Model results indicated that the mean WWTP influent concentration of NoV GII (3.9 log 10 gc/liter; 95% credible interval [CI], 3.5, 4.3 log 10 gc/liter) is larger than the value for NoV GI (1.5 log 10 gc/liter; 95% CI, 0.4, 2.4 log 10 gc/liter), with large variations occurring from one WWTP to another. For WWTPs with mechanical systems and chlorine disinfection, mean log 10 reductions were ؊2.4 log 10 gc/liter (95% CI, ؊3.9, ؊1.1 log 10 gc/liter) for NoV GI, ؊2.7 log 10 gc/liter (95% CI, ؊3.6, ؊1.9 log 10 gc/liter) for NoV GII, and ؊2.9 log 10 PFU per liter (95% CI, ؊3.4, ؊2.4 log 10 PFU per liter) for MSCs. Comparable values for WWTPs with lagoon systems and chlorine disinfection were ؊1.4 log 10 gc/liter (95% CI, ؊3.3, 0.5 log 10 gc/liter) for NoV GI, ؊1.7 log 10 gc/liter (95% CI, ؊3.1, ؊0.3 log 10 gc/liter) for NoV GII, and ؊3.6 log 10 PFU per liter (95% CI, ؊4.8, ؊2.4 PFU per liter) for MSCs. Within WWTPs, correlations exist between mean NoV GI and NoV GII influent concentrations and between the mean log 10 reduction in NoV GII and the mean log 10 reduction in MSCs.H uman norovirus (NoV) is the leading cause of food-associated gastroenteritis in the United States (1) and Canada (2). U.S. residents are estimated to experience five episodes of norovirus gastroenteritis in their lifetimes (3). NoV is primarily spread via the fecal-oral route. However, attribution of a particular case of NoV illness to a specific source is complex. The transmission may be direct (person to person) or indirect (via contact with contaminated fomites) or may occur through the ingestion of contaminated food or water (4). Noroviruses are genetically diverse, comprising six genogroups (5), three of which (genogroup I [GI], GII, and GIV) are capable of causing illness in humans (6).Among foodborne NoV outbreaks, bivalve molluscs (e.g., clams, oysters, mussels), leafy vegetables, and fruits are the most frequently implicated (7). More than half of the norovirus outbreaks attributed to the consumption of bivalve molluscs in the United States during the years from 2001 to 2008 are believed to have originated from contamination during production or processing (7). Bivalve molluscan shellfish typically grow in estuaries, which may contain NoV-contaminated human fecal material from municipal wastewater outfalls, combined sewer overflow, or nonpoint sources of pollution, including human waste discharged from marine vessels (8, 9). Bivalve molluscan shellfish feed on algae from the surrounding water. During this feeding process, each bivalve mollusc may filter 20 to 90 liters of water per day and bioaccumulate a variety of microorganisms, including viruses and bacteria that are associated with pollution sources (8,(10)(11)(12). Significantly, molluscan shellfish have been found to retain viruses to a greater extent and for much longer periods than they do bacteria (8,13,14). Bivalve molluscs, therefore, may become contaminated with NoV when they are grown in harvesting areas contaminated with human wastes.In the United States and in Canada, ar...
There is a high level of uncertainty surrounding the potential for iatrogenic prion transmission through transplantation, medical instrument reuse, blood transfusion, and blood product use due to a lack of evidence-based research on this important risk issue. A group of specialists was enlisted to evaluate some of the knowledge gaps in this area using the "Classical Model," a structured elicitation procedure for weighting and pooling expert judgment. The elicitation exercise was undertaken in March 2009 with 11 transmissible spongiform encephalopathy (TSE) experts who were first calibrated using a series of seed questions for which the answers are known; they were then asked to answer a number of target questions that are important for risk assessment purposes, but for which there remains high uncertainty at this time. The target questions focused on variant Creutzfeldt-Jakob disease (vCJD) prevalence, incubation times for vCJD, genetic susceptibility to prion disease, blood infectivity, prion reduction of blood and blood products, surgical instrument risks, and interspecies transmission of TSEs. The experts were also asked to perform pairwise risk rankings for 12 different potential routes of infection. Dura mater transplantation was seen as having the highest risk, while dental tissue grafts were viewed as presenting the lowest risk of iatrogenic transmission. The structured elicitation procedure provides a rational, auditable, and repeatable basis for obtaining useful information on prion disease risk issues, for which data are sparse.
Foodborne diseases are a major cause of illness in Canada. One of the main pathogens causing foodborne illnesses and outbreaks in Canada is Escherichia coli O157:H7.In Canada, from 2008 to 2018, 11 outbreaks of E. coli O157:H7 linked to leafy greens were identified, including 7 linked to romaine lettuce (63.6%), 2 linked to iceberg lettuce (18.2%) and 2 linked to other or unspecified types of leafy greens (18.2%). The consumption of lettuce in Canada, the behaviour of E. coli O157:H7 on lettuce leaves as well as the production practices used for romaine and iceberg lettuce do not seem to explain why a higher number of outbreaks of E. coli O157:H7 were linked to romaine compared to iceberg lettuce. However, the difference in the shape of iceberg and romaine lettuce could be an important factor.Looking at the 7 outbreaks linked to romaine lettuce in Canada between 2008 and 2018, an eastern distribution of cases was observed. Cases from western provinces were only reported twice. The consumption of romaine and iceberg lettuce by the Canadian population does not seem to explain the eastern distribution of cases observed but, the commercial distribution and the travel distance of lettuce as well as the storage practices used may be important factors.In the past 10 years, the majority of the outbreaks of E. coli O157:H7 linked to romaine lettuce happened during 2 time periods: in the spring between the months of March to June and in the fall between the months of September to December. The timing of these outbreaks may be explained by the lettuce availability in Canada, the growing region transition periods in the US and the seasonality in the prevalence of E. coli O157:H7. The consumption of romaine lettuce by the Canadian population does not to explain the timing of the outbreaks observed.
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