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Background: Hepatitis A is a disease of public health significance that typically causes acute, self-limiting infection. Understanding the risk factors and demographics associated with individual infections and outbreaks can guide public health communication and interventions. Objective: To assess the number of hepatitis A cases and outbreaks in Ontario from January 1, 2015, to November 22, 2022, and to identify common risk factors associated with sporadic and outbreak-associated infections in Ontario. Methods: Confirmed and probable hepatitis A cases reported between January 1, 2015, and November 22, 2022, were extracted from the Ontario electronic reporting system. Descriptive analyses were used to summarize and compare risk factors reported by sporadic and outbreak-associated hepatitis A cases. Annual rates of infection for individual public health units were calculated using annual population estimates for Ontario health regions. Results: During the study period, 938 cases of hepatitis A were reported in Ontario (an average annual rate of 0.9 cases per 100,000 population), with 31.3% (n=294) of cases linked to one of 18 unique outbreaks of hepatitis A. Four of 13 local outbreaks were associated with elementary school settings. Reported risk factors differed between sporadic cases (predominantly travel-related) and cases linked to known outbreaks (anal-oral contact, illicit drug use, diapering/assisting in toileting, close contact with a case). Rates of sporadic infection differed across public health units in Ontario over the study period. Conclusion: Public health interventions that aim to increase awareness of hepatitis A risk factors and increase vaccine uptake among those at increased risk of exposure could help to reduce the incidence of both locally acquired and travel-related sporadic infections and outbreaks.
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We identified 2 cases of Salmonella enterica serovar Vitkin infection linked by whole-genome sequencing in infants in Ontario, Canada, during 2022. Both households of the infants reported having bearded dragons as pets. The outbreak strain was also isolated from an environmental sample collected from a patient's bearded dragon enclosure. Twelve cases were detected in the United States, and onset dates occurred during March 2021-September 2022 (isolates related to isolates from Canada within 0-9 allele differences by core-genome multilocus sequence typing). Most US patients (66.7%) were <1 year of age, and most (72.7%) had reported bearded dragon exposure. Hospitalization was reported for 5 (38.5%) of 13 patients. Traceback of bearded dragons identified at least 1 potential common supplier in Southeast Asia. Sharing rare serovar information and whole-genome sequencing data between Canada and the United States can assist in timely identification of outbreaks, including those that might not be detected through routine surveillance.
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Lagartos , Salmonella , Lactante , Animales , Humanos , Estados Unidos/epidemiología , Ontario , Alelos , Brotes de Enfermedades , HospitalizaciónRESUMEN
The incidence of salmonellosis, and other enteric zoonotic diseases, has been associated with various food and environmental exposures and socioeconomic factors. Increasingly, there is interest in exploring differences among serotypes of Salmonella to better inform public health prevention efforts. Consequently, we investigated whether rates of Salmonella Heidelberg and Typhimurium in Ontario communities in 2015 were influenced by household characteristics, agricultural factors, and the presence of meat plants. Data for each reported case of S. Heidelberg and S. Typhimurium in Ontario in 2015 were collected. Expected cases of each serotype were calculated, stratified by age group and sex, according to the underlying population distribution from the Canadian census. Socioeconomic, agricultural census data, and data concerning provincial and federally inspected meat plants were combined with observed and expected case counts. The association between community-level agricultural, meat processing, and socioeconomic variables, serotype, and the rate of salmonellosis in each census subdivision (CSD) was explored using multilevel Poisson models, with random intercepts for CSD and census division (CD). Rates of S. Heidelberg and S. Typhimurium were associated with the proportion of married individuals in a CSD, and were higher in CSDs with the highest quantile of labour participation compared to those in the lowest quantile. There was an interaction effect between cattle, poultry and swine farm density in a CD and serotype, with rates of either serotype decreasing as cattle, poultry, or swine farm density in the encompassing CD increased. The rate of the decrease varied by serotype. Our findings concerning community-level household characteristics may be explained by the influence of family structure and occupation on food consumption patterns and environmental exposures. Rates of S. Heidelberg and S. Typhimurium may be lower in areas with increased animal farm density due to naturally acquired immunity from routine exposure to Salmonella via livestock.
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Objective: Chickens are a natural reservoir for zoonotic pathogens. Humans and pets may be at increased risk of illness due to contact with poultry, their eggs, and their environment. We aimed to identify any knowledge, attitude, or practice gaps among current and prospective backyard chicken owners. Animal: Backyard chickens. Procedure: Responses were collected through an anonymous online survey from December 2019 to March 2021. Respondents were asked questions regarding household demographics, previous, current, or future backyard chickens, primary reasons for having or wanting backyard chickens, and about animal handling practices and zoonotic disease awareness. Results: There were 279 respondents from Ontario (85.9%). Reported reasons for having or wanting backyard chickens included for eggs (94.0%), as pets (49.6%), and as a hobby (62.4%). Interestingly, 8.1% wanted chickens for their meat. Just over 1/5 (21.1%) of those with current or recent flocks allowed the birds to come into their house. Just over 7% incorrectly indicated rabies virus could be transmitted by backyard chickens. Conclusions: Reasons for having or wanting backyard chickens included food and companionship. Many owners reported allowing the chickens entry into their homes, highlighting increased opportunities for zoonotic pathogen transmission. There were misconceptions regarding pathogens transmissible by chickens.
Poulets urbains Une enquête transversale auprès des propriétaires actuels et potentiels de poulets urbains en Ontario (2019-2021). Objectif: Les poulets sont un réservoir naturel pour des agents pathogènes zoonotiques. Les humains et les animaux de compagnie peuvent courir un risque accru de maladie en raison du contact avec la volaille, leurs oeufs et leur environnement. Notre objectif était d'identifier les lacunes en matière de connaissances, d'attitudes ou de pratiques chez les propriétaires actuels et potentiels de poulets urbains. Animal: Poulets urbains. Procédure: Les réponses ont été recueillies par le biais d'une enquête en ligne anonyme de décembre 2019 à mars 2021. Les répondants ont été interrogés sur la démographie des ménages, les poulets urbains précédents, actuels ou futurs, les principales raisons d'avoir ou de vouloir des poulets urbains, et sur les pratiques de manipulation des animaux et la sensibilisation aux maladies zoonotiques. Résultats: Il y avait 279 répondants de l'Ontario (85,9 %). Les raisons déclarées d'avoir ou de vouloir des poulets urbains incluaient pour les oeufs (94,0 %), comme animaux de compagnie (49,6 %) et comme passe-temps (62,4 %). Fait intéressant, 8,1 % voulaient des poulets pour leur viande. Un peu plus de 1/5 (21,1 %) de ceux qui ont des troupeaux actuels ou récents ont permis aux oiseaux d'entrer dans leur maison. Un peu plus de 7 % ont indiqué à tort que le virus de la rage pouvait être transmis par des poulets urbains. Conclusions: Les raisons d'avoir ou de vouloir des poulets urbains comprenaient la nourriture et la compagnie. De nombreux propriétaires ont déclaré autoriser l'entrée des poulets dans leurs maisons, soulignant les possibilités accrues de transmission d'agents pathogènes zoonotiques. Il y avait des idées fausses concernant les agents pathogènes transmissibles par les poulets.(Traduit par Dr Serge Messier).
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Pollos , Enfermedades de las Aves de Corral , Animales , Humanos , Estudios Transversales , Ontario/epidemiología , Estudios Prospectivos , Crianza de Animales DomésticosRESUMEN
BACKGROUND: Outbreaks cause significant morbidity and mortality in healthcare settings. Current testing methods can identify specific viral respiratory pathogens, yet the approach to outbreak management remains general. OBJECTIVES: Our aim was to examine pathogen-specific trends in respiratory outbreaks, including how attack rates, case fatality rates and outbreak duration differ by pathogen between hospitals and long-term care (LTC) and retirement homes (RH) in Ontario. METHODS: Confirmed respiratory outbreaks in Ontario hospitals and LTC/RH reported between September 1, 2007, and August 31, 2017, were extracted from the integrated Public Health Information System (iPHIS). Median attack rates and outbreak duration and overall case fatality rates of pathogen-specific outbreaks were compared in both settings. RESULTS: Over the 10-year surveillance period, 9,870 confirmed respiratory outbreaks were reported in Ontario hospitals and LTC/RH. Influenza was responsible for most outbreaks (32% in LTC/RH, 51% in hospitals), but these outbreaks were shorter and had lower attack rates than most non-influenza outbreaks in either setting. Human metapneumovirus, while uncommon (<4% of outbreaks) had high case fatality rates in both settings. CONCLUSION: Attack rates and case fatality rates varied by pathogen, as did outbreak duration. Development of specific outbreak management guidance that takes into account pathogen and healthcare setting may be useful to limit the burden of respiratory outbreaks.
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Salmonellosis is one of several zoonotic diseases for which individuals with occupational animal contact, including abattoir workers, are at an increased risk. If meat is contaminated during slaughter, this can increase the risk of enteric illness for consumers. In this study, we investigated whether reported cases of Salmonella Heidelberg and Typhimurium were clustered around abattoirs in Ontario in 2015 and whether there was any evidence (laboratory/exposure) to suggest an abattoir at the centre of a cluster might be the source of exposure. Data for each reported case of S. Heidelberg and S. Typhimurium in Ontario in 2015 were collected. Multi-focused and non-focused spatial and space-time cluster detection tests were performed for each serotype, with and without cases linked to known outbreaks, using Poisson and space-time permutation models. Focused tests included the location of abattoirs operational in all or part of 2015. Laboratory data and exposure information were used to explore the relatedness of cases within identified clusters. Focused spatial tests identified clusters of S. Heidelberg and S. Typhimurium around abattoirs. Focused space-time permutation tests identified 2 significant space-time clusters of S. Heidelberg; one cluster (n = 11 cases) included 8 of 9 cases associated with a known outbreak and the other cluster (n = 18 cases) was not part of a previously identified outbreak. Review of laboratory and risk factor information suggested that cases within each cluster shared a common exposure. Cases were not asked about goat or sheep meat consumption. The focused cluster test, particularly with the space-time permutation model, could assist in identifying outbreaks associated with a particular physical location, such as an abattoir. Improvements to the current case investigation process, such as consistent collection and reporting of high-risk occupation information and more detailed food consumption history, could assist in outbreak identification when coupled with this statistic.
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Mataderos , Brotes de Enfermedades , Infecciones por Salmonella/microbiología , Salmonella/clasificación , Animales , Análisis por Conglomerados , Humanos , Ontario/epidemiología , Factores de Riesgo , Infecciones por Salmonella/epidemiología , ZoonosisRESUMEN
PURPOSE: Salmonellosis is one of several reportable diseases in Ontario (ON). Two or more cases of the same serotype that are linked to a common exposure or related to one another in time and/or space are considered a potential outbreak. While laboratory data can help to determine the molecular relatedness of cases, results may take up to several weeks. This study aimed to assess the utility of the retrospective spatial scan statistic in detecting clusters of Salmonella Heidelberg and Salmonella Typhimurium cases using data from ON in 2015. Identified clusters were validated by laboratory data (where available) to determine whether identified clusters were likely outbreaks. METHODS: Data representing the location of each reported S. Heidelberg or S. Typhimurium case in 2015, responsible serotype and symptom onset date were exported to SaTScan for retrospective spatial, temporal, and space-time analyses using the spatial scan statistic with Bernoulli models and a space-time permutation model. Analyses were performed with and without those cases linked to known outbreaks. Laboratory subtyping data (i.e. pulsed field gel electrophoresis (PFGE) and/or phage type) and food and environmental exposure information (e.g. travel, animal contact, poultry and other food item consumption) were used to explore the relatedness of cases within identified clusters. RESULTS: Spatial, temporal and space-time analyses identified a known outbreak of S. Heidelberg in 2015 (n = 9 cases) and a previously unidentified cluster of S. Heidelberg cases. Most cases (94%) within a cluster detected via a space-time permutation model of S. Heidelberg cases shared an identical PFGE pattern and appeared to represent a true outbreak. CONCLUSIONS: The spatial scan statistic, and particularly the space-time permutation model, could assist in outbreak identification before laboratory data are available, allowing for faster cluster identification and implementation of control measures.
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Infecciones por Salmonella/epidemiología , Infecciones por Salmonella/microbiología , Salmonella/clasificación , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Análisis por Conglomerados , Brotes de Enfermedades , Femenino , Microbiología de Alimentos , Humanos , Lactante , Masculino , Persona de Mediana Edad , Ontario/epidemiología , Estudios Retrospectivos , Adulto JovenRESUMEN
Salmonella Heidelberg and Salmonella Typhimurium are among the most common serotypes responsible for human salmonellosis in Ontario. Introduction of the Ontario Investigation Tools (OIT) in 2014 allowed for standardized case investigation and reporting. This study compared the risk factors and symptomatology for sporadic S. Heidelberg and S. Typhimurium cases reported in Ontario in 2015, following implementation of the OIT. Multilevel logistic regression models were applied to assess associations between serotype and individual-level demographic characteristics, exposures and symptoms for sporadic confirmed cases of S. Heidelberg and S. Typhimurium in Ontario in 2015. There were 476 sporadic cases of S. Typhimurium (n = 278) and S. Heidelberg (n = 198) reported in Ontario in 2015. There were significant associations between the odds of the isolate from a case being one of these serotypes, and travel, consumption of sprouts (any type), contact with reptiles and development of malaise, fever or bloody diarrhoea. The S. Typhimurium and S. Heidelberg cases differed in both symptom presentation and risk factors for illness. Case-case comparisons of Salmonella serotypes have some advantages over case-control studies in that these are less susceptible to selection and recall bias while allowing for rapid comparison of cases to identify potential high-risk exposures that are unique to one of the serotypes when compared to the other. Comparing cases of two different Salmonella serotypes can help to highlight risk factors that may be uniquely associated with one serotype, or more strongly associated with one serotype compared to another. This information may be useful for understanding relative source attribution between common serotypes of Salmonella.