Hans Peter Stüger

Wastewater data can be very useful for epidemic control during a disease outbreak and proper synthesis of different sources of information can be integrated towards an alerting system, that can be used for decision support. Wastewater data are considered to be of high quality, since they do not depend on testing and can take into account asymptomatic cases. However, little effort has been given into utilizing such information in statistical process control procedures, usually aimed at industrial problems. In this article, we demonstrate how wastewater data can be utilized in health surveillance and propose a statistical framework that can act as a decision support tool. Specifically, we analyze SARS-CoV-2 wastewater data from Austria, constructing summary variables to implicitly describe the Covid-19 prevalence and, based on them, we assess the effectiveness of the current sampling strategy of Austria. We propose a framework of a statistical process monitoring system to aid epidemic management procedures in case SARS-CoV-2 concentration gets dangerously high.

The WHO European Region has the lowest exclusive breastfeeding (EBF) rates at 6 months in the world. In Austria, 55.5% of infants are EBF at the age of one week, although breastfeeding initiation is 97.5%. The study was conducted in 2019/2020 and considered 1214 mothers of legal age, who received four online questionnaires during their child’s first year of life. The influence of different variables on total/exclusive breastfeeding duration were analysed by using a Cox model (Extension of the Cox Proportional Hazards Model) with time-dependent covariates. Multivariate analyses showed a significant influence of maternal BMI, lifestyle factors, such as smoking, and breastfeeding support on total breastfeeding duration. Remarkable differences in the median duration of any breastfeeding were found for breastfeeding support, where mothers breastfed twice as long. Support came primarily from hospital staff, the midwife and the partner. A higher monthly household net income, delivery in a baby-friendly certified hospital (BFH) and breastfeeding support were associated with a longer EBF duration. Obese mothers started feeding infant formula earlier and had a higher risk of early weaning. The results offer valuable insights into the importance of breastfeeding-friendly structures such as BFHs, a focus on breastfeeding aftercare and support of the mother to promote and protect breastfeeding.

Breastfeeding and infant nutrition have an important impact on child health. The last representative data on breastfeeding in Austria was collected in 2006. The SUKIE-Study (Säuglings- und Kinderernährung) is a representative, longitudinal survey (online questionnaire) for participating mothers at four time points (14 days, four, six and 12 months post-partum). Questions on when other foods were first introduced were asked retrospectively. To ensure international comparisons, the World Health Organization’s definitions for breastfeeding, including “Infant and Young Child Feeding” indicators, were used. After eligibility screening, 1214 of 1666 invited mothers were included in the analysis. The initial breastfeeding rate was 97.5% and was reduced to 40.8% after 12 months. The rate of exclusive breastfeeding at one week of age was 55.5% and decreased to 1.9% after six months. Half of the infants received infant formula for the first time within the first three days of life (median). Out of the mothers that did wean breastfeeding in the first 12 months, the median duration was 27 weeks (right-censored data). Compared with 2006, an increase (93.2% to 97.5%) in the initial breastfeeding rate was found. However, other findings show that breastfeeding duration, including exclusive breastfeeding rates, need further improvement.

Hygiene management is essential for rearing Campylobacter free broiler flocks. In this study, several hygiene factors (e.g., thinning, water supply, stable cloths, stable condition, stable environment, etc.) are categorized and aggregated in a developed risk priority number (RPN). This number is measuring the quality of hygiene management of a broiler farm with one single value (range: 801–4005 points), the higher the RPN, the better is the hygiene status. The distribution of the values is left skewed and none of the 53 examined Austrian broiler farms reached the maximum. Cecal samples (n = 610) from broilers at the point of slaughter determined the Campylobacter status of the farms. Farms with a high RPN consistently produced more Campylobacter free batches than farms with a low RPN. Ranking of the broiler farms based on their RPN was significantly correlated with their microbiological results for Campylobacter detection (Spearman’s correlation coefficient = 0.646). The risk priority number is an easy tool for the assessment and measurement of the hygiene management system at a broiler farm. Besides the educational benefits of the RPN, benchmarking against the mean value or the maximum is possible.