Daily Archives: January 9, 2015

A Blind Spot in Legionella Outbreak Diagnostics

Mercante JW, Winchell JM. Current and Emerging Legionella Diagnostics for Laboratory and Outbreak Investigations. Clinical Microbiology Reviews. 2015 Jan;28(1):95-133.

Legionnaires’ disease (LD) is an often severe and potentially fatal form of bacterial pneumonia caused by an extensive list of Legionella species. These ubiquitous freshwater and soil inhabitants cause human respiratory disease when amplified in man-made water or cooling systems and their aerosols expose a susceptible population. Treatment of sporadic cases and rapid control of LD outbreaks benefit from swift diagnosis in concert with discriminatory bacterial typing for immediate epidemiological responses. Traditional culture and serology were instrumental in describing disease incidence early in its history; currently, diagnosis of LD relies almost solely on the urinary antigen test, which captures only the dominant species and serogroup, Legionella pneumophila serogroup 1 (Lp1). This has created a diagnostic “blind spot” for LD caused by non-Lp1 strains. This review focuses on historic, current, and emerging technologies that hold promise for increasing LD diagnostic efficiency and detection rates as part of a coherent testing regimen. The importance of cooperation between epidemiologists and laboratorians for a rapid outbreak response is also illustrated in field investigations conducted by the CDC with state and local authorities. Finally, challenges facing health care professionals, building managers, and the public health community in combating LD are highlighted, and potential solutions are discussed.

Cholera in the Philippines Attributed to Infrastructure Breakdown and Non-Chlorination of Drinking Water

Lopez AL, Macasaet LY, Ylade M, Tayag EA, Ali M. Epidemiology of Cholera in the Philippines. PLoS Negl Trop Dis. 2015 Jan 8;9(1):e3440. doi: 10.1371/journal.pntd.0003440.

BACKGROUND: Despite being a cholera-endemic country, data on cholera in the Philippines remain sparse. Knowing the areas where cholera is known to occur and the factors that lead to its occurrence will assist in planning preventive measures and disaster mitigation.

METHODS: Using sentinel surveillance data, PubMed and ProMED searches covering information from 2008-2013 and event-based surveillance reports from 2010-2013, we assessed the epidemiology of cholera in the Philippines. Using spatial log regression, we assessed the role of water, sanitation and population density on the incidence of cholera.

RESULTS AND DISCUSSION: We identified 12 articles from ProMED and none from PubMed that reported on cholera in the Philippines from 2008 to 2013. Data from ProMed and surveillance revealed 42,071 suspected and confirmed cholera cases reported from 2008 to 2013, among which only 5,006 were confirmed. 38 (47%) of 81 provinces and metropolitan regions reported at least one confirmed case of cholera and 32 (40%) reported at least one suspected case. The overall case fatality ratio in sentinel sites was 0.62%, but was 2% in outbreaks. All age groups were affected. Using both confirmed and suspected cholera cases, the average annual incidence in 2010-2013 was 9.1 per 100,000 population. Poor access to improved sanitation was consistently associated with higher cholera incidence. Paradoxically, access to improved water sources was associated with higher cholera incidence using both suspected and confirmed cholera data sources. This finding may have been due to the breakdown in the infrastructure and non-chlorination of water supplies, emphasizing the need to maintain public water systems.

CONCLUSION: Our findings confirm that cholera affects a large proportion of the provinces in the country. Identifying areas most at risk for cholera will support the development and implementation of policies to minimize the morbidity and mortality due to this disease.

Litigation as a Method of Advancing Sanitation?

This study raises a number of important issues. The underlying philosophy of this particular publication promotes one particular point of view.

de Barcellos AP. Sanitation Rights, Public Law Litigation, and Inequality: A Case Study from Brazil. Health and Human Rights. 2014 Dec 11;16(2):E35-E46.

Public law litigation has been used in many places to advance human rights related to health. In Brazil, such lawsuits usually request that the government pay for pharmaceuticals to individuals. But could litigation play a role in shaping public health policies to benefit communities? To explore this question, this paper focuses on lawsuits involving determinants of health, namely water and sanitation public policies. This paper discusses the results of an empirical study of 258 Brazilian court orders, issued in a 10-year period, that address requests for sewage collection and treatment. The data show that the Brazilian judiciary is willing to improve access to sanitation services. However, litigation has addressed fewer than 177 out of the 2,495 Brazilian municipalities that lack both sewage collection and treatment systems, and lawsuits are concentrated in the richer cities, not in the poorest ones. This paper suggests that public law litigation can be used to foster public health policies similar to the way in which structural reform litigation and the experimentalism approach between courts and defendants have influenced public policies and achieved institutional reform in schools and prisons. However, greater effort is needed to target initiatives that would reach the most disenfranchised communities.

Microbiological Assessment of Well Water, Nigeria

Aboh EA, Giwa FJ, Giwa A. Microbiological assessment of well waters in Samaru, Zaria, Kaduna, State, Nigeria. Annals of African Medicine. 2015 Jan-Mar;14(1):32-8. doi: 10.4103/1596-3519.148732.

BACKGROUND: Majority of the human population in semi-urban and urban areas in Nigeria are heavily reliant on well water as the main source of water supply for drinking and domestic use due to inadequate provision of potable pipe borne water. These groundwater sources can easily be fecally contaminated and thus, increase the incidence and outbreaks of preventable waterborne diseases. This study was carried out to determine the bacteriological quality of some well waters in Samaru, Z.

MATERIALS AND METHODS: Samaru, Zaria located in Northern Nigeria, is a semi-urban university satellite town blessed with abundant ground and surface water. Five sampling sites were randomly selected for this study. A total of 10 samples: Two from each of the sites were collected fortnightly for 1 month (May-June, 2013). Samples were analyzed using presumptive multiple tube fermentation and confirmatory tests for total and fecal coliforms. The well water samples were also cultured for Salmonella, Shigella, and Vibrio chole.

RESULTS: The total coliform count for all the samples analyzed was >180+/100 ml. All the well water samples from the study locations were contaminated with one or more bacterial pathogens, Escherichia coli 20%, Klebsiella pneumoniae 100% and Proteus mirabilis 40%. Salmonella, Shigella, or V. cholerae were not isolated from any of the well water samples.

CONCLUSIONS: The results from this study showed contamination of all the wells studied with fecal coliforms thus, indicating the possible presence of other enteric pathogens and a potential source for waterborne disease outbreaks. Well water in Samaru is not safe for drinking without additional treatment like disinfection or boiling. Periodic testing and constant monitoring of well waters should also be done to meet up with the World Health Organization Standards in the provision of safe, clean drinking water.