More than 800 foodborne illness outbreaks have been reported to the United States Centers for Disease Control and Prevention (CDC) annually. Researchers have suggested that improving food safety culture in restaurants (i.e., shared values, beliefs, and norms about food safety) is an important way to reduce foodborne outbreaks. However, we know relatively little about the connections between food safety culture and food safety outcomes in restaurants. To bridge these gaps in knowledge, state and local health department staff with CDC's Environmental Health Specialists Network (EHS-Net) conducted a study in which they interviewed managers and administered written surveys to food workers in 321 restaurants across eight EHS-Net jurisdictions. Data on restaurant characteristics (e.g., the existence of food safety policies) were collected through interviews with restaurant managers. Data on food worker characteristics (e.g., food safety knowledge) were collected through a worker survey. The survey also assessed worker beliefs about food safety in their restaurants (i.e., food safety culture). Analyses showed that several restaurant characteristics, including the existence of food safety policies and methods for monitoring policy implementation, were significantly and positively associated with workers' perceptions of their restaurant's food safety culture. The worker characteristics of having had food safety training and possessing food safety knowledge were also significantly and positively related to worker food safety culture beliefs. These findings suggest that management actions, such as providing food safety training, implementing food safety policies, and monitoring compliance with those policies, are associated with a strong food safety culture.
This study demonstrates the use of wastewater monitoring for opioids and other high-risk substances on a university campus, intended to inform public health surveillance and response efforts for youth and transitional age youth. Over a 14-week campaign, we collected 54 grab samples from three campus manholes, including one that isolated flows from a student housing complex, and analyzed them for 24 parent compounds and metabolites using LC-MS/MS. Heroin and its metabolite 6-acetylmorphine were among several opioid-related detections, illustrating how campus wastewater monitoring can capture actionable use events for targeted public health interventions. Fentanyl, norfentanyl, and xylazine were consistently below their method reporting limits across all 54 samples, consistent with recent declines in national overdose and wastewater datasets. The highest detection frequencies were associated with methamphetamine (22-50%), amphetamine (39-83%), and a THC metabolite (50-100%). This study also highlights the implications of sample type (grab vs. composite) and day of week for wastewater-based epidemiology (WBE). Considering that the use of opioid-related WBE as an actionable public health surveillance tool is still relatively new, additional case studies are needed to explore the potential of this emerging tool and increase confidence in deploying public health interventions in response to wastewater data.
Abstract Background Prior studies involving music festivals (including on-site surveys, drug checking, and wastewater-based analyses) suggest that recreational substance use is common among festivalgoers, though preferred substances and usage may be region- and event-specific. However, multiyear, event-specific wastewater surveillance data in the United States are limited. Objective This study aimed to characterize concentrations of high-risk substances (HRS) and their metabolites in wastewater surrounding an annual electronic dance music (EDM) festival in Las Vegas, Nevada, USA. Using a progressive sampling approach over 3 consecutive years (2023‐2025), we assessed trends and examined comparisons by sample type, day, and location to inform situational awareness and future public health surveillance efforts and risk mitigation strategies. Methods Wastewater samples were collected from utility access points at the festival site (2024‐2025), off-site in the surrounding community (2023‐2024), and at the downstream wastewater treatment plant (WWTP; 2023‐2025) during the festival week and weekend. For comparison, samples from a nonfestival weekend were collected off-site and at the WWTP in 2023. Target analytes consisted of 24 parent compounds and metabolites, including stimulants, opioids, and sedatives, which were analyzed by liquid chromatography–tandem mass spectrometry (LC-MS/MS) with isotope dilution. Analyte selection prioritized substances associated with overdose risk and with prior festival-related surveillance. Results Cocaine (and 3 of 4 measured metabolites), methamphetamine, amphetamine, 11-nor-9-carboxy-Δ-9-tetrahydrocannabinol (THC-COOH), and tramadol were detected in 100% of festival weekend samples; 3,4-methylenedioxymethamphetamine (MDMA; ecstasy) was detected (at concentrations of up to nearly 2 mg/L) in all but 1 festival site sample collected prior to the start of the event in 2025. Festival-associated signals were most pronounced for stimulant-related analytes, which were also detected in WWTP and off-site samples during the festival. Compared with nonfestival weeks, MDMA concentrations were approximately 10 to 30 times higher at off-site locations and nearly 100 times higher at the downstream WWTP during the festival. Opioid-related concentrations were comparable at the WWTP and the festival site, although there were notable detections of norfentanyl and relatively high concentrations of tramadol in some festival site samples. MDMA- and cocaine-related analyte concentrations peaked during the final festival days in 2024 and 2025; the 2023 samples highlighted the presence of HRS in local wastewater during nonfestival weekends. Conclusions Event-focused, multiyear wastewater surveillance detected stimulants and psychoactive substances, opioids, and Δ-9-tetrahydrocannabinol (THC) associated with an annual EDM festival weekend. Findings are consistent with previous wastewater-based studies of music and dance festivals, with MDMA concentrations among the highest reported in similar surveillance efforts. Codetection of opioid- and stimulant-related analytes suggests varied usage preferences, polysubstance use, and/or unintentional adulteration (eg, lacing). These findings demonstrate the value of wastewater monitoring as a complementary, population-level tool to support public health preparedness, harm-reduction strategies, and attendee safety during large-scale events. These data also inform wastewater utilities about expected influent composition during special events, with relevance for treatment operations and water reuse applications.
Locally acquired arboviral infections are an increasing public health concern in the United States. Aedes aegypti and Culex quinquefasciatus, vectors of dengue virus and West Nile virus, respectively, are established in regions where local transmission has been reported. Seasonal variation in mosquito abundance affects vector density, human-vector contact, and arbovirus transmission risk. The aim of this study is to investigate seasonal variations in Ae. aegypti and Cx. quinquefasciatus population dynamics in Miami-Dade County, Florida; Maricopa County, Arizona; and Clark County, Nevada. Monthly relative abundance, average mosquitoes collected per trap-night, normalized abundance ratios, and seasonal-trend decomposition were used to evaluate species- and location-specific seasonal patterns. Mosquito population dynamics differed by species and location. In Miami-Dade County, the two species showed seasonal turnover, with Cx. quinquefasciatus peaking during winter and spring and Ae. aegypti peaking during summer. In Maricopa and Clark counties, both species peaked primarily between August and September. Species dominance also differed by site, with Ae. aegypti more abundant than Cx. quinquefasciatus in Maricopa County and Cx. quinquefasciatus more abundant than Ae. aegypti in Clark and Miami-Dade counties. Seasonal decomposition showed that Ae. aegypti peaked earlier in Miami-Dade County than in Maricopa and Clark counties, whereas Cx. quinquefasciatus showed a spring peak in Miami-Dade County and bimodal seasonal patterns in Maricopa and Clark counties. These results suggest that mosquito population dynamics are species- and location-specific and support the use of local surveillance data to guide the timing of mosquito control and arbovirus preparedness.
The rapid evolution of antifungal resistance in Candidozyma auris (formerly Candida auris) presents significant challenges for conventional public health surveillance methods, particularly in detecting emergent and highly transmissible drug-resistant variants. Here, using wastewater-based epidemiology tools initially developed during the COVID-19 pandemic, we implement a high-resolution, facility-level early warning system to monitor C. auris infections and resistance patterns. Our evaluation across Southern Nevada demonstrates that upstream sewage monitoring at healthcare facilities provides significant sensitivity (p < 0.001) compared to wastewater treatment plant sampling. By combining amplicon sequencing and MALDI-TOF mass spectrometry, we identify clinically-relevant, resistance-associated variants in wastewater samples, while whole-genome sequencing reveals >90% genomic concordance between 443 wastewater-derived genomes and 2945 clinical isolates. We also detect previously unreported subclades and resistance mutations, including FKS1 Phe635Leu and co-occurring ERG11/FKS1 variants in wastewater samples up to nearly five months before their appearance in clinical settings. Transcriptomic profiling of drug-resistant isolates under antifungal and stress conditions identifies previously uncharacterized adaptation mechanisms, including differential regulation of ribosomal assembly pathways and cell cycle checkpoints. These findings highlight how wastewater intelligence can enhance traditional public health approaches for early detection and monitoring of C. auris outbreaks and antifungal resistance.
