Background: Integrated bite case management (IBCM) is a multi-sectoral response to animal-bites which reduces human and canine rabies mortality through animal quarantine, bite-victim counseling, and vaccination tracking. Haiti's national rabies surveillance program was established in 2013 using paper-based IBCM (pIBCM) with adoption of an electronic smartphone application (eIBCM) in 2018.Methods: We evaluated the feasibility of implementing the electronic app in Haiti and compared pIBCM and eIBCM data quality collected January 2013–August 2019. Deaths prevented, cost-per-death averted, and cost-per-investigation during use of pIBCM and eIBCM were estimated using a previously validated rabies cost-effectiveness tool that accounted for bite-victim demographics; probability of acquiring rabies; post-exposure prophylaxis; and costs including training, supplies, and salaries. We compared pIBCM and eIBCM based on data comprehensiveness, completeness, and reporting efficiency. Surveys were administered to IBCM staff to evaluate the usefulness, simplicity, flexibility, and acceptability of eIBCM.Results: Of 15,526 investigations, 79% were paper-based and 21% electronic. IBCM prevented 241 (estimated) human rabies deaths. Using pIBCM, cost-per-death averted was $2,692 and the cost-per-investigation was $21.02; up to 55 data variables were collected per investigation; data transmission took 26 days to reach national staff, and 180 days until analysis. Using eIBCM, the cost-per-death averted was $1,247 and the cost-per-investigation was $22.70; up to 174 data variables were collected per investigation; data transmission took 3 days to reach national staff, and 30 days until analysis. Among 12,194 pIBCM investigations, 55% were mappable by commune, compared to 100% of eIBCM investigations mappable by GPS. Animal case definitions were incorrectly ascribed by investigators in 5.5% of pIBCM investigations and zero for eIBCM; typically, errors were in determining probable vs. suspect case assignments. Overall, eIBCM was well-accepted by staff, who reported the app is easy-to-use, facilitates investigations, and compared to pIBCM hastens data reporting.Discussion: In Haiti, eIBCM showed improved data completeness, data quality, and shorter notification times with minimal increase in operational cost. The electronic app is simple-to-use and facilitates IBCM investigations. Rabies endemic countries could refer to eIBCM in Haiti as a cost-effective means to reduce human rabies mortality and improve surveillance capacity.

Since 1997, nine cases of severe pneumonia, caused by species within the B. cereus group and with a presentation similar to that of inhalation anthrax, were reported in seemingly immunocompetent metalworkers, with most being welders. In seven of the cases, isolates were found to harbor a plasmid similar to the B. anthracis pXO1 that encodes anthrax toxins. In this paper, we review the literature on the B. cereus group spp. pneumonia among welders and other metalworkers, which we term welder’s anthrax. We describe the epidemiology, including more information on two cases of welder’s anthrax in 2020. We also describe the health risks associated with welding, potential mechanisms of infection and pathological damage, prevention measures according to the hierarchy of controls, and clinical and public health considerations. Considering occupational risk factors and controlling exposure to welding fumes and gases among workers, according to the hierarchy of controls, should help prevent disease transmission in the workplace.

Bacillus cereus group bacteria containing the anthrax toxin genes can cause fatal anthrax pneumonia in welders. Two welder’s anthrax cases identified in 2020 were investigated to determine the source of each patient’s exposure. Environmental sampling was performed at locations where each patient had recent exposure to soil and dust. Samples were tested for the anthrax toxin genes by real-time PCR, and culture was performed on positive samples to identify whether any environmental isolates matched the patient’s clinical isolate. A total of 185 environmental samples were collected in investigation A for patient A and 108 samples in investigation B for patient B. All samples from investigation B were real-time PCR-negative, but 14 (8%) samples from investigation A were positive, including 10 from patient A’s worksite and 4 from his work-related clothing and gear. An isolate genetically matching the one recovered from patient A was successfully cultured from a worksite soil sample. All welder’s anthrax cases should be investigated to determine the source of exposure, which may be linked to their worksite. Welding and metalworking employers should consider conducting a workplace hazard assessment and implementing controls to reduce the risk of occupationally associated illnesses including welder’s anthrax.

In 2022, Burkholderia pseudomallei was first identified in continental United States (U.S.) environmental samples from the Mississippi Gulf Coast following two autochthonous infections. To better understand the extent of exposure to this emerging bacterium, we tested a convenience sample of 825 residual sera samples (550 from the Mississippi Gulf Coast, 275 from the northern U.S.) from a commercial diagnostic laboratory for the presence of antibodies to B. pseudomallei, using an indirect hemagglutination assay. We estimated seroprevalence of antibodies to B. pseudomallei in Mississippi Gulf Coast residents and in controls from northern regions of the U.S. where B. pseudomallei is less likely to persist in the environment. At a titer cut-off of ≥1:40, we observed a similar seropositivity between Mississippi Gulf Coast residents (14%, 95% CI: 11%, 17%) and controls (17%, 95% CI: 13%, 18%). Similarities in seropositivity suggest environmental exposure to B. pseudomallei in the Mississippi Gulf Coast may be limited; however, a lack of accompanying illness and exposure information limits our ability to conclusively interpret these findings. These estimates can serve as a baseline of seropositivity in the U.S. for future studies and to track the spread of B. pseudomallei in the U.S. over time.

Infection with Burkholderia pseudomallei, the causative agent of melioidosis, is uncommon in the United States (U.S.), leading to delays in pathogen identification and clinical diagnosis which can often lead to laboratory exposures. The indirect hemagglutination assay (IHA) is the primary serological test for confirming exposure to B. pseudomallei. In the U.S., a titer of ≥1:40 suggests exposure to B. pseudomallei or a closely related species, and a 4-fold rise in IHA titer ≥1:40 with clinically compatible illness is considered diagnostically probable. A retrospective analysis of 160 voluntarily reported laboratory exposure events to B. pseudomallei across 29 U.S. jurisdictions and 5 countries between 2008–2024 was conducted. This analysis included post-exposure management data and IHA results for 855 exposed laboratory personnel who had serological monitoring performed at the U.S. Centers for Disease Control and Prevention (CDC). Among exposed laboratory personnel, 105 (12%) had a seropositive titer. Of these, ninety-one (87%) laboratory personnel remained seropositive (≥1:40) at their last IHA test. Five (1%) people had a 4-fold rise in titers, though none developed melioidosis. This report underscores the need for prospective studies to evaluate seropositive laboratory personnel and to update risk guidance for laboratory exposures in non-endemic areas.

Corrigendum: Electronic application for rabies management improves surveillance, data quality, and investigator experience in Haiti