Forest service employees and hunters compose a population with a high prevalence of alpha-gal-sIgE positivity and carry a considerable risk of red meat allergy.

Respiratory syncytial virus (RSV) usually causes self-limiting upper respiratory tract infections, but can be associated with severe lower respiratory tract infection disease (LRTID) in infants and in patients with hematologic malignancies. We have analyzed the risk factors and the measures for containment within an outbreak of nosocomial RSV infections in a hematology and SCT unit. A total of 56 patients were affected (53 RSV-A and 3 RSV-B) including 32 transplant patients (16 allogeneic and 16 autologous). Forty (71%) of the 56 patients suffered from LRTID and 14 (35%) of the patients with LRTID subsequently died. However, because of concomitant infections with fungal and bacterial pathogens, the impact of RSV on the fatal outcome was difficult to assess. Multivariate analysis showed that low levels of IgG were significantly associated with fatal outcome (P ¼ 0.007), treatment with oral ribavirin represented a protective factor (P ¼ 0.02). An extremely protracted viral shedding was observed in this cohort of patients (median ¼ 30.5 days, range: 1-162 days), especially pronounced in patients after allogeneic transplantation (P ¼ 0.002). Implementation of rigorous isolation and barrier measures, although challenged by long-term viral carriers, was effective in containment of the outbreak.

A cluster of seven human cases of listeriosis occurred in Austria and in Germany between April 2011 and July 2013. The Listeria monocytogenes serovar (SV) 1/2b isolates shared pulsed-field gel electrophoresis (PFGE) and fluorescent amplified fragment length polymorphism (fAFLP) patterns indistinguishable from those from five food producers. The seven human isolates, a control strain with a different PFGE/fAFLP profile and ten food isolates were subjected to whole genome sequencing (WGS) in a blinded fashion. A gene-by-gene comparison (multilocus sequence typing (MLST)+) was performed, and the resulting whole genome allelic profiles were compared using SeqSphere+ software version 1.0. On analysis of 2298 genes, the four human outbreak isolates from 2012 to 2013 had different alleles at ≤6 genes, i.e. differed by ≤6 genes from each other; the dendrogram placed these isolates in between five Austrian unaged soft cheese isolates from producer A (≤19-gene difference from the human cluster) and two Austrian ready-to-eat meat isolates from producer B (≤8-gene difference from the human cluster). Both food products appeared on grocery bills prospectively collected by these outbreak cases after hospital discharge. Epidemiological results on food consumption and MLST+ clearly separated the three cases in 2011 from the four 2012–2013 outbreak cases (≥48 different genes). We showed that WGS is capable of discriminating L. monocytogenes SV1/2b clones not distinguishable by PFGE and fAFLP. The listeriosis outbreak described clearly underlines the potential of sequence-based typing methods to offer enhanced resolution and comparability of typing systems for public health applications.

The diagnostic gains of repeat testing for Clostridium difficile by enzyme immunoassay and PCR (i.e., initial negative result followed by positive result) within a 7-day period were 1.9 and 1.7%, respectively. There is little value of repeat testing for C. difficile by enzyme immunoassay or PCR.

While efforts are underway to expand latrine coverage to an estimated 2.6 billion people who lack access to improved sanitation, there is evidence that actual use of latrines is suboptimal, limiting the potential health and environmental gains from containment of human excreta. We developed a passive latrine use monitor (PLUM) and compared its ability to measure latrine activity with structured observation. Each PLUM consisted of a passive infrared motion detector, microcontroller, data storage card, and batteries mounted in a small plastic housing that was positioned inside the latrine. During a field trial in Orissa, India, with ∼115 households, the number of latrine events measured by the PLUMs was in good agreement with that measured by trained observers during 5 h of structured observation per device per week. A significant finding was that the presence of a human observer was associated with a statistically significant increase in the number of latrine events, i.e., the users modified their behavior in response to the observer. Another advantage of the PLUM was the ability to measure activity continuously for an entire week. A shortcoming of the PLUM was the inability to separate latrine events that occurred in immediate succession, leading to possible undercounting during high-traffic periods. The PLUM is a promising technology that can provide detailed measures of latrine use to improve the understanding of sanitation behaviors and how to modify them and for assessing the intended health, livelihood, and environmental benefits of improved sanitation.

No abstract

We investigated 543 Listeria monocytogenes isolates from food having a temporal and spatial distribution compatible with that of the invasive listeriosis outbreak occurring 2012–2016 in southern Germany. Using forensic microbiology, we identified several products from 1 manufacturer contaminated with the outbreak genotype. Continuous molecular surveillance of food isolates could prevent such outbreaks.

Listeriosis patient isolates in Germany have shown a new identical pulsed-field gel electrophoresis (PFGE) pattern since 2012 (n = 66). Almost all isolates (Listeria monocytogenes serotype 1/2a) belonged to cases living in southern Germany, indicating an outbreak with a so far unknown source. Case numbers in 2015 are high (n = 28). No outbreak cases outside Germany have been reported. Next generation sequencing revealed the unique cluster type CT1248 and confirmed the outbreak. Investigations into the source are ongoing.