Brent Gilpin, Lisa McCallum, Virginia Hope Institute of Environmental Science & Research Limited

1. PulseNet Asia Pacific – Using KAREN to help advance international collaborations for analysis of disease causing bacteria for both research and public health action. Brent Gilpin, Lisa McCallum, Virginia Hope Institute of Environmental Science & Research Limited

2. E. coli O157:H7

3. E. coli O157:H7 Western USA, 1993 726 cases identified 4 deaths $160 million cost to company

4. 1993 Western States E. coli O157 Outbreak 726 cases 4 deaths outbreak detected 1993 Meat recall 39 d 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 1 3 4 6 7 PFGE Pulsed field gel electrophoresis Slide courtesy Bala Swaminathan, CDC Atlanta

5. Loading into well

6. PFGE Pulsed Field Gel Electrophoresis

15. PFGE analysis of all isolates PFGE DNA fingerprints compared using electronic databases Initiate and guide epidemiological investigations of outbreaks Interventions Preventative measures PulseNet in action • Pathogens isolated from faecal sample • E. coli O157, Listeria, Salmonella, Campylobacter

16. E. coli O157:H7 from Fresh Spinach

18. Many other examples…

19. S. Enteriditis • 12 May, 9:30 PM–1 AM • Discussions with Costco led to local recall • Nut-specific questionnaire developed • E-mail bulletin to all states, CDC, FDA, Canada • 13 May • PulseNet query finds matching cases elsewhere • Traceback implicates Paramount; other brands • National recall initiated

21. 1993 Western States E. coli O157 Outbreak 726 cases 4 deaths outbreak detected 1993 Meat recall 39 d With PulseNet outbreak detected 18 d Initial recall of 354,200 pounds of ground beef Expanded to 18.6 million pounds 38 cases from 11 states, 17 hospitalizations, one death Slide courtesy Bala Swaminathan, CDC Atlanta

22. Austria, Belgium, Bulgaria, Czech Republic, Denmark, England, Finland, France, Germany, Greece, Hungary, Iceland, Ireland, Italy, Luxembourg, Norway, Poland, Portugal, Romania, Scotland, Slovenia, Spain, Sweden, The Netherlands • 28 public health labs, 17 veterinary labs Uruguay, Chile, Argentina, Columbia, Mexico, Brazil Vietnam, Thailand, Taiwan, The Philippines, the People’s Republic of China, New Zealand, Malaysia, Korea, Japan, India, Hong Kong, Bangladesh, and Australia

24. PulseNet Asia Pacific • Vietnam, Thailand, Taiwan, The Philippines, the People’s Republic of China, New Zealand, Malaysia, Korea, Japan, India, Hong Kong, Bangladesh, and Australia

25. A B Meat Processor A Meat Processor B Supplier A Supplier B Supplier C USDA product testing - E. coli O157:H7 New Zealand

26. NZ beef exports to USA • USA 51% of total NZ beef exports • Value of approximately 1 billion dollars…

27. Findings • 12 human, 3 meat isolates same as US XbaI 74 • (This XbaI 5.9% of NZ isolates) • All of have BlnI patterns different to US BlnI 569 • No isolates with US XbaI pattern 1401 • Two isolates with BlnI pattern 569 (different Xba) • No evidence to suggest isolates came from NZ meat

28. Key components • Standardised methodology for lab analysis • Computer software analyse data • Databases of patterns • Communication among participants • Outbreaks • Education and upskilling

29. Role of KAREN network • Communication among participants • Outbreak investigations • Education • Regional and international databases

32. Hardware/Software Database managers Regional Databases Option 1

33. Japan E. coli O157 I D C I D C I D C I D C China New Zealand Listeria I D C I D C Campylobacter Data Copy Hong Kong Bangladesh I D C I D C Salmonella Vibrio I D C I D C Data Copy Taiwan India I D C I D C Neisseria Shigella Data Copy I D C I D C Data Copy Data Copy Data Copy Data Copy I D C I D C New Zealand Main Hub I D C I D C NML CDC Backup Server Regional Databases Backup Server Option 2 Backup Server Backup Server Backup Server Backup Server Backup Server Backup Server

34. Export data wish to submit (XML) Upload to folder on PNAP forum Download new submission Participants Download updated database Open regional database as “local copy” using BioNumerics Participants • Very simple solution • Every country equally important • Ensures access and sharing of data • Allows distribution of work, lower commitment required from coordinating lab. • Benefits • Archive of genotypes • Evaluations of variability in genotype • Geographical and temporal spread of genotypes • Get clues about potential sources • Evaluate how common/rare a genotype is Database coordinator • Check “compatibility” • Incorporate into “Regional database” • Post updated database into PNAP forum folder

35. PulseNet Asia Pacific portal • PNAP portal places NZ as the coordinating hub for the region. • Communication forum • Provides a mechanism for regional databases for Asia Pacific • Would like capacity for video meetings of participants from Asia Pacific, and also PulseNet International. • Would like capacity for educational sessions on both laboratory and computer analysis, and for research and outbreak seminars.

36. Research seminars

37. Training sessions

38. Video conferencing • Outbreak investigation • Coordination of activities

39. National Centre for Biosecurity and Infectious Disease - Wallaceville • Connect New Zealand’s highest level bio-containment laboratory at Wallaceville to the rest of NZ and the world via video microscopy and video conferencing.

40. www.pulsenetinternational.org brent.gilpin@esr.cri.nz