Andria Jones-Bitton

Global Incidence of Human Shiga Toxin–Producing Escherichia coli Infections and Deaths: A Systematic Review and Knowledge Synthesis

OBJECTIVES Shiga toxin-producing Escherichia coli (STEC) are an important cause of foodborne disease, yet global estimates of disease burden do not exist. Our objective was to estimate the global annual number of illnesses due to pathogenic STEC, and resultant hemolytic uremic syndrome (HUS), end-stage renal disease (ESRD), and death. MATERIALS We searched Medline, Scopus, SIGLE/OpenGrey, and CABI and World Health Organization (WHO) databases for studies of STEC incidence in the general population, published between January 1, 1990 and April 30, 2012, in all languages. We searched health institution websites for notifiable disease data and reports, cross-referenced citations, and consulted international knowledge experts. We employed an a priori hierarchical study selection process and synthesized results using a stochastic simulation model to account for uncertainty inherent in the data. RESULTS We identified 16 articles and databases from 21 countries, from 10 of the 14 WHO Sub-Regions. We estimated that STEC causes 2,801,000 acute illnesses annually (95% Credible Interval [Cr.I.]: 1,710,000; 5,227,000), and leads to 3890 cases of HUS (95% Cr.I.: 2400; 6700), 270 cases of ESRD (95% Cr.I.: 20; 800), and 230 deaths (95% Cr.I.: 130; 420). Sensitivity analyses indicated these estimates are likely conservative. CONCLUSIONS These are the first estimates of the global incidence of STEC-related illnesses, which have not been explicitly included in previous global burden of disease estimations. Compared to other pathogens with a foodborne transmission component, STEC appears to cause more cases than alveolar echinococcosis each year, but less than typhoid fever, foodborne trematodes, and nontyphoidal salmonellosis. APPLICATIONS Given the persistence of STEC globally, efforts aimed at reducing the burden of foodborne disease should consider the relative contribution of STEC in the target population.

A systematic review and meta-analysis of factors associated with anthelmintic resistance in sheep

BACKGROUND Anthelmintic drugs have been widely used in sheep as a cost-effective means for gastro-intestinal nematode (GIN) control. However, growing anthelmintic resistance (AHR) has created a compelling need to identify evidence-based management recommendations that reduce the risk of further development and impact of AHR. OBJECTIVE To identify, critically assess, and synthesize available data from primary research on factors associated with AHR in sheep. METHODS Publications reporting original observational or experimental research on selected factors associated with AHR in sheep GINs and published after 1974, were identified through two processes. Three electronic databases (PubMed, Agricola, CAB) and Web of Science (a collection of databases) were searched for potentially relevant publications. Additional publications were identified through consultation with experts, manual search of references of included publications and conference proceedings, and information solicited from small ruminant practitioner list-serves. Two independent investigators screened abstracts for relevance. Relevant publications were assessed for risk of systematic bias. Where sufficient data were available, random-effects Meta-Analyses (MAs) were performed to estimate the pooled Odds Ratio (OR) and 95% Confidence Intervals (CIs) of AHR for factors reported in ≥2 publications. RESULTS Of the 1712 abstracts screened for eligibility, 131 were deemed relevant for full publication review. Thirty publications describing 25 individual studies (15 observational studies, 7 challenge trials, and 3 controlled trials) were included in the qualitative synthesis and assessed for systematic bias. Unclear (i.e. not reported, or unable to assess) or high risk of selection bias and confounding bias was found in 93% (14/15) and 60% (9/15) of the observational studies, respectively, while unclear risk of selection bias was identified in all of the trials. Ten independent studies were included in the quantitative synthesis, and MAs were performed for five factors. Only high frequency of treatment was a significant risk factor (OR=4.39; 95% CI=1.59, 12.14), while the remaining 4 variables were marginally significant: mixed-species grazing (OR=1.63; 95% CI=0.66, 4.07); flock size (OR=1.02; 95% CI=0.97, 1.07); use of long-acting drug formulations (OR=2.85; 95% CI=0.79, 10.24); and drench-and-shift pasture management (OR=4.08; 95% CI=0.75, 22.16). CONCLUSIONS While there is abundant literature on the topic of AHR in sheep GINs, few studies have explicitly investigated the association between putative risk or protective factors and AHR. Consequently, several of the current recommendations on parasite management are not evidence-based. Moreover, many of the studies included in this review had a high or unclear risk of systematic bias, highlighting the need to improve study design and/or reporting of future research carried out in this field.

A Systematic Review of Waterborne Disease Outbreaks Associated with Small Non-Community Drinking Water Systems in Canada and the United States

Background Reports of outbreaks in Canada and the United States (U.S.) indicate that approximately 50% of all waterborne diseases occur in small non-community drinking water systems (SDWSs). Summarizing these investigations to identify the factors and conditions contributing to outbreaks is needed in order to help prevent future outbreaks. Objectives The objectives of this study were to: 1) identify published reports of waterborne disease outbreaks involving SDWSs in Canada and the U.S. since 1970; 2) summarize reported factors contributing to outbreaks, including water system characteristics and events surrounding the outbreaks; and 3) identify terminology used to describe SDWSs in outbreak reports. Methods Three electronic databases and grey literature sources were searched for outbreak reports involving SDWSs throughout Canada and the U.S. from 1970 to 2014. Two reviewers independently screened and extracted data related to water system characteristics and outbreak events. The data were analyzed descriptively with ‘outbreak’ as the unit of analysis. Results From a total of 1,995 citations, we identified 50 relevant articles reporting 293 unique outbreaks. Failure of an existing water treatment system (22.7%) and lack of water treatment (20.2%) were the leading causes of waterborne outbreaks in SDWSs. A seasonal trend was observed with 51% of outbreaks occurring in summer months (p<0.001). There was large variation in terminology used to describe SDWSs, and a large number of variables were not reported, including water source and whether water treatment was used (missing in 31% and 66% of reports, respectively). Conclusions More consistent reporting and descriptions of SDWSs in future outbreak reports are needed to understand the epidemiology of these outbreaks and to inform the development of targeted interventions for SDWSs. Additional monitoring of water systems that are used on a seasonal or infrequent basis would be worthwhile to inform future protection efforts.

Investigating public perceptions and knowledge translation priorities to improve water safety for residents with private water supplies: a cross-sectional study in Newfoundland and Labrador

BackgroundThe first objective of this study was to investigate the public perceptions of private water and alternative sources with respect to safety, quality, testing and treatment in Newfoundland and Labrador (NL), Canada. The second objective was to provide public health practitioners with recommendations for improving knowledge translation (KT) efforts in NL, based on assessments of respondents’ perceived information needs and preferred KT methods.MethodsA cross-sectional telephone survey of 618 households with private water supplies was conducted in March-April, 2007. Questions pertained to respondents’ perceptions of their tap water, water concerns, alternative water use, well characteristics, and water testing behaviours.ResultsApproximately 94% of households were supplied by private wells (50% drilled and 50% dug wells), while 6% obtained water from roadside ponds, rivers or springs (RPRS). While 85% rated their water quality highly, 55% nevertheless had concerns about its overall safety. Approximately 11% of respondents never tested their water, and of the 89% that had, 80% tested at frequencies below provincial recommendations for bacterial testing. More than one-third of respondents reported treating their water in the home, and 78% employed active carbon filtration methods. Respondents wanted more information on testing options and advice on effective treatment methods. Targeted advertising through television, flyers/brochures and/or radio is recommended as a first step to increase awareness. More active KT methods involving key stakeholders may be most effective in improving testing and treatment behaviour.ConclusionsThe results presented here can assist public health practitioners in tailoring current KT initiatives to influence well owner stewardship behaviour.

Distribution of, and risk factors associated with, sheep carcass condemnations due to Cysticercus ovis infection on Canadian sheep farms

Cysticercus ovis, the intermediate stage of a canine tapeworm, Taenia ovis, produces cystic lesions in the skeletal and cardiac muscle of sheep which, if numerous, will result in the condemnation of an entire carcass. In 2007 and 2008, the number of carcass condemnations due to C. ovis rose dramatically across Canada, suggesting that the prevalence of this infection on sheep farms was increasing. Trace-back of 237 carcasses condemned at Ontario provincially inspected abattoirs, between March 2009 and March 2011, revealed they originated from 133 farms across Canada. A case-control study was performed (n=40 cases, 56 controls) to identify farm-level risk factors associated with carcass condemnations due to C. ovis. Participating farms, located in Alberta, Saskatchewan, Manitoba and Ontario, were asked to answer a short questionnaire which collected information about each farms geographic location and management practices. A multivariable logistic regression model revealed that farm dogs scavenging deadstock (OR=4.04; 95% CI: 1.16-14.04) and failing to dispose of deadstock (OR=11.78; 95% CI: 2.93-47.40) were significantly associated with condemnations (p ≤ 0.05).

A survey of dairy calf management practices among farms using manual and automated milk feeding systems in Canada

Dairy calves in North America traditionally are housed individually and fed by manual milk feeding (MMF) systems with buckets or bottles. Automated milk feeders (AMF) allow for more natural milk feeding frequencies and volumes, and calves are usually housed in groups. The objectives of this study were to (1) determine the prevalence of various milk-fed calf management and feeding practices and (2) compare these practices between dairy farms using MMF and AMF systems. A national online survey was performed from January to May 2015 to quantify management practices for the care of milk-fed dairy calves in Canada. A total of 670 responses were received (6% of all dairy farms in Canada). Among respondents, 16% used AMF and 84% used MMF. Seventy percent of the farms using AMF had freestall barns compared with only 48% of those using MMF. A greater proportion of AMF farms (30%) also had automatic milking systems (AMS) compared with MMF farms (8%). Among tiestall farms, a herd size of >80 milking cows was associated with having an AMF [odds ratio (OR) = 3.8; 95% confidence interval (CI): 1.6-11.4]. For freestall or bedded-pack farms, a herd size of >80 milking cows (OR = 3.5; CI: 1.8-6.6), having an AMS (OR = 3.1; CI: 1.6-5.7), and use of cow brushes (OR = 3.1; CI: 1.3-6.9) were associated with having an AMF. Calves fed with AMS typically were housed in groups of 10 to 15, whereas almost 76% of the farms with MMF housed calves individually. Although both AMF and MMF farms fed similar amounts of milk in the first week of life (median = 6 L/d), the cumulative volume fed in the first 4 wk differed significantly, with a median of 231 versus 182 L for AMF and MMF, respectively. Median peak milk allowance was higher for AMF than for MMF (10 vs. 8 L/d, respectively). In summary, farms using AMF were larger, provided more milk to calves, and used more automation in general (i.e., in other areas of their operation). These data provide insights into calf-rearing practices across Canada and into how the use of AMF is affecting calf feeding and management on dairy farms.

Survey of reproduction management on Canadian dairy farms

The objectives of this study were to (1) quantify current reproduction management practices, and (2) assess the association between these practices and herd reproductive performance on dairy farms in Canada. A bilingual survey was developed, validated, and administered from March to May 2014 to collect general and reproduction management and performance measures [annual 21-d pregnancy rate (PR), 21-d insemination rate (IR), and conception risk (CR)]. Associations between management practices and reproductive performance measures were tested using linear regression models. A total of 832 questionnaires were completed online and by mail, representing a response rate of 9%. On average, farms had 77 lactating cows (median=50) and 13 dry cows (median=10), and Holstein was the most common breed (92% of herds). Lactating cow housing was tiestall on 61% of the farms, freestall on 37%, and bedded pack on 2%. The average voluntary waiting period was 58 d in milk (DIM). The main reproduction management practice per farm was defined as the means employed for >50% of inseminations. Farms reported their main reproduction management practice for first and subsequent inseminations, respectively, as visual estrus detection (51 and 44% of herds), timed AI (21 and 23% of herds), automated activity monitoring (AAM; 10 and 10% of herds), other management practice (bulls; 2 and 2% of herds), and a combination of management practices (16 and 21% of herds). On farms using visual estrus detection, cows were observed for signs of estrus on average 3.5 times per day, for an average total of 36 min/d. The most common use of reproductive hormones was to synchronize ovulation using Ovsynch (58% of the farms). Average PR, IR, and CR were 17.6, 44.1, and 40.5%, respectively. In linear regression analyses adjusted for confounders, pregnancy rate was significantly associated with geographic region, housing (tiestall: PR=15.4%, freestall: PR=17.6%), herd size (<50 lactating cows: PR=16.2%, 50-100 cows: PR=16.5%, >100 cows: PR=17.8%), voluntary waiting period (≤60 DIM: PR=17.6%, >60 DIM: PR=15.9%), and frequency of insemination per day (once daily: PR=16.6%, twice or more daily: PR=18.1%). The main reproduction management practice at first and subsequent inseminations was divergently associated with IR and CR, but not with PR (visual heat detection: PR=17.4%, timed AI: PR=18.4%, AAM: PR=17.1%, combined practices: PR=18.2%).

Taenia ovis infection and its control: a Canadian perspective

Distributed worldwide, Taenia ovis infection is responsible for the condemnation of sheep carcasses in many countries. This review highlights the programme used in New Zealand to successfully control T. ovis in sheep, and discusses how similar approaches may be modified for use in Canada, given what is currently known about the epidemiology of T. ovis. The lifecycle of the parasite is well known, involving dogs as the definitive host and sheep or goats as the intermediate host. An effective vaccine does exist, although it is not presently commercially available. In New Zealand an industry-based, non-regulatory programme was created to educate producers about T. ovis and necessary control strategies, including the need to treat farm dogs with cestocides regularly. This programme resulted in a substantial decrease in the prevalence of T. ovis infections between 1991 and 2012. Historically, T. ovis was not a concern for the Canadian sheep industry, but more recently the percentage of lamb condemnations due to T. ovis has increased from 1.5% in 2006 to 55% in 2012. It has been suggested that coyotes may be transmitting T. ovis, but this has not been confirmed. Recommendation are made for the Canadian sheep industry to adopt a control programme similar to that used in New Zealand in order to reduce the prevalence of T. ovis infection.

A longitudinal study on the effect of lambing season on the periparturient egg rise in Ontario sheep flocks

The epidemiology of the periparturient egg rise (PPER) of gastrointestinal nematodes (GINs) in sheep remains unclear, and may be influenced by the lambing season. This longitudinal study was performed to determine the effect of out-of-season lambing on the PPER in ewes in Ontario, and whether total plasma protein (TPP) and packed cell volume (PCV) were associated with the PPER. Six farms that practiced out-of-season lambing were enrolled, and sampled for three consecutive lambing seasons (winter, spring and autumn). For each lambing season, all farms were visited five times. On the first visit for each lambing season, 15-20 pregnant ewes and 15-20 non-pregnant/early gestation ewes were randomly selected. At each visit, fecal samples were collected from all selected animals and processed individually to measure GIN fecal egg counts (FECs). Blood samples were collected on three visits in each lambing period and processed to measure TPP and PCV. The ewes were classified into one of five production stages (maintenance [i.e. not pregnant], early or late gestation [<120 d and ≥ 120 d, respectively], and early or late lactation [<40 d and ≥ 40 d, respectively]) based on information collected during farm visits. Linear mixed models were developed for the TPP, PCV and logarithmic-transformed FEC (lnFEC). During the winter and spring lambing season, the FECs increased gradually over the gestation period and peaked during lactation, with these increases being larger in ewes with a low PCV (three-way interaction in the final model). In the autumn lambing season, the FECs started off higher in early gestation, and increased rapidly to peak in late gestation, particularly for animals with low PCV levels. In the TPP model, PCV and lnFEC were positively associated with TPP. During both autumn and winter lambing seasons, the TPP decreased from maintenance throughout gestation and early lactation, followed by an increase in late lactation, except for when there were high FECs. During the spring lambing season, TPP peaked at early gestation, and then decreased in late gestation, to increase more gradually over lactation. In the PCV model, PCV increased with TPP and decreased exponentially with increases in lnFEC. The PPER occurred during all three lambing seasons, and its magnitude and distribution varied with the lambing season, suggesting that the PPER in ewes depends on both environmental and animal physiological factors, an important consideration when implementing preventive parasite control strategies on sheep farms that practice out-of-season lambing.

Owned dog demography in Todos Santos Cuchumatán, Guatemala.

A thorough knowledge of the dog demography should be an integral element in the planning, implementation and evaluation of dog population control measures. In May 2008, a door-to-door household census of human and owned canine populations was conducted in 12 contiguous neighbourhoods in the town of Todos Santos Cuchumatán, Guatemala. During the census, household and footpath data were recorded using a handheld Global Positioning System (GPS), and used to create digital census route maps, and perimeter and area estimates of the study region. Approximately 99% of all households (472/476) participated in the census, representing 2461 people in the overall estimated study region area of 80 hectares (ha). A total of 382 dogs were owned by 50.8% (240/472) of households, yielding means of 0.8 (382/472) owned dogs per household and 1.6 (382/240) dogs per dog-owning household. Of the total 382 owned dogs, 88.2% (337/382) were aged three months or older; of these, 68.5% (231/337) were reported as not normally being confined on the household property during the average day, and 9.7% (24/247) of the males and none of the females (0/81) were reported to be neutered. Of the households that owned female dogs, 89.7% (52/58) and 91.4% (53/58) reported that they would have females surgically or non-surgically neutered, respectively, if these services were available. Of the households that owned male dogs, 90.3% (176/195) and 92.3% (180/195) reported that they would have males surgically or non-surgically neutered, respectively, if these services were available. Approximately 72% (238/330) of owned dogs were vaccinated for rabies, and 80% (187/238) of these were males. The owned dog male:female ratio was 2.6:1 (275/107), the owned dog:human ratio was 1:6.4 (382/2461), and the absolute density was 478 (382/0.80) owned dogs/km(2). This knowledge of the owned dog demography was generated using simple means and has been of direct use in support of, and as baseline data for the planning, implementation and evaluation of subsequent dog population control measures in this population; they may be of similar use in other comparable populations.