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The tests for tracking diseases in newborns available through the National Neonatal Screening Program of the Brazilian Unified Health Care System cover six diseases. Mass spectrometer equipment is needed to expand and more efficiently and effectively detect new diseases. However, only four neonatal screening centers have the equipment capable of carrying out the extended test, and the expansion of health service capacity should consider both the rationalization of costs and the comprehensiveness and accessibility of care to the population. This study uses analytics to analyze and estimate the cost of centralized or distributed logistics networks and the level of service to perform the expanded test for newborns throughout Brazil. We evaluate the accessibility of the current infrastructure for the neonatal screening program and propose a novel location–allocation model to create a more integrated infrastructure for reducing disparities and increase the accessibility to neonatal screening services.

Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Clinical testing has been the cornerstone of public health monitoring and infection control efforts in communities throughout the COVID-19 pandemic. With the anticipated reduction of clinical testing as the disease moves into an endemic state, SARS-CoV-2 wastewater surveillance (WWS) will have greater value as an important diagnostic tool. An in-depth analysis and understanding of the metrics derived from WWS is required to interpret and utilize WWS-acquired data effectively (McClary-Gutierrez et al., 2021; O'Keeffe, 2021). In this study, the SARS-CoV-2 wastewater signal to clinical cases (WC) ratio was investigated across seven cities in Canada over periods ranging from 8 to 21 months. This work demonstrates that significant increases in the WC ratio occurred when clinical testing eligibility was modified to appointment-only testing, identifying a period of insufficient clinical testing (resulting in a reduction to testing access and a reduction in the number of daily tests) in these communities, despite increases in the wastewater signal. Furthermore, the WC ratio decreased significantly in 6 of the 7 studied locations, serving as a potential signal of the emergence of the Alpha variant of concern (VOC) in a relatively non-immunized community (40-60 % allelic proportion), while a more muted decrease in the WC ratio signaled the emergence of the Delta VOC in a relatively well-immunized community (40-60 % allelic proportion). Finally, a significant decrease in the WC ratio signaled the emergence of the Omicron VOC, likely because of the variant's greater effectiveness at evading immunity, leading to a significant number of new reported clinical cases, even when community immunity was high. The WC ratio, used as an additional monitoring metric, could complement clinical case counts and wastewater signals as individual metrics in its potential ability to identify important epidemiological occurrences, adding value to WWS as a diagnostic technology during the COVID-19 pandemic and likely for future pandemics., Competing Interests: Declaration of competing interest The authors declare that no known competing financial interests or personal relationships influenced the work reported in this manuscript., (Copyright © 2022 The Authors. Published by Elsevier B.V. All rights reserved.)

Legionella pneumophila cause human infections via inhalation of contaminated water aerosols, resulting in severe pneumonia. Legionella spp. prevalence was monitored in a drinking-water distribution system (DWDS) in Northern Israel. Five points (toilet faucets and showers) were sampled seasonally along a three years period. Toilet faucets and shower use, both generating aerosols, are known transmission routes for this pathogen and thus, present a potential health risk. Quantitative Microbial Risk Assessment (QMRA) was applied in order to assess the health risks posed by Legionella for these two exposure scenarios, while considering Legionella seasonality. The obtained results were compared with estimated tolerable risk levels of infection and of disease set by the USEPA and WHO. Both limits were expressed as Disability-Adjusted Life Years index (DALY) being 1 × 10 -4 and 1 × 10 -6 , respectively. The QMRA revealed that the annual risk levels for both faucets and showers use exceeded the acceptable risk of infection with an average of 5.52 × 10 -4 and 2.37 × 10 -3 DALY'S per person per year, respectively. Annual risk levels were stable with no significant differences between the three years. Risk levels varied significantly between seasons by up to three orders of magnitude. Risk levels were highest during summer, autumn, and lowest during winter. The highest seasonal infection risk values were found in summer for both faucets and showers, which corresponded to 8.09 × 10 -4 and 2.75 × 10 -3 DALY'S per person per year, respectively. In conclusion, during summer and autumn there is a significant increase of the infection risk associated with exposure to Legionella-contaminated aerosols, in the studied water system. Public health assessment and prevention measures should focus on these seasons., (Copyright © 2019 Elsevier B.V. All rights reserved.)

A total of 391 goats from 13 dairy flocks from all Costa Rican regions were analyzed for Toxoplasma gondii-, Neospora caninum- and Coxiella burnetii-related seroprevalence by enzyme-linked immunosorbent assays (ELISA). Additionally, a risk factor analysis for these parasitic infections was performed based on a questionnaire considering several environmental and housing/management factors. A total of 62.1% (243/391) of individual serum samples revealed seropositive for T. gondii, 7.9% (31/391) for N. caninum, and 1.8% (7/391) for C. burnetii. At herd level, the overall seroprevalence for T. gondii was 100%, for N. caninum 69.2% and for C. burnetii 7.7%. However, no clinical signs related to toxoplasmosis, neosporosis or Q fever were apparent in these flocks. T. gondii-related risk factors were the contact with cats (OR = 3.44; CI 95%; 2.0-5.91), dogs (OR = 5.75; CI 95%; 2.84-11.66), and white-tailed deer (Odocoileus virginianus) (OR = 0.15; CI 95%; 0.08-0.26) within or around the farms. The presence of reproductive males in each flock (OR = 0.32; CI 95%; 0.14-0.74) and the coexistence of sheep (OR = 0.46; CI 95%; 0.2-1.08) and cattle (OR = 5.94; CI 95%; 1.70-20.78) revealed as protective and risk factors respectively for N. caninum infections. This study determined for the first time the seroprevalences of N. caninum, T. gondii and C. burnetii in Costa Rican goat flocks. Particularly, the high within-herd seroprevalences determined for T. gondii requires further surveillance to complement these findings., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Shiga toxigenic Escherichia coli (STEC) are pathogenic E. coli that cause infectious diarrhoea. In some cases infection may be complicated by renal failure and death. The incidence of human infection with STEC in Ireland is the highest in Europe. The objective of the study was to examine the spatial incidence of human STEC infection in a region of Ireland with significantly higher rates of STEC incidence than the national average and to identify possible risk factors of STEC incidence at area level. Anonymised laboratory records (n = 379) from 2009 to 2015 were obtained from laboratories serving three counties in the West of Ireland. Data included location and sample date. Population and electoral division (ED) data were obtained from the Irish 2011 Census of Population. STEC incidence was calculated for each ED (n = 498) and used to map hotspots/coldspots using the Getis-Ord Gi* spatial statistic and significant spatial clustering using the Anselin's Local Moran's I statistic. Multivariable regression analysis was used to consider the importance of a number of potential predictors of STEC incidence. Incidence rates for the seven-year period ranged from 0 to 10.9 cases per 1000. A number of areas with significant local clustering of STEC incidence as well as variation in the spatial distribution of the two main serogroups associated with disease in the region i.e. O26 and O157 were identified. Cattle density was found to be a statistically significant predictor of STEC in the region. GIS analysis of routine data indicates that cattle density is associated STEC infection in this high incidence region. This finding points to the importance of agricultural practices for human health and the importance of a "one-health" approach to public policy in relation to agriculture, health and environment., (Copyright © 2018 Elsevier B.V. All rights reserved.)