Browsing by Author "de Sousa, Rita"
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- Acute gastroenteritis outbreak associated to norovirus GI.9 in a Portuguese army basePublication . Lopes-João, António; Mesquita, João R.; de Sousa, Rita; Oleastro, Mónica; Penha-Gonçalves, Carlos; Nascimento, Maria São JoséGastroenteritis is considered a major illness within the military settings being caused by foodborne enteric pathogens that are particularly easily spread in the crowded conditions of military camps. Gastroenteritis outbreaks caused by norovirus usually affect a great number of soldiers due to the low infectious dose, copious viral shedding, and environmental stability. The present study describes the investigation of an outbreak of acute gastroenteritis that occurred in April 2015 in a Portuguese army base, focusing on the study of the epidemiological curve, symptoms experienced by the affected soldiers, and results of food, water, and stool microbiological analysis. From a total of 938 military personnel stationed on the base 46 soldiers developed acute gastroenteritis. Stool analysis of seven cases showed to be positive for norovirus GI.9 that was the probable cause of the outbreak. This report shows that genogroup I norovirus can also cause considerable morbidity in healthy young soldiers, affecting the operational effectiveness on the military forces. J. Med. Virol. 89:922-925, 2017. © 2016 Wiley Periodicals, Inc.
- Acute gastroenteritis outbreak associated to norovirus GI.9 in a Portuguese army basePublication . Lopes-João, António; Mesquita, João R.; de Sousa, Rita; Oleastro, Mónica; Penha-Gonçalves, Carlos; Nascimento, Maria Sao JoséGastroenteritis is considered a major illness within the military settings being caused by foodborne enteric pathogens that are particularly easily spread in the crowded conditions of military camps. Gastroenteritis outbreaks caused by norovirus usually affect a great number of soldiers due to the low infectious dose, copious viral shedding, and environmental stability. The present study describes the investigation of an outbreak of acute gastroenteritis that occurred in April 2015 in a Portuguese army base, focusing on the study of the epidemiological curve, symptoms experienced by the affected soldiers, and results of food, water, and stool microbiological analysis. From a total of 938 military personnel stationed on the base 46 soldiers developed acute gastroenteritis. Stool analysis of seven cases showed to be positive for norovirus GI.9 that was the probable cause of the outbreak. This report shows that genogroup I norovirus can also cause considerable morbidity in healthy young soldiers, affecting the operational effectiveness on the military forces. J. Med. Virol. © 2016 Wiley Periodicals, Inc.
- Detection of Rickettsia in ticks using loop-mediated isothermal amplification (LAMP)Publication . Lansdell, Samantha; Hassan, Marwa M.; La Ragione, Roberto; Betson, Martha; Nuncio, MS; Lopes de Carvalho, Isabel; Zé-Zé, Líbia; de Sousa, Rita; Cutler, Sally; Davis, Joshua S.Objectives: The objective of the study was to develop a Loop-mediated Isothermal Amplification (LAMP) assay for screening of Rickettsia species circulating in ticks using the citrate synthase gene (gltA). The LAMP assay employed portable visualisation methods, making the assay more field-suitable. Furthermore, prior methods have not used gltA as the target, despite proven success in Polymerase Chain Reaction (PCR) methods. Methods: Using an alignment of 72 DNA sequences (comprised of 21 Rickettsia species) from GenBank we designed a novel set of gltA LAMP primers. Evaluation used DNA from 12 Rickettsia species as positive controls (extracted from cultures or naturally infected ticks) alongside a panel of negative controls representing different bacterial species. Subsequently this assay was used to screen 295 Ixodes ricinus and 24 I. hexagonus ticks collected from the UK (including northern and southern England and northern Scotland). Results: LAMP successfully detected 11 out of 12 (91.7%) Rickettsia species, excluding Rickettsia akari. Among 319 ticks collected in the UK, three were positive for Rickettsia (0.9%). All three positives were I. ricinus ticks, while none of the 24 I. hexagonus ticks were positive. Results were confirmed using a published PCR method. Sanger sequencing of PCR amplicons generated for each positive tick showed that they were all R. helvetica. Conclusions: This study introduces a novel field-applicable LAMP protocol for efficient Rickettsia screening in ticks to better assess its prevalence and consequent health risks. Furthermore, this assay has proven suitability for rickettsial detection in I. ricinus ticks, which has been reported as unsuccessful in previous European studies.
- Diversity of microorganisms in Hyalomma aegyptium collected from spur-thighed tortoise (Testudo graeca) in North Africa and AnatoliaPublication . Norte, Ana Cláudia; Harris, David James; Silveira, Diogo; Nunes, Carolina Saramago; Núncio, Maria Sofia; Martínez, Eva Graciá; Giménez, Andrés; de Sousa, Rita; Lopes de Carvalho, Isabel; Perera, AnaTicks carry a diverse community of microorganisms including non-pathogenic symbionts, commensals, and pathogens, such as viruses, bacteria, protozoans, and fungi. The assessment of tick-borne microorganisms (TBM) in tortoises and their ticks is essential to understand their eco-epidemiology, and to map and monitor potential pathogens to humans and other animals. The aim of this study was to characterize the diversity of microorganisms found in ticks collected from the spur-thighed tortoise (Testudo graeca) in North Africa and Anatolia. Ticks feeding on wild T. graeca were collected, and pathogens were screened by polymerase chain reaction using group-specific primers. In total, 131 adult Hyalomma aegyptium ticks were collected from 92 T. graeca in Morocco (n = 48), Tunisia (n = 2), Algeria (n = 70), and Turkey (n = 11). Bacteria and protozoa detected included Hemolivia mauritanica (22.9%), Midichloria mitochondrii (11.4%), relapsing-fever borreliae (8.4%), Ehrlichia spp. (7.6%), Rickettsia spp. (3.4%), Borrelia burgdorferi s.l. (0.9%), Francisella spp. (0.9%), and Wolbachia spp. (0.8%). The characterization of Rickettsia included R. sibirica mongolitimonae (Algeria), R. aeschlimannii (Turkey), and R.africae (Morocco). Hemolivia mauritanica and Ehrlichia spp. prevalence varied significantly with the sampling region/country. We did not detect significant associations in microorganism presence within ticks, nor between microorganism presence and tick mitochondrial DNA haplogroups. This is the first report of Francisella persica-like, relapsing fever borreliae, M. mitochondrii, and Wolbachia spp. in H. aegyptium ticks collected from wild hosts from the South and Eastern Mediterranean region, and of R. sibirica mongolitimonae and R. africae in H. aegyptium from Algeria and Morocco, respectively. Given that T. graeca is a common species in commercial and non-commercial pet trade, the evaluation of the role of this species and its ticks as hosts for TBM is particularly relevant for public health.
- Hepatitis E virus: Assessment of the epidemiological situation in humans in Europe, 2014/15Publication . Adlhoch, Cornelia; Avellon, Ana; Baylis, Sally A.; Ciccaglione, Anna R.; Couturier, Elisabeth; de Sousa, Rita; Epštein, Jevgenia; Ethelberg, Steen; Faber, Mirko; Fehér, Ágnes; Ijaz, Samreen; Lange, Heidi; Manďáková, Zdenka; Mellou, Kassiani; Mozalevskis, Antons; Rimhanen-Finne, Ruska; Rizzi, Valentina; Said, Bengü; Sundqvist, Lena; Thornton, Lelia; Tosti, Maria E.; van Pelt, Wilfrid; Aspinall, Esther; Domanovic, Dragoslav; Severi, Ettore; Takkinen, Johanna; Dalton, Harry R.Hepatitis E virus (HEV) is endemic in EU/EEA countries, but the understanding of the burden of the infection in humans is inconsistent as the disease is not under EU surveillance but subject to national policies.
- Lessons learned from a prolonged norovirus GII.P16-GII.4 Sydney 2012 variant outbreak in a long-term care facility in Portugal, 2017Publication . Sáez-López, Emma; Marques, Rodrigo; Rodrigues, Nuno; Oleastro, Mónica; Andrade, Helena; Mexía, Ricardo; de Sousa, RitaObjective: To investigate an outbreak of acute gastroenteritis caused by norovirus (NoV) in a long-term care facility (LTCF) in Portugal to describe and estimate its extent, and we implemented control measures. Design: Outbreak investigation. Methods: Probable cases were residents or staff members in the LTCF with at least 1 of the following symptoms: (1) diarrhea, (2) vomiting, (3) nausea, and/or (4) abdominal pain between October 31 and December 8, 2017. Confirmed cases were probable cases with positive NoV infection detected by real-time polymerase chain reaction (RT-PCR) and the same genotype in stool specimens. Results: The outbreak was caused by NoV GII.P16-GII.4 Sydney 2012 variant and affected 146 people. The highest illness rates were observed in residents (97 of 335, 29%) and nurses (16 of 83, 19%). All 11 resident wards were affected. Data on cases and their working or living areas suggest that movement between wards facilitated the transmission of NoV, likely from person to person. Conclusions: The delay in the identification of the causative agent, a lack of restrictions of resident and staff movement between wards, and ineffective initial deep-cleaning procedures resulted an outbreak that continued for >1 month. The outbreak ended only after implementation of strict control measures. Recommendations for controlling future NoV outbreaks in LTCFs include emphasizing the need to control resident's movements and to restrict visitors, timely and effective environmental cleaning and disinfection, leave of absence for ill staff, and encouraging effective hand hygiene.
- MERS coronavirus: data gaps for laboratory preparednessPublication . de Sousa, Rita; Reusken, Chantal; Koopmans, MarionSince the emergence of Middle East Respiratory Syndrome Coronavirus (MERS-CoV) in 2012, many questions remain on modes of transmission and sources of virus. In outbreak situations, especially with emerging organisms causing severe human disease, it is important to understand the full spectrum of disease, and shedding kinetics in relation to infectivity and the ability to transmit the microorganism. Laboratory response capacity during the early stages of an outbreak focuses on development of virological and immunological methods for patient diagnosis, for contact tracing, and for epidemiological studies into sources, modes of transmission, identification of risk groups, and animal reservoirs. However, optimal use of this core public health laboratory capacity requires a fundamental understanding of kinetics of viral shedding and antibody response, of assay validation and of interpretation of test outcomes. We reviewed available data from MERS-CoV case reports, and compared this with data on kinetics of shedding and immune response from published literature on other human coronaviruses (hCoVs). We identify and discuss important data gaps, and biases that limit the laboratory preparedness to this novel disease. Public health management will benefit from standardised reporting of methods used, details of test outcomes by sample type, sampling date, in relation to symptoms and risk factors, along with the currently reported demographic, clinical and epidemiological findings.
- Ongoing outbreak of hepatitis A associated with sexual transmission among men who have sex with men, Portugal, October 2023 to April 2024Publication . Rosendal, Ebba; von Schreeb, Sebastian; Gomes, Alexandre; Lino, Sara; Grau-Pujol, Berta; Magalhães, Sara; Ricoca Peixoto, Vasco; Roque, Carla; Moreno, Joana; Maltez, Fernando; Almeida, Fernando; Sá Machado, Rita; Marinho, Rui Tato; Vasconcelos, Paula; de Sousa, Rita; Vieira Martins, JoãoAn outbreak of hepatitis A is ongoing in Portugal, with 71 confirmed cases from 7 October 2023 to 24 April 2024. Most cases are male, aged 18-44 years, with many identifying as men who have sex with men (MSM) and reported as suspected sexual transmission. Phylogenetic analysis identified the subgenotype IA, VRD 521-2016 strain, last observed in an MSM-associated multi-country outbreak in 2016 to 2018. We wish to alert colleagues in other countries to investigate potential similar spread.
- Portuguese National Serological Survey to Coronavirus Disease 19 - ISNCOVID-19Publication . Kislaya, Irina; Gómez, Verónica; Garcia, Ana Cristina; Machado, Ausenda; Torres, Ana Rita; Roquette, Rita; Sousa-Uva, Mafalda; Matias Dias, Carlos; Nunes, Baltazar; Costa, Inês; Gonçalves, Paulo; Matos, Rita; Machado, Jorge; Manita, Carla; Martins, Fátima; Santos, João; de Sousa, Rita; Soeiro, Sofia; Rocha, Raquel; Roque, Carla; Verdasca, Nuno; Guiomar, Raquel; Rodrigues, Ana Paula; ISNCOVID-19 study teamThe objective of this seroepidemiological survey was to estimate seroprevalence of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) specific antibodies (IgM and/or IgG) in Portugal in May-July 2020. The seroprevalence of SARS-Cov-2 infection (positive for IgM and/or IgG) was 2.9% (CI95: 2.0 - 4.2%). Our results support extend limited extent of infection by SARS-CoV-2 in Portugal due to early lockdown measures implementation.
- Prevention, protocols, and lab capacity: lessons from a norovirus outbreak in the AlgarvePublication . Sá, Regina; Roque, Joana; Marques Mendes, Pedro; Gonçalves, Inês; Sousa, Judite; Matos, Cátia; Júnior, Álvaro; Coelho, Anabela; Belo Correia, Cristina; Manageiro, Vera; Minetti, Corrado; de Sousa, Rita; Horta Correia, Filomena; Lopes, Carlos; Fonseca, Ana; Almeida, Soraia; Ferreira, Maria Jesus; Almendra, Tiago; des Neves, Natalie; Fernandes, Aida; Queiroz, Carolina; Maia, Carla; Bodião, Joaquim; Guerreiro, Ana CristinaThis brief report presents the findings of an epidemiological investigation into a large-scale outbreak of norovirus gastroenteritis that occurred in a hotel in Algarve, Portugal, in August 2022. A total of 244 cases were reported, primarily affecting Portuguese families, with the parents aged 40-50 years and the children aged 0-19 years. Reported symptoms included vomiting, nausea, abdominal pain, and diarrhoea. Norovirus genotype GI.3 [P3] was detected in stool samples from eight probable cases, while food samples tested negative for norovirus and common pathogenic bacteria. The investigation data collected suggest that the source of the outbreak was likely in the hotel's common areas, with subsequent person-to-person transmission in other areas. The final report emphasizes the importance of improving outbreak prevention and control measures, including the development of a foodborne outbreak investigation protocol, the establishment of an outbreak response team, and the enhancement of regional laboratory capacity.