Large waterborne Campylobacter outbreak: use of multiple approaches to investigate contamination of the drinking water supply system, Norway, June 2019

Hyllestad, Susanne; Iversen, A.; MacDonald, Emily; Amato, Ettore; Borge, Bengt Åge Sørby; Bøe, Anton; Sandvin, Aslaug; Brandal, Lin Thorstensen; Lyngstad, Trude Marie; Naseer, Umaer; Nygård, Karin; Veneti, Lamprini; Vold, Line

doi:10.2807/1560-7917.es.2020.25.35.2000011

Cited by 38 publications

(40 citation statements)

References 35 publications

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“…In addition, outbreaks caused by Campylobacter spp. are increasingly being identified and reported on a regular basis, often linked to consumption of untreated drinking water, raw milk or chicken liver paté ( Jakopanec et al., 2008 ; Revez et al., 2014 ; Davis et al., 2016 ; Lahti et al., 2017 ; Kang et al., 2019 ; Hyllestad et al., 2020 ).…”

Section: Introductionmentioning

confidence: 99%

Investigating Major Recurring Campylobacter jejuni Lineages in Luxembourg Using Four Core or Whole Genome Sequencing Typing Schemes

Nennig

Llarena

Herold

et al. 2021

Front. Cell. Infect. Microbiol.

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Campylobacter jejuni is the leading cause of bacterial gastroenteritis, which has motivated the monitoring of genetic profiles circulating in Luxembourg since 13 years. From our integrated surveillance using a genotyping strategy based on an extended MLST scheme including gyrA and porA markers, an unexpected endemic pattern was discovered in the temporal distribution of genotypes. We aimed to test the hypothesis of stable lineages occurrence by implementing whole genome sequencing (WGS) associated with comprehensive and internationally validated schemes. This pilot study assessed four WGS-based typing schemes to classify a panel of 108 strains previously identified as recurrent or sporadic profiles using this in-house typing system. The strain collection included four common lineages in human infection (N = 67) initially identified from recurrent combination of ST-gyrA-porA alleles also detected in non-human samples: veterinary (N = 19), food (N = 20), and environmental (N = 2) sources. An additional set of 19 strains belonging to sporadic profiles completed the tested panel. All the strains were processed by WGS by using Illumina technologies and by applying stringent criteria for filtering sequencing data; we ensure robustness in our genomic comparison. Four typing schemes were applied to classify the strains: (i) the cgMLST SeqSphere+ scheme of 637 loci, (ii) the cgMLST Oxford scheme of 1,343 loci, (iii) the cgMLST INNUENDO scheme of 678 loci, and (iv) the wgMLST INNUENDO scheme of 2,795 loci. A high concordance between the typing schemes was determined by comparing the calculated adjusted Wallace coefficients. After quality control and analyses with these four typing schemes, 60 strains were confirmed as members of the four recurrent lineages regardless of the method used (N = 32, 12, 7, and 9, respectively). Our results indicate that, regardless of the typing scheme used, epidemic or endemic signals were detected as reflected by lineage B (ST2254-gyrA9-porA1) in 2014 or lineage A (ST19-gyrA8-porA7), respectively. These findings support the clonal expansion of stable genomes in Campylobacter population exhibiting a multi-host profile and accounting for the majority of clinical strains isolated over a decade. Such recurring genotypes suggest persistence in reservoirs, sources or environment, emphasizing the need to investigate their survival strategy in greater depth.

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Section: Introductionmentioning

confidence: 99%

Investigating Major Recurring Campylobacter jejuni Lineages in Luxembourg Using Four Core or Whole Genome Sequencing Typing Schemes

Nennig

Llarena

Herold

et al. 2021

Front. Cell. Infect. Microbiol.

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“…In some of the identi ed articles included in this review, the bene t of combining the surveillance system to geographical supply zones to increase the likelihood of detecting a waterborne outbreak was highlighted. On the other hand, deploying such systems may be challenging, since it will most likely involve two different elds of expertise (health and technical), and the processing of data to inform health decisions must still be accounted for, since local outbreaks are usually short-lived (51).…”

Section: Effectiveness Of Sys Systems In Detecting Waterborne Outbreaksmentioning

confidence: 99%

“…However, none of the excluded studies reported on analysis linked to real or simulated outbreaks. One of the most reported causes of waterborne outbreaks is heavy rainfall, which represents a future increasing risk (53) and implies a greater call for a risk-based approach to surveillance for water supply systems (51). In general, since there will always be a risk of water contamination going undetected, prioritizing long-term preventive measures and risk-based surveillance should not be underestimated despite promising reporting on SyS systems.…”

Section: Effectiveness Of Sys Systems In Detecting Waterborne Outbreaksmentioning

confidence: 99%

The Effectiveness of Syndromic Surveillance for the Early Detection of Waterborne Outbreaks: A Systematic Review

Hyllestad

Amato

Nygård

et al. 2020

Preprint

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Background: Waterborne outbreaks are still a risk in high-income countries, and their early detection is crucial to limit their societal consequences. Although syndromic surveillance is widely used for the purpose of detecting outbreaks days earlier than traditional surveillance systems, evidence of the effectiveness of such systems is lacking. Thus, our objective was to conduct a systematic review of the effectiveness of syndromic surveillance to detect waterborne outbreaks. Method: We searched the Cochrane Library, Medline/PubMed, EMBASE, Scopus, and Web of Science for relevant published articles using a combination of the keywords ‘drinking water’, ‘surveillance’, and ‘waterborne disease’ for the period of 1990 to 2018. The references lists of the identified articles for full-text record assessment were screened, and random searches using the same key words were conducted. We assessed the risk of bias in the included articles using the ROBINS-I tool and PRECEPT for the cumulative body of evidence. Results: From the 1,955 articles identified, we reviewed 52 articles, of which 16 met the eligibility criteria. Ten were retrospective studies, whereas six were simulation studies. There is no clear evidence for syndromic surveillance in terms of the ability to detect waterborne outbreaks (low sensitivity and high specificity). However, one simulation study implied that multiple sources of signals combined with spatial information may increase the timeliness in detecting a waterborne outbreak and reduce false alarms. Conclusion: This review demonstrates that there is no conclusive evidence on the effectiveness of syndromic surveillance for the detection of waterborne outbreaks, thus suggesting the need to focus on primary prevention measures to reduce the risk of waterborne outbreaks. Future studies should investigate methods for combining health and environmental data with an assessment of needed financial and human resources for implementing such surveillance systems.

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“…In Norway, waterborne outbreaks are reported every year, with the second most common microorganism involved being Campylobacter spp. (Hyllestad et al, 2020). The microbiological analysis of water during an outbreak can be challenging, as the contamination is often a short period, and by the time the outbreak is detected, the contamination episode is over (Hänninen et al, 2003;Hyllestad et al, 2020).…”

Section: Introductionmentioning

confidence: 99%

Genomic and Phenotypic Characterisation of Campylobacter jejuni Isolates From a Waterborne Outbreak

Davies

Ebbesen

Johansson

et al. 2020

Front. Cell. Infect. Microbiol.

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Campylobacter infections are the leading cause of bacterial gastroenteritis. In Europe, over 246,000 cases are confirmed annually. Infections are often transmitted via contaminated food, such as poultry products, but water may be the source of infection as well. The aim of this study was to characterise a selection of Campylobacter jejuni human isolates, together with a water isolate, from a waterborne outbreak in Norway in 2019, including human isolates from early, mid-, and late epidemic. The isolates were characterised with whole-genome sequencing, analysing the expression of putative virulence genes and demonstrating the pathogenic potential in an in vitro adhesion model using HT-29 cells. All isolates belonged to the multilocus sequence type 1701 and ST45 clonal complex. In the genomic analysis, the water isolate clustered somewhat separately from the human isolates. There was some variation between the human isolates, but the water isolate seemed to display the greatest pathogenic potential, demonstrated by the highest levels of virulence gene expression, adhesion to epithelial cells and IL-8 induction. These results suggest that the water isolate of the study has potential to cause human infections, and that some bacterial changes due to host or environmental adaptation, may occur during a waterborne Campylobacter epidemic. This is, to the best of our knowledge, the first study on C. jejuni isolates from a waterborne outbreak, including both human isolates and a water isolate, characterised with genomic and phenotypic approaches.

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Large waterborne Campylobacter outbreak: use of multiple approaches to investigate contamination of the drinking water supply system, Norway, June 2019

Cited by 38 publications

References 35 publications

Investigating Major Recurring Campylobacter jejuni Lineages in Luxembourg Using Four Core or Whole Genome Sequencing Typing Schemes

Investigating Major Recurring Campylobacter jejuni Lineages in Luxembourg Using Four Core or Whole Genome Sequencing Typing Schemes

The Effectiveness of Syndromic Surveillance for the Early Detection of Waterborne Outbreaks: A Systematic Review

Genomic and Phenotypic Characterisation of Campylobacter jejuni Isolates From a Waterborne Outbreak

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