Alveolar echinococcosis, the disease caused by infection with the intermediate stage of the Echinococcus multilocularis tapeworm, is typically fatal in humans and dogs when left untreated. Since 2012, alveolar echinococcosis has been diagnosed in 5 dogs, 3 lemurs, and 1 chipmunk in southern Ontario, Canada, a region previously considered free of these tapeworms. Because of human and animal health concerns, we estimated prevalence of infection in wild canids across southern Ontario. During 2015–2017, we collected fecal samples from 460 wild canids (416 coyotes, 44 foxes) during postmortem examination and analyzed them by using a semiautomated magnetic capture probe DNA extraction and real-time PCR method for E. multilocularis DNA. Surprisingly, 23% (95% CI 20%–27%) of samples tested positive. By using a spatial scan test, we identified an infection cluster (relative risk 2.26; p = 0.002) in the western-central region of the province. The cluster encompasses areas of dense human population, suggesting zoonotic transmission.

higa toxin-producing Escherichia coli O157:H7/NM (STEC O157) are zoonotic pathogens associated with many foodborne and water-borne outbreaks in North America and elsewhere. 1-3 Most STEC O157 infections have been linked to the consumption of beef, produce or water contaminated directly or indirectly by cattle manure. 1,4-7 However, STEC O157 carriage has been reported not only in cattle but also in other animal species, including other ruminants, swine and poultry. 2,8-11 In October 2011, a local health department in southwestern Ontario was notified of several cases of bloody diarrhoea in persons who had attended a four-day gathering that had ended four days earlier. The 59 attendees had shared several meals prepared by attendees and caterers, including pork from a pig roasted whole by a caterer at a pig roast, served fresh on the second day of the event along with a meal prepared by another caterer, and as cold and reheated leftovers the following day. This report describes the investigation of this outbreak, in which evidence implicated the pork as the source of illness. METHODS Case definition A confirmed case was an attendee reporting enteric symptoms (nausea, abdominal cramps, vomiting, and/or diarrhoea) beginning anytime from day 2 of the event to 10 days after the last day of the event, with laboratory confirmation of STEC O157:H7 infection. A probable case was an attendee reporting enteric symptoms (nausea, abdominal cramps, vomiting, and/or diarrhoea) during the same period without laboratory confirmation of STEC O157:H7 infection. Case finding and administration of outbreak questionnaire Menu lists of all meals served were used to produce a questionnaire on demographics, symptoms, onset and recovery dates, and food exposures (consumption of individual menu items) at shared meals. A list of attendees was provided by the host. Those who could be contacted were asked to complete the questionnaire, either by telephone or in person.

In the 3 years since the first report of canine alveolar echinococcosis (AE) in Ontario, three additional cases have been diagnosed in the province. Of the four cases reported to date, three have had no known history of travel outside the province. It is possible that this development is an indication of previously unrecognized environmental contamination with Echinococcus multilocularis eggs in some areas of the province. If so, there is the potential for an emerging threat to human health. This article describes a local public health department's investigation of the possible exposure to E. multilocularis of a number of individuals who had had contact with the latest of the four cases of canine AE, and summarizes a comprehensive decision process that can be used by public health departments to assist in the follow-up of such exposures.

In spite of a greatly reduced incidence rate due to vaccination, mumps outbreaks continue to occur in several areas of the world, sometimes in vaccinated populations. This article describes an outbreak in a highly vaccinated population in southwestern Ontario, Canada, and the challenges encountered in interpreting the results of diagnostic tests used in the outbreak. During the outbreak, patients were interviewed and classified according to the outbreak case definition, and specimens were collected for diagnostic testing according to Ontario guidelines. Twentyseven individuals were classified as confirmed cases (n ϭ 19) or suspect cases (n ϭ 8) according to the case definition, only 9 of which were laboratory-confirmed cases: 7 confirmed by reverse transcriptase PCR (RT-PCR) and 2 by IgM serology. All 19 confirmed cases represented patients who were associated with secondary schools in the local area and had been vaccinated against mumps with one (n ϭ 2) or two (n ϭ 17) doses of the measles-mumps-rubella (MMR) vaccine. This is the first published report of an outbreak of mumps in Ontario in which all confirmed cases had been vaccinated against the disease. It highlights the limitations of and difficulties in interpreting current mumps diagnostic tests when used in vaccinated individuals.

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