Veterinary syndromic surveillance : current initiatives and potential for development

This paper reviews recent progress in the development of syndromic surveillance systems for veterinary medicine. Peer-reviewed and grey literature were searched in order to identify surveillance systems that explicitly address outbreak detection based on systematic monitoring of animal population data, in any phase of implementation. The review found that developments in veterinary syndromic surveillance are focused not only on animal health, but also on the use of animals as sentinels for public health, representing a further step towards One Medicine. The main sources of information are clinical data from practitioners and laboratory data, but a number of other sources are being explored. Due to limitations inherent in the way data on animal health is collected, the development of veterinary syndromic surveillance initially focused on animal health data collection strategies, analyzing historical data for their potential to support systematic monitoring, or solving problems of data classification and integration. Systems based on passive notification or data transfers are now dealing with sustainability issues. Given the ongoing barriers in availability of data, diagnostic laboratories appear to provide the most readily available data sources for syndromic surveillance in animal health. As the bottlenecks around data source availability are overcome, the next challenge is consolidating data standards for data classification, promoting the integration of different animal health surveillance systems, and also the integration to public health surveillance. Moreover, the outputs of systems for systematic monitoring of animal health data must be directly connected to real-time decision support systems which are increasingly being used for disease management and control

One health in the U.S. military: a review of existing systems and recommendations for the future

2014 Summer.Includes bibliographical references.Background: The merging of the former U.S. Army Veterinary Command (VETCOM) with the former U.S. Army Center for Health Promotion and Preventive Medicine (USACHPPM) into the U.S. Army Public Health Command (USAPHC) in 2011 created an opportunity for the military to fully embrace the One Health concept. That same year, the USAPHC began work on a Zoonotic Disease Report (ZDR) aimed at supporting critical zoonotic disease risk assessments by combining zoonotic disease data from human, entomological, laboratory, and animal data sources. The purpose of this dissertation is to facilitate the creation of a military Zoonotic Disease Surveillance program that combines disease data from both military human and animal sources. Methods: Five of the most commonly used human military medical data systems were systematically reviewed using a standardized template based on Centers for Disease Control and Preventive Medicine (CDC) guidelines. The systems were then compared to each other in order to recommend the one(s) best suited for use in the USAPHC ZDR. The first stage of the comparison focused on each system's ability to meet the specific goals and objectives of the ZDR, whereas the second stage applied capture-recapture methodology to data system queries in order to evaluate each system's data quality (completeness). A pilot study was conducted using Lyme borreliosis to investigate the utility of military pet dogs as sentinel surveillance for zoonotic disease in military populations. Canine data came from 3996 surveys collected from 15 military veterinary facilities from 1 November 2012 through 31 October 2013. Surveys simultaneously collected Borrelia burgdorferi (Bb) seroprevalence and canine risk factor data for each participating pet dog. Human data were obtained by querying the Defense Medical Surveillance System for the same 15 military locations and the same time period. The correlation of military pet dog Bb seroprevalence and military human Lyme disease (borreliosis) data was estimated using the Spearman Rank Correlation. The difference between military pet dog data and civilian pet dog data was examined through the use of the chi-squared test for proportions. Multivariable logistic regression was then used to investigate the potential for identified risk factors to impact the observed association. Results: The comparison of human military medical data systems found the Military Health System Management Analysis and Reporting Tool (M2) data system most completely met the specific goals and objects of the ZDR. In addition, completeness calculation showed the M2 data source to be the most complete source of human data; 55% of total captured cases coming from the M2 system alone. The pilot study found a strong positive correlation between military human borreliosis data and military pet dog Bb seroprevalence data by location (rs = 0.821). The study showed reassuring similarities in pet dog seroprevalence by location for the majority of sites, but also showed meaningful differences between two locations, potentially indicating military pet dogs as more appropriate indicators of Lyme disease risk for military populations than civilian pet dog data. Unfortunately, whether canine Bb seroprevalence is influenced by the distribution of identified risk factors could not be determined due to limited study power. Conclusions: Based on this study M2 was recommended as the primary source of military human medical data for use in the Public Health Command Zoonotic Disease Report. In addition, it was recommended that Service member pet dog data be incorporated as a sensitive and convenient measure of zoonotic disease risk in human military populations. The validity of the data, however, should be evaluated further with either larger sample sizes and/or a zoonotic disease with higher prevalence

Syndrome classification through a retrospective analysis of porcine submissions to a regional animal health laboratory

In response to the global threats of emerging infectious diseases and bioterrorism events, public health surveillance developed analytical methods to cluster early health indicators from multiple data sources into “syndromes” for rapid and efficient disease detection. Syndromic surveillance has become well established in public health, using many different health indicators from multiple sources. In animal health, the timeliness and efficiency of disease detection in early warning surveillance systems has been enhanced by including syndromic surveillance methods. Animal health syndromic surveillance improves disease detection through the analysis of pre-diagnostic data collected for other purposes, from sources such as laboratories, veterinary clinics, abattoirs, farms and pharmacies. However, the data are inherently non-disease specific compared to traditional surveillance and require analyses to ensure that syndromes represent significant diseases as accurately as possible. Syndrome classification is an analytical process that identifies, collates and validates pre-diagnostic indicators within a data source into accurate and viable syndromes. The goals of this thesis were as follows: a) Review surveillance systems and methods to understand the scale, complexity and validity of different syndromic surveillance approaches. b) Describe and evaluate six years of swine laboratory submission data to Veterinary Diagnostic Services (VDS) in the province of Manitoba, Canada, for the purpose of syndromic surveillance. c) Finally, identify and validate the most appropriate syndromes from pre-diagnostic data within the submitted swine cases. An initial systematic review of public health syndromic surveillance was conducted with 81 studies meeting the criteria. The variety and frequency of populations under surveillance, information sources, pre-diagnostic indicators, syndromes and reported values were recorded. The predominant methods for syndrome classification, temporal and spatial analysis and aberration detection were also described. 21,665 swine laboratory submissions from January 2003 to March 2009, including 4726 pathology cases, were evaluated. The frequency and distributions of the predominant pre-diagnostic indicators, test requests and specimen types, were described. The most common pathology diagnoses and organ system involvement were reported for the pathology submissions. For syndrome validation, a Multiple Correspondence Analysis was conducted to cluster multiple pathology diagnoses per case into four diagnostic groups based on organ systems; Respiratory, Multisystemic, Gastrointestinal and “Other”. Syndrome classification was completed, first using agglomerative hierarchical clustering to classify syndromes from 30 test requests and 34 specimen types. For validation, the syndromes were used as predictive variables in a multinomial logistic regression model applied to training and test data sets. The overall model sensitivity, specificity and predictive values for each organ system outcome were estimated. The individual syndromes were compared using relative risk ratios and marginal effects. Five syndromes were identified as having a significantly higher predictive association with one organ system group (compared to the other three): Respiratory, GI, Reproductive, Joint and PCV (specific to porcine circovirus associated disease). The methods in this thesis identified a simplified analytical approach for syndrome classification of laboratory test requests and specimen types within swine submissions. Alternative algorithms for syndrome grouping, establishment of temporal baselines and exploration of automated aberration detection were identified as areas for future research

Avian Paramyxovirus Serotype-1: A Review of Disease Distribution, Clinical Symptoms, and Laboratory Diagnostics

Avian paramyxovirus serotype-1 (APMV-1) is capable of infecting a wide range of avian species leading to a broad range of clinical symptoms. Ease of transmission has allowed the virus to spread worldwide with varying degrees of virulence depending on the virus strain and host species. Classification systems have been designed to group isolates based on their genetic composition. The genetic composition of the fusion gene cleavage site plays an important role in virulence. Presence of multiple basic amino acids at the cleavage site allows enzymatic cleavage of the fusion protein enabling virulent viruses to spread systemically. Diagnostic tests, including virus isolation, real-time reverse-transcription PCR, and sequencing, are used to characterize the virus and identify virulent strains. Genetic diversity within APMV-1 demonstrates the need for continual monitoring for changes that may arise requiring modifications to the molecular assays to maintain their usefulness for diagnostic testing

Poultry Meat and Human Salmonellosis: Establishing the Epidemiological Relationship

Extensive literature review confirms that in the industrialized countries, salmonellosis is a major public health problem, causing considerable social and economic losses. Non-typhoid salmonellosis occurs primarily as a foodborne zoonosis. There are different animal sources of human infections, and this raises the question of determining and defining which meat types constitute the major hazards for man. The studies reported in this thesis were designed to establish and clarify any epidemiological relationship between consumption of poultry meat and human salmonellosis. Three epidemiological approaches were employed: A 20-year retrospective study was undertaken to determine the epidemiological characteristics of foodborne salmonella infections and outbreaks. It was hoped that the retrospective analysis would generate some hypotheses on the incidence, risk factors, and trends of human salmonellosis in Scotland. All the 1,791 outbreaks of foodborne infections and intoxications recorded by the Communicable Diseases (Scotland) Unit (CD(S)U) between 1980 and 1987 were computer-analysed. A one in 5 systematic sample (n = 5,776) of approximately 29,000 human salmonella infections (laboratory reported isolations) listed in the Weekly and Annual Reports of the CD(S)U for the period 1968 to 1987 was also computer-analysed. Eight-five per cent of all foodborne outbreaks recorded from 1980 to 1987 were caused by the salmonellae. Salmonella food poisoning has been increasing in Scotland, as in England and Wales. Laboratory isolations of salmonellae were made from an average of 1,400 persons per year, and the standardized crude incidence rate is approximately 30/100,000 per year. Both the crude incidence and the standardized incidence rate showed a trend of a steady rise. There was a three-fold (30096) increase in the standardized incidence rate from 14/100,000 population per year for the period 1968-72 to 42/100,000 per year during 1983-87. With a mean age-specific incidence rate of 63/100,000 per year, children 5 years old and below are at highest risk of foodborne salmonellosis. Although highest case fatality rate occurs among the elderly, the age-specific incidence rate among persons over 70 years old is comparatively very low (15. 3/100,000 per year). Significantly higher incidence rates of salmonella infections were recorded in males than in females. There is a consistent seasonal trend in salmonella infections and outbreaks; more than half of all the outbreaks occurred during the months of July, August and September. S. typhimurium, S. enteritidis and S. virchow are the three major causes of foodborne salmonella infections and outbreaks. Up to 1985, S. typhimurium remained the primary cause of salmonellosis; but since 1986, S. enteritidis has assumed the primary place. Between 1968 and 1987, there was a four-fold (400 per cent) increase in the incidence of S. enteritidis; the upsurge in S. enteritidis seems to be due to an unprecedented increase in the incidence of phage type 4 in poultry products. Poultry meat was the primary vehicle of foodborne salmonella outbreaks, accounting for 69 per cent of all meatborne episodes. Between 1975 and 1987, there has been 400 per cent increase in the proportions of outbreaks in which poultry was implicated; and there has been no change in the primary place of poultry during the past 10 years. From the retrospective analysis, the hypothesis is that poultry is the major risk factor; consumption of poultry meat is significantly associated with salmonella infections. In most reported incidents of salmonellosis, the evidence which incriminates poultry meat is only circumstantial. In many outbreaks, the causative salmonella types are isolated from both clinically infected and symptomless excretors. It seems important to be able to demonstrate an epidemiological association between consumption of poultry meat and salmonella excretion without relying on investigation of clinical incidents. Poultry meat used in a catering establishment can be screened to identify salmonella types to which the consumers are exposed. Salmonella excretion (an indicator of salmonella infection or transient carriage) in the consuming population can be investigated by parallel monitoring of the sewers draining the defined population area. By comparing the salmonella types isolated from the poultry meat and the sewers, and the frequency of isolation of identical types, an epidemiological association between the poultry meat and human infection can be assessed. This was the overall objective of the second epidemiological approach employed - the bacteriological surveys. (Abstract shortened by ProQuest.)

2011 progress towards implementation of a public health action plan to combat antimicrobial resistance

In 2001, the Task Force developed an initial Action Plan, outlining specific issues, goals, and actions important for addressing the problem of AR. This document, entitled A Public Health Action Plan to Combat Antimicrobial Resistance, Part I: Domestic Issues, reflected a broad- based consensus of participating federal agencies, which was reached with individual input from state and local health agencies, universities, professional societies, pharmaceutical companies, healthcare delivery organizations, agricultural producers, consumer groups, and other members of the public. Continued collaboration with these partners has been vital to achieving successful implementation of the Action Plan. The 2011 revision of the Action Plan was based in part on individual input obtained at a consultants' meeting held in Atlanta, Georgia, in December 2007. Present at the public meeting were consultants with wide-ranging expertise in areas such as human and veterinary medicine, pharmaceutical and diagnostics manufacturing, animal husbandry, clinical microbiology, epidemiology, infectious diseases and infection control, and state and local public health officials. The Action Plan includes action items organized into four focus areas: Surveillance, Prevention and Control, Research, and Product Development.Executive summary -- Introduction and overview -- The Focus Areas -- Focus Area I: Surveillance -- Focus Area II: Prevention and Control -- Focus Area III: Research -- Focus Area IV: Product Development -- Acronyms and abbreviationsInteragency Task Force on Antimicrobial Resistance ; co-chairs: Centers for Disease Control and Prevention, Food and Drug Administration.Title from caption (viewed on October 1, 2012).The Interagency Task Force on Antimicrobial Resistance (hereafter referred to as the Task Force) was created in 1999 to coordinate the activities of federal agencies in addressing antimicrobiala resistance (AR) in recognition of the increasing importance of AR as a public health threat. The Task Force is co-chaired by the Centers for Disease Control and Prevention (CDC), the Food and Drug Administration (FDA), and the National Institutes of Health (NIH) and also includes the Agency for Healthcare Research and Quality (AHRQ), the Centers for Medicare and Medicaid Services (CMS), the Department of Agriculture (USDA), the Department of Defense (DoD), the Department of Veterans Affairs (VA), the Environmental Protection Agency (EPA), the Health Resources and Services Administration (HRSA), the Department of Health and Human Services Office of the Assistant Secretary for Preparedness and Response (HHS/ASPR), and the Department of Health and Human Services Office of the Assistant Secretary for Health (HHS/OASH).Mode of access: Internet; PDF reader (Acrobat .pdf file: 459 KB, 69 p.).Text (electronic publication