{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2024,6,17]],"date-time":"2024-06-17T13:58:01Z","timestamp":1718632681460},"reference-count":24,"publisher":"Oxford University Press (OUP)","license":[{"start":{"date-parts":[[2020,11,13]],"date-time":"2020-11-13T00:00:00Z","timestamp":1605225600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>Outbreaks of gastrointestinal disease among military service personnel can have severe impact on operational effectivity and force readiness. Thus, early outbreak detection is critical to minimize spread. This pilot study aimed to explore field-based molecular screening of sewage as a supplemental tool in early outbreak warning before disease is diagnosed in personnel seeking medical care.<\/jats:p><\/jats:sec><jats:sec><jats:title>Materials and Methods<\/jats:title><jats:p>Sewage from permanent (n\u2009=\u20093) and temporary (n\u2009=\u20093) military camps, hosting national and international military personnel, were sampled during the NATO Exercise TRJE18 taking place in southern Norway during fall 2018. Samples were screened for 22 gastrointestinal pathogens using multiplex PCR.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Markers of multiple enteropathogens were detected in samples from all locations with some variations in diversity. Yersinia enterocolitica, pathogenic Escherichia coli, adenovirus, and Giardia were detected in sewage from all six camps during the exercise. Agent diversity seemed to increase with population size, regardless of nationality. Only a minor outbreak (n\u2009=\u20096) of norovirus was reported in one of the permanent camps. From the same camp, genetic markers of norovirus were detected in sewage 2 days before outbreak notification. No other outbreaks of gastrointestinal disease were reported during the exercise, indicating that markers of several enteropathogens can be normally found in sewage from healthy soldier populations. Thus, discriminating between true outbreaks and nonrelevant \u201cbackground levels\u201d would be of critical importance for correct decision-making in operational contexts.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Molecular screening of sewage allows rapid detection of multiple gastrointestinal pathogens in biological waste from military camps. However, background levels of pathogens challenges interpretation of qualitative analyses in outbreak situations. As such, quantitative measures, as well as high-resolution sequence-based methods, which allows strain identification and broader target spectrum, should be further explored in future studies.<\/jats:p><\/jats:sec>","DOI":"10.1093\/milmed\/usaa365","type":"journal-article","created":{"date-parts":[[2020,12,7]],"date-time":"2020-12-07T03:51:14Z","timestamp":1607313074000},"source":"Crossref","is-referenced-by-count":2,"title":["Molecular Monitoring of Enteropathogens in Sewage During NATO Exercise Trident Juncture 2018: Potential Tool in Early Outbreak Warning?"],"prefix":"10.1093","author":[{"given":"\u00d8yvind","family":"\u00d8rmen","sequence":"first","affiliation":[{"name":"Department for Veterinary Services and Force Health Protection, Norwegian Armed Forces Joint Medical Services, 2617 Lillehammer, Norway"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elisabeth Henie","family":"Madslien","sequence":"additional","affiliation":[{"name":"Division of comprehensive defense, Norwegian Defence Research Establishment, 2027 Kjeller, Norway"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2020,11,13]]},"reference":[{"key":"2020120620472544200_R1","doi-asserted-by":"publisher","first-page":"34","DOI":"10.1016\/j.tmaid.2018.12.004","article-title":"Epidemiology and etiology of diarrhea in UK military personnel serving on the United Nations Mission in South Sudan in 2017: a prospective cohort study","volume":"28","author":"Biswas","year":"2019","journal-title":"Travel Med Infect Dis"},{"issue":"6","key":"2020120620472544200_R2","first-page":"8","article-title":"Norovirus outbreak in Army service members, Camp Arifjan, Kuwait, May 2018","volume":"26","author":"Kebisek","year":"2019","journal-title":"MSMR"},{"issue":"6","key":"2020120620472544200_R3","doi-asserted-by":"crossref","first-page":"419","DOI":"10.1136\/jramc-2018-000991","article-title":"Country-wide surveillance of norovirus outbreaks in the Portuguese Army, 2015-2017","volume":"164","author":"Lopes-Joao","year":"2018","journal-title":"J R Army Med Corps"},{"key":"2020120620472544200_R4","doi-asserted-by":"publisher","DOI":"10.1017\/S0950268818003199","article-title":"Estimate of the annual burden of foodborne illness in nondeployed active duty US Army Service Members: five major pathogens, 2010-2015","volume":"147","author":"Mullaney","year":"2019","journal-title":"Epidemiol Infect"},{"key":"2020120620472544200_R5","doi-asserted-by":"publisher","first-page":"748","DOI":"10.1016\/j.scitotenv.2017.11.102","article-title":"Monitoring wastewater for assessing community health: Sewage Chemical-Information Mining (SCIM)","volume":"619-620","author":"Daughton","year":"2018","journal-title":"Sci Total Environ"},{"issue":"1","key":"2020120620472544200_R6","doi-asserted-by":"crossref","DOI":"10.1038\/s41467-019-08853-3","article-title":"Global monitoring of antimicrobial resistance based on metagenomics analyses of urban sewage","volume":"10","author":"Hendriksen","year":"2019","journal-title":"Nat Commun"},{"key":"2020120620472544200_R7","doi-asserted-by":"publisher","first-page":"249","DOI":"10.1016\/S0065-2164(08)00609-6","article-title":"Pathogen surveillance through monitoring of sewer systems","volume":"65","author":"Sinclair","year":"2008","journal-title":"Adv Appl Microbiol"},{"issue":"1","key":"2020120620472544200_R8","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0210368","article-title":"Metagenomic analysis of viruses in toilet waste from long distance flights\u2014a new procedure for global infectious disease surveillance","volume":"14","author":"Hjelmso","year":"2019","journal-title":"PLoS One"},{"issue":"1","key":"2020120620472544200_R9","doi-asserted-by":"crossref","DOI":"10.1186\/s13028-019-0445-5","article-title":"Multiplex polymerase chain reaction detection of enteropathogens in sewage in Norway","volume":"61","author":"\u00d8rmen","year":"2019","journal-title":"Acta Vet Scand"},{"issue":"27","key":"2020120620472544200_R10","doi-asserted-by":"crossref","first-page":"27657","DOI":"10.1007\/s11356-018-2869-2","article-title":"Preliminary evaluation of BioFire FilmArray\u00ae Gastrointestinal Panel for the detection of noroviruses and other enteric viruses from wastewater and shellfish","volume":"25","author":"Gyawali","year":"2018","journal-title":"Environ Sci Pollut Res Int"},{"issue":"3","key":"2020120620472544200_R11","first-page":"179","article-title":"Yersinia enterocolitica and Yersinia enterocolitica-like bacteria in drinking water and sewage sludge","volume":"91","author":"Langeland","year":"1983","journal-title":"Acta Path Micro Im B"},{"issue":"5","key":"2020120620472544200_R12","doi-asserted-by":"crossref","first-page":"367","DOI":"10.1016\/S0232-4393(11)80066-1","article-title":"The occurrence of Yersinia enterocolitica in sewage","volume":"145","author":"Ziegert","year":"1990","journal-title":"Zentralbl Mikrobiol"},{"issue":"4","key":"2020120620472544200_R13","doi-asserted-by":"crossref","first-page":"762","DOI":"10.4269\/ajtmh.2006.75.762","article-title":"Incidence, etiology, and impact of diarrhea among deployed US military personnel in support of Operation Iraqi Freedom and Operation Enduring Freedom","volume":"75","author":"Monteville","year":"2006","journal-title":"Am J Trop Med Hyg"},{"issue":"34","key":"2020120620472544200_R14","doi-asserted-by":"publisher","DOI":"10.2807\/1560-7917.ES.2016.21.34.30321","article-title":"National outbreak of Yersinia enterocolitica infections in military and civilian populations associated with consumption of mixed salad, Norway, 2014","volume":"21","author":"MacDonald","year":"2016","journal-title":"Euro Surveill"},{"issue":"8","key":"2020120620472544200_R15","doi-asserted-by":"crossref","first-page":"967","DOI":"10.1586\/14787210.2014.920252","article-title":"Asymptomatic Clostridium difficile colonization as a reservoir for Clostridium difficile infection","volume":"12","author":"Galdys","year":"2014","journal-title":"Expert Rev Anti Infect Ther"},{"issue":"3","key":"2020120620472544200_R16","doi-asserted-by":"crossref","first-page":"891","DOI":"10.1111\/jam.12575","article-title":"Fate of Clostridium difficile during wastewater treatment and incidence in Southern Ontario watersheds","volume":"117","author":"Xu","year":"2014","journal-title":"J Appl Microbiol"},{"issue":"3","key":"2020120620472544200_R17","doi-asserted-by":"crossref","first-page":"237","DOI":"10.7861\/clinmedicine.18-3-237","article-title":"Clostridium difficile infection and antibiotic-associated diarrhoea","volume":"18","author":"Mullish","year":"2018","journal-title":"Clin Med (Northfield Il)"},{"issue":"8","key":"2020120620472544200_R18","doi-asserted-by":"crossref","first-page":"719","DOI":"10.1016\/j.cmi.2015.04.007","article-title":"Spectrum of enteropathogens detected by the FilmArray GI Panel in a multicentre study of community-acquired gastroenteritis","volume":"21","author":"Spina","year":"2015","journal-title":"Clin Microbiol Infect"},{"issue":"4","key":"2020120620472544200_R19","doi-asserted-by":"crossref","first-page":"232","DOI":"10.1007\/s12560-014-9161-5","article-title":"A one year study on the concentrations of norovirus and enteric adenoviruses in wastewater and a surface drinking water source in Norway","volume":"6","author":"Grondahl-Rosado","year":"2014","journal-title":"Food Environ Virol"},{"key":"2020120620472544200_R20","article-title":"Meldingssystemet for smittsomme sykdommer (MSIS)","author":"Folkehelseinstituttet"},{"issue":"1","key":"2020120620472544200_R21","doi-asserted-by":"crossref","first-page":"218","DOI":"10.1128\/CMR.00026-09","article-title":"Update on Cyclospora cayetanensis, a food-borne and waterborne parasite","volume":"23","author":"Ortega","year":"2010","journal-title":"Clin Microbiol Rev"},{"issue":"6","key":"2020120620472544200_R22","doi-asserted-by":"crossref","first-page":"1453","DOI":"10.1093\/clinids\/20.6.1453","article-title":"Amebiasis","volume":"20","author":"Ravdin","year":"1995","journal-title":"Clin Infect Dis"},{"issue":"1","key":"2020120620472544200_R23","doi-asserted-by":"crossref","first-page":"96","DOI":"10.1016\/j.coviro.2011.11.005","article-title":"Environmental transmission of norovirus gastroenteritis","volume":"2","author":"Lopman","year":"2012","journal-title":"Curr Opin Virol"},{"issue":"30","key":"2020120620472544200_R24","doi-asserted-by":"crossref","DOI":"10.2807\/ese.16.30.19930-en","article-title":"Food-borne outbreak of norovirus infection in a French military parachuting unit, April 2011","volume":"16","author":"Mayet","year":"2011","journal-title":"Euro Surveill"}],"container-title":["Military Medicine"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/academic.oup.com\/milmed\/advance-article-pdf\/doi\/10.1093\/milmed\/usaa365\/34299366\/usaa365.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"http:\/\/academic.oup.com\/milmed\/advance-article-pdf\/doi\/10.1093\/milmed\/usaa365\/34299366\/usaa365.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,4,16]],"date-time":"2021-04-16T20:43:54Z","timestamp":1618605834000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/milmed\/advance-article\/doi\/10.1093\/milmed\/usaa365\/5981196"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,11,13]]},"references-count":24,"URL":"https:\/\/doi.org\/10.1093\/milmed\/usaa365","relation":{},"ISSN":["0026-4075","1930-613X"],"issn-type":[{"value":"0026-4075","type":"print"},{"value":"1930-613X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,11,13]]}}}