Methods & Materials: We analysed data on incident mumps cases
reported to the Czech national surveillance system EPIDAT in period
2007вЂ“2012. We described the epidemiological characteristics of the
patients with mumps. We assessed association between vaccination and the most frequent mumps complications and hospitalization.
Univariate analysis and multivariate logistic regression with predictors
age, sex, year of onset, region NUTS2, were performed using the statistical programme STATA9. We compared adjusted odds ratios (OR)
and computed the preventable fractions for mumps complications in
vaccinated, reflecting the effect of vaccitation (VE). Point estimates
with 95% confidence intervals (95% CI) were determined, p<0.05 was
considered significant.
Results: In 2007вЂ“2012, total 9898 mumps cases were reported,
5740 (58 %) in males. Mean age was 17.3, median 16 years. The most
affected age groups were 10-24 years old. Seventeen percent were not
vaccinated, 1.4 % received one dose and 80% two doses. Ninety percent of cases had no complications, while 1.8 % developed meningitis
or encephalitis and 0.7 % pancreatitis. Mumps orchitis occured in 680
(11.8 %) of male cases. Total 1224 (12.4 %) mumps cases required
hospitalization. After two doses of mumps vaccine the risk was significantly (p<0.001) reduced for hospitalization OR 0.29 (95% CI 0.240.35), reflecting 71% (95% CI 65-76) preventable fraction. Significant
(p<0.001) protective effect of two-dose vaccination was 70 % (95%
CI 53-81) for meningitis or encephalitis and 73 % (95% CI 65-79) for
orchitis in male.
Conclusion: Our study demonstrates significant positive preventive
effect of vaccination for complications (orchitis, meningitis, encephalitis) and hospitalization need in mumps cases reported to surveillance.
Results: The antigens induced T cell-based immunity in natural
infection as demonstrated with T cells from individuals who had recovered from leishmaniasis, and harbor epitopes for both CD4 and CD8
T cells in genetically diverse human populations of different endemic
regions. The vaccine proved immunogenic and protective in a mouse
model of visceral leishmaniasis. GLP studies with single and multiple
vaccinations revealed a good safety profile of the vaccine.
Conclusion: From establishing the immunology of vaccine antigens
in human populations of endemic regions to the proof-of-principle
for induction of specific immune responses and protection against
Leishmania infection in mice, the development strategy for the vaccine
was translational. The vaccine is ready to be tested in clinical trials.
The project was funded by the 7th Framework Program of the
European Commission.
1. Das, S., et al., Modular multiantigen T cell epitope-enriched DNA
vaccine against human leishmaniasis. Science Translational Medicine,
2014. 6(234): p. 234ra56.
113
IMED 2014
Poster Presentations I
SATURDAY вЂў November 1, 2014
International Meeting on Emerging Diseases and Surveillance 2014
22.151 Immune response to hepatitis B vaccine in
health-care providers of an intensive care unit
at a teaching hospital in Guatemala City
SATURDAY
вЂў
November 1, 2014
I. Cazali, D. R. Erdmenger, L. OвЂ™Connell, J. Guerra, A. E. Arana,
I. Gudiel
Hospital Roosevelt, Guatemala, Guatemala
Purpose: Hepatitis B (HBV) infection due to percutaneous exposure
through occupational accidents in health-care workers (HCWвЂ™s) continues to be a significant health hazard. Estimates are that 66,000 new
cases of HBV infections can be related to percutaneous injury in HCWвЂ™s.
Little information is available about vaccination coverage of HCWвЂ™s in
Guatemala. Evaluating the immunization status among HCWвЂ™s should
be a public health priority. A review of the immunization status among
HCWвЂ™s of an intensive care unit (ICU) and Cardiovascular Surgery Unit
(CSU) in a Guatemalan hospital was done from 2011 to 2013, as an
effort to reinforce vaccination policies.
Methods & Materials: To evaluate the immune response to HBV
vaccine in health-care workers of an ICU and a CSU of a Guatemalan
hospital, blood samples from 440 HCWвЂ™s were obtained in order to
analyse Anti-HBs titers, those with negative Anti-HBs were analysed for
Anti-HBc and AgHBs. Immunization history and occupational accidents
history were obtained from a questionnaire.
Results: A total of 41 (63%) and and 399 (100%) HCWвЂ™s in the ICU
and CSU, were evaluated respectively. Twenty nine percent of the
subjects (53.6% ICU; 27% CSU) had a history of HBV vaccination.
Of these, 20% (18.2% ICU; 20% CSU) had a negative Anti-HBs titer.
Anti-HBc and AgHBs titers were measured and none proved positive.
Eleven subjects (26.83%) from the ICU and 189 (47.36%) from the
CSU groups had never been vaccinated. Of these 4 (36.3%) and 143
(75.66%), had a positive Anti-HBs titer respectively. Regarding occupational injuries a total of 21 incidents were reported. No transfusions
were reported in the last 5 years. No significant correlation between
age and Anti-HBs titer was identified.
Conclusion: Eighteen percent of subjects with a history of complete
vaccination did not develop immunity. The number of subjects without
vaccination history and positive Anti-HBs titers could be attributable to
occupational related injuries. However no HBV carriers were identified.
Based on our findings, several new internal policies were established.
Efforts to create vaccination campaigns to include all HCWвЂ™s have been
initiated. The high incidence of occupational injuries requires additional
research and interventions.
22.152 Epidemiological, clinical and virological
supervision of the seasonal influenza in
Tunisia: Season 2013вЂ“2014
D. G. Kilani1, N. Achour2, S. Amin3, M. A. Hadj Kacem4
1
National Observatory of Emerging Diseases, Tunis, Tunisia, 2Health
Ministry, Tunis, 1009, Tunisia, 3Charles Nicolle Hospital, Tunis,
Tunisia, 4charles Nicolle Hospital, Tunis, Tunisia
Purpose: The monitoring of the circulation of influenza viruses and
its antigenic characteristics will be an important aspect for prevention
of any influenza outbreak. The circulating influenza viruses in Tunisia,
during 2013-2014, compared with the past season.
Methods & Materials: A descriptive study, to identify the influenza
viruses that circulated in Tunisia during the seasonal influenza 20132014, comparing with the past season. The field data is, first the
sentinel physicians collecting respiratory specimens to identify those
positive for influenza viruses, and second the virological surveillance.
The data are weekly and the analyses are done in the Observatory.
Results: The 268 sentinal physicians distributed throughout the
country detected 156593 influenza virus among 2196715 medical consultation (7.1%). According to the regions, Monastir(14.6%),
Manouba(14.2%), Kef(14.1%), Siliana(13.6%), Kasserine(8.9%),
Mahdia(9.6%). The indicator increased from 5% in October 2013, to
6.6% in November, 7.5% in December, 8.4% in January 2014, 8.9% in
February, than 7.6% in March and 5.3% in April 2014. A total of 270000
114
IMED 2014
doses of vaccines was distributed, 37300 doses to the public health
patients, 32300 doses for the elderly persons and the chronic diseases,
5000 doses for the healthy personal. Sentinal physicians collected 514
respiratory specimens of which were positive for 61 cases, one case
of the virus A/H1N1 and 60 cases of A/H3N2.The interval of age 5-16
years old is the most important, than > 16, than 0-4 years old. The
seasonal indicator is about 8%.
Conclusion: Public health vigilance should be maintained throughout the seasons as influenza outbreaks are unpredictable events.
Vectorborne Diseases
22.153 Seroprevalence of arboviral infections in young
male volunteers in Azerbaijan
E. Huseynova1, E. Garges2, R. Rivard3, A. Seyidov4, N. Huseynov4, T.
Ahmadkhanov4, C. Bautista2, A. Debes3, R. Woelfel5, H. Dyson6
1
US Army Medical Research Institute of Infectious Diseases, Baku,
Azerbaijan, 2Walter Reed Army Institute of Research, Silver Spring,
MD, USA, 3U.S. Army Medical Research Institute of Infectious
Diseases, Frederick, MD, USA, 4Ministry of Defense Army Medical
Office, Baku, Azerbaijan, 5Bundeswehr Institute of Microbiology,
Munich, Germany, 6Defense Science and Technology Laboratories,
Porton Down, United Kingdom
Purpose: The purpose of the study was to determine the prevalence
of antibodies to certain arboviral infections in young male volunteers,
as well as their incidence, as evidenced by seroconversion during the
study period, and assess risk factors associated with prior exposure
and development of an antibody response to the infections studied.
Methods & Materials: We have evaluated the sero-prevalence in
a cohort of 892 healthy male individuals arising from urban and rural
regions of Azerbaijan, as part of medical in-processing. We collected
serum and self-reported risk factor and medical history information at
enrollment and at follow-up 12 months later. Specific IgG ELISAs were
performed.
Results: Evidence of prior exposure to these pathogens was very
rare. 6/892 samples tested positive for WNV at enrollment (prevalence
0.45%). Similar results were found for CCHF (0.45%) and TBE (0.11%).
No seroconversions were noted within the cohort at follow-up.
Conclusion: Despite a history of reported WNV disease in Azerbaijan,
we failed to detect significant exposure history in the cohort studied.
This may be due to a temporal trend in outbreaks and epidemics in the
community, an age-cohort effect, or a true lack of any transmission in the
region. Similarly, despite known vectors and the presence of TBE infections throughout Ukraine, the Baltic States, Russia and Asia, exposure
to TBE appears to be rare among young males in Azerbaijan. CCHF is
commonly reported in neighboring Turkey and Iran, but appears to be
limited in Azerbaijan. These studies suggest that despite the potential
for transmission in the region, it is unlikely that significant transmission
does occur. Further study in additional populations is warranted.
22.154 Sero-study of rickettsial infections in young
male volunteers in Azerbaijan
E. Huseynova1, C. Bautista2, R. Rivard3, E. Garges2, H. Dyson4,
A. Seyidov5, N. Huseynov5, T. Ahmadkhanov5, A. Richards6, C. Farris6
1
US Army Medical Research Institute of Infectious Diseases, Baku,
Azerbaijan, 2Walter Reed Army Institute of Research, Silver Spring,
MD, USA, 3U.S. Army Medical Research Institute of Infectious
Diseases, Frederick, MD, USA, 4Defense Science and Technology
Laboratories, Porton Down, United Kingdom, 5Ministry of Defense
Army Medical Office, Baku, Azerbaijan, 6Naval Medical Research
Center, Silver Spring, MD, USA
Purpose: Rickettsial diseases, including both the typhus group (TGR)
and spotted fever group rickettsiae (SFGR), show considerable variation in their regional epidemiology. Prior studies from the Southern
Caucasus region demonstrate a variety of regional SFGR; in addition,
Rickettsia typhi is also known to be prevalent. Published data regarding
the epidemiology of rickettsial disease in Azerbaijan is limited. However,
recent studies of known tick vectors in the country have demonstrated
the presence of human-pathogenic rickettsia. Both TGR and SFGR are
reported in the Azeri public health system with low frequency. However,
Poster Presentations I
SATURDAY вЂў November 1, 2014
International Meeting on Emerging Diseases and Surveillance 2014
A. Sa-ngasang1, J. Ohashi2, I. Naka2, S. Anantapreecha1,
P. Sawanpanyalert3, J. Patarapotikul4
1
National Institute of Health, Nonthaburi, Thailand, 2Graduated School
of Comprehensive Human Sciences, Ibaraki, Japan, 3Food and drug
Administration, Nonthaburi, Thailand, 4Department of Microbiology
and Immunology, Bangkok, Thailand
Purpose: Dengue patients present a range of symptoms: dengue fever
(DF), dengue hemorrhagic fever (DHF), and dengue shock syndrome
(DSS). It is not clear whether this variability is due to their genetic background. Here we tested polymorphisms of interleukin 1 beta (IL1B) and
interleukin 1 receptor antagonist (IL1RA) genes for association with
DSS in Thai population.
Methods & Materials: Polymorphisms of IL1B в€’31C/T (rs1143627)
and IL1RA 86-bp tandem repeat were analyzed in 871 patients (DF =
384, DHF = 413, and DSS = 74).
Results: IL1B в€’31C and IL1RA 2/4 genotype were associated
with DSS [IL1B в€’31C: DSS versus DHF: p = 0.0061, OR (95% CI)
= 3.49 (1.36вЂ“8.95); DSS versus DF: p = 0.027, OR (95% CI) = 2.81
(1.12вЂ“7.06); IL1RA 2/4: DSS versus DHF: p = 0.017, OR (95% CI)
= 1.94 (1.12вЂ“3.40); DSS versus DF: p = 0.024, OR (95% CI) = 1.90
(1.07вЂ“3.4)]. No difference was found between DF and DHF. Logistic
regression analysis revealed that IL1B в€’31C and IL1RA 2/4 genotypes
were each independently associated with DSS.
Conclusion: Patients with IL1B в€’31C carrier, or IL1RA 2/4 genotype
carry a risk for DSS implying that IL1B may play a role in pathogenesis
of DSS.
22.156 Severe fever with thrombocytopenia syndrome
in Miyazaki, Japan
T. Kawaguchi, M. Matsuda, I. Takajo, A. Okayama
Miyazaki University Hospital, Miyazaki, Japan
Purpose: Severe fever with thrombocytopenia syndrome (SFTS)
caused by SFTS virus (SFTSV), a novel bunyavirus, was discovered in
China in 2010. SFTS was first reported in Japan in 2013. Subsequently,
the number of SFTS cases has been increasing in western Japan and
we analyzed the clinical characteristics of cases in Miyazaki, Japan.
Methods & Materials: The diagnosis of SFTS was made by the
detection of SFTSV by conventional RT-PCR. We analyzed 6 patients
treated at Miyazaki University Hospital.
vascular leakage through macrophage
migration inhibitory factor secretion and
glycocalyx degradation
T. M. Yeh1, H.-R. Chen2
National Cheng Kung University, Tainan, Taiwan, R.O.C., 2National
Cheng Kung University, Tainan, Please Select, Taiwan, R.O.C.
1
Purpose: Dengue virus (DENV) is the most common mosquito-borne
Flavivirus. DENV can cause life-threatening dengue hemorrhagic fever
(DHF) and shock syndrome (DSS). One of the characteristic features
of DHF/DSS is vascular leakage, of which the mechanisms remain
unclear. DENV non-structural protein 1 (NS1) is a highly conserved
protein which can be secreted into patientsвЂ™ plasma and its level is
positively-correlated with the severity of the disease. In this study,
we tested the hypothesis that NS1 plays a pathogenic role in DENVinduced vascular leakage.
Methods & Materials: Recombinant NS1 (rNS1) was incubated with
human endothelial cell line (HMEC-1). The expression and secretion
of pro-inflammatory cytokine, macrophage migration inhibitory factor
(MIF) and heparanase-1 (HPA-1) were determined by RT-PCR and
ELISA. Endothelial permeability was determined by transwell permeability assay. The junction proteins were stained by fluorescent antibodies and their distribution was observed by confocal microscope. The
degradation of glycocalyx was measured by CD138 levels in culture
medium.
Results: We demonstrated that rNS1 induced HMEC-1 cell to secrete
MIF which may cause autophagy formation, junctional proteins disarray
and endothelial permeability increase. NS1-induced hyperpermeability
were inhibited in the presence of NS1 antibodies, MIF or autophagy
inhibitors. Besides to MIF secretion, HPA-1 expression and CD138 level
in rNS1-treated endothelial cell cultured medium were also increased,
indicating NS1 may cause endothelial glycocalyx degradation.
Conclusion: Taken together, these results suggest that NS1 may
play pathogenic roles in DENV-induced vascular hyperpermeability
through MIF secretion and glycocalyx degradation.
November 1, 2014
number of an 86-bp tandem repeat with dengue
shock syndrome in Thailand
22.157 Dengue virus non-structural protein 1 induces
вЂў
22.155 Association of IL1B-31C/T and IL1RA variable
Results: None of the 6 patients (2 men and 4 women; mean age
69 years) lived in urban areas and none had traveled abroad during
the several months before onset. Four patients had cats, cows, and
wild boar as pets or livestock. Obvious tick bite was observed only in
2 patients. All patients exhibited high fever, fatigue and gastrointestinal symptoms (lack of appetite, nausea, vomiting, and diarrhea). Five
patients exhibited neurological symptoms (disturbance of consciousness, convulsion and myoclonus). Hemorrhage (melena and hemoptysis) were seen in only 2 patients. Leukopenia, thrombocytopenia and
elevation of transaminase and creatine kinase (CK) were seen in all
patients. It is possible that these data were the result of hemophagocytosis due to SFTSV infection. Heart failure was seen in 1 patient.
Corticosteroid was administered in all save 1 patient, who was rather
young (47 years old) and showed only a mild abnormality. Five patients
survived, and their symptoms and abnormal laboratory data improved
gradually over the 7 days following onset. One patient, who showed the
highest transaminase and CK, died on day 10 post onset.
Conclusion: The elevation of transaminase and CK may be an indicator of poor prognosis. It is still not clear whether the steroid therapy
can improve the clinical course of SFTS. Further studies including a
larger number of patients with SFTS are necessary.
SATURDAY
limited diagnostic capacity and clinical recognition of often non-specific
disease may decrease the clinical awareness of rickettsial diseases.
Therefore, the purpose of the study was to identify seroprevalence and
seroincidence of Rickettsial Diseases, including SFGR and TGR, as
well as associated risk factors in young male volunteers arising from
urban and rural regions of Azerbaijan.
Methods & Materials: We have evaluated the sero-prevalence and
sero-incidence in a cohort of 886 healthy male individuals originating
from urban and rural regions of the country, as part of routine medical
in-processing. We collected serum samples and self-reported risk factor and medical history information at enrollment and at follow-up12
months later. Rickettsia-specific IgG ELISAs were performed using
whole cell antigen preparations of R. conorii Moroccan strain and R.
typhi Wilmington strain for detecting SFG- and TG- specific antibodies,
respectively.
Results: 33 subjects tested positive for Rickettsial antibodies, while
853 tested negative, resulting in a seroprevalence of 3.7% at enrollment. Of those who tested negative for SFGR on enrollment, 18 tested
positive on follow up, resulting in a one year cumulative seroincidence
of 2.09% (1.3%, 3.4%). No antibodies against TGR were identified in
the population at either enrollment or follow-up.
Conclusion: The seroprevalence of both pathogen groups was substantially lower than expected. SFGR sero-incidence was high considering the one year window of follow up. This study suggests that similar
aged individuals from the same region may be at higher risk of SFGR
exposure. Although the baseline endemicity for TGR is unclear, this
study demonstrates that exposure is unlikely to occur during childhood
in these regions.
22.158 Avian biodiversity and Usutu virus circulation
in Emilia-Romagna (Italy), 2010вЂ“2012
M. Calzolari1, L. Fornasari2, G. Calvi2, R. Bellini3, P. Angelini4,
M. Dottori1
1
IZSLER, Reggio Emilia, Italy, 2MITO2000, Parma, Italy, 3CAA,
Crevalcore, Italy, 4Regione Emilia-Romagna, Bologna, Italy
Purpose: Usutu virus (USUV) circulates between mosquitoes, particularly Culex pipiens, and wild birds, for which this arbovirus could
be pathogenic. Since 2009 the Regional plan of arboviral surveillance (based on testing field-sampled mosquito) recorded the USUV
115
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SATURDAY
вЂў
November 1, 2014
International Meeting on Emerging Diseases and Surveillance 2014
circulation in Emilia-Romagna (northern Italy). Several mosquito sampling stations were close to bird survey areas included in the Italian
breeding bird monitoring programme MITO2000 (www.mito2000.it),
performed by means of single visit point counts.
Aim: To identify possible correlation between avian fauna and virus
circulation, USUV and MITO data recorded in the same period (20102012) were analyzed.
Methods & Materials: Cx. pipiens mosquito population data and
USUV test results were obtained for 40 entomological stations which
operated all years in 2010-2012; the overall minimum infection rate
(MIR) was calculated for every station.
MITO2000 observation points, in a buffer of 3 km around mosquito
stations, were selected and bird number for every species, as well as
the maximal number of observed bird species, were retrieved.
Results: A total of 349,341 Cx. pipiens specimens, grouped in 2,135
pools (of which 90 USUV-positive), were obtained in selected stations.
210 MITO observations were performed around these stations, with
the detection of 90 bird species. A meaningful polynomial relation
was found between maximal number of bird species and the overall
MLE (p<0.01, R2=0.3, figure) for every station. According to the linear
correlation model, the abundance of twelve species was significantly
correlated to the USUV circulation. Among these the Blackbird Turdus
merula, the Blackcap Sylvia atricapilla, and the Turtle Dove Streptopelia
turtur were found around more than 40% of stations.
Conclusion: This preliminary investigation candidates some birds,
like Blackbird (particularly susceptible to USUV), as key species in the
virus circulation; but theirs role must be deepen investigated, to discern
causal relationships from spurious correlations. The obtained data
seem to indicate an early positive association between USUV circulation and number of bird species, followed by a decreasing effect (figure). This particular dynamic seem to combine the opposed hypothesis
postulated to describe the relation between arbovirus circulation and
biodiversity. Obtained results stressed out the added value of combining bird and mosquito data to understand arbovirus ecology.
22.159 Clinical profiles of dengue infection in a
teaching hospital of Sourthren province
Sri Lanka
J. I. Abeynayake
Medical Research Institute, Colombo, Sri Lanka
Purpose: Dengue infection with one of four related serotypes of dengue virus (DENV-1, -2, -3, and -4) results in a range of clinical manifestations spanning asymptomatic infection, classical dengue fever
(DF), dengue hemorrhagic fever (DHF) and dengue shock syndrome
(DSS). The outbreaks hitting with different clinical manifestations are
being reported recently. In this study, we present varied clinical manifestations of dengue patients who had been admitted to the teaching
hospital in southern province Sri Lanka.
Methods & Materials: This observational study included total of 81
laboratory confirmed dengue patients, from October 2013 to February
2014. Clinically suspected, 81routine serum samples from both children and adults, received to the hospital laboratory have been tested
for dengue virus infection, using rapid immunochromatographic assay
(Dengue SD-Bio line, Germany). Assay detects anti-DENV IgM and
IgG antibodies. Patients were diagnosed with primary dengue if they
were IgM positive with or without detectable IgG antibody. Patients with
only detectable IgG were judged to have secondary dengue infection.
Patient data sent along with the sample on the request form included
age and clinical history. Rapid antibody test positive patientвЂ™s clinical
profile analyses was performed and categorized carefully.
Results: The clinical features gathered stratified the patients with
dengue.
It was noted fever was present in all patients. Next common symptoms were headache 73 (90.1%) followed by body aches 69 (85.1%),
chills/rigors 63 (77.7%), abdominal pain 61 (75.3%), nausea/vomiting
52 (64.1%), retro-orbital pain 41 (50.6%). Rash and bleeding from different sites were evident in 23 (28.3%) and 14 (17.2%) respectively.
Analysis also observed some had chest pain 22 (27.1%), diarrhea 19
(23.4%), dyspnea 11 (13.5%), ascites 9 (11.1%), pleural effusion 7
(8.6%), and neurological features 4 (4.9%).
Conclusion: This study proved dengue patients can present with different clinical manifestations varied from known clinical presentations
like fever, headache, body aches to some atypical presentations like
chest pain and neurological features. One should aware of different
presentations of dengue to early diagnose and intervene timely.
22.160 Human granulocytic anaplasmosis is
an emerging disease in South Korea:
A 10-year study
J. Yi1, K.-H. Kim2, E. Y. Lee1, M.-D. Oh2
Pusan National University School of Medicine, Busan, Korea,
Republic of, 2Seoul National University College of Medicine, Seoul,
Korea, Republic of
1
Purpose: Human granulocytic anaplasmosis (HGA) and human monocytic ehrlichiosis (HME) are tick-borne rickettsial diseases that affect
humans and domestic and wild animals. Major clinical manifestations
of HGA and HME are fever, thrombocytopenia and leukopenia. Severe
cases can show hemophagocytic lymphohistiocytosis and be fatal. HGA
and HME were first identified in the United States and subsequently
in European countries in 1980-1990s. HGA cases were only recently
reported in Asian countries, i.e., China in 2008 and Japan in 2013. In
South Korea, Anaplasma phagocytophilum has been detected in ticks
and wild animals, however, there is no report with clinical description
of HGA yet. The aim of this study was to investigate the patients with
fever, thrombocytopenia, and leukopenia for HGA or HME.
Methods & Materials: A retrospective study was conducted on
patients who came to a university hospital between 2003 and 2013
due to fever, thrombocytopenia and leukopenia without hematologic or
microbiologic causes. Patients were included if they had a bone marrow
examination and if their blood samples had been stored. Laboratory
diagnosis of HGA or HME was made by detecting 16S rRNA genes of
A. phagocytophilum or E. chaffeensis from the stored blood samples.
DNA was extracted from the samples, and nested PCRs were conducted to amplify 16S rRNA genes using species-specific primer sets
for A. phagocytophilum and E. chaffeensis. Stored peripheral blood
smear slides were reviewed under microscope for morulae within
neutrophils.
Results: A total of 73 cases met inclusion criteria. Of these, 16S rRNA
gene of A. phagocytophilum was detected in 6 patients (8.2%). Median
age of the 6 patients was 42.5 years (range 0.5-61), and the ratio of
males to females was 5:1. Two cases were fatal and the earliest case
dated back to 2006. In two cases, hemophagocytosis was shown in
bone marrow examination. All patients were living in southeastern part
of Korea, and three patients have had outdoor activities or tick-bites
before the illness. In retrospective review of peripheral blood smears,
morulae were found in three patients.
Conclusion: In South Korea, HGA should be considered as one of
the differential diagnoses in patients with fever and thrombocytopenia.
22.161 Old world vs. new world West Nile virus:
is there any difference?
M. A. Jimenez-Clavero1, E. Perez-Ramirez1, F. Llorente1,
J. Del Amo1, N. Nowotny2, R. Soriguer3, J. Figuerola4
1
INIA, Valdeolmos, Spain, 2University of Veterinary Medicine, Vienna,
Austria, 3Sevilla, Seville, Spain, 4EstaciГіn BiolГіgica de DoГ±ana, CSIC,
Seville, Spain
Purpose: West Nile virus (WNV) emerged in New York in 1999, and
subsequently spread throughout the Americas, with an unprecedented
speed and virulence for humans, horses and wild birds. Almost simultaneously, WNV re-emerged in Europe and the Mediterranean area after
116
IMED 2014
Poster Presentations I
SATURDAY вЂў November 1, 2014
International Meeting on Emerging Diseases and Surveillance 2014
T. Fredeking1, J. Zavala-Castro2, P. GonzГЎlez-Martinez2, W. MoguelRodriguez2, E. C. Sanchez3, M. J. Foster1, F. A. Diaz-Quijano4
1
Antibody Systems, Inc., Hurst, TX, USA, 2Universidad AutГіnoma de
YucatГЎn, MГ©rida, YucatГЎn, Mexico, 3Hospital AgustГn OВґHoran SSY,
MГ©rida, YucatГЎn, Mexico, 4Universidade de Sao Paulo, Sao Paulo,
Sao Paulo, Brazil
Purpose: Incidence of dengue has increased dramatically over the
past 30 years since its reemergence in South and Central America.
Unfortunately, there is no specific treatment for dengue or its complications. However, treatment by modulation of the cytokine response
through use of drugs or antibodies has attracted considerable attention.
Recently doxycycline or tetracycline has been shown to down-regulate
pro-inflammatory cytokine levels in tick borne encephalitis and dengue
patients.
Objective: To determine the effect of doxycycline treatment on cytokine levels and mortality in dengue patients at high risk of complication.
Methods & Materials: A group of dengue hemorrhagic fever patients
(n=231) were randomized to receive either standard supportive care or
supportive care in addition to oral doxycycline twice daily for 7 days.
Dengue virus infection was confirmed by PCR using multiple primers.
Serum samples were obtained at days 0, 3, 5 and 7 and tested for
levels of tumor necrosis factor (TNF) and interleukin 6 (IL-6).
Results: Doxycycline-treated group presented a 46% lower mortality
than that observed in the untreated group (11,2% [13/116] vs 20,9%
[24/115], respectively, p=0.05). Moreover, administration of doxycycline
resulted in a significant (p<0.01) decrease in levels of TNF and IL-6
versus controls in the tests performed during follow-up (day 3, 5 and
7). Patients who died in both groups possessed significantly (p<0.01)
higher levels of TNF and IL-6 compared to those who survived at alltime points.
Conclusion: This study has some limitations that must be considered.
First, this trial was not conducted following a double blind, placebo-controlled design. Moreover, since only patients who eventually received
doxycycline treatment were considered in the doxycycline group, the
fever-negative samples in Nuevo Leon, Mexico
E. Jaramillo1, E. Jaramillo-Reyna2, J. Z. Villarreal-PГ©rez 3,
F. J. GarcГa-Elizondo3, F. GonzГЎlez-AlanГs 3, E. I. Galindo-Galindo3,
M. I. Tavitas-Aguilar3, S. P. Mora-Gloria3, P. Carranza-Rosales4,
C. B. Brito-LorГЎn5
Laboratorio Estatal de Salud Publica -Secretaria de Salud PГєblica
del Estado de Nuevo LeГіn. Guadalupe, NL, MГ©xico, Guadalupe,
NL, Nuevo LeГіn, Mexico, 2Laboratorio Estatal de Salud Publica
-Secretaria de Salud PГєblica del Estado de Nuevo LeГіn. Guadalupe,
NL, MГ©xico, Guadalupe, Nuevo LeГіn, Mexico, 3Laboratorio Estatal
de Salud Publica -Secretaria de Salud PГєblica del Estado de Nuevo
LeГіn. Guadalupe, NL, MГ©xico, Guadalupe, Mexico, 4Centro de
InvestigaciГіn BiomГ©dica del Noreste-Instituto Mexicano del Seguro
Social. Monterrey, NL, MГ©xico, Monterrey, Mexico, 5Laboratorio de
Leptospirosis y Rickettsiosis-Instituto de Diagnostico y Referencia
EpidemiolГіgicos. MГ©xico, DF, Mexico, Mexico
1
Purpose: Rickettsioses are zoonotic diseases with heterogeneous
geographical distribution, the severity of the disease varies from benign
to fulminant infections with elevated mortality. The distribution of rickettsial diseases is global, with geographical boundaries depending
on the reservoirs and vectors involved. In Mexico, different outbreaks
were reported between 2008 and 2010, the most important was in
Mexicali, with 275 infections of R. rickettsii and 3 of R. prowazekii; in
Baja California Sur, and in Sonora, 25 and 14 cases where detected
respectively for each species during the same period. In Nuevo Leon,
during 2010-2012, 233 cases were reported, 175 of R. rickettsii, 40
of R. typhi and 18 of R. prowazekii. These cases placed Nuevo LeГіn
within the three entities with more cases registered in the country. The
clinical signs reported included fever, headache, vomiting, skin rashes,
sore throat, abdominal pain, diarrhea, and petechiae. This same
symptoms were presented in another outbreak in the state of Coahuila
during 2012, with 3 deaths. However, the symptoms are nonspecific
and rickettsial diseases are misdiagnosed as other infectious diseases,
such as dengue fever, leptospirosis, meningococcemia, typhoid fever,
or influenza. Objective: To determine the presence of Rickettsia in
dengue-negative human serum samples.
Methods & Materials: Methods: One hundred and fifty three samples
were selected for diagnosis of R. rickettsii, R. typhi and R. prowazekii
from a bank of 11090 samples with negative result for dengue fever
which were analyzed during 2012, this was because of the similarity of
symptoms that patients presented and also because of the scarce epidemiological information about rickettsiosis in Nuevo LeГіn. Detection
of Rickettsias was performed by indirect immunofluorescence. The
rickettsial antigens were provided by the Centers for Disease Control
Disease and Prevention CDC, Atlanta, USA.
Results: Results: 7.189% of the samples had positive titers for IgM
(1:64) and R. rickettsii (1:512), suggesting recent infection.
Conclusion: Conclusion: With this study we present serological
evidence of infection with R. rickettsii in negative samples of patients
presumable with dengue fever. This finding suggests that the disease
can be confused with other infectious disease and therefore epidemiological data, clinical symptoms, and differential diagnosis must be
taken into account.
November 1, 2014
A potential alternative to a disease with no
specific treatment
22.163 Serological detection of R. rickettsii in dengue
вЂў
22.162 Use of doxycycline in dengue patients:
principle of intention to treat analysis was not applied. However, analyzed groups were comparable in demographic variables and cytokine
levels at baseline. Consequently, we believe that this study provides
clinical evidence of a benefit from the use of doxycycline to reduce
the case fatality rate of dengue through its immune-modulatory effects.
Nevertheless, we consider these results need to be validated in other
studies, preferably randomized, double blind, placebo-controlled trial to
conclusively demonstrate the ability of doxycycline to reduce dengue
mortality.
SATURDAY
an absence of almost three decades, but showing more limited spread
capacity and virulence, and lower bird mortality. We and others have
demonstrated recently that European wild bird species are susceptible
to disease and death by WNV infection. Therefore, the strains circulating in each Continent could account for this different behaviour. We
have shown previously that European WNV strains are as pathogenic
as North American ones, either for birds and for mice. It thus may be
interesting to determine if there are differences between Old World and
New World WNV strains on phenotypic traits other than virulence. In
the present work we hypothesized the existence of differences in transmissibility between WNV strains circulating in each Continent, which
would account for the observed differences.
Methods & Materials: For this purpose, we determined experimentally the competence index (Ci) of 4 European WNV strains (Spain/2007;
Austria/2008; Italy/2008, and Italy/2009) and compared them to the
North American WNV prototype strain NY99, determined in parallel, in
a competent host species that is common in both continents: the House
sparrow. One of these strains (Austria/2008) belongs to genetic lineage
2 while the other strains examined belong to lineage 1. In addition to
competence indexes, we compared the course of infection caused by
the different WNV strains in this passerine host, Clinical and analytic
parameters (viraemia, viral load, antibodies) were examined until 14
days after inoculation.
Results: The main outcome of these experiments is that we found
consistently lower Ci for the recent European and Mediterranean
strains than for the North American strain, i.e. we can expect House
sparrows infected with NY99 to infect a higher number of mosquitoes
than if infected with a European strain.
Conclusion: We concluded that this different transmission capacity observed between Old and New World WNV strains could, at least
in part, account for the different epidemiological behavior of WNV
between Europe and North America.
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International Meeting on Emerging Diseases and Surveillance 2014
22.164 Development of serological tools to detect
antibodies to zoonotic arboviruses in sera of
neurological disease cases of humans,
livestock and horses in southern Africa
SATURDAY
вЂў
November 1, 2014
T. Jooste1, C. van Eeden1, V. Stivaktas1, R. Swanepoel1, M. Venter2
1
University of Pretoria, Pretoria, South Africa, 2Global Disease
Detection, US Centres for Disease Control and Prevention, Pretoria,
South Africa
Purpose: A high proportion of cases of neurological disease remain
undiagnosed worldwide. Diagnosis is complicated by diseases caused
by veterinary pathogens, such as African horse sickness and equine
encephalosis viruses, poor awareness of the zoonotic agents with only
a small proportion of cases being subjected to laboratory investigation,
and the large proportion of infections that are asymptomatic. Molecular
assays and reliable antibody tests to diagnose infection during acute or
later stages of infection are not available for less known arboviruses.
Our aim is to increase our differential serological assay repertoire to
complement our recently developed molecular assays to detect arboviral contribution to neurological disease burden and relevance to veterinary vaccine development strategies.
In the present study we evaluate the potential of recombinant and cell
culture antigen serological assays to detect antibodies to WNV, Rift
Valley fever (RVF) and Shuni virus in humans, livestock and horses.
Methods & Materials: Recombinant RVF nucleoprotein (rRVFN) and
WNV envelope (ectodomain region) (rWNVEcto) proteins were produced using a bacterial expression system and purified using histidine
tag purification methods. The rRVFN was conjugated to HRP for use
in IgM capture ELISA. Polyethylene glycol (PEG) was used to produce
whole-virus antigen derived from tissue culture cells infected with a
Shuni virus. Standard checkerboard titration was used to determine
optimal conditions for the ELISAs.
Results: Indirect and capture ELISAs using rRVFN and rWNVEcto
as antigens (Ag) and rRVFN conjugated to HRP was used effectively to
detect IgG and IgM antibodies to RVF and WNV in sera of humans and
livestock, as well as horses respectively. IgG to Shuni virus was also
detected in horse sera screened in an indirect cell culture Ag ELISA.
Conclusion: Development of reliable in-house serological and
molecular tools have aided in preliminary efforts to determine the etiology of hitherto undiagnosed cases of neurological disease in humans
and animals, and highlighted that arboviruses are being overlooked as
a possible cause of neurological disease in southern Africa. Expansion
of the assays to include more arboviruses prevalent in southern Africa
is recommended.
22.165 High seroprevalence of Borrelia miyamotoi
antibodies in forestry workers and individuals
suspected of human granulocytic anaplasmosis
in the Netherlands
S. Jahfari
National Institute for Public Health and the Environment (RIVM),
Bilthoven, Netherlands
Purpose: Substantial exposure to Borrelia miyamotoi occurs through
bites from Ixodes ricinus ticks in the Netherlands, which also transmit Borrelia burgdorferi sensu lato and Anaplasma phagocytophilum.
A flu-like illness with high fever, resembling Human Granulocytic
Anaplasmosis, has been attributed to Borrelia miyamotoi-infections.
Borrelia miyamotoi-infections associated with chronic meningoencephalitis have also been described in case reports. The long-term
objective of our studies is to gain more insight of public health risk of B.
miyamotoi. As a first attempt to describe the exposure of B. miyamotoi
in the Netherlands, using a newly developed serological assay, we
determined here the seroprevalence of anti-B. miyamotoi antibodies in
different risk groups within the general population.
Methods & Materials: Assuming that an IgG antibody response
against Borrelia miyamotoi antigens reflects (endured) infection, the
seroprevalence in different risk groups was examined. Antibodies to the
118
IMED 2014
GlpQ protein of B. miyamotoi were determined by an in house Luminexassay. Sera from different groups were used for this study; blood
donors, erythema migrans patients, suspected Human Granulocytic
Anaplasmosis patients and in individuals with serologically confirmed
or unconfirmed Lyme neuroborreliosis.
Results: Sera from nine out of ten confirmed Borrelia miyamotoi
infections from Russia were found positive, and no significant crossreactivity was observed in secondary syphilis patients. The seroprevalence in blood donors was set at 2.0% (95% CI 0.4вЂ“5.7%). Elevated
seroprevalences in erythema migrans patients 5.6% (3.0-9.2%) and
in individuals with serologically confirmed 7.4% (2.0-17.9%) or unconfirmed 8.6% (1.8-23%) Lyme neuroborreliosis were not significantly
different from blood donors. The prevalence of anti-Borrelia miyamotoi
antibodies among forestry workers 10% (5.3-16.8%) and in patients
with serologically unconfirmed but suspected Human Granulocytic
Anaplasmosis 14.6% (9.0-21.8%) were significantly higher compared
the seroprevalence in blood donors.
Conclusion: Our findings indicate that infections with Borrelia miyamotoi occur in tick-exposed individuals in the Netherlands. In addition, Borrelia miyamotoi infections should be considered in patients
reporting tick bites and febrile illness with unresolved aetiology in
the Netherlands, and other countries where Ixodes ricinus ticks are
endemic.
22.166 Complete genome sequence of the first West
Nile virus strain from Turkey
K. Ergunay1, T. Bakonyi2, N. Nowotny3, A. Ozkul4
1
Hacettepe University Faculty of Medicine, Ankara, Turkey, 2Viral
Zoonoses, Emerging and Vector-Borne Infections Group, Institute of
Virology, Vienna, Austria, 3University of Veterinary Medicine, Vienna,
Austria, 4Ankara University, Faculty of Veterinary Medicine, Ankara,
Turkey
Purpose: Serosurveillance reports, sporadic human and equine
cases and vector screening studies have revealed widespread WNV
circulation inTurkey. Partial genomic sequences have so far suggested
the activity of lineage 1 viruses. The complete genome of the WNV
strain (WNV-T2), isolated from an equine with febrile disease inCentral
Anatolia in 2011, was sequenced and analyzed.
Methods & Materials: Viral RNA was extracted from Vero cell culture supernatant and converted to complementary DNA via commercial
assays. The viral genome was amplified via continuous Polymerase
Chain Reaction (PCR) assays using WNV lineage 1 specific primers as
previously described. Amplification products were directly sequenced
by SangerвЂ™s method. The obtained sequences were aligned and overlapping regions were compiled. Three regions, not covered by the reactions, were amplified with novel primers and sequenced to complete
the viiral genome.
Results: The viral genome consisted of 11026 nucleotides (nt),
where 5вЂ™ and 3вЂ™ untranslated regions comprised 93 (nt:1-93) and 630
bases (nt:10396-11026), respectively. The putative open reading
frame (nt:93-10395) was translated to a 3433 aminoacid polypeptide
that encoded viral capsid (C, 1-105), C-anchor peptide (ER, 106-123),
premembrane protein (prM, 124-290), envelope protein (E, 291-791),
non-structural proteins NS1 (792-1143), NS2A (1144-1374), NS2B
(1375-1505), NS3 (1506-2124), NS4A (2125-2250), Peptide 2k (22512273), NS4B (2274-2528) and NS5 (2529-3433). T2 strain grouped
with WNV lineage 1 clade 1a viruses. Comparison of the T2 sequence
with several lineage 1 viruses revealed 0.7% to 20.6% divergence.
Phylogenetic analyses demonstrated T2 to form a separate group with
the WNV strain ArB310/67, isolated from theCentral African Republicin
1967. Network analysis indicated a closer location of T2 to the common
ancestor and a closer network with IS98-Israel and PaH001-Tunisia
strains. T2 strain retained the original envelope glycosylation motif and
lacked substitutions associated with attenuated or enhanced neurovirulence. However, aminoacid variations with unknown implications were
noted.
Conclusion: The WNV Turkish strain T2 has been observed to be
closely -related with the Central African Strain ArB310/67. It is genetically distinct from viruses fromEastern Europe, albeit with common
ancestors circulating and/or originating from the Mediterranean region.
Poster Presentations I
SATURDAY вЂў November 1, 2014
International Meeting on Emerging Diseases and Surveillance 2014
22.167 Studies of vector competence of Italian Aedes
albopictus populations by experimental
infections with Chikungunya virus
C. Fortuna, M. E. Remoli, M. Di Luca, F. Severini, L. Toma,
E. Benedetti, P. Bucci, M. G. Ciufolini, D. Boccolini, R. Romi
Istituto Superiore di SanitГ , Rome, Italy
P. Dhar-Chowdhury1, C. E. Haque2, R. Lindsay3, S. Hossian4,
M. Drebot3
1
University of Manitoba; National Microbiology Laboratory, Winnipeg,
MB, Canada, 2University of Manitoba, Winnipeg, MB, Canada,
3
National Microbiology Laboratory, Winnipeg, MB, Canada, 4University
of Winnipeg, Winnipeg, MB, Canada
Purpose: Southeast Asian countries including Bangladesh have
remained hyperendemic for dengue due to unplanned urbanization,
overcrowding, poverty and health inequalities. In recognition of the
need for a multidisciplinary, scientific research on this problem, we
applied an вЂњEcohealth ApproachвЂќ to understand dengue virus (DENV)
transmission and social-ecological risk factors in Dhaka, Bangladesh.
Methods & Materials: Multiple disciplinary aspects were encapsulated by examination of: i) rates of human exposure to DENV by
identifying individuals (via a serosurvey in 1200 households/season for
three seasons) with IgM and IgG antibodies; ii) abundance of dengue
vector during different seasons in the same households; iii) self-risk
perception and knowledge, attitudes, and practices by the community
members. Data included in the analysis are: a) four vector surveys [i.e.,
pupal surveys conducted in 2537 households (monsoon season 20112013) and 459 households (dry season 2012)]; b) two serosurveys [
i.e., serosurveys conducted in 1126 households (pre monsoon season
2012), 1130 households (630 paired sera and 500 replacement sera
during post monsoon season 2012), and 817 households in post monsoon 2013 for seroconversion]; c) socio-demographic survey of 300
households; and d) 12 focus group discussions and 18 key informant
interviews.
T. Fredeking1, G. Ignatyev2, A. Atrasheuskaya2, F. A. Diaz-Quijano3
1
Antibody Systems, Inc., Hurst, TX, USA, 2State Research Centre of
Virology and Biotechnology (Vector), Koltsovo, Russian Federation,
3
Universidade de Sao Paulo, Sao Paulo, Sao Paulo, Brazil
Purpose: The absence of readily available and effective vaccines for
Ebola, Marburg and Lassa virus infections has dictated the development
viable post exposure treatment modalities that can be used early on in
the disease course. Mononuclear phagocytic cells are activated upon
infection and the resulting release of soluble host factors, in particular
cytokines and their soluble receptors, in response to the pathogen and
are important players in the pathogenesis of these viruses. It has been
shown that the systemic release of soluble host factors, in particular
cytokines and their soluble receptors, in response to the pathogen are
important players in the pathogenesis of these viruses. Increases in the
production of cytokines (IFN-Оі, TNF-О±, IL-1ОІ and IL-2, -4, -6, and -10),
as well as chemokines (MCP-1, MIP1-О±, MIP1-ОІ, IP-10 and RANTES)
play an important role in the outcome of Ebola and Marburg infections,
and although the key cytokines in Lassa fever are somewhat different,
it is clear that immunomodulation of cytokine release may be a viable
target for therapy.
Methods & Materials: Challenge virus
Ebola virus, strain <May>; Marburg, Popp strain; Lassa, strain Josiah
Ebola, Marburg, Lassa fever experiments were performed in the maximum-containment biosafety level-4 (BSL-4) of the SRC VB вЂњVector.вЂќ
Animals
Ebola
4-week-old BALB/c mice (haplotype H-2k) were used in the experiments with Ebola virus. Mice weighed 10-12 grams. The animals were
received from the vivarium of SRC VB вЂњVectorвЂќ and kept at a standard
ration.
Marburg
Outbreed guinea pigs weighing 200-220 grams
Lassa
4-week-old CBA/calac mice (haplotype H-2k)
Results: 20% Survival rate from Ebola infection when doxycycline
was administered at day 3 through 7. 33% Survival rate from Marburg
virus, but only when doxycycline was administered at day 3 through 7.
70% Survival rate from Lassa virus when tetracycline was administered
at day 3 through 7. 80% Survival rate from Lassa virus when doxycycline was administered at day 3 through 7. Controls without drug had
a 40% Survival rate.
Conclusion: Cytokine levels remained elevated in the control group
but declined upon the initiation of tetracycline therapy. Soluble receptor levels increased in the treatment group while there was little if any
increase in the control group.
November 1, 2014
transmission in developing country context:
The case of Dhaka, Bangladesh
and doxycycline alters disease course in
experimental Ebola, Marburg and Lassa
virus infections
вЂў
22.168 Addressing the risk of dengue virus
22.169 Modulation of cytokine activity by tetracycline
SATURDAY
Background: Chikungunya virus (CHIKV) is endemic in Africa, India
and South-East Asia. Aedes aegypti and Aedes albopictus, both vectors of CHIKV, are two mosquito species co-existing in the Indian
Ocean region. In the Reunion Island, a single mutation in the viral
envelope has been selected leading to high levels of replication and a
short extrinsic incubation period in Ae. albopictus. In 2005 the mutated
CHIKV spread from the Indian Ocean producing large epidemics in
India, Southeast Asia and Italy.
Purpose: To evaluate the vector competence of several Italian populations of Ae. albopictus by experimental infections with CHIKV using a
membrane feeding apparatus
Methods & Materials: Experimental infections were performed using
CHIKV GB M2V2 seed, isolated from serum of a patient during the
Italian outbreak (2007). Nine laboratory colonies, from different Italian
regions, were tested. Females 8-12 days old were fed and monitored
for 3 weeks after the infected meal. CHIKV titre of infected mosquitoes
was evaluated both by quantitative Real Time PCR and titration by
Plaque Forming Units/ml in VERO cells. Infection, Dissemination, and
Transmission Rates (IR, DR, TR) were assessed by detection of the
virus in body, legs plus wings and saliva respectively.
Results: All tested Ae. albopictus populations resulted susceptible to
the CHIKV infection with similar trend of viral titres analyzed at different
time points. Six populations showed viral dissemination starting from
day 2 p.i. From day 3 p.i. the virus was detected in legs plus wings in all
tested populations. We detected high values of IR and DR in all tested
populations. The viral titre increased, both in the body and in legs plus
wings of tested infected females, reaching the higher value of dissemination on day 7 p.i. The analysis of the TR, to determine the capacity
of the considered populations to transmit the virus, is still in progress
Conclusion: Our preliminary results demonstrate the susceptibility of
all tested populations to CHIKV infection and the virus ability to quickly
disseminate in the processed specimens. These findings confirm that
Ae. albopictus could represent a potential threat in Italy playing an
important role as CHIKV vector
Results: Competent dengue vectors were detected in >40% and 12%
of households during the monsoon and dry seasons respectively. The
monsoon and dry seasonal pupal index were 0.40 and 0.33 respectively for the selected 12 wards. Only 8 types of key containers and
two types of ecological clusters are responsible for 72% of pupal distribution. More than 80% IgG and nearly 3% IgM were positive during
pre- and post-monsoon serosurvey. Among the IgM positives, in-house
PRNTs, using a serial dilution of sera mixed with a DENV serotype,
are being carried out. There are significant variations in dengue risk
perception between lower and higher socioeconomic groups. Also,
experts ranked dengue risk at a much lower level than lay persons
and experts emphasized the need for stronger institutional measures
to control dengue outbreaks.
Conclusion: From this study, we were able to capture multidimensionality in dengue transmission, as well as to determine the need for
effective dengue transmission knowledge and awareness enhancement campaign for community target groups.
119
IMED 2014
Poster Presentations I
SATURDAY вЂў November 1, 2014
International Meeting on Emerging Diseases and Surveillance 2014
22.170 A case control study of risk factors associated
with dengue fever in Swat Valley, Khyber
Pakhtunkhwa, Pakistan
SATURDAY
вЂў
November 1, 2014
S. Ahmad1, M. Chaudhry1, H. B. Rashid1, H. Ali2, M. Ahmad1,
M. H. Mushtaq1
1
University of Veterinary and Animal Sciences, Lahore, Pakistan,
Pakistan, 2Dengue Cell, Swat, Pakistan
Purpose: Among vector-borne diseases dengue fever (DF) is the most
rapidly spreading viral infection that affects human population throughout the world, transmitted mainly by the bite of female mosquito Aedes
aegypti. Between August and November 2013, an outbreak of dengue
fever occurred in Swat valley, Khyber Pakhtunkhawa (KPK) province,
Pakistan. To establish the relationship of recent dengue infection in
current outbreak and potential risk factors, this matched case-control
study was conducted.
Methods & Materials: Patients presented with acute febrile illness of
two to seven days, myalgia, and headache to the Saidu Sharif Group of
Teaching Hospital, Swat and confirmed by laboratory diagnosis (NS1
rapid detection test) were approached to participate in the study. For
each case of DF, one hospital control was selected from the wards
other than infectious diseases and was negative for any clinical sign
of DF. Controls were matched with cases on the date of admission
to the hospital. Data about potential risk factors was collected on a
pre-structured questionnaire from the cases and controls in a face-toface interview. Conditional logistic regression was used to calculate
the strength of the association between the potential risk factors and
occurrence of DF.
Results: A total of 133 cases and 133 controls were included.
Significant associations were found between DF and travel to endemic
area (OR=15.73; 95% CI: 3.248-76.271), uncovered water container in
bathroom (OR=4.51; 95% CI: 1.598-12.736), stagnant water in drainage holes (OR=5.25; 95% CI 1.719-16.064), water supply (public or
private) (OR=5.63; 95% CI: 1.866-17.030), and family size (OR=2.80;
95% CI: 1.348-5.834). Monthly income (OR=0.07897, 95% CI: 0.0590.416) was found as protecting factor against dengue infection.
Conclusion: This study was conducted to find an association
between DF and potential risk factor in the current outbreak of DF in
Swat. There are several factors like travel to endemic area, uncovered
water container in bathroom, stagnant water in drainage holes, water
supply and family size that are significantly associated with outbreak
of dengue fever in district Swat, Khyber Pakhtunkhwa. By avoiding
or eliminates these risk factors, future outbreaks could be controlled.
Enhanced sanitary practices and awareness of masses could further
reduce the risk.
22.171 Differential serodiagnosis of tick-borne virus
encephalitis (TBE) and West Nile fever (WNF)
in the South of Russia
S. Vodyanitskaya, L. Ermakova, N. Pshenichnaya
Rostov State Medical University, Rostov-on-Don, Russian Federation
Purpose: Flaviviridae family is characterized by marked antigenic
cross-reactivity between its members. Blood samples of the population
of the South of Russia were screened for the presence of anti-TBE
virus IgG and anti-WNF virus IgG in ELISA. The positivity coefficient
(PK)вЂ”the ratio of optical density (OD) of serum tested to OD value of
negative controlвЂ”was used as a differentiation criterion.
Methods & Materials: Human antibodies to TBE were detected with
test-systems вЂњVectoVKE-IgGвЂќ (Novosibirsk), вЂњEIA-VKE-IgGвЂќ (вЂњEcolabвЂќ,
Moscow), вЂњDS-EIA-Anti-VKE-GвЂќ (Nizhny Novgorod). For the detection
of antibodies to WNF virus вЂњVectorNile-IgGвЂќ test-system was used
(Novosibirsk).
Results: Results obtained were classified into three groups. Group
I included blood sera which reacted only with homologous antigen to
WNF or TBE. Group II contained sera, cross-reacting with antigens of
вЂњVectorNile-IgGвЂќ and вЂњEIA-VKE-IgGвЂќ test-systems. Group III included
donor blood sera, reacting simultaneously with antigens of all three
manufacturersвЂ™ test-systems.
120
IMED 2014
In Group I antibodies to WNF were detected with вЂњVectorNile-IgGвЂќ
in 23 sera (38.3 %). The antibodies to TBE were detected with the
use of вЂњVectoVKE-IgGвЂќ in 10 sera (16.7 %). With the use of вЂњDS-EIAAnti-VKE-GвЂќ homologous results were obtained in 13 sera (21.7 %).
When comparing OD reactions it was found that with вЂњVectoVKE-IgGвЂќ
the OD index was 4.3 times higher than results, obtained with вЂњDS-EIAAnti-VKE-GвЂќ. Thus, we could consider reaction with diagnosticum
вЂњVectoVKE-IgGвЂќ positive.
Group II included blood sera simultaneously reacting with antigens
of вЂњVectorNile-IgGвЂќ and вЂњEIA-VKE-IgGвЂќ diagnosticums; specific density
of such sera constituted 16.7 %. Analysis of sera OD revealed that its
value ranged from 1.16 to 10.3. On this base 10 sera positively reacting with two antigens were classified as follows: seven were attributed
to sera with higher OD index to WNF, threeвЂ”to TBE, with OD values
exceed those to вЂњVectorNile-IgGвЂќ 1.2-1.9 times.
Group III was made of two blood sera which tested positive to all
three antigenic preparations used. The serum was attributed to WNF
by OD index.
Conclusion: The use of two proven diagnosticums for serodiagnosis
of TBE and WNF is advisable, because the use of only one test-system
could limit informational content of results by 40-60 %.
22.172 Toscana virus and Leishmania nucleic acids in
sandflies, Northern Cyprus
K. Ergunay1, O. Erisoz Kasap2, S. Orsten1, F. Gunay2, E. Dincer3,
K. Oter4, A. Ozkul5, B. Alten2
1
Hacettepe University Faculty of Medicine, Ankara, Turkey, 2Hacettepe
University, Faculty of Sciences, Ankara, Turkey, 3Mersin University,
Mersin, Turkey, 4Istanbul University, Faculty of Veterinary Medicine,
Istanbul, Turkey, 5Ankara University, Faculty of Veterinary Medicine,
Ankara, Turkey
Purpose: Phleboviruses and Leishmania parasites are causative
agents of two important neglected infectous diseases prevalent around
the Meditarranean area and constitute significant public health threats
to indigenous populations and travellers. Epidemiological association
of phleboviruses, including Toscana virus (TOSV), a phlebovirus with
neuroinvasive potential, with Leishmaniasis due to the common sandfly vectors has been recently described. This study was undertaken
to identify Phlebovirus and Leishmania activity in field-collected sandflies from the Turkish Republic of Northern Cyprus, a Leishmaniasis
endemic area with preliminary evidence for phlebovirus infections.
Methods & Materials: Sandfly sampling was carried out in localizations around Girne province in 2013. A total of 1484 specimens were
evaluated. In selected specimens (n:614), morphological identification
to species level was performed. Phlebovirus and Leishmania nucleic
acids were sought via nested Polymerase Chain Reaction (PCR)
assays in 870 samples distributed in 45 pools with subsequent characterization of the amplicons via sequencing. Pools with detectable
nucleic acids were further evaluated via DNA barcoding based on partial cytochrome oxidase sequences.
Results: Sandfly specimens belonging to 7 species were captured, where Phlebotomus perfiliewi sensu lato (n:536, 87.3%) and
P. tobbi (n:52, 8.5%) comprise the most abundant species, followed
by P. papatasi, Larroussius sp., P. jacusieli, Sergentomyia minuta and
Sergentomyia sp. In 2 (4.4%) and 3 (6.7%) pools, Leishmania and
Phlebovirus nucleic acids were detected. The Leishmania sp. were
characterized as L. infantum and phlebovirus strains were identified
as TOSV that grouped with genotype A strains, prevalent in several
Mediterranean countries and in Turkey. Leishmania and TOSV positive pools originated from the identical sampling localization. Barcoding
revealed Leishmania and TOSV positive pools to include P. tobbi and
P.perfiliewi s.l./P. tobbi sandflies, respectively.
Conclusion: These findings reveal the presence of TOSV in sandflies for the first time in Cyprus and suggest P.perfiliewi s.l./P. tobbi as
probable vectors. Leishmania and TOSV were detected in sandflies
collected from the same sampling site, confirming co-localization and
circulation of these agents.
Poster Presentations I
SATURDAY вЂў November 1, 2014
International Meeting on Emerging Diseases and Surveillance 2014
22.173 Seroprevalence and asymptomatic carriage
of Leishmania spp. in Austrian soldiers
returning from missions in the Lebanon,
Syria and Bosnia
A. G. Obwaller1, W. Poeppl2, A. Graf-Langheinz3, G. Mooseder4,
A. Faas4, J. Walochnik2
1
Federal Ministry of Defence and Sports, Vienna, Austria, 2Medical
University Vienna, Vienna, Austria, 3National Defence Academy,
Vienna, Austria, 4Military Hospital Vienna, Vienna, Austria
D. Goedhals1, J. Paweska2, F. Burt3
1
University of the Free State/National Health Laboratory Service,
Bloemfontein, South Africa, 2National Institute for Communicable
Diseases of the National Health Labolatory Service, SnadringhamJohannesburg, Gauteng, South Africa, 3UFS/NHLS, Bloemfontein,
South Africa
Purpose: Crimean-Congo haemorrhagic fever virus (CCHFV) is a
member of the Nairovirus genus of the Bunyaviridae family. This tickborne virus is associated with haemorrhagic fever in humans, with a
fatality rate of approximately 30%. The negative-stranded RNA genome
consists of three segments (S, M and L) coding for the nucleoprotein,
the envelope glycoproteins (GN and GC), and the viral polymerase
respectively. Although T lymphocyte responses are known to play a
role in protection from and clearance of many viral infections, specific
T cell epitopes have yet to be identified for CCHFV and immune correlates of protection have not been defined.
Methods & Materials: A panel of 156 overlapping peptides covering the CCHFV nucleoprotein and the structural glycoproteins, GN
and GC, were screened by Elispot assay to detect interferon gamma
R. Potiwat
Mahidol University, Bangkok, Thailand
Purpose: To differntiation of human bed bugs (Cimex hemipterus) and
bat bugs(Leptocimex inordinatus) from bat cave in Thailand.
Methods & Materials: We applied molecular markers to mitochondrial DNA (mtDNA) to clarify Leptocimex inordinatus (Hemipterus:
Cimicidae) from a bat cave in Thailand. Samples from individual
adult L. inordinatus were extracted for molecular identification, and
two genes, 16S rRNA and COI were used to evaluate each genetic
sequence according to the manufacturerвЂ™s protocol. This phylogenetic
tree was constructed by using the MEGA version 5.10 programs with
default parameters.
Results: Phylogenetic trees revealed that L. inordinatus are in a
separate genetic group to Cimex hemipterus, and also displayed the
closest relative bat bug species, Cacodmus vicinus. These results help
us to clarify the genetic lineage between tropical human bedbugs (C.
hemipterus) and bat bugs (L. inordinatus). The molecular identification
of L. inordinatus has never been reported.
Conclusion: Short mitochondrial gene COI fragments are commonly
used as the standard barcode region for insects and animals. However,
this mitochondrial gene sequence can be altered with the insertion of
bacteria that effect mtDNA, meaning species identification based on
mtDNA might not be possible for many insects (Whitworth et al, 2007).
Here, we used 16S rRNA of mtDNA to identify L. inordinatus. The
results showed positive results at 134 bp, but genetic sequences from
the database were rarely reported (data not shown). Finally, our study
suggests that the molecular genetic loci of COI and 16S rRNA can be
used to identify L. inordinatus. This study described the genetic information and potential molecular identification method for L. inordinatus
from Thailand.
November 1, 2014
Crimean-Congo haemorrhagic fever virus
and confirmation of long-lived memory
T cell responses
tropical human bed bugs and bat bugs:
Leptocimex inordinatus
вЂў
22.174 Identification of novel T cell epitopes on
22.175 Genetic marker tools for identifying
SATURDAY
Purpose: Leishmaniases are caused by the protozoan parasites of the
genus Leishmania, ranging from cutaneous lesions to visceral disease.
Especially, in the Eastern Mediterranean Region leishmaniases are a
major public health problem and occur in 14 of the 22 countries of the
region. Despite this, leishmaniases increase in conflict areas, where
sanitation and hygiene practices as well as medical prevention and
treatment were collapsed. Humanitarian assistance or peace-keeping
missions allow extensive contact with the local population and environment which increases the chance of getting into contact with endemic
infectious diseases.
Aim: To assess the risk factors and exposure to Leishmania spp.
in Austrian soldiers serving in UN or EU peace-keeping missions
inSyria,Lebanon and Bosnia-Herzegovina.
Methods & Materials: During an explorative cross-sectional serological study in June and July 2013, serum, EDTA whole blood samples
and epidemiological data were collected from 225 healthy soldiers.
Antibodies were tested using a commercial ELISA. All seropositive and
borderline subjects were then tested for the presence of Leishmania
DNA by PCR using the LITSR/L5.8 S primer pair and the respective
Leishmania species were identified by DNA sequencing.
Results: In total, 18 out of 225 individuals (8%) tested positive and
12 (5%) showed borderline results in the serological screening. Broken
down to the operation areas, the data showed an expected higher seroprevalence in soldiers returning from Syria (12% positive, 6% borderline) and Lebanon (7% positive, 5% borderline). Individuals returning
from Bosnia and Herzegovina showed a seroprevalence of 3%. Out
of the 12 seropositive/borderline samples from Syria tested by ELISA
10 were also positive by PCR. All PCR amplicons were identified as
belonging to the Leishmania donovani/infantum complex. Interestingly,
Leishmania DNA only detected in the samples from Syria.
Conclusion: The present study indicates that the risk of being
exposed to Leishmania spp. is highest inSyria and lowest inBosnia.
For a detailed risk assessment further investigation such as vector/
pathogen-monitoring, epidemiological studies in mission areas and
recurring cross-sectional studies, especially before and after missions,
should be performed.
(IFN-Оі) production in vitro by peripheral blood mononuclear cells from
ten subjects with previous CCHFV infection. Cell depletion studies
were performed to confirm whether the responses identified were
due to CD8+ or CD4+ T cells. Epitope conservation was evaluated by
comparing the amino acid residues to the sequences of geographically
distinct CCHFV isolates available on GenBank.
Results: Sixteen novel T cell epitopes were identified predominantly
on the nucleoprotein, with only a single subject reacting to two epitopes on the glycoprotein GC. No single epitope was immunodominant,
but all subjects showed reactivity to at least one T cell epitope. These
responses were present at high frequency and detectable several years
after the acute infection despite the absence of continued antigenic
stimulation, with the time since infection ranging from 10 months to 13
years. Depletion studies confirmed that IFN-Оі production was mediated
chiefly by CD8+ cytotoxic T cells. Amino acid sequence conservation
was high among southern African isolates, with a maximum of one
amino acid difference across each 19mer peptide.
Conclusion: The novel epitopic regions identified in this study represent the first such T cell epitopes to be described following natural
infection with CCHFV. These findings provide confirmation of long-lived
memory T cell responses in survivors which may aid vaccine development and evaluation of vaccine immunogenicity.
22.176 Potential Animal Reservoirs of Toscana Virus
and Co-infections with Leishmania infantum
E. Dincer1, S. Gargari2, A. Ozkul3, K. Ergunay4
1
Mersin University, Mersin, Turkey, 2Ankara University Faculty of
Veterinary Medicine, Ankara, Turkey, 3Ankara University, Faculty of
Veterinary Medicine, Ankara, Turkey, 4Hacettepe University Faculty of
Medicine, Ankara, Turkey
Purpose: Toscana virus (TOSV), a sandfly-borne phlebovirus, is an
important agent of human meningoencephalitis in the Mediterranean
region. Mechanisms of TOSV maintenance in times when the vector
sandflies are inactive and the impact of potential animal reservoirs
121
IMED 2014
Poster Presentations I
SATURDAY вЂў November 1, 2014
SATURDAY
вЂў
November 1, 2014
International Meeting on Emerging Diseases and Surveillance 2014
are not thoroughly elucidated. Leishmaniasis is another sandfly-borne
disease, endemic in several countries and has been continously
reported in the Mediterranean region. Preliminary reports revealed that
these agents were epidemiologically-related. This study investigates
TOSV and Leishmania infections in dogs, cats, sheep and goats fromAdana andMersin provinces in southeasternTurkey, an Leishmaniasis
endemic region.
Methods & Materials: The study was conducted in districts of Mersin
and Adana provinces, southern Anatolia, during May-September
2013. TOSV and Leishmania nucleic acids were sought via nested
Polymerase Chain Reaction (PCR) assays, with subsequent sequencing of the amplicons.
Results: Among 252 samples, TOSV RNA was detected in a total
of 25 samples (9.9%), that comprise 24 dogs (9.5%) and a cat (0.4%).
Partial sequences characterized in positive samples demonstrated
TOSV genotype A and B strains. No association of TOSV detection or
virus genotype with animal age, gender, location or collection date was
noted. Leishmania DNA was investigated in 155 canine and 22 feline
samples where Leishmania infanfum was identified in 2 canine (1.3%)
and 1 feline (4.5%) plasma. The infected dogs were presenting with
symptoms of canine leishmaniasis and concominant TOSV genotype
B RNA in plasma. All other animals with detectable TOSV RNA were
asymptomatic.
Conclusion: Canine species can be suggested as the potential reservoir hosts of TOSV. Presence of TOSV genotype B and co-circulation
of genotypes A and B have been described for the first time in southern Anatolia. TOSV genotype B and L. infantum co-infections were
documented.
22.177 Detection of West Nile Virus from mosquito
Culex pipiens (fam: Culicidae) in Belgrade,
Serbia 2012вЂ“2013
M. DjordjeviД‡1, N. P. Stajkovic2, B. PeЕЎiД‡3
1
Faculty of Veterinary Medicine, Belgrade, Serbia, 2MIlitary Medical
Academy, Belgrade, Serbia, 3Institute for Biocides and Medical
Ecology, Belgrade, Serbia
Purpose: West Nile virus (WNV) is a zoonotic, vector-borne virus
within the genus Flavivirus, family Flaviviridae. West Nile natural cycle
involves birds and mosquitoes. Many species of wild birds might act as
vertebrate amplifying hosts, whereas humans, horses and other mammals are considered incidental or dead-end hosts.
Methods & Materials: Following the evidence of WNV circulation
in humans in the summer 2012, mosquito traps (BG SentinelВ®) were
located in 30 different sites in the territory of Belgrade. The collection
sites were characterized by the contemporaneous presence of wild
birds, potential reservoirs of the virus, and an increased population of
the competent vector Cx. pipiens.
Results: One hundred fifty samples were collected and 20 female
mosquitoes were identified as Cx. Pipiens. Samples were tested in
the Veterinary Specialized Institute-Kraljevo, Serbia. The RT-PCR
technique identified 10 positive samples (6.66%). and sequencing classified the WNV circulating strain as Lineage 2. From June to
September 2013 the circulation of WNV in mosquitoes in the Belgrade
area was investigated as previously described. A total of 259 samples
were analyzed by RAMP WNV test and WNV genome was detected in
45samples(17.37%). The number of positive samples varied from one
in June to 12 in September with a peak in July (15) and August (17)
In order to confirm the results of the RAMP test and to determinate
the Lineage of the virus, the samples were sent to the OIE reference
laboratory for West Nile Fever, in Teramo, Italy.
Conclusion: RAMP WNV test provides rapid and reliable results for
use in detection of West Nile Virus from mosquitoes.
122
IMED 2014
22.178 Changing pattern of DENV serotypes
in Vietnam
N. T. T. Thuy1, F. Hasebe2, K. Morira3
1
National Institute of Hygiene and epidemiology, Ha noi, HN, Viet
Nam, 2Institute of Tropical Medicine., Nagasaki, Japan, 3Institute of
Tropical Medicine., Nagasaki, Viet Nam
Purpose: Large outbreak of dengue virus infection occurred in Vietnam
at intervals of 10 years. In this study, a total of 444 and 896 blood specimens were collected in 2012 and 2013, Vietnam.
Methods & Materials: RNA extraction: Total RNA was extracted from
blood samples using QIAGEN kits. RNA was then amplified via RT-PCR
using degenerate primers and sequenced. Phylogenetic analysis
was conducted using ClustalX.
Results: Serotyped DENV from blood samples in 2012, DENV-1, -2,
-3 and -4 were 29.8%, 44.7%, 9.3% and 16%, respectively. Comparing
2012 and 2013 serotyped samples, an increase from 9.3% to 25.6% in
DENV-3 and from 16.1% to 37.2% in DENV-4 was observed. Number
of DENV-3 case-patients in the Northern increased to 67.3% and
of DENV-4 case- patients in the Central to 41.9% in 2013. Among
genotype I of DENV-1 circulating in Vietnam, different sub-clusters of
viruses have been shifted and some sub-clusters exist for long period.
Genotype shift was occurred within DENV-2 in Vietnam, with Asian 1
lineage viruses entirely displacing the Asian/American lineage viruses
between 2004 and 2006. All Vietnamese DENV-3 isolates were fell
into the genotype II and formed a distinct cluster. One isolate in Hanoi
in 2012 was belong to another subtype of genotype I which was not
reported in Vietnam. Vietnamese DENV-4 isolates formed a distinct
cluster and this cluster was observed to group together with isolates
from other countries, except for some strains isolated in 2010 and
2011, in Vietnam.
Conclusion: Huge dengue outbreak have been reported in the
Central provinces of Vietnam in 2013. DENV-4 was first detected in
Vietnam in 1984 but with a low incidence and this was followed by a
long period where this serotype could not be detected. Then, it became
the predominant serotype in the outbreaks from late 1999 to 2002
but later became rare because DENV-1&2 predominated. It seems a
changing pattern is emerging recently with DENV-3 and -4 becoming
the predominant serotypes.
22.179 Risk mapping of West Nile virus transmission
to humans in Spain
A. SГЎnchez GГіmez1, M. J. Sierra1, M. Martinez-Aviles2,
E. Fernandez-Carrion2, J. M. Sanchez-Vizcaino2, S. Santos1,
C. Amela1
1
Spanish Ministry of Health, Social Services and Equity, Madrid,
Spain, 2University Complutense of Madrid, Madrid, Spain
Background: West Nile Virus (WNV) infection is an emergent disease
in Europe. Since 2010, areas with confirmed human cases have further
spread and the number of cases has increased markedly. In Spain, two
cases of human WNV disease were confirmed in 2010 in Andalusia
(southern Spain). In the same area, outbreaks in horses have been
detected since 2010 to 2013.
Objective: To assess the risk of WNV transmission to humans in
Spain, categorizing risk areas, in order to set up recommendations for
risk-based surveillance and early detection of potential viral circulation.
Methods & Materials: Risk maps for WNV transmission to humans
were obtained. Predisposed areas (where existing conditions might
facilitate the transmission), imperilled areas (where transmission to
animals or humans has been previously detected) and areas not at
risk were identified following the risk assessment tool recently proposed (July 2013) by the European Center of Disease Prevention and
Control. Predisposing conditions were defined based on environmental
and climatic variables as well as avian and human host presence and
combined using a multi criteria decision analysis model based in GIS.
Results: Imperilled areas were located mainly in Andalusia (near
Guadalquivir marshes and adjoining wetlands) but also in some areas
of central (Castilla La Mancha) and northeastern Spain (CataluГ±a).
Poster Presentations I
SATURDAY вЂў November 1, 2014
International Meeting on Emerging Diseases and Surveillance 2014
Predisposed areas were widely distributed, as propitious climatic and
ecologic conditions, such as long periods of high temperatures and
abundance of wetlands, habitat of avian hosts including migratory birds
from endemic areas, are present in Spain.
Conclusion: This study highlights the vulnerability of Spain to WNV
transmission and contributes to identify areas at higher risk. Reinforcing
animal and human WNV surveillance, within a multisectoral and collaborative approach, is needed for an appropriate response to WNV
in Spain.
22.180 First molecular detection of human relapsing
fever spirochete Borrelia miyamotoi in Ixodes
ricinus from Portugal
M. Nunes, N. Lopes, T. Carreira, C. Maia, A. P. G. Almeida,
M. L. Veira
Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa
(IHMT,UNL), Lisbon, Portugal
Purpose: Mosquito-borne viruses (MBV) represent a considerable
healthcare problem worldwide, causing numerous infections both in
humans and animals. MBVs belong to a variety of virus families; most
prominent members of MBVs are those within the Flaviviridae (eg.
West Nile virus, Dengue virus, Usutu virus), Bunyaviridae (eg. Tahyna
virus), and Togaviridae (eg. Sindbis virus). In many parts of Europe,
the greatest medical and veterinary burden is attributed to flaviviruses,
November 1, 2014
mosquito Uranotaenia unguiculata
G. Kemenesi1, M. Oldal1, A. Kutas1, B. Dallos1, F. FГ¶ldes1,
V. NГ©meth1, P. Reiter2, T. Bakonyi3, K. BГЎnyai4, F. Jakab1
1
University of PГ©cs, PГ©cs, Hungary, 2Institute Pasteur, Paris, France,
3
Faculty of Veterinary Science, Szent IstvГЎn University, Budapest,
Hungary, 4Veterinary Medical Research Institute, Budapest, Hungary
Germany 2001вЂ“2013
C. Wagner-Wiening1, G. Pfaff2, I. Boone3
1
European Centre for Disease Prevention and Control (ECDC),
Stockholm, Sweden, 2Baden-Wuerttemberg State Health Office,
Stuttgart, Germany, 3Bundesinstitut fГјr Risikobewertung, Berlin,
Germany
вЂў
22.181 Putative new lineage of West Nile virus in the
22.182 Epidemiology of Tularaemia in South West
SATURDAY
Purpose: Human pathogenic Borrelia species can be divided in two
groups: Lyme Borreliosis (LB) group which agents are widely spread
through Europe and North America and are transmitted by hard ticks;
the relapsing fever (RF) spirochetes, mainly transmitted by soft ticks.
Borrelia miyamotoi belongs to RF group, although it can also be
transmitted by Ixodes species of LB, such as Ixodes scapularis, I.
persulcatus and I. ricinus. B. miyamotoi was first isolated from vector
in Japan (1995), and the first human cases were reported in Russia
(2011), and more recently, in USA and Netherlands. In Europe, LB is
the most common tick-borne disease, caused by spirochetes belonging
to Borrelia burgdorferi sensu lato complex (B.b.s.l). In Portugal several
studies have confirmed LB spirochetes circulation in tick and human
populations.
Objective: collect and identify ticks from vegetation, at Tapada
Nacional de Mafra, (TNM, Portugal); determine B.b.s.l. infection rate in
captured ticks, contributing to update tickвЂ™s fauna and LB epidemiology.
Methods & Materials: Between May 2012 and May 2014, ticks were
captured and identified taxonomically. Two different nested-PCR protocols, targeting ITS region between 5S and 23S rRNA and flagellin
genes were used for B.b.s.l.DNA detection. LB species were identified
by RFLP and sequencing.
Results: 2,999 ticks were collected from vegetation belonging to
Ixodes, Rhipicephalus, Haemaphysalis, Hyalomma and Dermacentor
species, being I. ricinus the most prevalent. 35 out of 731 ticks (4.8%)
showed B.b.s.l DNA and Borrelia garinii was the most prevalent species. B. miyamotoi was detected in one I. ricinus nymph, and sequencing showed that the genotype is close to those found in other countries
(Poland, Russia,Switzerland).
Conclusion: B.b.s.l. DNA was found in I. ricinus, being nymphs the
most infected stage. The genotype of B. miyamotoi circulating in TNM is
closed to those already described in vectors, animal and human hosts.
This result suggests that even though no human cases have been so
far reported in Portugal, more studies should be done. Moreover itвЂ™s
possible that ticks could carry both B miyamotoi and LB spirochetes,
increasing human co-infection risk.
and particularly West Nile virus (WNV). WNV has been subdivided into
at least eight distinct lineages (WNV-1 to WNV-8): WNV-1 and WNV-2
strains have been identified most frequently in human and animal diseases, while strains within WNV-3 to WNV-8 have been detected sporadically during MBV surveillance in parts of Europe, Asia, and Africa.
We report the description of a novel putative lineage of WNV (WNV-9)
which was identified during a 3-year surveillance of MBVs conducted
in Southwest Hungary.
Methods & Materials: A total of 23,029 female mosquitoes captured
in a range of habitats in Hungary were tested for flaviviruses and
orthobunyaviruses. WNV was detected in a single pool of Uranotaenia
unguiculata. Sequence- and phylogenetic analyses for two different
regions (NS5 and E) of the viral genome indicated the virus was different from other previously described WNV lineages.
Results: In the phylogenetic tree, the Hungarian WNV sequence
clustered with other WNV strains, but unambiguously formed a separate monophyletic branch. The NS5 gene-based analyses showed that
the Hungarian novel WNV strain shared the greatest similarity with
representatives of WNV-4 (up to 82%, phylogenetic distance: 0.413)
and the putative lineage 8 strain (83%, phylogenetic distance: 0.360),
originating from Russia and Spain, respectively. Similarly, the E genebased analyses indicated that the novel Hungarian WNV strain was
different from the WNV strain that derived from the same mosquito species in Volgograd, Russia, which rather clustered together with WNV-4.
Conclusion: These findings may indicate the presence of a novel
lineage of WNV (WNV-9) in Europe.
Purpose: Tularaemia is a rare zoonosis endemic inSouthwest
Germany. We described cases notified in the federal state of BadenWuerttemberg during 2001вЂ“2013 in order to guide physiciansвЂ™ practice towards an increased awareness of tularaemia especially among
patients reporting tick bites.
Methods & Materials: We defined cases as persons reported to the
mandatory surveillance with clinical illness and detection of IgM and IgG
specific antibodies against Francisella tularensis. We described cases
by age, sex, symptoms, suspected route of transmission, pathogen,
lag between day of onset and laboratory diagnosis, and geographical
distribution.
Results: Since 2001, forty-five cases (median age 52, range 1вЂ“86
years; 33 males) of human tularaemia were notified; two had reported
travel history. Nineteen of 44 districts notified cases. The average
annual number of tularaemia cases increased from two (2001-2007)
up to six (2008вЂ“2013). Suspected vectors were hares, 10 cases (22%),
ticks, 8 cases (18%) and mosquitoes, 3 cases (7%). In 24 (53%) cases,
the source was unknown. Most cases showed ulceroglandular (41%)
or glandular (15%) lesions; 27 (60%) were hospitalized. Lags between
disease onset and diagnosis varied from seven days to three months.
In six cases (13%), Francisella tularensis subsp. holarctica was identified as the causative agent by culture or PCR.
Conclusion: Long lags between disease onset and diagnosis indicate a delay in the identification of Francisella tularensis as causal
pathogen. An increase in tickborne tularaemia indicates that ticks may
play an important role in the pathogen transmission. Tularaemia should
be included in the differential diagnosis among patients with fever and
ulcerative lymphadenopathy, notably after tick bite exposure.
123
IMED 2014
Poster Presentations I
SATURDAY вЂў November 1, 2014
International Meeting on Emerging Diseases and Surveillance 2014
22.183 Dengue in India: An epidemiological
perspective
SATURDAY
вЂў
November 1, 2014
K. Baruah1, P. K. Sen1, A. Dhariwal2
1
National Vector Borne Disease Control Programme, Delhi, Outside
U.S. & Canada, India, 2National Vector Borne Disease Control
Program, Dehli, India
Purpose: Dengue is the most rapidly spreading mosquito borne
viral disease with 30 fold increase in global incidence over the last
five decades. Almost half the worldвЂ™s population lives in countries
where Dengue is endemic. About 50вЂ“100 million new Dengue infections are occurring annually in more than 100 endemic countries.
Approximately 1.8 billion (> 70 %) of population at risk for Dengue
worldwide live in SEAR and WPR bearing 75 % of the global
Dengue burden. India contributes 19% of SEAR dengue burden.
Methods & Materials: A National Strategy with eight elements is implemented in the country for prevention and control of Dengue. Diagostic
facilities and proactive surveiallnce through a network of laboratories
across the country.
Results: In India dengue virus was first isolated in Calcutta in 1945,
first evidence of dengue fever documented from Vellore district, Tamil
Nadu 1956 and DHF from Calcutta in 1963. During last two decades
the disease is spreading to newer geographical areas including rural
areas with recurring outbreaks from various States. In 2012, total
50,222 cases reported, which increased to 75,808 in 2013, the highest
since 1991. The actual figure may be much higher as all private sector
hospitals are not reporting. All age of both the genders are affected.
Though cases are increasing case fatality ratio has declined from 3.3%
in 1996 to 0.3% in 2013 after the National Guidelines were developed
in 2007. All 4 serotypes are in circulation. Aedes aegypti is the principal vector, but Ae. albopictus, has posed serious threats in certain
geographical regions endowed with sylvatic environment leading to
perennial transmission. Breeding habitats of both the vectors varies in
different parts of the country. Seasonal trend of the disease is changing
and the transmission window is expanding in recent years.
Conclusion: Based on transmission potential at macro and micro
levels, WHO SEARO grouped India as Category A Countries in 2010
where Dengue is a major public health problem. Average economic
burden of dengue in India was estimated at US$29.3million. However,
in absence of any drug or vaccine, increasing morbidity with varying
clinical spectrum dengue has emerged as a serious public health challenge in India.
22.184 Culex pipiens and Culex torrentium mosquitoes
from Germany have vector competence for
West Nile virus
M. Leggewie1, M. Badusche1, M. Rudolf1, S. Jansen1, J. BГ¶rstler2,
K. Huber1, A. KrГјger3, J. Schmidt-Chanasit2, E. Tannich1, S. C. Becker4
1
Bernhard-Nocht-Institute For Tropical Medicine, Hamburg, Germany,
2
Bernhard Nocht Institute for Tropical Medicine, Hamburg, Germany,
3
Bundeswehr Hospital Hamburg, Hamburg, Germany, 4FriedrichLoeffler-Institute, Federal Research Institute for Animal Health,
Greifswald-Insel Riems, Germany
Purpose: West Nile virus (WNV), a flavivirus with an avian primary
host, can pose an infection risk to Germany since millions of birds
migrate every year between West Nile endemic areas in south and
southeast Europe to Germany. If competent vectors are present, introduction of WNV could establish an enzootic transmission cycle within
the resident bird population in Germany. Furthermore, potential bridge
vectors i.e mosquitoes that use both birds and mammals for blood
meals, might induce epidemic WNV outbreaks in human and equine
populations.Therefore, we analysed the ability of WNV circulation
through German Culex mosquitoes with special emphasis on Culex
torrentium and the separation of Culex pipiens sibling species with different host preferences.
Methods & Materials: Egg rafts of Culex species collected over
two subsequent seasons at geographically distinct sampling areas in
124
IMED 2014
Germany were differentiated by molecular methods. Adult females,
reared from the various egg rafts, were challenged with WNV by feeding of artificial blood meals. WNV infection status was subsequently
analysed using a WNV specific qRT-PCR.
Results: All of the tested Culex species and biotypes, most abundant and native to Germany, are susceptible to WNV infection at 25В°C
incubation temperature, with infection rates between 25,0 and 90,1%.
The two ornithophilic species Culex pipiens biotype pipiens and Culex
torrentium also promoted WNV infection at 18В°C with infection rates
similar to those at 25В°C (35,0-85,0% at 18В°C), whereas the mamalophilic species Culex pipiens biotype molestus did not support replication of WNV at low temperatures. Culex torrentium mosquitoes, which
have not been established as WNV vector so far, were most efficient
in amplifying WNV with maximum infection rates of 90,1% at 25В°C.
Furthermore, 84,5 to 97,8% of infected Culex pipiens biotype pipiens
and Culex. torrentium mosquitoes had disseminating infections at 18
as well as 25В°C.
Conclusion: These findings indicate that a WNV enzootic infection cycle in Germany is possible. However, transmission of WNV to
humans by Culex pipiens biotype molestus appears rather unlikely,
since prolonged periods with temperatures of 25В°C required for WNV
replication in this mamalophilic species, are rarely being reached in
Germany.
22.185 ArrГЎbida virus: First isolation of a phlebovirus
in sandflies in Portugal
F. Amaro, L. ZГ©-ZГ©, M.-J. Alves
National Institute of Health Dr. Ricardo Jorge, ГЃguas de Moura,
Portugal
Purpose: Viruses within the genus Phlebovirus (Bunyaviridae family) are widely spread and emerging, particularly in the Mediterranean
Basin. In this region Toscana virus is the most important sandfly-borne
phlebovirus in what concerns to human health due to its neurotropism
and consequent ability to cause central nervous system disease. Other
recently described viruses are also being implicated in human disease
such as Adria, Cyprus and Turkey viruses. On the other hand, Massilia,
Punique and Granada are examples of newly found phleboviruses for
which medical importance is yet to be determined.
The main goal of this work was to conduct a field study to assess
sandflies as possible phlebovirusesвЂ™ vectors in ArrГЎbida region, in
south Portugal.
Methods & Materials: Sandflies were collected with modified CDC
light-traps from May to October 2007 and 2008 and pooled according to
collection station, date of collection and gender. Pools were screened
by RT-PCR for the presence of viral RNA and isolation attempts were
made.
Results: A novel putative virus was isolated in a pool of 53 P. perniciosus female sandflies. RT-PCR results showed amplification products
of 391 bp for the nucleocapsid protein, an amplicon of 456 bp for the G2
glycoprotein and an amplicon of 284 bp, for the RNA-dependent RNA
polymerase. This virus was provisionally named ArrГЎbida virus. Based
on the analyzed genomic sequences, ArrГЎbida virus is undoubtedly
assigned to the Sandfly fever Naples virus species complex. Genetic
analysis showed that the virus sequences present higher similarity with
Massilia and Granada viruses nucleotide sequences. However, in G2
glycoprotein tree ArrГЎbida virus clusters closer to Punique virus than to
Massilia or Granada viruses at amino acid level.
Conclusion: This is the first description of a phlebovirus isolation in
sandflies in Portugal. Therefore, in addition to Toscana virus previously reported, there is, at least, one more sandfly-borne phlebovirus
occurring in this country. Full genome sequencing is ongoing and
further studies are planned to clarify the human health impact of
ArrГЎbida virus.
This work was partly supported by the PTDC/SAU-SAP/119199/2010
FCT project.
Poster Presentations I
SATURDAY вЂў November 1, 2014
International Meeting on Emerging Diseases and Surveillance 2014
22.186 Epidemiologic characteristics of severe fever
with thrombocytopenia syndrome in South
Korea, 2013
J. Shin1, J. Kim1, Y.-S. Park2, D. Kwon1, G.-R. Bae1
Korean Centers for Disease Control and prevention, Cheongju,
Korea, Republic of, 2Korea Centers for Disease Control and
prevention, Cheongju, Korea, Republic of
1
Purpose: The presence of major arbovirus mosquito vector species,
several potential animal reservoirs and a particularly favorable climate
for vector-borne diseases, represents a significant health risk for the
human and equine populations of Mallorca Island. For these reasons,
microbiological monitoring of circulating arboviruses, particularly flaviviruses and alphaviruses causing equine and human encephalitis,
was initiated. In this context, domestic horse populations from different
localities placed near wetlands were used as вЂњsentinelвЂќ hosts.
Methods & Materials: Serum samples were collected from 235
horses between 2011 and 2012, and paired samples were taken from
several horses during the study period to highlight seroconversion
events reflecting recent arboviral infections. An in-house multiplex
immune-assay (MIA) was used to screen equine sera for specific
immunoglobulin G (IgG) antibodies against 3 major arboviruses: WestNile virus (WNV), Usutu virus (USUV) and Tick-borne encephalitis
virus (TBEV). Results were confirmed using gold standard serological
assays.
I. Rudolf1, T. Bakonyi2, O. Sebesta1, J. Mendel1, L. Betasova1,
H. Blazejova1, K. Venclikova1, P. Strakova1, N. Nowotny3, Z. Hubalek1
1
Institute of Vertebrate Biology v.v.i, Academy of Sciences of the
Czech Republic, Brno, Czech Republic, 2Faculty of Veterinary
Science, Szent IstvГЎn University, Budapest, Hungary, 3University of
Veterinary Medicine, Vienna, Austria
Purpose: Because of the rapidly changing epidemiological situation
regarding West Nile fever (WNF) in Europe, we decided to perform
virological surveillance of mosquitoes for West Nile virus (WNV) to
investigate the epidemiological relevance of WNF in our country.
Methods & Materials: Mosquitoes were collected within reed belts of
South-Moravian fishponds during July and August 2013 with the help
of CDC minilight-CO2 baited traps, identified, and monospecific pools
consisting of 50 Cx. modestus females were processed for molecular
analysis and virus isolation. Generic primers targeting the NS5 region
of flaviviruses were used for screening purposes. In case of positive
samples, WNV-specific primers were applied in continuous RT-PCR
for amplification of overlapping genome regions which cover the entire
genome sequences of the detected viruses. Amplification products
were subjected to direct sequencing and the sequences were aligned,
compiled, and identified by BLAST search against the GenBank database. The original mosquito homogenates of PCR positive samples
were inoculated intracerebrally into suckling mice.
Results: A total of 32,500 females of Cx. modestus mosquitoes in
650 pools were examined for flaviviruses by RT-PCR. RNA of WNV-2
was detected in four pools:13-104 (collected at NovГЅ fishpond on 8
August 2013); 13-329 (coll. at Nesyt fishpond on 23 August 2013);
13-479 (coll. at MlГЅnskГЅ fishpond on 15 August 2013); and 13-502 (coll.
at MlГЅnskГЅ fishpond on 1 August 2013); minimum prevalence rate of
WNV is therefore 1:8,125 (0.012%). Three of these pools killed specifically suckling mice after inoculation. Phylogenetic analysis based
on full genome sequences demonstrated that the Czech WNV strains
form two, closely related groups and they are clustered together with
an Austrian WNV strain (goshawk; 2008), a Serbian WNV strain (Cx.
pipiens; 2012) and an Italian WNV strain (human, 2011), while they
differ partially from other European WNV-2 strains compared.
Conclusion: Discovery of neuroinvasive WNV-2 in the Czech
Republic has added another country to the list of WNV risk areas in
Europe. This record presents the currently northernmost range of
WNV-2 in Europe and highlights the need for epidemiological surveillance of (re-)emerging mosquito-borne viruses in Central Europe.
November 1, 2014
populations of Mallorca island
J. Vanhomwegen1, J.-C. Manuguerra1, C. Beck2, R. G. GarcГa3,
A. Figuerola3, S. Lecollinet2, M. LГіpez-Roig4, C. Rousseaux1,
J. Serra-Cobo4
1
Institut Pasteur, Paris, France, 2European Reference Laboratory
for equine diseases, Maisons-Alfort, France, 3ColВ·legi Oficial de
Veterinaris de les Illes Balears, Palma de Mallorca, Spain, 4Universitat
de Barcelona, Barcelona, Spain
modestus mosquitoes in the Czech Republic,
2013: expansion of the European West Nile
virus endemic area to the North?
вЂў
22.187 Circulation of zoonotic arboviruses in equine
22.188 West Nile virus lineage 2 isolated from Culex
SATURDAY
Purpose: Severe fever with thrombocytopenia syndrome (SFTS)
caused by novel bunyavirus, SFTS virus (SFTSV), is an emerging vector-borne infectious disease. The disease was first identified
in China, 2009. Based on the nationwide distribution of the vector,
Haemophysalis longicornis, it has been suggested that SFTS can be
occurred in South Korea. We conducted epidemiological investigations
to determine the extent of SFTS and to find out epidemiological and
clinical features of SFTS in South Korea.
Methods & Materials: Korea Centers for Disease Control and
Prevention have begun national surveillance since March 2013.
Isolation of SFTSV from the patientвЂ™s serum and the detection of
SFTSV RNA with polymerase chain reaction were performed to confirm the human infection of SFTS. Epidemiological investigations were
conducted in all confirmed cases.
Results: The diagnosis of SFTS was confirmed in 35 patients and 16
patients (45.7%) were dead in 2013. The 35 patients consisted of 17
males and 18 females with ages ranging from 28 to 84 and median age
of 69 years. Twenty-eight patients (80.0%) were over 60-year-old. Fatal
groups were statistically older than non-fatal group (p value <0.05)
Geographically patients were uniformly distributed, except 6 patients
(17.1%) in Jeju Province. Twenty patients (60.6%) were farmers living
in rural areas. Main symptoms were fever (100.0%), diarrhea (62.9%),
vomiting (42.9%), and the common abnormal results of laboratory
tests were thrombocytopenia (100%) and leukocytopenia (88.9%).
Neurologic symptoms occurred in 27 patients (80.0%) and were associated with fatality (p value <0.05)
Conclusion: We confirmed and described characteristics of SFTS
cases in Korea. Old population in rural area with field works is high
risk group and requires precautions and changes of working habits. In
the Asia-Pacific nations reported with H. longicornis, active surveillance
system should be implemented to detect SFTS cases.
Results: The overall IgG antibodies seroprevalence in the surveyed
horse population was 8.5 % for WNV, 1.3 % for USUV and 0.9 % for
TBEV. Two seroconversion events were detected between the spring
of 2011 and the fall of 2012 for WNV and for USUV, respectively. The
southern region was significantly associated with a higher prevalence
of IgG antibodies against WNV.
Conclusion: These observations highlight the active transmission
of zoonotic arboviruses in Mallorca, particularly in the southern wetlands and salt marshes which (i) host a wide variety of waterfowl, (ii)
are favorable to mosquito breeding and (iii) serve as a drop point for
migratory birds. These findings reinforce the urgent need to conduct
complementary studies, including serosurveys of the human population to identify risk groups and screening of collected mosquitoes to
describe circulating arboviral strains.
125
IMED 2014
Poster Presentations I
SATURDAY вЂў November 1, 2014
International Meeting on Emerging Diseases and Surveillance 2014
22.189 What is the role of asymptomatic carriers in
transmission of gambiense human African
trypanosomiasis? Mathematical model of
data from North West Uganda
SATURDAY
вЂў
November 1, 2014
R. Oettle, F. Checchi, J. Edmunds
London School of Hygiene and Tropical Medicine, London, United
Kingdom
Background: Studies from West Africa have reported self-resolving
first stage infection and chronic, non-pathogenic carriage of gambiense
human African trypanosomiasis (HAT) (Sternberg, 2010; Checchi et al.,
2008). Chronic carriers may constitute an important reservoir of infection and thus contribute to transmission maintenance even in foci with
intensive control.
Objectives: The objective of the study was to examine the role of
chronic carriers of HAT in seeding ongoing disease transmission in
North West Uganda and suggest priorities for control programmes and
diagnosis in the drive towards elimination.
Methods & Materials: A mathematical model incorporating an
explicit chronic carriage compartment was fitted to time series data
observed during a HAT intervention programme in 26 villages in North
West Uganda, between 1995-2002 (data taken from a HAT control
project implemented by MГ©decins Sans FrontiГЁres and the Ugandan
National Sleeping Sickness Control Programme). A total of 67071 individuals were screened, 237 of which had either stage 1 or 2 infection.
The model was run under varying assumptions of the fraction of infections that are chronic and of their detectability. The model-predicted
prevalence was fitted to the observed prevalence data. The best-fitting
parameter assumptions were adopted as the most plausible estimates.
Results: Results indicated that chronic carriage of HAT represented
between 0вЂ“10% of all infections in the time series analysed. Force of
infection estimates were relatively consistent across varying parameter
combinations. The model was inconclusive with regard to the ease with
which chronic cases can be detected.
Conclusion: Chronic carriage of gambiense HAT is unlikely to contribute significantly to the reservoir of infection, but may play some
role in maintaining transmission. This study demonstrates considerable inter-village variation in infection dynamics, highlighting the need
for targeted control programmes. Further investigation into chronic
infection and its detectability is needed to predicate future control programmes aiming for long-term control or elimination.
References: Checchi F. et al.. The natural progrssion of Gambiense
sleeping sickness: what is the evidence? PLoS Neglected Tropical
Diseases. 2008;2(12):e303. Sternberg, J.M. et al. (2010) A spectrum of
disease in Human trypanosomiasis: the host and parasite genetics of
virulence. Parasitology. 137, 2007вЂ“2015.
22.190 Pathogenetic markers of severity in DF/DHF
A. Biswas1, P. Sohal2, K. Baruah3, S. Sharma2, N. Wig1, P. Aggarwal1
All India Institute of Medical Sciences, New Delhi, Delhi, India,
2
AIIMS, New Delhi, India, 3 National Vector Borne Disease Control
Programme, New Delhi, India
1
Purpose: Dengue epidemic has become a serious emerging infectious diseases and a major public health problem in India. Some of
the Dengue Fever patients present with mild symptoms and some
present with severe manifestations such as Dengue Haemorrahgic
Fever (DHF), Dengue Shock Syndrome (DSS) and involvement of vital
organs responsible for high morbidity and mortality. Exact pathogenetic
mechanism of severity is still not clearly understood. It is hypothesized
that high level of serum TNF-alpha, IL-6 and soluble Thrombomodulin
are associated with severe Dengue Fever, bleeding and shock.
126
IMED 2014
Methods & Materials: It was a prospective observational case control study conducted at tertiary care hospital. All cases with either +ve
for IgM or NS1 were enrolled for the study. Patients with shock were
enrolled as cases and patients without shock were enrolled as control. We estimated serum TNF-alpha, IL-6 and sTM among shock and
non-shock patients at the time of 1st visit and followed up till death,
discharge or 14 days.
Results: Thirty Dengue patients with shock were enrolled as cases
and 50 patients without shock were enrolled as control. Mean value of
sTM was 15.8В±6.4 ng/ml among shock and 6.4В±4.4 ng/ml among nonshock and their difference was highly statistically significant (p<0.001).
About 21 cases (70%) from shock and 3 cases (6%) from noshock
were found to have high sTM level (>15 ng/ml) and their association
was also found to have statistically significant (<0.001). About 12 cases
(39.9%) from shock and 10 cases (20%) from non-shock were found
to have elevated TNF-alpha (>100 pg/ml). About 11 cases (37.7%)
from shock and 15 cases (30%) from non-shock were found to have
elevated IL-6 (>100 pg/ml). However serum level of TNF-alpha and
IL-6 were not found to be significant.We found 22% incidence (11) of
shock among Dengue Fever and found to have significant rise of sTM
(13В±4.67) and IL-6 (136В±76.4) at the time of 1st visit and they all had
normal blood pressure but subsequently developed shock.
Conclusion: In our study we foundhigh serum soluble
Thrombomoduline level (sTM) and IL-6 were both predictor and risk
factor for the development of severe Dengue Fever and shock.
22.191 Imported and autochthonous dengue in
PortugalвЂ”Three unusual years of experience
at the National Institute of Health
L. ZГ©-ZГ©, F. Amaro, H. C. OsГіrio, M. J. Alves
National Institute of Health Dr. Ricardo Jorge, ГЃguas de Moura,
Portugal
Purpose: Dengue virus (genus Flavivirus) is the etiological agent of
dengue fever, a mosquito-borne infection endemic in tropics and subtropics. Four distinct serotypes (DEN-1-4) are recognized. Infection
with Dengue causes a wide spectrum of human disease, from asymptomatic cases to classic dengue fever and more severe life threatening cases. Since 1991 the diagnostic of arboviral diseases, including
Dengue virus, is performed at the Centre for Vectors and Infectious
Disease Research/National Institute of Health (CEVDI/INSA). Annually
the laboratory identifies 15-20 dengue cases imported from endemic
areas, mainly Brazil, but also Timor, India, Cape Verde, Angola, Mexico,
Peru, Venezuela, Bolivia, Equator, Thailand, Pakistan and Vietnam. In
2012 an autochthonous outbreak of dengue was recognized in Madeira
Island and in 2013 the laboratory identified a major outbreak occurring
in Angola.
Methods & Materials: The diagnostic of dengue at the CEVDI/INSA
(national reference laboratory) is performed by serological methods
namely in-house Immunofluorescent Assay (IgM and IgG) and molecular methods (Real time-qPCR and RT-PCR).
Results: In 2011, the laboratory identified only six cases (less than
usual), half of them from Brazil. In October 2012 the laboratory confirmed the first two autochthonous cases from Madeira Island and identified the circulating serotype as DEN-1, with a probable origin from
Latin America. The laboratory followed this Dengue outbreak with more
than 2000 cases. In February 2013 the laboratory received the first
samples related to the Dengue outbreak in Angola. These were the first
cases of a major outbreak occurring in Luanda region where more than
800 cases were reported. CEVDI/INSA confirmed 89 imported cases,
of those 20 were diagnosed by RT-PCR and identified as DEN-1 virus,
related to DEN viruses circulating in Africa and Asia.
Conclusion: The geographical areas, where dengue confirmed
cases in this last three years were acquired, reflects the global distribution of dengue (2011) but also the how dengue affects new areas
(2012) and how the travelling preferences, in this case professional,
changes every year (2013). In dengue imported and autochthonous
cases, the laboratory has an essential role for early detection,precise
identification of the aetiological agent and reporting. This work was
partly funded by the PTDC/SAU-SAP/119199/2010 FCT project.
Poster Presentations I
SATURDAY вЂў November 1, 2014
International Meeting on Emerging Diseases and Surveillance 2014
22.192 Active surveillance for human plague in
Northwestern Uganda, 2008-2014
T. Apangu1, S. Acayo2, J. Kaggwa2, L. Atiku2, J. Tendo2, P. Anguzy3,
J. Wamala3, I. Makumbi3, B. Yockey4, E. Mbidde5
1
Uganda Virus Research Institute, Arua, Uganda, 2UVRI, Arua,
Uganda, 3Ministry of Health, Kampala, Uganda, 4CDC, Fort Collins,
CO, USA, 5Uganda Virus Reseacrh Institute, Entebbe, Uganda
A public health challenge
R. S. Sharma
National Centre for Disease Control, Delhi, India
вЂў
November 1, 2014
Purpose: India contains approximately half of the 205 billion people
worldwide who are at risk of dengue fever. The virus causing Dengue/
DHF is believed to have established in almost all parts of India and has
emerged as major public health concern. Dengue is found in tropical
and sub-tropical regions around the world, predominantly in urban and
semi-urban areas. It is the most common mosquito-borne viral disease
of humans. Globally, 2.5 billion people live in areas where dengue
viruses can be transmitted.
At the National level, dengue control is coordinated by the National
Vector Borne Diseases Control Programme (NVBDCP). NVBDCP is
the agency responsible for framing national dengue guidelines and
policies for guiding the implementations of programme strategies at the
state level.
This paper highlights the state of dengue control in India, explore
vector control mechanisms that have worked elsewhere, to strengthen
dengue control activities by policy and practice.
Methods & Materials: A systematic review was done to identify eligible articles. Relevant findings of all published articles were compiled
together and discussed in this paper. The NVBDCP web sites also
searched to get valuable information on dengue control pragramme.
The entomological survey was conducted for dengue vectors in different states as well as Air ports/Sea ports.
Results: In the absence of a vaccine, vector control is the primary
means of controlling dengue. Aedes spp. Mosquitoes provides
challenges to traditional vector measures. The cement tanks in
Maharashtra state were preferential breeding source for Aedes
aegypti. Coconut shells and Latex cup reported maximum breeding in
southern states viz Kerala and Lakshadweep Island.
Conclusion: As control measures continue to focus on emergency
epidemic containment and personal protections, the urban and rural
poor, who are at most risk of transmission, will bear the brunt of the
disease. India must become a world leader in dengue research control.
The mobility of modern populations and good means that no country is
safe if neighboring countries still harbor dengue. The country must take
action to curb the transmission and spread of Aedes-borne diseases.
SATURDAY
Purpose: Plague is a life-threatening flea-borne zoonosis caused by
Yersinia pestis. Over 95% of cases worldwide are reported from rural
Africa. We developed a program to better define the epidemiology,
clinical features, and outcome of human plague in Uganda
Methods & Materials: Active surveillance, coupled with central
laboratory support, was established in 10 clinics and 2 hospitals in
the endemic West Nile region. Community awareness was enhanced
though training of Village Health Team workers and a small number of
traditional healers. For surveillance purposes, a suspect plague case
was defined as rapid onset of fever and painful lymphadenopathy or
hemoptysis. A confirmed case was defined as a suspect case with
isolation of Y. pestis from a clinical specimen (blood, bubo aspirate,
or sputum) confirmed by phage lysis, or a 4-fold increase in anti-F1
antibody titers. A probable case was defined as a suspect case epidemiological linked to a laboratory-confirmed case.
Results: A total of 250 cases were identified during January 2008вЂ“
March 2014, including 75 laboratory confirmed and 25 probable cases.
The number of cases per full year ranged from a high of 153 in 2008
to a low of 13 in 2013. Median patient age was 11 years (range <1-70
yrs); 53% were female. Overall, 211 patients had bubonic, 20 septicemic, and 18 pneumonic forms of plague. Among 248 patients with a
documented outcome, 26% (26/100) with confirmed or probable plague
died, as compared with 8% (12/148) of those with suspect plague.
Mortality among patients with pneumonic plague was 44% (8/18)
overall, and 55% (5/9) for those with confirmed pneumonic plague.
Antimicrobials used for treatment included doxycycline, gentamycin,
chloramphenicol, co-trimoxazole, and ciprofloxacin. Forty-nine (19.6%)
cases were outbreak-related.
Conclusion: Plague remains a public health concern in the West
Nile region of Uganda. Although most cases are bubonic and sporadic,
small outbreak of pneumonic plague with person-to-person transmission do occur, with the potential for larger outbreaks. Mechanisms to
enhance prompt referral, rapid diagnosis, and effective antimicrobial
treatment are needed to reduce mortality.
22.193 Emergence of a dengue problem in IndiaвЂ”
127
IMED 2014
Poster Presentations II
SUNDAY вЂў November 2, 2014
International Meeting on Emerging Diseases and Surveillance 2014
23.002 High prevalence of faecal carriage of bla-SHV
Session 23
type extended spectrum-ОІ-lactamases
producing Escherichia coli among
healthcare workers
Poster Presentations II
Sunday, November 2, 2014
Room: Bruckner/Mahler/Brahms вЂў Upper Level
11:45вЂ“13:15
Antimicrobial Resistance
23.001 Inhibitor-resistant beta-lactamases in
Enterobacteriaceae from Croatia
SUNDAY
вЂў
November 2, 2014
B. Bedenic1, S. Jaman2, V. Zujic-Atalic3, J. Vranes4
1
University hospital Center Zagreb, Zagreb, Croatia, 2Sonesta,
Zagreb, Croatia, 3Public Health Institute of Osijek-baranja county,
Osijek, Croatia, 4School of Medicine, University of Zagreb, Zagreb
Institute of Public Health, Zagreb, Croatia
Purpose: Inhibitor-resistant ОІ-lactamases (IRT) are derivatives of
TEM, SHV and OXA-ОІ-lactamases and confer resistance to betalactam combinations with inhibitors such as amoxycillin/clavulanate
and ampicillin/sulbactam. Plasmid-mediated AmpC ОІ-lactamases also
confer resistance to ОІ-lactam/inhibitor combinations. They pose therapeutic problem in the treatment of urinary tract infections. Recently,
emergence of resistance to amoxycillin/clavulanate was noticed among
Escherichia coli and Klebsiella pneumoniae isolates in Croatia.
The aim of the study was to determine the phenotype and the mechanisms of resistance to ОІ-lactam/inhibitor combinations in clinical
isolates of E. coli and K. pneumoniae isolates in Croatia.
Methods & Materials: In total, 56 isolates (52 E. coli and 4 K.
pneumoniae) were collected from urine in three large medical centers
(University Hospital Center Zagreb, Sisters of Mercy Hospital and
Public Health Institute Osijek). The susceptibility to a wide range of
antibiotics was determined by disk-diffusion and broth microdilution
method. Transferability of resistance to amoxycillin/clavulanate was
determined by conjugation (broth mating method). PCR was used to
detect genes encoding resistance to ОІ-lactam/inhibitor combinations
(blaTEM, blaSHV, blaOXA, blaampC).
Results: All strains showed resistance to amoxycillin, piperacillin
and amoxycillin/clavulanate. Thirty six% (21/56) of the strains were
resistant to cefotaxime, ceftriaxone and ciprofloxacin, 26% (15/56) to
cefepime, 25% (14/56) to cefoxitin and 14% (8/56) to ceftazidime and
piperacillin/tazobactam. Only 10% (6/56) of the strains were resistant
to gentamicin. No resistance to carbapenems was observed. Fourteen
strains (25%) transferred resistance to co-amoxyclav to E. coli recipient
strain. TEM type of ОІ-lactamase was identified in 28 strains (50%) and
OXA-1 in 19 strains (34%). Twelve strains coproduced TEM and OXA-1
ОІ-lactamase. Plasmid-mediated AmpC ОІ-lactamases were found in
30% of the isolates. CMY type of ОІ-lactamase was found in 13 strains
(23%) and DHA-2 in four strains (7%). Sequencing of the representative amplicons revealed OXA-1, CMY-2 and DHA-1 ОІ-lactamase.
Conclusion: This is the first investigation of inhibitor-resistant
ОІ-lactamases in Croatia. The results showed that TEM and OXA
variants are the most prevalent IRT. Inhibitor-resistant variants pose
serious therapeutic problem in the treatment of community acquired
urinary tract infections. Accurate and quick laboratory identification of
such isolates is imporant to improve antimicrobial therapy.
128
IMED 2014
R. H. A. Bassyouni1, S. Gaber2, A. A. Wegdan2
Fayoum University, Fayoum, Egypt, 2Fayoum University, Fayoum,
Egypt
1
Purpose: The aim of this study was to determine the prevalence of
faecal carriage of ESBLs producing E. coli among Health Care Workers
(HCWs) by conventional microbiological methods and on molecular
basis.
Methods & Materials: Stool samples were collected from 200 HCWs.
Phenotypic screening test for ESBLs and AmpC ОІ-lactamases was
done using disc diffusion test and minimum inhibitory concentrations
of ceftazidime and cefotaxime. Phenotypic confirmation was performed
by combined discs test and Double Synergy Differential Test. Multiplex
PCR was used to detect blaSHV, blaTEM, blaCTX-M and bla CIT group
of genes.
Results: Of 200 isolated E. coli; 100%were susceptible to imipenem,
59 (29.5%) isolates were resistant for one or more of 3rd generation
cephalosporins, By molecular analysis: 21% (42/200) were colonized
by ESBL-producing E. coli and 3% (6/200) were colonized by AmpCproducing E. coli. bla. SHV genes was the predominant ESBL gene
detected in 81.8% of the resistant E. coli isolates while bla TEM 15.9%,
bla CTX-M 4.5% and AmpC genes (CIT group) 13.6%.
Conclusion: These findings report an alarming increase in the fecal
carriage of ESBL and AmpC resistant E.coli among HCWs. This is the
first study that reports faecal carriage rate of AmpC among HCWs.
Sound infection control measures and regular detection of ESBLAmpC producing isolates should be carried in Hospitals.
23.003 Emergence of of vancomycin resistant
Staphylococcus aureus (VRSA) in Portugal
J. Melo-Cristino1, A. FriГЈes1, C. Resina2, V. Manuel2, L. Lito2,
M. Ramirez1
1
Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal,
2
Centro Hospitalar Lisboa Norte, Lisbon, Portugal
Purpose: Portugal is a country with one of the highest prevalences of
Methicillin-Resistant Staphylococcus aureus (MRSA) and VancomycinResistant Enterococci (VRE) in Portugal. Vancomycin is widely used in
the therapy of Gram-positive infections in the country. A VRSA strain
(vancomycin MIC = 1024 mg/l) was isolated from a 74 year-old female
patient under treatment with vancomycin for a MRSA infection of a
toe amputation wound. The patient had chronic renal failure requiring haemodialysis, diabetes mellitus and peripheral vascular disease.
Vancomycin-resistant Enterococcus faecalis and Pseudomonas aeruginosa were also isolated from the wound.
Methods & Materials: The patient was treated with with daptomycin,
rifampicin and amikacin, control precautions were reinforced and an
epidemiological survey to monitor its possible dissemination was carried out. The patient and 53 close contacts were screened for S. aureus
colonization. All isolates were characterized by multilocus sequence
typing (MLST), spa typing, and pulsed-field gel electrophoresis (PFGE)
profiling, and the structure of the SCCmec element of all MRSA isolates
was determined.
Results: The VRSA strain harboured vanA, was ST105-II and
belonged to CC5, like most of the characterized isolates of VRSA from
other countries. vanA-positive E. faecalis may have been the donor of
the vanA into a MRSA during co-infection and therapy with vancomycin. The VRSA strain was no longer found in the wound after 3 weeks of
antimicrobial therapy. The strain remained confined to the infected foot
of the patient and was not detected in any of the close contacts. Nasal
colonization with S. aureus was detected in 20 subjects, five harbouring
MRSA. The majority of the isolates belonged to prevalent clones in
Portugal.
Conclusion: Despite the absence of VRSA dissemination, the
recent increase in the incidence of MRSA lineages belonging to CC5
in Portugal and other European countries may result in more frequent
opportunities for the emergence of VRSA.
Poster Presentations II
SUNDAY вЂў November 2, 2014
International Meeting on Emerging Diseases and Surveillance 2014
23.004 Detection of antimicrobial resistance in
selected bacteria isolated from non-human
primates at a wildlife-human interface
B. A. Glover, A. O. Jenkins, M. vanVuuren
University of Pretoria, Onderstepoort, Pretoria, Gauteng, South Africa
R. Zenteno-Cuevas1, O. Xochihua-Gonzalez2, B. Cuevas-Cordoba3,
R. MuГ±is-Salazar4
1
Universidad Veracruzana, Xalapa, Mexico, 2University of Veracruz,
Veracruz, VERACRUZ, Mexico, 3University of Veracruz, Veracruz,
Mexico, 4Universidad AutГіnoma de Baja California, Baja California,
Mexico
Purpose: According to the Pan-American Health Organization in 2013,
MГ©xico was on the top ten contributors of multidrug resistant tuberculosis (MDR-TB) in Latin America. Nevertheless, the genetic mechanisms
related with this phenomenon are poorly described, for that reason the
aim of this work was to characterize the genes related with MDR-TB in
isolates from MГ©xico.
Methods & Materials: In a collection of isolates of tuberculosis
with resistance toward rifampin (R) and isoniazid (H) determined by
BACTEC, the genes rpoB, katG e inhA were sequenced and mutations
characterized. In addition, a sub-set of 24 MDR-TB strains were spoligotyped and genes gyrA, rrS, eiS and tlyA were sequenced.
Results: From the period 2010вЂ“2013, 113 isolates with resistance
to H and 95 to R were recovered, 90 of these isolates were MDR-TB.
Only 39 (35%) isolates with resistance to H had SNPs in katG, the most
frequent mutation was S315T (276 G/C) in 29 (26%) isolates. Just 15
(13%) isolates had SNPs in inhA gene and the most common change
was -15 C/T in 6 (8%) isolates. Of the isolates with resistance to R, only
Purpose: To review was to evaluate the optimal number sampling sites
for detection of methicillin-resistant Staphylococcus aureus (MRSA)
colonization.
Methods & Materials: MEDLINE search was conducted from
January 2005 to February 2014 for articles which reported the prevalence of MRSA at different body sites. Studies were characterized by
study design, country and period of the study, number of patients and/
or isolates of MRSA, specimen type, site of MRSA isolation, and percentage of the MRSA isolates at each site in relation to total sites.
Results: A total of 124 abstracts and 45 manuscripts were reviewed,
of which 8 met the criteria for analysis. (n=37570 patients). MRSA
colonization prevalence varied from 2.8% to 22.5% in different studies
and 8% to 93% at different body sites. The throat and nares gave the
highest detection rates as single sites. A combination of two swabs
improved MRSA detection rates with the best combination being groin/
throat (74.5%). A combination of three swabs improved MRSA detection rate to 99% with the best combination being groin/nose/throat.
Certain combinations were associated with low detection rates. MRSA
detection rates also varied with different culture methods.
Conclusion: A combination of three swabs from different body sites
resulted in the highest detection rate for MRSA colonization. The use of
3 swabs would likely improve recognition and treatment of MRSA colonization, which may in turn reduce infection and transmission to other
patients in hospital. However, this is associated with incremental costs.
23.007 Chromosome-mediated multidrug resistance
in Salmonella enterica serovar Typhi
November 2, 2014
resistance against first and second line drugs
in multidrug resistant isolates of
Mycobacterium tuberculosis from Mexico
multiple sites surveillance: A systematic review
J. Chipolombwe1, E. TГ¶rГ¶k2, J. Taljaard3, G. Revathi4, P. S. Nyasulu5
1
Mzuzu Central Hospital, Mzuzu, Malawi, 2University of Cambridge,
Cambridge, United Kingdom, 3Stellenbosch University, Cape Town,
South Africa, 4Aga Khan University Hospital, Nairobi, Kenya, 5Monash
South Africa, Johannesburg, South Africa
вЂў
23.005 Characterization of mutations conferring
23.006 Methicillin resistant Staphylococcus aureus
SUNDAY
Purpose: Though wild animals are not directly exposed to antimicrobials, antimicrobial resistance (AMR) has been reported in some wild
animal populations. Proximity to humans has been reported to be associated with higher prevalence of AMR in some wild animal populations.
Methods & Materials: 300 fresh faecal samples from non-human
primates at two wildlife rehabilitation centres in South Africa were
screened for the presence of indicator and zoonotic bacteria. For comparison purposes, samples were obtained from non-human primates
with 3 distinct levels of exposure to humans. The 1st had maximum
human contact, the 2nd had occasional contact whilst the 3rd had
almost no human contact. 60 enterococci, 64 Klebsiella sp., and 64
E. coli strains were each isolated from the baboon and vervet monkey
samples. Antimicrobial susceptibility testing was carried out on all our
isolates using the Sensititre GPALL1F and GNX2F MIC plates (Trekds,
UK).
Results: 99% of the gram negative isolates were resistant to polymyxin B and E (Colistin) as well as the carbapenems with occasional
resistance recorded against aminoglycosides whilst 99% of the gram
positives were resistant to aminoglycosides, carbapenems and flouroquinolines. Over 90% of the entire gram negative isolates were susceptible to Penicillins and ОІ-Lactamase Inhibitor combinations with the
exception of the Salmonella spp. in which about 50% of the isolates
were resistant. We observed the highest level of resistance in group 1.
Comparatively; group 1 had 20% and 23% higher levels of resistance
than group 2 and group 3 respectively. This was observed across most
antimicrobials tested; especially polymyxin B and Colistin. We further
observed decreasing levels of antimicrobial resistance with age; with
isolates from older animals being less resistant. This resistance profile
was similar in all 3 groups in both camps.
Conclusion: Microbial connectivity between human populations
and wildlife even in the absence of immediate disease concerns, may
identify points of contact where the justifying of increased surveillance may be needed because of higher risks of disease emergence.
Further molecular typing will be carried out on resistance genes via
integron PCRs and PFGE to assess the clonality, genetic evolution and
transmission dynamics of resistance genes at the human-non human
primate interphase.
61 (84%) had SNPs in rpoB, the most frequent was S531L (163C/T) in
43 (61%) isolates. Only 3 (13%) MDR-TB isolates presented changes
in genes associated to second line drug resistance. The first had mutations H-R (1401A/G) in rrS, and V-S (322 GTG/AGT) in tlyA. The second had mutation N-S (1356 A/G) in rrS, and the third had mutations
S91P (271 TC/) in gyrA, H-R (1401 A/G) in rrS and -10G/A in eis. These
two isolates shared the lineage LAM (SIT 379).
Conclusion: Hitherto this is one of the most detailed characterizations of the genetic mechanisms associated to MDR-TB in MГ©xico.
Our results show a considerable number of isolates lacking of вЂњtraditionalвЂќ mutations. This could have implications for the implementation
of molecular diagnostic test, and show a considerable diversity of
MDR-TB isolates circulating. One of the MDR-TB isolates was identified as pre-XDR-TB and one as XDR-TB; hence the DNA sequencing
could be of great support for the screening of XDR-TB isolates.
Y.-S. Liao1, T.-L. Lauderdale2, D. C. Phung3, H. Watanabe4,
J.-C. Kuo1, Y.-Y. Liu1, P.-J. Wang1, S.-Y. Liang1, C.-S. Chiou5
1
Taiwan Centers for Disease Control, Taichung City, Taiwan, R.O.C.,
2
National Health Research Institutes, Zhunan, Taiwan, R.O.C.,
3
National Institute of Hygiene and Epidemiology, Hanoi, Viet Nam,
4
National Institute of Infectious Diseases, Tokyo, Japan, 5Centers for
Disease Control, Taiwan, Taichung, Taiwan, R.O.C.
Purpose: To characterize genetic relatedness and antimicrobial
resistance among Salmonella enterica serovar Typhi isolates from
Bangladesh, Indonesia, Taiwan and Vietnam.
Methods & Materials: Pulsed-field gel electrophoresis was applied
to assess the genetic relatedness among S. Typhi isolates and whole
genome sequencing approach was used to determine a multidrug
resistant (MDR) island in chromosomes and the clonality of the MDR
strains. DNA sequencing was applied to reveal mutations on the
quinolone-resistance determining regions of the gyrA, gyrB, parC and
parE genes, PCR was used to detect the presence of qnrA, qnrB1,
129
IMED 2014
Poster Presentations II
SUNDAY вЂў November 2, 2014
International Meeting on Emerging Diseases and Surveillance 2014
qnrB4, qnrD, and qnrS, and phenylalanine-arginine ОІ-naphthylamide
was used to assess the effect of the efflux pump on nalidixic acid and
ciprofloxacin resistance.
Results: The isolates from Bangladesh and Vietnam were genetically closely related but distant from those from Indonesia and Taiwan.
All but a few isolates from Indonesia and Taiwan were susceptible to
all antimicrobials tested. Of the isolates from Bangladesh and Vietnam,
68% and 82% were multidrug resistant (MDR), respectively, and
belonged to the widespread haplotype H58 clone. MDR in S. Typhi are
almost exclusively conferred by a suite of resistance genes carried by
IncHI1 plasmids. That plasmid type was detected in all MDR S. Typhi
from Vietnam but in only 15% of MDR isolates from Bangladesh; 12
of the 26 MDR isolates from Bangladesh did not bear any plasmid.
Whole genome sequencing analysis identified a MDR genomic island,
designated SGI5, which conferred resistance to ampicillin, chloramphenicol, streptomycin, sulfonamide, and trimethoprim in 18 of the 26
MDR isolates. Of the isolates from Bangladesh, 82% and 40% isolates
were resistant to varying concentrations of nalidixic acid and ciprofloxacin, respectively. Several resistance mechanisms including alterations
in gyrase A, the presence of QnrS and enhanced efflux pumps were
involved in the reduced susceptibility and resistance to fluoroquinolone.
Conclusion: Antimicrobial resistance in the majority of MDR S. Typhi
isolates from Bangladesh was chromosome-mediated. Intensive surveillance is necessary to monitor the spread of the chromosome-borne
resistance in S. Typhi strains emerging in Bangladesh.
23.008 ESKAPE bacteremia
SUNDAY
вЂў
November 2, 2014
R. GonГ§alves, D. Aguiar, J. TrГЄpa, R. Magano, J. Cortez, H. Oliveira,
J. Gamboa
Centro Hospitalar e UniversitГЎrio de Coimbra, Coimbra, Portugal
Purpose: Bacteremia is a serious and frequently life-threatening entity,
linked to risk factors and comorbidities. It is quite often associated to
prolonged hospital admissions, but may occur in patients with no admittances to health facilities. We aimed to characterize the bacteremia
patients admitted to the ward, assessing comorbidities and risk factors,
isolated pathogens (more specifically the ESKAPE group), antibiotics
on use and clinical evolution.
Methods & Materials: A retrospective analysis of 105 patients clinical charts (admitted to the wards of Internal Medicine and Infectious
Diseases amid January 2010 and December 2012) was established,
concerning patients with two or more positive blood cultures for the
same pathogen (correctly drought).
Results: There was equal distribution of genders, with a mean age
of 77 years. In 95% of cases comorbidities associated to immunosuppression or predisposing to infections (neurological diseases, heart
failure, diabetes mellitis, obstructive lung disease) were noted. Half of
the bacteremia were attributed to ESKAPE pathogens (Enterococcos
faecium 1%, Staphylococcos aureus 27%, Klebsiella pneumoniae
4%, Acinetobacter Baumanii 7%, Pseudomonas aeruginosa 8% e
Enterobacter spp <1%), 50% of these with respiratory source and 33%
with urinary source. 75% were nosocomial in origin, and drug-resistance risk factors were present on 70% of these cases, mostly previous
antibiotic therapy (62%) and recent hospital admission (40%).Empirical
antibiotic therapy was started in 82% of patients, only 21% of antibiotics
being appropriate. The drug classes more frequently used were glycopeptides (45%), carbapenems (22%) and linezolid (15%). The drug
scheme was altered in 68% of patients, mostly due to resistance, and
guided by drug susceptibility testing (68%). The rate of innapropriate
use of carbapenems attained 72%. The drug combination, typically
glycopeptides and polymixin (29%) was mostly used in A. baumanii
infections.The ESKAPE bacteremia patients developed septic shock in
25% of cases and respiratory failure requiring assisted ventilation in 4%
of case. The global mortality rate was 37% (46% ESKAPE pathogens
vs. 25% other bacteria).
Conclusion: ESKAPE pathogens have greater resistance rates,
are associated with more complications and mortality. The empirical
therapy is frequently inappropriate, and so, larger (eventually combination therapy) and earlier antibiotic therapy shift should be considered.
130
IMED 2014
23.009 Investigating role of putative peptidoglycan
amidase, in biofilm formation and antimicrobial
resistance of Mycobacterium tuberculosis
A. Padhi, S. Mohanty, A. Sonawane
KIIT University, Bhubaneswar, Bhubaneswar, Odisha, India
Purpose: Bacterial species are capable of living as biofilm and/
or planktonic forms. Role of biofilms in pathogenesis of mycobacterial diseases remains largely unknown. Here we try to characterize a
Mycobacterium tuberculosis (Mtb) hypothetical gene for its role in biofilm formation and to correlate the role of biofilm with their antimicrobial
resistance and bacterial adherence onto cells.
Methods & Materials: The Mtb gene was over-expressed in saprophytic M.smegmatis with shuttle vector pSMT3. The mutant strain was
checked for its planktonic growth at air-water interface using SautonвЂ™s
media. Surface attached biofilm formation was studied using crystal
violet staining method and acridine orange staining under fluorescence
microscope. Antimicrobial resistance to anti-TB drugs of biofilm was
studied by fluorescence microscopy and with antibiotic susceptibility
test using Polycarbonate membrane. Correlating with Biofilm formation
bacterial adherence onto lung epithelial cells (A549) was studied with
SYTO 9 staining of bacteria and Rhodamine Phalloidin staining of cells
and observed under fluorescence microscopy. Microbial adhesion to
hydrocarbons (MATH) test was performed to assess bacterial hydrophocity in presence and absence of antibacterial agents.
Results: Mutant over-expressing putative Mtb peptidoglycan amidase gene was found to show significantly enhanced planktonic growth
in SautonвЂ™s media after 5 days incubation without shaking. Crystal violet
staining and flourescence microscopy showed increased biofilm formation on Polystyrene cell culture plates. Antibiotic susceptibility testing of
biofilm on polycarbonate membrane, showed resistance against antiTB drugs Pyrazinamide and Isoniazid at their MIC (Minimum Inhibitory
concentration), CFU (Colony forming unit) assay indicates resistance
towards cell degrading agents i.e. SDS, ciprofloxacin. SYTO 9 and
Phallodin staining showed increased bacterial adherence onto cell
surface.
Conclusion: The present study highlights the role of a novel peptidoglycan amidase in bacterial growth in media and inside the host. It
was found to alter the colony morphology, cell surface hydrophobicity,
biofilm forming ability and resistance to anti-Tb antibiotics. Since the
gene plays a role in many different cellular functions, it could be good
target for drugs against Mtb.
23.010 Cefmetazole for bactermia caused by
ESBL-producing Enterobacteriacae
comparing with carbapanems
T. Fukuchi, K. Iwata, G. Ohji
Kobe University Graduate School of Medicine, Hyogo, Japan
Purpose: ESBL-producing Enterobacteriacae are challenging organisms with little treatment options. Carbapenems are often used to treat
these but other options are intently sought as judicious use of carbapenems are immensely necessary in the era of increasing multi-drug
resistant organisms. Cephamycins such as cefmetazole can be good
option in treating urinary tract infections caused by ESBL-producers,
but its efficacy against bacteremia caused by ESBLs remains unknown.
Methods & Materials: We performed a retrospective study on 73
cases of ESBL bacteremia to investigate the efficacy of cefmetazole
comparing with carbapenems, at Kobe-University Hospital from Jan 1
2008, through 31 Dec 2013. Retrospective chart review was conducted
for data such as causative pathogens, entries of infection, SOFA score,
with the primary outcome of 30-day mortality after blood culture becoming positive.
Results: Seventy-three patients (male 38, female 34), including two
relapse cases, were reviewed for this analysis. The average age of the
patients was 69.2В±14.4 years old. Most common causative organisms
were E. coli (93%), followed by Klebsiella pneumoniae (4%), K. oxytoca
(4%). Fifty-six percent of the patients received carbapenems as definitive therapy, whereas 37% of them received cefmetazole. Forty-five
Poster Presentations II
SUNDAY вЂў November 2, 2014
International Meeting on Emerging Diseases and Surveillance 2014
percent of entries of infection were urinary tract, and 12% were hepatobiliary. Mean SOFA score on cefmetazole group and carbapenem group
were 2.8В±2.8, and 5.0В±4.7, respectively (p=0.049). Mortality appeared
better on cefmetazole group than carbapenem group (4% vs 12%) but
the difference was not statistically significant. Only one patient died
on cefmetazole group secondary to hemorrhagic shock unrelated to
the infection. In majority of cases, infectious diseases consultants were
involved in therapeutic decision-making.
Conclusion: Cefmetazole may be safely given to patients with ESBL
bacteremia in Japan, where CTX-M is predominant, if ID consultants
are involved and select out relatively stable patients.
23.011 High antimicrobial resistance of urinary
bacteria isolated from long-term respiratory
care wards in a regional hospital in Taiwan
W.-C. Lin, K.-S. Liu
St. JosephвЂ™s hospital, Yunlin County, Taiwan, R.O.C.
G. M. Misgana1, N. H. Geda2, G. J. Guto1, T. W. Abebe1,
M. S. Hassen3
1
Adama Hospital Medical College, Adama, Oromia, Ethiopia, 2Oromia
Public Health Laboratory, Adama, Oromia, Ethiopia, 3Oromia Public
Health Laboratory, Adama, Ethiopia
Purpose: Diagnosis and treatment of Multi drug resistant tuberculosis
(MDR-TB) is challenging in resource limited countries. Thus prevention
of MDR TB is the feasible approach to overcome difficulties posed by
it. Thus this study aimed to determine risk factors for the emergency of
concomitant Isoniazid (INH) and Rifampicin (RIF) resistant tuberculosis
(TB)
Purpose: To determine the prevalence, risk factors, and treatment
outcome of infections due to CRE in King Fahad Medical City, Riyadh,
Saudi Arabia.
Methods & Materials: Prospective observational case-control study.
Ethical approval was obtained. Subjects aged 13 years and above with
infection due to CRE were compared with those without CRE infection
as controls. Matching was for infection site, organism and admission
site. Isolation and susceptibility testing of the Enterobacteriacae was
done by the disk diffusion method and phoenix according to CLSI
and EUCAST guidelines. A structured sheet was used to collect data.
Analysis was with SPSS (20.0, Chicago, IL, USA). Results are presented as means (В±SD). Alpha level was set at 0.05.
Results: Between March, 2012 and December, 2013, 29 cases of
healthcare-associated infections due to CRE were recorded. Controls
were selected in a ratio of 1:2. Males made up 57.5% of the subjects
with an age-range of 15-94 years [mean 54.9 (В±19.927)]. Fifty-six
per cent of the subjects were in the 51-80-year-age group. Eighteen
(62%) cases were admitted from other hospitals. Admissions were in to
medical (41.4%), and surgical (40.2%) wards, while 16 (18.4%) went to
the intensive care unit (ICU). Mean age (p=0.065) and sex (p=0.647)
distribution among the study subjects were similar. More cases died
(31% vs 12.1%; p=0.031). Mortality was more among females OR 3.98
[1.04-15.19]. By univariable analysis CRE infection was associated
with prior antibiotic use (p=0.000), ICU stay (p=0.000), prior surgery
(p=0.019), urinary catheterization (p=0.003), renal disease (p=0.017)
and mechanical ventilation (p=0.011). By multivariable analysis only
prior antibiotic use was associated with CRE infection (OR 15.71
[95% CI, 1.00-32.26]). Majority (87.4%) of the subjects had co-morbid
conditions [DM (52.9%), hypertension (52.9%), and renal disease
(31%)]. Renal disease was associated with CRE infection (p=0.014).
Cases had more co-morbid conditions (p=0.006), urinary catheterization (p=0.003), mechanical ventilation (p=0.011), dialysis (p=0.017),
ICU stay (p=0.000), prior surgery (p=0.021) and CVC line placement
(p=0.000) than controls.
Conclusion: Nosocomial infection due to CRE is associated with
significant morbidity and mortality. improved survellance, effective
infection control measures, and antimicrobial stewardship should be
strengthened. Development of novel antimicrobial agents with reliable
efficacy against resistant organisms should be pursued.
November 2, 2014
resistant tuberculosis among suspected
cases of Oromia Region, Ethiopia, 2014
due to carbapenem-resistant Enterobacteriacae
M. A. Garbati1, H. Sakkijha2, A. Abu-Shaheen2
1
King Fahad Medical City, Riyadh, Riyadh, Saudi Arabia, 2King Fahad
Medical City, Riyadh, Saudi Arabia
вЂў
23.012 Determinants of isoniazid and rifampicin
23.013 Prospective case-control study of infections
SUNDAY
Purpose: Prolonged mechanical ventilation (PMV) patients are unique
because of multiple underlying diseases, long-term hospitalization in
specific wards and in high antibiotic pressure. Urine tract infections are
most common among these patients. However, the changing pattern of
antibiotic resistance makes the treatment very difficultly. The objective
of this study is to investigate the distribution of bacteria isolated from
urine and their antibiogram.
Methods & Materials: The urine samples from PMV patients in a
499-bed regional hospital were obtained in every month during 2012.
All PMV patients were hospitalized at specialized respiratory care
wards. There were total 50 beds for those patients who were mechanical ventilator-dependent more than 21 days. The bacterial identification
and antimicrobial susceptibility were performed by ViITEK-2 following
instructions of the Clinical and Laboratory Standards Institute 2011.
Results: Total 340 bacteria were isolated and identified. The most
frequently reported urinary microorganisms in PMV wards were
Eschericheria coli (27%), Proteus mirabilis (21%), Klebsiella pneumoniae (16%), Pseudomonas aeruginosa (9%) and Enterococcus faecium (8%). Among these isolated Enterobacteriaceae, the percentage of
extended-spectrum ОІ-lactamase producing E. coli and K. pneumoniae
is high (53% and 59%, respectively). Fluoroquinolone resistance was
noted in these urinary gram-negative pathogens, especially among
E. coli which was 78% resistant to Ciprofloxacin and Levofloxacin. K.
pneumoniae and P. mirabilis were less resistant to fluoroguinolones
but the rates were still high (45% and 55%, respectively). In another
way, no carbapenem resistant Enterobacteriaceae was found in these
isolates. Similar fluoroquinolone resistance could be found among P.
aeruginosa (48%). P. aeruginosa was also resistant to ceftazidime
(52%) and piperacillin-tazobactam (27%). Most Enterococci was susceptible to vancomycin but resistant to ampicillin. The rate of ampicillin
resistance were E. faecalis 44% and E. faecium 91%.
Conclusion: The most common isolated bacteria from urine samples
were Enterobacteriaceae. The emerging multi-drug resistance was a
serious problem in such specialized long-term respiratory care units.
Markedly increased prevalence of extended-spectrum ОІ-lactamase
producing E. coli and K. pneumoniae were observed, which limited the
treating options if nosocomial infection developed.
Methods & Materials: A case control study design was employed
to achieve the desired objective among MDR-TB suspected cases.
Associated factors data were collected using the predesigned questioner and sensitivity to INH and RIF were determined using line probe
assay. Data were analyzed using SPSS version 20.0.
Results: Based on the data obtained from 88 cases and 177 controls
bi-variate analysis reveals rural residence, tertiary education, alcoholism and anti-acid use for gastritis during TB treatment were statistically
associated with concomitant resistance. In the multi-variate analysis;
four exposure variables occupation/farmer/AOR= 4.8(1.07, 11.98), TB
patient contact history AOR= 6.6(1.48, 29.60), Human Immuno Viru
(HIV) infection AOR= 1.4(1.03, 6.71) and pervious TB treatment outcome AOR 3.5(1.57, 6.99) were found to be independent determinant
factors of simultaneous resistance after adjusting for other variables.
Conclusion: TB patient contact history, pervious TB treatment, HIV
infection and rural community should be considered in MDR TB control
in the study area.
131
IMED 2014
Poster Presentations II
SUNDAY вЂў November 2, 2014
International Meeting on Emerging Diseases and Surveillance 2014
23.014 Intestinal microflora in adults with acute
infectious diarrhea
Purpose: Opportunistic microflora demonstrates in increase of resistance to various antibiotics.вЂЁThe aim of study was to determine the composition of bacterial flora in AID and evaluate its sensitivity to antibiotics.
Methods & Materials: We observed 20 patients with AID in the age
from 31 to 54 years old, who admitted to the hospital in the 1st day of
the onset of symptoms. Rectal swab samples were taken from each
patient within 1вЂ“2 hours of admission.
Results: The symptoms at the onset of AID were: fever in 40%, nausea in 80%, vomiting in 35%, diarrhea in 100% of patients. Diarrhea
was watery in 85 В± 7,98% of cases, with mucus in 15 В± 7,98%, p =
0,001. Leukocytosis was recorded in 80% of cases.вЂЁвЂЁBacteriological
examination of rectal swabs based on MULTI-TOF mass spectrometry
revealed in all patients only representatives of opportunistic microflora.
In 100% of cases the basis of the microbial landscape consisted of
E.coli with normal lactate dehydrogenase activity (N-LDA). In 40% of
cases, its association with S. capitis was defined, in 35% with S. epidermidis and K.pneumonia. E.coli NLA was found together with S.hominis
and Citrobacter freundii in 25%, with E.faecium and S. aureusвЂ”in
20%. Also in 20% of cases E.coli N-LDA was detected simultaneously with E.coli wich had reduced lactate dehydrogenase activity,
Citrobacter freundii, K.pneumonia and yeast-like fungi of the genus
Candida. At least 2 microbes were detected in all samples of rectal
swabs. Association of 3 microorganisms was revealed in 20%, 4вЂ”in
40% of cases.вЂЁвЂЁIntestinal microflora was resistant to cephalosporins
of IвЂ“IIIth generations and penicillins in 100% of cases. Resistance to
chloramphenicol was detected in 85%, tetracyclineвЂ”in 80%, aminoglycosidesвЂ”in 80%, macrolidesвЂ”in 75% of samples. Less frequency of
resistance was observed to fluoroquinolones (65%) and carbapenems
(60%).
Conclusion: Detected opportunistic microflora in patients with AID
consists of different association of microorganisms based on E.coli
N-LDA. Intestinal microflora in 60вЂ“100% of cases demonstrated
resistant to antibiotics used as primary regime of therapy for various
diseases.
23.015 23.015Antibiotic resistanceвЂ”Challenges
SUNDAY
вЂў
November 2, 2014
N. Pshenichnaya1, A. Aleshukina2, A. Buslenko1, A. Juravlev3,
I. Aleshukina2
1
Rostov State Medical University, Rostov-on-Don, Russian
Federation, 2Rostov Scientific and Research Institute of microbiology
and parasitology, Rostov-on-Don, Russian Federation, 3First Moscow
Medical University named after I.M.Sechenov, Moscow, Russian
Federation
and opportunities with bacteriophage and
lytic proteins
D. Trudil1, M. Kutateladze2
NHDetect Corp, Reisterstown, MD, USA, 2Eliava Institute of
Bacteriophage, Tbilisi, Georgia
1
Purpose: Drug-resistant pathogens are a growing menace to all individuls, regardless of background. They endanger industrial societies as
well as less developed nations, causing problems in hospitals, homes
and farms at an increasing rate. What can be done?
One approach is to treat bacterial diseases by the use of bacteriophages. Phages are very small viruses that destroy by lysing select
bacteria. First proposed by dвЂ™Herelle around World War I and used over
80 years bacteriophage has been a key tool of healthcare professionals within Eastern Europe. More recently scientists have isolated and
developed specific lytic components which have further broadened the
potential of phage derived technologies. These include applications for
treatments, preventatives and decontaminants as well as diagnostics
and more recently linked to psychological disorders.
The current state of the phage related technologies will be discussed
with specific application examples provided. Although previously
focused primarily on human therapies, the use of phage has been
132
IMED 2014
further expanded to include use for agricultural, environmental and
novel detection applications. This includes aquaculture, incorporation
within animal feed/water, and control of sulfate reducing bacteria as
well as new emerging bacteria. Also, a novel decontamination method
for hospital use will be presented. Next step projects and technologies will be mentioned with a goal of enhancing collaborations and
applications.
Methods & Materials: A phage preparationof sterile filtrates of phage
lysate active to various strains of S. aureus was obtained from Eliava
Institute of Bacteriophages (Tbilisi).
Phage was applied via oral administration (soda solution to neutralize
pH of gastric juice was administered prior to phage preparation) 5 ml of
preparation twice a day over a period of 7 days.
Results: The Eliava Instituteanti-staphylococcal phage preparations
demonstrated lytic activity to 91.1% strains (95.4% of sensitive strains
of S. aureus and 83.2% of coagulase-negative staphylococcus), while
in case of pediatric patients, the sensitivity of S. aureus strains isolated
was 98%.
Conclusion: The clinical studies of phage therapy in cases of staphylococcaemia clearly show the high efficacy of phage treatment. Multiresistance strains of S. aureus, including MRSA (methicillin resistant),
may induce scientists to divert to alternative therapies to treat antibiotic
resistant.
23.016 Comparisons of drugs resistant results
between pulmonary and extra pulmonary
tuberculosis in lower northern of Thailand 2013
R. Khummin
The office of Diseases Prevention and Control region 9 Phitsanulok,
Phitsanulok, Thailand
Purpose: Tuberculosis(TB) is the major respiratory infection disease
inThailand. The problem with TB treatment are follow: patients lost
in contact, stop medication, not take medicine on time, side effect,
life styles. All reasons can lead to multi drug resistant tuberculosis
(MDR-TB). The aim of this study is a comparisons of drugs resistant
results between pulmonary and extra pulmonary tuberculosis.
Methods & Materials: The samples from 40 hospitals in lower
northern of Thailand in year 2013 with symptomatic of tuberculosis(TB)
were collected. All samples were culture by automate Bectec MGIT
960 and solid culture, identified Mycobacterium tuberculosis by
immuno chromatographic assay (ICA). AllICA positive samples
were determine drug susceptibility testing (DST) with 4 drug follow: Isoniazid (0.1 ug/ml), Rifampicin (1.0 ug/ml),Streptomycin
(1.0 ug/ml) and Ethambutol (5.0 ug/ml) by bectec MGIT 960.
Results: The results showed 1,855 samples were collected for TB culture.617 samples were identified M. tuberculosis (497 sputum and 120
were the other samples: Pus, Bone marrow, CSF, Fluid, Urine, Stool,
Synovial fluid, Lymp node, Gastric fluid).Found MDR-TB 24 samples. In
addition, 23 samples of MDR-TB were collected from sputum. The data
showed both sputum and other samples were resistance to TB drug.
Conclusion: MDR-TB can be found in all type of patients and
specimens then need to be improved on the process of case
finding, specimens collection and good national strategy plan.
23.017 Reliability of Kirby-Bauer disk diffusion
method for detecting doripenem susceptibility
in oxidase positive non-fermenting
gram negative bacilli
R. Misra1, K. N. Prasad2
Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow,
Uttar Pradesh, India, 2Sanjay Gandhi Postgraduate Institute of
Medical Sciences, Lucknow, UP, India
1
Purpose: To determine the reliability of the Kirby-Bauer Disk Diffusion
(KBDD) method for detecting doripenem susceptibility against 80 isolates of Non-fermenting Gram negative bacilli.
Methods & Materials: Eighty consecutive clinical isolates of oxidase
positive NFGNB recovered from pus and urine samples of patients with
cUTI and cIAI were included in this study. The isolates were identified
Poster Presentations II
SUNDAY вЂў November 2, 2014
International Meeting on Emerging Diseases and Surveillance 2014
by standard bacteriological techniques and sensitivity to doripenem
was determined by the KBDD method using discs (10Вµgm) of both
Hi-media and BD diagnostics. The E test was taken as the reference
standard. Escherichia coli ATCC 25922 and Pseudomonas aeruginosa
ATCC 27853 were used as quality control strains. Susceptibility pattern
of the isolates was determined by both current CLSI guidelines as well
as EUCAST.Discordant results were categorized as very major (sensitive according to KBDD method but resistant by E test), major (resistant
according to KBDD method but sensitive by E test) and minor (reported
intermediate when resistant or susceptible or vice versa).
Results: The isolates were identified as Pseudomonas aeruginosa
(n=34), other Pseudomonas species (n=38) and Burkholderia cepacia complex (n=8).Very major errors and major errors were observed
with two and one isolates respectively. Minor error rates of 7.5% were
observed when results were interpreted as per CLSI breakpoints. No
discrepancies were recorded between KBDD method and E test when
EUCAST break-points were applied to the results obtained.
Conclusion: CLSI does not provide interpretive break-points of
doripenem for oxidase positive NFGNB other than Pseudomonas
aeruginosa while EUCAST has clubbed all isolates under the heading Pseudomonas spp. Though we used the E test as the reference
method and tested only a small number of isolates,the KBDD method
can be reliably used for routine testing of doripenem susceptibility
against oxidase positive NFGNB
23.018 Prevalence and detection of ampC beta-
lactamases in gram negative clinical isolates
and associated risk factors at a tertiary care
centre in northern India
R. Misra1, K. N. Prasad2
Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow,
Uttar Pradesh, India, 2Sanjay Gandhi Postgraduate Institute of
Medical Sciences, Lucknow, UP, India
1
enterobacteria in the SMART study (2011вЂ“2013)
I. S. Azizov, D. Babenko, E. Zakharova, A. Lavrinenko,
N. Shambilova, E. Tishkanbayev
Karaganda State Medical University, Karaganda, Kazakhstan
Purpose: Study of ESBLs structure of enterobacteria from Kazakhstan
collected in the frame of SMART Project (2011-2013yy).
Methods & Materials: Samples of enterobacteria have been collected according SMART criteria. Subtyping of ESBLs has been
performed with using Check Point biochips in the Central laboratory
of IHMA. Statistical analysis was done based on the resources of
www.globalsmartsite.org; calculation of 95% CI was performed with
Pearsone-Clopper method.
Results: The part of ESBL was significant increased during all period
of study. In 2011 the proportion of ESBL-positive strains was 24,77%
(95%CI=14,97-36,85), in 2012вЂ”29,51% (95%CI=15,77-46,54) and in
2013вЂ”51,35% (95%CI=38,85-63,74). CTX-M genes were major group
and detected in 84,62% (95%CI 67,80-94,83). Old group of ESBL
(SHV/TEM genes) was found in 82,69% (95%CI=65,49-93,67). During
the period of 2011вЂ“2013 the part of CTX-M-15 were increased twice,
from 23,08% to 44,23%. However, the proportion of AmpC-positive
strains was significant decreased. Simultaneously spectrum of other
types of ESBL was narrowed. About half of ESBL positive strains
(48,08%; 95%CI=30,17-66,35) were with two ESBL genes and more
than quarter cases (26,92%; 95%CI=12,86-45,33), the ESBL-positive
strains had 3 or more different types of ESBL genes.
Conclusion: The results of SMART study (2011-2013 yy.) showed
that the proportion of ESBL-positive enterobacteria collected in
Kazakhstan was increased twice. The major part of ESBL genes was
CTX-M-15.
23.020 The analysis of resistance of M.tuberculosis to
drugs in Kazakstan (2010вЂ“2013)
D. Babenko1, I. S. Azizov2, N. Tabriz1
1
Karaganda state medical university, Karaganda, Kazakhstan,
2
Karaganda State Medical University, Karaganda, Kazakhstan
вЂў
November 2, 2014
Purpose: Drug-resistant tuberculosis is a growing hazard to public
health. As a result, the standard antimicrobial therapy, such as directly
observed therapy, short course (DOTS) in the cases with multi-drug
resistant and especially extensively drug resistant M.tuberculosis is
considered to be ineffective. It requires longer treatment with drugs
that are very expensive and show not so good efп¬Ѓcacy with increased
side effects.
Aim: To analyze the resistance among M.tuberculosis strains in
Kazakhstan for period of time 2010вЂ“2013 yy and influence standard
therapy for the level of drug resistance.
Methods & Materials: From 2010 to 2013, 5067 stains of
M.tuberculosis were isolated from two groups of patients in tuberculosis dispensary laboratory (Karaganda, Kazakhstan). First group
included the patients who never received treatment (or <1 month),
and second group of patients who received standard four-drug therapy
(isoniazid [INH], rifampicin [RIF], pyrazinamide [PZA], and ethambutol
[EMB]) more than for one month. Antimicrobial susceptibility testing
has been carried out with disk diffusion method. Statistical analyses
were performed using MedCalc for Windows, version 10.2 (MedCalc
Software, Ostend, Belgium). P-value less than 0.05 was considered
as a significant.
Results: Investigation of 5067 strains of M.tuberculosis showed that
total level of resistance to antimicrobial drugs fluctuated within the
range of 0.2%-5.6%. The rate of resistant strains to isoniaside was
from 0.57% in 2012 to 2.3% in 2011. The ranges of portion resistant
microorganisms for rifampicin, ethambutol and streptomycin were 0.21.08%, 1.22-3.95% and 3.08-5.67% respectively. Analysis the level of
SUNDAY
Purpose: To determine the prevalence, molecular types, associated
risk factors and outcome of plasmid mediated AmpC ОІ-lactamases
in Gram negative clinical isolates at a tertiary care centre in northern
India.
Methods & Materials: Consecutive non-repeat clinical isolates
(n=1677) of Gram negative bacilli were collected at the Department
of Microbiology from various clinical specimens such as pus, urine,
sputum, blood and infected body fluids. Antimicrobial sensitivity testing was carried out by the disc diffusion method using current CLSI
recommendations. Co-resistance to other antimicrobial agents such
as ceftazidime, ceftriaxone, cefoperazone-sulbactam, piperacillinвЂ“tazobactam, imipenem, meropenem, amikacin, gentamicin,
trimethoprim-sulphamethoxazole, cefepime and ciprofloxacin was also
determined. Candidate isolates were those resistant to cefotaxime and/
or ceftazidime irrespective of addition of clavulanic acid. A 30Вµg cefoxitin disc was used as a screen test. All isolates resistant to cefoxitin
were confirmed by a phenotypic three dimensional (3D) extract test.
Genes encoding six phylogenetic groups of acquired AmpC enzymes
were sought by multiplex PCR. The following factors were analyzed
as risk for infections by AmpC producing strains: surgery, sepsis, use
of invasive procedure, diabetes, immunosupression, renal failure, total
parenteral nutrition and hemodialysis.
Results: One thousand twenty seven isolates (61.2%) out of 1539
were screen positive and 505 (30.1%) were 3D test positive. These
were Escherichia coli (n=341), Klebsiella pneumoniae (n=79),
Acinetobacter baumannii (n=56), Proteus mirabilis (n=18) Citrobacter
spp. (n=8) and Pseudomonas spp. (n=3).Out of 53 isolates tested by
multiplex PCR, 18 yielded amplicons for FOX enzymes. Plasmid mediated inducible enzyme production was confirmed in Escherichia coli
(n=11) and Klebsiella pneumoniae (n=7).On binary logistic regression
surgery, sepsis and use of invasive procedure were risk factors most
predictive of mortality associated with AmpC production.
Conclusion: This study has describedthe prevalence and associated
risk factors with outcome of infections caused by a large number of
AmpC ОІ-lactamase-producing clinical Gram negative bacilli.Diverse
acquired Amp C enzymes occur in Gram negative bacilli;however FOX
type was recovered at our centre.Since only genes that are expressed
cause resistance, a phenotypic test like the 3D test may be more valuable than a genotypic method like PCR for such isolates.
23.019 ESBLs structure from KazakhstanвЂ™s
133
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Poster Presentations II
SUNDAY вЂў November 2, 2014
International Meeting on Emerging Diseases and Surveillance 2014
resistance among microorganisms isolated from two groups of patients
revealed higher rate resistance (45.28%; 95%CI 43.4-47.2) simultaneously to 4 drugs (isoniaside + rifampicin+ethambutol+streptomycin) in
the group who received standard therapy in comparison with microorganisms from patients who never received treatment (22.37%; 95% CI
20.8-24.1) (p<0.001)
Conclusion: Our study showed that initial standard therapy with
using four drugs (isoniazid, rifampicin, pyrazinamide, and ethambutol)
might be as a factor resk for appearance of extensively drug-resistant
(XDR) M.tuberculosis.
23.021 Carbapenemase-producing Enterobacteriaceae
in a clinical hospital from Bucharest, Romania
SUNDAY
вЂў
November 2, 2014
D. Talapan1, O. M. Dorobat1, A. Streinu Cercel2, A. Rafila 1
1
National Institute for Infectious Diseases вЂњProf. Dr. Matei BalsвЂќ,
Bucharest, Romania, 2National Institute for Infectious Diseases вЂњProf.
Dr. Matei BalИ™вЂќ, Bucharest, Romania
Background: The spread of carbapenem-resistant Enterobacteriaceae
(most frequently Klebsiella pneumoniae) in the last years was observed
worldwide. Hospital-acquired infections caused by Enterobacteriaceae
producing different types of carbapenem-hydrolizing enzymes are now
commonly observed and represent a great limitation for antimicrobial
therapy.
Purpose: To evaluate the emergence of carbapenem-resistant
Enterobaceriaceae among the strains isolated from patients admitted
to the National Institute of Infectious Diseases, Bucharest and the identification of different types of carbapenemases.
Methods & Materials: Between JanuaryвЂ“June 2014, 582 strains of
Klebsiella pneumoniae, Enterobacter species and E.coli were isolated
from various clinical specimens. In the study were included all the
strains nonsusceptible to carbapenems according to the EUCAST clinical breakpoints (MIC>0.5 Вµg/L for ertapenem and >2 Вµg/L for meropenem and imipenem) as determined by using microdilution MicroScan
Panels (Siemens Healthcare Diagnostics).
The modified Hodge test (MHT) was performed as phenotypic confirmatory test for carbapenemase production according to CLSI guidelines and the combination disk test (KPC, MBL and OXA-48 Confirm
kit, Rosco Diagnostica) according to EUCAST guidelines (following the
manufacturerвЂ™s instructions).
Results: Fifty nonrepeat Enterobaceriaceae (34 Klebsiella pneumoniae, 6 E.coli, 6 Enterobacter cloacae and 4 Enterobacter aerogenes) were identified with decrease susceptibility to one or more
carbapenems (7.50% ertapenem, 51.02% meropenem, 53.16% imipenem). Most of these strains were isolated from urine (72%). MHT
was positive in 50% of carbapenem-resistant strains for which in 23
cases the carbapenem-hydrolizing enzyme was identified: 16 OXA-48,
3 KPC, 2 MBL and 2 strains had both KPC and MBL. Among carbapenemase-negative strains, false positive results were obtained by MHT
for 2 isolates. All carbapenemase-positive strains were 100% resistant
to 3rd and 4th generation cephalosporins, showing less resistance to
tigecycline (26.66% resistant and 26.66% intermediate), fosfomycin
(42.85%) and colistin (18.18%).
Conclusion: During 6 months there were isolated 23 carbapenemase-producing Enterobacteriaceae. The combinationn disk test
(Rosco) was able to detect not only MBL and KPC producers, but also
OXA-48 which proved to be the most frequent carbapenemase isolated
in our study.
Acknowledgment: this study is supported by SOP HRD, financed
from the European Social Fund and by the Romanian Government
under the contract number POSDRU/159/1.5/S/137390
134
IMED 2014
23.022 Increase in Clostridium difficile mortality in the
United States, 1999вЂ“011
V. N. Abdullatif, A. Noymer
University of California, Irvine, CA, USA
Purpose: To describe overall, as well as age- and sex-specific mortality from Clostridium difficile enteritis in the United States.
Methods & Materials: We analyze complete mortality records for the
United States during the ICD-10 era, 1999 to present (approximately
30 million deaths up to and including 2011, the most recent year for
which data are available). We calculate age-specific mortality rates and
age-adjusted mortality rates separately by sex.
Results: We find that mortality from Clostridium difficile has increased
dramatically in the last 13 years. The age-adjusted mortality rate for this
cause has more than quadrupled duting this period. Similar changes
are seen when considering use of this cause of death as a conributory
cause. The observed increases are remarkably stable at all ages 30
and up and are not caused by sharp increases among the elderly. Both
sexes are equally effected by the increase in C. difficile mortality.
Conclusion: Clostridium difficile entiritis is an emerging cause of
death in the United States. Changes in mortality rates due to this cause
by age have assumed a proportional-hazard pattern, ruling-out sharp
increases in (e.g.) nursing homes as the root cause. Continued vigilence and antibiotic stewardship is required.
23.023 Efficacy of antibiotic combinations against
P. aeruginosa isolated from UTI in Northern
Jordan hospitals
Y. H. Tarazi
Jordan University of Science and Technology, Irbid, Irbid, Jordan
Purpose: The current study aims to isolate and identify P. aeruginosa
from human urinary tract infections (UTI), evaluate their MICs for commonly used antimicrobial agents in North Jordan hospitals and to determine the best antibiotic combinations to be used for clinical treatment.
Methods & Materials: Six P. aeruginosa strains. Conventional methods for isolation and idetification of Pseudomonas aeruginosa Minimum
Inhibitory concentration (MIC) test, checkerboard titration technique
and Fractional Inhibitory Concentration Index (FICI) were used to
evaluate the synergy of antimicrobial combinations.
Results: The 6 isolates were susceptible to 10 antimicrobial agents;
ciprofloxacin, levofloxacin, amikacin, gentamicin, piperacillin, azlocillin,
ticarcillin, ceftazidime, imipenem, and colistin and resistant to chlortetracycline, doxycycline, amoxicillin, clavulanic acid and ceftazidime with
resistant rate 100, 100, 100, 100% and 83.3%, respectively. One hundred and four possible combinations of two antimicrobial agents were
tested. Synergistic interaction were observed in 37 combinations (26
showed 100% synergy and 11 showed 50-93% synergy of the 6 isolates). The best antimicrobials combinations showed synergism were;
ceftazidime and piperacillin with other beta-lactam group, ceftazidime
with tetracycline, aztreonam, ticarcillin, azlocillin, amoxicillin and tetracycline with clavulanic acid, piperacillin with chlortetracycline, ticarcillin
with amikacin and tetracycline, azlocillin with amikacin and tetracycline
with amoxicillin.In contrast, 39 combinations showed antagonistic
interactions (20 showed 100% antagonism and 19 showed 50-83.3%
antagonism) of the six isolates.
Conclusion: The current study shows that combinations of ОІ-lactam/
ОІ-lactam, ОІ-lactam/amikacin, ОІ-lactam/tetracycline were the best
in-vitro antimicrobial combination to be used to control P. aeruginosa
urinary tract infections. In addition the use of single drug of; ciprofloxacin, levofloxacin, gentamicin, amikacin, colistin, piperacillin, ticarcillin,
azlocillin, aztreonam, ceftazidime, and imipenem are effective.
Poster Presentations II
SUNDAY вЂў November 2, 2014
International Meeting on Emerging Diseases and Surveillance 2014
23.024 Antimicrobial resistance of fecal E. coli isolated
from cattle and pigs
M. Niculae1, I. C. Mates2, C. D. Sandru1, G. F. Brudasca1, E. Pall1,
M. Spinu1
1
University of Agricultural Sciences and Veterinary Medicine ClujNapoca, Cluj, Romania, 2Krka RomГўnia Srl, Bucharest, Romania
Purpose: Fusidic acid (FA) is largely used in the treatment of staphylococcal infections in different forms, including creams and ointments
which are its most common dosage forms in Egypt. The past few years
have seen a clinically significant prevalence of FA resistant staphylococci. Here, we are reporting the prevalence of FA resistance among
100 clinical isolates obtained from three major tertiary hospitals in
Alexandria, Egypt over 3 months in 2011. We are monitoring the rate of
emergence of resistant clones among some of the originally sensitive
M. M. WrГіblewska1, I. SeferyЕ„ska2, E. Lech-MaraЕ„da2, K. Warzocha1,
M. Giemza1, E. Mik1, A. Kuziak1, D. Е»abicka3, M. Gniadkowski3,
W. Hryniewicz3
Institute of Haematology and Transfusion Medicine, Warsaw, Poland,
Institute of Haematology and Transfusion Medicine, Postgraduate
Medical Training Centre, Warsaw, Poland, 3National Medicines
Institute, Warsaw, Poland
1
2
Purpose: In recent years a worldwide increase in the frequency of
isolation of carbapenem-resistant Gram-negative rods from clinical
specimens has been observed. Resistance mechanisms mediating
this phenotype in enteric rods are variable and comprise the production
of carbapenemases of class A (e.g. KPC), class B (e.g. VIM, NDM) or
class D (e.g. OXA-48). OXA-48 type carbapenemases are encoded
by genes located on the plasmids, which are responsible to a large
extent for their spread in the bacterial populations.Enteric rods producing OXA-48-type carbapenemase are now endemic in Turkey, Marocco
and India, as well as in France. Many cases, including epidemic outbreaks reported in Western Europe, are now linked to endemic regions,
particularly in the Mediterranean region. These strains belong to different species, the most common being Klebsiella pneumoniae, E. coli
and Enterobacter cloacae.
Methods & Materials: A 39-year-old woman from Cambodia was
treated at the Institute of Haematology and Transfusion Medicine (IHT)
in Warsaw from May 2012 because of acute lymphoblastic leukaemia
(ALL) diagnosed in Cambodia.
Results: In July 2012 and in February 2013 a significant bacteriuria
was detected (105 CFU/ml) with a strain of E. coli ESBL(+) susceptible to carbapenems. During the following hospitalisation in July 2013
a carbapenem-resistant strain of E. coli ESBL(+) was cultured from
the patientвЂ™s urine, and in August 2013вЂ”from stool culture. In the
National Medicines Institute in Warsaw it was confirmed that the strain
was producing carbapenemase of OXA-48 type. Strict infection control
procedures had been implemented and to date no other cases of colonisation or infection with this strain of other patients hospitalised in the
IHT were detected.
Conclusion: 1) OXA-48- producing strains of the Enterobacteriaceae
family may spread in Europe and other parts of the world not only by
November 2, 2014
A study from Alexandria, Egypt
A. Abouelfetouh1, M. Naguib2, M. Kassem1, M. El-Nakeeb1
1
Faculty of Pharmacy, Alexandria University, Alexandria, Egypt,
2
Faculty of Pharmacy, Damanhour University, Damanhour, Egypt
with acute lymphoblastic leukaemia and
potential for spread in hospitalised patients
вЂў
23.025 It is a no-brainer: never use fusidic acid alone!
23.026 Escherichia coli OXA-48 infection in a patient
SUNDAY
Purpose: The aim of the study was to investigate and analyze the
antibiotic resistance in bovine and swine fecal Escherichia coli strains
considering the impact of intensive antimicrobials practices, therapeutic and prophylactic, applied for these farm animals on the antimicrobial
resistance emergence.
Methods & Materials: The in vitro susceptibility patterns of a total of
117 strains isolated from pooled fecal samples obtained from finisher
pigs (n=65) and dairy bovine (n=52) towards 12 antimicrobials were
determined using the standard Kirby-Bauer disc diffusion antimicrobial susceptibility testing method according to CLSI guidelines. E. coli
ATCC 25922 was also tested as a quality control organism.
Results: Overall, E. coli isolates recovered from fecal samples were
resistant to one or more of 12 tested antimicrobials, with decreased
susceptibility towards penicillin/streptomycin (20.51%), tetracycline
(29.06%), ampicillin (30.77%), amoxicillin (45.30%) and amoxicillin/clavulanic acid (47.86%). Significantly higher levels (p < 0.01) of susceptibility were recorded only for fluoroquinolones: enrofloxacin (75.21%),
marbofloxacin (92.31%) and ciprofloxacin (100.00%) and cephalosporins: ceftiofur (87.18%) and cefquinome (82.91%), respectively.
Gentamycin and florfenicol were also active against E. coli (64.96%
and 61.54%, respectively). Multi-drug resistance (MAR) was exhibited
by both bovine and swine isolates, with strains simultaneously resistant to two or more antimicrobial groups. The most commonly recorded
multidrug-resistance patterns were represented by: penicillin/streptomycin-tetracycline,
penicillin/streptomycin-tetracycline-ampicillin,
penicillin/streptomycin-tetracycline-ampicillin-amoxicillin and penicillin/
streptomycin-tetracycline-ampicillin- amoxicillin/clavulanic acid. The
resistance level did not vary widely among the commensal bovine isolates compared to swine, except for a significant difference (p < 0.05)
in ceftiofur and cefquinome susceptibility in case of bovine strains suggesting differences in use regimens of these drugs in case of the farm
species.
Conclusion: The results of the in vitro antimicrobial susceptibility
testing from the study indicate that cattle and pigs feces contain strains
of E. coli resistant to various antimicrobials commonly used in veterinary medicine and with relevance for human medicine. MAR detection
in fecal E coli of bovine and swine origin reflects the importance of the
rational use of antimicrobials and recommends continuous monitoring
of the trends and features of resistance given the role of commensal
enteric bacteria as potential reservoir of resistance genes.
isolates. We are exploring some combinations for treating infections
due to resistant strains.
Methods & Materials: We determined FA minimum inhibitory concentrations (MIC) of the isolates using the agar dilution technique. For
laboratory-induction of FA resistance, we passed the strains 10 times in
medium containing FA (ВЅ x MIC). We also used polymerase chain reaction to screen for the presence of fusB, a gene coding for FA resistance.
Results: Forty two % of the isolates were resistant to FA with MICs
ranging between 3.1 and 1000 Вµg/mL. Of the remaining sensitive
strains, ten (MIC в‰¤0.4 Вµg/mL) were studied for development of FA resistance, without induction, and the level ranged between 1 in 106.3 and
108 colony forming units. The same isolates were laboratory-induced
for FA resistance, and as a result, FA MIC increased between 4 and 32
folds. S208, an originally-sensitive isolate, was subjected to a conjugation experiment with a FA resistant clone where rate of conjugation
reached 30%. It is interesting to note that S208 was shown to contain
fusB, but never exhibited FA resistance phenotype without induction
or conjugation. FA, at subinhibitory concentrations, was tested in
combination with gentamicin, rifampicin or ampicillin/sulbactam (SAM)
against the induced S208. All 3 combinations were synergistic with a
decrease in survivors of about 4 logs, relative to FA alone.
Conclusion: Although the exact mechanism of FA resistance in
S208 is not quite clear at this point, it is evident that exposure to FA
alone is deleterious to the responsiveness of the strain to treatment.
This finding suggests combination therapy with agents like gentamicin,
rifampicin or SAM as a necessity.
135
IMED 2014
Poster Presentations II
SUNDAY вЂў November 2, 2014
International Meeting on Emerging Diseases and Surveillance 2014
travellers, but also by patients requiring hospital care. 2). This report
comprises the third case of a carbapenemase OXA-48- producing
strain of the Enterobacteriaceae family in Poland. To date further 5
cases have been recorded in Poland. It points to the danger of these
strains being further spread in the country and the need for stringent
implementation of infection control procedures in healthcare.
23.027 Antimicrobial susceptibility and biofilm
formation by NT H. influenzae (NTHi) strains
isolated from Mexican patients
P. Gomez de Leon1, T. Santander1, F. J. DГaz1, F. QuiГ±ones2, E. Sada2
Universidad Nacional Autonoma de Mexico UNAM, Mexico City, DF,
Mexico, 2INER, Mexico, DF, Mexico
SUNDAY
вЂў
November 2, 2014
1
Purpose: NTHi strains are major cause of respiratory infections among
adults with chronic obstructive pulmonary disease (COPD), mainly
during exacerbation episodes. Several lines of evidence suggest that
biofilm formation by this microorganism may play an important role in
the pathogenesis of COPD. Our objective was to assess the possible
correlation between the antimicrobial susceptibility profiles and the ability of NTHi to form biofilms.
Methods & Materials: Forty NTHi strains from hospitalized adults
with COPD (INER, Mexico City) were evaluated for the in vitro biofilm
formation ability by means of a crystal violet staining-based microtiter
plate assay and optical density (OD) measurements. The NTHi strains
2019 and its siaB- mutant (donated by E. Swords, Wake Forest Univ.
USA) were included. The antimicrobial susceptibility patterns against
nine antibiotics were determined by the Kirby-Bauer method.
Results: Ninety % of the strains showed varying ability to form biofilms. Biofilm-producing strains were categorized as follows: Strong
(OD > 1.7), moderate (OD between 0.862 and 1.7), weak (OD between
0.48 and 0.862) and null (OD<0.48). Frequencies of biofilm-forming
strains were of 19.1%, 50%, 21.4% and 9.5% for the strong, moderate,
weak and null categories respectively. Seven out of 9 strong biofilmproducing strains showed antimicrobial susceptibility to all antibiotics
tested. Heterogeneous antibiotic susceptibility was observed among
moderate and weak biofilm-producing strains, whereas the null biofilmproducing strains showed resistance to two or more antibiotics. Overall,
antibiotic resistance to beta lactams and quinolones was observed
among the strains.
Conclusion: Most of the NTHi isolates from COPD patients were
able to form biofilms. Our results point to a high frequency of NTHi
strains with moderate to strong biofilm-forming ability that are susceptible to most of the tested antimicrobial agents. Analysis of data as
showed in this study concerning antimicrobial susceptibility and biofilm
formation ability of NTHi from COPD patients, may serve as a guide
for proper surveillance and selection of antibiotic treatment of airway
infections in these patients.
23.028 Understanding the mutations responsible for
carbapenem resistance in KPC-2
G. Cortina, P. Kasson
University of Virginia, Charlottesville, VA, USA
Purpose: The most common cause of carbapenem resistance in
Enterobacteriaceae is the presence of a beta-lactamase capable of
cleaving carbapenems. The KPC beta-lactamase is responsible for a
large fraction of clinical resistance to carbapenems, and constitutes all
Enterobacteriaceal carbapenemases in clinical isolates to date from
our hospital. We have examined KPC-2 and the extended-spectrum
beta-lactamase CTX-M9 to identify which mutations are be necessary
and sufficient to confer carbapenemase activity. To systematically test
a large number of mutations, we have used large-scale simulation of
gain-of-function mutants in CTX-M9 and loss-of-function mutants in
KPC-2 followed by targeted experimental validation.
Methods & Materials: We have examined point mutants for all
residues that differ between CTX-M9 and KPC-2, both the CTX-toKPC and the KPC-to-CTX mutations. Molecular dynamics simulations
of each mutant enzyme in complex with meropenem were performed
136
IMED 2014
using the GROMACS molecular dynamics package. We performed
1000 independent simulations per mutant and scored structural snapshots in these simulations by predicted ability to hydrolyze meropenem. Top-scoring mutations were then tested for gain-of-function by
introducing the CTX-to-KPC mutation into CTX-M9 via site-directed
mutagenesis and expressing the beta-lactamase in porin-deficient E.
coli. Carbapenemase activity was assessed via meropenem disc diffusion assays.
Results: Our simulations suggest a structural hypothesis for the carbapenemase activity of KPC-2: this enzyme in complex with meropenem is capable of assuming a conformation poised for hydrolysis that
CTX-M9 is not. When tested in complex with a cephalosporin that both
enzymes can hydrolyze, both simulated enzymes access the hydrolysis-ready position. We used this structural characteristic to score
KPC-to-CTX and CTX-to-KPC mutations. Of our five top-scoring mutations, all confer an increased ability to survive meropenem challenge,
suggesting that these mutations contribute to the activity of KPC. As
expected, no single mutation confers complete resistance.
Conclusion: We have developed a mutant scoring technology and
identified a set of mutations that increase the ability of CTX-M9 to
hydrolyze carbapenems. As expected, no single point mutation confers
complete resistance. We are currently investigating combinations of
mutations to better understand resistance. Another important question
is why CTX-M9 does not spontaneously acquire any of these mutations
when under selective pressure.
23.029 The changes of the levels of PFOR gene
expression between MZ-resistant and MZsusceptibility strains of G. intestinalis
R. Begaydarova1, Y. Yukhnevich2, D. Babenko1, S. Kaliyeva2,
I. S. Azizov2
1
Karaganda state medical university, Karaganda, Kazakhstan,
2
Karaganda State Medical University, Karaganda, Kazakhstan
Purpose: Gardia intestinalis is considered to be the most common
intestinal protozoan in the world (Thompson 2000). Widely using of
metronidazole for the treatment of giardiasis led to drug-resistant protozoa (Bansal,Sehgal et al.2006). Investigations for finding the genetic
markers related with resisstance to metronidazole led to discovery the
correlation between expression of PFOR gene and drug resistance
(Muller,Sterk et al.2007). The aim of the study was to evaluate the difference in the levels of PFOR gene expression between MZ-resistant
and MZ-susceptibility strains of G.inestinalis with relative gene expression approach.
Methods & Materials: The collection (n=159) of fecal samples
with cysts of G. intestinalis proved by commercial PCR real-time kit
вЂњParasitic Stool PanelвЂќ were gathered from 2013 to 2014. Phenotypic
detection of resistance to metronidazole was performed by cultivation G. intestinalis trophozoites in the presence of metronidazole
as described in (Upcroft and Upcroft 2001) with two concentration
of drug (6.3 and 3.2ВµM of metronidazole). The relative PFOR gene
expression was performed with real-time PCR (sybr gene) using
primer pair (F: 5 вЂ�-CTACGACATTGACTTTGCTG- 3 and R: 5
вЂ�-CCCATCTTCTTGTCCTTGAC- 3 вЂ�) normalized on Actin gene.
Bayesian analysis of qRT-PCR using MCMC.qpcr of R statistics package was used to calculate the relative gene expression.
Results: The rate of successful cultivation, when we were able to
obtain axenic cultures, was 30.2 % (48 strains out 159). 13 strains of
G. intestinalis showed the growth at 6.3 ВµM of metronidazole and were
considered as Resistant (R). 11 samples were with intermediate resistance and others (n=24) were susceptible to metronidazole and considered as a control. Based on Bayesian analysis MCMC.qpcr package,
the level of PFOR gene expression was down-regulated, ranged from
-1.7 to -1.34, in group of Giardia with MIC 6.3 ВµM (p<0.05), while the
level of relative expression of PFOR gene did not differ (p<0.05) in
group with MIC 3.2 ВµM. The gene expressions in different groups of G.
intestinalis are presented in Figure 1.
Conclusion: PFOR gene was down-regulated in sample group (MIC
6.3 ВµM) in comparison to control group.
Poster Presentations II
SUNDAY вЂў November 2, 2014
International Meeting on Emerging Diseases and Surveillance 2014
23.030 Antibiogram, virulence genes markers and
biofilm formation of aeromonas species
recovered from cattle
I. H. Igbinosa1, E. O. Igbinosa2, A. I. Okoh3
1
University of Pretoria, Pretoria, South Africa, 2University of Benin,
Benin City, Nigeria, 3University of FortHare, Alice, South Africa
Purpose: This study was carried out to assess the antibiotic susceptibility profiles of Aeromonas strains recovered from cow feces, and the
virulence potentials of the isolates by examining some virulence genes
markers and the adherence ability of the isolates.
Methods & Materials: Disc diffusion method was used for detection of antibiotic susceptibility of isolates, polymerase chain reaction
was used for the detection of virulence genes and antibiotic resistant
determinant while microtitre plate was used for quantification of biofilm
producing potential of Aeromonas isolates.
Results: Aeromonas isolates obtained in the study were found to
show total resistance to novobiocin, oxacillin, clindamycin, ticarcillin
and trimethoprim. Also Aeromonas strains demonstrated susceptibility against oxytetracycline, tobramycin and cefotaxime. Aeromonas
strains from Lovedale farm were found to harbor virulence genes in
the following proportion:-ast 35.7%, aer 71.4%, fla 60.7%, hlyA.25%,
lip 35.7%. While isolates from Fort Cox farms were found to possess
virulence markers in the following fraction:-ast 55.2%, fla 78.9%, alt
10.5%, aer 63.1%, hlyA 35.9%, lip 21%. Antibiotic resistance determinants were also found present in some isolates. Class 1 integron was
present in 27.2% of isolates; blaTEM gene was detected in 34.8% of
isolates while blaP1class A ОІ-lactamase gene was present in 12.1% of
isolates. About 86% of the isolates form biofilm on microtitre plates and
were categorized as follows:-non biofilm producer 14%, weak producer
35%, moderate producer 39% and strong producer 12%.
Conclusion: The possession of multidrug-resistant determinants
and virulence genes presence in Aeromonas isolates from cow feces
reveals the pathogenic and infectious significance of these isolates and
is of great significant to public health. The biofilm forming potential of
the isolates may pose challenge during treatment of infection associated with Aeromonas species.
cephalexin and co-trimoxasole due to changes
in ambulatory antibiotic consumption in Croatia
A. Asghar
Umm Al-Qura University-Hajj Research Institute, Makkah,
Saudi Arabia
Purpose: Methicillin-resistant S. aureus (MRSA) has become widespread and tends to be resistant to multiple antibiotics. Methicillin
resistance is conferred by the acquisition of the mecA gene, which is
carried by a mobile genetic element called the staphylococcal cassette
chromosome mec (SCCmec). There are five major types of SCCmec
elements (IвЂ“V). The majority of hospital acquired MRSA (HA-MRSA)
strains carry SCCmec types I, II, or III, whereas communityacquired
MRSA (CA-MRSA) strains carry SCCmec types IV or V. In addition,
Panton-Valentine Leucocidin (PVL) is a gene encoding a powerful cytotoxin that strongly associated with CAMRSA strains. The present study
aimed to identify the types of SCCmec and PVL genes among clinical
MRSA isolates.
Methods & Materials: This study was conducted in Makkah hospitals from March to September of 2012. A total of 206 S. aureus clinical isolates were analysed using standard microbiological methods.
Multiplex PCR was performed on genomic DNA from MRSA isolates in
order to identify the types of SCCmec. In addition, PCR was performed
to detect the PVL gene among the isolates.
Results: Of the 206 S. aureus isolates, 114 (55.3%) were
MRSA, and 100 of the MRSA isolates carried the mecA gene.
Results from SCCmec typing revealed that 3% were type I; 9%
were type II; 47% were type III, and 29% were type IV. Nineteen
per cent of the isolates harboured the PVL gene. Furthermore,
there was a statistically significant correlation between the
presence of the PVL gene and SCCmec type IV.
Conclusion: The virulence of MRSA strains is increasing in both hospital and community settings in Makkah, highlighting the importance of
their rapid identification in order to appropriately control infection.
November 2, 2014
Background: Community-acquired urinary tract infections (CA-UTIs)
are very frequent infections and Escherichia coli is the most common
cause of UTIs.
Aim: To assess the impact of ambulatory antibiotic consumption
on resistance patterns of E. coli strains isolated from patients with
CA-UTIs in Zagreb region
Methods & Materials: All urinary specimens with significant bacteriuria processed during three different years in nine-year period (2005,
2011 and 2013) were included. Urinary specimens were collected in the
course of routine diagnostics procedures. Resistance patterns of 3052
E. coli strains collected during the first study period were compared
with those of 4817 E. coli strains from the second study period, and
9417 strains isolated in 2013. Antimicrobial susceptibility of isolates to
commonly prescribed antibiotics was tested by disk diffusion method
according to CLSI criteria. Information on ambulatory consumption of
antibiotics was expressed in defined daily doses per 1000 inhabitants
per day (DID).
Results: In the studied period ambulatory consumption of broad
spectrum penicillins, first generation of cephalosporins and co-trimoxasole declined from 4.09 DID, 1.65 DID and 1.70 DID in 2001 to 3.60
DID, 1.21 DID and 0.98 DID in 2009, respectively. While consumption
of fluoroquinolones (FQs) remained more or less unchanged, usage
of nitrofurantoin showed since 2007 constant increase. Considering
the resistance of E. coli between 2005 and 2013, significant decrease
resistant Staphylococcus aureus isolated
from Makkah hospitals
вЂў
J. Vranes1, V. Ticic2, B. Bedenic3, M. Anusic2, T. Marjan2,
A. Mlinaric-Djepina2
1
School of Medicine, University of Zagreb, Zagreb Institute of Public
Health вЂњAndrija StamparвЂќ, Zagreb, Croatia, 2Zagreb Institute of Public
Health вЂњAndrija StamparвЂќ, Zagreb, Croatia, 3University hospital Center
Zagreb, Zagreb, Croatia
23.032 Molecular characterization of methicillin-
SUNDAY
23.031 Recovery of Escherichia coli susceptibility to
in resistance was observed for amoxicillin (from 46.1% to 38.7%;
p<0.01, cephalexin (from 21.3% to 10.2%; p<0.01) and co-trimoxasole
(from 28.9% to 19.85%; p<0.01). The recovery of susceptibility to cotrimoxasole was the most significant in younger women group, where
only 16.5% strains were resistant. While resistance to nitrofurantoin
remained very low in the study periods (2.4% in 2005, 2.1% in 2010,2.5
in2013), resistance to FQs significantly increased (8.6% in 2005, 12.0%
in 2010 and 15% in 2013; p<0.01).
Conclusion: Due to the updates in Croatian guidelines on empirical treatment of CA-UTIs, changes in ambulatory use of antibiotics
occurred. Withdrawal of amoxicillin, cephalexin and co-trimoxasole
from the list of first line agents for empirical treatment of uncomplicated
cystitis, elicited significant improvement in susceptibility of uropathogenic E. coli to these antibiotics.
23.033 Prevalence of opportunistic intestinal parasites
and drug resistance pattern of selected
diarrheogenic enterobacteriaceae among
cotrimoxazole prophylaxis taking HIV
seropositive individuals at St. PaulвЂ™s Teaching
Hospital, Addis Ababa
M. M. T. K. Kebede, M. M. T. K. Tadesse
Ethiopian Public Health Institute, Addis Ababa, Ethiopia
Purpose: The objectives of this study were to determine the prevalence of opportunistic intestinal parasites as well as to assess antibiotic
resistance pattern of selected diarrheognic Enterobacteriaceae among
HIV infected ART-NaГЇve as well as ART-experienced individuals taking
co-trimoxazole prophylaxis.
Methods & Materials: A hospital based cross-sectional study was
conducted among HIV sero-positive individuals with diarrhea taking cotrimoxazole prophylaxis at least for two weeks or more. Stool samples
was collected and examined, using modified Ziehl-Neelsenmethods
137
IMED 2014
Poster Presentations II
SUNDAY вЂў November 2, 2014
International Meeting on Emerging Diseases and Surveillance 2014
to determine the prevalence of opportunistic intestinal parasites.
Besides, culture followed by sensitivity tests was done to isolate and
evaluate the antibiotic sensitivity patterns of selected diarrheogenic
Enterobacteriaceae. The strength of association was measured using
chi-square for both OIs and bacterial isolates. p-value of < 0.05 were
considered statistically significant within 95% confidence intervals.
Results: A total of 162 HIV sero-positive co-trimoxazole taking
patients presented with diarrhea, Frequently isolated intestinal parasites were Cryptosporidium spp. (6.8%), Larva of Strongyloides stercoralis(3.7%) and oocyst of Isospora belli (3.1%). The common bacterial
isolates was Shigella species (6.8%), Salmonella paratyphi (4.9%) and
Salmonella typhi (3.1%).There were co-infection with intestinal parasites and pathogenic Enterobacteriaceae with rate of (3.7%).Most bacterial isolates were resistant to co-trimoxazole with over all resistance
pattern of 91.7% and these isolates were sensitive to Ceftraxone with
the overall resistance pattern of 20.8%,Next to Ceftraxone the isolates
were sensitive to Chloramphenicol with resistance pattern of 33.3%.
The most multi drug resistant bacteria isolates were Salmonella typhi
which is 100 resistant to co-trimoxazole, Ampicilline, Nitroforantine and
Naldixic acid. There was no significant relation observed with water
source and other related risk factors.In addition patient at high WHO
clinical stage were not a risk for prevalence of intestinal opportunistic
parasite (COR = 0.5 [95% C.I. 180вЂ“1.141]).
Conclusion: In the present study the prevalence of intestinal opportunistic parasite were lower than the from prevalence studies report
without co-trimoxazole intervention. Bacterial resistance to co-trimoxazole was found very high, hence its use for routine treatment of acute
diarrheal illness is questionable.
23.034 Detection of CTX-M-15 type of extended
spectrum beta lactamase producing Klebsiella
pneumoniae in Cairo University Hospitals
in Egypt
SUNDAY
вЂў
November 2, 2014
R. H. Abd El-Aziz, M. Abd El-Halim, A. El-Banna, A. El-Kholy
Cairo university, Faculty of medicine, Cairo, Egypt
Purpose: CTX-M ESBLs have emerged as the predominant type of
ESBLs in many parts of the world. However, data about the presence
of CTX-M ОІ-lactamases in Cairo University Hospitals are still missing.
Our study was carried out to detect the presence of CTX-M ESBLproducers among isolates of Klebsiella spp. and to identify the predominant specific CTX-M group in Cairo University Hospitals, Egypt.
Methods & Materials: In our study 100 Klebsiella clinical isolates
were identified as K. pneumoniae using Microbact TM gram-negative
identification system 12A for Enterobacteriaceae (Oxoid, Basingstoke,
UK). The isolates were phenotypically confirmed as ESBL producers
by both the double disk synergy test(DDST) and combined disk test
according to the guidelines of the Clinical and Laboratory Standards
Institute. Further genotypic analysis was done using PCR to amplify a
universal DNA fragment specific for the different CTX-M ОІ-lactamases
to detect the presence of CTX-M gene followed by RFLP to identify the
specific blaCTX-M groups.
Results: the CTX-M gene was found in 16 (16%) of the ESBLproducing K. pneumoniae clinical isolates; 14 (87.5%) of them
belonged to CTX-M-1-group and 2 (12.5%) belonged to CTX-M-8group. Sequencing of two randomly selected isolates from the CTX-M-1
group identified blaCTX-M-15 (GenBank accession no. JN849393). In
our study 76% of ESBL-producing K. pneumoniae infection were health
care-associated (HAI), 7.9% of them were CTX-M producers. The rest
of the ESBL isolates (24%) were community-acquired (CA) infections,
41.7% of them were CTX-M producers p value < 0.001. Thus a significantly higher percent of the CTX-M gene was found among CA
infections.
Conclusion: This demonstrates for the first time the incidence of
CTX-M enzymes, the predominant CTX-M group and the presence
of CTX-M-15 gene among ESBL-producing Klebsiella pneumoniae in
Cairo University Hospitals. It also demonstrates that CTX-M enzymes
especially CTX-M-15 were significantly higher among CA versus HAI.
138
IMED 2014
23.035 First identification of NDM-1 carbapenemase
from Klebsiella pneumoniae in Seychelles
J. T. Bibi1, A. Michault2
1
Ministry of Health, Victoria, Seychelles, 2Centre Hospitalier RГ©gional,
St Pierre, France
Purpose: This abstract documents the emergence of New Delhi
metallo-beta-lactamase (NDM-1) in Klebsiella pneumoniae in
Seychelles.
Methods & Materials: In September 2012, a 47 year old Seychelles
man with a history of paraplegia was transferred from Seychelles
Hospital to the department of neurology of the Centre Hospitalier
Universitaire in the south of Reunion Island. On the day of admission
the patient was screened for multidrug resistance.
Results: Culture on chromID ESBL media (BioMГ©rieux La Balme
les Grottes France) isolated Klebsiella pneumoniae strain from a rectal swab. MIC values were measured by the Vitek Compact system
(BioMГ©rieux). The K. pneumoniae was resistant to carbapenem (imipenem MIC = 8 mg/liter, ertapenem MICв‰Ґ 8). The isolate was not susceptible to 19 other antimicrobial agents screened (MIC Vitek: ampicillin,
ticarcillin, cephalotin, cefoxitine, ceftazidime, cefotaxime, gentamicin,
tobramycin, netimicin, amikacin, trimethoprim sulfamethoxazole, nalidixic acid, ofloxacin, norfloxacin, ciprofloxacin; Etest MIC: colistin; disk
diffusion method: tigecycline).The strain was tested on Mueller Hinton
agar with the KPC + MBL confirmation ID Kit (Rosco diagnostica
Taastrup Denmark). The diameters obtained with meropenem 10Вµg,
meropenem 10Вµg cloxacillin, meropenem 10 Вµg boronic acid, meropenem dipicolinic acid were respectively 17, 17, 17, 25 millimeters that
were interpreted as positive metallo-ОІ-lactamase test.
The metallo-ОІ-lactamase was confirmed genotypically by CheckMDR CT 102 (Naas Cuzon et al 2011) (Check-Points Health BV, The
Netherlands) and gave a positive result for NDM-1 carbapenemase
and CTX-M group 1 and SHV wt extended spectrum ОІ-lactamase
(ESBL) genes.
Most bacteria NDM-1 gene harbour multiple resistance (Potron 2011,
Doccobo-Perez 2012) and the only treatment options are often colistine
and tygecycline. For this patient all the tested antibiotics were resistant
including colistin and tigecycline.
Conclusion: This patient had never left the Seychelles before
September 2012 for hospitalization in Reunion Island. The acquisition
of NDM-1 K. pneumonia was probably in Seychelles. To our knowledge
this is the first report of carbapenemase and NDM-1 in Seychelles
and the fourth report of NDM-1 in the South West islands of the Indian
Ocean (Poirel L 2012 Antimicrobiol Agents Chemo, Cabanes 2012
JCM). Protocols need to be put in place for active surveillance of New
Delhimetallo-beta-lactamase (NDM-1) inKlebsiella pneumoniae in
Seychelles.
23.036 Magnitude of extended spectrum beta-
lactamase producing entrobacteriaceae
among patients admitted for bacterial infection
in Adama Hospital and clinical sample sent
to Oromia Public Health Laboratory,
Adama, Ethiopia
G. M. Misgana, T. W. Abebe, G. J. Guto
Adama Hospital Medical College, Adama, Oromia, Ethiopia
Purpose: Beta-lactam group of antibiotics is by far the largest group of
antibacterial agents used in clinical medicine and they are among the
most frequently prescribed antibiotics worldwide. Despite this fact the
emergency and spread of extended-spectrum ОІ lactamases producing
bacterial pathogens compromised the use of these novel antibiotics.
Prevalence of ESBLs varies from institute to institute. Thus the current study aimed to determine the magnitude of extended-spectrum ОІ
lactamases producing entrobacteriaceae.
Methods & Materials: Across sectional laboratory based prevalence
study was conducted from May 1/2013-June 1/2014. Consecutive nonrepeat culture isolates of were obtained from different clinical specimens of 384 clients. Antimicrobial susceptibility was determined by
Kirby-Bauer disk diffusion method. All strains which were resistant for
cefotaxime and ceftriaxone were selected for checking the extendedspectrum ОІ lactamases production by the modified double disc synergy
test.
Poster Presentations II
SUNDAY вЂў November 2, 2014
International Meeting on Emerging Diseases and Surveillance 2014
Results: A total 384 different clinical samples from 178 males and
279 females were processed and 133 organisms were isolated of which
entrobacteriaceae were account for 46.61% (62). E. coli (56.45%) is
the leading isolate among the entrobacteriaceae. Twenty one entrobacteriaceae were suspected for extended-spectrum ОІ lactamases
production and 88.95% of them were confirmed to produce it. Majority
of extended-spectrum ОІ lactamases producer were isolated from urine
and surgical wound swab with 23.5% (4), 52.9% (9), 17.6% (3) 5.9%
(1) were isolated from urine, surgical wound swab, body fluids and
ear discharge respectively. E.coli is the leading extended-spectrum ОІ
lactamases producer and it accounts for 58.8% while Proteus species,
Klebsiella species, E. cloacae, Citrobacter species and accounts for
17.6%, 11.8%, 5.9%,and 5.9% respectively.
Conclusion: Routine detection of extended-spectrum ОІ lactamases
-producing microorganisms should be done by each laboratory, which
helps physicians in choosing an appropriate empirical therapy and conserve powerful antibiotics for life threatening infections.
23.037 Drug resistance variants in chronic hepatitis B
Iranian patients under long term Lamivudine
treatment
S. R. Mohebbi1, P. Azimzadeh1, S. Mokhtari2, M. Khanyaghma1,
S. Kazemian1, A. Sharifian1, M. R. Zali1
1
Gastroenterology and Liver Diseases Research Center, Tehran, Iran,
Islamic Republic of, 2Department of Microbiology, Faculty of Biological
Sciences, Tehran, Iran, Islamic Republic of
industry: an analysis of the current state of
surveillance metrics
J. Varco, M. J. Varco
Georgetown University, Washington, DC, USA
Purpose: Over 90% of international cargo is transported via the maritime shipping industry, with over 50,000 cargo ships servicing over 150
nations; despite this, a mere 10% of cargo is screened. As the global
trade industry grows, attention must be paid to the potential for disease
dissemination, whether accidental or deliberate. At present, significant
gaps exist in shipping infrastructures with respect to surveillance, prevention, and mitigation.
and occurrence of aflatoxin contamination in
stored maize across three agro-ecological
zones in Kenya
G. W. Gachara
Kenyatta University, Nairobi, nairobi, Kenya
Purpose: Aflatoxin contamination of maize in Africa poses a major
threat to food security and the health of many African people. In Kenya,
aflatoxin contamination of maize is high due to environmental, agricultural and socio-economic factors. This research was carried out
to gather scientific information on the fungi population, diversity and
aflatoxin level during post-harvest period. The study was conducted in
three geographical locations of Kitui, Kitale and Nakuru.
Methods & Materials: Samples were collected from storage structures of farmers and transported to the Biosciences eastern and central
Africa (BecA)-International Livestock and Research Institute (ILRI) hub
laboratories. Mycoflora were recovered using the direct plating method.
A total of five fungal genera (Aspergillus, Penicillium, Fusarium,
Rhizopus and Bssyochlamys spp.) were isolated from the stored maize
samples.
Results: The most common fungal species that were isolated from
the three study sites included A. flavus at 82.03% followed by A.niger
and F.solani at 49% and 26% respectively. When individual samples
were analysed using Vicam fluorometer method,aflatoxin analysis
revealed that most of the samples (58.4%) had been contaminated
with aflatoxins. The means were significantly different (p=0.00<0.05) in
all the three locations. Genetic relationships of A. flavus isolates were
determined using 13 Simple Sequence Repeats (SSRs) markers. T
Principal Coordinates Analysis (PCoA) of the genetic distances among
the 91 A.flavus isolates explained over 50.3% of the total variation
when two coordinates were used to cluster the isolates.
Conclusion: Findings from this study showed that maize stored in
the sampled geographical regions were found to be highly contaminated. The level of extracted aflatoxins was found to higher than recommended levels (10 Вµg/kg). A. flavus strains were found to be the
most predominant hence calling for adequate procedures that maintain
low moisture content.
November 2, 2014
23.038 Biosecurity and the global maritime shipping
23.039 Genetic diversity of Aspergillus flavus
вЂў
Bioterrorism and Biological Warfare
Climate Change and Ecological Factors
in Disease Emergence
SUNDAY
Purpose: Worldwide, about 2 billion people have been infected with
hepatitis B virus and 400 million people have become chronically
infected. Chronic HBV infection can lead to serious liver damage, cirrhosis and hepatocellular carcinoma. Lamivudine, a nucleoside analogue, has been widely used for treatment of chronic HBV since 1998.
Lamivudine treatment results in significant histologic, virologic, and
biochemical improvement among patients with chronic HBV infection.
However, treatment with treatment results in a high rate of drug resistance, which is primarily associated with the substitutions in the YMDD
motif of HBV reverse transcriptase domain. Therefore, the detection
and monitoring of these resistance mutations is of clinical importance.
Aim: To determine the rate of YMDD mutation among Iranian HBV
infected patients under long term Lamivudine therapy.
Methods & Materials: Samples from 70 HBV infected patients under
long term Lamivudine therapy who were sent to gastroenterology ward
of the Taleghani Hospital, Tehran, were studied. Serological and biochemical markers of HBV infection were determined. HBV DNA was
extracted and a semi nested-PCR was performed to amplify a region
of the Polymerase gene that covers sequences codifying YMDD motif
of HBV. Substitution of the Methionine at residue 204 with Valine,
Isoleucine or serine in these patients was investigated.
Results: YMDD mutations were detected among 36 patients. 7 of
them had rtM204V mutation and the rest of them showed rtM204I variant. No YSDD mutation was found among Iranian patients.
Conclusion: Results indicate that mutations related to Lamivudine
arise during prolong treatment, in chronically infected patients. The
incidence and pattern may be different but YIDD mutation is more common among these patients.
We seek to elucidate upon the relationship between infectious disease prevention, surveillance, biosecurity, and global shipping. We
examine specifically the metrics of oversight currently employed in the
United States, the European Union, and the nation-states of Southeast
Asia. Global and local policies are examined, as well as the efficacy
thereof through an evaluation of recorded metrics. We seek also to
elucidate upon a well-known event of precedenceвЂ”the Black Death
(plague) outbreak of Medieval Europe, which was introduced via the
shipping industry at that time. We identify вЂ�lessons learnedвЂ™ from previous events, as well as methodologies that should be employed to
address these issues and ensure global trade is neither hindered by,
nor acts as the vehicle for the dissemination of infectious agents.
Methods & Materials: We evaluate all available scientific literature,
as well as individual shipping methodologies and metrics, as well
as policies instituted by governmental, nongovernmental, and local
authorities, in addition to statistical analyses and key interviews with
industry professionals. We generate feasibility metrics for potential
amendments, as well as identify unique, global sociodynamic factors
that must be considered in the implementation thereof.
Results: Our findings illuminate notable gaps with regard to disease
surveillance and prevention in the global maritime shipping arena. We
propose both engineering and policy-based solutions to address these
issues, from the perspectives of both accidental transport and deliberate dissemination of infectious agents.
Conclusion: The global maritime shipping industry presents several
notable vulnerabilities from the perspective of disease transmission,
whether accidental or deliberate. We identify these deficiencies and
propose effective surveillance and mitigative metrics by which to better
protect global public health.
139
IMED 2014
Poster Presentations II
SUNDAY вЂў November 2, 2014
International Meeting on Emerging Diseases and Surveillance 2014
23.040 Climatic influences on seasonality associated
23.042 Escherichia fergusonii: an emerging multi-drug
P. Souliphone
National Center for Laboratory and Epidemiology (NCLE), Vientiane,
Vientiane, Lao, PeopleвЂ™s Democratic Republic of
B. A. Glover, A. O. Jenkins, M. vanVuuren
University of Pretoria, Onderstepoort, Pretoria, Gauteng, South Africa
with influenza illness in Lao PDR, 2008вЂ“2011
Purpose: the study objective was to determine the relationship of seasonality of ILI patient and climate pattern in Lao PDR.
Methods & Materials: Sampling of ILI cases using prescribed
selection criteria was carried out one day per week from five hospital
surveillance sites and aggregated into three geographical representative regions: north, central and south. Laboratory testing nasal pharyngeal swabs was carried out at the National Center for Laboratory
and Epidemiology (NCLE), using RT PCR. A retrospective review of
climatic data (rainfall, humidity and temperature) was obtained from
the Department of Meteorology, Ministry of Science and Environment,
from 2008вЂ“2011.
Results: Twenty-four percent (512 out of 2053) of samples tested
from seasonality of ILI patients were positive for influenza. It is clearly
demonstrated, principally from July through December. Whereas gradual increases and declines of ILI correspond with beginning and ending
of the rainy season, influenza positivity yields are observed rising and
dramatically peaking only at the tail end of this period, accounting for
over 40% of ILI. This climatic phenomenon was evident in the all three
geographical regions, annually.
Conclusion: Rainfall proved predictive of ILI, but not so for laboratory
confirmed influenza although seasonal patterns were clearly evident.
Diseases at the Interface of Humans,
Wildlife and Other Animals
23.041 Molecular characterization of Echinococcus
SUNDAY
вЂў
November 2, 2014
granulosus from hydatid cysts isolated from
human and animals in Golestan Province,
North of Iran
M. Soosaraei
Social Security Organization, Gorgan, Iran, Islamic Republic of
Purpose: The aim of the present study was to determine the molecular
characteristics of Echinococcus granulosus from paraffin-embedded
tissues of hydatid cysts isolated from human and protoscoleces of
hydatid cysts from sheep, cattle and camel isolates using PCR- RFLP
of ITS1- rDNA analysis in Golestan Province, northern Iran.
Methods & Materials: E. granulosus isolates from human patients
infected with hydatid cyst and protoscoleces from hydatid cysts of
sheep, cattle and camel isolates were collected from different hospitals
and the abattoir throughout the Golestan Province. In all, 60 E. granulosus genomic DNA were extracted and examined by PCR-ITS1 of
rDNA and amplified using BD1/4S and EGF1/EGR2 primers, followed
by RFLP using Alu1, Msp1 and TaqI restriction enzymes.
Results: The PCR-ITS1 products obtained from sheep, cattle and
human isolates were similar to sheep strain (1000 bp and 391 bp).
Majority of the camel samples yielded 295 bp DNA bands. RFLP -ITS1
of E. granulosus with Taq1 in human, sheep and cattle isolates showed
similar patterns in the number and size of DNA. RFLP methods in
camel isolates showed a different genotype, using Taq1, whereas no
DNA bands were observed using Alu1 in camel and human isolates.
Therefore, two clearly distinguishable banding patterns of E. granulosus were obtained with the three enzymes, which separating human,
sheep and cattle isolates from the camel origin.
Conclusion: The results indicate the possible of transmission of the
G1 and G6 genotypes of E. granulosus between livestock animals and
human in Golestan Province.
140
IMED 2014
resistant pathogen
Purpose: Escherichia fergusonii was first proposed as a new species
within the genus Escherichia and family Enterobacteriaceae in 1985
with a 64% similarity to Escherichia coli when analysed through DNA
hybridization. It has been isolated from humans usually in cases of
opportunistic infections and was first described in animals in cases clinically suggestive of salmonellosis abd identified to be of enteric origin.
Methods & Materials: Bacterial isolates from faecal samples of nonhuman primates at two wildlife rehabilitation centres in South Africa
were screened for the presence of Escherichia coli. Samples were
obtained from non-human primates with 3 distinct levels of exposure
to humans. Biochemical characterization of the bacterial isolates done
using the RemelВ® RapidID One panel strips showed some adonitol
positive, sorbitol negative strains uncharacteristic of E. coli. Two tests
were further carried out using Simmons citrate agar supplemented
with 2% adonitol and other biochemical tests based on their ability to
ferment cellobiose and D-arabitol. A duplex PCR was carried out targeting two genes; the yliE gene (cellulose synthase and regulator of
cellulose synthase island) and the EFER_1569 (putative transcriptional
activator for multiple antibiotic resistance). E. fergusonii isolates were
confirmed by the presence of 233bp for the yliE gene and or 432bp for
the EFER_1569 gene. Antimicrobial susceptibility tests were run on the
isolates using microbroth-dilution-plates
Results: Twenty three E. coli-like bacteria were confirmed as E.
fergusonii based on the confirmatory tests and they were in 100%
agreement. All E. fergusonii bacteria isolated from juvenile vervet monkeys with maximum human exposure showed positive amplification to
EFER_1569. Resistance patterns to the antimicrobial drugs in both E.
coli and E. fergusonii were 95% similar with observed differences to
Amikacin.
Conclusion: This is the first reported isolation and confirmation of E.
fergusonii in non-human primates. The presence of EFER_1569 genes
in young vervets that had consistent human contact is suggestive of
the possible routes of transmission of antimicrobial resistance into the
non-human primate populations; however we cannot fully conclude
this until we carry out molecular fingerprinting analysis. Our findings
support the assertion that E. fergusonii is an emerging pathogen of
zoonotic importance.
23.043 Parapoxvirus infections in Turkey
T. C. Oguzoglu1, A. Karakas2, B. T. KoГ§1, S. Salar1
1
Ankara University Veterinary Faculty, Ankara, Turkey, 2Gulhane
Military Medical Academy, School of Medicine, Ankara, Turkey
Purpose: Viruses of the genus parapoxvirus from the family Poxviridae
are comprised traditionally of orf virus (ORFV, ecthyma contagiosum),
pseudocowpox virus (PCPV) and bovine papular stomatitis virus
(BPSV), which infect ruminants, and zoonotic transmission is capable
of causing cutaneous infections in humans worldwide. At the same
time these infections may be classified as emerging diseases. The
purpose of this study, to present informations about the existence
of parapoxvirus infections in Turkey in ruminants and human. This
study is originated from two studies that have already been published
(Karakas et al., 2013, ArchVirol May;158(5):1105-8; Oguzoglu et al.,
2014, VirusDisease, DOI:10.1007/s13337-014-0214-z) on presence of
emerging zoonotic parapoxviruses in Turkey, and additionally contributed with molecular characterization based on sequence analysis of
new achived parapoxvirus from a goat at seasonal outbreaks in 2014,
Turkey.
Methods & Materials: Molecular characterization methods in the
cited studies have been used. The additional material of this study is
scab sample from one Saanen goat kid that two months old age. In this
herd, Orfvirus-associated some clinical signs have been described on
the muzzle, lips, mouth and in the oral cavity of infected animals.
Results: In our two studies about parapoxvirus infections in Turkey
were titled that вЂњFirst molecular characterization of a Turkish orf virus
strain from a human based on a partial B2L sequenceвЂќ and вЂњEvidence
of zoonotic pseudocowpox virus infection from a cattle in turkeyвЂќ.
Poster Presentations II
SUNDAY вЂў November 2, 2014
International Meeting on Emerging Diseases and Surveillance 2014
Molecular charaterization results of new achived scab sample from an
infected goat kid showed that it also was a parapoxvirus.
Conclusion: Domestic ruminants infected with parapoxviruses
provides the most likely source of human infections. Additionally,
the current live vaccines also may be efficient on spreading of
parapoxviruses which contaminates the environment in a manner similar to natural infection. Our results showed that zoonotic
parapoxvirus infections are endemic among the different animal species in Turkey. Clinicians in hospitals with questions regarding the
diagnosis of a suspected parapoxvirus infection in Turkey should be
consider that may be originated occupational or other contact with
infected ruminants.
23.044 Preventive vaccination against rabies and
necessity of oral vaccination of wildlife
L. Ninidze1, R. Obiso2
1
National Food Agency, Tbilisi, Georgia, 2Attimo R&D, Blacksburg, VA,
USA
Z. N. Hedge
San Diego Humane Society & SPCA, San Diego, CA, USA
Purpose: Few studies exist on the zoonotic disease risk for animal
shelter workers with regards to rabies, and no studies have examined if
animal shelters in the US have protocols and policies in place to protect
staff against rabies exposure. Animal shelter workers are a high risk
population that come in contact with a variety of domestic animals and
wildlife species with unknown medical histories on a daily basis.
Methods & Materials: A cross-sectional internet-based survey was
conducted to gain knowledge about rabies prevention policies, practices, and training for shelter staff in the US. Survey questions focused
on demographic shelter information, rabies preventive protocols, rabies
tissue submission protocols, rabies pre-exposure prophylactic vaccination and rabies concern and worker training.
Background: West Nile Virus (WNV) is spread to humans from a mosquito-bird cycle. Originally endemic in Africa and the Mediterranean
region, it has emerged as a global disease of medical significance with
symptoms ranging from mild fever to severe neuroinvasive disease.
Kenya has a significant wild and domestic bird population and three
active migratory bird paths: the Rift Valley, the Eastern and Coastal flyways. West Nile Virus has been isolated from vectors in these different
regions in Kenya and we hypothesis that these isolates could represent
independent introductions of the virus into the country.
Objective: To perform genomic sequence comparisons of West Nile
virus isolates from different regions in Kenya to identify genetic diversity consistent with independent introductions into the country.
Methods & Materials: Archived West Nile Virus isolates were
cultured, RNA extracted and RT-PCR performed to generate fifteen
overlapping fragments spanning the genome. The fragments were
sequenced and assembled into consensus sequences for each virus
isolate using DNA Baser Sequence Assembler and translated using
Transeq (EMBOSS). Sequence comparisons were made with publically available sequences using Clustal Omega alignments to identify
mutations associated with distinct West Nile lineages and phenotypes.
Results: Partial genome sequences were obtained for all the West
Nile virus isolates from the regions representing the 3 bird migratory
flyways and deduced amino acid sequences analyzed for strain divergence at key residues in the envelope and nonstructural proteins. Key
findings were that the coastal isolate had a T249P substitution at the
NS3 -249 locus associated with increased virulence in birds and an A
at position 70 in the NS1 protein unlike the rift valley isolate which had
the Cluster 2 defining A70S substitution. The isolate from the Eastern
region had an L in the L338T position of the NS1 protein undocumented
in any WNV isolates from Kenya and associated with attenuated strains.
Conclusion: This study provides evidence of the co-circulation of
West Nile virus isolates in Kenya with unique genetic signatures correlated with the different bird migratory paths consistent with independent
virus introductions. The study highlights the importance of surveillance
along these flyways to identify emergent virulent strains.
November 2, 2014
staff knowledge and training in animal shelters
in the United States
from different geographical regions in Kenya
L. Musila1, A. Nyunja1, H. Koka1, R. Sang2
1
USAMRU-K, Nairobi, Kenya, 2Kenya Medical Research Institute,
Nairobi, Kenya
вЂў
23.045 Rabies prevention protocols and policies and
23.046 Genetic analysis of West Nile Virus isolates
SUNDAY
Purpose: The rabies virus represents a serious, endemic concern in
Georgia. This virus affects the central nervous system, which leads to
brain damage and death for the infected animal. Cases of rabies in
Georgia are mostly found in villages bordering forested areas. In total,
37.7% of GeorgiaвЂ™s 69,700 km2 land area is forested, which provides
a great habitat for many species of wild animals that may act to spread
the rabies virus. Historically, there has been little effort to preemptively
vaccinate species against the virus. From 2008 to 2012, vaccination
against rabies was conducted only when the disease was detected at
a given foci.
Methods & Materials: In this study, 2,883 tissue samples were collected from different species of animals in order to test for the rabies
virus. These species include: dogs, cats, cattle, small ruminants,
horses, pigs, and other wild animals. This sampling represents wild animals as well as livestock who are likely to interact with these species.
Results: Of the animals tested, 959 tested positive for rabies. The
species that tested positive include: 715 dogs, 178 cattle, 19 cats, 19
horses and pigs, 17 wild animals, and 11 small ruminants. The most
commonly affected animals were: domestic animals (78.2%), livestock
(22.1%), and wild mammals (1.8%). During this time period, 46 people
died from hydrophobia as a result of the rabies virus in Georgia during this period. In the second half of 2013, a prophylactic vaccination
campaign against rabies was initiated. The goal of the campaign was
to vaccinate carnivores in high-risk areas in order to reduce virus
transmission.
Conclusion: In total, 62,113 domestic animals were vaccinated during the campaign in 2013. In that year, only 116 cases of rabies were
registered in Georgia, a decrease of approximately 20% over the previous years. The countryвЂ™s unregulated breeding system and likelihood of
livestock coming into contact with rabies-infected animals contributes
to the endemic threat of the rabies virus in Georgia. Preventative vaccination of wildlife is a promising and necessary practice that should
continue to be utilized.
Results: A total of 100 animal shelters participated in the survey and
shelters varied in type, size, location and species accepted at the shelter. The majority of shelters have at least one individual in charge of
infection control, with the veterinarian being the most common (63%).
With regard to requirements for personal protective equipment (PPE)
worn by animal staff when handling animals at intake, during euthanasia or in quarantine, 38% required the use of PPE. Latex gloves (43%)
were the most commonly required PPE. In 75% of responding shelters,
there is a written policy for staff-related animal bites, and 83% keep
records on all bite quarantine animals. With regard to bite quarantine,
63% of shelters place a warning sign on bite quarantine housing. Sixty
percent of shelters submit animals or tissues for rabies testing, and
50% of those shelters have written protocols for tissue submission.
The majority of responding shelters (56%) do not provide pre-exposure
prophylactic vaccination for staff, and rabies was listed as a top disease
concern by 26% of shelters. Many shelters do provide staff training in
animal handling (90%), proper use of animal restraint equipment (77%)
and bite and scratch prevention (86%).
Conclusion: Results from this survey show the need for further
education on rabies prevention policies within animal shelters and an
emphasis for written protocols and requirements for staff to follow in
order to reduce the risk of rabies exposure.
141
IMED 2014
Poster Presentations II
SUNDAY вЂў November 2, 2014
International Meeting on Emerging Diseases and Surveillance 2014
23.047 A вЂ�One HealthвЂ™ approach to the elimination
of rabies
SUNDAY
вЂў
November 2, 2014
E. Fogelberg, M. Kennedy, W. Gates
World Animal Protection, London, London, United Kingdom
Purpose: Globally there are an estimated 55,000 human deaths
caused by rabies each year. The majority of cases occur in Africa
and Asia, with children under the age of 15 most often infected.
More than 99% of cases are transmitted via dog bites (WHO, 2013).
Misconceptions about the best means of controlling rabies often result
in inhumane dog culling; this is not an effective means of rabies control
(WHO, 2013). Risk of transmission in rabies-endemic areas is high,
due to an abundance of potentially-infected stray and free-roaming
dogs in conjunction with poor local knowledge of rabies management
and dog behaviour. Rabies has been effectively controlled in several
areas through coordinated mass canine vaccination campaigns when
at least 70% herd immunity has been achieved (WHO, 2013). The
elimination of rabies is possible through raising awareness about the
disease, coupled with humane dog population management and mass
dog vaccination campaigns.
Methods & Materials: To ensure this is achieved, sharing of knowledge across regions and a вЂ�One HealthвЂ™ approach to animal and
human health is critical. Programmes require political support that
actively integrates human and animal health agencies. NGOs, such as
World Animal Protection, have a key role to play in facilitation. By way
of example, World Animal Protection worked with the government of
Zanzibar to establish a humane and sustainable dog population management programme as part of their rabies control strategy.
Results: Following initial success, the objectives of the Zanzibar dog
population management programme were expanded to include rabies
elimination through mass dog vaccination. The project integrates public
health and veterinary resources with village administrative systems to
produce a strong multi-sectorial approach. This has led to rabies being
controlled on the island with the programme now transitioning to the
elimination and surveillance stage.
Conclusion: World Animal Protection supports a holistic approach
which sees animal and human health as inextricably connected, and
works through cooperation between municipalities and public health
and veterinary sectors. By coupling humane dog population management with responsible ownership and mass canine rabies vaccination,
conflict between humans and dogs can be mitigated, creating a harmonious co-existence.
23.048 Molecular and microbiological detection of
Bartonella spp. bacteremia in cats
M. R. Drummond1, P. P. V. D. P. Diniz2, B. G. Lania1,
D. M. R. Demolin1, R. Gilioli1, E. Breitschwerdt3, G. Vieira-Damiani1,
D. G. Scorpio4, P. E. N. F. Velho1
State University of Campinas, Campinas, Sao Paulo, Brazil, 2Western
University of Health Sciences, Pomona, CA, USA, 3North Carolina
State University, Raleigh, NC, USA, 4Johns Hopkins University School
of Medicine, Baltimore, MD, USA
1
Purpose: Currently, Bartonella genus comprises at least 31 species
and subspecies, 15 of them are pathogenic to humans. Three species
are associated with the largest number of clinical symptoms in human
beings: Bartonella bacilliformis, Bartonella quintana and Bartonella
henselae. B. henselae is the one most frequently associated with
human diseases. This specie is considered zoonotic and its transmission is usually related with infected cat scratches In order to evaluate
Bartonella spp. bacteremia prevalence in cats from Campinas, Brazil
and to isolate a B. henselae regional strain, we analyzed blood samples
from 112 cats.
Methods & Materials: An overview of the diagnostic procedures
performed is presented in the Figure 1. The whole blood was collected
during spay/neuter surgery and submitted to DNA extraction. A preenrichment culture in liquid medium was also performed. An aliquot of
142
IMED 2014
the ten-day culture was seeded in a solid medium supplemented with
30% sheep blood. Another aliquot was tested for PCRs of two different
gene targets. Sample isolates obtained from solid cultures were also
tested.
Results: An overview of the results is presented in the table 1. B.
henselae DNA was detected in 86 (77%) of blood samples and 56
(50%) of liquid culture samples. In total, bacteremia was detected in
90% (101/112) cats. When the genus-specific ITS conventional PCR
was used, Bartonella spp. bacteremia was detected just in 31/112
(28%) of liquid culture. Sixteen Gram-negative isolates were obtained
from solid medium culture and eleven of them were PCR positive.
Some samples were sequenced and three of these isolates demonstrated a 100% homology with B. henselae Brazil-1 strain at analyzed
ITS region. These isolates were the first samples of this strain to be
deposited at a Culture Collection in Brazil. The specie-specific FtsZ
nested PCR was positive at least at one sample of bacteremic cats.
Conclusion: Our results show that Bartonella sp. bacteremia prevalence among cats is very frequent in Campinas, Brazil and suggest that
the prevalence of Bartonella spp. infection among cats and its consequences for public health remains underestimated. More sensitive
diagnostic methods should be used in studying of this infection.
23.049 Age-specific seriousness of avian influenza
A(H7N9) in the second-wave epidemic in China
E. H. Lau1, P. Wu1, J. Y. Wong1, G. Freeman1, J. T. Wu1, G. M. Leung1,
Y. Hongjie2, B. J. Cowling1
1
The University of Hong Kong, Hong Kong, China, 2Chinese Center
for Disease Control and Prevention, Beijing, China
Purpose: In spring 2013, a novel avian influenza A(H7N9) emerged in
China causing more than 130 human infections mostly in the eastern
provinces. The hospital fatality risk of A(H7N9) were about 35% and
caused severe illness especially in older patients. In winter 2013-14,
a second wave of A(H7N9) began with higher burden in the southern
provinces in China. We estimated the relative risk of serious illness of
patients aged 65 or above in the second wave of A(H7N9) epidemic,
accounting for potential age-specific differences in poultry exposure
across different geographic locations.
Methods & Materials: A line list of laboratory-confirmed A(H7N9)
cases with information on age, geographic location and seriousness
of disease (mild/severe) were collated by Chinese Center for Disease
Control and Prevention. A recent survey was also conducted in early
2014 on residences in 5 urban cities and 3 rural cities, to measure the
age-specific exposure to live poultry. We constructed a statistical model
on age-specific risk of serious illness as a function of geographic location and live poultry exposure, stratified by urban and rural areas. The
relative age-specific risk seriousness of A(H7N9) was estimated under
a Bayesian framework.
Results: There were 274 laboratory-confirmed A(H7N9) cases aged
15 or above in China, Oct 1, 2013вЂ“May 19, 2014. Of which, 156 were
severe cases. The estimated average exposure to live poultry shows
small variation across urban areas but exhibited strong age-specific
patterns with older people having higher exposure in most cities. We
estimated that the risk of serious illness after A(H7N9) infection was
3.1 times higher in patients aged 65 or above (95% credibility interval
2.7-4.1), compared to 5.1 times (95% credibility interval 3.0-8.2) in the
first wave of the epidemic.
Conclusion: Adjusted for the age-specific and geographical variation
in live poultry exposure, we found a slightly lower relative risk of serious
illness in laboratory-confirmed A(H7N9) patients in the second wave
epidemic. This may indicate improvements in patient management particularly for patients with co-morbid conditions, or change in virulence of
the circulating virus strain in Southern China which was divergent from
that in the first wave epidemic.
Poster Presentations II
SUNDAY вЂў November 2, 2014
International Meeting on Emerging Diseases and Surveillance 2014
23.050 Do Costa Rican urban raccoon populations
pose a public health concern?
M. Baldi1, G. Alvarado2, E. Barquero3, G. Hernadez4, C. Jimenez1,
M. Santoro5, S. Hutter6, S. Smith7, C. Walzer 8
1
Universidad Nacional, Heredia, Costa Rica, 2Universidad de Costa
Rica, San JosГЁ, Costa Rica, 3Universidad Nacional de Costa Rica,
Heredia, Costa Rica, 4Servicio Nacional de Salud Animal, Heredia,
Costa Rica, 5вЂњSapienzaвЂќ University of Rome, Rome, Italy, 6University
of Veterinary Medicine, Vienna, Vienna, Austria, 7University of
Veterinary Medicine Vienna, Vienna, Austria, 8University of Veterinary
Medicine, Vienna, Austria
M. T. Q. Le1, D. Tham1, D. N. Pham1, N. S. Vu2, T. M. Luong1,
H. L. K. Nguyen1, T. T. Le1
1
National Institute of Hygiene and Epidemiology, Hanoi, Viet Nam,
2
Ministry of Health, Hanoi, Viet Nam
Purpose: Highly pathogenic avian influenza A/H5N1 (H5N1) is
endemic in poultry in Vietnam. The country has experienced the third
highest number of human infections with H5N1 in the world. A study in
Hanoi in 2001 prior to the epizootic that was identified in 2003, found
A/H5N1 specific antibodies in 4% of poultry market workers (PMWs).
After eight years of circulation of H5N1 in Vietnam, we conducted a
seroprevalence study to determine the seroprevalence of antibodies
to H5N1 among 607 PMWs in Hanoi city, Thaibinh and Thanhhoa
provinces.
Methods & Materials: Using the horse hemagglutination inhibition
Purpose: Increasing contact between human and non-human primates
enhances exchange of pathogens in both directions. Close host relationship and previous Parvovirus cross species transmission evidence
prompts a question, whether also newly described primate bocaviruses
may cross the species barrier. Members of the genus Bocavirus belong
to the Parvoviridae family. These are small, non-enveloped single
stranded DNA viruses infecting large number of mammals including
human and non-human primates resulting in respiratory and gastrointestinal tract disorders. To investigate whether primate bocaviruses
cross the species barrier, we analyzed fecal sample isolates from wild
living savanna-woodland chimpanzees (Pan troglodytes schweinfurthii)
from Ugalla, Tanzania and captive chimpanzees from Czech and
Slovak zoos to determine their phylogenetic relationship to previously
established human and nonhuman primate bocaviruses. Although primate bocaviruses were previously described, there are only few partial
sequences of NS1 and VP2 genes of gorilla (GBoV) and chimpanzee
bocaviruses obtained from wild living primates available on GenBank,
and only little is known about their phylogenetic relationship to human
(HBoV) isolates.
Methods & Materials: Diagnostic nested PCR with degenerated
primers targeted in NS1 and VP2 genes were performed. Whole
genome sequences were obtained by PCR using sets of degenerated primers. Phylogenetic analyses of obtained NS1 and VP2 genes
sequences were performed using maximum likelihood method.
Results: Nested PCR results confirmed the presence of Bocavirus
DNA in one captive (1/25) and 13 wild living Ugalla chimpanzee
(13/113) fecal samples. Phylogenetic analyses of both genes revealed
a close relationship of Ugalla chimpanzee isolates to bocaviruses isolated from Cameroonian chimpanzees described previously. The captive chimpanzee isolate did not cluster to any other known chimpanzee
bocavirus, either in NS1, or VP2 genes, and formed separated cluster
more related to HBoV genotypes.
Conclusion: Bocaviruses infecting wild chimpanzees are species
specific and form two distinct lineages circulating in wild living chimpanzee population. The captive chimpanzee isolate formed a separated cluster divergent from other chimpanzee bocaviruses and due
to frequent contact with human care-takers may have a human origin.
To further support or refute the potential of bocaviruses crossing the
species barrier, more samples from different chimpanzee populations
in various stages of habituation should be investigated.
November 2, 2014
H5N1 virus among live poultry market workers
in NorthernVietnam, 2011
infecting wild and captive living chimpanzees
K. Brozova1, K. Hrazdilova1, A. K. Piel2, F. A. Stewart2,
K. J. Petrzelkova3, V. Celer1
1
University of Veterinary and Pharmaceutical Sciences Brno, Brno,
Czech Republic, 2University of Cambridge, Cambridge, United
Kingdom, 3Academy of Sciences of the Czech Republic, Brno, Czech
Republic
вЂў
23.051 Prevalence of antibodies against influenza A/
23.052 Phylogenetic characterization of Bocaviruses
SUNDAY
Purpose: Due to the increasing report of raccoons in Costa Rican
urban areas there is a risk of zoonotic transmission. The purpose of our
study was determine which zoonotic disease agents are holded by an
urban raccoon population that can pose a real disease risk to humans
Methods & Materials: A total of 20 raccoons classified as problematic intruders, were removed in collaboration with the Veterinary School
(Universidad Nacional de Costa Rica) and National Wildlife Service
(MINAE). Life traps were placed either in a small wooded area or inside
the gardens in affected areas and left three nights. Biological samples
were taken from captured animals (serum, blood and faeces). To assess
Baylisascaris procyonis parasites a real-time PCR specific for primer
sequence of it was used (Dangoudoubiyam et al 2009). Adult parasites were measure following the description given by Karacas 2001.
Raccoon faeces were culture for Salmonella isolation and identification. It was cultured directly onto selective agar media (Xylose-LysineDesoxycholate (XLD), and biochemistry methods for identification were
used. Serological positive isolates were assess against serovar using
specific antisera (antigen for flagellar [H]and somatic [O]). Leptospira
antibodies in serum were assessed by microscopic agglutination test
(MAT) according to OIE diagnostic test recommendations.
Results: We found that 50% of the raccoons were positive to Baylisascaris
procyonis. We also found that 30% of 20 assessed animals were
culture positive to Salmonella Typhimurium, Hartford and San Diego.
Additionally, 20% of them were seropositive to Leptospira interogans,
including; serovare Australis, Copenhagani, Kantorowics, RGA,
Tarrasovi, Hebdomadibus and Icterohaemorrhagiae.
Conclusion: Based on our preliminary findings we are sure that
Costa Rica`s urban raccoon population harbours zoonotic agents that
can pose a real disease risk to humans. Human public concern has
a direct connection to how wildlife is perceived, especially when they
are associated with a potential risk for disease transmission.Risk factors and their dynamics urgently need be studied to mitigate zoonotic
transmission to the susceptible human population.
assays (HHI) and the microneutralization assay (MN) with all three
clades of HPAI H5N1 viruses that have cirulated in Vietnam since 2004
Results: The overall seroprevalence was 6.1% (95%CI 4.6%вЂ“8.3%).
The highest rate (7.2%) was found in PMWs at Hanoi city, and the
majority of seropositive subjects (70.3%) were slaughters or sellers of
poultry
Conclusion: The continued circulation and evolution of HPAI H5N1
requires comprehensive surveillance of both human and animal sites
throughout country, with follow up studies on PMWs to estimate the risk
of avian-human transmission of HPAI H5N1 viruses in Vietnam
143
IMED 2014
Poster Presentations II
SUNDAY вЂў November 2, 2014
International Meeting on Emerging Diseases and Surveillance 2014
23.053 Hantavirus in persons exposed to domestic
and wild rats in the UK: Results of a
sero-prevalence study
SUNDAY
вЂў
November 2, 2014
J. Duggan1, R. Close2, L. McCann3, N. McCarthy2, T. Mannes2,
M. Keys1, D. Wright1, A. Walsh4, A. Charlett4, T. Brooks1
1
Public Health England, Salisbury, United Kingdom, 2Public Health
England, Oxford, United Kingdom, 3Public Health England, Bristol,
United Kingdom, 4Health Protection Agency, London, United Kingdom
Purpose: Introduction: Six recent indigenous cases of acute kidney
injury due to Seoul hantavirus infection from exposure to wild or pet
rats suggest this infection is emerging in the UK. In particular, Seoul
hantavirus infection in people exposed to pet вЂњfancyвЂќ rats has not previously been documented. The recent cases of hantavirus indigenous
to the UK suggest that the problem may be more widespread than is
currently known and that there may be a public health risk to those who
breed, own or handle pet rats in the UK, or are exposed to wild rats
through their occupation.
Objective: To conduct a sero-prevalence study to determine the
exposure incidence in at-risk groups with close contact with domesticated and wild rats to assess risk and inform public health advice.
Methods & Materials: We compared a random sample of stored
blood specimens (group 1) with recruited owners/breeders of pet rats
(group 2), persons with occupational exposure to pet rats (e.g. veterinarians, group 3) and persons with occupational exposure to wild rats
(e.g. farmers, sewage workers, pest control workers, group 4), aiming
to sample 300 participants per group. Information on the nature and
extent of contact with rats was collected by questionnaire. Hantavirus
immune response was measured using a commercial immunofluorescence assay (Euroimmune) to test for 6 hantaviruses (Hantaan,
Puumala, Seoul, Dobrava, Saareema, Sin Nombre).
Results: From October 2013 to May 2014, 498 individuals were sampled, 84 in group 2 (all were members of the specialist pet rat owning/
breeding community), 170 in group 3 and 244 in group 4. Preliminary
results suggest that hantavirus seroprevalence varied from 35% in
group 2 (95% CI:25-45%) to 1.4% in group 4 (95% CI:0.5-3.9%)
Conclusion: Variation in seroprevalence across groups with different exposure suggests that occupational exposure to wild rats carries
almost no risk, however domestic acquisition of hantavirus among specialist pet rat owners/breeders may be more common than previously
thought. Awareness among clinicians should be raised to ensure diagnosis and appropriate treatment. Additional testing of non-specialist pet
rat owners is required to determine whether the risk of hantavirus is
isolated to the specialist pet rat community.
23.054 Bovine tuberculosis in pigs: a case of
Mycobacterium caprae infection
B. Amato1, V. Di Marco Lo Presti1, E. Gerace1, F. Mandanici1,
E. Biasibetti2, M. B. Boniotti3, L. Spuria1, F. Valenza2, M. L. Pacciarini3,
M. T. Capucchio2
1
Istituto Zooprofilattico Sperimentale of Sicily, Barcellona P.G.
(Messina), Italy, 2University of Torino, Grugliasco (Torino), Italy,
3
Istituto Zooprofilattico Sperimentale della Lombardia ed Emilia
Romagna, Brescia, Italy
Purpose: Bovine tuberculosis is a worldwide zoonosis that has been
reemerging in different ecological scenarios. The presence of wildlife
reservoirs frequently hampers eradication. In Sicily cases of tuberculous lesions have been reported in a population of Sicilian Black pig, an
autochthonous variety of pig that live in Natural Parks of Nebrodi and
Madonie in free or semifree roaming conditions, frequently sharing pastures with cattle. The authors report a description of M. caprae infection
case in a Nebrodi Black pig with the characterization of pathological
lesions and genotyping of isolated strains.
Methods & Materials: In the first half of 2013, a Nebrodi Black pig
carcass was subjected to a complete routine meat inspection at the
abattoir. Macroscopical, histopathological and bacteriological investigations were carried out on suspected lesions. Molecular identification
144
IMED 2014
and genotyping of the isolate was also performed by Spoligotyping
and MIRU-VNTR analysis (ETRA-E, VNTR 2163a, 2163b, 4052, 3155,
1895, 3232 and MIRU-26).
Results: An adult sow, showed generalized granulomatous lesions
involving lymph nodes of the head, thorax and abdomen, tonsils,
udders and coxo-femoral joint. In the tonsils small translucent gray
nodules with a pale yellow core were observed. Multiple granulomatous lesions of different size were identified in three udders. A voluminous neoformation (10 cm) involving the right coxo-femoral joint
was also detected. The X-ray examination revealed bone remodeling
of the trochanter and ischial bones osteolysis. Histologically granulomatous lesions appeared as classical fibronecrotic granulomas with a
necrotic centre surrounded by epithelioid, multinucleated giant cells,
macrophages and lymphocytes with minimal or abundant calcifications.
Mycobacterial colonies Ziehl-Neelsen positive were isolated from all
the affected organs. By genotyping, all the isolates were M. caprae,
spoligotype SB0866 and MIRU-VNTR 4,1,5,4,4,11, 4,2,4,3,8,7.
Conclusion: In Sicily, the number of isolates of M.caprae compared
to M.bovis in domestic and wild animals since 2004 till now is very low
(0,01%). This is the first report of M. caprae isolation in pigs in Italy.
The same genotype was found in two cattle herds from neighboring
areas, suggesting an inter-species transmission. At the moment, little
is known about the host susceptibility to M. caprae infection in swine.
23.055 Features of epidemiology of Echinococcosus
granulosus in the Southern Russia
L. Ermakova1, N. Pshenichnaya2, Y. Kirtanasov3, K. Bolatchiev4,
T. Tverdokhlebova1
1
Rostov Research Institute of Microbiology and Parasitology, Rostovon-Don, Russian Federation, 2Rostov State Medical University,
Rostov-on-Don, Russian Federation, 3Rostov regional hospital
#2, Rostov-on-Don, Russian Federation, 4Rospotrebnadzor on
Karachaevo-Cherkessia Republic, Cherkessk, Russian Federation
Background: Human echinococcosis is characterized by the formation of permanent endemic foci. In the Southern Russia (SR) maintaining of current foci provides by a dry and hot climate, large number of
livestock and dogs. These areas are the habitat of all definitive hosts
of EchinococcusвЂ”wolf, jackal, fox, raccoon dog and vulpes corsac.
High prevalence of Echinococcosis in humans constantly recorded
in Karachaevo-Cherkessia and Kabardino-Balkaria, Astrakhan and
Stavropol regions. Human morbidity in these areas exceeds the average level in Russia more than 2 times. However, in the neighboring
areas (Ingushetia and Chechnya, Rostov region) with the same conditions for the implementation of the full life cycle of parasite, the incidence of Echinococcosis is missing or significantly below the average
level in Russia.
Aim: To determine the reasons of variability in the incidence rate of
echinococcosis among a population in the territories with similar climatic and household conditions in SR.
Methods & Materials: During the period from 2008 to 2013 we performed a retrospective analysis of the medical records of 74 patients,
treated surgically due to echinococcosis in the republican hospital in
Karachaevo-Cherkessia and 68 in the Rostov Regional Hospital #2.
Also we analyzed 82 epidemiological survey of echinococcosis cases
in Karachaevo-Cherkessia and 57 in the Rostov region. 5914 blood
serums of healthy inhabitants have been studied for anti-Echinococcus IgG by ELISA in the frames of sero-epidemiological study in the
several territories of the SR.
Results: Analysis of the medical records demonstrated that the
number of patients received surgical treatment in hospitals of the
Rostov region in the period 2008-2013 exceeds the officially registered
cases. In Karachaevo-Cherkessia number of officially reported cases
is more than number of patients, who operated due to echinococcosis
in the republican hospital, because patients surgically treated in other
territories of the SR were also taken into this account. The results of
sero-epidemiological surveys showed that the percentage of seropositive persons among conditionally healthy population of the Rostov
region 2 times more than in Karachaevo-CherkessiaвЂ”0.8% and 1.6%
respectively.
Conclusion: The real prevalence of echinococcosis in some territories of the SR is higher than official statistics.
Poster Presentations II
SUNDAY вЂў November 2, 2014
International Meeting on Emerging Diseases and Surveillance 2014
23.056 Psittacosis associated with pet birdвЂ™s
ownership: a cause of public health concern
V. L. Ferreira1, M. V. Silva2, T. F. Raso1
1
Faculdade de Medicina VeterinГЎria e Zootecnia (FMVZ),
Universidade de SГЈo Paulo (USP), SГЈo Paulo, SP, Brazil,
2
Instituto de Infectologia Emilio Ribas, SГЈo Paulo, SP, Brazil
T. Perez-Gracia1, F. Rivas2, B. Suay1, S. GarcГa-Valdivia3, F. GalanSanchez2, M. Rodriguez-Iglesias2
1
Cardenal Herrera Univ, Valencia, Spain, 2Puerta del Mar Univ Hosp,
Cadiz, Spain, 3Puerto Real Univ Hosp, Puerto Real, Spain
Purpose: Hepatitis E is a very important public health disease in many
developing countries. Sporadic cases of acute hepatitis E virus (HEV)
infections have been described and the number of documented autochthonous infections seems to be increasing in industrialized countries.
The common transmission route is fecal-oral. Other probable modes
of transmission in endemic areas include vertical transmission, blood
transmission, person-to-person contact and zoonotic transmission
route. The aim of this study was to determine the prevalence and
incidence of HEV infection among normal population with anormal
transaminases levels in the south of Spain, once discarded other hepatotropic infections.
Methods & Materials: A total of 267 patients were included in this
study due to present ALT >100U/mL in sera obtained in a community
area of 550.000 assigned to Puerto Real and Puerta del Mar Univ
Hosp (CГЎdiz, Spain). These patients were selected with hepatitis viral
markers negative with the exception of hepatitis A virus infection. Blood
samples were obtained from all the participants by venipuncture, and
sera were obtained and frozen at в€’80В°C until used. The presence
of anti-HEV antibodies (IgG and IgM) was investigated using the
Fortress Diagnostics ELISAs (Fortress Diagnostics Limited, Antrim,
Northern Ireland). Positive results by the immunoenzymatic methods
K. Russell, B. Said, D. Brown, D. Morgan, H. Kirkbride
Public Health England, London, United Kingdom
Purpose: Human exposure to potentially zoonotic infections often
occurs first in occupational groups with close and frequent exposure to
animals. The ability to undertake serological surveys of such groups has
been helpful in building up the evidence base of the zoonotic potential
of new pathogens. This approach was used in Europe to determine the
zoonotic potential of Schmallenberg virus which first appeared in cattle
and sheep in 2011. The United KingdomвЂ™s cross-governmental Human
Animal Infections and Risk Surveillance (HAIRS) group is responsible
for the risk assessment of new and emerging animal pathogens and the
Serum Archive for Emerging Zoonoses (SAfEZ) has been established
to collect blood samples which can be tested for new and emerging
animal pathogens to inform these risk assessments.
Methods & Materials: This anonymous archive of sera has been
developed from individuals regularly exposed to animals through their
work or recreational activities. It includes an occupational cohort from
veterinary and field staff based at the United Kingdom governmentвЂ™s
Animal Health and Veterinary Laboratories Agency (AHVLA), as well as
blood samples donated from bat handlers, sheep, pig and poultry workers across England. Public Health England is working collaboratively
with the AHVLA and a range of stakeholder organisations representing
the pig, poultry, and sheep industries to promote participation in the
study to animal workers.
Results: 150 serum samples have been collected to date since
recruitment commenced in May 2014, with an expected target of 750
samples collected during the first year of the archive. Further recruitment is planned throughout 2014-2015 via the AHVLAвЂ™s occupational
health service and other large animal industry events. A steering
committee will oversee the future management and use of the serum
archive.
Conclusion: This unique archive, the first of its kind worldwide,
will contribute to the understanding and risk assessment of new and
emerging zoonoses, and is consistent with the One Health concept that
human and animal health are inextricably linked. The Serum Archive for
Emerging Zoonoses represents a valuable national resource and is a
successful model which could easily be replicated in other countries to
contribute to a greater international understanding of emerging threats
to health.
November 2, 2014
seroprevalence and acute infection in patients
with anormal transaminases levels
A new national resource to inform public
health risk assessments for new and emerging
animal infections
вЂў
23.057 Hepatitis E virus in the South of Spain:
23.058 The serum archive for emerging zoonosesвЂ”
SUNDAY
Purpose: Birds are among the most popular pets around the world.
Nonetheless, public awareness about the risks regarding zoonotic
disease posed by pet birds is very limited. One of the main bacterial
diseases related to birds exposure is psittacosis, caused by Chlamydia
psittaci. Infections occur when a person inhales the aerosolized organism from secretions of infected birds. In humans psittacosis varies in
severity from mild вЂњflu-likeвЂќ symptoms with fever, headache and photophobia to serious atypical pneumonia. Unless specifically thought of
and investigated, the diagnosis of psittacosis can be easily missed and
the disease is usually treated as atypical pneumonia. The aim of this
report is to describe cases of psittacosis related to household pet birds.
Methods & Materials: A 16 years old male patient was admitted to
the Instituto de Infectologia Emilio Ribas, Brazil, with fever, fatigue and
persistent cough. During anamnesis the patient reported previously
therapy with broad-spectrum antibiotics with limited improvement of his
health conditions and having pet birds, thus psittacosis was suspected.
Chest x-ray revealed interstitial infiltrate in the lungs. Serum samples
of the patient and others five family members were obtained and tested
using a microimmunofluorescence assay (Foccus,В® USA).
Results: Three of those presented anti-C. psittaci antibodies. The
patient revealing IgG titer of 1:64; IgM titer was not detected. The
patientвЂ™s father, 51 years old, with IgG titer of 1:64 and IgM 1:20 and
the patientвЂ™s brother, 14 years old, with IgG titer of 1:128. Both reported
having mild respiratory symptoms in the past. Due to the zoonotic
nature of this disease swabs samples of their birds were collected and
C. psittaciвЂ™s DNA was detected by PCR in love birds (A. personata) and
cockatiel (N. hollandicus).
Conclusion: Probably this disease occurs more often than reported.
As shown in this study, milder cases may not seek medical attention
and physicians may not elicit a history of bird exposure. Furthermore,
laboratorial confirm cases can be difficult to determine since antimicrobials employed empirically for community-acquired pneumonia therapy
may inhibit antibodies response. Due to the popularity of birds as pets
there is a need for consciousness campaigns directed at health workers and the general public.
were confirmed by Western Blot analysis (RecomBlot HEV IgG/IgM,
Mikrogen, Martinsried, Germany).
Results: The overall prevalence of anti-HEV IgG confirmed by immunoblotting was 6.8% (18/263) and anti-HEV IgM was detected in 4.9%
(13/263). Fourteen patients (61.2%) with anti-HEV were male. The
median age of anti-HEV IgG positive patients was 53 years and the
median age of anti-HEV IgM positive patients was 29 (p<0,005). Two
cases were hepatitis A coinfection with anti-HAV IgM positive.
Conclusion: Hepatitis E is a global infection with an estimated incidence of millions of cases per year and it should no longer be considered of little importance in developed countries. It must be included
in the diagnostic algorithm of acute, chronic and fulminant hepatitis
even in the presence of more common hepatitis virus or other non-viral
hepatitis.
23.059 Seroprevalence of hepatitis E virus in wild
boars in Serbia
B. I. Kureljusic, B. SaviД‡, N. JezdimiroviД‡, Дђ. CvetojeviД‡,
J. Kureljusic, D. JakiД‡-DimiД‡, O. RadanoviД‡, V. MiliД‡eviД‡, V. IvetiД‡
Institute of Veterinary Medicine of Serbia, Belgrade, Serbia
Purpose: Hepatitis E is considered an emerging human viral disease
with many evidences of zoonotic nature of disease. Recent studies
from Serbia indicated presence of the hepatitis E virus (HEV) in commercial pig farms, as well as high seroprevalence in human population.
145
IMED 2014
Poster Presentations II
SUNDAY вЂў November 2, 2014
International Meeting on Emerging Diseases and Surveillance 2014
Aim: To determine HEV seroprevalence in wild boars in 9 large hunting areas in northern, southern, western, eastern and central parts of
Serbia.
Methods & Materials: Serum samples collected from 111 wild boars
from 2010 to 2013 were analysed by commercial ELISA test for the
presence of antibodies directed against HEV. Recombinant HEV antigen of the ORF 2 and ORF 3 of the genotypes 1 and 3 was coated on
the ELISA plate.
Results: Overall HEV seroprevalence was 52,25% (58/111). All hunting areas in all 5 parts of Serbia were positive on the presence of antibodies against HEV. Detection of anti-HEV varied with the geographical
origin of the boar, being 65,22% (15/23) in northern, 40,91% (9/22) in
southern, 47,62% (10/21) in western, 52,17% (12/23) in eastern, and
54,54% (12/22) in central part of Serbia.
Conclusion: Very high seroprevalence of anti-HEV antibodies indicated an active circulation of HEV in the Serbian wild boar population
suggests that wild boars can be source of HEV infection for domestic
pigs, as well as for human beings, particular in northern part where the
seroprevalence is the highest.
23.060 Clinical analysis of Helicobacter cinaedi
bacteremia in patients with rheumatic diseases
SUNDAY
вЂў
November 2, 2014
I. Takajo, T. Kawaguchi, M. Matsuda, A. Okayama
Miyazaki University Hospital, Miyazaki, Japan
Purpose: Helicobacter cinaedi (H. cinaedi) has been increasingly
recognized as important pathogen for human bacteremia. It has been
commonly isolated from the immune-compromised hosts like patients
infected with human immunodeficiency virus. We experienced cases
of H. cinaedi bacteremia in patients with rheumatic diseases and analyzed their clinical pictures.
Methods & Materials: Four cases of H. cinaedi bacteremia in patients
with rheumatic diseases were diagnosed in Miyazaki University hospital
during 2008-2014. Their background, clinical pictures, and treatment
were retrospectively analyzed based on the medical record.
Results: All 4 patients were female and medium age was 58 years
old (48-64 years old). All of them were admitted in the hospital because
of rheumatic arthritis (RA) and systemic lupus erythematosus (SLE).
These patients received low to medium doses of prednisolone (2-60mg/
day). In addition, two patients with RA received biologics agents (antiTNFs) and 2 patients with SLE received immunosuppressive agents
(cyclosporine and cyclophosphamide). At the onset of H. cinaedi bacteremia, all of them complained fever and 2 of them had eruption. Three
of them were treated with ceftriaxone and the other one was treated
with meropenem. H. cinaedi isolated from blood culture was sensitive
to these agents in all 4 cases; however, one case repeatedly had bacteremia for 6months. The administration of minocycline for a month finally
stopped the bacteremia in this case.
Conclusion: H. cinaedi could be the important pathogen for the
patients with rheumatic diseases, who are treated with corticosteroid,
biologics agents, and immunosuppressive agents. Minocycline can be
effective to the patients with H. cinaedi bacteremia, that is resistant to
the beta-lactams. Further study to include many cases is necessary to
clarify the best treatment for H. cinaedi bacteremia.
23.061 Molecular investigation of RNA viruses in bats
V. Nikolic1, G. Stamenkovic2, J. Jovanovic3, M. Paunovic3,
M. Stanojevic1
1
University of Belgrade Faculty of Medicine, Belgrade, Serbia,
2
University of Belgrade, Belgrade, Serbia, 3Natural History Museum,
Belgrade, Serbia
Purpose: Bats have recently been recognized as potential reservoir
of emerging human pathogens, including hantaviruses and paramyxoviruses. Hantaviruses are known to be endemically present in Serbia,
both in humans and in animal reservoirs comprising several rodent
species, and causing hemorrhagic fever with renal syndrome. On the
146
IMED 2014
other hand, paramyxoviruses are widely distributed worldwide and
known to be associated with a range of human diseases (bronchiolitis,
pneumonia, encephalitis, meningitis, parotitis, orchitis). No molecular
data exist about the occurrence of human or zoonotic viruses in bats
in Serbia.
Aim: To examine the presence of paramyxovirus and hantavirus
genetic material in bats in Serbia.
Methods & Materials: Ninety-five deceased bats were collected on
different sites in Serbia, in the period 2002 to 2009. Bat carcasses were
identified to species and stored at вЂ“20oC until further examination.
Isolation of total RNA from animal lungs was performed using TRIZOL
Reagent (GibcoBRL, Invitrogen, Karlsruhe, Germany) according to
manufacturerвЂ™s instruction. All samples were tested with universal primers for beta-actin mRNA as RT-PCR positive control. Viral RNA was
detected by nested RT-PCR method. Hantaviral RNA was detected
using degenerate primers partially amplifying the highly conserved L
segment of all known hantaviruses, while paramyxoviruses were tested
for by primers that afford amplification of both paramyxovirus subfamilies. Obtained RT-PCR products were visualized by 1% agarose gel
electrophoresis.
Results: Collected animals were identified as: Rhinolophus ferrumequinum, Hypsugo savii, Myotis alcathoe, Myotis brandtii, Myotis
myotis, Myotis mystacinus, Myotis oxygnathus, Pipistrellus pipistrellus,
Pipistrellus pygmaeus, Pipistrellus nathusii, Plecotus auritus, Plecotus
austriacus. All tested samples were found positive for beta-actin mRNA,
confirming successful RNA isolation and amplification. However, no
sample tested positive for virus specific RNA.
Conclusion: We report negative finding of viral genetic material in
bats, in the first study exploring bats as paramyxovirus and hantavirus
reservoirs in Serbia. Lack of detection of specific viral RNA may be due
to tissue degradation prior to collection. In view of challenges in studies involving protected and endangered species, approaches involving
better quality and non-invasive sampling are needed. Further investigations are underway to research bats as putative reservoirs of emerging
viruses in Serbia.
23.062 Novel point mutations in rpoB gene useful for
Brucella melitensis typing
S. AbuBakar1, K.-K. Tan1, Y.-C. Tan2, K.-W. Lee2, W.-Y. Yee2,
L.-Y. Chang1
1
University of Malaya, Kuala Lumpur, Malaysia, 2Codon Genomics
Sdn. Bhd., Selangor, Malaysia
Purpose: Brucellosis is an important zoonotic disease that affects
humans and animals. Differentiation of the different Brucella species
however, is difficult. The rpoB gene encoding for the ОІ subunit of RNA
polymerase was proposed as a new chromosomal marker useful for
the Brucella spp typing. The canonical pattern of nucleotide polymorphisms within the gene allows segregation of the B. melitensis into
three major types. Adaptation of the bacteria into new hosts however,
could introduce changes in the genome which could result in the emergence of new polymorphic variants. The present study was undertaken
to investigate and compare the complete rpoB gene sequences of globally distributed B. melitensis strains.
Methods & Materials: B. melitensis rpoB gene sequences were
retrieved from the GenBank and the PATRIC database. The rpoB
gene sequences were aligned against that of the B. melitensis 16M.
Strains with similar nucleotide sequences to the B. melintensis 16M
were recorded as the rpoB type 1. Whereas, strains with nucleotide
substitutions at codon 629, GCG to GTG (A629I), codon 985, GCC to
GTC (A985V) and codon 1309, CTG to CTA were identified as the rpoB
type 2. Lastly, strains with changes at codon 1249, ATG to ATA were
identified as the rpoB type 3.
Results: Comparisons of the rpoB gene sequences revealed the
presence of two new SNPs at codons 186 and 1067. Nucleotide substitution at codon 1067, GGC to GGT, was present in most of the African
B. melitensis strains and one B. melitensis strain isolated in the UK
(UK22_04). This mutation was specific and absent in other Brucella
spp. It is a canonical SNP that is unique to the newly identified B. melitensis type, which we denote as the rpoB type 4. Within the rpoB type
Poster Presentations II
SUNDAY вЂў November 2, 2014
International Meeting on Emerging Diseases and Surveillance 2014
4 strains, an additional nucleotide substitution at codon 186, CCT to
CCA, was observed in the UK22_04 strain.
Conclusion: A novel canonical SNP at codon 1067 was found specific to a newly identified rpoB type 4 strains. The usefulness of the
codon 186 for B. melitensis typing and phylogeography studies however, requires further investigation.
23.063 The risk of import of potentially zoonotic and
multi resistant bacteria through import of
ornamental fish into the EU
N. Tafro1, O. Stenvers2, O. Haenen3
1
Netherlands Food & Consumer Product Safety Authority, Schiphol,
Netherlands, 2Netherlands Food & Consumer Product Safety
Authority, Utrecht, Netherlands, 3Central Veterinary Institute,
Wageningen, Netherlands
Background: Q fever, caused by Coxiella burnetii, is a zoonotic infection worldwide distributed. The role of wild animals in the transmission
of the infection is globally recognized but poorly known.
Objectives: The aims of this study were firstly to investigate the
exposure of wild boars to C. burnetii infection and, secondly, to clarify
the infection status of the animals by detection of C. burnetii DNA in
sera.
Purpose: Influenza AH1N1pdm09 virus, first detected in humans in
April 2009, has been reported in pigs in multiple countries globally.
We carried out surveillance in pigs at a slaughterhouse located near
Nairobi to determine prevalence and sero-prevalence of influenza A
viruses.
Methods & Materials: We collected nasal and bronchial swabs and
blood samples from pigs at a slaughterhouse for 10-day periods in May
2010, August and December 2011 and April, August and December
2012. A standardized questionnaire was administered to traders to collect data on characteristics of the farm of origin. Swabs were tested for
influenza A by rt RT-PCR and virus isolation undertaken on all positive swabs. Virus subtyping was carried out on the virus isolated. Sera
were tested for anti-influenza A nucleoprotein antibodies by ELISA and
all positive sera tested by hemagglutination inhibition (HI) for specific
antibodies to swine influenza AH1N1, H3N2 and AH1N1pdm09.
Results: A total of 1346 nasal and bronchiole swabs and 978 blood
samples were collected. A majority of the pigs (82%) were from Kiambu
County in Central Kenya with median pig herd size of 10. In total 7/1346
(0.5%; 95% CI 0.2-1.1) swabs were positive for influenza A. Three virus
isolates were obtained from nasal swabs collected in August 2011 and
were determined to be A/California/07/2009-like (H1N1) pdm09 on
antigenic characterization.
Of the 957 pig sera tested by ELISA, 16.6 % (95% CI, 14.3вЂ“19.1)
were positive for influenza A. Influenza A sero-prevalence was variable
over the sampling periods; with a sero-prevalence of 42.2% recorded
in August 2011 significantly higher than the lowest (4.7%) recorded in
April, 2012 (О§2, 119.8, df =5, p<0.0001). Generally, the sero-prevalence
declined after 2011 and remained at low levels (<10%) in 2012. On HI,
89/156 (57.1%) of the sera were positive for AH1N1pdm09 antibodies.
Conclusion: We report infection and circulation of AH1N1pdm09
over a two year period among pigs raised on small holder farms in
Kenya suggesting introduction and maintenance of the virus in local pig
populations. Continued influenza surveillance in humans and pigs, is
key in monitoring evolution of influenza viruses in this critical interface.
November 2, 2014
(Sus scrofa)
S. Anastacio1, C. Coelho2, M. Pereira3, M. M. Vieira-Pinto4,
K. Sidi-Boumedine5, G. J. da Silva6
1
Escola UniversitГЎria Vasco da Gama-Faculdade de FarmГЎcia
e Centro de NeurociГЄncias e Biologia Celular, Universidade de
Coimbra, Coimbra, Coimbra, Portugal, 2Escola Superior AgrГЎria
de Viseu, Instituto PolitГ©cnico de Viseu-Centro de Estudos em
CiГЄncia Animal e VeterinГЎria, Universidade de TrГЎs-os-Montes e Alto
Douro, Vila Real, Portugal, 3Faculdade de FarmГЎcia, Universidade
de Coimbra, Coimbra, Portugal, 4Dept. CiГЄncias VeterinГЎrias.
Universidade de TrГЎs-os-Montes e Alto Douro. Centro de Estudos em
CiГЄncia Animal e VeterinГЎria. Universidade de TrГЎs-os-Montes e Alto
Douro, Vila Real, Portugal, 5ANSES, Laboratoire Sophia-Antipolis,
Sophia Antipolis, France, 6Faculdade de FarmГЎcia e Centro de
NeurociГЄncias e Biologia Celular, Universidade de Coimbra, Coimbra,
Portugal
smallholder farms in Kenya, 2010вЂ“2012
P. M. Munyua1, L. Mwasi2, C. Onyango1, C. Cardona3, L. Waiboci1,
K. Njenga4, P. Kitala5, P. Nyaga5, J. Mott1
1
Centers for Disease Control and Prevention-Kenya, Nairobi, Kenya,
2
Kenya Medical Research Institute/CDC, Nairobi, Kenya, 3University
of Minnesota, Saint Paul, MN, USA, 4Centers for Disease Control and
Prevention in Kenya, Nairobi, Kenya, 5University of Nairobi, Nairobi,
Kenya
вЂў
23.064 Coxiella burnetii infection in wild boars
23.065 Pandemic influenza virus in pigs raised in
SUNDAY
Purpose: This paper presents an overview of the current EU legislative
criteria for import control of ornamental fish from third countries (outside the EU) into the EU and describes the principal topically acquired
zoonoses and risks of importing multiresistant bacteria.
Methods & Materials: Within the current EU legislation imported
ornamental fishes intended for closed water systems are checked at
the border inspection posts for clinical signs and mortality only, and not
for presence of any zoonotical agent, nor for multiresistant bacteria.
With the increase of global international trade in ornamental fish and
imports into the EU this implies a risk and requires special attention.
Results: Annually, millions of ornamental fishes from third counties
are imported into the EU. Handling these animals, including contact
with water in which they are transported may cause topical bacterial
infections, via puncture of fish spines or by open wounds. The principal
potentially zoonotic bacteria which can be transmitted via this route to
humans are Mycobacterium marinum, Vibrio vulnificus, Streptococcus
iniae and Edwardsiella tarda. Groups at risk are professionals in all
segments of the ornamental fish business (aquaculture and fisheries), but also people having an aquarium at home and all individuals
having direct skin contact with live fish kept in warm water. Especially
immunocompromised people with open skin injuries or pierced by fish
spines are at risk of developing a topically acquired zoonosis, which
may be serious. Moreover, ornamental fish and the water in which there
are transported may contain bacteria which are (multi)resistant against
antibiotics, due to intensive use of antibiotics in the farm of origin and/
or transport water.
Conclusion: It is important, to increase awareness of these risks
to the ornamental fish branch, including the fish hobbyist, but also to
veterinarian and medical practitioners and governing authorities, to
prevent for ornamental fish related bacterial zoonoses.
Methods & Materials: A cross-sectional study was developed during the hunting season 2011/2012 in the northeast region of Portugal.
Sera samples were collected from wild boars (n=89) and tested for
specific antibodies anti-C. burnetii by ELISA kit (LSIVET Ruminant
Milk/Serum Q Fever,В® LSI) adapted for multi-species detection, using a
multi-antispecies conjugate. Sera with an S/P per cent <50% were considered to be negative. Samples with an S/P per cent of between 50%
and 75% were considered to be positive; those >75% were considered
strongly positive. Of the 89 serum samples, 28 were randomly selected
to detect the DNA of C. burnetii by PCR testing.
Results: Of the tested animals, 5.6% (95% CI: 1.8 to 12.6%) were
seropositive and among these 40% (95% CI: 11.8 to 76.9%) were classified as strong positive. No positive results were obtained on PCR
testing, revealing that the animals were not in acute phase of infection.
Conclusion: To the best of our knowledge this is the first report of
seroprevalence of C. burnetii in wild boars in Europe. Despite the low
seroprevalence, the exposure to the pathogen occurs, revealing wild
boar as a potential reservoir of infection and highlighting the importance of monitoring this population. Furthermore, and considering the
C. burnetii low infectious dose for humans, the zoonotic risk when handling hunted wild boars should not be neglected.
147
IMED 2014
Poster Presentations II
SUNDAY вЂў November 2, 2014
International Meeting on Emerging Diseases and Surveillance 2014
23.066 PRRS virus/Streptococcus suis co-infection
in nursery pig which have unstable status
of PRRS from farm in North-Eastern part
of Thailand
SUNDAY
вЂў
November 2, 2014
S. Porntrakulpipat1, J. Jiwakanon2, T. C. Nutravong3, S. Angkititrakul2
1
Research Group for Preventive Technology in Livestock, Faculty of
Veterinary Medicine, Khon Kaen University, Khon Kaen, Thailand,
2
Faculty of Veterinary Medicine, Khon Kaen University, Khon Kaen,
Thailand, 3Faculty of Medicine, Khon Kaen University, Khon Kaen, -,
Thailand
Background: Since the primary infects cells of PRRS virus are macrophage cell lineage which are important in the destruction of bacteria,
this scenario predisposing the pig to Streptococcus suis (S. suis). S.
suis, an opportunistic pathogen of pigs, is an emerging zoonotic pathogen among humans. Around 35 S.suis serotypes have been found
worldwide, only a limited number are pathogenic for pigs, and sertype
2 have been found to be the cause of human disease.
Objective: To find the percentage of nursery pig with PRRS virus/S.
suis co-infection in farms which have unstable status of PRRS in
nursery.
Methods & Materials: Forty crossbred pigs age between 7 and 10
weeks from farm which had an outbreak of Highly-virulent PRRS in
year 2010 were grouped into clinically normal and sick. The sick group
were pig with respiratory sign. Blood collection and tonsillar swab were
applied in both group to detect antibody tiger to PRRS and S.suis
respectively. Inactivated PRRS vaccine had been applied to breeding
herd since the outbreak. The PRRS status was considered stable in
breeding herd. In weaning, however, the PRRS status was unstable.
Results: Most all of nursery pigs considered infected with PRRS
virus during week 4 and 5 of age according to ELISA s/p ratio result.
Ten percent of nursery pig showed respiratory sign and 50% of which
died. Only 10 percent of clinically normal pigs were found positive to
S.suis whereas 30% of sick pigs were found positive and one pig in this
group was serotype 2.
Conclusion: Our study demonstrated that pig farm in North-eastern
part of Thailand were positive to S.suis including serotype 2. Both clinically normal and sick pigs, in farm with unstable status of PRRS, could
be the source of S.suis. Awareness should be raised to veterinary and
worker who work closely in this pig farm. Regarding to the study of
Thanawongnuwech (2000), Cefiofur antibiotic should be applied during
week 4 and 5 of pig life to reduce the loss cause by PRRS virus/S.suis
co-infection and S.suis infection in pig.
23.067 Rabies boosters: serological follow-up of bat
workers in the United Kingdom
B. Said1, H. Kirkbride1, D. Horton2, A. R. Fooks2, D. Morgan1,
D. Brown1
1
Public Health England, London, United Kingdom, 2Animal Health and
Veterinary Laboratories Agency, Surrey, United Kingdom
Purpose: Rabies is an acute viral infection affecting the central
nervous system. Clinical rabies is invariably fatal once symptoms
become apparent but can be prevented by prompt administration of
post-exposure treatment. There have been no human cases of indigenous classical rabies in the UK since 1902. However, a fatal case
caused by European bat lyssavirus type 2 (EBLV-2) occurred in a bat
handler in 2002 and around 2% of British DaubentonвЂ™s bats (Myotis
daubentonii) are known to have EBLV-2 antibodies. UK bat workers are
considered to be at risk of exposure to rabies and therefore receive a
primary course of rabies vaccine (three intramuscular injections) with a
single reinforcing dose one year later, followed by subsequent boosting
every three to five years. The WHO recommends boosters should be
administered when rabies virus-neutralising antibody (VNA) titre falls
below 0.5IU/ml. To improve the understanding of the serological antibody response to rabies vaccination in order to develop more specific
advice on the timing of rabies booster vaccinations for bat handlers and
148
IMED 2014
to record the rate of adverse reactions due to booster vaccinations.
Methods & Materials: Bat workers recruited to the study were due
for second or subsequent rabies booster vaccinations between August
2010 and August 2013. Blood samples, taken before boosting, were
tested for rabies VNA. Dedicated questionnaires were used to collect
information about adverse reactions.
Results: A total of 150 bat workers participated in the study. There
were 77 male and 73 female participants aged between 29 and 81
years (mean 54 years). All participants were due for their booster and
all but one had rabies VNA titre в‰Ґ0.5IU/ml. There was a wide range
of antibody titres and no clear correlation between titre and number
of previous boosters or length of time since boosting. A range of mild
adverse reactions, including redness and swelling at the site, were
reported by 65 (43%) participants.
Conclusion: These results suggest that, whilst there is no indication of increasing frequency or severity of reactions with more doses,
there is considerable individual variation in response to rabies vaccine. Therefore monitoring of rabies VNA may be preferable to routine
boosters.
23.068 Canine rabies diagnosis from formalin fixed
paraffin embedded (FFPE) tissue
S. Beck1, P. Gunawardena2, D. Horton3, D. J. Hicks1, D. A. Marston3,
A. Ortiz-Pelaez3, A. R. Fooks3, A. Nunez1
1
Animal Health and Veterinary Laboratories Agency, Addlestone,
Surrey, United Kingdom, 2Faculty of Veterinary Medicine & Animal
Science, University of Peradeniya, Peradeniya, Sri Lanka, 3Animal
Health and Veterinary Laboratories Agency, Surrey, United Kingdom
Purpose: Rabies is a highly neurotropic virus, with the potential to infect
most mammalian species. Dog bites are the most common source of
exposure leading to human deaths from rabies in many developing
countries. Although WHO recommended screening involves testing
fresh brain tissue, preservation of fresh tissue may be difficult under
field conditions: formalin fixation provides a simple alternative. In this
study we describe the sensitivity of histopathology and immunohistochemistry (IHC) for rabies diagnosis using formalin fixed paraffin
embedded (FFPE) canine brains.
Methods & Materials: Samples from 57 rabies suspect cases from
Sri-Lanka were examined. Presence of Negri bodies and detection of
rabies antigen using IHC was evaluated in cortex, hippocampus, cerebellum and brainstem. The effect of autolysis and artefactual degeneration of the tissue was also assessed. In 13 cases confirmatory PCR
for rabies was performed using RNA extracted from fresh frozen tissue
and from FFPE samples.
Results: Rabies was confirmed in 53/57 cases by IHC. IHC labeling was significantly increased in the brainstem as compared to other
encephalic areas. Negri bodies were observed in 60% of the cases.
Tissue degradation did not prevent diagnosis by IHC but it was associated with not detecting Negri bodies. PCR testing of fresh tissue was in
agreement with testing of FFPE tissue and IHC results.
Conclusion: Formalin fixation allowed confirmatory diagnosis of
rabies by IHC and PCR with increased viral antigen found in the brainstem of infected animals.
23.069 Highly pathogenic avian influenza in the
occupational environment: Attitudinal and
structural determinants of behavior among
commercial poultry sector workers in Indonesia
J. M. Kreslake1, Y. Wahyuningrum1, B. Safi1, M. E. Figueroa1,
D. Storey2
1
Johns Hopkins Bloomberg School of Public Health, Baltimore, MD,
USA, 2Johns Hopkins Bloomberg School of Public Health, Baltimore,
MD, USA
Purpose: Highly pathogenic avian influenza (H5N1) is endemic among
poultry in Indonesia and can be transmitted through the commercial
poultry supply chain. There is ongoing risk of poultry worker and community exposure to HPAI(H5N1)-infected poultry at trade, slaughter,
and markets. This study identifies attitudinal and structural predictors
of occupational risk/protective behaviors.
Poster Presentations II
SUNDAY вЂў November 2, 2014
International Meeting on Emerging Diseases and Surveillance 2014
23.070 Assessing the risk of Mycobacterium bovis
Purpose: Bovine tuberculosis caused by Mycobacterium bovis is one
of the most significant issues facing cattle farmers in Britain. This epidemic in cattle has not significantly affected companion animal populations which are considered вЂ�spill-overвЂ™ hosts. Since 2006, when M.
bovis infection in companion animals became notifiable in England,
fewer than 30 cats have been confirmed with M. bovis disease annually. The risk of cat-to-human transmission of M. bovis was previously
assumed to be negligible and public health actions in response to notification of feline cases were minimal and sporadic. In 2013, an unprecedented feline outbreak involving ten cats across nine households in
one geographically defined area in England provided the first recorded
incident of cat-to-human transmission of M. bovis. The objective of this
study was to determine the risk cats infected with M. bovis present to
human health.
Methods & Materials: A qualitative assessment of the risk of transmission of M. bovis infection from cats to human contacts was carried out using information from the 2013 outbreak and combined with
results from a comprehensive review of the scientific literature.
Results: The 2013 feline M. bovis outbreak and subsequent human
cases in England provided the first documented evidence of zoonotic
transmission of M. bovis from cats to humans. While this demonstration
of transmission, coupled with the clinical presentation of M. bovis disease in cats indicates that there is a risk, the absence of any previous
reports of cat-to-human spread indicates that the risk of transmission of
M. bovis from infected catsto humans is very low.
rodents in Cotonou, Benin
G. Bonnet1, G. Houemenou2, A. MartГn-Alonso1, E. Abreu-Yanes1,
I. Montoliu3, B. Valladares1, C. Feliu3, P. Foronda1
1
University Institute of Tropical Diseases and Public Health of the
Canary Islands, University of La Laguna, Santa Cruz de Tenerife,
Spain, 2UniversitГ© de LiГ©ge, Sart Tilman, Belgium, 3University of
Barcelona, Barcelona, Spain
Purpose: Bartonella infections in rodents have been reported worldwide and close contacts between humans and rodent populations
around the world have been found to create excellent conditions for
transmission of Bartonella spp. from animals to humans. However,
there have been no studies investigating the presence of Bartonella
spp. in rodents from Benin.
Aims: To determine the possible infection of rodents and insectivores
from Benin with Bartonella spp. and evaluate the genetic heterogeneity
of the Bartonella strains in this country and estimate the importance of
our results from the point of view of the public health.
Methods & Materials: A total of 69 rodents and 4 insectivores
were captured in four zones of Cotonou, Republic of Benin. Those
rodents belonged to the species Rattus rattus, Rattus norvegicus and
Mastomys sp., whereas Crocidura sp. and Crocidura oliveri were the
insectivore species analyzed. Spleens of the animals were examined
for the presence of Bartonella by PCR targeting a 767-bp fragment of
the citrate synthase gene.
Results: Four out of the 73 individuals analyzed were positive for
Bartonella species. Therefore, the overall prevalence found in this
study was 5.48%. We obtained positive results for two rodent species,
R. norvegicus and Mastomys sp., and the highest prevalence was
observed in R. norvegicus (37.5%). No significant prevalence differences were found between those rodent species which were found to
harbour Bartonella organisms. On the other hand, no positive results
were obtained for the insectivore species. The sequences obtained
showed highest similarity with pathogenic Bartonella species
Conclusion: The results of this study could indicate that Bartonella
organisms are present in wild rodents in Cotonou, Benin. To our knowledge, this study constitutes the first finding of Bartonella spp. in rodents
in Benin. Our results are important from a public health point of view
due to the pathogenic potential of the species identified, which have
been isolated from humans with severe clinical manifestations.
23.072 Antiparasitic activity of bovine milk protein
lactoferrin on Toxoplasma gondii: An in vitro
and in vivo study
November 2, 2014
C. OвЂ™Connor, A. Walsh, D. Morgan
Public Health England, London, London, United Kingdom
23.071 Zoonotic Bartonella species identified in wild
вЂў
transmission from domestic cats to human
contacts
Conclusion: In response to the first occurrence of cat-to-human
transmission of M. bovis infection and the assessment of the risk to
human health being raised from negligible to very low, it is recommended that household and other close contacts of cats with confirmed
M. bovis should be assessed and receive advice to minimise the risk
to their health.
SUNDAY
Methods & Materials: Multilevel regression was performed on a
2009 representative survey (n=1,404) of trader/transporters, slaughterers, and market vendors in Java. Outcomes: Risk/protective behaviors
(hygiene, protective equipment, unsold poultry treatment, caging practices, waste disposal). Predictors: Respondent attitudes (perceived
risk, collective efficacy of neighborhood and workplace, self-efficacy)
and workplace features. Covariates: age, gender, SES, knowledge of
protective actions, presence of local interventions. Results for no-incidence subdistricts (no outbreaks in prior three months) are reported.
Results: Controlling for covariates, perceived severity and susceptibility predicted lower likelihood of recommended practices among
vendors and trader/transporters. High perceived neighborhood efficacy
was positively associated with: vendor soap use (coeff:0.58, p=0.02),
vendorsвЂ™ disinfectant use (OR:2.32, p=0.002), slaughtersвЂ™ use of protective equipment (coeff:0.31, p=0.02), and trader/transporters having
clean tires (OR:2.42, p<0.001). High perceived workplace efficacy predicted: vendorsвЂ™ disinfectant use (OR:2.28 p=0.001); trader/transportersвЂ™ disinfectant use (OR:2.21, p<0.001), having clean tires (OR:3.00,
p<0.001) and crates (OR:2.81, p<0.001). High self-efficacy predicted:
vendorsвЂ™ disinfectant use (OR:2.07, p=0.004); trader/transportersвЂ™ soap
use (coeff:0.99, p=0.01); disinfectant use (OR:2.15, p=0.004), having
clean tires (OR:1.98, p=0.006) and crates (OR:1.84, p=0.03). Plastic
crates predicted trader/transportersвЂ™ soap use (coeff:1.55, p<0.001)
and disinfectant use (OR:3.67, p<0.001). Workplaces providing (1)disinfectant: predicted disinfectant use by vendors (OR:25.25, p<0.001),
slaughters (OR:54.47, p<0.001), and trader/transporters (OR:20.90,
p<0.001); (2)brushes: predicted soap use by vendors (coeff:0.57,
p=0.03) and trader/transporters (coeff:1.42, p=0.007); (3)soap: predicted lower likelihood of vendors bringing poultry home (OR:0.25,
p=0.02) and greater likelihood of trader/transporters having clean tires
(OR:2.08, p=0.04); and (4)waste bins: predicted vendorsвЂ™ proper disposal of poultry waste (OR: 3.23, p<0.001). Routine closure of slaughter areas increased odds of disinfectant use (OR:2.41, p=0.009).
Conclusion: Simple interventions (e.g., provision of cleaning supplies, plastic cages/crates) improve poultry workersвЂ™ protective actions.
Targeted communication efforts to foster responsibility to community,
occupational norms, and self-efficacy can encourage behavioral vigilance. Emphasizing susceptibility to and severity of HPAI(H5N1) is not
recommended.
N. Anand
Postgraduate Institute of Medical Education and Research,
Chandigarh, Chandigarh, India
Purpose: Lactoferrin (Lf) protein is a milk protein known as antimicrobial and immunomodulating in nature. The protein has shown its
effect against parasites like Giardia, Entamoeba,. But till now there
is no study which has shown its inhibitory effect on animal & human
parasite Toxoplasma
Methods & Materials: In vitro Inhibition Assay: infected macrophages
with intracellular tachyzoites were incubated with: 1) Apo Lf & 2) Fe
Lf 3) Native Lf at 40 and 80ug/ml concentrations 4), Sulphadiazine
(std doses) 5) untreated group. After 24 and 48 hrs, Giemsa smear
for counting inhibited parasites & nitric oxide production in culture
supernatant was measured. In vivo Inhibition Assay: Study divided
in four gps. Gp: 1) Bovine Lf. 2) Sulphadiazine. 3) Untreated group.
Histopathology of liver and spleen tissues was done to determine
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IMED 2014
Poster Presentations II
SUNDAY вЂў November 2, 2014
International Meeting on Emerging Diseases and Surveillance 2014
parasite and RT-PCR was done to determine the parasite load. ROS,
NO, Th1 and Th2 type of cytoine analysis studies was done to study
the type of immune response in treated and untreated mice. Statistical
Analysis: All parameters were studied by One way Anova test and significant difference was calculated by t test (p<0.05).
Results: In vitro: The parasitemia count was found to be high in
untreated group of mice compared with treated group (p = 0.005). NO
production was found to be high in treated group compared with untreated
group which expressed the killing action of macrophages(p<0.005).
Results: In vivo: RT-PCR results of parasite load determination
showed significantly less copy number of parasite in treated group
(p=0.005). These results well correlated with histopathology of spleen
and liver which showed less foci of parasites in various visceral organs
& did not show any site of inflammation. Elevated levels of ROS, NO
and cytokine in treated group of mice showed protective response of
Lactoferrin. Lf helped mice survived till day 25 post infection, whereas,
all mice in untreated mice died at day 10 post infection.
Conclusion: Present study has shown good inhibitory effect of Lf
protein on virulent parasite T. gondii and has shown immunomodulatory effect. Hence, Lf a milk protein can act as a potential drug against
intracellular parasite T. gondii.
23.073 Detection of Coxiella burnetii in rodents and
wild birds in Portugal
SUNDAY
вЂў
November 2, 2014
A. S. P. Santos1, F. Amaro1, A. C. Norte2, P. Melo3, M. M. Santos-Silva
1
, R. De Sousa1, M. J. Alves1, M. S. Nuncio1, F. Hagen4, J. J. H. C.
Tilburg 4
1
National Institute of Health Dr. Ricardo Jorge, ГЃguas de Moura,
Portugal, 2Institute of Marine Research (IMAR/CMA), Coimbra,
Portugal, 3VetNatura, Lisbon, Portugal, 4Canisius Wilhelmina Hospital,
Nijmegen, Netherlands
Purpose: Coxiella burnetii is a zoonotic bacterium that infects a wide
range of animal species and causes a disease known as Q fever.
Domestic ruminants are regarded as the main source of human infection but the agentВґs natural cycle may also involve other domestic as
well as wild animals, such as birds and rodents. Portugal is regarded
as a C. burnetii endemic country but limited information is available on
animal infection, especially regarding the wildlife. This work presents
the results of C. burnetii screening on bird cloacae swabs and rodent
spleens preserved in a sample biobank.
Methods & Materials: A total of 244 rodents belonging to five species and 451 wild birds of more than 68 species were included in this
study. DNA was manually extracted and screened by realtime PCR
targeting the multicopy insertion element IS1111 of C. burnetii.
Results: Active infections were detected on both rodents (n=2;
0.82%) and birds (n=12; 2.67%) and were linked to species and geographical area. All positive samples were additionally processed for
multiple-locus variable-number tandem repeat analysis (MLVA) in order
to compare the genotypes found with those that circulate in domestic
animals and are associated to human infection inPortugal.
Conclusion: The low infection rate found suggests a limited role for
these hosts in C. burnetii maintenance cycle in the screened areas.
23.074 Lyophilisation of lentiviral pseudotypes for the
development and distribution of virus
neutralisation assay kits for rabies, Marburg
and influenza viruses
S. D. Scott1, S. Mather1, E. Wright2, N. Temperton3
University of Kent, Chatham Maritime, Kent, United Kingdom,
2
University of Westminster, London, United Kingdom, 3University of
Kent, Chatham Maritime, United Kingdom
1
Purpose: Some conventional serological assays can accurately quantify neutralising antibody responses raised against epitopes on virus
glycoproteins, enabling mass vaccine evaluation and serosurveillance
studies to take place. However, these assays often necessitate the handling of wild-type virus in expensive high biosafety laboratories, which
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IMED 2014
restricts the scope of their application, particularly in resource-deprived
areas. A solution to this issue is the use of lentiviral pseudotype viruses
(PVs)вЂ”chimeric, replication-deficient virions that imitate the binding
and entry mechanisms of their wild-type equivalents. Pseudotype virus
neutralisation assays (PVNAs) bypass high biosafety requirements and
yield comparable results to established assays. This study explores
the potential for using lyophilisation of pseudotypes as a cost-effective,
alternative means for production, distribution and storage of a PVNAbased diagnostic kit.
Methods & Materials: Rabies, Marburg and H5 subtype Influenza
virus pseudotypes were each suspended in cryoprotectant solutions of
various molarities and subjected to freeze-drying before incubation at
a variety of temperatures, humidities and time periods. Samples were
then employed in antibody neutralisation assays using specific sera.
Results: High levels of PV titre were retained post-lyophilisation, with
acceptable levels of virus activity maintained even after medium-term
storage in tropical conditions. Also, the performance of PVs in neutralisation assays was not affected by the lyophilisation process.
Conclusion: These results confirm the viability of a freeze-dried
PVNA-based diagnostic kit, which could considerably facilitate in-field
serology for a number of clinically important viruses.
23.075 Gastrointestinal helminthes of green-winged
teal (Anas crecca) from north Iran
M. R. Youssefi1, H. Hosseini1, M. T. Rahimi2
1
Islamic azad university, Babol-Branch, Babol, Mazandaran, Iran,
Islamic Republic of, 2Islamic Azad University, Babol-Branch, Babol,
Iran, Islamic Republic of
Purpose: Annually, an enormous number of aquatic migratory birds
migrate from northern hemisphere to Mazandaran province, north of
Iran due to considerable appropriate winter quarters. Thus, the purpose
of the current study was to determine the helminth parasites ofAnas
crecca in one of proper refuges of Iran, Fereydoonkenar.
Methods & Materials: A total number of one hundred thirty-six gastrointestinal tracts of green-winged teal (A. crecca) were collected from
Fereydoonkenar, Mazandaran province during September and October
2011.The gastrointestinal tracts were examined for helminth infection.
Results: The total infection rate was 70.5% (96) that 68.96 % (40)
of males and 71.79 (56) of females shown helminth infection. The
examined A. crecca harbored one species of Nematoda, Cestoda
and two species of Digenea which were as following: Contracecum
larvae, Diorchis stefanskii Hypoderaeum conoideum and Notocotylus
attenuates, respectively. There was no significant difference in the
prevalence of infection between examined males and females ducks
in Hypoderaeum conoideum, Diorchis stefanskii and Notocotylus
attenuates (P > 0.05) whereas a significant relationship was observed
between males and females in Contracecum larvae (P < 0.05).
Conclusion: Based on the results of the present study, we conclude
that A. crecca plays a prominent role in transmission of mentioned
parasites. In addition, this is the first report of Conteracecum larvae,
Diorchis stefanskii and Notocotylus attenuates from A. crecca in Iran.
23.076 Facility based national rabies survey in
Ethiopia
H. M. Hailu
Ethiopian Public Health Institute, Addis Ababa, Ethiopia
Purpose: Rabies is a viral disease caused by Lyssa virus with 100%
case fatality. According to WHO report around 55 000 deaths have
been estimated annually. However, Asia and Africa account for the vast
majority of rabies fatalities. In Ethiopia, rabies is one of the notifiable
diseases in humans and animals. Thus, conducting rabies survey at
public health, veterinary service and wildlife facilities has great significant impact on prevention and control of rabies. The aim of this study
was to estimate the incidence of animal and human rabies cases,
identify the distribution of rabies among different animal species, measure the level of vaccination coverage, assess the challenges and give
recommendation.
Poster Presentations II
SUNDAY вЂў November 2, 2014
International Meeting on Emerging Diseases and Surveillance 2014
Methods & Materials: Cross sectional study has been used and
randomly selected 176 Public Health, 176 Veterinary services and
15 Wildlife facilities were involved in the survey using pretested
Questionnaire and retrospective data collection were also used for
analysis during the period of 2007 to 2012.
Results: The facility based survey resultshowed that, 69% of public
health facilities were reported that rabies as major public health problem. Similarly, lower rate of surveillance data completeness 46 % were
reported, which is below the WHO recommended rate i.e. 80%. High
percentage of human rabies death was observed in Amhara (33.6)
and Oromia (25.6) as well as high human anti-rabies vaccination was
covered by Amhara region, i.e. 57%, followed by Oromia, SNNP and
Tigray regions i.e. 23%, 14%, and 4%, respectively. The distribution of
rabies case in different animal species indicates that 67% of Dogs, 11%
of Cats, 20% of livestock and 1% of wild animals are the main sources
of rabies. Wild animals in the national as well as regional parks were
not protected, and there had been seen rabid animals with in the parks.
Conclusion: Rabies is a public and animal health problem in
Ethiopia, thus development and implementation of comprehensive and
sustainable national rabies prevention and control strategy is mandatory. Participation and contribution of veterinary services to the goal
of prevention and control of human rabies at animal source is crucial.
23.077 Contribution of molecular biology in the
diagnosis of human and animal
cryptosporidiosis
F. Cheikhrouhou, N. Sourour, T. Houaida, G. Raida, S. Hayet,
F. Makni, A. Ayadi
laboratory of parasitology mycology, Sfax, Tunisia
Purpose: Rotavirus infection is the most important cause of severe
diarrhea in children and the young of a variety of animals resulting in
significant economic losses in livestock. In this study we present the
first rotavirus epidemiology in domesticated animals in Cameroon.
Methods & Materials: The study was conducted in 3 geographic
locations in Cameroon (Esu, Bamenda, and Maroua) between 2010
and 2011. Stool samples were collected from symptomatic diarrhea
and asymptomatic domesticated animals. Rotavirus was identified by
RT-PCR targeting VP6 and genotyping of the VP7 and VP4 genes by
multiplex RT-PCR and sequencing.
Results: A total of 393 stool samples were collected from symptomatic and asymptomatic animals including pigs (50); Bos primigenius
taurus and Bos primigenius indicus cattle species (157); Sahel type
and Uda type sheep species (50); Nigerian dwarf goats and the Black
Bengal goat species (36); dogs (5); ducks (16) and chickens (79). Of
these, group A rotaviruses was detected in 3(6.0%) porcine samples,
3(8.3%) caprine samples, 4(2.5%) bovine samples and 3(6.0%) ovine
samples giving an overall group A animal rotavirus prevalence of
3.3% (13/393). Group A rotavirus was not detected in dogs and avian
samples.
VP7 genotypes determination was possible for only 7 samples including genotypes G1(one ovine G1, one porcine G1), one porcine G4 and
four bovine G12, Two VP4 genotypes were identified circulating in
November 2, 2014
emerging human Rotavirus G6P[6] in Cameroon
V. N. Ndze1, M. Esona2, E. A. Achidi3, R. Doro4, S. L. Farkas5,
M. T. Obama-Abena1, K. BГЎnyai4
1
Faculty of Medicine and Biomedical Sciences, University of Yaounde
I, Yaounde, Cameroon, 2Centers for disease control and prevention,
Atlanta, GA, USA, 3Faculty of Science, University of Buea, Buea,
Cameroon, 4Hungarian Academy of Sciences, Centre for Agricultural
Research, Budapest, Hungary, 5Centre for Agricultural Research,
Hungarian Academy of Sciences, Budapest, Hungary
Cameroon
V. N. Ndze1, M. Esona2, E. A. Achidi3, M. T. Obama-Abena4,
K. Banyai5
1
Faculty of Medicine and Biomedical Sciences, Yaounde, Cameroon,
2
Centers for disease control and prevention, Atlanta, GA, USA,
3
Faculty of Science, University of Buea, Buea, Cameroon, 4Faculty of
Medicine and Biomedical Sciences, University of Yaounde I, Yaounde,
Cameroon, 5Hungarian Academy of Sciences, Centre for Agricultural
Research, Budapest, Hungary
вЂў
23.078 Whole genome analysis of an explosively
23.079 Group A rotavirus in domesticated animals in
SUNDAY
Purpose: Cryptosporidiosis is an emerging opportunistic disease with
a significant impact in immunocompromised patients, including AIDS
patient. In Calves, Cryptosporidium is also one of the major causative
agents of diarrhea of the newborn calf.
Objective: The aim of our study was to evaluate the contribution of
molecular techniques in the diagnosis and typing of Cryptosporidium
sp. in calves and HIV patients in the region of Sfax (south of TUNISIA).
Methods & Materials: We conducted a survey during a one-month
period (September 2013) following recognition of diarrhea occurred in
young calves in two farms. We also analyzed samples of human feces
from 5 HIV-infected patients.
Detection of Cryptosporidium oocysts in the feces of calves in the
two farms and in the stools of HIV patients was based on the Ziehl
Neelsen coloration and PCR-RFLP detection using CPB DIAG F and R
as primers and VspI restriction enzyme, and the real time PCR method
using SYBR Green I.
Results: in calves, cryptosporidiosis frequency was 32. 6% by the
Ziehl Neelsen and 57.1% by PCR. It only affects calves between one
and four weeks with a frequency of 39.6% by Ziehl Neelson and 75.7%
by PCR. For samples of sideen patients, 12.5% of samples were
positive by microscopy, whereas the PCR analysis gives a frequency of
75%. These results clearly show the sensitivity of the PCR compared
to Ziehl Neelsen. RFLP analysis gives the same profile for all samples,
corresponding to Cryptosporidium parvum species. The real-time PCR
correlates with PCR.
Conclusion: PCR-RFLP of 18S rRNA gene after digestion with
the restriction enzyme VspI allowed the identification of the species
Cryptosporidium parvum as a species responsible for human and animal cryptosporidiosis in our region.
Purpose: Rotavirus still remains the leading cause of under 5 years
diarrhea. Rotavirus strain surveillance has intensified in recent years
globally to gain information on the impact of vaccines on circulating
rotavirus strains. Here we report the whole genome analysis of an
explosively emerging human rotavirus G6P[6] in Cameroon.
Methods & Materials: The study was conducted in Cameroon (Esu,
Bamenda, and Maroua) between 2010 and 2011. Stool samples were
collected from diarrheic patients <5 years old. Viral RNA was amplified by RT-PCR and genotyping by multiplex RT-PCR assay, targeting
the medically most important rotavirus G and P types. Whole genome
sequencing was done using the semi-conductor Ion Torrent PGM
method and phylogenetic analysis done using Mega 5.
Results: Whole genome analysis of the five Cameroonian human
rotavirus G6 showed a DS-1-like gene constellation of G6 P[6] I2 R2
C2 M2 A2 N2 T2 E2 H2. The VP7 gene of genotype G6 RVA strains
detected for the first time in Cameroon shared >95% nucleotide and
amino acid similarity identities among themselves. Compared with
other G6 rotaviruses the five Cameroonian strains shared similar
ranges of sequence identities with contemporary African and European
G6 rotavirus strains, whereas a lower identity was seen with a variety
of other human and animal origin strains detected worldwide (range: nt,
76.7%вЂ“86.6%; aa, 87.8%вЂ“93.0%). The phylogenetic analysis showed
that our Cameroonian G6 RVA strains represented two clusters, both
classified into lineage I. The detection of G6P[6] strains on the DS-1-like
backbone gene constellation was unexpected, and perhaps the finding
was most intriguing. Furthermore, molecular analysis of the VP7 (and
some of the backbone genes) of Cameroonian G6P[6] strains indicated
the separation of the strains identified in the Far North region (Maroua)
and the Northwest region (Bamenda and Esu) into two branches that is
consistent with multiple introductions of G6P[6] strains into this country.
Conclusion: The emergence and explosive spread of G6P[6] RVA
strains in west and central African countries over the past few years
must be better understood using whole genome analysis and should
be closely monitored in the future following the routine administration
of rotavirus vaccines in these countries.
151
IMED 2014
Poster Presentations II
SUNDAY вЂў November 2, 2014
International Meeting on Emerging Diseases and Surveillance 2014
animals in Cameroon during the study period including a porcine P[6]
and a caprine P[14] genotypes. G-P gene constellation was possible in
only one porcine sample with the following combination G4P[6].
Conclusion: A better understanding of the potential long-term effect
of vaccine use on the epidemiology of co-circulating wild type strains
requires sustained and continuous rotavirus strain surveillance in both
the animal and human population in Africa and Cameroon in particular.
23.080 Rodents as potencial reservoirs of
vacciniavirus in periurban area of
Sao Paulo City, Brazil
SUNDAY
вЂў
November 2, 2014
L. H. Okuda, A. L. Arruda, C. Del Fava, M. M. Fusuma, S. F. Souza,
A. H. C. Nogueira, E. De Stefano, E. M. Pituco, A. E. C. Campos
Instituto Biologico, Sao Paulo, Sao Paulo, Brazil
Background:The rodents are considered potentials reservoirs of
pathogens, making a problem in worldwide public health. Brazilian
experimental studies have proved the role of rodents as reservoir of
vaccinia virus (Orthopoxvirus genus of Poxviridae family) with elimination of virus in feces and risk to transmission to animals and humans.
The vaccinia virus is endemic in Brazil causing vesicular disease in
dairy cattle and humans and commonly is associated with poor management conditions. Antibodies anti-vaccinia were previously detected
in rodents in periurban area of Sao Paulo city, once this area is characterized by family farming.
Objective: research the vaccinia virus in rodents of periurban area of
Sao Paulo city, Brazil, using a semi nested PCR and possible implications in health public.
Methods & Materials: There were captured 23 rodents (Rattus rattus
and Rattus novergicus) of Campo Limpo periurban region of Sao Paulo
city. The rodents were slaughtered in CO2 chamber according the
regulations of Bioethic Committee of Instituto BiolГіgico. For vaccinia
virus were selected tissues such as lymph nodes, spleen, heart and
liver. For DNA extraction was used Trizol Reagent (Life Technologies)
and for amplifications of semi nested PCR was selected primers from
hemmaglutinin gene. The PCR products were submitted to electrophoresis. The samples were considered positive when they presented the
band specific in the same height of control.
Results: The region of present study belongs to a periurban area of
Sao Paulo city, which is characterized by family farming with raising
animals (horses, cattle, chicken, turkeys, ducks, geese, mallards, goats
and sheep), low or none infrastructure and sanitation, often without garbage collection, favoring the proliferation of rodents. From 23 rodents,
six were Rattus rattus species and 17 of Rattus novergicus. For vaccГnia virus were detected five positive animals, one of Rattus rattus
species and four of Rattus novergicus species. From tissues analyzed
were detected vaccГnia virus in lymph nodes and spleen indicating
these as tissues election to research for this agent.
Conclusion: The preliminary results show rodents as potentials reservoirs of vaccГnia virus and the risk of transmission for animals and
humans.
Financial support: FAPESP nВє 12/51431-9
23.081 HPAI H5N1 detection in illegally imported
captive birds from Bali at the Vienna
International Airport
S. Revilla-FernГЎndez, Z. BagГі, E. Wodak, S. Richter, F. Schmoll
AGES, Institute for Veterinary Disease Control, MГ¶dling, Austria
Purpose: In June 2013, 60 birds were confiscated at the Vienna airport
in the suitcases of a couple smuggling them from Bali to Prague. The
birds, crammed into boxes and cardboard rolls with small air holes,
were detected by trained dogs during a routine airport check. Forty of
them did not survive the journey.
Methods & Materials: All dead birds were sent to Institute for
Veterinary Disease Control MГ¶dling to determine the cause of death
and to screen for Avian Influenza by real-time PCR and virus isolation.
The 20 live animals were transported to a quarantine station.
152
IMED 2014
Results: All captive birds belonged to CITES2-listed species:
mynahs, bluebirds, bamboo parrotfinches, fire-tufted barbets, paradise
sparrows, pesquets parrots and birds of paradise. Hemagglutination
inhibition test from died embrionated eggs was positive. The specific
real-time PCRs were also positive, confirming the H5N1 virus initially
in 3 mynahs. The H5 amino acid sequence revealed a HPAI motif
detected in Asian poultry.
Positive samples were sent to the EURL at AHVLA in Weybridge,
where full HA and NA sequences were analysed. Phylogeny showed a
HPAI H5N1 isolate clustering the new clade 2.3.2.1 detected before in
Vietnam and since 2012 in Indonesian poultry.
Consequently, official authorities ordered the euthanization of the
live birds. Two further mynahs and one bird of paradise were found as
positive.
Pathological examination revealed inanition, exsiccosis, pulmonary
congestion, pneumonia, endoparasites and air sac mycosis. In some
of H5N1 positive birds, additionally meningitis, meningoencephalitis,
necrotic pancreatitis and parenchymal hyperemia were present. In the
mynahs, iron overload (siderosis) in liver and spleen was seen, the
most common metabolic disorder in these birds.
Conclusion: This case represented the first detection of the new
clade 2.3.2.1 of HPAI H5N1 in wild birds of Indonesia and the first introduction since 2005 of H5N1 into the EU due to smuggled birds.
Typical encephalitis and pancreatitis were seen at least in 2-3 positive H5N1 mynahs. However, most birds died because of starvation,
dehydratation or shock.
The risk for human health was considered and therefore all the persons having contact to the birds (customs officials, border veterinarians
at the quarantine helpers) received Tamiflu.
23.082 Outbreak of Chlamydia psittaci: timely
detection and diagnostics in a wild bird
rehabilitation centre
I. Goverse1, N. Reedijk1, I. Veldhuijzen1, R. van Gageldonk2,
O. Stenvers3, F. Velkers4, E. Heddema5, O. Pontesilli6, A. Tjon-A-Tsien1
1
GGD Rotterdam-Rijnmond, Rotterdam, Netherlands, 2National
Institute for Public Health and the Environment, Bilthoven,
Netherlands, 3Netherlands Food & Consumer Product Safety
Authority, Utrecht, Netherlands, 4Utrecht University, Utrecht,
Netherlands, 5Orbis

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