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Background Dogs in the US are commonly infected with vector-borne pathogens, including heartworm and tick-borne disease agents. The geographic distribution of both arthropod vectors and the pathogens they transmit continues to expand. Methods To describe the current geographic distribution and prevalence of antigen of Dirofilaria immitis and antibody to Borrelia burgdorferi , Ehrlichia spp., and Anaplasma spp. in dogs, we summarized over 144 million test results from 2013 to 2019, inclusive, by county, state, and region. Canine seroprevalence by state was compared to population-adjusted human reports of tick-borne diseases. Results Results varied regionally, with D. immitis antigen and Ehrlichia spp. antibodies more frequently detected in the Southeast (2.6% and 5.2%, respectively) and antibody to B. burgdorferi and Anaplasma spp. most common in the Northeast (12.1% and 7.3%, respectively). Overall, percent positive test results to D. immitis decreased in the Southeast by 33.3% when compared to earlier summaries using the same strategy (from 3.9 to 2.6%). Geographic expansion of areas where dogs commonly test positive for Ehrlichia spp. was evident, likely because of a change in the test made in 2012 to allow detection of antibodies to E. ewingii concomitant with expansion of vector tick populations. Percent positive test results to Ehrlichia spp. increased in every region; this shift was particularly pronounced in the Southeast, where percent positive test results increased fourfold (from 1.3 to 5.2%). Continued geographic expansion of B. burgdorferi and A. phagocytophilum was apparent in the Northeast, Midwest, and Upper South, although canine seroprevalence of antibody to B. burgdorferi was much lower than prior surveys in many Lyme-endemic areas. Annual reports of human cases of Lyme disease, ehrlichiosis, and anaplasmosis were associated with percent positive canine results by state for the three tick-borne disease agents ( R 2  = 0.812, 0.521, and 0.546, respectively). Within endemic areas, percent positive test results for all three tick-borne agents demonstrated evidence of geographic expansion. Conclusions Large scale analysis of results from screening dogs in practice for evidence of vector-borne infections, including those with zoonotic importance, continues to be a valuable strategy for understanding geographic trends in infection risk over time. Graphical Abstract

Background Borrelia burgdorferi and Anaplasma phagocytophilum are tick-borne infections transmitted by Ixodes scapularis in the eastern USA; both agents cause disease in dogs and people. To characterize changes in seroprevalence over time, Cochran Armitage trend tests were used to evaluate percent positive test results for antibodies to B. burgdorferi and Anaplasma spp. in approximately 20 million canine tests from 2010–2017 in 25 states and 905 counties in the eastern USA. Results A significant decreasing trend in seroprevalence to B. burgdorferi was evident in eight states along the mid-Atlantic coast from Virginia to New Hampshire, and in Wisconsin. In contrast, a continued increasing trend was evident in five northeastern and Midwestern states where Lyme borreliosis is endemic or emerging, as well as in three southern states where endemicity has not yet been widely established. Similarly, seroprevalence to Anaplasma spp. showed a significant, although smaller, decreasing trend in five states along the mid-Atlantic coast from Virginia to Connecticut and Rhode Island, as well as in Minnesota and Wisconsin in the Midwest; despite the fact that those trends were significant they were weak. However, a strong increasing trend was evident in Massachusetts and three states in northern New England as well as in Pennsylvania. Conclusions As expected, seroprevalence continued to increase in regions where Lyme borreliosis and anaplasmosis are more newly endemic. However, the declining seroprevalence evident in other areas was not anticipated. Although the reasons for the decreasing trends are not clear, our finding may reflect shifting ecologic factors that have resulted in decreased infection risk or the combined positive influence of canine vaccination, tick control, and routine testing of dogs in regions where these infections have long been endemic. Analysis of trends in canine test results for tick-borne infections continues to be a valuable tool to understand relative geographical and temporal risk for these zoonotic agents.

The World Health Organization (WHO) has recommended various COVID-19 surveillance tools, including wastewater-based surveillance (WBS), which has demonstrated promising results in high-income countries (HICs). However, its application in low- and middle-income countries (LMICs) remains limited. This study explores WBS's potential as a complementary surveillance tool in a resource-constrained environment, Kisumu, Kenya, where sewer infrastructure is inadequate.Conducted from March 2022 to March 2023 by University of Illinois Chicago (UIC) researchers and the Kenyan non-profit Safe Water and AIDS Project, the research involved sporadic sampling of wastewater from centralized and decentralized sites, yielding 161 samples with 23 positive for SARS-CoV-2 and epidemiological data from 4 major hospitals in Kisumu. Time series analysis shows that by combining centralized and decentralized samples wastewater surveillance has the capacity to predict an upcoming wave 6 to 11 days prior to a positive case report. Additionally, wastewater testing in Kisumu has detected SARS-CoV-2, highlighting a chance to enhance COVID-19 surveillance among high-risk groups in resource limited settings.The study also addresses the barriers to utilizing WBS data for decision-making in Kisumu. Key barriers identified include the absence of a policy framework for use of WBS, financial limitations, and insufficient awareness among stakeholders. In-depth interviews with 14 stakeholders were conducted. Participants noted that although WBS has potential to support public health, it was rarely used in public health decisions in Kisumu due to above challenges. To address these challenges, we recommend establishing a comprehensive network that includes a broader range of stakeholders. This collaborative approach is crucial for successfully implementing WBS for COVID-19 in any setting.Effective health communication requires understanding the demographics, COVID-19 knowledge, attitudes, and information preferences of informal settlement residents compared to those in formal communities. We conducted intercept interviews at public toilets near informal settlements to evaluate these factors. Analysis of data from 752 study participants shows that informal settlement residents perceive a higher risk of contracting COVID-19 and struggle more with accessing and understanding related health information. These insights suggest the need for tailored health communication strategies to better address the specific needs of informal settlement residents.

While wastewater-based surveillance (WBS) has proven to be effective as an early warning system for SARS-CoV-2 monitoring in high-income countries (HICs), its feasibility in low- and middle-income countries (LMICs) is challenging due to limited sewer infrastructure, particularly outside major cities. This study evaluated SARS-CoV-2 in community-based wastewater sampling locations in addition to centralized wastewater treatment plants in Kisumu, Kenya from March 29, 2022, to March 8, 2023. The results of wastewater analysis were evaluated in relation to documented COVID-19 case counts. Wastewater samples (n = 161) were collected from centralized wastewater treatment sites (n = 41) and from decentralized sites: hospitals (n = 50), public toilets in markets (n = 31), and public toilets at transportation hubs (n = 39). Twenty-three samples (14.3%) tested positive for SARS-CoV-2 RNA. Epidemiological data were obtained from official sources. The odds of detecting one or more COVID-19 cases within 4–7 days after a positive WBS sample were 9 times higher than on days with negative WBS samples. Rates of viral RNA detection were similar for centralized and decentralized sampling sites. On five of the 32 days (15.6%) on which both centralized and decentralize samples were tested, SARS CoV-2 was detected only in the samples from decentralized sites. Centralized WBS can be supplemented with public toilet monitoring to increase the sensitivity of COVID-19 surveillance in areas with limited sewer infrastructure to enhance early detection of new cases.

Ixodes scapularis is responsible for the transmission of Borrelia burgdorferi sensu stricto (Bb) and Anaplasma phagocytophilum (Ap), the agents of Lyme disease and anaplasmosis, respectively, to dogs and humans in the eastern United States. Understanding trends in evidence of canine infection with tick-borne pathogens can reveal areas where transmission is increasing and thus identify regions where dogs and people are at risk of infection and disease. Exposure of dogs to both Bb and Ap was assessed in 25 eastern states where both pathogens are known to be endemic using results of approximately 20 million canine serological tests. Cochran Armitage trend test was used to evaluate changes in annual seroprevalence for antibodies against Bb and Ap at the state (P < 0.0001) and county (P < 0.01) level. Eight Mid-Atlantic States and 1 state in the Midwest showed a decreasing trend for antibodies against Bb over the 8-year period. In contrast, 10 states in the Northeast, Midwest, and South showed increasing trends, while no significant trend for antibodies against Bb was evident in 6 states. Similarly, 8 states in the East and Midwest showed a decreasing trend for canine antibodies against Ap while 5 states in the Northeast showed increasing trends. County analysis identified focused geographic areas where trends in Bb or Ap seroprevalence had significantly increased or decreased surrounded by regions of relatively endemic stability. Continued increase in seroprevalence was evident in several regions where Lyme disease and anaplasmosis are more newly endemic, but the significant decrease evident in other areas over the 8-year period considered was unexpected. Tick populations and subsequent infection risk with tick-borne disease agents are influenced by habitat and reservoir host populations as well as abiotic factors such as temperature and humidity. The trends seen in the present study may be a result of shifts in these ecologic factors although infection risk in dogs is also influenced by canine vaccination, tick control, and routine testing and treatment in regions where these infections have long been endemic. Analysis of trends in canine test results for tick-borne infections continues to be a valuable tool to understand relative geographic and temporal risk for these zoonotic agents.