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In August 2018, Public Health England (PHE) was made aware of five probable cases of Shiga toxin-producing Escherichia coli (STEC) O157:H7 among individuals reporting participation in a mud-based obstacle race. An additional four cases, identified via routine whole-genome sequencing, were subsequently linked to the same event. Two of the nine cases were due to secondary household transmission. Despite an agreement between the event organizers and the local authority, to ensure that all livestock were removed from the site 28 days before the event, sheep were observed grazing on some of the routes taken by the runners 2 days prior to the race taking place. A retrospective review of incidents reported to PHE between 2015 and 2018 identified 41 cases of gastroenteritis associated with muddy assault course events. Of these, 25 cases were due to infection with STEC O157:H7, of which all but one were associated with outbreaks. Due to the environment in which such events take place, it is impossible to entirely remove the risk of exposure to potentially pathogenic zoonoses. However, race organizers should ensure that livestock are removed from the course 28 days before the event. They should also ensure that participants are made aware of the risk of contracting gastrointestinal disease from the environment, and to stress the importance of hand hygiene post-event and the risk of secondary transmission, particularly to children who are at risk of developing haemolytic uraemic syndrome., (© 2020 Blackwell Verlag GmbH.)

Background: Lassa fever is an acute viral haemorrhagic disease endemic in Nigeria. The 2018 Lassa fever outbreak in Nigeria was unprecedented, with 8% of all cases occurring among healthcare workers (HCWs). A disproportionately high number of these infections occurred in HCWs working in a tertiary health facility in Nigeria. This paper describes the cluster of Lassa fever infections among HCWs in a treatment centre and the lessons learnt., Methods: We analysed clinical, epidemiological and laboratory data from surveillance and laboratory records kept during the 2018 outbreak. Interviews were conducted with surviving HCWs using a questionnaire developed specifically for the investigation of Lassa fever infections in HCWs. Descriptive analysis of the data was performed in Microsoft excel., Results: The index case was a 15-year-old male who presented at the health facility with fever and uncontrolled nasopharyngeal bleeding, following a recent uvulectomy by a traditional healer. Overall, 16 HCWs were affected (15 confirmed and 1 probable) with five deaths (CFR-31.6%). Of the 15 confirmed cases, five (33.3%) were asymptomatic. Nine HCWs were direct contacts of the index case; the remaining six HCWs had no direct contact with the index case. HCW interviews identified a low index of suspicion for Lassa fever leading to inadequate infection prevention and control (IPC) practices as possible contributing factors to nosocomial transmission., Conclusion: Maintaining a high index of suspicion for Lassa fever in all patients, especially in endemic areas, is essential in adhering to adequate IPC practices in health facilities in order to prevent nosocomial transmission of Lassa fever among HCWs. There is a need to continually train and sensitise HCWs on strict adherence to IPC measures while providing care, irrespective of a patient's provisional diagnosis., (Crown Copyright © 2019. Published by Elsevier Ltd. All rights reserved.)

Background: Mistrust, suspicion and rumours have circulated around the purpose and motives behind recent Ebola vaccine clinical trials. EBOVAC-Salone is a community-based Phase II trial of the candidate Ad26.ZEBOV/MVA-BN-Filo prime-boost vaccine regimen against Ebola being conducted in Kambia, Sierra Leone. In this setting, we established a system for regular dialogue between trial staff and community members in order to build and sustain trust and to provide a mechanism to listen and respond promptly to rumours, concerns or misinformation in the community. Methods & Materials: A local community liaison team engage with the community at levels. Strategies include one-toone engagement with key stakeholders; public meetings with influential civil society and traditional leaders; house-to-house sensitisation, and use of traditional communication media such as radio. In addition, a social science team act as the 'eyes and ears' for the trial, listening to what individuals are saying about the study through both informal community observation and formal clinic exit interviews, in-depth interviews with participants and key stakeholders, and focus group discussions. The social science team provide daily feedback to the community liaison team on any rumours, concerns or misinformation circulating in the community, to inform prompt responses or clarifications. Furthermore, an external communications manager monitors national-level rumours and concerns and provides information on the trial at national and international level. Results: Full engagement has occurred with both local leaders and the community. Enrolment in the trial has occurred successfully thus far, with trial participants voluntarily acting as ambassadors and encouraging others to volunteer. No disruption has occurred to the trial through rumours or misinformation thus far. Influential individuals in the community have assisted with disseminating messages and promptly addressing misconceptions. Conclusion: Through a novel collaboration, we have formed an effective rapid response system for rumours and misinformation related to an Ebola vaccine trial during an outbreak. In addition, we have developed strong collaboration with the community through regular dialogue with stakeholders and trial participants. As a result, a community in rural Sierra Leone with no previous experience of medical research have developed a strong acceptance and understanding of the purpose of and processes involved in an Ebola vaccine trial. [ABSTRACT FROM AUTHOR]