Katharina D.C. Stärk

Concepts for risk-based surveillance in the field of veterinary medicine and veterinary public health: Review of current approaches

BackgroundEmerging animal and zoonotic diseases and increasing international trade have resulted in an increased demand for veterinary surveillance systems. However, human and financial resources available to support government veterinary services are becoming more and more limited in many countries world-wide. Intuitively, issues that present higher risks merit higher priority for surveillance resources as investments will yield higher benefit-cost ratios. The rapid rate of acceptance of this core concept of risk-based surveillance has outpaced the development of its theoretical and practical bases.DiscussionThe principal objectives of risk-based veterinary surveillance are to identify surveillance needs to protect the health of livestock and consumers, to set priorities, and to allocate resources effectively and efficiently. An important goal is to achieve a higher benefit-cost ratio with existing or reduced resources. We propose to define risk-based surveillance systems as those that apply risk assessment methods in different steps of traditional surveillance design for early detection and management of diseases or hazards. In risk-based designs, public health, economic and trade consequences of diseases play an important role in selection of diseases or hazards. Furthermore, certain strata of the population of interest have a higher probability to be sampled for detection of diseases or hazards. Evaluation of risk-based surveillance systems shall prove that the efficacy of risk-based systems is equal or higher than traditional systems; however, the efficiency (benefit-cost ratio) shall be higher in risk-based surveillance systems.SummaryRisk-based surveillance considerations are useful to support both strategic and operational decision making. This article highlights applications of risk-based surveillance systems in the veterinary field including food safety. Examples are provided for risk-based hazard selection, risk-based selection of sampling strata as well as sample size calculation based on risk considerations.

Towards a conceptual framework to support one-health research for policy on emerging zoonoses.

Summary In the past two decades there has been a growing realisation that the livestock sector was in a process of change, resulting from an expansion of intensive animal production systems and trade to meet a globalised worlds increasing demand for livestock products. One unintended consequence has been the emergence and spread of transboundary animal diseases and, more specifically, the resurgence and emergence of zoonotic diseases. Concurrent with changes in the livestock sector, contact with wildlife has increased. This development has increased the risk of transmission of infections from wildlife to human beings and livestock. Two overarching questions arise with respect to the real and perceived threat from emerging infectious diseases: why are these problems arising with increasing frequency, and how should we manage and control them? A clear conceptual research framework can provide a guide to ensure a research strategy that coherently links to the overarching goals of policy makers. We propose such a new framework in support of a research and policy-generation strategy to help to address the challenges posed by emerging zoonoses.

Molecular and immunodiagnostic investigations on bovine neosporosis in Switzerland

Abstract Neospora caninum has gained considerable attention through its role in the aetiology of bovine abortion. Due to its close phylogenetic relationship with Toxoplasma gondii, respective unequivocal differential diagnosis deserves special consideration. In order to evaluate the diagnostic performance of molecular and immunodiagnostic techniques and to provide insights into the epidemiological significance of bovine neosporosis in Switzerland, we conducted a study on 83 cases of bovine abortion: of these, 24 (29%) foetal brains were positive by Neospora-PCR, six of these foetuses were simultaneously seropositive in Neospora-IFAT and/or somatic antigen-ELISA. Conversely, four (5%) foetal brains were considered positive by Toxoplasma-PCR, two of which were also seropositive in the Toxoplasma-P30-ELISA and/or direct agglutination test. The seroprevalence in 1689 cattle sera obtained from 113 dairy farms was 11.5% (95% confidence interval: 9.2–13.8) by Neospora-somatic antigen-ELISA and 10.7% (95% confidence interval: 8.3–12.6) by Toxoplasma-P30-ELISA. From the same samples, 1.1%, less than statistically expected, were positive in both ELISA. Within selected groups of cow-calf farms, the seroprevalence determined using the Neospora-somatic antigen-ELISA was 14% (95% confidence interval: 5.0–23.0) for dams and 15% (95% confidence interval: 3.0–28.0) for offspring calves. Seroprevalences determined by Toxoplasma-P30-ELISA were 8% (95% confidence interval: 4.0–12.0) for dams and 3% (95% confidence interval: 0.3–6.0) for calves. None of the sera gave a positive reaction in both ELISA. Our data indicated that prenatal neosporosis appears as an important cause of bovine abortion in Switzerland.

Risk factors for infection of sow herds with porcine reproductive and respiratory syndrome (PRRS) virus

In 1992, the porcine reproductive and respiratory syndrome virus (PRRSV) of European type (PRRSV-EU) was introduced in Denmark. By 1996, the virus had spread to approximately 25% of the Danish herds. In January 1996, a modified-live vaccine based on the American type of the virus (PRRSV-US) was used in replacement boars for Danish artificial insemination (AI) centres and from July 1996, the vaccine was used in PRRSV-EU infected herds for prevention of disease. Soon after vaccine introduction, PRRSV non-infected herds experienced outbreaks of disease due to infection with PRRSV-US. In this study, we investigated the risk factors (biosecurity level, animals, exposure from PRRSV-US-infected neighbour herds, semen, herd size, pig density and herd density) for infection with PRRSV-US in a cohort of 1071 sow herds; we used a nested case-control study. The retrospective observation period lasted from June 1996 (when they all were non-infected) to October 1997. Seventy-three non-vaccinated, closed sow herds became infected with the vaccine strain during this period. Each case herd was matched with two control herds from the cohort (controls had not been infected at the time of infection in the case herds). The data were analysed using a Cox-regression model. The hazard of infection increased significantly with exposure from PRRSV-US-infected neighbouring herds, purchase of animals from herds incubating PRRSV-US infection, increasing herd size and purchase of semen from boars at PRRSV-US-infected AI centres. The results are consistent with the modified-live vaccine strain spread to other herds by trade with animals and semen and by neighbour (area) transmission. We suggest that virus spread by aerosols was a frequent mode of transmission.

Evaluation and optimization of surveillance systems for rare and emerging infectious diseases

Surveillance for rare and emerging infectious diseases poses a special challenge to veterinary services. Most emerging infectious diseases like bovine tuberculosis (bTB) are zoonoses, affecting both human and animal populations. Despite the low prevalence of such an emerging infectious disease at time of incursion, the surveillance system should be able to detect the presence of the disease as early as possible. Because passive surveillance is a relatively cost-effective and therefore commonly used process, it is the basic tool for infectious disease surveillance. Because of under-reporting in passive surveillance, cost-intensive active surveillance is often required to increase the sensitivity of the surveillance system. Using scenario tree modelling, the sensitivity of passive and active surveillance system components (SSC) can be quantified and an optimal, cost-effective surveillance system developed considering the contributions of each SSC. We illustrate this approach with the example of bTB surveillance in Switzerland where the surveillance system for bTB consists of meat inspection at the slaughterhouse (SLI), passive clinical surveillance on farm (CLIN) and human surveillance (HS). While the sensitivities for CLIN and HS were both negligible (<1%), SLI was assessed to be 55.6%. The scenario tree model showed that SLI is increasable up to 80.4% when the disease awareness of meat inspectors in Switzerland is enhanced. A hypothetical random survey (RS) was also compared with a targeted survey (TS) in high-risk strata of the cattle population, and the sensitivity of TS was 1.17-fold better than in RS but with 50% of the sample size.

Evaluation of animal and public health surveillance systems: a systematic review

Disease surveillance programmes ought to be evaluated regularly to ensure they provide valuable information in an efficient manner. Evaluation of human and animal health surveillance programmes around the world is currently not standardized and therefore inconsistent. The aim of this systematic review was to review surveillance system attributes and the methods used for their assessment, together with the strengths and weaknesses of existing frameworks for evaluating surveillance in animal health, public health and allied disciplines. Information from 99 articles describing the evaluation of 101 surveillance systems was examined. A wide range of approaches for assessing 23 different system attributes was identified although most evaluations addressed only one or two attributes and comprehensive evaluations were uncommon. Surveillance objectives were often not stated in the articles reviewed and so the reasons for choosing certain attributes for assessment were not always apparent. This has the potential to introduce misleading results in surveillance evaluation. Due to the wide range of system attributes that may be assessed, methods should be explored which collapse these down into a small number of grouped characteristics by focusing on the relationships between attributes and their links to the objectives of the surveillance system and the evaluation. A generic and comprehensive evaluation framework could then be developed consisting of a limited number of common attributes together with several sets of secondary attributes which could be selected depending on the disease or range of diseases under surveillance and the purpose of the surveillance. Economic evaluation should be an integral part of the surveillance evaluation process. This would provide a significant benefit to decision-makers who often need to make choices based on limited or diminishing resources.

Influenza at the animal-human interface: A review of the literature for virological evidence of human infection with swine or avian influenza viruses other than A(H5N1)

Factors that trigger human infection with animal influenza virus progressing into a pandemic are poorly understood. Within a project developing an evidence-based risk assessment framework for influenza viruses in animals, we conducted a review of the literature for evidence of human infection with animal influenza viruses by diagnostic methods used. The review covering Medline, Embase, SciSearch and CabAbstracts yielded 6,955 articles, of which we retained 89; for influenza A(H5N1) and A(H7N9), the official case counts of t he World Health Organization were used. An additional 30 studies were included by scanning the reference lists. Here, we present the findings for confirmed infections with virological evidence. We found reports of 1,419 naturally infected human cases, of which 648 were associated with avian influenza virus (AIV) A(H5N1), 375 with other AIV subtypes, and 396 with swine influenza virus (SIV). Human cases naturally infected with AIV spanned haemagglutinin subtypes H5, H6, H7, H9 and H10. SIV cases were associated with endemic SIV of H1 and H3 subtype descending from North American and Eurasian SIV lineages and various reassortants thereof. Direct exposure to birds or swine was the most likely source of infection for the cases with available information on exposure.

Economic principles for resource allocation decisions at national level to mitigate the effects of disease in farm animal populations.

SUMMARY This paper originated in a project to develop a practical, generic tool for the economic evaluation of surveillance for farm animal diseases at national level by a state veterinary service. Fundamental to that process is integration of epidemiological and economic perspectives. Using a generalized example of epidemic disease, we show that an epidemic curve maps into its economic equivalent, a disease mitigation function, that traces the relationship between value losses avoided and mitigation resources expended. Crucially, elementary economic principles show that mitigation, defined as loss reduction achieved by surveillance and intervention, must be explicitly conceptualized as a three-variable process, and the relative contributions of surveillance and intervention resources investigated with regard to the substitution possibilities between them. Modelling the resultant mitigation surfaces for different diseases should become a standard approach to animal health policy analysis for economic efficiency, a contribution to the evolving agenda for animal health economics research.

Antimicrobial usage in dogs and cats in first opinion veterinary practices in the UK

OBJECTIVES To provide baseline data on patterns of antimicrobial usage in dogs and cats through the analysis of data stored in electronic practice management systems. METHODS Clinical data from 11 first opinion veterinary practices were extracted for the year 2007. Descriptive statistical analysis was performed to assess the usage of antimicrobials. RESULTS Widespread usage of systemic broad-spectrum antimicrobials was observed. Antimicrobials most frequently used in both species were potentiated amoxicillin (44·4% and 46.1% in cats and dogs, respectively) and amoxicillin (14·3% and 20·7%). Cephalexin (13·4%) and cefovecin (15·0%) were also commonly used in dogs and cats, respectively. Systemic critically important antimicrobials in human medicine were widely used in dogs (60·5%) and cats (82·7%). Topical antimicrobials used in both species included fusidic acid (48·4% and 54·8%), framycetin (20·4% and 13·4%), polymyxin B (12·6% and 9·3%) and neomycin (6·5% and 6·6%). CLINICAL SIGNIFICANCE Inappropriate usage of broad-spectrum antimicrobials may contribute to the development of antimicrobial resistance and loss of efficacy of antimicrobials in veterinary settings. Data recorded in practice management systems were demonstrated to be a practical source for monitoring antimicrobial usage in pets.

Estimating the temporal and spatial risk of bluetongue related to the incursion of infected vectors into Switzerland

BackgroundThe design of veterinary and public health surveillance systems has been improved by the ability to combine Geographical Information Systems (GIS), mathematical models and up to date epidemiological knowledge. In Switzerland, an early warning system was developed for detecting the incursion of the bluetongue disease virus (BT) and to monitor the frequency of its vectors. Based on data generated by this surveillance system, GIS and transmission models were used in order to determine suitable seasonal vector habitat locations and risk periods for a larger and more targeted surveillance program.ResultsCombined thematic maps of temperature, humidity and altitude were created to visualize the association with Culicoides vector habitat locations. Additional monthly maps of estimated basic reproduction number transmission rates (R0) were created in order to highlight areas of Switzerland prone to higher BT outbreaks in relation to both vector activity and transmission levels. The maps revealed several foci of higher risk areas, especially in northern parts of Switzerland, suitable for both vector presence and vector activity for 2006.Results showed a variation of R0 values comparing 2005 and 2006 yet suggested that Switzerland was at risk of an outbreak of BT, especially if the incursion arrived in a suitable vector activity period. Since the time of conducting these analyses, this suitability has proved to be the case with the recent outbreaks of BT in northern Switzerland.ConclusionOur results stress the importance of environmental factors and their effect on the dynamics of a vector-borne disease. In this case, results of this model were used as input parameters for creating a national targeted surveillance program tailored to both the spatial and the temporal aspect of the disease and its vectors. In this manner, financial and logistic resources can be used in an optimal way through seasonally and geographically adjusted surveillance efforts. This model can serve as a tool for other vector-borne diseases including human zoonotic vectors which are likely to spread into Europe.